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3 authors, including:
Susan A Saliba
University of Virginia
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Key Points
N Measurements of subcutaneous fat thickness of the thigh taken with the skinfold calipers and ultrasound imaging were
strongly correlated, whereas limits of agreement were wide.
N Compared with ultrasound imaging, the skinfold calipers tended to overestimate subcutaneous fat thickness of the thigh at
the vastus medialis obliquus, distal rectus femoris, and proximal rectus femoris, and this overestimation increased as fat
thickness increased.
N Clinicians and researchers should use caution when interpreting the results of measurements taken with skinfold calipers,
especially in large individuals.
S
ite-specific skinfold-thickness measurements have The accurate measurement of subcutaneous tissue
been used to determine duration of cryotherapy thickness is important in therapeutic modality application
treatments,1,2 depth of thermocouple placement when and research, and Petrofsky8 recently suggested that
measuring skeletal muscle temperature,3,4 and total body subcutaneous fat might affect the conduction of electric
fat percentage.5 This technique is relatively inexpensive, stimulation. The assessment of thermal responses to
noninvasive, and widely used in most therapeutic clinics.6 therapeutic ultrasound4 and cryotherapy1,2 is affected by
However, accurate measurement might be difficult to adipose thickness. During laboratory study, the muscular
attain in all individuals, especially in those with adipose interface can be difficult to identify with SC. Therefore, the
tissue that does not separate well from the underlying thermocouple might not be placed properly into the
muscle or when the end range of the tool is too small to muscle, usually at depths of 1 to 2 cm beyond the
capture the entire subcutaneous fat thickness. In addition, subcutaneous tissue, resulting in inaccurate temperature
interrater reproducibility of measurements using skinfold estimations at the target tissue. When thermocouples are
calipers (SC) is not high,7 resulting in clinicians questioning inserted to evaluate temperature changes in various depths
the accuracy of the measurement. of tissue, subcutaneous tissue thickness often is assessed by
using SC and dividing the measurement in half.1,3,4 Thus participants with both measurement devices. The order of
far, this method has not been challenged for accuracy. measurements was counterbalanced. This was part of a
Advances in technology have resulted in the use of larger study in which we examined how electrode type and
ultrasound imaging (USI) within clinical settings. Although placement on the thigh affected analysis of quadriceps
more expensive than SC, USI has been shown to be muscle activation. We were interested in examining the
comparable to the criterion standard of magnetic reso- possible effects of fat thickness under the electrode pads on
nance imaging in image clarity, is portable, and is muscle activation in the position relative to that specific
noninvasive.6 Compared with magnetic resonance imaging, testing. The position was also consistent with a thermal
USI has been deemed a valid tool for measuring visceral treatment to the anterior thigh because the modality
and abdominal subcutaneous fat.9 Orphanidou et al10 typically would be applied with the participant sitting
found that computed tomography and SC had similar rather than standing.
agreement but that computed tomography and USI did
not. They did not compare USI and SC. With advances in Participants
technology, their results might differ now. With USI,
Twenty healthy individuals (13 men, 7 women; age 5
subcutaneous fat thickness measurements can be taken 26.9 6 5.4 years, height 5 173.9 6 7.3 cm, mass 5 77.4 6
without pinching the skin and can be used on individuals of 16.1 kg) volunteered to participate in our study. Partici-
all sizes. The images obtained are clear, and structures of pants were recruited via fliers and word of mouth in a
interest can be identified visually. university community. They were excluded if they had
Subcutaneous fat thickness at specific locations, such as experienced a lower extremity injury in the 6 weeks before
the gastrocnemius or thigh, is important to measure the study, had undergone lower extremity surgery in the
accurately, especially when proper injury management year before the study, or had an open wound to the
might depend on it. Therefore, the purpose of our study anterior thigh. All participants provided written informed
was to compare subcutaneous fat-thickness measurements consent, and the Institutional Review Board of Health
of the thigh taken with SC and USI. Sciences Research at the University of Virginia approved
the study.
METHODS
Procedures
Design
The participants sat in a standardized position using a
We used a correlational design in which all participants dynamometer (System 3 PRO; Biodex Medical Systems,
were measured with SC and USI. Four regions of the Inc, Shirley, NY) with their knees in 906 of flexion and
anterior thigh were identified with a template, and their trunks in 856 of extension. Before testing, a template
measurements were recorded in the same area in all was used to trace a 12 3 7–cm rectangular area over each
Address correspondence to Noelle M. Selkow, MEd, ATC, Memorial Gym, PO Box 400407, Charlottesville, VA 22904. Address e-mail to
nmp4p@virginia.edu.