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Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Research Article

Clinical Application of Ultrasound Elastic Imaging in Assessing Poststroke Complex Regional Pain Syndrome (CRPS)

Author(s): Min Gao, Zhenwu Gao, Yingchun Li, Bo Zeng and Ying Liang*

Volume 20, 2024

Published on: 06 September, 2023

Article ID: e010823219335 Pages: 6

DOI: 10.2174/1573405620666230801121419

Price: $65

Abstract

Aims: This study aimed to explore the characteristics and clinical application of ultrasonic elastography in peripheral soft tissue in patients with poststroke complex regional pain syndrome (CRPS).

Background: Complex regional pain syndrome (CRPS) type I is also known as shoulder hand syndrome (SHS). Its main symptoms include shoulder pain, limited activity, upper arm, wrist, and knuckle joint pain. Ultrasonic elastic imaging technology is gradually being applied to musculoskeletal system evaluation, primarily for the elastic examination of superficial tissue, as a result of the continual advancements in ultrasound technology. To make up for the absence of conventional imaging, functional state evaluation of the motor system can offer conventional ultrasonic tissue elasticity and hardness data.

Objectives: The purpose of this study was to objectively quantify the soft tissue surrounding the shoulder joint of stroke patients with CRPS using ultrasonic elastic imaging and to determine the diagnostic usefulness of ultrasonic elastic imaging for CRPS in stroke in order to promote its usage in clinical practice.

Materials and Methods: Patients diagnosed with CRPS following a stroke and admitted to the rehabilitation unit at Shanxi Bethune Hospital between January, 2021 to June, 2021 were included in the analysis. The control group consisted of people without pain in their shoulder joints. Each group consisted of 30 patients. A high-frequency wire array probe (frequency = 8-16 Hz) was employed in conjunction with an ultrasonic diagnostic apparatus. A quantitative analytic system determined Young's modulus of the tissue, while the tracking of the shear wave provided an elastin map in real-time. An excitation pulse of acoustic radiation force was used to cause shear waves in the tissue.

Results: The Young's modulus of supraspinatus muscle in the study and control groups was 289.16±22.07 Kpa and 231.99±23.61 Kpa, respectively (P <0.01). Young's modulus values of the study group's subscapular biceps were compared to those of the control group (P > 0.05). The supraspinatus shear wave elastographic (SWE) imaging value was 10.01±0.49 m/s in the study group and 7.92±0.50 in the control group (P <0.05). The study and control groups had subscapular muscle SWE values of 15.99±1.95 and 8.64±0.56 m/s, respectively (P <0.05). The average biceps tendon SWE value in the study and control groups was 6.39±0.42 and 4.69±0.36 m/s, respectively (P <0.05).

Conclusion: In conclusion, the SWE assessed by ultrasound elastography is useful for early diagnosis and evaluation of the superior shoulder tendon, subscapular tendon, and biceps tendon of CRPS following stroke.

[1]
Borchers AT, Gershwin ME. Complex regional pain syndrome: A comprehensive and critical review. Autoimmun Rev 2014; 13(3): 242-65.
[http://dx.doi.org/10.1016/j.autrev.2013.10.006] [PMID: 24161450]
[2]
Dunkun S. Rehabilitation Medicine. (3rd ed..). Beijing: People’s Health Publishing 2005; pp. 208-9.
[3]
Huimin X, Xiuqin Z, Shuo W, et al. Diagnosis characteristics of shoulder joint MRI in patients with hemiplegia and shoulder pain in stroke. J Med Coll PLA 2018; 9: 376-9.
[4]
Goldstein B, Young J, Escobedo EM. Rotator cuff repairs in individuals with paraplegia. Am J Phys Med Rehabil 1997; 76(4): 316-22.
[http://dx.doi.org/10.1097/00002060-199707000-00011] [PMID: 9267192]
[5]
Yi Y, Shim JS, Kim K, et al. Prevalence of the rotator cuff tear increases with weakness in hemiplegic shoulder. Ann Rehabil Med 2013; 37(4): 471-8.
[http://dx.doi.org/10.5535/arm.2013.37.4.471] [PMID: 24020027]
[6]
Gilmore PE, Spaulding SJ, Vandervoort AA. Hemiplegic shoulder pain: Implications for occupational therapy treatment. Can J Occup Ther 2004; 71(1): 36-46.
[http://dx.doi.org/10.1177/000841740407100108] [PMID: 15015899]
[7]
Drakonaki EE, Allen GM, Wilson DJ. Ultrasound elastography for musculoskeletal applications. Br J Radiol 2012; 85(1019): 1435-45.
[http://dx.doi.org/10.1259/bjr/93042867] [PMID: 23091287]
[8]
Okechukwu Erondu F. Perspective chapter: Recent advances in musculo-skeletal ultrasound. Ultrasound Imaging. IntechOpen 2021.
[http://dx.doi.org/10.5772/intechopen.101338]
[9]
Balaban M, Cilengir AH, Idilman IS. Evaluation of tendon disorders with ultrasonography and elastography. J Ultrasound Med 2021; 40(7): 1267-86.
[http://dx.doi.org/10.1002/jum.15520] [PMID: 33078869]
[10]
Sigrist RMS, Liau J, Kaffas AE, Chammas MC, Willmann JK. Ultrasound elastography: Review of techniques and clinical applications. Theranostics 2017; 7(5): 1303-29.
[http://dx.doi.org/10.7150/thno.18650] [PMID: 28435467]
[11]
Wells PNT, Liang HD. Medical ultrasound: Imaging of soft tissue strain and elasticity. J R Soc Interface 2011; 8(64): 1521-49.
[http://dx.doi.org/10.1098/rsif.2011.0054] [PMID: 21680780]
[12]
Nishida Y, Saito Y, Yokota T, Kanda T, Mizusawa H. Skeletal muscle MRI in complex regional pain syndrome. Intern Med 2009; 48(4): 209-12.
[http://dx.doi.org/10.2169/internalmedicine.48.1611] [PMID: 19218770]
[13]
Kim YW, Kim Y, Kim JM, Hong JS, Lim HS, Kim HS. Is poststroke complex regional pain syndrome the combination of shoulder pain and soft tissue injury of the wrist? Medicine 2016; 95(31): e4388.
[http://dx.doi.org/10.1097/MD.0000000000004388] [PMID: 27495051]
[14]
El-Sonbaty HAE, Abou Elmaaty AA, Zarad CA, El-Bahnasawy AS. Clinical and radiological assessment of hemiplegic shoulder pain in stroke patients. Egypt J Neurol Psychiat Neurosurg 2022; 58(1): 41.
[http://dx.doi.org/10.1186/s41983-022-00474-w]
[15]
Shin SH, Kim SJ. Bone scintigraphy in patients with pain. Korean J Pain 2017; 30(3): 165-75.
[http://dx.doi.org/10.3344/kjp.2017.30.3.165] [PMID: 28757916]
[16]
Ryu J, Jeong WK. Current status of musculoskeletal application of shear wave elastography. Ultrasonography 2017; 36(3): 185-97.
[http://dx.doi.org/10.14366/usg.16053] [PMID: 28292005]
[17]
Davis LC, Baumer TG, Bey MJ, Holsbeeck M. Clinical utilization of shear wave elastography in the musculoskeletal system. Ultrasonography 2019; 38(1): 2-12.
[http://dx.doi.org/10.14366/usg.18039] [PMID: 30343557]
[18]
Hongxia D, Shunshi Y, Qian G, Jianxin L. Application value of ultrasonic elasticography in diagnosis and prognosis evaluation of tendonitis. Radiol Res Pract 2019; 34: 1034-9.
[19]
Yun SJ, Jin W, Cho NS, et al. Shear-wave and strain ultrasound elastography of the supraspinatus and infraspinatus tendons in patients with idiopathic adhesive capsulitis of the shoulder: A prospective case-control study. Korean J Radiol 2019; 20(7): 1176-85.
[http://dx.doi.org/10.3348/kjr.2018.0918] [PMID: 31270981]
[20]
Matson A, Konow N, Miller S, Konow PP, Roberts TJ. Tendon material properties vary and are interdependent among turkey hindlimb muscles. J Exp Biol 2012; 215(Pt 20): 3552-8.
[http://dx.doi.org/10.1242/jeb.072728]
[21]
Hodgson RJ, O’Connor PJ, Grainger AJ. Tendon and ligament imaging. Br J Radiol 2012; 85(1016): 1157-72.
[http://dx.doi.org/10.1259/bjr/34786470] [PMID: 22553301]
[22]
Pedersen M, Fredberg U, Langberg H. Sonoelastography as a diagnostic tool in the assessment of musculoskeletal alterations: A systematic review. Ultraschall Med 2012; 33(5): 441-6.
[http://dx.doi.org/10.1055/s-0032-1312923] [PMID: 22744444]
[23]
Weinreb JH, Sheth C, Apostolakos J, et al. Tendon structure, disease, and imaging. Muscles Ligaments Tendons J 2019; 4(1): 66-73.
[http://dx.doi.org/10.32098/mltj.01.2014.12] [PMID: 24932450]
[24]
Xiaoxia R, Xiaoping D, Bo L, Shichang X, Wenyun Z. Application of ultrasonic elastic imaging technology in the diagnosis of tendon diseases. J Med Ultrasound 2019; 16: 176-80.
[25]
Zheng TD, Changsheng C, Zheng D. Application of action observation based on mirror neuron theory in pain recovery of shoulder and hand syndrome after stroke. Chinese J Rehabilitation Med 2016; 31: 145-9.

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