- •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.
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.
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.
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).
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.
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- Race and ethnicity on MS presentation and disease course.Mult. Scler. 2020; 26: 561-567https://doi.org/10.1177/1352458519887328
- Gait disorders in multiple sclerosis.Continuum N Y. 2013; 19: 1007-1022
- Multiple sclerosis.Lancet. 2008; 372: 1502-1517
- Myosteatosis in the context of skeletal muscle function deficit: an interdisciplinary workshop at the national institute on aging.Front. Physiol. 2020; 11: 963https://doi.org/10.3389/fphys.2020.00963
- The need for standardized assessment of muscle quality in skeletal muscle function deficit and other aging-related muscle dysfunctions: a symposium report.Front. Physiol. 2017; 8https://doi.org/10.3389/fphys.2017.00087
- Resistance training improves muscle strength and functional capacity in multiple sclerosis.Neurology. 2009; 73: 1478-1484https://doi.org/10.1212/WNL.0b013e3181bf98b4
- Muscle fiber size increases following resistance training in multiple sclerosis.Mult Scler. 2010; 16: 1367-1376https://doi.org/10.1177/1352458510377222
- Skeletal muscle quality assessed from echo intensity is associated with muscle strength of middle-aged and elderly persons.Eur. J. Appl. Physiol. 2012; 112: 1519-1525https://doi.org/10.1007/s00421-011-2099-5
- Quantitative ultrasound imaging to assess skeletal muscles in adults with multiple sclerosis: a feasibility study.J. Ultrasound Med. 2019; 38: 2915-2923https://doi.org/10.1002/jum.14997
- Cross-bridge mechanisms of muscle weakness in multiple sclerosis.Muscle Nerve. 2003; 27: 456-464https://doi.org/10.1002/mus.10346
- The comparative associations of ultrasound and computed tomography estimates of muscle quality with physical performance and metabolic parameters in older men.J. Clin. Med. 2018; 7: 340https://doi.org/10.3390/jcm7100340
- Quantitative ultrasound: measurement considerations for the assessment of muscular dystrophy and sarcopenia. Front.Aging Neurosci. 2014; 6: 172https://doi.org/10.3389/fnagi.2014.00172
- Ultrasound estimates of muscle quality in older adults: reliability and comparison of Photoshop and ImageJ for the grayscale analysis of muscle echogenicity.PeerJ. 2016; 4: e1721https://doi.org/10.7717/peerj.1721
- Progressive resistance exercise with eccentric loading for the management of knee osteoarthritis.Front. Med. 2015; 2: 45https://doi.org/10.3389/fmed.2015.00045
- Association between knee extensor and ankle plantarflexor muscle thickness and echo intensity with postural sway, mobility and physical function in older adults.Exp. Gerontol. 2021; 150111385https://doi.org/10.1016/j.exger.2021.111385
- Prevalence of joint contractures and muscle weakness in people with multiple sclerosis.Disabil. Rehabil. 2014; 36: 1588-1593https://doi.org/10.3109/09638288.2013.854841
- Diagnostic ultrasound estimates of muscle mass and muscle quality discriminate between women with and without sarcopenia.Front. Physiol. 2015; 6: 302https://doi.org/10.3389/fphys.2015.00302
- Muscle strength and power in persons with multiple sclerosis – a systematic review and meta-analysis.J. Neurol. Sci. 2017; 376: 225-241https://doi.org/10.1016/j.jns.2017.03.022
- Aging With a Progressive Neurologic Disease: Rehabilitation Management of the Adult Aging With Parkinson Disease or Multiple Sclerosis.Top. Geriatr. Rehabil. 2019; 35: 172-182https://doi.org/10.1097/TGR.0000000000000232
- Strength, skeletal muscle composition, and enzyme activity in multiple sclerosis.J. Appl. Physiol. 1997; 83: 1998-2004https://doi.org/10.1152/jappl.19188.8.131.528
- The clinical correlates of the chair sit to stand performance in people with multiple sclerosis.Physiother. Theory Pract. 2021; : 1-12https://doi.org/10.1080/09593985.2021.1931590
- Multiple sclerosis in US minority populations: clinical practice insights.Neurol. Clin. Pract. 2015; 5: 132-142https://doi.org/10.1212/CPJ.0000000000000112
- Assessing walking disability in multiple sclerosis.Mult Scler. 2012; 18: 914-924https://doi.org/10.1177/1352458512444498
- Muscle architecture and its relationship with lower extremity muscle strength in multiple sclerosis.Acta Neurol. Belg. 2021; https://doi.org/10.1007/s13760-021-01768-1
- Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS).Neurology. 1983; 33: 1444-1452
- Echo intensity independently predicts functionality in sedentary older men.Muscle Nerve. 2017; 55: 9-15https://doi.org/10.1002/mus.25168
- Defining the clinical course of multiple sclerosis.Neurology. 2014; 83: 278-286https://doi.org/10.1212/WNL.0000000000000560
- Psychometric properties of a clinical strength assessment protocol in people with multiple sclerosis.Int. J. MS Care. 2017; 19: 253-262https://doi.org/10.7224/1537-2073.2016-078
- Physical activity and irreversible disability in multiple sclerosis.Exerc. Sport Sci. Rev. 2010; 38: 186-191https://doi.org/10.1097/JES.0b013e3181f44fab
- Functional relationships of central and peripheral muscle alterations in multiple sclerosis.Muscle Nerve. 2004; 29: 843-852https://doi.org/10.1002/mus.20038
- Rehabilitative ultrasound imaging of the lower trapezius muscle: technical description and reliability.J Orthop. Sports Phys. Ther. 2007; 37: 620-626
- Sarcopenia: clinical evaluation, biological markers and other evaluation tools.J. Nutr. Health Aging. 2009; 13: 724-728
- Global prevalence of sarcopenia and severe sarcopenia: a systematic review and meta-analysis.J. Cachexia Sarcopenia Muscle. 2022; 13: 86-99https://doi.org/10.1002/jcsm.12783
- Quantitative skeletal muscle ultrasonography in children with suspected neuromuscular disease.Muscle Nerve. 2003; 27: 699-705https://doi.org/10.1002/mus.10385
- Foundations of clinical research: applications to practice.3rd Ed. Pearson Prentice Hall, Upper Saddle River, NJ2009
- The importance of lower-extremity muscle strength for lower-limb functional capacity in multiple sclerosis: Systematic review.Ann. Phys. Rehabil. Med. SI Multiple Sclerosis. 2020; 63: 123-137https://doi.org/10.1016/j.rehab.2019.11.005
- Echo intensity is negatively associated with functional capacity in older women.Age Dordr. Neth. 2014; 36: 9708https://doi.org/10.1007/s11357-014-9708-2
- Psychometric properties and validity of Beck depression Inventory II in multiple sclerosis.Eur. J. Neurol. 2016; 23: 744-750https://doi.org/10.1111/ene.12932
- Clinical definition of sarcopenia.Clin. Cases Miner. Bone Metab. 2014; 11: 177-180
- Predicting changes in physical performance in a high-functioning elderly cohort: MacArthur studies of successful aging.J. Gerontol. 1994; 49: M97-108
- Lower extremity muscle strength across the adult lifespan in multiple sclerosis: Implications for walking and stair climbing capacity.Exp. Gerontol. 2020; 111025https://doi.org/10.1016/j.exger.2020.111025
- Echo intensity versus muscle function correlations in older adults are influenced by subcutaneous fat thickness.Ultrasound Med. Biol. 2018; 44: 1597-1605https://doi.org/10.1016/j.ultrasmedbio.2018.04.009
- Muscle ultrasound measurements and functional muscle parameters in non-dystrophic myotonias suggest structural muscle changes.Neuromuscul. Disord. 2009; 19: 462-467https://doi.org/10.1016/j.nmd.2009.06.369
- The prevalence of MS in the United States: a population-based estimate using health claims data.Neurology. 2019; 92: e1029-e1040https://doi.org/10.1212/WNL.0000000000007035
- The Gulf War era multiple sclerosis cohort: age and incidence rates by race, sex and service.Brain J. Neurol. 2012; 135: 1778-1785https://doi.org/10.1093/brain/aws099
- Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition.Mult. Scler. Houndmills Basingstoke Engl. 2020; 26: 1816-1821https://doi.org/10.1177/1352458520970841
- Multiple sclerosis affects skeletal muscle characteristics.PLoS One. 2014; 9e108158https://doi.org/10.1371/journal.pone.0108158
- Relationship between quadriceps femoris echo intensity, muscle power, and functional capacity of older men.Age. 2014; 36: 9625https://doi.org/10.1007/s11357-014-9625-4
- Sarcopenia is associated with mortality in adults: a systematic review and meta-analysis.Gerontology. 2022; 68: 361-376https://doi.org/10.1159/000517099
- Measurement of intramuscular fat by muscle echo intensity.Muscle Nerve. 2015; 52: 963-971https://doi.org/10.1002/mus.24656
Published online: May 10, 2023
Accepted: May 9, 2023
Received in revised form: April 27, 2023
Received: March 8, 2023
☆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.
Published by Elsevier B.V.