Skip to main content
Log in

An MRI-based leg model used to simulate biomechanical phenomena during cuff algometry: a finite element study

  • Original Article
  • Published:
Medical & Biological Engineering & Computing Aims and scope Submit manuscript

Abstract

Cuff pressure stimulation is applicable for assessing deep-tissue pain sensitivity by exciting a variety of deep-tissue nociceptors. In this study, the relative transfer of biomechanical stresses and strains from the cuff via the skin to the muscle and the somatic tissue layers around bones were investigated. Cuff pressure was applied on the lower leg at three different stimulation intensities (mild pressure to pain). Three-dimensional finite element models including bones and three different layers of deep tissues were developed based on magnetic resonance images (MRI). The skin indentation maps at mild pressure, pain threshold, and intense painful stimulations were extracted from MRI and applied to the model. The mean stress under the cuff position around tibia was 4.6, 4.9 and around fibula 14.8, 16.4 times greater than mean stress of muscle surface in the same section at pain threshold and intense painful stimulations, respectively. At the same stimulation intensities, the mean strains around tibia were 36.4, 42.3 % and around fibula 32.9, 35.0 %, respectively, of mean strain on the muscle surface. Assuming strain as the ideal stimulus for nociceptors the results suggest that cuff algometry is less capable to challenge the nociceptors of tissues around bones as compared to more superficially located muscles.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Birtane M, Tuna H, Ekuklu G, Demirbağ D, Tuna F, Kokino S (2004) Pressure-induced pain on the tibia: an indicator of low bone mineral density? J Bone Miner Metab 22:456–461

    Article  PubMed  Google Scholar 

  2. Brandt KD (1999) Osteophytes in osteoarthritis. Clinical aspects. Osteoarthritis Cartilage 7:334–335

    Article  CAS  PubMed  Google Scholar 

  3. Cheung JT, Zhang M, Leung AK, Fan Y (2005) Three-dimensional finite element analysis of the foot during standing—A material sensitivity study. J Biomech 38:1045–1054

    Article  PubMed  Google Scholar 

  4. Crews JC, Denson DD, Hilgenhurst G, Bridenbaugh PO, Leavitt B, Stuebing RC (1991) Tourniquet pain: the response to the maintenance of tourniquet inflation on the upper extremity of volunteers. Reg Anesth Pain Med 16:314–317

    CAS  Google Scholar 

  5. Cua A, Wilhelm K, Maibach H (1990) Elastic properties of human skin: relation to age, sex, and anatomical region. Arch Dermatol Res 282:283–288

    Article  CAS  PubMed  Google Scholar 

  6. Delaney A, Fleetwood-Walker SM, Colvin LA, Fallon M (2008) Translational medicine: cancer pain mechanisms and management. Br J Anaesth 101:87–94

    Article  CAS  PubMed  Google Scholar 

  7. Dubuis L, Avril S, Debayle J, Badel P (2012) Identification of the material parameters of soft tissues in the compressed leg. Comput Method Biomech 15:3–11

    Article  CAS  Google Scholar 

  8. Finocchietti S, Nielsen M, Mørch CD, Arendt-Nielsen L, Graven-Nielsen T (2011) Pressure-induced muscle pain and tissue biomechanics: a computational and experimental study. Eur J Pain 15:36–44

    Article  PubMed  Google Scholar 

  9. Finocchietti S, Mørch CD, Arendt-Nielsen L, Graven-Nielsen T (2011) Effects of adipose thickness and muscle hardness on pressure pain sensitivity. Clin J Pain 27:414–424

    Article  PubMed  Google Scholar 

  10. Finocchietti S, Andresen T, Arendt-Nielsen L, Graven-Nielsen T (2012) Pain evoked by pressure stimulation on the tibia bone–influence of probe diameter on tissue stress and strain. Eur J Pain 16:534–542

    Article  CAS  PubMed  Google Scholar 

  11. Finocchietti S, Takahashi K, Okada K, Watanabe Y, Graven-Nielsen T, Mizumura K (2013) Deformation and pressure propagation in deep tissue during mechanical painful pressure stimulation. Med Biol Eng Comput 51:113–122

    Article  PubMed  Google Scholar 

  12. Gibson W, Arendt-Nielsen L, Taguchi T, Mizumura K, Graven-Nielsen T (2009) Increased pain from muscle fascia following eccentric exercise: animal and human findings. Exp Brain Res 194:299–308

    Article  PubMed  Google Scholar 

  13. Graven-Nielsen T, Arendt-Nielsen L (2010) Assessment of mechanisms in localized and widespread musculoskeletal pain. Nat Rev Rheumatol 6:599–606

    Article  PubMed  Google Scholar 

  14. Graven-Nielsen T, Arendt-Nielsen L, Svensson P, Jensen TS (1997) Experimental muscle pain: a quantitative study of local and referred pain in humans following injection of hypertonic saline. J Musculoskelet Pain 5:49–69

    Article  Google Scholar 

  15. Graven-Nielsen T, Mense S, Arendt-Nielsen L (2004) Painful and non-painful pressure sensations from human skeletal muscle. Exp Brain Res 159:273–283

    Article  PubMed  Google Scholar 

  16. Grönblad M, Liesi P, Korkala O, Karaharju E, Polak J (1984) Innervation of human bone periosteum by peptidergic nerves. Anat Rec 209:297–299

    Article  PubMed  Google Scholar 

  17. Hockaday JM, Whitty CW (1967) Patterns of referred pain in the normal subject. Brain 90:481–496

    Article  CAS  PubMed  Google Scholar 

  18. Honore P, Mantyh PW (2000) Bone cancer pain: from mechanism to model to therapy. Pain Med 1:303–309

    Article  CAS  PubMed  Google Scholar 

  19. Itoh K, Kawakita K (2002) Effect of indomethacin on the development of eccentric exercise-induced localized sensitive region in the fascia of the rabbit. Jpn J Physiol 52:173–180

    Article  PubMed  Google Scholar 

  20. Itoh K, Okada K, Kawakita K (2004) A proposed experimental model of myofascial trigger points in human muscle after slow eccentric exercise. Acupunct Med 22:2–12 discussion 12-3

    Article  PubMed  Google Scholar 

  21. Jespersen A, Dreyer L, Kendall S, Graven-Nielsen T, Arendt-Nielsen L, Bliddal H, Danneskiold-Samsoe B (2007) Computerized cuff pressure algometry: a new method to assess deep-tissue hypersensitivity in fibromyalgia. Pain 131:57–62

    Article  PubMed  Google Scholar 

  22. Kawakita K, Miura T, Iwase Y (1991) Deep pain measurement at tender points by pulse algometry with insulated needle electrodes. Pain 44:235–239

    Article  CAS  PubMed  Google Scholar 

  23. Kellgren J (1938) Observations on referred pain arising from muscle. Clin Sci 3:1937–1938

    Google Scholar 

  24. Lewis T (1938) Study of somatic pain. BMJ 1:321–325

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Linder-Ganz E, Shabshin N, Itzchak Y, Yizhar Z, Siev-Ner I, Gefen A (2008) Strains and stresses in sub-dermal tissues of the buttocks are greater in paraplegics than in healthy during sitting. J Biomech 41:567–580

    Article  PubMed  Google Scholar 

  26. Mach D, Rogers S, Sabino M, Luger N, Schwei M, Pomonis J, Keyser C, Clohisy D, Adams D, O’leary P (2002) Origins of skeletal pain: sensory and sympathetic innervation of the mouse femur. Neuroscience 113:155–166

    Article  CAS  PubMed  Google Scholar 

  27. Martin CD, Jimenez-Andrade JM, Ghilardi JR, Mantyh PW (2007) Organization of a unique net-like meshwork of CGRP sensory fibers in the mouse periosteum: implications for the generation and maintenance of bone fracture pain. Neurosci Lett 427:148–152

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Nie H, Arendt-Nielsen L, Andersen H, Graven-Nielsen T (2005) Temporal summation of pain evoked by mechanical stimulation in deep and superficial tissue. J Pain 6:348–355

    Article  PubMed  Google Scholar 

  29. Polianskis R, Graven-Nielsen T, Arendt-Nielsen L (2002) Spatial and temporal aspects of deep tissue pain assessed by cuff algometry. Pain 100:19–26

    Article  PubMed  Google Scholar 

  30. Rolke R, Campbell KA, Magerl W, Treede R (2005) Deep pain thresholds in the distal limbs of healthy human subjects. Eur J Pain 9:39–48

    Article  CAS  PubMed  Google Scholar 

  31. Sabino MA, Ghilardi JR, Jongen JL, Keyser CP, Luger NM, Mach DB, Peters CM, Rogers SD, Schwei MJ, de Felipe C, Mantyh PW (2002) Simultaneous reduction in cancer pain, bone destruction, and tumor growth by selective inhibition of cyclooxygenase-2. Cancer Res 62:7343–7349

    CAS  PubMed  Google Scholar 

  32. Sakada S, Taguchi S (1971) Electrophysiological studies on the free-fiber ending units of the cat mandibular periosteum. Bull Tokyo Dent Coll 12:175–197

    CAS  PubMed  Google Scholar 

  33. Takahashi K, Taguchi T, Itoh K, Okada K, Kawakita K, Mizumura K (2005) Influence of surface anesthesia on the pressure pain threshold measured with different-sized probes. Somatosens Mot Res 22:299–305

    Article  PubMed  Google Scholar 

  34. Tran H, Charleux F, Rachik M, Ehrlacher A, Ho Ba Tho M (2007) In vivo characterization of the mechanical properties of human skin derived from MRI and indentation techniques. Comput Method Biomech 10:401–407

    Article  CAS  Google Scholar 

  35. Vannah WM, Childress DS (1996) Indentor tests and finite element modeling of bulk muscular tissue in vivo. J Rehabil Res Dev 33:239–252

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The study was supported by a Proof of Concept grant from the Ministry of Higher Education and Science, Denmark. EIR and SMI at Aalborg University are acknowledged for providing facilities and funding for the study. Nocitech is a company partly owned by Aalborg University. The authors have no conflict to report.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Thomas Graven-Nielsen.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Manafi-Khanian, B., Arendt-Nielsen, L. & Graven-Nielsen, T. An MRI-based leg model used to simulate biomechanical phenomena during cuff algometry: a finite element study. Med Biol Eng Comput 54, 315–324 (2016). https://doi.org/10.1007/s11517-015-1291-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11517-015-1291-x

Keywords

Navigation