Sternocleidomastoid Thickness Research Articles

Evaluation of patients with chronic obstructive pulmonary disease by maximal inspiratory pressure and diaphragmatic excursion with ultrasound sonography

BackgroundDecreased respiratory muscle strength and muscle mass is key in diagnosing respiratory sarcopenia. However, the role of reduced diaphragm activity, expressed as the maximal level of diaphragmatic excursion (DEmax), in diagnosing respiratory sarcopenia in patients with chronic obstructive pulmonary disease (COPD) remains unclear. This study aimed to characterize patients with COPD and low DEmax and maximal inspiratory pressure (MIP), a measure of inspiratory muscle strength, and assess the role of DEmax in respiratory sarcopenia. MethodsPatients with COPD underwent spirometry, exercise tolerance (VO2peak) test, and MIP measurement. DEmax and sternocleidomastoid thickness at the maximal inspiratory level (TscmMIL) were assessed using ultrasound sonography. ResultsOverall, 58 patients with COPD (median age, 76 years; median %FEV1, 51.3 %) were included, 28 of whom showed a %MIP of ≥80 %, defined as having preserved MIP. Based on the %MIP of 80 % and median value of DEmax (48.0 mm) as thresholds, the patients were stratified into four groups: both-high (n = 18), %MIP-alone low (n = 11), DEmax-alone low (n = 10), and both-low (n = 19) groups. The both-low group exhibited the lowest %FEV1, Δinspiratory capacity, VO2peak, and TscmMIL, and these values were significantly lower than those of the both-high group. Except for %FEV1, these values were significantly lower in the both-low group than in the %MIP-alone low group despite adjusting DEmax level for body mass index. ConclusionMeasuring DEmax along with MIP can characterize patients with COPD, reduced exercise capacity, and decreased accessory respiratory muscle mass and can help diagnose respiratory sarcopenia.

Acute effects of an isometric neck warm-up programme on neck performance characteristics and ultrasound-based morphology

Objective Athletic performance can be enhanced immediately after an isometric warm-up, a phenomenon termed post-activation performance enhancement (PAPE). While isometric warm-ups can improve lower extremity sprint and jump performance, neck-specific isometric warm-ups need development and validation for mild traumatic brain disorders and neck pain. This study examined acute effects of isometric warm-ups on neck performance and morphology. Methods Arm 1: Twenty-six adults (13 M:13F) completed neck performance testing before and after a 10-minute neck isometric warm-up or stationary bike (sham) between two visits. Testing included visual-motor reaction time, peak force, rate of force development, force steadiness, and force replication/proprioception measured by a 6-axis load cell. An inclinometer assessed range-of-motion. Paired t-tests and two-way ANOVA examined effects of neck/bike warm-up and interaction effects, respectively. Arm 2: 24 adults (11 M:13F) completed ultrasound scans of cervical muscles: before 20-minute rest (sham), and before/after a 5-min neck isometric warm-up. Longus colli cross-sectional area and sternocleidomastoid/upper trapezius thickness and stiffness, and cervical extensors thickness was assessed. One-way ANOVA compared morphological values at sham, before, and after warm-up. Significance was set at p < 0.05. Results Isometric neck warm-up increased rate of force development in flexion (p = 0.022), extension (p = 0.001–0.003), right lateral flexion (p = 0.004–0.032), left lateral flexion (p = 0.005–0.014), while peak force improved only in left lateral flexion (p = 0.032). Lateral flexion range-of-motion increased after neck warm-up (p = 0.003-0.026). Similarly, longus colli cross-sectional area (p = 0.016) and sternocleidomastoid thickness (p = 0.004) increased. Conclusions Increased neck performance characteristics and morphology are likely due to PAPE effects of isometric neck warm-up. For coaches and athletes, simple isometric contractions could be added to existing warm-ups to reduce prevalence, incidence, and severity of mild traumatic brain injuries and neck pain.

Efficacy of Intensive Inpatient Therapy in Infants with Congenital Muscular Torticollis Involving the Entire Sternocleidomastoid Muscle.

The efficacy and frequency of physiotherapy in the prognosis of congenital muscular torticollis (CMT) that involves the entire sternocleidomastoid (SCM) muscle continues to be unclear. This study investigated the therapeutic effect of intensive inpatient therapy given to infants with CMT that involves the whole SCM using clinical measurements and ultrasound (US). This study included 54 infants (27 boys and 27 girls; mean corrected age of 18.57 days) evaluated for CMT at our outpatient clinic from January 2014 to May 2021. The included patients were divided into three groups (groups 1, 2, and 3). Patients in group 1 underwent outpatient treatment 12 times. Patients in groups 2 and 3 underwent therapeutic exercise followed by US diathermy with microcurrent twice daily for 1 or 2 weeks, respectively. Passive range of motion of the cervical rotation (PCRROM) and SCM thickness were evaluated pre- and post-treatment. Among the three groups, the demographic data at baseline were not significantly different, SCM thickness and PCRROM were significantly decreased/increased at post-treatment compared to pre-treatment (p < 0.05), mean PCRROM change was significantly greater in group 3 (p < 0.05), and mean SCM thickness reduction between pre-treatment and 3 months post-treatment was significantly greater in groups 2 and 3 (p < 0.05). Therefore, intensive inpatient therapeutic exercise and US diathermy with microcurrent may enhance the prognosis of CMT involving the entire SCM muscle.

Reliability of Selective Neck Muscle Size in Migraine Patients and Healthy Controls Using Ultrasonography

Introduction: In migraine headaches, motor control of muscles is impaired. In this research, thickness measurement of bilateral muscle thickness of upper trapezius (UT) and sternocleidomastoid (SCM) muscles was conducted and intra-rater reliability of the thickness measurement of these muscles was assessed in migraine headache and healthy subjects.&#x0D; Materials and Methods: This study was a cross-sectional study to measure bilateral ultrasound images of UT and SCM muscles in 15 patients with migraine headaches and 15 healthy controls. A linear array probe with a 50-mm footprint and frequency range of 7.5 MHz measured the thickness of UT and SCM, parallel to the orientation of the muscle fibers. Intra- class correlation coefficients (ICC) and standard error of measurement (SEM) were used for data analysis.&#x0D; Results: The ICC and SEM for thickness measurement of left UT were 0.88 and 0.06 (excellent) and it was 0.87 and 0.07 (excellent) for right UT thickness. The ICC and SEM for left SCM muscle thickness were 0.88 and 0.06 (excellent) and it was 0.85 and 0.08 (excellent) for right SCM thickness. Muscle thickness of the right UT muscle was 13.38±0.92 mm and 11.12±1.00 mm, in migraine and healthy groups, respectively. Also, muscle thickness of the right SCM muscle was 7.24±0.70 mm and 9.16±0.67 mm in migraine and healthy groups, respectively.&#x0D; Conclusion: The present study showed that ultrasonography can be a reliable tool to measure cervical muscle thickness in migraine patients. Additionally, the ultrasonography protocol of the current study, the position, and the measurement level can be used with high reliability in future studies.

Effect of physical therapy intervention on thickness and ratio of the sternocleidomastoid muscle and head rotation angle in infants with congenital muscular torticollis: A randomized clinical trial (CONSORT).

Background:Early diagnosis as well as treatment is important in management of congenital muscular torticollis (CMT). The purpose of this study was to find an effective physical therapy modality to improve the sternocleidomastoid (SCM) muscle thickness, the ratio of the SCM muscle thickness on the affected side to that on the non-affected side (A/N ratio), and head rotation in infant under 3 months of age diagnosed with CMT.Methods and analysis:A single-blind, randomized clinical trial was conducted. Participants were assigned in one of the 3 study groups through randomization. The treatment was performed 3 times a week for 30 minutes until the head tilt was ≤5 degrees. Group 1 was treated by handling for active or active-assist movement, group 2 was treated with passive stretching, and group 3 was treated with thermotherapy. For general characteristics, a χ2 test and 1-way analysis of variance were used. Intragroup differences were analyzed using a paired t test, and intergroup differences were analyzed using an age-adjusted analysis of covariance.Results:After the intervention, there was no significant difference between groups in terms of SCM thickness on the affected side and A/N ratio (P > .05). Degree of head rotation on the affected side showed significant differences between groups (P < .05), with Group 2 showing significantly better results than group 1 and group 3 (P < .05, both).Conclusion:Passive stretching treatment was more effective than other treatments of this study for improvement in degree of head rotation in CMT infants under 3 months of age.Trial registration:The trial is registered at the Institutional Review Board of Sahmyook University (IRB number, 2-7001793-AB-N-012019103HR) and the Clinical Research Information Service (CRiS; registry number, KCT0004862)

The Effect of Gaze Directions and Pressure Levels on longus colli and Sternocleidomastoid Thickness during Cranio-cervical flexor Exercise in Young Adults

The Effect of Gaze Directions and Pressure Levels on longus colli and Sternocleidomastoid Thickness during Cranio-cervical flexor Exercise in Young Adults

The Importance of Optimal Gaze Direction on Deep Neck Flexor Activation in Chronic Neck Pain.

Chronic neck pain (CNP) patients have weak deep neck flexors (DNF) and a hyperactive sternocleidomastoid (SCM). The cranio-cervical flexion test (CCFT) promotes activation of the DNF and decreases activity of the SCM, promoting pain recovery, but research suggests SCM activation increases with increasing gaze direction. We aimed to investigate how DNF and SCM activation varies according to gaze direction in the CCFT, and to prescribe the appropriate gaze direction for CNP. Twenty-eight CNP subjects had their maximum strength pressure level determined by CCFT for strength (20–~30 mmHg) and at each of the measured pressures, DNF and SCM thickness in each of four gaze directions (0°, 20°, 40°, and 60°) was measured by ultrasound imaging. The DNF to SCM ratio varied significantly according to gaze direction (p < 0.05), with gaze directions of 20° and 0° being significantly different from 40° (p < 0.05). Although there was no significant difference in DNF activation according to gaze direction, there was in SCM activation (p < 0.05), with SCM 60° significantly different from SCM 20° and SCM 40° (p < 0.05). In order to increase DNF activation efficiency during the CCFT, SCM activation should be controlled, and a gaze direction below 20° is the most efficient. This can inform DNF training of CNP patients in a clinical environment.

Sex Differences in Ultrasound-Based Muscle Size and Mechanical Properties of the Cervical-Flexor and -Extensor Muscles.

Neck pain (NP), neck injuries, and concussions are more prevalent in female athletes than in their male counterparts. Females exhibit less neck girth, strength, and stiffness against a perturbation. As part of the clinical examination for individuals with NP, ultrasound (US)-based imaging of the cervical muscles has become common. Muscle size or thickness and stiffness can be measured with US-based B-mode and shear-wave elastography (SWE), respectively. Information on reliability, normative values, and sex differences based on US-based muscle size or thickness and stiffness in young and athletic individuals is limited. To evaluate sex differences in US-based muscle size or thickness and biomechanical properties of the cervical-flexor and -extensor muscles. Cross-sectional study. Laboratory. A total of 13 women (age = 23.7 ± 1.9 years, height = 167.1 ± 6.1 cm, mass = 63.8 ± 5.6 kg) and 11 men (age = 25.6 ± 4.9 years, height = 178.7 ± 8.3 cm, mass = 78.9 ± 12.0 kg). The same examiner collected all measures, using US B-mode to scan the cross-sectional area and thickness of the longus colli (LC), sternocleidomastoid (SCM), cervical-extensor muscles, and upper trapezius (UT) muscle. The US SWE-mode was used to measure the stiffness of the SCM and UT. Independent t tests or Mann-Whitney U tests were calculated to determine sex differences. The intraclass correlation coefficient (ICC) measured intrarater test-retest reliability. Men had thicker SCMs than women (P = .01). No sex differences were present for longus colli cross-sectional area, cervical-extensor muscle thickness, or UT thickness (P > .05). In addition, no sex differences were evident for SCM (P = .302) or UT (P = .703) SWE stiffness. Reliability was good to excellent (ICC = 0.715-0.890) except for SCM SWE stiffness (ICC = 0.554). The only sex difference was in SCM thickness. However, smaller SCMs in women did not result in less SCM SWE stiffness. We provided normative values for US-based imaging of the cervical-flexor and -extensor muscles in young and athletic men and women.

Clinical Efficacy of Real-Time Sonoelastography for the Follow-Up of Congenital Sternocleidomastoid Muscle Torticollis.

PurposeTo evaluate the clinical efficacy of real-time sonoelastography (RTS) for the follow-up of congenital muscular torticollis, based on measurements of muscle elasticity.Materials and MethodsThirty-four infants (23 male, 11 female) with congenital sternocleidomastoid (SCM) muscle torticollis underwent ultrasonography and elastography between November 2012 and December 2014. We evaluated the thickness, morphology (mass-like, fusiform, or overall thickened shape), and echogenicity of the SCM muscle on grayscale images and color patterns (homogeneous blue, mixed green < 50% and ≥ 50%, and green to red) on elastography. Strain ratios were measured using Q-lab software. A clinician classified the degree of neck rotation and side flexion deficits using a 5-point grade system based on angles of neck rotation and side flexion. Correlations between the ultrasonography and clinical findings were evaluated by statistical analysis.ResultsTwenty-two infants had right and 12 had left SCM torticollis, respectively. Linear regression analysis showed that involved/contralateral SCM thickness differences, morphology, elasticity color scores, and strain ratios of the affected SCM muscles were significantly correlated with neck rotation and side flexion deficit scores (p < 0.05). The elasticity color score of the affected SCM muscle was the most significant factor.ConclusionRTS might provide a reliable means for evaluating and monitoring congenital muscular torticollis.

Changes in Muscle Stiffness in Infants with Congenital Muscular Torticollis.

Congenital muscular torticollis (CMT) results from unilateral shortening of the sternocleidomastoid (SCM) muscle, usually associated with a fibrotic mass. Although CMT may resolve with physical therapy, some cases persist, resulting in long-term musculoskeletal problems. It is therefore helpful to be able to monitor and predict the outcomes of physical therapy. Shear-wave velocity (SWV) determined by acoustic radiation force impulse (ARFI) elastography can provide a quantitative measure of muscle stiffness. We therefore measured SCM SWV in 22 infants with unilateral CMT before and after 3 months of physical therapy and evaluated the relationships between SWV and SCM thickness and various clinical features, including cervical range of motion (ROM). SWV was initially higher and the ROM was smaller in affected muscles before physical therapy. SWV decreased significantly (2.33 ± 0.47 to 1.56 ± 0.63 m/s, p < 0.001), indicating reduced stiffness, and muscle thickness also decreased after physical therapy (15.64 ± 5.24 to 11.36 ± 5.71 mm, p < 0.001), both in line with increased neck ROM of rotation (64.77 ± 18.87 to 87.27 ± 6.31°, p < 0.001) and lateral flexion (37.50 ± 11.31 to 53.64 ± 9.41°, p < 0.001). However, the improved ROM more closely reflected the changes in SWV than in muscle thickness. These results suggest that a change in SWV detected by ARFI elastography could help to predict improvements in clinical outcomes, such as stiffness-related loss of motion, in patients with CMT undergoing physical therapy.

The effectiveness of stretching for infants with congenital muscular torticollis

Introduction: Congenital muscular torticollis (CMT) is a neck deformity that involves unilateral shortening of the sternocleidomastoid (SCM). Conservative physiotherapy management of CMT is primarily focused on stretching the affected SCM. However, there is limited research evidence on the use of stretching to improve the extensibility of SCM in infants with CMT.Aim: To investigate the effectiveness of stretching for infants with CMT.Method: A systematic search of AMED, CINAHL, MEDLINE, EMBASE, Physiotherapy Evidence Database (PEDro) and Cochrane Library was conducted during the period 2011–2018.Results: Seven articles that met eligibility criteria were reviewed out of a total number of 415 articles that were screened; two articles were randomised control trials and five were cohort studies. The studies typically reported statistically significant benefits of stretching for the restoration of cervical range of movement and SCM thickness (p < 0.05). Appraisal of the studies revealed varied quality.Conclusion: The results suggest that stretching is an effective treatment intervention for the management of infants with CMT and early physiotherapy referral can lead to decreased treatment duration. However, due to a variation in study quality; additional high-quality research is needed to help formulate more robust conclusions.

Elimination of dysphagia using ultrasound guidance for botulinum toxin injections in cervical dystonia

Dysphagia is a common side effect after botulinum toxin injections for cervical dystonia, with an incidence of 10-40%, depending upon the study and dose used. Our study consisted of 5 preselected women who met criteria for cervical dystonia and subsequent dysphagia after electromyography (EMG)-guided injections. Injections were performed with ultrasound (US) imaging, and the effects on swallowing were examined. Separately, sternocleidomastoid (SCM) thickness in healthy controls and treated patients was measured. There were 34 episodes of dysphagia over 98 injection sessions using EMG guidance for a cumulative rate of 34.7%. Using US plus EMG guidance, there was 0% dysphagia across 27 injection sessions. SCM thickness was <1.1 cm. US combined with EMG guidance eliminated recurrent dysphagia after botulinum toxin treatment, possibly by keeping the injectate within the SCM.

54. Normal values of the cervical nerve roots and brachial plexus for ultrasonography

Introduction: Dysphagia is a common adverse event following botulinum toxin injections for cervical dystonia. Objectives: A case is reported where the addition of ultrasound (US) guidance eliminated dysphagia as an adverse event. Methods: Records were reviewed from a 33-year-old female with cervical dystonia from 2003 to present. Injection visits with botulinum toxin injections were categorized as using needle electromyography (EMG) alone or US guidance with a 10 MHz linear array transducer and injectable EMG needle (US + EMG). Measurements of sternocleidomastoid (SCM) thickness were recorded using US. Needle placement was in the upper one-third of the SCM at the level of the tragus for both needle EMG and US + EMG. Results: Twenty-nine office visits for botulinum toxin injections by one physician were analyzed. Twenty-two sessions were conducted with needle EMG and 7 sessions utilized US + EMG. Dysphagia occurred in 40.9% (9/22) with needle EMG only guidance. Severe dysphagia with inability to swallow solids or liquids associated with choking was reported after several sessions. Dietary modifications included eating pudding-consistency foods for 2 weeks and referral to a swallowing center. With the US + EMG technique, 0% (0/7) dysphagia was reported. Skin to SCM superior border average measurement was 0.38 cm and the average SCM thickness was 0.5 cm for a skin-SCM total measurement of 0.88 cm. Conclusion: When treating cervical dystonia, botulinum toxin injections utilizing US localization may be an important technique to eliminate dysphagia. It is proposed that with unguided needle EMG technique, injections go through the target muscle belly to deeper muscles because the SCM becomes atrophic.