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Table 1 Are there quantitative imaging biomarkers associated with the presence of neck and shoulder MSDs?

From: Systematic review of quantitative imaging biomarkers for neck and shoulder musculoskeletal disorders

MSD Classification and diagnosis Author(s) Major results (case-control comparison) Conclusion
Neck disorders and symptoms
 Neck pain Dibai Filho (2012) [37] Skin temperature
Skin temperature (L & R trapezius), difference btwn sides (thermal asymmetry), NS.
No
 Neck pain Elliott (2008) [46] Fat index indicating fatty infiltration (relative fat)
Fat index: cases < controls, p < 0.001 in all muscles.
Yes
↓ fat index in cases in all neck extensor muscles (see Additional file 7).
 Neck pain Falla (2004) [38] Subcutaneous tissue thickness over SCM, AS
SCM subcutaneous tissue thickness (L & R): NS cases vs. controls
AS subcutaneous tissue thickness (L & R): NS cases vs. controls
No
 Neck pain Fernández-de-las-Peñas (2008) [47] Multifidus CSA, muscle shape ratio
CSA: ANOVA, group (p < 0.001) & cervical level (p < 0.001) effects. No interactions. Cases < controls at C3, C4, C5 (p < 0.001) & at C6 (p < 0.01). Muscle shape ratio: ANOVA, group (p < 0.001) & cervical level (p < 0.001) effects. Significant interactions btwn group & level (p = 0.01). Cases > controls at C3 (p < 0.001) & C6 (p < 0.01).
Yes
↓ multifidus CSA in cases at C3, C4, C5, C6
↑ muscle shape ratio in cases at C3, C6
 Neck pain Javanshir (2011) [48] Lco CSA, anterior-posterior dimension (APD), lateral dimension (LD), and shape ratio (LD/APD)
Lco CSA: cases < controls, p < 0.001.
Lco APD: cases < controls, p < 0.01.
Lco LD, shape ratio, NS cases vs. controls.
Yes
↓ Lco CSA in cases
↓ Lco APD in cases
 Neck pain Karimi (2016) [53] Dorsal neck muscle thickness change w. 50% & 100% shoulder MVC in 6 directions
Dorsal neck muscle thickness: During MVC: significant interaction of group x muscle, p = 0.008. NS, cases vs. controls group x direction; group x force.
Yes
Dorsal neck muscle thickness group x muscle effect
 Neck pain Jesus-Moraleida (2011) [49] Lco thickness, SCM thickness, change of thickness during test/thickness during rest = proportion of muscle recruitment
Lco thickness increase throughout all CCFT phases: cases < controls (p < 0.001). SCM thickness increase throughout all CCFT phases: NS, cases vs. controls. Lco recruitment: cases < controls, phase 4 (p = 0.02), phase 5 (p = 0.004), NS other phases. SCM recruitment: NS, cases vs. controls.
Yes
↓ Lco thickness increase throughout all CCFT phases in cases
↓ Lco recruitment, phases 4 & 5
 Neck pain Park (2013) [50] Mean difference in the bilateral semispinalis capitis muscle thickness
Mean difference in the bilateral semispinalis capitis thickness: cases > controls, p < 0.05. Within cases mean difference in the bilateral semispinalis capitis thickness: painful side < asymptomatic side, p < 0.05.
Yes
↑ mean difference in the bilateral semispinalis capitis thickness in cases
↓ mean difference in the bilateral semispinalis capitis thickness in painful side
 Neck pain Rahnama (2015) [52] Multifidus muscle thickness change w. shoulder MVC in 6 directions
Multifidus muscle thickness: baseline: NS, cases vs. controls;
During MVC: significant interaction of group x force, controls > cases (p = 0.03). NS, cases vs. controls group x direction; 3- & 4-way interactions involving group.
Yes
↓ multifidus muscle thickness increase in cases during isometric MVC
 Neck pain Sheard
(2012) [51]
Differences in water relaxation values (T2 relaxation) quantified from scans before and after exercise were calculated (T2 shift) as a measure of SA muscle activity
T2 shift: significant effect for level (p = .03) and significant group × level interaction (p = .04) but no significant main effect for group (p = .59). Post hoc T2 shift: cases > controls at the T6 level (P = .02) only.
Yes
↑ T2 shift at T6 in cases
Shoulder disorders and symptoms
 Degenerative rotator cuff lesion Biberthaler (2003) [54] Mean functional capillary density, mean capillary diameterMean functional capillary density: lesion < control tissue (p < 0.05). Mean capillary diameter: NS, lesion vs. control tissue (p > 0.05). Yes
↓ mean functional capillary density in lesion tissue
 Rotator cuff tear (full thickness) Chang (2014) [56] Biceps long tendon (BLT) width, thickness, flattening ratio (width/thickness), cross-sectional area, echogenicity ratio
BLT width, echogenicity ratio: NS, cases vs. controls
BLT thickness: cases > controls, p < 0.01.
BLT flattening ratio: cases < controls, p < 0.01.
BLT cross-sectional area: cases > controls, p < 0.01.
Yes
↑ BLT thickness in cases
↓ BLT flattening ratio in cases
↑ BLT cross-sectional area in cases
 Rotator cuff tear Choo (2014) [57] Rotator cable thickness, width
Rotator cable thickness: difference among 4 groups (see shoulder tendinosis - Choo), p < 0.001; post-hoc analysis – full-thickness tear > normal, p < 0.001.
Rotator cable width: difference among 4 groups (see shoulder tendinosis - Choo), p < 0.001; post-hoc analysis – full-thickness tear > normal, p < 0.001; partial-thickness tear > normala.
Yes
↑ rotator cable thickness in full-thickness tears
↑ rotator cable width in full-thickness tears
Perhaps
↑ rotator cable width in partial-thickness tears
 Rotator cuff tear Funakoshi (2010) [55] Vascularity in 4 ROIs: articular & bursal sides of supraspinatus tendon, medial & lateral sides of bursa
Non-injected side: cases (RCT) < controls, p < 0.0001, in articular & bursal side of the supraspinatus tendon. Injected side: cases (contralateral to RCT) < controls, p < 0.0001, in articular & bursal side of the supraspinatus tendon. Cases vs. controls, NS, in medial and lateral side of bursa.
Perhaps
↓ vascularity in articular & bursal sides of supraspinatus in non-injected (rotator cuff tear) side in cases, but may be attributed to age.
↓ vascularity in articular & bursal sides of supraspinatus in injected (rotator cuff intact) side in cases, but may be attributed to age.
 Rotator cuff tear Hirano (2006) [39] Full vs. partial rotator cuff tear, rotator cuff tear length, amount of subacrominal-subdeltoid bursal fluid
Proportion of full & partial tears, NS.
Proportion in categorical size of tears, NS.
amount of subacrominal-subdeltoid bursal fluid, NS .
No
 Rotator cuff tear Karthikeyan (2015) [58] Total blood flow in 4 supraspinatus zones, in anteromedial zone, in posteromedial zone
Total blood flow in 4 supraspinatus zones: cases (including shoulder impingement – see below) < controls, p = 0.001.
Anteromedial supraspinatus zone: full-thickness tears < controls, p = 0.02; partial-thickness tears vs. controls, NS.
Posteromedial supraspinatus zone: full-thickness tears < controls, p = 0.04; partial-thickness tears vs. controls, NS.
Yes
↓ supraspinatus blood flow in cases
↓ anteromedial supraspinatus blood flow in full-thickness tears
↓ posteromedial supraspinatus blood flow in full-thickness tears
 Rotator cuff tear (full-thickness) Keener (2015) [35] Baseline rotator cuff tear width; Width enlargement (defined as ≥ 5 mm compared with that at baseline) percentage
Baseline rotator cuff tear width: rotator cuff tear with anterior supraspinatus cable disruption > rotator cuff tear with anterior supraspinatus cable intact, p < 0.0001.
Width enlargement percentage: NS, rotator cuff tear with anterior supraspinatus cable disruption vs. rotator cuff tear with anterior supraspinatus cable intact .
Yes
↑ baseline rotator cuff tear width with anterior supraspinatus cable disruption.
 Rotator cuff tear Mall
(2010) [33]
Rotator cuff tear length, tear width, tear area, rate of substantial tear progression (transformation of a partial-thickness tear into a full-thickness tear or a size increase of > 5 mm in either the width or the length of a full thickness tear compared with that at the time of enrollment)
Time of enrollment:
full-thickness tear width: symptomatic > asymptomatic, p = 0.02;
tear length, tear area, NS.
Change between visit 1 & visit 2 (see paper for definitions):
Shoulder remained asymptomatic:
NS, tear length, width, area.
Shoulder became symptomatic:
tear length: visit 2 > visit 1, p = 0.008.
tear width: visit 2 > visit 1, p = 0.01 tear area: visit 2 > visit 1, p = 0.006.
Rate of substantial tear progression: symptomatic > asymptomatic, p < 0.01
Yes
↑ full-thickness tear width at enrollment in those who later became symptomatic in asymptomatic shoulder.
↑ tear length, width, & area at visit 2 vs. at visit 1 in those who became symptomatic in asymptomatic shoulder.
↑ rate substantial tear progression in in those who became symptomatic in asymptomatic shoulder.
 Rotator cuff tear Moosmayer (2013) [36] Rotator cuff tear size in anteroposterior plane, in mediolateral plane, tear size increase in anteroposterior plane, in mediolateral plane.
Rotator cuff tear size in anteroposterior plane: baseline: NS, symptomatic vs. asymptomatic; 3-year follow-up: symptomatic > asymptomatic, p = 0.02
Rotator cuff tear size in mediolateral plane: baseline: NS, symptomatic vs. asymptomatic; 3-year follow-up: NS, symptomatic vs. asymptomatic.
Tear size increase in anteroposterior plane: NS, symptomatic vs. asymptomatic.
Tear size increase in mediolateral plane: NS, symptomatic vs. asymptomatic.
Yes
↑ rotator cuff tear size in anteroposterior plane at follow-up in tears that became symptomatic
 Rotator cuff tear (partial & full) or rotator cuff disease Keener (2015) [34] Rotator cuff tear enlargement (see paper for definition)
Tear enlargement in 49%; median time to enlargement = 2.8 yrs. tear enlargement: assoc. w. final tear type, p < 0.05: full vs. control, HR = 4.17; partial vs. control, HR = 2.73; full vs. partial, HR = 1.53 (all p < 0.05, no CI given).
New shoulder pain in 46%; median time to pain = 2.6 yrs. shoulder pain assoc. w. final tear type, p < 0.05. Assoc. w. tear enlargement, HR = 1.66, p < 0.05. 63% became painful before or at tear enlargement; 22% became painful later.
Yes
↑ risk tear enlargement in full-tears vs. controls, in partial tears vs controls, in full-tears vs. partial tears.
↑ risk new shoulder pain w. tear enlargement.
 Rotator cuff tear Terabayashi (2014) [59] Difference in blood flow peak systolic velocity (PSV), resistance index (RI) between sides
Difference between sides in PSV in BA: NS, in any group.
Difference between sides in PSV in AHCA: affected > unaffected side in rotator cuff tear with night pain, p < 0.001. NS, other groups.
Difference between sides in RI in BA: NS, in any group.
Difference between sides in RI in AHCA: affected < unaffected side in rotator cuff tear with night pain, p < 0.01.
Yes
↑ PSV in AHCA in affected vs unaffected side in rotator cuff tear with night pain.
↓ RI in AHCA in affected vs unaffected side in rotator cuff tear with night pain.
 Supraspinatus tendinopathy Arend (2014) [63] Maximal supraspinatus tendon thickness (MSTT)
MSTT: cases > controls, p < 0.05
Yes
↑ MSTT in cases
 Rotator cuff tendinitis Cay (2012) [60] Subacromial distance, humeral head diameter, Glenoid APD, glenoid articular surface diameter
Sagittal subacromial distance: cases < controls, p < 0.001
humeral head diameter, glenoid APD, axial glenoid/humerus, and axial glenoid minus humerus, NS in cases vs controls.
coronal diameter of humerus: cases < controls, p = 0.02.
coronal glenoid/humerus, coronal glenoid minus humerus: NS in cases vs controls.
Yes
↓ sagittal subacromial distance in cases
↓ coronal diameter of humerus in cases
 Rotator cuff tendinosis Choo (2014) [57] Rotator cable thickness, width
Rotator cable thickness: difference among 4 groups (see rotator cuff tear - Choo), p < 0.001; post-hoc analysis – NS, tendinosis vs controls. Rotator cable width: difference among 4 groups (see rotator cuff tear - Choo), p < 0.001; post-hoc analysis – tendinosis > normal, p < 0.05a.
Perhaps
↑ rotator cable width in tendinosis
 Rotator cuff tendinitis Rechardt (2010) [61] Carotid artery intima-media thickness
Carotid artery imtima-media thickness: NS, in males and females.
No
 Shoulder tendinopathy Joensen (2009) [62] Supraspinatus tendon thickness
Tendon thickness: symptomatic side > asymptomatic side, p < 0.01.
Yes
↑ tendon thickness in symptomatic side
 Frozen shoulder (Adhesive capsulitis) Li (2011) [64] CHL thickness
CHL thickness: cases > controls, p < 0.001.
Yes
↑ CHL thickness in cases
 Frozen shoulder (Adhesive capsulitis) Michelin (2013) [67] Joint capsule thickness
Joint capsule thickness: cases > controls, p < 0.0001
Yes
↑ joint capsule thickness in cases
 Frozen shoulder (Adhesive capsulitis) Song (2011) [65] Joint capsule thickness in the axillary recess, enhancing portion of the axillary recess thickness, rotator interval thickness
Axillary recess: Joint capsule thickness: cases > controls, p < 0.001.
Axillary recess enhancing portion thickness: cases > controls, p < 0.001.
Rotator interval Enhancing portion thickness cases > controls, p < 0.001.
Yes
↑ axillary recess joint capsule thickness in cases
↑ Axillary recess enhancing portion thickness in cases
↑ Rotator interval Enhancing portion thickness in cases
 Frozen shoulder (Adhesive capsulitis Zhao (2012) [66] CHL thickness, articular capsule thickness
CHL thickness: cases > controls, p < 0.001 .
articular capsule thickness: cases > controls, p < 0.05.
Yes
↑ CHL thickness in cases
↑ articular capsule thickness in cases
 Shoulder impingement syndrome Daghir (2011) [71] Subacromial-subdeltoid bursal thickness Greatest thickness in any view: NS cases vs. controls. Thickness in shortaxis supraspinatus view: cases > controls, p = 0.0009. Thickness in long-axis supraspinatus view: NS cases vs. controls.Thickness in long-axis subscapularis view: NS cases vs. controls. Yes
↑ subacromial-subdeltoid bursal thickness in cases on shortaxis supraspinatus view
 Shoulder impingement syndrome Hébert (2003) [68] AHD
Cases vs. contralateral control:
Flexion: main effect of group, p < 0.01, and no interaction with position. Post hoc comparisons: cases < controls at 70, 90, 110 & 130 degrees, p < 0.01.
Abduction: main effect of group, p < 0.01, no interaction with position. Post hoc comparisons: cases < controls at 80, 90, p < 0.05 and 110 degrees, p < 0.01.
Cases vs. contralateral control vs. asymptomatic controls:
Flexion - main effect of group, p < 0.0001, (position effect, p < 0.0001) interaction with position, p = 0.01. Post hoc comparisons: cases < asymptomatic controls at 90 & 110 degrees, p < 0.01. NS contralateral control vs asymptomatic controls, all positions.
Abduction - main effect of group, p = 0.052. Post hoc comparisons: cases < asymptomatic controls at 90 & 110 degrees, p < 0.01. NS contralateral control vs asymptomatic controls, all positions.
Yes
↓ AHD in cases at 70, 90, 110, 130 degrees flexion vs. contralateral control
↓ AHD in cases at 80, 90, 110 degrees abduction vs. contralateral control
↓ AHD in cases at 90, 110 degrees flexion vs. asymptomatic controls
↓ AHD in cases at in 90, 110 degrees abduction vs. asymptomatic controls
 Shoulder impingement syndrome Karthikeyan (2015) [58] Total blood flow in 4 supraspinatus zones, in anteromedial zone, in posteromedial zone
Total blood flow in 4 supraspinatus zones: cases (including rotator cuff tears – see above) < controls, p = 0.001.
Anteromedial supraspinatus zone: shoulder impingement < controls, p = 0.01.
Posteromedial supraspinatus zone: shoulder impingement < controls, p = 0.03.
Yes
↓ supraspinatus blood flow in cases
↓ anteromedial supraspinatus blood flow in cases
↓ posteromedial supraspinatus blood flow in cases
 Shoulder impingement syndrome Leong (2012) [69] AHD, supraspinatus tendon thickness
AHD: NS group effect, p = 0.08
Supraspinatus tendon thickness: group effect, p = 0.002, post-hoc analysis: control volleyball players > controls, p < 0.001; cases > controls: p = 0.02; NS, control volleyball players vs. cases.
Yes
↑ supraspinatus tendon thickness in cases vs non-volleyball player controls
 Shoulder impingement syndrome Park (2007) [70] Difference in mean skin temperature btwn sh sides in 5 ROIs
Difference in mean skin temperature btwn sh sides
anteromedial ROI: cases > controls, p = 0.004.
anterolateral: cases > controls, p = 0.001.
posteromedial: cases > controls, p = 0.013.
posterolateral: cases > controls, p = 0.030.
lateral: cases > controls, p = 0.039.
Yes
↑ difference in mean skin temperature btwn sides in all 5 ROIs in cases
 Shoulder pain w. rotator cuff disease (multiple diagnoses) Kalra (2010) [40] AHD
No group effects at rest (p = 0.43) or 45 degrees abduction (p = 0.84). No interaction between group and posture.
No
 Shoulder pain O’Sullivan (2012) [41] Trapezius muscle thickness
% change in thickness during contraction vs. rest: NS btwn cases & controls in any of the 4 trapezius regions, at 90 degrees or 120 degrees abduction.
Muscle thickness difference between sides at rest or during contractions in cases: NS in any of the 4 trapezius regions, at 0, 90, or 120 degrees abduction.
No
 Shoulder pain Rechardt (2010) [61] Carotid artery intima-media thickness
Carotid imtima-media thickness, NS in males and females. For each standard deviation increase in carotid IMT, risk of unilateral or bilateral sh pain, OR = 1.4 (95% CI 1.0–1.9) for males 60 + .
Perhaps
↑ carotid artery intima-media thickness increases odds of shoulder pain in males 60+
 Shoulder pain (internal impingement pain) Tuite (2007) [72] Labral length, thick-capsule labrum length, posterior recess angle
Labral length: cases > controls, p = 0.001. Thick-capsule labrum length: cases > controls, p < 0.001. Posterior recess angle: cases > controls, p = 0.002. MR arthrogram: greater (dichotomized) glenohumeral internal rotation deficit (GIRD): labral length, thick-capsule labrum length, posterior recess angle, NS.
Yes
↑ labral length in cases
↑ thick capsule labral length in cases
↑ posterior recess angle in cases
Neck/shoulder disorders and symptoms
 Neck/shoulder pain Hallman (2011) [80] Muscle blood flow (MBF)
During HGT: MBF cases < controls (p = 0.02 - ipsi; p = 0.04 - contra). After HGT: MBF cases < controls (p = 0.001 - ipsi; p = 0.003 - contra). During CPT: increase in MBF cases < controls (p = 0.04 - ipsi); NS, contra. After CPT: increase in MBF cases < controls (p < 0.05 - ipsi); NS, contra.
Yes
↓ MBF in cases during & after HGT in ipsi- and contralateral sides.
↓ increase in MBF during and after CPT in ipsilateral side.
 Neck/shoulder pain Nilsen (2007) [42] Finger blood flow
Finger blood flow: baseline, NS. Response to stressful task: group x time (baseline, 0–10 min, 50–60 min) interaction, p = 0.02. Post-hoc comparison: controls vs. cases: p = 0.35.
No
 Neck/shoulder pain Shiro (2012) [81] ΔOHb, ΔHHb, ΔTHb from baseline
ΔO2Hb: cases < controls during Relax 3 (p < 0.01) & recovery (p < 0.05). ΔHHb: NS, cases vs. controls. ΔTHb: cases < controls during Relax 2 & Relax 3 in R trapezius (p < 0.05); cases < controls: each Relax & recovery in L trapezius (all p < 0.05, except Relax 2 & Relax 3, p < 0.001).
Yes
↓ ΔO2Hb in cases during Relax 3 & recovery.
↓ ΔTHb in cases during Relax 2 & Relax 3 in R trapezius; during each Relax & recovery in L trapezius
 Neck/shoulder pain Strøm (2009) [43] Muscle blood flow
At start of work task: cases vs controls, NS difference in blood flow increase in either active or contralateral trapezius. Blood flow during 15 min of recovery in active & contralateral trapezius: cases > controls (p = 0.05).
No
 Neck/shoulder pain Takiguchi (2010) [79] Minimal & maximal standardized uptake values (SUV) of [18F]fluorodeoxyglucose (18F–FDG)
Trapezius: mean SUVmax, mean SUVmin: cases < controls, p < 0.0001. Presence/absence of neck/shoulder pain and mean SUVmax (R2 = 0.16, p < 0.0001), and for SUVmin(R2 = 0.26, p < 0.0001), after adjusting for age, gender, smoking status, and diabetes.
Gluteus maximus: mean SUVmax, mean SUVmin: NS, cases vs. controls mean. Presence/absence of neck/shoulder pain and mean SUVmax or SUVmin, NS.
Yes
 Cervicobrachial pain syndrome Larsson (1998) [114] Muscle blood flow
Unilateral pain patients: muscle blood flow: painful < asymptomatic side, p = 0.01; painful < control, p = 0.0009.
Yes
↓ blood flow in painful side in unilateral cases
↓ blood flow in cases
 Trapezius myalgia Acero (1999) [74] Relative blood volume
ANOVA - main effect for group, case < control, during 61–120 s of cold pressor stimulation, p = 0.04. All other time points group NS.
Yes
↓ relative blood volume in cases during 61–120 s of cold pressor stimulation.
 Trapezius myalgia Andersen (2010) [44] ΔOHb, ΔHHb, ΔTHb from baseline
ANOVA - main effect of time for all 3ΔxHb (p < 0.0001), group x time interaction for OHb (p < 0.05). Group effect NS for HHb & THb. Group effect p-value for OHb not stated. OHb after exercise increase from baseline: cases < controls, p = 0.05.
No
 Trapezius myalgia Cagnie (2012) [75] Oxygen saturation, muscle blood flow
Oxygen saturation: MANOVA - main effects of time, muscle part, and interaction muscle part x group (p = 0.049). Post hoc cases < controls in L & R middle trapezius at all time points p = 0.03, except 40 min for R middle trapezius (NS). Blood flow: MANOVA - main effects of time, muscle part, and no interaction muscle part x group. No group effect.
Yes
↓ oxygen saturation in L & R trapezius at all but 1 time point.
 Trapezius myalgia Flodgren (2010) [76] Muscle oxygenation
Muscle oxygenation percentage decreased during work (P = 0.02), and returned to baseline during recovery.
Perhaps
No control subjects were included in this study. Authors conclude normal response in these cases when comparing them to a previous similar study with normal subjects (see Flodgren (2005)).
 Trapezius myalgia Peolsson (2008) [45] Strain rate, strain rate RMS - before provocation, after provocation, difference after - before
NS cases vs. controls: strain rate, strain rate RMS - before provocation, after provocation, difference after - before. After factor analysis with strain rate and strain variables (not velocity variables), followed by clustering, distribution of cases and controls differed, p = 0.05. Examination of factors indicated that post-provocation -- most cases have lower levels of strain rate & strain after pain provocation compared with most controls.
No
 Trapezius myalgia Sjøgaard (2010) [77] ΔOHb, ΔHHb, ΔTHb from baseline
Cases: OHb 35 min after start of peg board task < baseline, p < 0.05. Controls: OHb not different from baseline. Other OHb, HHb, and THb similar results for cases and controls.
Yes
↓ OHb (vs. baseline) 35 min after start of peg board task in cases, but no change in controls.
  1. a: result significant in 1 of 2 radiologists