AB1199 Dynamic ultrasound for multilevel evaluation of motion and posture in lower extremity and spine

Background

Evaluation of motion and posture is a crucial task in management patient with rheumatic diseases and pain. Integrative protocol including multilevel assessment of intrinsic/extrinsic muscles postural imbalance for disease staging and treatment efficacy control has not been finally developed.

Objectives

The aim was to study feasibility of multilevel motion and posture analysis using dynamic M-mode ultrasound in foot, ankle, gluteus region, pelvis and spine.

Methods

We included 21 patients (13 females, aged 18–52 y.o.) with clinically diagnosed reduced motility in spine, pelvis and lower extremity levels due to detected back leg, pain, muscle spasticity, joints effusion, tissue swelling, etc. Another healthy 20 patients (aged 18–50 y.o.) without movement rstriction and pain were controls. We conducted precise physical tests, extensive neuromuscular ultrasound (US) using M-mode to evaluate muscle thickness, CSA and motion in intervetrebral spaces, pelvis, intrinsic/extrinsic muscles in foot and ankle gluteus region and pelvis, central and peripheral trigger points identification.¹

Results

We obtained sufficient quality panoramic scans on leg using convex 5–8 MHz probe in 2 approaches to evaluate structure and motion of extrinsic/intrinsic portion of muscles during one session. Thickness measurements of peroneal portion, plantar intrinsic foot muscles on the plantar surface in two transverse positions and one longitudinal using linear probe; contractility using M-mode tested in walking were most representative data. We evaluated different patterns of decreasing motility, contractility (muscle contracted/rested thickness) on M-mode during functional tests and walking in all levels in group 1 (p<0.05). We observed the preliminary correlation between the changes (muscle hypertrophy) in contralateral extrinsics and intrinsics muscles at the same levels, due to biomechanical instability; local areas of spasticity (trigger points) were successfully detected on distal/proximal leg, pelvis and spine. Documented pictures were collected and accessible for telemedical consulting.

Conclusions

Extensive evaluation of motion posture in foot, ankle, and gluteus region, pelvis and spine is feasible and informative protocol for patient with pain and rheumatic diseases. Further studies needed to evaluate reliability studies, comparative RCT using US, CAREN, static and dynamic balance tests, pressure analysis, and extensive molecular profiling, to study crosslinks with immune phenotype of the patients; and to develop educational programs.

Reference

[1] Bubnov R Trigger Points Dry Needling Under Ultrasound Guidance for Low Back Pain Therapy. Comparative Study. Annals of the Rheumatic Diseases2015;74:624. http://dx.doi.org/10.1136/annrheumdis-2015-eular.2323

Disclosure of Interest

None declared