Ultrasonography of the Cervical Muscles: A Critical Review of the Literature

doi:10.1016/j.jmpt.2010.08.016

Journal of Manipulative and Physiological Therapeutics

Volume 33, Issue 8, October 2010, Pages 630-637

https://doi.org/10.1016/j.jmpt.2010.08.016 Get rights and content

Abstract

Objective

This article presents a review of the literature concerning size measurement of cervical muscles using real-time ultrasound imaging (RUSI) in patients with neck pain and in healthy populations.

Methods

A literature search from 1996 to December 2009 making use of Science Direct and PubMed databases was conducted. Medical Subject Headings and other terms were as follows: ultrasonography, cervical, muscle, neck, size, pain, validity, reliability, neck pain, and healthy subjects. We included studies using RUSI for assessing cervical paraspinal muscles both in healthy subjects and in patients with neck pain. We assessed muscles investigated and the reliability and validity of the method used.

Results

The literature search yielded 16 studies. Twelve (75%) studies assessed the posterior muscles, whereas in the remaining 4 (25%), the anterior muscles were studied. Three studies quantified the size of the muscles during contraction; 3 assessed the relationship between cross-sectional area, linear dimensions, and anthropometric variables; 1 evaluated the training-induced changes in muscle size; 1 assessed the differences in muscle shape and cross-sectional area of cervical multifidus between patients with chronic neck pain and controls; 8 studies looked at the reliability of using RUSI in patients with neck pain or healthy subjects; and 3 studies evaluated the validity of RUSI compared with magnetic resonance imaging.

Conclusions

This literature review has shown that there are not sufficient studies for assessing neck muscles with RUSI. It seems that using constant landmarks, knowledge of anatomy and function of target muscle, and a proper definition of muscle borders can help to take a clear image. Standardized position of the subject, correct placement of the transducer, and using multiple RUSI for statistical analyses may improve results.

Section snippets

Data Sources

A literature search from 1996 to December 2009 making use of Science Direct and PubMed databases was conducted. Medical Subject Headings and other key words for search were ultrasonography AND cervical, muscle, neck, size, pain, validity, reliability, neck pain, and healthy subjects. Search strategy was done following the guidelines described by Greenhalgh.¹⁹ We also checked reference lists of the articles that were identified in the database. The search strategy attempted to retrieve all

Results

The literature search yielded 16 possible relevant studies.4, 15, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34 In 12 of 16 studies, the posterior muscles were assessed,4, 15, 21, 22, 24, 25, 26, 27, 28, 29, 33, 34 whereas in the remaining 4, the anterior muscles were studied.23, 30, 31, 32 In 7 studies, RUSI was performed with subjects in prone position4, 21, 24, 26, 28, 29, 33; in 4 studies, the subjects were in sitting position15, 23, 27, 34; in 2 studies, both positions were used22

Cervical Muscle Size

The muscles assessed in the studies included the splenius capitis (SPC),21, 34 SSC,15, 22, 24, 25, 34 sternocleidomastoid (SCM),23, 30 trapezius (TRP),28, 33 MF,4, 27, 29 longus colli (LC),31, 32 deep cervical flexors (DCFs) as a group,³⁰ deep posterior muscles as a group,²⁶ rectus capitis posterior (RCP),³⁴ and oblique capitis superior (OCS).³⁴ It is necessary to know the anatomy and function of the muscles for a proper understanding of the evaluated muscles. Here we briefly review—and readers

Conclusion

Over the past decades, RUSI has become increasingly integrated in the field of musculoskeletal study; but this review of the literature demonstrated that there are not sufficient studies for assessing the cervical muscles. For reliability studies, it seems that using constant landmarks, knowledge of anatomy and function of target muscle, and a proper definition of muscle borders can help in obtaining a clear image. Furthermore, standardized position of the subject, correct placement of the

Funding Sources and Potential Conflicts of Interest

No funding sources or conflicts of interest were reported for this study.

Practical Applications

•
A review of the literature found that RUSI is a reliable and valid method for muscle assessment.
•
Sixteen studies about RUSI, 12 (75%) assessing the posterior neck muscles and 4 (25%) the anterior muscles, have been published.
•
Standardized position of the subject, correct placement of the transducer, and using multiple RUSI for statistical analysis may tend to better results.
•
Because of the possible clinical applications of

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Cited by (59)

Reliability of ultrasonography to measure cervical multifidus, semispinalis cervicis and longus colli muscles dimensions in patients with unilateral cervical disc herniation: An observational cross-sectional test-retest study
2024, Journal of Bodywork and Movement Therapies
Ultrasonography (US) has been suggested to assess the morphology and function of cervical muscles; but little is known about the reliability of the US measures in patients with cervical disc herniation (CDH). The purpose of this study was to evaluate within-day inter and intra-rater and between-day intra-rater reliability of US to measure dimensions of deep cervical muscles in patients with unilateral CDH.
Thirty patients with unilateral CDH participated. Anterior-posterior and lateral dimension of longus colli (LC), multifidus (MF) and semispinalis cervicis (SC) were measured using B-mode ultrasound. The measurements were repeated by rater A 1 h (for within-day reliability) and one week (for between-day reliability) later. For inter-rater reliability, rater B performed all muscles measurements like rater A.
Within-day reliability measurement for all muscles was good to excellent with IntraClass Correlation Coefficients (ICC) ranging from 0.82 to 0.96, standard error of measurement (SEM) from 0.18 to 0.46 and minimal detectable changes (MDC) from 0.43 to 1.09. Between-day reliability was good for all muscle dimensions with ICC ranging from 0.75 to 0.89, SEM from 0.30 to 0.64 and MDC from 0.71 to 1.52. Inter-rater reliability was also good with ICC ranging from 0.75 to 0.89, SEM from 0.34 to 0.65 and MDC from 0.81 to 1.55.
US was demonstrated to have high within-day inter and intra-rater and between-day intra-rater reliability to measure muscles dimensions in patients with unilateral CDH. It can be used to assess deep cervical muscles or to monitor the effects of interventions.
A Procedure for Measuring Anterior Scalene Morphology and Quality with Ultrasound Imaging: An Intra- and Inter-rater Reliability Study
2023, Ultrasound in Medicine and Biology
Ultrasound (US) imaging is an essential tool for clinicians because of its cost-effectiveness and accessibility for assessing multiple muscle metrics including muscle quality, size and shape. Although previous studies highlighted the importance of the anterior scalene muscle (AS) in patients with neck pain, studies analyzing the reliability of US measurements for this muscle are lacking. This study aimed to develop a protocol for assessing AS muscle shape and quality measured with US and investigating its intra- and inter-examiner reliability.
Through use of a linear transducer, B-mode images of the anterolateral neck region at the C7 level were acquired in 28 healthy volunteers by two examiners (one experienced and one novel). Cross-sectional area, perimeter, shape descriptors and mean echo-intensity were measured twice by each examiner in randomized order. Intra-class correlation coefficients (ICCs), standard errors of measurement and minimal detectable changes were calculated.
Results indicated no muscle side-to-side asymmetries (p > 0.05). Gender differences were found for muscle size (p < 0.01), but muscle shape and brightness were comparable (p > 0.05). Intra-examiner reliability was good to excellent for all metrics for the experienced and (ICC >0.846) and novel (ICC >780) examiners. Although inter-examiner reliability was good for most of the metrics (ICC >0.709), the estimates for assessing solidity and circularity were unacceptable (ICC <0.70).
This study found that the described ultrasound procedure for locating and measuring anterior scalene muscle morphology and quality is highly reliable in asymptomatic individuals.
Intra-rater and inter-rater reliability of rehabilitative ultrasound imaging of cervical multifidus muscle in healthy people: Imaging capturing and imaging calculation
2020, Musculoskeletal Science and Practice
Studies have analyzed muscle morphometry of cervical multifidus by using ultrasound imaging, but its reliability is not clearly determined.
To investigate intra- and inter-rater reliability of imaging capturing (probe assessment/patient positioning) and imaging calculation (scan assessment) of cervical multifidus cross sectional area (CSA) by considering the assessor's experience in asymptomatic individuals.
Reliability study.
The CSA of C4/C5 cervical multifidus was assessed in 16 asymptomatic subjects. Two examiners performed the imaging capture and also repeated the procedure (probe placement/patient positioning) twice with a 10-min period between each. Other two raters conducted imaging calculations of CSA. Intra-examiner imaging capturing reliability, each rater (experienced and novice) calculated multifidus CSA of both images obtained by each examiner. Inter-examiner imaging capturing reliability, each rater calculated the CSA obtained by each examiner at the first imaging attempt. For imaging calculation reliability, each rater calculated multifidus CSA of all images captured by both examiners. Intra-class correlation coefficients (ICC) and standard error of measurement (SEM) were calculated.
Intra- (ICC_3,1 0.988–0.996, SEM 0.3%–0.7%) and inter- (ICC_3,2 0.958–0.965, SEM 2.6%–3.2%) examiner reliability of imaging capturing was excellent. Intra- and inter-rater reliability of imaging calculation was also excellent for both raters (experienced/novice). No significant differences between experienced or novice examiners or testers were found.
This study found that intra- and inter-examiner/rater reliability of imaging capturing (probe assessment/patient positioning) and imaging calculation (scan assessment) of the cervical multifidus CSA at C4/C5 level was excellent in asymptomatic subjects.
Reliability of sonography in the assessment of lumbar stabilizer muscles size in healthy subjects and patients with scoliosis
2019, Journal of Bodywork and Movement Therapies
The purpose of the present study was to compare the reliability of sonography in the evaluation of abdominal and multifidus muscles size between healthy subjects and patients with scoliosis.
In this study, 20 healthy males and 20 male patients with scoliosis (20–50 years old) were recruited. Multifidus and abdominal muscles (transversus abdominis, internal and external oblique) size were assessed by sonography. Three images were recorded; the first and second images were taken on the same day with an hour interval to evaluate within-day reliability, and the third image was taken one-week later to assess between-day reliability.
Intraclass correlation coefficient (ICC = 0.82–0.91) demonstrated high within-day reliability of sonography in the assessment of abdominal muscle thickness in both groups. In addition, high between-day reliability was observed for these muscles in both healthy and patient groups (ICC = 0.80–0.89). Within-day and also between-day reliability of multifidus muscle were shown to be high in the healthy group (ICC = 0.81–0.88) and the patient group (ICC = 0.78–0.85). Overall, within-day reliability was higher than between-day reliability and also the reliability of sonography in healthy subjects was greater than of those suffering from scoliosis.
According to the results, sonography was shown to be a highly reliable imaging technique for assessment of abdominal and multifidus muscle size in healthy males and those suffering from scoliosis.
A Comparison of the Abdominal and Lumbar Multifidus Muscle Size in Patients With Lumbar Spondylolisthesis and Healthy Patients at Rest and During Contraction Using Ultrasonography
2018, Journal of Manipulative and Physiological Therapeutics
Using ultrasonography, this study investigated the abdominal and lumbar multifidus muscle size in patients with lumbar spondylolisthesis compared with healthy patients at rest and during contraction.
This research was a nonexperimental, analytic case-control study. Ultrasound imaging was used to assess the thickness of the abdominal and lumbar multifidus muscles in 25 healthy patients and 25 patients with spondylolisthesis. For the purpose of this study, both men and women, aged 30 to 70 years, were recruited from physiotherapy clinics affiliated with the University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Measurements were taken at rest and during contraction.
There was a significant difference in abdominal and lumbar multifidus muscle size between the healthy and spondylolisthesic groups, both at rest and contraction (P < .05 in all instances). No significant difference was found between the right and left for all measurements (P > .05).
Patients with spondylolisthesis had smaller stabilizer muscle thickness at rest and during contraction compared with the healthy group.
Multifidus muscle size changes at different directions of head and neck movements in females with unilateral chronic non-specific neck pain and healthy subjects using ultrasonography
2018, Journal of Bodywork and Movement Therapies
The aim of the study was to compare the dimensions of cervical multifidus muscle (CMM) in different conditions.
Twenty five women with neck pain and 25 healthy subjects participated in this study. The dimensions of the CMM were measured at rest, 50% and 100% maximum isometric voluntary contraction (MIVC) at six directions of neck movements, using ultrasonography.
The size of multifidus was smaller in patients than healthy individuals at rest state (P < 0.05). A significant smaller CMM dimension was found in the affected side compared with unaffected side in patients group (P < 0.05). The result of ANOVA for MLD showed a significant difference for contraction levels (P < 0.001) and neck movements (P < 0.001) in both groups. The MLD of the CMM was significantly different between CMM at rest and 50%, and 100% MIVC (P < 0.001). No significant differences were found between the groups at 50% and 100% MIVC (P > 0.05 in both instances). The most prominent CMM size change was observed during neck extension, flexion, ipsilateral lateral-flexion, and ipsilateral rotation, respectively (P < 0.05).
Results of the present study indicate that the size of CMM was decreased in patients with neck pain in rest state. The size of CMM changes in all directions of neck movements, although the most prominent was during neck extension. This points out CMM stabilization role's in different directions of neck movements.

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Literature ReviewUltrasonography of the Cervical Muscles: A Critical Review of the Literature

Abstract

Objective

Methods

Results

Conclusions

Section snippets

Data Sources

Results

Cervical Muscle Size

Conclusion

Funding Sources and Potential Conflicts of Interest

Practical Applications

J Manipulative Physiol Ther

Man Ther

J Manipulative Physiol Ther

Man Ther

Oral Surg Oral Med Oral Pathol Oral Radiol Endod

Man Ther

Man Ther

Man Ther

Man Ther

Man Ther

Clin Biomech

Eur J Pain

J Electromyogr Kinesiol

Increased sagittal plane segmental motion in the lower cervical spine in women with chronic whiplash-associated disorders, grades I-II: a case-control study using a new measurement protocol

Spine

Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain

Spine

Accuracy of abnormal paraspinal muscle findings on contrast-enhanced MR images as indirect signs of unilateral cervical root-avulsion injury

Radiology

Eye-head coupling in humans. I. Simultaneous recording of isolated motor units in dorsal neck muscles and horizontal eye movements

Exp Brain Res

Focal atrophy of the multifidus muscle in lumbosacral radiculopathy

Muscle Nerve

Evidence of lumbar multifidus muscle wasting ipsi-lateral to symptoms in patients with acute/sub-acute low back pain

Spine

Muscle dysfunction in cervical spine pain: implications for assessment and management

J Orthop Sports Phys Ther

Specificity in retraining cranio-cervical flexor muscle performance

J Orthop Sports Phys Ther

Cervical mal-alignment after laminoplasty: relationship to deep extensor musculature of the cervical spine and neurological outcome

J Neurosurg Spine

Strength and cross-sectional area of the dorsal neck muscles

Ergonomics

Isometric cervical extension force and dimensions of semispinalis capitis muscle

J Rehabil Res Dev

MRI of normal and pathologic skeletal muscle

Am J Roentgenol

CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects

Eur Spine J

Selective electromyography of dorsal neck muscles in humans

Exp Brain Res

How to read a paper: the Medline database

BMJ

Literature Review
Ultrasonography of the Cervical Muscles: A Critical Review of the Literature