What are the most frequently used imaging tools for evaluating deep fascia? A scoping review

Given the growing body of literature on the relationship between musculoskeletal disorders and fascial tissue, there is an increasing need to understand and accurately measure deep fascia in order to detect pathological involvement and monitor the efficacy of therapeutic interventions. The objective of this scoping review is to identify the most commonly used diagnostic imaging tools for assessing deep fascia. Secondary aims include identifying which fascial characteristics have been evaluated and which anatomical structures have been most frequently examined. A systematic literature search was conducted across Scopus, Web of Science, and PubMed between January and July 2024. Studies were included if they evaluated animals or humans, assessed deep musculoskeletal fascia or muscle fascia, and were observational - whether conducted in vivo or in cadavers - or interventional in design. Of the 69 articles meeting the inclusion criteria, ultrasound emerged as the most frequently used imaging modality. Elastography, magnetic resonance imaging, and computed tomography were also employed. The plantar fascia was the most frequently evaluated structure, followed by the thoracolumbar fascia, while fascial thickness was the most commonly assessed characteristic. It is concluded that ultrasound represents the most cost-effective tool for real-time, structural evaluation of deep fascia. When assessment of biomechanical properties is required, ultrasound should be complemented with elastography. In both cases, it is essential that assessors are adequately trained and adhere strictly to internationally agreed-upon protocols and terminology.