Highlights
- •Sonography can identify muscle morphology deficits in people with multiple sclerosis.
- •Both muscle thickness and echogenicity are related to muscle strength and power.
- •Sonography may be an important clinical measurement tool in persons with multiple sclerosis.
Abstract
Background
Neurologically-based muscle weakness is a common symptom in people with multiple sclerosis
MS (MS), who may also exhibit muscle morphology changes and intrinsic muscle dysfunction.
Diagnostic ultrasound (sonography) is a non-invasive, inexpensive, and clinically
feasible method to measure muscle morphology. The purpose of this study was to investigate
possible asymmetries in lower limb muscle morphology and performance in people with
MS, and to assess the relationships of muscle morphology measures with individual
patient characteristics, muscle performance, and functional mobility.
Methods
This cross-sectional study was conducted at the Washington, DC Veterans Affairs Medical
Center. The study participants were 29 Veterans with MS (52% female, 79% African-American,
48.6 ± 11.2 years old, Mean Expanded Disability Status Scale: 3.6 ± 1.4) who completed
seated knee extension isokinetic strength and power tests, functional assessments
(Timed 25-Foot Walk - T25FW, 5-Times Sit-to-Stand - 5STS), and quantitative B-mode
ultrasound image acquisition of the rectus femoris muscle to derive morphology measures
(thickness and echogenicity). The limb with weaker knee extension strength was identified
as the more-involved limb. Differences between the more and less-involved limb were
quantified using a t-test for all muscle morphology and muscle performance measures.
Relationships between muscle morphology and patient characteristics, muscle performance,
and functional mobility were evaluated using bivariate and multivariate analyses.
Results
The rectus femoris thickness from the more-involved limb was lower (p<0.001) than
that of the less-involved limb, whereas echogenicity was not different between the
two limbs (p=0.147). Rectus femoris thickness of the more-involved limb was directly
related to age (r=-0.63, p<0.001), muscle strength (r=0.53, p=0.003) and power (r=0.53,
p=0.003), and gait speed (r=0.42, p=0.024); whereas its echogenicity was positively
associated only with muscle strength (r=-0.46, p=0.013) and power (r=-0.50, p=0.006).
Together rectus femoris thickness and echogenicity of the more involved limb explained
44% and 48% of the variance in muscle strength and power, respectively (p<0.001).
Conclusion
This study supports the ability of sonography to measure muscle morphology in people
with MS, identify asymmetries, and quantify associations with important clinical correlates.
Compared with more invasive and costly alternatives, sonography is a clinically feasible,
relatively low-cost tool that can be used to assess muscle morphology in people with
MS. Further research is warranted to determine the potential clinical utility of sonographic
measures of muscle morphology in evaluating changes due to disease progression or
therapeutic interventions in this population.
Keywords
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Article info
Publication history
Published online: May 10, 2023
Accepted:
May 9,
2023
Received in revised form:
April 27,
2023
Received:
March 8,
2023
Footnotes
☆Any opinions or recommendations expressed in this publication are those of the authors and do not necessarily reflect the view of the U.S. Department of Veterans Affairs, U.S. Department of Health and Human Services, NIH or Foundation for Physical Therapy Research.
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Published by Elsevier B.V.
