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Ultrasound Evaluation of Quadriceps Muscle Dysfunction in Respiratory Disease

Parry, Selina M., PhD1; Burtin, Chris, PhD2; Denehy, Linda, PhD1; Puthucheary, Zudin A., PhD3,4; Bear, Danielle, MRes5,6,7,8

Cardiopulmonary Physical Therapy Journal: January 2019 - Volume 30 - Issue 1 - p 15–23
doi: 10.1097/CPT.0000000000000102
Literature Review

Purpose: Peripheral muscle dysfunction can encompass reductions in muscle mass, strength, endurance, and fatigability, and is common in both critical illness and chronic respiratory diseases. There is growing interest in nonvolitional methods to quantify the severity of peripheral muscle dysfunction—in particular, the utility of ultrasonography. This review provides an up-to-date narrative synthesis of current knowledge around ultrasonography methodology and the quantitative and qualitative measures that can be obtained from ultrasound imaging. The application of ultrasonography in chronic respiratory disease and critical illness will be discussed alongside the need for standardized methodologies.

Summary: Quadriceps muscle dysfunction is multifactorial with changes in muscle quantity and quality impacting on patient clinical outcomes. There is significant variability in ultrasonography image acquisition and analysis methodologies, which requires standardization. Ultrasound imaging is a promising evaluation tool that may enable identification of individuals at highest risk of muscle dysfunction and thus targeting of intervention resources.

Conclusion: Ultrasonography is noninvasive and easily integrated at the bedside in clinical practice. A range of quantitative and qualitative parameters can be assessed to provide detail on severity of peripheral muscle dysfunction in respiratory disease. There is significant variability in the application of ultrasonography, in order for the field to progress standardized approach to ultrasonography needs to be developed.

1Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia

2Faculty of Medicine and Life Sciences, Rehabilitation Research Centre, Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium

3Department of Anaesthesia and Intensive Care, Royal Brompton Hospital, London, United Kingdom

4Institute for Sport, Exercise and Health, University College London Hospitals, London, United Kingdom

5Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom

6Department of Nutrition and Dietetics, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom

7Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom

8Division of Asthma, Allergy and Lung Biology, King's College London, London, United Kingdom

Correspondence: Selina M. Parry, PhD, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia (

Z.A. Puthucheary and D. Bear are joint senior authors. S.M. Parry is currently in receipt of an NHMRC Early Career Research Fellowship. C. Burtin is partially funded by Limburgs Kankerfonds. The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

© 2019 Cardiovascular and Pulmonary Section, APTA
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