Trunk Muscle Characteristics: Differences Between Sedentary Adults With and Without Unilateral Lower Limb Amputation

• Published in: Archives of physical medicine and rehabilitation Vol. 102; no. 7; pp. 1331 - 1339
• Main Authors: Sions, Jaclyn M., Beisheim, Emma H., Hoggarth, Mark A., Elliott, James M., Hicks, Gregory E., Pohlig, Ryan T., Seth, Mayank
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2021
• Subjects: Amputation; Artificial limbs; Atrophy; Back; Disuse; Magnetic resonance imaging; Paraspinal muscles; Rehabilitation; Reliability; Ultrasonography; LLA; Artificial limbs; IMF; Paraspinal muscles; MRI; ICC; MV; Atrophy; Magnetic resonance imaging; Amputation; Ultrasonography; Back; Rehabilitation; Reliability; Disuse; EMG; US
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2021.02.008

•Adults with a unilateral lower limb amputation demonstrate trunk muscle deficits.•Side-to-side trunk muscle asymmetries appear present after transfemoral amputation.•Postamputation trunk muscle deficits may be targets for intervention.•Magnetic resonance imaging may be used to monitor trunk muscles changes over time.
The primary purpose of this study was to compare trunk muscle characteristics between adults with and without unilateral lower limb amputation (LLA) to determine the presence of modifiable trunk muscle deficits (ie, impaired activity, reduced volume, increased intramuscular fat) evaluated by ultrasonography (US) and magnetic resonance imaging (MRI). We hypothesized that compared with adults without LLA (controls), individuals with transfemoral or transtibial LLA would demonstrate reduced multifidi activity, worse multifidi and erector spinae morphology, and greater side-to-side trunk muscle asymmetries.
Cross-sectional imaging study.
Research laboratory and imaging center.
Sedentary adults (n=38 total) with LLA (n=9 transfemoral level; n=14 transtibial level) and controls without LLA (n=15).
Not applicable.
We examined bilateral multifidi activity using US at levels L3/L4-L5/S1. MRI was performed using 3-dimensional quantitative fat-water imaging; bilateral L1-L5 multifidi and erector spinae were manually traced, and muscle volume (normalized to body weight) and percentage intramuscular fat were determined. Between-group and side-to-side differences were evaluated.
Compared with adults without LLA, participants with LLA demonstrated reduced sound-side multifidi activity; those with transfemoral LLA had larger amputated-side multifidi volume, whereas those with transtibial LLA had greater sound- and amputated-side erector spinae intramuscular fat (P<.050). With transfemoral LLA, side-to-side differences in erector spinae volume, as well as multifidi and erector spinae intramuscular fat, were found (P<.050).
Impaired trunk muscle activity and increased intramuscular fat may be modifiable targets for intervention after LLA.