Measurement of maximal muscle cross-sectional area of the elbow extensors and flexors in children, teenagers and adults

The aims of this study were to examine age and sex differences in elbow extensor and flexor anatomical muscle cross-sectional area (mCSA) measured by magnetic resonance imaging (MRI) and the location of maximal mCSA as a percentage of the distance from the distal to the proximal end of the humerus. Ninety-five individuals spread across the age groups 9 - 10 years, 16 - 17 years and 521 years participated in the study. Muscle cross-sectional area derived from the manual MRI tracing proved to be highly reliable in terms of limits of agreement (-2.5 to 1.5 cm(2)) and the intraclass correlation coefficient (ICC = 0.998). A sex-by-age group analysis of variance revealed significant effects (P<0.01) of sex, group and a sex-by-group interaction, the latter reflecting a greater increase in males than females of upper arm mCSA from childhood to adulthood. Extensor mCSA was more proximal (55 +/- 6%) than that of the flexors (28 +/- 6%). A significant effect (P<0.01) of group was found for location of maximal extensor mCSA, reflecting its more distal position with increasing age. Measurements of muscle size should be made at the individually determined position of maximal mCSA if interpreting data collected during growth and maturation, especially if the muscle group of interest is the elbow extensors and if different age groups are being monitored.