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Background and Aims The use of ultrasound in physiotherapy helps to increase the precision and effectiveness of different techniques and provide a more objective assessment. Standardized clinical practice guidelines are needed to enable an appropriate reproducibility. The aims of this study were to perform a literature review to identify studies using ultrasound for the assessment of peroneal muscles. Also, to establish whether reliable and reproducible assessment protocols exist, and analyze these protocols to determine both reliability as well as methodology. Material and Methods A literature search was performed in PubMed, Cochrane Library, PEDro and ScienceDirect databases over the last 10 years (2009-2018). The descriptors "Ultrasonography" and "Peroneus Muscle" were used, restricting the search to publications in English and Spanish for studies performed in humans.The two main researchers revised the results and selected those that were most relevant. The data were then extracted individually and blindly. The third researcher shared the data obtained, verifying the exactness of the same and commenting the differences. There were no disagreements. Results Initially, 92 studies were retrieved. After the analysis of the title, abstract and full-text (when necessary), 12 studies were selected for the analysis. Seven studies used ultrasound in B mode. In total, 10 morphometric descriptors were identified. Eight descriptors presented a very good reliability (CCI >90) and two descriptors had good reliability (CCI 0.71-0.90). Of the measurements performed in the cross-sectional plane, the cross-sectional area (CSA) and circular perimeter (CP) demonstrated a CCI >90 both in the analysis of the peroneus longus as well as the peroneus brevis, jointly or individually. The measurements of the CSA and CP demonstrated a CCI between 0.71-0.90 when these were performed upon the connective tissue of these muscles. The measurement of the anterior-posterior thickness presented a CCI >90. In the longitudinal plane, the measurement of muscle thickness presented a CCI >90. Five studies employed elastography to analyze muscle stiffness using Shear Wave Elastography and providing very good CCI results (>0.90) or good results (0.71-0.90) in peroneus muscles. Only one study reported a moderate CCI (0.51-0.70) for the measurement of the peroneus brevis. Sufficient data were obtained to perform a standardized measurement protocol based on good or very good reliability criteria. Conclusions It is possible to perform a sonographic exploration with reliability and reproducibility in the peroneal muscles for descriptors in B mode. Although some studies analyzed echogenicity, the authors recognized that this technique depends on the echographer and the operator and values of reliability are not reported. Although shear wave elastography has demonstrated to be reproducible, with moderate to good reliability, further studies are required to enable an objective interpretation of these results in clinical practice.

Background and Aims Previous studies have evaluated electrostimulation of the tibialis anterior muscle via ultrasound. However, to the best of our knowledge, to date, no study has compared percutaneous stimulation compared to transcutaneous stimulation. The aim of this study was to analyze and compare the influence of percutaneous stimulation versus transcutaneous stimulation on the angle and muscle width of the proximal motor point of the tibialis anterior among healthy individuals using ultrasound. Material and Methods A longitudinal prospective study. The study variables were muscle thickness and pennation angle, measured using ultrasound. A sample of 4 healthy individuals with a mean age of 35.25 years ( ± 2.17), mean height of 1.70m ( ±  0.03) and weight of 67.35kg ( ±  6.32), participated in this study. Stimulation was performed on the tibialis anterior of the dominant leg of each individual (n = 4). The subjects were seated in a vertical position. For position 1, the knee of the dominant leg remained completely extended and the ankle was fixed in a neutral position with an orthosis comprised of Velcro straps which immobilized the ankle and forefoot joints. For position 2, the knee remained flexed 90 degrees with the foot fixed in the orthosis and supported on the floor. The proximal motor point of the tibialis anterior muscle was located. A biphasic symmetric pulse current was used with the maximum tolerated intensity. Transcutaneous stimulation was performed via a small circular electrode, and for percutaneous stimulation a filiform acupuncture needle was used. To capture the ultrasound images, the probe was placed on a system with an articulated mechanical arm and a clamp that enabled the possibility of adjusting the height and/or angle and the position marked on the skin. Normality was contrasted using the Shapiro-Wilk test and sphericity was tested using the Mauchly's test. Analysis of variance was performed (ANOVA) for repeated measures. Results The comparison of both techniques in position 1 did not show significant differences between the transcutaneous technique versus the percutaneous technique neither for the angle (F = 2.07; p-valor = 0.18), nor for the width (F =0.28; p-value = 0.60). In the case of position 2, significant differences were not found between the transcutaneous technique versus the percutaneous technique, neither for the angle (F = 0.28; p-value = 0.606) nor for the weight (F =0.11; p-value = 0.75). Conclusions The comparison of transcutaneous stimulation versus percutaneous stimulation in the proximal motor point of the tibialis anterior does not seem to show statistically significant differences for muscle width nor pennation angle.

Background and Aims Ultrasound is a non-invasive test which enables a fast real time exam, which is both dynamic and accessible. In contrast, the mechanisms of functioning of acupuncture have not been completely understood. The aim of this review was to determine the various uses assigned to ultrasound in acupuncture research. Material and Methods A literature search was performed in PubMed, Cochrane Library, PEDro and ScienceDirect databases. Manual searches were performed in the following journals: Evidence-Based Complementary and Alternative Medicine, Acupuncture Medicine, Medical Acupuncture and The Journal of Alternative and Complementary Medicine. The search terms “ultrasonography” and “Acupuncture” were used, related with AND. Research studies in humans were included in which ultrasound was used to assess some aspect of the acupuncture intervention. No time limit was established and the languages were limited to Spanish, English, Galician or Portuguese. The data extraction was performed by two independently blinded evaluators. Results A total of 46 studies were included for the analysis. B Mode is the most used form of imaging, followed by Doppler and elastography. In total, 18 studies performed an analysis of vascular parameters. Doppler was commonly used, with a dominance of transcranial Doppler methods, although B mode was also used to measure the transverse diameter of blood vessels. In 11 studies, B mode was used alone or combined with Doppler to obtain measures of safety, precision, location of target structures and needle position regarding sensitive structures. Seven studies used elastography. Five studies quantified tissue movement and another quantified muscle stiffness using elastography and B mode. A further study also included Doppler for the measurement of blood flow. Six studies evaluated visceral conditions. One study evaluated gastric emptying and the five remaining studies focused on the genitourinary sphere such as the rate of pregnancy, fetal position, prostate characteristics, intrapelvic venous congestion and bladder emptying. From the musculoskeletal point of view, 4 studies were located. Two studies evaluated the thickness parameter of the common extensor tendon of the epicondyle and two layers of connective tissue, respectively. One study concluded that the application of acupuncture can influence the viscoelastic properties of the tendon and one remaining study informed of the positive association between ultrasound as an assessment tool and follow up tool in acupuncture treatments. Conclusions In this field of study, ultrasound has been used to obtain objective outcomes and adopt safety guidelines related to acupuncture procedures.