Research Papers

Change in Shear Modulus of Healthy Lower Leg Muscles After Treadmill Running: Toward a Noninvasive Diagnosis of Chronic Exertional Compartment Syndrome

[+] Author and Article Information
Seyedali Sadeghi

Department of Mechanical and
Nuclear Engineering,
College of Engineering,
The Pennsylvania State University,
State College, PA 16802
e-mail: sus653@psu.edu

Matthew Johnson

Department of Mechanical and
Nuclear Engineering,
College of Engineering,
The Pennsylvania State University,
State College, PA 16802
e-mail: matthewj005@gmail.com

Dov A. Bader

Department of Orthopaedics
& Rehabilitation,
Penn State College of Medicine,
University Park, PA 16803
e-mail: dbader@pennstatehealth.psu.edu

Daniel H. Cortes

Department of Mechanical and
Nuclear Engineering,
College of Engineering;
Department of Biomedical Engineering,
The Pennsylvania State University,
University Park, PA 16802
e-mail: dhc13@psu.edu

1Corresponding author.

Contributed by the Materials Division of ASME for publication in the JOURNAL OF ENGINEERING AND SCIENCE IN MEDICAL DIAGNOSTICS AND THERAPY Manuscript received December 26, 2018; final manuscript received April 3, 2019; published online May 8, 2019. Assoc. Editor: Mostafa Fatemi.

ASME J of Medical Diagnostics 2(3), 031004 (May 08, 2019) (7 pages) Paper No: JESMDT-18-1067; doi: 10.1115/1.4043537 History: Received December 26, 2018; Revised April 03, 2019

Chronic exertional compartment syndrome (CECS) is an exercise-induced condition, in which high pressure develops in one or several lower leg compartments, resulting in pain, numbness, and temporary muscle paresis. Diagnosis of CECS is assisted by measurements of intracompartment pressures (ICP) at rest, 1-min and 5-min after cessation of running exercise (Pedowitz criteria). ICP is measured via needle manometry, which is an invasive procedure. We have recently shown that intramuscular pressure is correlated to shear modulus measured via shear wave elastography (SWE) (Spearman's correlation coefficient = 0.99). The objectives of this study were to quantify temporal changes in shear modulus of muscle in lower leg compartments of healthy individuals before and after running exercise, and to evaluate a Pedowitz-like criterion for diagnosis of CECS using muscle shear modulus as biomarker. Specifically, the shear modulus of the tibialis anterior (TA) and peroneus longus (PL) was measured at time intervals of 1 min for 10 min after cessation of exercise. The shear modulus of the TA, PL, Soleus and Tibialis posterior were also measured bilaterally before, and at 1- and 5-min after exercise in a procedure that resembles the Pedowitz test for ICP. The shear modulus of all compartments increased significantly in both legs 1-min postexercise and gradually decreased to prerunning values. 50% of such decrease occurred at between 3 and 5 min after cessation of exercise. Additionally, the change in shear modulus followed a similar pattern than ICP in the Pedowitz-like protocol. Therefore, SWE has the potential to diagnose CECS noninvasively.

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Grahic Jump Location
Fig. 1

The experimental setup for elastography of the TA muscle (left) and the PL muscle (right). The ankle is placed in a support block to avoid applying contact pressure to the calf muscles. The transducer was placed at a point 30% of the distance from the head of the fibula to the tip of the lateral malleolus.

Grahic Jump Location
Fig. 2

The shear modulus maps of the (a) TA and (b) PL muscles at prerunning (left) immediately (center), and 5 min after cessation of exercise (right)

Grahic Jump Location
Fig. 3

The change in shear modulus for the (a) TA and (b) PL muscles (mean + standard deviation) over time shows an initial increase of shear modulus after treadmill running followed by gradual decrease back to pre-exercise values

Grahic Jump Location
Fig. 4

The curve fitting of the Weibull cumulative distribution function to the average change in shear modulus for the (a) TA and (b) PL muscles over time after cessation of treadmill running. The median, calculated from the Weibull parameters, was 3.6 and 5.1 min for the TA and PL muscles, representing the time needed for a decrease of 50% of the change in shear modulus after exercise.

Grahic Jump Location
Fig. 5

Results of a Pedowitz-like protocol using the shear modulus (kPa) measured before, immediately and 5 min after cessation of exercise show that shear modulus can be used a surrogate measurement of ICP (median and interquartile range)



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