Cervical Multifidus Muscle Research Articles

Diagnostic Accuracy of Ultrasound Imaging and Shear Wave Elastography to Discriminate Patients with Chronic Neck Pain from Asymptomatic Individuals

Objectives: The aim of this study was to determine and compare the capability of several B-mode ultrasound (US) and shear wave elastography (SWE) metrics to differentiate subjects with chronic non-specific neck pain from asymptomatic subjects. Methods: A diagnostic accuracy study recruiting a sample of patients with chronic neck pain and asymptomatic controls was conducted. Data collection included sociodemographic information (i.e., gender, age, height, weight and body mass index), clinical information (pain intensity assessed using the Visual Analogue Scale and pain-related disability using the Neck Disability Index) and B-mode ultrasound and shear wave elastography features of the cervical multifidus muscle (cross-sectional area, perimeter, mean echo intensity, fat infiltration, shear wave speed and Young’s modulus). After analyzing between-group differences for left/right sides, cases and controls, and males and females, the area under the receiver operating characteristic (ROC) curve, the optimal cut-off point, the sensitivity, the specificity, the positive likelihood ratio (LR) and negative LR for each metric were calculated. A total of 316 individuals were recruited in this study (n = 174 cases with neck pain and n = 142 asymptomatic controls). Results: No significant differences (p > 0.05) were found between cases and controls for most variables, except for fatty infiltration, which was significantly higher in chronic neck pain cases (p < 0.001). Gender differences were significant across all US and SWE metrics (all, p < 0.001 except p = 0.015 for fatty infiltrates). A slight asymmetry was observed between the left and right sides for area (p = 0.038). No significant interactions between group, gender and side (all metrics, p > 0.008) were identified. Fatty infiltration was the most effective discriminator, with a ROC value of 0.723, indicating acceptable discrimination. The optimal cut-off point for fatty infiltration was 25.77, with a moderate balance between sensitivity (59.8%) and specificity (20.5%). However, its positive likelihood ratio (LR) of 0.75 suggests limited usefulness in confirming the condition. Conclusions: Fatty infiltration was significantly higher in individuals with chronic idiopathic neck pain compared to those without symptoms, while other muscle metrics were similar between both groups. However, since fat infiltration had moderate diagnostic accuracy and the other metrics showed poor discriminatory power, US cannot be used solely to discriminate patients with idiopathic neck pain.

Study on the consistency between CT hounsfield units and MRI evaluation of preoperative cervical paraspinal muscular fat infiltration in patients undergoing ACDF

ObjectiveTo explore the feasibility of applying CT Hounsfield Units (HUs) for the assessment of preoperative paraspinal muscle fat infiltration (FI) in different segments in patients who underwent anterior cervical discectomy and fusion (ACDF). To compare the consistency of preoperative paraspinal muscle FI evaluations using MRI and those via CT HUs in patients who underwent ACDF surgery.MethodsNinety-five patients (45 males and 50 females, aged 37‒71 years) who received CT and MRI examinations and underwent ACDF surgery were retrospectively analyzed. In the axial T2-weighted MR images at the median level of the C3/4, C4/5, and C5/6 segments, regions of interests (ROIs) were delineated along the boundaries of the cervical multifidus (MF) and semispinalis cervicis (Scer) muscles. Using the threshold tool in ImageJ software, areas of fat tissue and intermuscular septa within the ROI were quantified. The effective cross-sectional area (ECSA) for each side was obtained by subtracting the areas of fat tissue and intermuscular septa from the total ROI area. The ratio of the fat tissue area to the CSA was then calculated to determine the initial FI value. The depth of subcutaneous fat from the midline spinous process to the epidermis at the median plane of the C4/5 intervertebral disc was measured. The initial FI values were then divided by the depth of fat to determine the post-correction FI value. Using the Picture Archiving and Communication System (PACS), at identical segments and planes, ROIs were delineated using the same method as in MRI under a standard soft tissue window (width of 500 HU, level of 60 HU). The CT HU values were measured within these defined areas. The CT HU values from both sides are summed to obtain the total HU value for the segment. According to whether the measurement results of two sets of data follow a normal distribution, Pearson’s test or Sperman’s test was used to analyze the correlation.ResultsOn MRI, a statistically significant difference was observed in the post-correction FI only at the C3/4 segment compared to the other two segments (P < 0.05). No significant difference in the post-correction FI between the C4/5 and C5/6 segments was noted (P > 0.05). The CT HU results showed a substantial discrepancy between C3/4 and C4/5 segments and between C3/4 and C5/6 segments (P < 0.05), whereas no statistically significant difference was found in the CT HU value between the C4/5 and C5/6 segments (P > 0.05). The consistency analysis revealed a relatively strong correlation between the post-correction FI and CT HU values of the C3/4 and C4/5 segments. Furthermore, a strong correlation was detected in the variations in the measurement outcomes at the C5/6 segment.ConclusionPatients requiring surgical treatment for the cervical spine exhibit varying degrees of FI in paraspinal muscles across different locations and segments. Evaluating the degree of FI in the paraspinal muscles of the cervical spine through CT HU values is feasible. There is considerable consistency between the post-correction FI assessed under MRI and the measurements of CT HU values in evaluating the FI of paraspinal muscles in the cervical spine.

Cervical Multifidus Stiffness Assessment in Individuals with and without Unilateral Chronic Neck Pain: An Inter-Examiner Reliability Study.

This study aimed to evaluate the inter-examiner reliability of shear wave elastography (SWE) for measuring cervical multifidus (CM) muscle stiffness in asymptomatic controls and patients with chronic neck pain. A longitudinal observational study was conducted to assess the diagnostic accuracy of a procedure. SWE images, following a detailed procedure previously tested, were acquired by two examiners (one novice and one experienced) to calculate the shear wave speed (SWS) and Young's modulus. The painful side was examined for the experimental cases while the side examined in the control group was selected randomly. Data analyses calculated the intra-class correlation coefficients (ICCs), absolute errors between examiners, standard errors of measurement, and minimal detectable changes. A total of 125 participants were analyzed (n = 54 controls and n = 71 cases). The Young's modulus and SWS measurements obtained by both examiners were comparable within the asymptomatic group (both, p > 0.05) and the chronic neck pain group (both, p > 0.05). Nonetheless, a notable distinction was observed in the absolute error between examiners for shear wave speed measurements among patients with neck pain, where a significant difference was registered (p = 0.045), pointing to a sensitivity in measurement consistency affected by the presence of chronic neck pain. ICCs demonstrated moderate-to-good reliability across both groups, with ICC values for asymptomatic individuals reported as >0.8. Among the chronic neck pain patients, ICC values were slightly lower (>0.780). The study revealed moderate-to-good consistency, highlighting the practicality and generalizability of SWE.

Exploring the Impact of Cervical Multifidus Muscle Morphology on Postural Balance in Post-Stroke Patients: A pilot study

The aim of this study was to examine cervical multifidus muscle morphology and its impact on postural balance in post-stroke patients. This is a pilot study. A convenience sample of 24 volunteers of 67 ± 8.5 years (12 with hemiparesis due to post-stroke, 12 healthy) was recruited for this study. The outcomes measured were the thickness of the multifidus muscle using ultrasonography, Timed Up and Go (TUG) test and Berg Balance scale (BBS). No significant differences in the ultrasound values between affected and unaffected sides in post-stroke patients were found. Similarly, there were no significant differences between the unaffected side of post-stroke patients and the dominant side of the control group, (p &gt; 0.05). Additionally, no significant correlations in post-stroke patients between the ultrasonographic variables of the multifidus muscles and the main outcome were identified. In conclusion, our study did not find significant differences in cervical multifidus muscle morphology between healthy individuals and post-stroke patients in relation to postural balance. The exploratory nature of our study limits the ability to draw definitive conclusions. Keywords: Stroke; Ultrasonography; Postural balance; Multifidus; Cervical muscle

Degeneration of Cervical Multifidus Muscles Negatively Affects Physical Activity-related Quality of Life After Laminoplasty for Degenerative Cervical Myelopathy.

A retrospective cohort study. The study aimed to investigate the related factors affecting physical activity-related quality of life (QOL) after 2 years of cervical laminoplasty for degenerative cervical myelopathy (DCM), focusing on the degree of preoperative degeneration of the cervical multifidus muscles. The association between paraspinal muscle degeneration and clinical outcomes after spinal surgery is being investigated. The effect of preoperative degeneration of the cervical multifidus muscles in patients undergoing cervical laminoplasty is ambiguous. Patients who underwent laminoplasty for DCM and followed up for more than 2 years were reviewed. To evaluate physical QOL, the physical component summary (PCS) of the 36-Item Short-Form Health Survey (SF-36) was recorded at 2 years postoperatively. The degree of preoperative degeneration in the multifidus muscles at the C4 and C7 levels on axial T2-weighted magnetic resonance imaging (MRI) was categorized according to the Goutallier grading system. The correlation between 2-year postoperative PCS and each preoperative clinical outcome, radiographic parameter, and MRI finding, including Goutallier classification, was analyzed. Variables with a P value <0.10 in univariate analysis were included in multiple linear regression analysis. In total, 106 consecutive patients were included. The 2-year postoperative PCS demonstrated significant correlation with age ( R =-0.358, P =0.002), preoperative JOA score ( R =0.286, P =0.021), preoperative PCS ( R =0.603, P <0.001), C2-C7 lordotic angle ( R =-0.284, P =0.017), stenosis severity ( R =-0.271, P =0.019), and Goutallier classification at the C7 level ( R =-0.268, P =0.021). In multiple linear regression analysis, sex (β=-0.334, P =0.002), age (β=-0.299, P =0.013), preoperative PCS (β=0.356, P =0.009), and Goutallier classification at the C7 level (β=-0.280, P =0.018) were significantly related to 2-year postoperative PCS. Increased degeneration of the multifidus muscle at the C7 level negatively affected physical activity-related QOL postoperatively. These results may guide spine surgeons in predicting physical activity-related QOL in patients with DCM after laminoplasty. Level III.

Cervical Multifidus and Longus Colli Ultrasound Differences among Patients with Cervical Disc Bulging, Protrusion and Extrusion and Asymptomatic Controls: A Cross-Sectional Study.

The aim of this study was to analyze the differences in morphological and histological features of the cervical multifidus (CM) and longus colli (LC) muscles among patients with cervical disc bulging, protrusion, or extrusion. Fifteen patients with cervical disc bulging (20% male, mean age: 48.5, standard deviation (SD) 7.5 years), fifteen with cervical disc protrusion (6% male, mean age: 43, SD 7.8 years), and fifteen with cervical disc extrusion (40% male, mean age: 44, SD 8 years) diagnosed via clinical and imaging findings participated in this study. Additionally, fifteen asymptomatic controls (40% male, mean age: 40.4, SD 9.7 years) were also included. The following ultrasound measurements, cross-sectional area (CSA), anterior-posterior distance (APD), lateral dimension (LD), and mean echo-intensity (EI) of the CM and LC at C5-C6 level were examined by an assessor blinded to the subject's condition. The results revealed no group ×side significant differences among the groups (p > 0. 00625). However, group effects were found for APD and MEI of the CM (p = 0.006 and p < 0.001, respectively) and CSA, APD and MEI of the LC (all, p < 0.001). The LD of the LC muscle and the APD and LD of the CM were negatively associated with related disability (p < 0.01; p < 0.05 and p < 0.01, respectively), and pain intensity was negatively associated with LC APD and LD (both p < 0.05). These results suggest that US can be used to detect bilateral morphological changes in deep cervical flexors and extensors to discriminate patients with cervical disc alterations.

Association between severity of the cervical foraminal stenosis and paraspinal muscle parameters in patients undergoing anterior cervical discectomy and fusion.

The cervical multifidus and rotatores muscles are innervated by the posterior rami of the spinal nerves of the corresponding level, and it has been hypothesized that cervical foraminal stenosis (CFS) affecting the spinal nerves results in changes in these muscles. The purpose of this study was to evaluate the relationship between the severity of CFS and fat infiltration (FI) of the multifidus and rotatores muscles. Patients who received preoperative cervical MRI, underwent anterior cervical decompression and fusion between 2015 and 2018, and met inclusion and exclusion criteria were included. Multifidus and rotatores muscles were segmented bilaterally from C3 to C7, and the percent FI was measured using custom-written MATLAB software. The severity of the CFS was assessed by the Kim classification. Multivariable linear mixed models were conducted and adjusted for age, sex, BMI, and repeated measures. In total, 149 patients were included. Linear mixed modeling results showed that a more severe CFS at C3-4 was correlated with a greater FI of the multifidus and rotatores muscles at C4 (estimate 0.034, 95% CI 0.003-0.064; p = 0.031), a more severe CFS at C4-5 was correlated with a greater FI of the multifidus and rotatores muscles at C5 (estimate 0.037, 95% CI 0.015-0.057; p < 0.001), a more severe CFS at C5-6 was correlated with a greater FI of the multifidus and rotatores muscles at C6 (estimate 0.041, 95% CI 0.019-0.062; p < 0.001) and C7 (estimate 0.035, 95% CI 0.012-0.058; p = 0.003), and a more severe CFS at C6-7 was correlated with a greater FI of the multifidus and rotatores muscles at C7 (estimate 0.049, 95% CI 0.027-0.071; p < 0.001). These results demonstrated level- and side-specific correlations between the FI of the multifidus and rotatores muscles and severity of CFS. Given the segmental innervation of the multifidus and rotatores muscles, the authors hypothesize that the observed increased FI could be reflective of changes due to muscle denervation from CFS.

Reliability of ultrasonography to measure cervical multifidus, semispinalis cervicis and longus colli muscles dimensions in patients with unilateral cervical disc herniation: An observational cross-sectional test-retest study

BackgroundUltrasonography (US) has been suggested to assess the morphology and function of cervical muscles; but little is known about the reliability of the US measures in patients with cervical disc herniation (CDH). The purpose of this study was to evaluate within-day inter and intra-rater and between-day intra-rater reliability of US to measure dimensions of deep cervical muscles in patients with unilateral CDH. MethodsThirty patients with unilateral CDH participated. Anterior-posterior and lateral dimension of longus colli (LC), multifidus (MF) and semispinalis cervicis (SC) were measured using B-mode ultrasound. The measurements were repeated by rater A 1 h (for within-day reliability) and one week (for between-day reliability) later. For inter-rater reliability, rater B performed all muscles measurements like rater A. ResultsWithin-day reliability measurement for all muscles was good to excellent with IntraClass Correlation Coefficients (ICC) ranging from 0.82 to 0.96, standard error of measurement (SEM) from 0.18 to 0.46 and minimal detectable changes (MDC) from 0.43 to 1.09. Between-day reliability was good for all muscle dimensions with ICC ranging from 0.75 to 0.89, SEM from 0.30 to 0.64 and MDC from 0.71 to 1.52. Inter-rater reliability was also good with ICC ranging from 0.75 to 0.89, SEM from 0.34 to 0.65 and MDC from 0.81 to 1.55. ConclusionsUS was demonstrated to have high within-day inter and intra-rater and between-day intra-rater reliability to measure muscles dimensions in patients with unilateral CDH. It can be used to assess deep cervical muscles or to monitor the effects of interventions.

Cervical Multifidus Morphology and Quality Are Not Associated with Clinical Variables in Women with Fibromyalgia: An Observational Study

Abstract Objective Some studies have reported the presence of histological alterations, such as myofiber disorganization and abnormalities in the number and shape of mitochondria, in patients with fibromyalgia syndrome (FMS). Although Ultrasound imaging (US) is used to quantitatively characterize muscle tissues, US studies in patients with FMS are lacking. Therefore, we aimed to describe morphological and qualitative cervical multifidus (CM) muscle US features in women with FMS and to assess their correlation with clinical indicators. Design Observational study. Setting AFINSYFACRO Fibromyalgia Association (Madrid, Spain). Subjects Forty-five women with FMS participated. Methods Sociodemographic variables (e.g., age, height, weight, body mass index) and clinical outcomes (e.g., pain as assessed on a numerical pain rating scale, evolution time, pain-related disability as assessed by the Fibromyalgia Impact Questionnaire) were collected. Images were acquired bilaterally at the cervical spine (C4–C5 level) and measured by an experienced examiner for assessment of muscle morphology (e.g., cross-sectional area, perimeter, and shape) and quality (mean echo intensity and intramuscular fatty infiltration). Side-to-side comparisons and a correlational analysis were conducted. Results No significant side-to-side differences were found for morphology or quality features (P &amp;gt; 0.05). None of the clinical indicators were associated with US characteristics (all, P &amp;gt; 0.05). Conclusion Our results showed no side-to-side differences for CM morphology and quality as assessed with US. No associations between CM muscle morphology or quality and Fibromyalgia Impact Questionnaire, pressure pain threshold, numerical pain rating scale score, or evolution time were observed. Our preliminary data suggest that muscle morphology is not directly related to pain and pain-related disability in women with FMS.

Intra-rater reliability of rehabilitative ultrasound imaging of the cervical multifidus muscle in healthy subjects

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Czechowska B, Gilbov K, ŚwiÄ tczak M. Intra-rater reliability of rehabilitative ultrasound imaging of the cervical multifidus muscle in healthy subjects. Physiotherapy Review. 2021;25(2):41-49. doi:10.5114/for.2021.106948. APA Czechowska, B., Gilbov, K., & ŚwiÄ tczak, M. (2021). Intra-rater reliability of rehabilitative ultrasound imaging of the cervical multifidus muscle in healthy subjects. Physiotherapy Review, 25(2), 41-49. https://doi.org/10.5114/for.2021.106948 Chicago Czechowska, Beata, Katarzyna Gilbov, and Marcin ŚwiÄ tczak. 2021. "Intra-rater reliability of rehabilitative ultrasound imaging of the cervical multifidus muscle in healthy subjects". Physiotherapy Review 25 (2): 41-49. doi:10.5114/for.2021.106948. Harvard Czechowska, B., Gilbov, K., and ŚwiÄ tczak, M. (2021). Intra-rater reliability of rehabilitative ultrasound imaging of the cervical multifidus muscle in healthy subjects. Physiotherapy Review, 25(2), pp.41-49. https://doi.org/10.5114/for.2021.106948 MLA Czechowska, Beata et al. "Intra-rater reliability of rehabilitative ultrasound imaging of the cervical multifidus muscle in healthy subjects." Physiotherapy Review, vol. 25, no. 2, 2021, pp. 41-49. doi:10.5114/for.2021.106948. Vancouver Czechowska B, Gilbov K, ŚwiÄ tczak M. Intra-rater reliability of rehabilitative ultrasound imaging of the cervical multifidus muscle in healthy subjects. Physiotherapy Review. 2021;25(2):41-49. doi:10.5114/for.2021.106948.

Effects of fatigue on spatiotemporal characteristics of healthy individuals

The aim of the study was to compare the dimensions of cervical multifidus muscle (CMM) in different conditions.Twenty five women with neck pain and 25 healthy subjects participated in this study. The dimensions of the CMM were measured at rest, 50% and 100% maximum isometric voluntary contraction (MIVC) at six directions of neck movements, using ultrasonography.The size of multifidus was smaller in patients than healthy individuals at rest state (P < 0.05). A significant smaller CMM dimension was found in the affected side compared with unaffected side in patients group (P < 0.05). The result of ANOVA for MLD showed a significant difference for contraction levels (P < 0.001) and neck movements (P < 0.001) in both groups. The MLD of the CMM was significantly different between CMM at rest and 50%, and 100% MIVC (P < 0.001). No significant differences were found between the groups at 50% and 100% MIVC (P > 0.05 in both instances). The most prominent CMM size change was observed during neck extension, flexion, ipsilateral lateral-flexion, and ipsilateral rotation, respectively (P < 0.05).Results of the present study indicate that the size of CMM was decreased in patients with neck pain in rest state. The size of CMM changes in all directions of neck movements, although the most prominent was during neck extension. This points out CMM stabilization role's in different directions of neck movements.

Intra-rater and inter-rater reliability of rehabilitative ultrasound imaging of cervical multifidus muscle in healthy people: Imaging capturing and imaging calculation

BackgroundStudies have analyzed muscle morphometry of cervical multifidus by using ultrasound imaging, but its reliability is not clearly determined. ObjectiveTo investigate intra- and inter-rater reliability of imaging capturing (probe assessment/patient positioning) and imaging calculation (scan assessment) of cervical multifidus cross sectional area (CSA) by considering the assessor's experience in asymptomatic individuals. DesignReliability study. MethodsThe CSA of C4/C5 cervical multifidus was assessed in 16 asymptomatic subjects. Two examiners performed the imaging capture and also repeated the procedure (probe placement/patient positioning) twice with a 10-min period between each. Other two raters conducted imaging calculations of CSA. Intra-examiner imaging capturing reliability, each rater (experienced and novice) calculated multifidus CSA of both images obtained by each examiner. Inter-examiner imaging capturing reliability, each rater calculated the CSA obtained by each examiner at the first imaging attempt. For imaging calculation reliability, each rater calculated multifidus CSA of all images captured by both examiners. Intra-class correlation coefficients (ICC) and standard error of measurement (SEM) were calculated. ResultsIntra- (ICC3,1 0.988–0.996, SEM 0.3%–0.7%) and inter- (ICC3,2 0.958–0.965, SEM 2.6%–3.2%) examiner reliability of imaging capturing was excellent. Intra- and inter-rater reliability of imaging calculation was also excellent for both raters (experienced/novice). No significant differences between experienced or novice examiners or testers were found. ConclusionsThis study found that intra- and inter-examiner/rater reliability of imaging capturing (probe assessment/patient positioning) and imaging calculation (scan assessment) of the cervical multifidus CSA at C4/C5 level was excellent in asymptomatic subjects.

Asymmetry of Cervical Multifidus and Longus Colli Muscles Size in Participants With and Without Cervical Radicular Pain

ObjectivesThe aim of this study was to determine the asymmetry of cervical multifidus (MF) and longus colli (LC) muscles in patients with unilateral chronic radicular neck pain (CRNP) and healthy subjects using ultrasonography. Materials and MethodsNinety five individuals (50 patients with unilateral CRNP and 45 healthy subjects) participated in this study. The size of the cervical MF and LC muscles; anterior posterior dimension (APD) and lateral dimension (LD); were bilaterally measured in a relaxed state using ultrasonography. ResultsPatients with CRNP showed greater asymmetry in the cervical MF and LC muscles size than the healthy subjects. The mean percentages differences between sides for MF and LC muscles size was higher in patients than that of healthy subjects (for both APD and LD; P<0.05). The ratio of smaller to larger dimensions of the cervical MF and LC muscles for patients were significantly less than that of healthy controls (for both APD and LD; P< 0.05). ConclusionThe results indicated that cervical MF and LC muscles showed higher asymmetry between sides and lesser ratio of smaller size to larger size in patients with CRNP as compared with healthy subjects. Current results confirmed the presence of MF and LC muscles atrophy in subjects with CRNP.

Asymmetric atrophy of cervical multifidus muscles in patients with chronic unilateral cervical radiculopathy.

The purpose of this study was to assess whether the asymmetry of cervical multifidus muscles occurred in radiculopathy patients, and if it did, whether it was related to the chronicity of unilateral cervical radiculopathy by assessing the cross-sectional area (CSA) of multifidus muscles using magnetic resonance imaging (MRI).This study used a retrospective design and was conducted from January 2013 to August 2016. Seventy-seven patients (age 18–65) who had unilateral neck pain, symptom duration of 3 months to 1 year, and who were diagnosed with unilateral 6th cervical radiculopathy by electrodiagnostic testing, were included in study. The CSA of cervical multifidus muscles was measured at the midpoint between the lower margin of the upper vertebra and upper margin of the lower vertebra on axial MRI. Relative CSA (rCSA), which is the ratio of the CSA of muscles to that of the lower margin of C5 vertebra was also obtained.At the C4-5 and C6-7 levels, CSA and rCSA of cervical multifidus muscles showed no statistically difference between the affected and unaffected sides. At the C5-6 level, multifidus muscles were significantly smaller in the affected side (at the C5-6 level, P value of CSA.007 and P value of rCSA.102).The atrophy of multifidus muscles ipsilateral to cervical radiculopathy was observed in patients who had chronic unilateral cervical radiculopathy.

Measurement of Cervical Multifidus and Longus Colli Muscle Dimensions in Patients With Cervical Radiculopathy and Healthy Controls Using Ultrasonography: A Reliability Study

Cervical radiculopathy is a musculoskeletal disorder with an increasing prevalence in office workers. In recent years, ultrasonography (US) has been reported to be a valid, inexpensive, and noninvasive technique for the objective evaluation of muscle morphology. However, measuring deep cervical paraspinal muscle dimensions using US in patients with cervical radiculopathy has not been described. To evaluate intrasession and intersession reliabilities of US to measure dimensions of deep cervical muscles at rest in patients with chronic cervical radiculopathy and healthy controls. Reliability study. Outpatients who presented for treatment at an outpatient university physiotherapy clinic. Fifteen patients with cervical radiculopathy and 15 healthy controls. US measurements. Cervical multifidus and longus colli muscle dimensions at separate occasions. Two measurements separated by a 1-hour interval were taken on the same day and the third measurement was taken 5 days later. The intraclass correlation coefficient (ICC), SE of measurement, and minimal detectable change were used to evaluate relative and absolute reliabilities. US was a highly reliable method for measuring the multifidus and longus colli muscle dimensions in patients and healthy subjects. The highest reliability scores were found for the anteroposterior dimension measurement of the multifidus muscle (ICC = 0.92) and the lateral dimension measurement of the longus colli muscle (ICC = 0.97) in healthy subjects. The results indicated that US is a highly reliable method of measuring deep cervical muscle dimensions in patients with cervical radiculopathy and healthy controls when measured by the same investigator. III.

S78. MRI assessment of neck muscles in patients with unilateral cervical radiculopathy patients

Introduction Several recent studies have investigated the changes of multifidus muscles in patients with chronic neck pain. Also, the longus coli muscle, one of the deep cervical flexor muscles, showed smaller cross sectional area (CSA) in patients with chronic neck pain in comparison with healthy people. To our knowledge, there is no study investigating the association between morphological features of cervical paravertebral muscles in electrodiagnosed cervical radiculopathy patients. In this study, we investigate the change in CSA and composition of the cervical flexor and multifidus muscles using the digital data from MRIs of patients with electrodiagnosed cervical radiculopathy. Methods Twenty-four patients with unilateral cervical radicular pain who had cervical MRI and EMG examinations between 1 January 2015 and 2016 were retrospectively analysed. The inclusion criteria were as follows: (1) patients with the symptoms of unilateral cervical pain or referral to one upper limb, (2) diagnosis of cervical radiculopathy in EMG. Exclusion criteria included: (1) a history of cervical surgery; (2) a history of spinal fracture or injuries; (3) primary or metastatic spinal tumor. Axial slice at the level of C4-5 mid disc level image was selected to calculate the muscle CSA, with their maximal CSAs. Total CSA and functional CSA measurements of the bilateral longus colli, sternocleidomastoid and multifidus muscles were measured by using Image J (version 1.43, National Institutes of Health, Bethesda, Maryland). All muscle measurements were acquired by one investigators. Functional CSA measurement was obtained by using threshold method (including only pixels within lean muscle tissue range). Statistical analysis was performed using SPSS® v. 15. Results The baseline characteristics of the study participants are shown in Table 1. There was no significant difference in total CSA in longus colli, sternocleidomastoid and multifidus muscles between involved and uninvolved groups. Data analysis showed significant difference between the functional CSA of the lognus colli muscle the involved/uninvolved sides (Table 2). Also, there is significant difference in the ratio of longus colli musle (functional longus colli muscle CSA/total longus colli muscle CSA) between the involved and uninvolved sides (P Conclusion This is the study to show via MRI assessment that patients with cervical radiculopathy have smaller ipsilateral functional CSA of the longus colli muscle LCM in comparison with uninvolved side. Consideration of these muscles in MRI could be helpful in the diagnosis and prognosis of cervical radiculopathy.

The relationship between shoulder joint response with cervical multifidus muscle dimensions

Abstract Deep cervical muscles play an important role in creating neck stability. Several changes in muscles function have been observed in people with neck pain. With regard to the problems of recording activity of cervical multifidus muscle with EMG, ultrasound has been used to evaluate the activity of this muscle. Purpose of this paper is investigation the effect of shoulder joint activities on the cervical multifidus muscle thickness changes in people with and without neck pain and providing predictive models by response surface methodology for the relationship between this factors. So, after data clustering in two groups of over 50% and less than 50% of maximum voluntary contraction (MVC), predictive models for each subjects, two groups, both left and right sides and six activities calculated. R2 (regression correlation coefficient) values of the resulting models in healthy subjects and people with neck pain are between 0.24–0.96 and 0.09–0.87, respectively. By assessing the resulting models, it seems that assessment the thickness of this muscle in the dominant hand side during shoulder abduction activity in the strength of 0–50% MVC for healthy subjects and 50–100% MVC for people with neck pain can be an appropriate factor for evaluation the behavior of this muscle.

Multifidus muscle size changes at different directions of head and neck movements in females with unilateral chronic non-specific neck pain and healthy subjects using ultrasonography

ObjectiveThe aim of the study was to compare the dimensions of cervical multifidus muscle (CMM) in different conditions. MethodsTwenty five women with neck pain and 25 healthy subjects participated in this study. The dimensions of the CMM were measured at rest, 50% and 100% maximum isometric voluntary contraction (MIVC) at six directions of neck movements, using ultrasonography. ResultsThe size of multifidus was smaller in patients than healthy individuals at rest state (P < 0.05). A significant smaller CMM dimension was found in the affected side compared with unaffected side in patients group (P < 0.05). The result of ANOVA for MLD showed a significant difference for contraction levels (P < 0.001) and neck movements (P < 0.001) in both groups. The MLD of the CMM was significantly different between CMM at rest and 50%, and 100% MIVC (P < 0.001). No significant differences were found between the groups at 50% and 100% MIVC (P > 0.05 in both instances). The most prominent CMM size change was observed during neck extension, flexion, ipsilateral lateral-flexion, and ipsilateral rotation, respectively (P < 0.05). ConclusionsResults of the present study indicate that the size of CMM was decreased in patients with neck pain in rest state. The size of CMM changes in all directions of neck movements, although the most prominent was during neck extension. This points out CMM stabilization role's in different directions of neck movements.

Cadaveric and Ultrasonographic Validation of Needling Placement in the Cervical Multifidus Muscle

ObjectiveThe aim of this study was to determine if a needle is able to reach the cervical multifidus during the application of dry needling or acupuncture. MethodsDry needling and ultrasound imaging of cervical multifidi was conducted on 5 patients (age: 32 ± 5 years) with mechanical neck pain and on 2 fresh cadavers (age: 64 ± 1 years). Dry needling was done using a needle of 40 mm in length inserted perpendicular to the skin about 1 cm lateral to the spinous process at C3-C4. The needle was advanced from a posterior to anterior direction into the cervical multifidus with a slight inferior-medial angle (approximately 10°) to reach the vertebra lamina. For the cadaveric study, the multifidus was isolated by carefully resecting the superficial posterior cervical muscles: trapezius, splenius, and semispinalis. For the ultrasonographic study, a convex transducer was placed transversely over C3-C4 after the insertion of the needle into the muscle. ResultsThe results of both the cadaveric and ultrasonic studies found that the needle does pierce the cervical multifidus muscle during insertion and that the tip of the needle rests properly against the vertebral laminae, thereby guarding the sensitive underlying spinal structures from damage. ConclusionThis anatomical and ultrasound imaging study supports that dry needling of the cervical multifidus could be conducted clinically.

The Consequence of the Relationship between Shoulder and Cervical Multifiduc Muscles Contractions

Cervical multifidus muscles (MM) are small and strong spinal muscles which are well suited to keep the posture of cervical vertebras [1]. They are located in the deepest layers of posterior neck area attaching directly to the facet joint capsules and cervical bones. The function of this muscle may be disturbed in people who work for a long period of time while their head and neck are kept in a static bended posture