Contrasting echogenicity in flexor digitorum profundus–flexor carpi ulnaris: A diagnostic ultrasound pattern in sporadic inclusion body myositis

Noto, Yu‐ichi; Shiga, Kiyoto; Tsuji, Yukiko; Kondo, Masaki; Tokuda, Takahiko; Mizuno, Toshiki; Nakagawa, Masanori

doi:10.1002/mus.24056

Cited by 61 publications

(67 citation statements)

References 11 publications

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“…The low cost, ease of imaging at bedside and wide availability make ultrasound an appealing modality, particularly in cases of inflammatory and infectious muscle disease 5 6. Noto et al 7 showed that those with IBM have atrophy and increased echogenicity in the flexor digitorum profundus muscles, which is in striking contrast to the normal appearance of the adjacent flexor carpi ulnaris muscle. When compared with other inflammatory myopathies and amyotrophic lateral sclerosis, they showed statistically significant (p<0.05) differences in flexor digitorum-to-flexor carpi ulnaris comparisons in regard to subjective assessments of muscle echogenicity, quantitative assessments of muscle echogenicity and quality measures of muscle thickness.…”

Section: Discussionmentioning

confidence: 99%

Neuromuscular ultrasound in the evaluation of inclusion body myositis

Vu¹,

Cartwright

2016

BMJ Case Reports

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This case report illustrates the role of using neuromuscular ultrasound to diagnose inclusion body myositis (IBM) in a patient who was previously diagnosed with polymyositis. Emerging studies have demonstrated the accuracy of MRI in detecting the selective involvement of the flexor digitorum profundus muscle in those with IBM. However, there have been only few reports on the use of ultrasound in diagnosing this condition. Our case demonstrates the benefit of using this ultrasonographic approach, which is simple, clear, inexpensive, painless and radiation-free, and provides another modality to assist in the evaluation of this sometimes difficult to diagnose condition.

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Section: Discussionmentioning

confidence: 99%

Neuromuscular ultrasound in the evaluation of inclusion body myositis

Vu¹,

Cartwright

2016

BMJ Case Reports

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“…(Sekul et al, 1997) described the differential pattern of involvement of the forearm muscles, with the FDP being preferentially affected, whereas the flexor digitorum superficialis and extensor muscles are often spared even in the later stages of the disease (Figure 2), and these findings were subsequently confirmed in other studies (Phillips et al, 2001, Takamure et al, 2005. The differential involvement of the forearm muscles can also be demonstrated with ultrasound, and a contrasting pattern of echogenicity in the FDP and flexor carpi ulnaris muscles is considered to be typical of IBM (Noto et al, 2014).…”

Section: Muscle Imagingmentioning

confidence: 53%

Sporadic inclusion body myositis: A review of recent clinical advances and current approaches to diagnosis and treatment

Needham

Mastaglia

2016

Clinical Neurophysiology

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Sporadic inclusion body myositis is the most frequent acquired myopathy of middle and later life and is distinguished from other inflammatory myopathies by its selective pattern of muscle involvement and slowly progressive course, and by the combination of inflammatory and degenerative muscle pathology and multi-protein deposits in muscle tissue. This review summarises the findings of recent studies that provide a more complete picture of the clinical phenotype and natural history of the disease and its global prevalence and genetic predisposition. Current diagnostic criteria, including the role of electrophysiological and muscle imaging studies and the recently identified anti-5'-nucleotidase (anti-cN1A) antibody in diagnosis are also discussed as well as current trends in the treatment of the disease.

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“…However, there are clinical situations, such as botulinum toxin administration or fine wire electrode placement for physiological studies, in which it is critical for the electrode to be in the correct muscle. In addition, there are disease processes that affect specific muscles, such as the preferential involvement of the flexor digitorum profundus seen in inclusion body myositis [20,21]. Ultrasound is important for avoiding unintended complications such as puncturing nerves or blood vessels.…”

Section: Discussionmentioning

confidence: 99%

Resident Accuracy of Electromyography Needle Electrode Placement Using Ultrasound Verification

Karvelas

Ziegler

Rho

2015

PM&R

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Background Electromyography (EMG) and musculoskeletal (MSK) ultrasound (US) are core learning objectives during physical medicine and rehabilitation (PM&R) training. However, there have been no prior studies using MSK US to assess the acquisition of EMG procedural skills during residency training. This study aims to demonstrate the differences in skillful needle placement between junior and senior physiatry residents. The integration of both EMG and MSK US may have tremendous potential for additional learning opportunities related to electrodiagnostic education. Objective To determine the accuracy of anatomic landmark–guided EMG needle electrode placement in commonly used muscles by PM&R resident physicians. Design Cross-sectional study. Setting An academic PM&R residency program. Participants Twelve (5 postgraduate year [PGY] −3 and 7 PGY-4) PM&R resident physicians participating in a MSK US training course. Methods Twelve PM&R residents in the eighth month of their third and fourth years of postgraduate training performed anatomic landmark–guided needle placement to the extensor indicis proprius (EIP), pronator teres (PT), peroneus longus (PL), and soleus muscles of live subjects. Once the needle electrode was satisfactorily placed, needle localization was verified with US. Main outcome measures Accuracy of EMG needle electrode placement. Results The overall accuracy of needle electrode placement for all resident participants was 68.8%. The mean accuracy of the 4 selected muscles was 50% by PGY-3 residents and 82.1% for PGY-4 residents (P = .01). EIP was the most commonly missed muscle, with correct placement performed by 20% of PGY-3 and 42.9% of PGY-4 residents. PGY-3 residents demonstrated 60% accuracy with localizing the PT, PL, and soleus muscles. PGY-4 residents demonstrated 85.7% accuracy for PT, and 100% accuracy for both PL and soleus muscles. Conclusions Senior residents demonstrated greater accuracy of landmark-guided needle placement than junior residents. EMG procedural skills are important milestones in PM&R training, and MSK US may be a useful tool to enhance resident learning.

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Contrasting echogenicity in flexor digitorum profundus–flexor carpi ulnaris: A diagnostic ultrasound pattern in sporadic inclusion body myositis

Abstract: FDP-FCU echogenicity contrast in muscle US is a sensitive diagnostic indicator of s-IBM.

Cited by 61 publications

References 11 publications

Neuromuscular ultrasound in the evaluation of inclusion body myositis

Neuromuscular ultrasound in the evaluation of inclusion body myositis

Sporadic inclusion body myositis: A review of recent clinical advances and current approaches to diagnosis and treatment

Resident Accuracy of Electromyography Needle Electrode Placement Using Ultrasound Verification

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