Original article
Ultrasound Imaging of Acute Biceps Tendon Changes After Wheelchair Sports

https://doi.org/10.1016/j.apmr.2006.11.024Get rights and content

Abstract

van Drongelen S, Boninger ML, Impink BG, Khalaf T. Ultrasound imaging of acute biceps tendon changes after wheelchair sports.

Objectives

To investigate acute changes in the biceps tendon after a high-intensity wheelchair propulsion activity and to determine whether these changes are related to subject characteristics.

Design

The biceps tendon was imaged with ultrasound before and after wheelchair basketball or quad rugby. The average diameter of the tendon was calculated as well as the echogenicity ratio (the pixel intensity ratio of the biceps tendon to a reference just superficial to the tendon sheath).

Setting

National Veterans Wheelchair Games in 2004 and 2005.

Participants

Forty-two subjects who participated in wheelchair basketball or quad rugby at the Veterans Games.

Interventions

Not applicable.

Main Outcome Measures

Biceps tendon diameter and biceps echogenicity.

Results

The echogenicity ratio of the tendon significantly decreased from 1.97 to 1.73 after the event (P=.038). The diameter of the biceps tendon increased from 4.60 to 4.82mm (P=.178). Also, it was found that the change in tendon diameter positively correlated with the time of play (P=.004).

Conclusions

Acute changes in biceps tendon properties after exercise were found and likely represent edema, a first sign of overuse injury. The significance of continuous activity was shown by the fact that subjects who had more playing time showed a larger increase in tendon diameter.

Section snippets

Participants

Persons who participated in wheelchair basketball or quad rugby at the National Veterans Wheelchair Games of 2004 and 2005 were recruited for this study. A convenience sample of 42 subjects participated in this study after giving written informed consent.

Subjects were eligible to participate if they used a wheelchair as their main means of mobility and were between 18 and 65 years old. The exclusion criterion was a history of trauma or surgery to both arms. The protocol of this study received

Participants

Of the 42 subjects who entered the study, data of 34 subjects (33 men, 1 woman) were used for the data analysis (see table 1). The images of 5 subjects were unsatisfactory to clearly identify and measure the biceps tendon. One subject did not participate in his sporting event; therefore, no postgame ultrasound could be performed. The biceps characteristics of 2 subjects were more than 4 SDs from the mean; therefore, these subjects were considered outliers and were omitted as well. We compared

Discussion

In this study, we found that after exercise the tendon to reference echogenicity ratio decreased. The decrease in echogenicity likely represents an increase in fluid in the tendon. Increased fluid in the tendon can be representative of edema, and one might expect it to be the cause of an increase in tendon diameter. However, the increase in biceps tendon diameter we found (from 4.60 to 4.82mm after the game) was not significant.

In the acute phase of tendon pathology, increased fluid content

Conclusions

Acute changes in biceps tendon properties after exercise were found. A decrease in tendon echogenicity likely represents edema, a first sign of overuse injury. Subjects who had more playing time showed a larger increase in the tendon diameter, showing the significance of continuous activity. The fact that subjects with pain had a lower tendon echogenicity might indicate additional pathology. Further research will be necessary to improve the understanding of the effect of acute changes on

References (32)

  • W.E. Pentland et al.

    Upper limb function in persons with long term paraplegia and implications for independence: Part I

    Paraplegia

    (1994)
  • P.J. Nichols et al.

    Wheelchair user’s shoulder?Shoulder pain in patients with spinal cord lesions

    Scand J Rehabil Med

    (1979)
  • S.E. Seltzer et al.

    Arthrosonography: gray-scale ultrasound evaluation of the shoulder

    Radiology

    (1979)
  • J.P. Iannotti et al.

    Accuracy of office-based ultrasonography of the shoulder for the diagnosis of rotator cuff tears

    J Bone Joint Surg Am

    (2005)
  • S.A. Teefey et al.

    Detection and quantification of rotator cuff tearsComparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases

    J Bone Joint Surg Am

    (2004)
  • L.M. Thain et al.

    Sonography of the rotator cuff and biceps tendon: technique, normal anatomy, and pathology

    J Clin Ultrasound

    (1999)

    • Cited by (0)

    Supported by the VA Center of Excellence for Wheelchairs and Associated Rehabilitation (grant no. B3142C), the National Science Foundation Integrative Graduate Education and Research Traineeship, Interdisciplinary Research Training in Assistive Technology (grant no. DGE0333420), the National Institute on Disability and Rehabilitation Research (grant no. H133N000019), and the Paralyzed Veterans of America.

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

    Reprints are not available from the author.

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    Copyright © 2007 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.