Discriminative and convergent validity of strain elastography for detecting tendinopathy within the supraspinatus tendon: a cross-sectional study

Brage, Karen; Hjarbæk, John; Boyle, Eleanor; Ingwersen, Kim Gordon; Kjær, Per; Juul-Kristensen, Birgit

doi:10.1016/j.jseint.2019.12.008

Cited by 10 publications

(11 citation statements)

References 34 publications

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“…Further, changes in tendon structure after a training intervention of short-term duration are often minimal, and SEL therefore may not be able to measure these tendon changes. Although SEL has been shown to have satisfactory reliability 4 , 32 as well as validity 3 , 23 , 32 in both patients with and patients without supraspinatus tendinopathy, SEL may not yet have the capability to detect changes over a short time.…”

Section: Discussionmentioning

confidence: 99%

“…The strengths of the study are its use of reliable 4 and valid 3 SEL and PROM methods, in addition to the use of 2 different quantitative variables (ratio and RAW), not previously reported in a longitudinal study of SEL of the supraspinatus tendon. The performances of the blinded measurements using SEL, MRI scans, and US are further strengths of this study.…”

Section: Discussionmentioning

confidence: 99%

“… 9 , 12 SEL has shown satisfactory reliability 4 and validity in patients with supraspinatus tendinopathy and healthy volunteers. 3 , 23 Follow-up evaluation of tissue elasticity using sonoelastography has, to our knowledge, only been estimated in 2 studies, both of which involved only the Achilles tendon. 5 , 39 In both studies, 1 using SEL 5 and the other using SWE, the Achilles tendon had undergone surgery and was significantly stiffer 1 year later.…”

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confidence: 99%

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Strain Elastography and Tendon Response to an Exercise Program in Patients With Supraspinatus Tendinopathy: An Exploratory Study

Brage

Juul-Kristensen

Hjarbæk

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Shoulder pain is common, with a lifetime prevalence of up to 67%. Evidence is conflicting in relation to imaging findings and pain in the shoulder. Sonoelastography can be used to estimate tissue stiffness and may be a clinically relevant technique for diagnosing and monitoring tendon healing. Purpose: To evaluate changes in supraspinatus tendon stiffness using strain elastography (SEL) and associations with changes in patient-reported outcomes, supraspinatus tendon thickness, and grade of tendinopathy after 12 weeks of unilateral shoulder exercises in patients with supraspinatus tendinopathy. Study Design: Controlled laboratory study. Methods: A total of 23 patients with unilateral clinical supraspinatus tendinopathy performed 12 weeks of “standard care” exercises. At baseline and follow-up, supraspinatus tendon stiffness was measured bilaterally using SEL and compared with tendinopathy grading on magnetic resonance imaging scans and tendon thickness measured using conventional ultrasound. Patient-reported outcome measures included physical function and symptoms from the Disabilities of the Arm, Shoulder and Hand questionnaire and pain rating (visual analog scale). Results: No significant changes in SEL within or between groups (asymptomatic vs symptomatic tendon) were seen. All patient-reported outcomes showed significant improvement from baseline to follow-up, but with no change in tendinopathy grading and tendon thickness. No significant differences in the proportion of patients changing above the minimal detectable change in SEL and PROM were seen, except for discomfort while sleeping. Conclusion: Despite no significant within-group or between-group changes in SEL, significant improvements were found in patient-reported outcomes. An acceptable agreement between patients changing above the minimal detectable change in SEL and patient-reported outcome measure was seen. Further studies should explore the use of SEL to detect changes after tendon repair and long-term training potentially in subgroups of different tendinopathy phases. Clinical Relevance: In the short term, structural changes in supraspinatus tendons could not be visualized using SEL, indicating that a longer time span should be expected in order to observe structural changes, which should be considered before return to sports. Subgrouping based on stage of tendinopathy may also be important in order to evaluate changes over time with SEL among patients with supraspinatus tendinopathy. Registration: NCT03425357 ( ClinicalTrials.gov identifier).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Strain Elastography and Tendon Response to an Exercise Program in Patients With Supraspinatus Tendinopathy: An Exploratory Study

Brage

Juul-Kristensen

Hjarbæk

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…The validity of SEL in the supraspinatus tendon has been shown [ 13 , 14 , 15 , 16 , 17 ], as has its ability to detect changes in the elasticity of both the supraspinatus tendon and muscle in participants who are healthy [ 7 , 16 ]. Current research shows the supraspinatus tendon elasticity to be around 3.75 in healthy subjects, 3.8 in healthy sports populations and 3.55 in subjects with supraspinatus tendinopathy [ 7 , 17 , 18 , 19 ]. To date, laboratory studies have shown promising effects, but there is an important need to increase knowledge about these interventions in order to extrapolate results to clinical settings.…”

Section: Introductionmentioning

confidence: 99%

Mid- and Long-Term Results Using 448 kHz Stimulation on the Elasticity of the Supraspinatus Tendon Measured by Quantitative Ultrasound Elastographyin Badminton Professionals: Prospective Randomized Double-Blinded Clinical Trial with Nine Months of Follow-Up

Navarro-Ledesma

González-Muñoz²

2022

JCM

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The aim of this study is to analyse the changes that occur in the elasticity of the supraspinatus tendon after the application of a 448 kHz capacitive resistive monopolar radiofrequency (CRMR) at 3, 6 and 9 months in professional badminton players. A randomized double-blinded clinical trial that included 9 months of follow-up was used. A private care practice was used to recruit the participants of this study. They were randomly assigned either the CRMR treatment (n = 19) or the placebo treatment (n = 19). The experimental group received a total of nine treatments of 448 kHz CRMR divided into three treatments per week. The control group received the same regimen but with no radiofrequency. Quantitative ultrasound strain elastography was used to report the main values for three areas of the supraspinatus tendon. These were measured at the start (T1) and directly after (T2), one week after, (T3), three months after (T4), six months after (T5) and nine months after (T6) the completion of the intervention program. There were statistically significant differences in the supraspinatus tendon elasticity immediately after (p ≤ 0.001), one week after (p ≤ 0.001) and three months after (p = 0.01) the intervention program. No significant changes were found six or nine months after the intervention program. A three-week intervention program using 448 kHz produced significant changes in the elasticity of the supraspinatus tendon, with the changes lasting up to approximately three months when compared to the control group.

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“…Only RAW and DELT were able to discriminate significantly between patients with supraspinatus tendinopathy and healthy shoulder controls (adjusted for sex and BMI). Only RAW, MRI and DASH were statistically and significantly associated (adjusted for sex and BMI), meaning that patients with MRI-verified tendinopathy and/or increased disability had softer tendons [8].…”

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confidence: 97%

Discriminative and convergent validity of strain elastography for detecting tendinopathy within the supraspinatus tendon: a cross-sectional study

Cited by 10 publications

References 34 publications

Strain Elastography and Tendon Response to an Exercise Program in Patients With Supraspinatus Tendinopathy: An Exploratory Study

Strain Elastography and Tendon Response to an Exercise Program in Patients With Supraspinatus Tendinopathy: An Exploratory Study

Mid- and Long-Term Results Using 448 kHz Stimulation on the Elasticity of the Supraspinatus Tendon Measured by Quantitative Ultrasound Elastographyin Badminton Professionals: Prospective Randomized Double-Blinded Clinical Trial with Nine Months of Follow-Up

Clinimetric properties of Strain Elastography in patients with supraspinatus tendinopathy

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