The Use of Motion Tracking Analysis Program in Detecting Linear Muscular Displacement of the Extensor Digitorum Communis in Patients with Lateral Epicondylalgia: A Cross-Sectional Study

Research Article

Austin J Musculoskelet Disord. 2015;2(2): 1021.

The Use of Motion Tracking Analysis Program in Detecting Linear Muscular Displacement of the Extensor Digitorum Communis in Patients with Lateral Epicondylalgia: A Cross-Sectional Study

Dones VC III¹*, Suarez CG², Rimando CD³, Yap M4, Seril4, Lopez JF4, Dizon LB4, Carbajal JO4, Francisco CD4, Macaranas JD4 and Paris JH4

¹Senior Researcher - Centre for Health Research and Movement Sciences, Assistant Professor - College of Rehabilitation Sciences, University of Santo Tomas, Philippines

²Director, Centre for Health Researches and Movement Science, College of Rehabilitation Sciences, University of Santo Tomas Professor, College of Rehabilitation Sciences, University of Santo Tomas

³Instructor/Physical Therapy Internship Coordinator - College of Rehabilitation Sciences, University of Santo Tomas, Philippines

4Physical Therapy Graduates - College of Rehabilitation Sciences, University of Santo Tomas, Philippines

*Corresponding author: Valentin C. Dones III, Senior Researcher - Centre for Health Research and Movement Sciences, Assistant Professor - College of Rehabilitation Sciences, University of Santo Tomas, Philippines

Received: May 06, 2015; Accepted: June 18, 2015; Published: June 23, 2015

Abstract

Background/Objectives: The pathology underlying Lateral Epicondylalgia (LE) remains debatable. Abnormality in the movements of the Extensor Digitorum Communis (EDC) was amongst the cited sources of pain in LE. Using the Motion Tracking Analysis Program (MTAP), this study compared the amount of linear displacement of the EDC in elbows with and without LE. Methodology: 54 participants with Lateral Epicondylalgia confirmed by replication of lateral elbow pain in either one of the Cozen, Mill or Maudsley’s test were enrolled in the study. A sonologist scanned both elbows of participants using Musculoskeletal Ultrasound (MSUS). The linear displacement of the EDC shown in the MSUS video was quantified using the Motion Tracking Analysis Program (MTAP). Results: A general trend towards significantly increased linear displacement of EDC in elbows with LE compared to elbows without LE was noted (p=0.06). Based on age, gender, Chronicity of pain, and handedness, no significant differences in the linear displacement of EDC using MTAP were found. Conclusion: Albeit bordering significance (p= 0.06), the increased linear displacement of the extensor digitorum communis reflected its decreased stiffness in elbows with lateral epicondylalgia.

Keywords: Tennis elbow; Motion tracking; Motion tracking analysis program; Extensor digitorum communis

Introduction

Lateral Epicondylalgia (LE) causes pain on the lateral aspect of the elbow attributed to forceful and repetitive hand, wrist and elbow movements. Lateral epicondylalgia is found in 1.1–4.0% in women and 1.0-1.3% in men [1] commonly affecting people in the age range of 35-60 years albeit may also be observed in age younger than 35 and older than 60 years old [1,2]. The higher incidence of LE in women was attributed to the usual activities they are engaged in requiring repetitive movements of their elbow, forearm, wrist and hand such as doing laundry and household keeping. Potential sources of LE include pathological findings in the Extensor Digitorum Communis (EDC) and Extensor Carpi Radialis Brevis (ECRB) [3]. Suggested pathomechanism involved pulling of the EDC on the lateral epicondyle during forceful wrist extension [3-5] and pulling of the ECRB on the lateral epicondyle during resisted wrist extension (Roles and Maudsley 1972). Overuse of these muscles will result to pain and difficulty in moving the wrist especially in to extension (Roles and Maudsley, 1972). The EDC and ECRB stabilize the wrist during gripping activities, counteracting the finger flexor moment force. Forceful handgrip increases stresses on the Common Extensor Origin (CEO) associated with lateral elbow pain [6]. Pathological findings in the EDC and ECRB in elbows with LE are investigated through use of Musculoskeletal Ultrasound (MSUS). According to Iagnocco et al [7]. MSUS is the reference standard in evaluating pathology found in joints involved in various musculoskeletal conditions yielding high resolution images [6]. In an attempt to characterize the linear displacements of the forearm extensor muscles and associate it with Lateral Epicondylalgia, Dones et al. And Liu et al. used MSUS to quantify the movement of these forearm extensor muscles. Additionally, the (ECRB) has small cross-sectional area that made it challenging to be scanned using MSUS [3]. The Motion Tracking Analysis Program (MTAP) by Nicoud et al. quantified the linear displacement of the Extensor Carpi Radialis Brevis in the video images of MSUS [8]. Dones et al. reported the reliability of quantifying the linear displacement of EDC in the proximal half of the forearm using MTAP (ICC=1, 0.99-1.00). Considering that the EDC shares a common origin with the ECRB, both enveloped by a common fascia, the researchers are hypothesizing that the EDC might be associated with LE. Due to the lack of evidence associating Lateral. Epicondylalgia with movement of EDC, this study aimed to compare the linear displacement of the EDC between elbows with LE and elbows without LE. This study determined the association of age, gender, chronicity of symptoms, and handedness with the linear displacement of EDC.

Methodology

Study design

This study was divided into two phased namely:

• Phase 1. This is a reliability study that established the intertester and intra-tester reliability of the three MTAP readers.

• Phase 2. This is a cross-sectional case-control study that compared the EDC movement in elbows with LE and without LE.

Ethics approval

This study was approved by the Human Research Ethics Committee of the University of South Australia (Ethics protocol number 21929) and the Institutional Review Board of the Santo Tomas University Hospital (IRB-AP210-D-LEPS).

Setting

Department of Rehabilitation Medicine of the Faculty of Medicine and Surgery of the University of Santo Tomas

Assessors

The physiotherapist who screened the participants had 5 years of experience in manual physiotherapy. The sonologist has 20 years of experience in rehabilitation medicine and 5 years of experience in the use of musculoskeletal ultrasound with a musculoskeletal case load of 5-7 patients a day for 5 days in a week. In a published intertester reliability study, the sonologist’s reliability in scanning elbows with LE for bony lesions, neovascularity and fluid was comparable to a sonographer who had 20 years of experience in the use of musculoskeletal ultrasound (Kappa=0.53-1.0) [9]. Three 5th year physical therapy students with 11 months of clinical physiotherapy experience quantified the linear displacement of the EDC using the Motion Tracking Analysis Program (MTAP).

Equipment Used

Musculoskeletal ultrasound

Ultrasound measurements were made with a Siemens Antares Sonoline Ultrasound machine [Siemens Medical Solutions, USA, Inc, Ultrasound Group Issaquah, and WA] with a 5-13 MHz linear array broadband transducer.

Motion tracking analysis program

The Motion Tracking Analysis Program (MTAP) by Nicoud et al. is a program that quantifies the linear displacement of anatomical structures in pixel as unit of measurement, such as the EDC which is the variable of interest in this study [8]. During EDC tracking, a muscle’s location is determined & given coordinate values in each frame of a video. MTAP uses normalized cross-correlation to track a rectangular area known as a template from frame-to-frame in the video. Dones et al. and Nicoud et al. reported the mechanism of quantifying the movements of muscles using MTAP [8,9].

Participant Selection

Participants were recruited from hospitals, clinics, sports centres and barangay health centres. Flyers and social networking sites were used to disseminate information. Potential participants with lateral elbow pain were screened by an experienced physiotherapist using the initial screening checklist (Appendix 1). Participants were given and signed consent forms. Participants whose lateral elbow pain was replicated by either one of the Cozen, Mill or Maudsley’s test were included in the study. Exclusion criteria were: current general body malaise, diagnosis of cancer, previous or current fractures in the upper limb, osteoarthritis of the elbow, recent blunt trauma to the elbow, and previous surgery to the elbow. Consequently, regardless of side of pain, both elbows of participants were scanned by a sonologist using a musculoskeletal ultrasound.

Musculoskeletal ultrasound protocol

Elbows of seated participants were placed in a mechanical contraption keeping the elbow extended while the wrist was flexing (Figure 1). The right elbow was scanned first before the left elbow. The wrist was flexed only once. During wrist flexion, the sonologist placed the transducer head on the proximal half of the dorsal side of the forearm (Figure 1).