Location In Vivo of the Innervation Zone in the Human Medial Gastrocnemius Using Imposed Contractions: A Comparison of the Usefulness of the M-Wave and H-Reflex.

Abstract

The anatomical territory where the neuromuscular junctions are grouped corresponds to the innervation zone (IZ). This can be located in-vivo using high-density electromyography and voluntary muscle contractions. However, in patients with motor impairment, the use of contractions imposed by electrical stimulation (ES) could be an alternative. The present study has two aims: Firstly, to describe the location of the IZ in-vivo of the medial gastrocnemius (MG) using imposed contractions by ES. Secondly, to compare the usefulness of M-waves and H-reflexes to localize the IZs. Twenty-four volunteers participated (age: 21.2 ± 1.5 years). ES was elicited in the tibial nerve to obtain M-waves and H-reflexes in the MG. The evaluators used these responses to localize the IZs relative to anatomical landmarks. M-wave and H-reflex IZ frequency identification were compared. The IZs of the MG were mostly located in the cephalocaudal direction, at 39.7% of the leg length and 34% of the knee's condylar width. The IZs were most frequently identified in the M-wave (83.33%, 22/24) compared to the H-reflex (8.33%, 2/24) (p > 0.001). Imposed contractions revealed that the IZ of the MG is located at 39.7% of the leg length. To locate the IZs of the MG muscle, the M-wave is more useful than the H-reflex.