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Peer-reviewedCC BYPLOS One

Serial ultrasound assessment of flexor carpi ulnaris and biceps brachii cross-sectional area in critically ill patients: A prospective cohort study

  • Keiichiro Aoki1,2
  • Fumihito Kasai3
  • Kazuki Komaba2
  • Jin Saito2
  • Akira Yoshikawa4
  • Naonori Tashiro5
  • Hiroyasu Inoue6
  • Kengo Uchibori2
  • Miwa Fukazawa3
6 affiliations
  1. 1Department of Occupational Therapy, School of Rehabilitation, Tokyo Professional University of Health Sciences, Koto-ku, Tokyo, Japan.
  2. 2Division of Occupational Therapy, Department of Rehabilitation, School of Nursing and Rehabilitation Sciences, Showa Medical University, Midori-ku, Kanagawa, Japan.
  3. 3Department of Rehabilitation Medicine, Showa Medical University, School of Medicine, Shinagawa-ku, Tokyo, Japan.
  4. 4Division of Morphology, Anatomy and Physiology, Department of Medical Basics, Specialty and Education, Showa Medical University, Graduate School of Nursing and Rehabilitation Sciences, Midori-ku, Kanagawa, Japan.
  5. 5Department of Physical Therapy, Faculty of Rehabilitation, Gunma Paz University, Takasaki-shi, Japan.
  6. 6Division of Cardiopulmonary Rehabilitation Science, Department of Rehabilitation, Showa Medical University, Graduate School of Nursing and Rehabilitation Sciences, Midori-ku, Kanagawa, Japan.
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Abstract

Background: Serial ultrasound measurements may help characterize muscle wasting in critically ill patients. The flexor carpi ulnaris (FCU) is a superficial forearm muscle that may provide an additional assessment site. We described longitudinal FCU and biceps brachii (BB) cross-sectional area (CSA) changes and explored between-muscle differences and clinical associations. Methods: This prospective two-center observational study enrolled 23 intensive care unit (ICU) patients; 20 were included in the analysis (median age, 57 years; range, 33–82). CSA was measured on days 0, 5, 7, and 14 after ICU admission. Analyses used Friedman tests, exact conditional Wilcoxon signed-rank tests with Bonferroni correction, and exploratory Spearman correlations. Post hoc between-muscle comparisons assessed participant-level percentage changes. Results: Mean FCU CSA decreased from 1.36 to 1.08 cm² and mean BB CSA from 6.08 to 5.09 cm² over 14 days, corresponding to reductions of 20.9% and 16.4% in the unrounded group means. The median paired difference in percentage change (FCU minus BB) was −11.9 percentage points on day 7 (unadjusted p = 0.0023), meeting the Bonferroni threshold of 0.05/3. Differences on days 5 and 14 did not meet this threshold (p = 0.1429 and p = 0.2024). Baseline CSA values were correlated (ρ = 0.845, p < 0.001), as were 14-day percentage changes (ρ = 0.549, p = 0.0122); correlation p-values were unadjusted. Conclusions: Serial ultrasound documented decreases in FCU and BB CSA in this small cohort, with an exploratory direct comparison identifying a greater proportional FCU decrease on day 7. These findings support further evaluation of FCU ultrasound as an additional muscle-monitoring measure. Its value for earlier detection of muscle wasting or diagnosis of ICU-acquired weakness requires direct validation.

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Cite

BibTeXRIS
BibTeX
@article{aoki2026serial,
  title = {{Serial ultrasound assessment of flexor carpi ulnaris and biceps brachii cross-sectional area in critically ill patients: A prospective cohort study}},
  author = {Keiichiro Aoki and Fumihito Kasai and Kazuki Komaba and Jin Saito and Akira Yoshikawa and Naonori Tashiro and Hiroyasu Inoue and Kengo Uchibori and Miwa Fukazawa},
  journal = {PLOS One},
  year = {2026},
  month = oct,
  doi = {10.1371/journal.pone.0361123},
  url = {https://doi.org/10.1371/journal.pone.0361123},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Serial ultrasound assessment of flexor carpi ulnaris and biceps brachii cross-sectional area in critically ill patients: A prospective cohort study
AU  - Keiichiro Aoki
AU  - Fumihito Kasai
AU  - Kazuki Komaba
AU  - Jin Saito
AU  - Akira Yoshikawa
AU  - Naonori Tashiro
AU  - Hiroyasu Inoue
AU  - Kengo Uchibori
AU  - Miwa Fukazawa
PY  - 2026
DA  - 2026/10/29
JO  - PLOS One
DO  - 10.1371/journal.pone.0361123
UR  - https://doi.org/10.1371/journal.pone.0361123
AB  - Background: Serial ultrasound measurements may help characterize muscle wasting in critically ill patients. The flexor carpi ulnaris (FCU) is a superficial forearm muscle that may provide an additional assessment site. We described longitudinal FCU and biceps brachii (BB) cross-sectional area (CSA) changes and explored between-muscle differences and clinical associations. Methods: This prospective two-center observational study enrolled 23 intensive care unit (ICU) patients; 20 were included in the analysis (median age, 57 years; range, 33–82). CSA was measured on days 0, 5, 7, and 14 after ICU admission. Analyses used Friedman tests, exact conditional Wilcoxon signed-rank tests with Bonferroni correction, and exploratory Spearman correlations. Post hoc between-muscle comparisons assessed participant-level percentage changes. Results: Mean FCU CSA decreased from 1.36 to 1.08 cm² and mean BB CSA from 6.08 to 5.09 cm² over 14 days, corresponding to reductions of 20.9% and 16.4% in the unrounded group means. The median paired difference in percentage change (FCU minus BB) was −11.9 percentage points on day 7 (unadjusted p = 0.0023), meeting the Bonferroni threshold of 0.05/3. Differences on days 5 and 14 did not meet this threshold (p = 0.1429 and p = 0.2024). Baseline CSA values were correlated (ρ = 0.845, p < 0.001), as were 14-day percentage changes (ρ = 0.549, p = 0.0122); correlation p-values were unadjusted. Conclusions: Serial ultrasound documented decreases in FCU and BB CSA in this small cohort, with an exploratory direct comparison identifying a greater proportional FCU decrease on day 7. These findings support further evaluation of FCU ultrasound as an additional muscle-monitoring measure. Its value for earlier detection of muscle wasting or diagnosis of ICU-acquired weakness requires direct validation.
SN  - 1932-6203
ER  -