慢性颈痛患者颈肩部肌肉性能差异及其与疼痛、体质量指数的相关性

doi:10.3969/j.issn.1006-9771.2023.12.006

Abstract

Abstract:

Objective To test the inter-tester reliability and test-retest reliability of MyotonPRO for evaluating neck and shoulder muscle performance parameters in patients with unilateral chronic neck pain, observe the difference of muscle performance between the healthy and affected sides of patients with chronic neck pain, and analyze the factors that cause the imbalance of muscle performance in patients with chronic neck pain.

Methods From January to June, 2023, 32 patients with unilateral chronic neck pain in Guangdong Second Traditional Chinese Medicine Hospital were selected. Two testers used the same MyotonPRO equipment to measure the muscle tone, muscle hardness and muscle elasticity on both sides of the sternocleidomastoid muscle and the upper trapezius muscle in the relaxed position. Tester 1 repeated the measurement after an interval of 30 minutes, and Tester 2 was measured within the time interval between the two measurements of Tester 1. The intraclass correlation coefficient (ICC), standard error of mean (SEM) and minimum detectable change (MDC) were calculated simultaneously. The measurement results were plotted into Bland-Altman diagram and systematic bias analysis was performed. The difference in muscle characteristics between the affected side and the healthy side was compared. At the same time, the Visual Analogue Scale (VAS) score and body mass index (BMI) of the subjects were collected for correlation analysis.

Results Except the sternocleidomastoid muscle elasticity of the affected side (ICC = 0.697), the inter-tester reliability of all other parameters was high to very high (ICC = 0.719 to 0.952, SEM = 0.04 to 6.53, MDC = 0.12 to 18.11). The test-retest reliability of all parameters was high (ICC = 0.883 to 0.981, SEM = 0.03 to 5.72, MDC = 0.09 to 15.84). Bland-Altman plot analysis showed that the scatter distribution was consistent. The muscle tone, muscle hardness and muscle elasticity of sternocleidomastoid muscle and upper trapezius muscle were higher on the affected side than on the healthy side (t > 2.846, P< 0.05). The asymmetry index of tension, hardness and elasticity of upper trapezius muscle and sternocleidomastoid muscle was significantly positively correlated with VAS score and BMI (r> 0.385, P< 0.05).

Conclusion MyotonPRO has good inter-tester reliability and retest reliability in evaluating the muscle performance of both sides of patients with chronic neck pain. The muscle tone, muscle hardness and muscle elasticity of sternocleidomastoid muscle and upper trapezius muscle on the affected side were higher than on the healthy side, and the difference of muscle performance was positively correlated with pain and BMI.

Key words: upper trapezius muscle, sternocleidomastoid muscle, MyotonPRO, muscle tone, muscle hardness, muscle elasticity, reliability

CLC Number:

R681.5

SHEN Xingxing, XIONG Yuling, CHEN Weijian, LI Congcong, LI Junyi, WANG Shuai, ZHANG Jiahao, XIANG Ruian, CHEN Jiahao, LIU Wengang, XU Xuemeng. Difference of cervical and shoulder muscle performance and its correlation with pain and body mass index in patients with chronic neck pain[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(12): 1420-1428.

Figures/Tables 7

References 41

[1]	CHILDRESS M A, STUEK S J. Neck pain: initial evaluation and management[J]. Am Fam Phys, 2020, 102(3): 150-156.
[2]	POPESCU A, LEE H. Neck pain and lower back pain[J]. Med Clin, 2020, 104(2): 279-292.
[3]	李梦瑜, 宋雅, 徐坚. 慢性颈痛患者健康体适能的特征[J]. 中国康复理论与实践, 2023, 29(7): 756-760. doi: 10.3969/j.issn.1006-9771.2023.07.003
	LI M Y, SONG Y, XU J. Characteristics of health-related physical fitness of patients with chronic neck pain[J]. Chin J Rehabil Theory Pract, 2023, 29(7): 756-760.
[4]	PENG B, YANG L, LI Y, et al. Cervical proprioception impairment in neck pain-pathophysiology, clinical evaluation, and management: a narrative review[J]. Pain Ther, 2021, 10(1): 143-164. doi: 10.1007/s40122-020-00230-z pmid: 33464539
[5]	HSU W L, CHEN C P, NIKKHOO M, et al. Fatigue changes neck muscle control and deteriorates postural stability during arm movement perturbations in patients with chronic neck pain[J]. Spine J, 2020, 20(4): 530-537. doi: 10.1016/j.spinee.2019.10.016
[6]	LEE Y, KIM M, LEE H. The measurement of stiffness for major muscles with shear wave elastography and Myoton: a quantitative analysis study[J]. Diagnostics (Basel), 2021, 11(3): 524.
[7]	李亚鹏, 冯亚男, 刘春龙, 等. 一种新型弹性测试仪用于健康人群斜方肌弹性评估的信度研究[J]. 中国康复医学杂志, 2017, 32(10): 1183-1185.
[8]	CHEN G, WU J, CHEN G, et al. Reliability of a portable device for quantifying tone and stiffness of quadriceps femoris and patellar tendon at different knee flexion angles[J]. PLoS One, 2019, 14(7): e0220521. doi: 10.1371/journal.pone.0220521
[9]	ROSICKA K, MIERZEJEWSKA-KRZYŻOWSKA B, MRÓWCZYŃSKI W. Comparison of different MyotonPRO probes for skin stiffness evaluation in young women[J]. Skin Res Technol, 2021, 27(3): 332-339. doi: 10.1111/srt.12946 pmid: 33078499
[10]	LI Y P, LIU C L, ZHANG Z J. Feasibility of using a portable MyotonPRO device to quantify the elastic properties of skeletal muscle[J]. Med Sci Monit, 2022, 28: e934121.
[11]	中华医学会疼痛学分会. 临床诊疗指南-疼痛学分册[M]. 北京: 人民卫生出版社, 2007: 96.
[12]	CHENG Z J, ZHANG S P, GU Y J, et al. Effectiveness of Tuina therapy combined with Yijinjing exercise in the treatment of nonspecific chronic neck pain: a randomized clinical trial[J]. JAMA Network Open, 2022, 5(12): e2246538. doi: 10.1001/jamanetworkopen.2022.46538
[13]	HU X, LEI D, LI L, et al. Quantifying paraspinal muscle tone and stiffness in young adults with chronic low back pain: a reliability study[J]. Sci Rep, 2018, 8(1): 14343. doi: 10.1038/s41598-018-32418-x pmid: 30254233
[14]	陈伟健, 陈泽华, 吴佳涛, 等. 新型肌肉定量评估仪评估神经根型颈椎病患者两侧肩颈肌肉的性能失衡[J]. 中国组织工程研究, 2022, 26(3): 430-434.
	CHEN W J, CHEN Z H, WU J T, et al. Imbalance of mechanical properties about bilateral shoulder and neck muscle in patients with cervical spondylotic radiculopathy using MyotonPRO[J]. Chin J Tissue Eng Res, 2022, 26(3): 430-434.
[15]	WU Z, WANG Y, YE Z, et al. Effects of age and sex on properties of lumbar erector spinae in healthy people: preliminary results from a pilot study[J]. Front Physiol, 2021, 12: 718068. doi: 10.3389/fphys.2021.718068
[16]	HUANG J, QIN K, TANG C, et al. Assessment of passive stiffness of medial and lateral heads of gastrocnemius muscle, achilles tendon, and plantar fascia at different ankle and knee positions using the MyotonPRO[J]. Med Sci Monit, 2018, 24: 7570-7576. doi: 10.12659/MSM.909550
[17]	吴佳涛, 陈国茜, 许学猛, 等. MyotonPRO用于评估健康青年人股四头肌肌肉弹性的信度研究[J]. 中国康复医学杂志, 2021, 36(1): 57-62.
	WU J T, CHEN G Q, XU X M, et al. Measurement reliability of MyotonPRO for elasticity of quadriceps femoris in healthy youth[J]. Chin J Rehabil Med, 2021, 36(1): 57-62.
[18]	YEO S M, KANG H, AN S, et al. Mechanical properties of muscles around the shoulder in breast cancer patients: intra-rater and inter-rater reliability of the MyotonPRO[J]. PMR, 2020, 12(4): 374-381.
[19]	李俊毅, 陈泽华, 吴祖贵, 等. 超声回声强度评价膝骨关节炎患者股四头肌质量的信度[J]. 中国康复理论与实践, 2023, 29(6): 738-744. doi: 10.3969/j.issn.1006-9771.2023.06.017
	LI J Y, CHEN Z H, WU Z G, et al. Reliability on evaluation of quadriceps femoris muscle quality by ultrasonic echo intensity in patients with knee osteoarthritis[J]. Chin J Rehabil Theory Pract, 2023, 29(6): 738-744.
[20]	KARAPINAR M, AYYILDIZ V A, ÜNAL M, et al. Ultrasound imaging of quadriceps muscle in patients with knee osteoarthritis: the test-retest and inter-rater reliability and concurrent validity of echo intensity measurement[J]. Musculoskelet Sci Pract, 2021, 56: 102453.
[21]	MUCKELT P E, WARNER M B, CHELIOTIS-JAMES T, et al. Protocol and reference values for minimal detectable change of MyotonPRO and ultrasound imaging measurements of muscle and subcutaneous tissue[J]. Sci Rep, 2022, 12(1): 13654. doi: 10.1038/s41598-022-17507-2 pmid: 35953503
[22]	KOCUR P, TOMCZAK M, WIERNICKA M, et al. Relationship between age, BMI, head posture and superficial neck muscle stiffness and elasticity in adult women[J]. Sci Rep, 2019, 9(1): 8515. doi: 10.1038/s41598-019-44837-5 pmid: 31186509
[23]	SALDIRAN T Ç, KARA İ, YIKILMAZ S K. Quantification of the forearm muscles mechanical properties using Myotonometer: intra-and inter-examiner reliability and its relation with hand grip strength[J]. J Electromyogr Kinesiol, 2022, 67: 102718. doi: 10.1016/j.jelekin.2022.102718
[24]	YU J F, CHANG T T, ZHANG Z J. The reliability of MyotonPRO in assessing masseter muscle stiffness and the effect of muscle contraction[J]. Med Sci Monit, 2020, 26: e926578.
[25]	卫小梅, 喻勇, 姜丽, 等. 肌张力检测仪用于口面部肌张力评估的初步研究[J]. 中国康复医学杂志, 2017, 32(7): 768-772.
	WEI X M, YU Y, JIANG L, et al. Quantifying oromoter muscle tone using MyotonPro device: a pilot study[J]. Chin J Rehabil Med, 2017, 32(7): 768-772.
[26]	杨佳曼, 王毅, 毛志涛, 等. 足姿指数评价青少年特发性脊柱侧弯患者足部位置的信度[J]. 中国康复理论与实践, 2022, 28(8): 909-913. doi: 10.3969/j.issn.1006-9771.2022.08.006
	YANG J M, WANG Y, MAO Z T, et al. Reliability of foot posture index for adolescent idiopathic scoliosis[J]. Chin J Rehabil Theory Pract, 2022, 28(8): 909-913.
[27]	GE J S, CHANG T T, ZHANG Z J. Reliability of myotonometric measurement of stiffness in patients with spinal cord injury[J]. Med Sci Monit, 2020, 26: e924811-1.
[28]	FENG Y N, LI Y P, LIU C L, et al. Assessing the elastic properties of skeletal muscle and tendon using shearwave ultrasound elastography and MyotonPRO[J]. Sci Rep, 2018, 8(1): 17064. doi: 10.1038/s41598-018-34719-7 pmid: 30459432
[29]	KENNEDY P, BARNHILL E, GRAY C, et al. Magnetic resonance elastography (MRE) shows significant reduction of thigh muscle stiffness in healthy older adults[J]. Geroscience, 2020, 42(1): 311-321. doi: 10.1007/s11357-019-00147-2 pmid: 31865527
[30]	LEE M T, WU C Y, CHEN C W, et al. Age and sex differences in the biomechanical and viscoelastic properties of upper limb muscles in middle-aged and older adults: a pilot study[J]. J Biomech, 2022, 134: 111002. doi: 10.1016/j.jbiomech.2022.111002
[31]	殷德振, 王元浩. 颈椎间盘退变对颈椎生物力学影响的有限元研究[J]. 临床医学研究与实践, 2017, 2(3): 106-107.
	YIN D Z, WANG Y H. Finite element study on the biomechanical effect of cervical intervertebral disc degeneration on cervical spine[J]. Clin Res Pract, 2017, 2(3): 106-107.
[32]	PENG B, DEPALMA M J. Cervical disc degeneration and neck pain[J]. J Pain Res, 2018: 2853-2857.
[33]	PENG Q, ZHANG Y, YANG S, et al. Morphological changes of cervical musculature in relation to chronic nonspecific neck pain: a systematic review and meta-analysis[J]. World Neurosurg, 2022, 168: 79-88. doi: 10.1016/j.wneu.2022.09.057
[34]	WU Z, YE X, YE Z, et al. Asymmetric biomechanical properties of the paravertebral muscle in elderly patients with unilateral chronic low back pain: a preliminary study[J]. Front Bioeng Biotechnol, 2022, 10: 814099. doi: 10.3389/fbioe.2022.814099
[35]	MEZNARIC M, ERŽEN I, KAREN P, et al. Effect of ageing on the myosin heavy chain composition of the human sternocleidomastoid muscle[J]. Ann Anat, 2018, 216: 95-99. doi: S0940-9602(17)30154-1 pmid: 29289708
[36]	MASAKI M, AOYAMA T, MURAKAMI T, et al. Association of low back pain with muscle stiffness and muscle mass of the lumbar back muscles, and sagittal spinal alignment in young and middle-aged medical workers[J]. Clin Biomech, 2017, 49: 128-133. doi: 10.1016/j.clinbiomech.2017.09.008
[37]	MULTANEN J, HÄKKINEN A, KAUTIAINEN H, et al. Associations of neck muscle strength and cervical spine mobility with future neck pain and disability: a prospective 16-year study[J]. BMC Musculoskelet Disord, 2021, 22(1): 911. doi: 10.1186/s12891-021-04807-3
[38]	ALQAHTANI M, ALTUWAIJRI O, ALTAF M, et al. Influence of body mass index and weight lifting on bicep brachii muscle and distal bicep tendon stiffness evaluated using ultrasound elastography[J]. BMC Med Imaging, 2020, 20(1): 129. doi: 10.1186/s12880-020-00531-x
[39]	LIN L Z, YU Y N, FAN J C, et al. Increased stiffness of the superficial cervical extensor muscles in patients with cervicogenic headache: a study using shear wave elastography[J]. Front Neurol, 2022, 13: 874643. doi: 10.3389/fneur.2022.874643
[40]	舒霁坤, 资应能, 程海龙. 深层肌肉刺激结合悬吊训练治疗慢性非特异性颈痛的疗效观察[J]. 颈腰痛杂志, 2023, 44(2): 295-296.
	SHU J K, ZI Y N, CHENG H L. Observation on the curative effect of deep muscle stimulation combined with suspension training in the treatment of chronic nonspecific neck pain[J]. J Cervicodynia Lumbodynia, 2023, 44(2): 295-296.
[41]	李亚鹏, 刘书芳, 刘春龙, 等. 肌肉筋膜软组织弹性量化分析临床研究及新进展[J]. 中国康复医学杂志, 2017, 32(8): 970-974.
	LI Y P, LIU S F, LIU C L, et al. Clinical research and new progress of quantitative analysis of muscle fascia soft tissue elasticity[J]. Chin J Rehabil Med, 2017, 32(8): 970-974.

肌肉	性能	测试者	患侧		健侧
肌肉	性能	测试者	第1次测量	第2次测量	第1次测量	第2次测量
上斜方肌	肌张力/Hz	1	19.88±1.02	19.78±0.96	18.61±0.75	18.49±0.76
		2	19.43±0.86		18.18±0.90
	肌肉硬度/(N•m^-1)	1	389.66±25.97	393.38±25.00	361.03±24.64	364.19±22.22
		2	381.69±23.82		355.34±23.07
	弹性系数	1	1.24±0.11	1.27±0.11	1.10±0.11	1.11±0.11
		2	1.17±0.12		1.04±0.11
胸锁乳突肌	肌张力/Hz	1	13.94±1.14	14.03±1.10	13.14±0.94	13.23±1.10
		2	13.49±1.24		12.72±1.22
	肌肉硬度/(N•m^-1)	1	251.03±13.24	255.09±13.18	237.19±11.82	240.34±12.73
		2	246.09±13.46
	弹性系数	1	1.52±0.12	1.54±0.13	1.61±0.13	1.62±0.13
		2	1.48±0.11		1.55±0.12

肌肉	性能	患侧			健侧
肌肉	性能	ICC (95% CI)	SEM	MDC	ICC (95% CI)	SEM	MDC
上斜方肌	肌张力	0.719(0.498, 0.852)	0.51	1.41	0.839(0.695, 0.918)	0.34	0.95
	肌肉硬度	0.932(0.865, 0.966)	6.53	18.11	0.952(0.905, 0.852)	5.23	14.48
	弹性系数	0.849(0.713, 0.923)	0.05	0.13	0.841(0.699, 0.919)	0.04	0.12
胸锁乳突肌	肌张力	0.890(0.787, 0.946)	0.40	1.10	0.757(0.559, 0.874)	0.55	1.52
	肌肉硬度	0.892(0.791, 0.946)	4.43	12.28	0.801(0.630, 0.897)	5.36	14.86
	弹性系数	0.697(0.464, 0.840)	0.07	0.20	0.742(0.535, 0.865)	0.06	0.17

肌肉	性能	患侧			健侧
肌肉	性能	ICC (95% CI)	SEM	MDC	ICC (95% CI)	SEM	MDC
上斜方肌	肌张力	0.981(0.961, 0.991)	0.14	0.37	0.977(0.952, 0.989)	0.11	0.32
	肌肉硬度	0.981(0.960, 0.991)	3.50	9.69	0.940(0.877, 0.971)	5.72	15.84
	弹性系数	0.921(0.838, 0.961)	0.03	0.09	0.909(0.814, 0.956)	0.03	0.09
胸锁乳突肌	肌张力	0.929(0.854, 0.965)	0.30	0.82	0.883(0.761, 0.943)	0.35	0.97
	肌肉硬度	0.963(0.924, 0.982)	2.55	7.08	0.898(0.790, 0.950)	3.93	10.88
	弹性系数	0.886(0.767, 0.945)	0.04	0.12	0.933(0.862, 0.967)	0.03	0.09

肌肉	性能	患侧	健侧	t值	P值
上斜方肌	肌张力/Hz	19.70±0.96	18.43±0.82	17.353	< 0.001
	肌肉硬度/(N•m^-1)	388.24±25.16	360.19±23.37	27.639	< 0.001
	弹性系数	1.23±0.12	1.09±0.11	25.045	< 0.001
胸锁乳突肌	肌张力/Hz	13.82±1.17	13.03±1.11	2.846	0.013
	肌肉硬度/(N•m^-1)	250.74±13.67	236.49±12.49	20.210	< 0.001
	弹性系数	1.60±0.13	1.51±0.12	3.495	0.004

肌肉	性能	不对称指数/%	VAS评分		BMI
肌肉	性能	不对称指数/%	r值	P值	r值	P值
上斜方肌	肌张力	6.38±2.89	0.620	< 0.001	0.527	0.002
	肌肉硬度	7.21±1.84	0.529	0.002	0.400	0.023
	弹性系数	11.62±3.08	0.531	0.002	0.504	0.003
胸锁乳突肌	肌张力	5.98±2.47	0.499	0.004	0.462	0.008
	肌肉硬度	5.75±2.05	0.455	0.009	0.470	0.007
	弹性系数	5.35±2.95	0.417	0.018	0.385	0.030

Difference of cervical and shoulder muscle performance and its correlation with pain and body mass index in patients with chronic neck pain

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