Stiffness and echogenicity: Development of a stiffness-echogenicity matrix for clinical problem solving

  • Antonio Stecco | RUSK Rehabilitation, New York University School of Medicine, New York, United States.
  • Carmelo Pirri Physical and Rehabilitation Medicine, Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University, Rome, Italy.
  • Raffaele De Caro Department of Neuroscience, Institute of Human Anatomy, University of Padova, Padova, Italy.
  • Preeti Raghavan Departments of Physical Medicine and Rehabilitation and Neurology, Johns Hopkins University School of Medicine, Baltimore, United States.


The assessment of soft tissue stiffness is important to evaluate many neuromusculoskeletal conditions. Several tools have been proposed for the assessment of stiffness, but ultrasonography appears to be most practical. The reflection of ultrasound waves as it travels through tissue enables assessment of tissue echogenicity, which is influenced by the characteristics of the sound wave as well as the characteristics of the tissue through which it passes, such as the amount of fat and fibrous tissue. However, tissue stiffness is not directly proportional to its echogenicity. Hence evaluation of echogenicity, as a stand-alone technique, is inadequate to describe its mechanical properties. The aim of this manuscript is to present a method of combining echogenicity evaluation by ultrasound and stiffness evaluation by palpation to better describe the mechanical properties of muscle using a stiffness-echogenicity matrix.



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Muscle Fascia - Perspective Reviews
stiffness, echogenicity, ultrasound, elastography
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How to Cite
Stecco, A., Pirri, C., De Caro, R., & Raghavan, P. (2019). Stiffness and echogenicity: Development of a stiffness-echogenicity matrix for clinical problem solving. European Journal of Translational Myology, 29(3).