Yaylı enstrüman çalan müzisyenlerde median sinir, fleksör tendonlar ve fleksör retinakulum'un shear wave elastografi ile değerlendirilmesi
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Tarih
2023
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Hatay Mustafa Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Müzisyenlerde tekrarlı hareket, statik postür, kas tendon zorlanmaları sebebiyle kas iskelet sistemi problemlerinin yaygın olduğu bilinmektedir. Yaylı enstürman çalan müzisyenlerde tekrarlı yay hareketleri sebebiyle el bileğinde overuse problemlerinin yaygın olduğu önceki çalışmalarda bildirilmiştir. Bu çalışmada yaylı enstrüman çalan müzisyenlerde el bileği anterior kompartmanında yer alan median sinir, fleksör tendonlar ve fleksör retinakulum'u Shear wave elastografi ile incelemek, bu yapıların elastisitesindeki değişimi kontrol grubu ile kıyaslayarak değerlendirmek ve oluşabilecek riskler açısından doku elastisitesi için bir eşik değer araştırılması amaçlanmaktadır. Çalışma grubu en az beş yıldır yaylı enstürman çalan 22 müzisyenden oluşmaktadır. Müzisyenlerin %59,1 (n=13) erkek, %40,9 (n=9) kadındır ve yaş ortalamaları 31,05 ± 8,850 'dir. Müzisyenler İçin Kas-İskelet Ağrısı Şiddeti ve Etkilenimi Anketi'ni (MMQII) ve Boston Karpal Tünel sendrom anketi dolduruldu. Ardından carpal bölgenin anterior'unda m. flexor pollicis longus, m. flexor carpi radialis longus, n. medianus ve retinaculum flexorum kalınlıkları ölçüldü. Ölçüm üç defa tekrarlanıp ortalaması alınarak not edildi. Shear wave elastografi görüntülemede, görüntü penceresi kas kalınlığına göre ayarlandıktan sonra makaslama modülü haritası oluşturularak 5 milimetre (mm) çaplı Roi kullanıldı ve shear modülü değeri kilopascal (kPa) cinsinden hesaplandı. Ölçümler üç defa tekrar edilip ortalaması alınarak not edildi. Çalışmaya katılan müzisyenlerin %31,8 ağrı yaşadığını ve bu ağrının en az bir yıl devam ettiğini belirtmişlerdir. Yapılan shear wave elastografi (SWE) ve kalınlık ölçümlerinde müzisyenlerin, m. flexor carpi radialis longus, m. flexor pollicis longus, n. medianus sertlik ve kalınlıklarının kontrol grubuna göre artmış olduğu belirlendi (p<0.001). Çalışma grubunda kadınlar ve erkekler kıyaslandığında yalnızca n. medianus sertlik artışının istatistiksel olarak anlamlı olduğu, kontrol grubunda ise m. flexor carpi radialis longus'un kalınlığının anlamlı derecede yüksek olduğu, bunlarla beraber çalışma grubunda yaş arttıkça n. medianus kalınlığı ve sertliğinin, m. flexor carpi radialis longus sertliğinin arttığı gözlemlenmiştir. Değerlendirilen anatomik yapıların eşik değerleri; m. flexor carpi radialis longus elastografi için "51,595" (%86,4 duyarlılık, %95,5 özgüllük), m. flexor pollicis longus elastogarfi değeri "33,420" (%90,9 duyarlılık, %95,5 özgüllük), m. flexor pollicis longus kalınlığı için iki eşik değer değerlendirmeye alınmıştır, ilki olan "2,475" (%72,7 duyarlılık, %59,1 özgüllük) ikincisi "2,820" ise (%54,5 duyarlılık, %72,7 özgüllük), n. medianus elastografi değeri "31,195" (%86,4 duyarlılık, %90,9 özgüllük), medianus kalınlığı "2,010" (%63,6 duyarlılık, %77,3 özgüllük) olarak tespit edilmiştir. Sonuç olarak yaylı enstrüman çalan müzisyenlerde m. flexor carpi radialis longus, m. pollicis longus ve n. medianus'un sertliğinin ve kalınlığının kontrol grubuna kıyasla belirgin derece artmış olduğu bulundu ve bu yapılar için eşik değer tespit edildi. M. flexor carpi radialis longus, m. flexor pollicis longus, n. medianus elastografi değerlerinin ayırma yeteneğinin "mükemmel" olduğu, m. flexor pollicis longus, n. medianus kalınlık değerlerinin ayırma yeteneğinin "orta" olduğu saptanmıştır. Bu eşik değerlerin kas iskelet sistemi problemlerinin değerlendirilmesinde önemli bir rol oynayacağı kanısındayız.
It is known that musculoskeletal problems are common in musicians due to repetitive movements, static posture, muscle and tendon strains. It has been reported in previous studies that overuse problems in the wrist due to repetitive bow movements are common in musicians playing string instruments. The main aim of this study is to examine and determine the median nerve, flexor tendons and flexor retinaculum by Shear wave elastography in musicians playing string instruments in order to evaluate the change in the elasticity of these structures by comparing them with the control group, and to set a threshold value (cut point) for tissue elasticity in terms of possible risks. The study group consists of 22 musicians who have been playing string instruments for at least five years. Of them, 59.1% (n=13) of the musicians are male, 40.9% (n=9) are female, and their mean age is 31.05 ± 8.850. The study group was asked to complete the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians (MMQII) and the Boston Carpal Tunnel syndrome questionnaire. Then in the anterior part of the carpal region m. flexor pollicis longus, m. flexor carpi radialis longus, n. medianus, and retinaculum flexorum thicknesses were measured. The measurement was repeated three times. In shear wave elastography imaging, after the image window was adjusted according to muscle thickness, shear modulus map was created and Roi with a diameter of 5 millimeters (mm) was used. The shear modulus value was calculated in kilopascal (kPa), measurements were repeated three times. 31.8% of the musicians participating in the study stated that they experienced pain and this pain continued at least for the past one year. In the shear wave (SWE) elastography and thickness measurements, the musicians' m. flexor carpi radialis longus, m. flexor pollicis longus, n. medianus muscles were determined. Their stiffness and thickness were increased compared to the control group (p<0.001). When comparing women and men in the study group, only n. medianus' stiffness significantly increased. In the control group, it was observed that the thickness of the m. flexor carpi radialis longus was significantly higher and the thickness and stiffness of the n. medianus and the stiffness of the m. flexor carpi radialis longus increased as the age increased in the study group. Elastography threshold values of anatomical structures were evaluated. These values were for m. flexor carpi radialis longus "51.595" (86.4% sensitivity, 95.5% specificity) and m. flexor pollicis longus elastography value "33.420" (90.9% sensitivity, 95.5% specificity). However, for m. flexor pollicis longus thickness two threshold values were evaluated. The first was "2.475" (72.7% sensitivity, 59.1% specificity) and the second was "2.820" (54.5% sensitivity, 72.7% specificity). N. median elastography value was determined as "31.195" (86.4% sensitivity, 90.9% specificity), and the median thickness calculated as "2.010" (63.6% sensitivity, 77.3% specificity). As a result, in musicians playing string instruments, m. flexor carpi radialis longus, m. pollicis longus and n. medianus's stiffness and thickness were found to be significantly increased when compared to the control group, and the threshold value was estimated for these structures. M. flexor carpi radialis longus, m. flexor pollicis longus, n. median elastography values found to have "excellent" separation ability, whereas m. flexor pollicis longus, n. median thickness values were found to be "moderate". We believe that these threshold values will play an important role in the evaluation of musculoskeletal problems.
It is known that musculoskeletal problems are common in musicians due to repetitive movements, static posture, muscle and tendon strains. It has been reported in previous studies that overuse problems in the wrist due to repetitive bow movements are common in musicians playing string instruments. The main aim of this study is to examine and determine the median nerve, flexor tendons and flexor retinaculum by Shear wave elastography in musicians playing string instruments in order to evaluate the change in the elasticity of these structures by comparing them with the control group, and to set a threshold value (cut point) for tissue elasticity in terms of possible risks. The study group consists of 22 musicians who have been playing string instruments for at least five years. Of them, 59.1% (n=13) of the musicians are male, 40.9% (n=9) are female, and their mean age is 31.05 ± 8.850. The study group was asked to complete the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians (MMQII) and the Boston Carpal Tunnel syndrome questionnaire. Then in the anterior part of the carpal region m. flexor pollicis longus, m. flexor carpi radialis longus, n. medianus, and retinaculum flexorum thicknesses were measured. The measurement was repeated three times. In shear wave elastography imaging, after the image window was adjusted according to muscle thickness, shear modulus map was created and Roi with a diameter of 5 millimeters (mm) was used. The shear modulus value was calculated in kilopascal (kPa), measurements were repeated three times. 31.8% of the musicians participating in the study stated that they experienced pain and this pain continued at least for the past one year. In the shear wave (SWE) elastography and thickness measurements, the musicians' m. flexor carpi radialis longus, m. flexor pollicis longus, n. medianus muscles were determined. Their stiffness and thickness were increased compared to the control group (p<0.001). When comparing women and men in the study group, only n. medianus' stiffness significantly increased. In the control group, it was observed that the thickness of the m. flexor carpi radialis longus was significantly higher and the thickness and stiffness of the n. medianus and the stiffness of the m. flexor carpi radialis longus increased as the age increased in the study group. Elastography threshold values of anatomical structures were evaluated. These values were for m. flexor carpi radialis longus "51.595" (86.4% sensitivity, 95.5% specificity) and m. flexor pollicis longus elastography value "33.420" (90.9% sensitivity, 95.5% specificity). However, for m. flexor pollicis longus thickness two threshold values were evaluated. The first was "2.475" (72.7% sensitivity, 59.1% specificity) and the second was "2.820" (54.5% sensitivity, 72.7% specificity). N. median elastography value was determined as "31.195" (86.4% sensitivity, 90.9% specificity), and the median thickness calculated as "2.010" (63.6% sensitivity, 77.3% specificity). As a result, in musicians playing string instruments, m. flexor carpi radialis longus, m. pollicis longus and n. medianus's stiffness and thickness were found to be significantly increased when compared to the control group, and the threshold value was estimated for these structures. M. flexor carpi radialis longus, m. flexor pollicis longus, n. median elastography values found to have "excellent" separation ability, whereas m. flexor pollicis longus, n. median thickness values were found to be "moderate". We believe that these threshold values will play an important role in the evaluation of musculoskeletal problems.
Açıklama
Anahtar Kelimeler
Fizyoterapi ve Rehabilitasyon, Physiotherapy and Rehabilitation
