PURPOSE: The patients diagnosed with Ehlers-Danlos Syndrome Hypermobility Type (EDS-HT) are characterized by pain, proprioceptive inacuity, muscle weakness, potentially leading to activity limitations. In EDS-HT, a direct relationship between muscle strength, proprioception and activity limitations has never been studied. The objective of the study was to establish the association between muscle strength and activity limitations and the impact of proprioception on this association in EDS-HT patients.METHODS: Twenty-four EDS-HT patients were compared with 24 controls. Activity limitations were quantified by Health Assessment Questionnaire (HAQ), Six-Minute Walk test (6MWT) and 30-s chair-rise test (30CRT). Muscle strength was quantified by handheld dynamometry. Proprioception was quantified by movement detection paradigm. In analyses, the association between muscle strength and activity limitations was controlled for proprioception and confounders.RESULTS: Muscle strength was associated with 30CRT (r = 0.67, p = <0.001), 6MWT (r = 0.58, p = <0.001) and HAQ (r = 0.63, p= <0.001). Proprioception was associated with 30CRT (r = 0.55, p < 0.001), 6MWT (r = 0.40, p = <0.05) and HAQ (r = 0.46, p < 0.05). Muscle strength was found to be associated with activity limitations, however, proprioceptive inacuity confounded this association.CONCLUSIONS: Muscle strength is associated with activity limitations in EDS-HT patients. Joint proprioception is of influence on this association and should be considered in the development of new treatment strategies for patients with EDS-HT. Implications for rehabilitation Reducing activity limitations by enhancing muscle strength is frequently applied in the treatment of EDS-HT patients. Although evidence regarding treatment efficacy is scarce, the current paper confirms the rationality that muscle strength is an important factor in the occurrence of activity limitations in EDS-HT patients. Although muscle strength is the most dominant factor that is associated with activity limitations, this association is confounded by proprioception. In contrast to common belief proprioception was not directly associated with activity limitations but confounded this association. Controlling muscle strength on the bases of proprioceptive input may be more important for reducing activity limitations than just enhancing sheer muscle strength.
Generalized loss of muscle mass is associated with increased morbidity and mortality in patients with cancer. The gold standard to measure muscle mass is by using computed tomography (CT). However, the aim of this prospective observational cohort study was to determine whether point-of-care ultrasound (POCUS) could be an easy-to-use, bedside measurement alternative to evaluate muscle status. Patients scheduled for major abdominal cancer surgery with a recent preoperative CT scan available were included. POCUS was used to measure the muscle thickness of mm. biceps brachii, mm. recti femoris, and mm. vasti intermedius 1 day prior to surgery. The total skeletal muscle index (SMI) was derived from patients’ abdominal CT scan at the third lumbar level. Muscle force of the upper and lower extremities was measured using a handheld dynamometer. A total of 165 patients were included (55% male; 65 ± 12 years). All POCUS measurements of muscle thickness had a statistically significant correlation with CT-derived SMI (r ≥ 0.48; p < 0.001). The strongest correlation between POCUS muscle measurements and SMI was observed when all POCUS muscle groups were added together (r = 0.73; p < 0.001). Muscle strength had a stronger correlation with POCUS-measured muscle thickness than with CT-derived SMI. To conclude, this study indicated a strong correlation between combined muscle thickness measurements performed by POCUS- and CT-derived SMI and measurements of muscle strength. These results suggest that handheld ultrasound is a valid tool for the assessment of skeletal muscle status.
Background: Lipoedema is a chronic disorder of adipose tissue typically involving an abnormal build-up of fat cells in the legs, thighs and buttocks. Occurring almost exclusively in women, it often co-exists with obesity. Due to an absence of clear objective diagnostic criteria, lipoedema is frequently misdiagnosed as obesity, lymphoedema or a combination of both. The purpose of this observational study was to compare muscle strength and exercise capacity in patients with lipoedema and obesity, and to use the findings to help distinguish between lipoedema and obesity. Design: This cross-sectional, comparative pilot study performed in the Dutch Expertise Centre of Lymphovascular Medicine, Drachten, a secondary-care facility, included 44 women aged 18 years or older with lipoedema and obesity. Twenty-two women with lipoedema (diagnosed according the criteria of Wold et al, 1951) and 22 women with body mass index ≥30kg/m2 (obesity) were include in the study. No interventions were undertaken as part of the study. Results: Muscle strength of the quadriceps was measured with the MicroFET™, and functional exercise capacity was measured with the 6-minute walk test. The group with lipoedema had, for both legs, significantly lower muscle strength (left: 259.9 Newtons [N]; right: 269.7 N; p < 0.001) than the group with obesity. The group with lipoedema had a non-significant, but clinically relevant lower exercise-endurance capacity (494.1±116.0 metres) than the group with obesity (523.9±62.9 metres; p=0.296). Conclusions: Patients with lipoedema exhibit muscle weakness in the quadriceps. This finding provides a potential new criterion for differentiating lipoedema from obesity. We recommend adding measuring of muscle strength and physical endurance to create an extra diagnostic parameter when assessing for lipoedema.
LINK
