Cross-sectional areas of fat and muscle in limbs during growth and middle age

Gender, body mass and age as risk factors for ulnar mononeuropathy at the elbow

Factors that predispose patients to ulnar mononeuropathy at the elbow (UME) are poorly defined. We compared 112 electrodiagnostic reports which met criteria for definite or probable UME to 104 reports which excluded UME. Male gender was strongly associated with definite (OR = 6.9, 95% CI = 2.4-20.4; P < 0.001) and all UME (OR = 2.2, 95% CI = 1.2-4.1; P = 0.010) after controlling for age and body mass index (BMI). Among men, UME was associated with increasing age (P = 0.008) but not a decreased BMI. Women, however, demonstrated an association between decreased BMI and UME (OR = 2.3, 95% CI = 1.3-4.2 for BMI < or =22.0 versus >22.0). These findings, in conjunction with gender differences in ulnar motor nerve parameters among UME subjects and controls, suggest that the pathophysiology of UME differs with gender.

Anatomy of the ulnar nerve at the elbow: potential relationship of acute ulnar neuropathy to gender differences

Men develop perioperative ulnar neuropathies more frequently than women. To determine the role of anatomical gender differences in the development of these neuropathies, we performed several studies of the anatomy of the ulnar nerve, cubital tunnel, and elbow region. These studies included detailed dissection of male and female embalmed and unembalmed cadavers, ultrasound measurements of the tissue layers at the elbow, and measurement of various dimensions of the coronoid process of the ulna in multiple skeletal sets. No gross anatomical differences were found between genders regarding the course of the ulnar nerve through the upper limb. However, there was a strikingly larger (2-19 times greater) fat content on the medial aspect of the elbow in women compared to men, and the tubercle of the coronoid process was approximately 1.5 times larger in men (P < or = .002, rank sum test). Our finding suggest that the tubercle of the coronoid process is a likely area for external compression-induced ischemia of the ulnar nerve because the nerve and its arterial supply (the posterior ulnar recurrent artery) are covered at the tubercle only by skin, subcutaneous fat, and a very thin aponeurosis of the flexor carpi ulnaris. Importantly, this tubercle is larger and the nerve and blood vessels passing by it are less protected by subcutaneous fat in men than in women. These two anatomical differences between men and women may contribute to the increased frequency of perioperative ulnar neuropathy induced by external pressure at the medial aspect of the elbow in men.

Muscle quality. I. Age-associated differences between arm and leg muscle groups

To determine the differences between arm and leg muscle quality (MQ) across the adult life span in men and women, concentric (Con) and eccentric (Ecc) peak torque (PT) were measured in 703 subjects (364 men and 339 women, age range 19-93 yr) and appendicular skeletal muscle mass (MM) was determined in the arm and leg in a subgroup of 502 of these subjects (224 men and 278 women). Regression analysis showed that MQ, defined as PT per unit of MM, was significantly higher in the arm ( approximately 30%) than in the leg across age in both genders (P < 0.01). Arm and leg MQ declined at a similar rate with age in men, whereas leg MQ declined approximately 20% more than arm MQ with increasing age in women (P </= 0.01 and P < 0.05 for Con and Ecc PT, respectively). Moreover, the age-associated decrease in arm MQ was steeper in men than in women whether Con or Ecc PT was used (both P < 0.05). Arm MQ as determined by Con PT showed a linear age-related decline in men and women (28 and 20%, respectively, P < 0.001), whereas arm MQ as determined by Ecc PT showed a linear age-related decline in men (25%, P < 0.001) but not in women (not significant). In contrast, both genders exhibited an age-related quadratic decline in leg MQ as determined by Con PT ( approximately 40%) and Ecc PT ( approximately 25%; both P < 0.001), and the rate of decline was similar for men and women. Thus MQ is affected by age and gender, but the magnitude of this effect depends on the muscle group studied and the type of muscle action (Con vs. Ecc) used to assess strength.

Body composition and cross-sectional areas of limb lean tissues in Olympic weight lifters

The cross-sectional area (CSAs) of bone and muscle tissues in the forearm, upper arm, lower leg, and thigh and body composition were determined by B-mode ultrasound and underwater weighing methods, respectively for 56 college Olympic weight lifters and 28 age-matched non-athletes to investigate the magnitude of musculoskeletal development in the strength-trained athletes belonging to the weight-classified sports event. The average value of fat-free mass (FFM) for the weight lifters ranked 12.6 kg above the regression line of FFM on stature for untrained subjects. In the weight lifters, however, the percentage of fat mass to body mass was also highly correlated to body mass index. Bone and muscle CSAs in every site were significantly larger in the weight lifter than in the untrained subjects with relative differences of 22 to 58% and 17 to 56%, respectively. Moreover, as a result of regression analysis for the mixed data from weight lifters and untrained subjects, significant correlation was found between bone and muscle CSAs in every site (r = 0.620 to 0.791, P < 0.05). The differences in lean (bone + muscle) CSA were still significant in all sites except for the lower leg even when the difference in body size was statistically controlled. The comparisons between the weight lifters and untrained subjects on the lean CSA ratios of site to site and muscle CSA ratios of flexors to extensors indicated that the weight lifters had achieved a high relative distribution of lean tissues in the arms and a dominant development in elbow and knee extensors. Thus, the present results suggested that participation in weight lifting exercises for a long period could increase bone CSA as well as muscle CSA, and induce in the participants a noticeable enlargement in given sites and muscle groups responsible for performing the Olympic lifts.

A cross-sectional study of the size and strength of the lower leg muscles during growth

The influences of age and sex on the cross-sectional area (CSA) and isometric strength of the ankle dorsiflexors and plantarflexors (PF) were investigated in four age groups of 121 boys and 121 girls aged: 7-9, 10-12, 13-15, and 16-18 years. A single anatomical cross-section was determined at 30% of the distance from the articular cleft between the femur and tibiacondyles by using an ultrasonic apparatus. In both sexes, the increase in age was associated with significant increases in the CSA and strength (ST) of these opposing muscle groups. The sex differences became apparent in the 13-15 year group for CSA and in the 16-18 year group for ST but the differences reduced considerably when CSA and ST were expressed per unit of the second power of the lower leg length (CSA.LL-2) and the product of CSA and the lower leg length (ST.CSA-1.LL-1), respectively. However, CSA.LL-2 of both muscles had a tendency to be increased at and over the age of 10-12 years, and was the highest at 16-18 years, and ST.CSA-1.LL-1 of PF showed higher values in the older boys than in the younger. Thus, it appeared that, at least in the reciprocal muscle groups of the ankle joint, the sex differences in muscle CSA and ST during growth could be accounted for by differences in LL and muscle mass, respectively. However, other factors must also be involved to explain completely the age differences in these variables.