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Use of shear wave elastography to analyze the muscle structure in children with spastic cerebral palsy
Pinar Doruk Analan1, Hulya Aslan2
1Department of Physical Medicine and Rehabilitation, Baskent University Faculty of Medicine, Ankara, Turkey.
Insights
In children with cerebral palsy, stiff gastrocnemius muscles contribute to pes equinus foot posture. Shear wave elastography (SWE) non-invasively measured muscle stiffness, confirming gastrocnemius muscles are stiffer than tibialis anterior muscles.
Area of Science:
- Biomedical Engineering
- Orthopedics
- Pediatrics
Background:
- Cerebral palsy (CP) can cause gastrocnemius muscle spasticity, leading to pes equinus posture.
- Pes equinus results in insufficient ankle dorsiflexion, impacting normal gait in children.
Purpose of the Study:
- To analyze gastrocnemius and tibialis anterior muscle stiffness in children with CP-related pes equinus.
- To evaluate the clinical utility of shear wave elastography (SWE) for assessing calf muscle stiffness.
Main Methods:
- Prospective study including 24 legs from 12 children (mean age 45.8 months) with CP.
- Shear wave elastography (SWE) used for tissue stiffness quantification via shear-wave velocity (SWV).
Main Results:
- Mean SWV for gastrocnemius muscles was 3.91±0.26 m/s; for tibialis anterior, it was 2.67±0.18 m/s.
- Gastrocnemius muscles showed significantly higher stiffness than tibialis anterior muscles (p < 0.0001).
- No significant correlation was found between the stiffness of the two muscles (r=0.129, p>0.05).
Conclusions:
- Gastrocnemius muscles are stiffer than tibialis anterior muscles in children with spastic CP.
- Pes equinus deformity in these patients may be linked to gastrocnemius muscle stiffness.
- SWE shows promise as a non-invasive clinical tool for evaluating calf muscle stiffness in CP.
Purpose:
In children with cerebral palsy (CP), gastrocnemius muscle spasticity may lead to pes equinus posture which causes insufficient ankle joint dorsiflexion for normal gait. The aim of this study was to analyze the stiffness of gastrocnemius and tibialis anterior muscles by shear wave elastography (SWE) in children with pes equinus deformity due to spastic CP.
Methods:
24 legs of 12 children (6 females and 6 males, mean age 45.8 months) with CP were prospectively included in the study. Tissue stiffness quantification with shear-wave velocity (SWV) was analyzed.
Results:
The mean SWVs of the gastrocnemius and tibialis anterior muscles were 3.91±0.26 m/s and 2.67±0.18 m/s, respectively. The stiffness of the gastrocnemius muscle was significantly higher than the stiffness of the tibialis anterior muscle (p < 0.0001). There was no correlation between the stiffness of these muscles (r = 0.129, p > 0.05).
Conclusion:
Gastrocnemius muscles were stiffer than tibialis anterior muscles in patients with spastic CP. But stiffness between these muscles was not correlated with each other. Pes equinus may be related to stiff gastrocnemius in these patients. This study demonstrates the clinical potential for SWE as a non-invasive tool for analyzing calf muscle stiffness.
