Elastography Clinical Trial
Official title:
Changes in the Tension of the Flexor Carpi Ulnar Muscle With the Tensioning of the Ulnar Nerve by Shear-wave Elastography: a Pilot Study
A single-center, observational, prospective, single cohort study with before-after design. Evaluation by shear-wave elastography, measured in kilopascals (KPa), of the muscle, tendon and cubital nerve, before and after the maneuver of putting in tension of the ulnar nerve.
Once each subject has signed the informed consent document and it has been verified that the
inclusion criteria are met, it will be assigned the same identification number (ID) that is
related to its Clinical History (CH) by simple coding; custody of the file with the
relationship of each ID with its CH will be the responsibility of the principal investigator.
Body placement: The participants will be placed in the supine position with the hips and
knees bent, in such a way that the soles of the feet rest on the plane of the stretcher. the
palm of the hand of the left extremity will rest on the abdomen and the head in a neutral
position, with the maximum relaxation of the sternocleidomastoids.
Upper limb placement: The right extremity will be placed in abduction of 90°, the elbow to
flexion of 10° and the forearm to 30° of supination. Wrist and joints metacarpophalangic
(mcf), proximal interphalangeal (ifp) and distal interphalangeal (ifp) of the first three
fingers in full extension. The articulations mcf, ifp, ifd of the fourth and fifth fingers in
a relaxed position. In this position, the first ultrasound measurement will be taken.
Tension maneuver of the ulnar nerve: An expert researcher in mobilization of neural tissue
will perform an extension of fourth and fifth finger, respecting the initial parameters that
are maintained in position by the splint. To do this, he will use the index and middle of his
left hand and make a contact on the palmar side of the fingers and a back pressure with the
thumb on the back of the hand. Next, it will extend the fingers until the exponential
resistance following the path of elastic deformation (linear resistance) of the tensioned
tissues is perceived. At this time the new ultrasound record will be made.
Ultrasound records: A Toshiba ai800 ultrasound scanner (Toshiba Medical Corporation, Japan)
with a multifrequency linear probe plt-1005bt 14l5 (5-14 Mhz) will be used. The
identification number (ID) registered in the ultrasound will correspond to the participant
number.
The same researcher, with experience in the acquisition and management of medical images,
will perform the ultrasound and in-line measurements of the images obtained.
The ultrasound will be obtained in a pre and post-median situation after the neural tension
put on by the expert investigator in manual therapy and a label will be consigned in the
images indicating if the acquisition was "pre" or "post".
To perform the acquisition of the images the probe wil be positioned on the skin of the
forearm with minimal pressure and with angulation such that there is no anisotropy. The
anatomical region where the myotendinous junction of the flexor carpi ulnaris muscle and the
ulnar nerve is observed will be searched transversally. the parameters of emission power,
general gain, depth of the image, position of the focus and frequency of emission will be
adapted to obtain a quality image. The protocol will be the following:
- 2d image in transverse plane.
- 2d image in longitudinal plane.
- Shear-wave elastography in longitudinal plane.
- Measurement of the images: They will be carried out off-line using the elastography
software of the team itself once all the participants have been explored. three regions
of interest (ROIs) adjacent to each other will be established in the body of the ulnar
nerve, three in the distal area of the flexor carpi ulnaris muscle and three in the
tendinous body of the same muscle. The size of the ROI should include the entire body of
the mentioned structures.
- The average value of the three ROIs will be written down in units of pressure (KPa).
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