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Validation of Grayscale-Based Quantitative Ultrasound in Manual Wheelchair Users: Relationship to Established Clinical Measures of Shoulder Pathology

Collinger, Jennifer L. PhD; Fullerton, Bradley MD; Impink, Bradley G. BSE; Koontz, Alicia M. PhD; Boninger, Michael L. MD

American Journal of Physical Medicine & Rehabilitation: May 2010 - Volume 89 - Issue 5 - pp 390-400
doi: 10.1097/PHM.0b013e3181d8a238
Original Research Article: Ultrasound

Collinger JL, Fullerton B, Impink BG, Koontz AM, Boninger ML: Validation of grayscale-based quantitative ultrasound in manual wheelchair users: Relationship to established clinical measures of shoulder pathology.

Objective: The primary aim of this study is to establish the validity of grayscale-based quantitative ultrasound (QUS) measures of the biceps and supraspinatus tendons.

Design: Nine QUS measures of the biceps and supraspinatus tendons were computed from ultrasound images collected from 67 manual wheelchair users. Shoulder pathology was measured using questionnaires, physical examination maneuvers, and a clinical ultrasound grading scale.

Results: Increased age, duration of wheelchair use, and body mass correlated with a darker and more homogenous tendon appearance. Subjects with pain during physical examination tests for biceps tenderness and acromioclavicular joint tenderness exhibited significantly different supraspinatus QUS values. Even when controlling for tendon depth, QUS measures of the biceps tendon differed significantly between subjects with healthy tendons, mild tendinosis, and severe tendinosis. Clinical grading of supraspinatus tendon health was correlated with QUS measures of the supraspinatus tendon.

Conclusions: QUS is valid method to quantify tendinopathy and may allow for early detection of tendinosis. Manual wheelchair users are at a high risk for developing shoulder tendon pathology and may benefit from QUS-based research that focuses on identifying interventions designed to reduce this risk.

From the Human Engineering Research Laboratories (JLC, BGI, AMK, MLB), Department of Veterans Affairs, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Department of Physical Medicine and Rehabilitation (JLC, MLB), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Bioengineering (JLC, BGI, AMK, MLB), University of Pittsburgh, Pittsburgh, Pennsylvania; The Patient-Physician Partnership and Dell Children's Medical Center of Central Texas (BF), Austin, Texas; and Department of Rehabilitation Science and Technology (AMK, MLB), University of Pittsburgh, Pittsburgh, Pennsylvania.

All correspondence and requests for reprints should be addressed to: Michael Boninger, MD, Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, 7180 Highland Drive, Building 4, 151R-1, Pittsburgh, PA 15206.

This article is based on work supported by the Office of Research and Development, Rehabilitation Research and Development Service, Department of Veterans Affairs, grant B3142C, the National Institute of Health, grant R21HD054529, the National Institute on Disability and Rehabilitation Research (NIDRR) Rehabilitation Engineering Research Center on Spinal Cord Injury, grant H133E070024, and an NSF graduate research fellowship. Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

© 2010 Lippincott Williams & Wilkins, Inc.