Table 1

Currently used diagnostic methods to examine fascial tissue structure and function

MethodAssessment targetAdvantagesDisadvantagesReferences
BiopsyHistological properties including molecular analysis.Permits analysis of tissue damage, infiltration of inflammatory cells, cytokines and others.Invasiveness. 66 75 77
BioimpedanceHydration changes.High sensitivity.Lacking data on reliability and validity for smaller regions. 78
Manual palpationStiffness, elasticity and shearing mobility of tissue.Cost-effectiveness.
Psychosocial factors.
Limited reliability. 79 80 82
IndentometryStiffness and elasticity.Established reproducibility.Limited depth.) 81 83–85
Ultrasound (US) imagingThickness of layers, tendon elongation.Permits diagnosis of a fibrotic thickening (eg, of a particular endomysium) or of tendon strain response during loading.Difficulty in standardising the exact viewing angle. 86 88
US with correlation softwareRelative shearing motion of adjacent layers.Permits diagnosis of adhesive tissue connections, such as in chronic low back pain.Lacking standards for selection of regions of interest. 89
Compression-based US elastographyStiffness.Measurements possible at further depth than, for example, with indentometry.Lack of standardisation.
Frequent appearance of artefacts.
Shear-wave US elastographyStiffness.Enhancement by propagation analysis permits morphological analysis.Lack of standardisation. 90 91
B-mode ultrasonographyTendon structure and mechanical/material properties.
  1. In vivo methodology.

  2. Application in perspective studies.

  3. Relatively inexpensive.

  1. Accuracy is user-dependent.

  2. Applicability is limited to superficial tendons mainly.

  3. Limited control of any mediolateral deviation of the tendon line of pull off the scanning plane.

  4. Tendon slack length (ie, at 0% strain) and tendon force cannot be directly measured and need to be estimated.

  5. Scanning frame rate is currently limited.

90 96–98 103