Ultrasound imaging of the serratus anterior muscle at rest and during contraction

The purpose of this study is to describe a clinically feasible method for measuring the thickness of the serratus anterior (SA) muscle using rehabilitative ultrasound imaging (RUSI) and to determine the reliability of repeated measures of that method. An exploratory clinical measurement study using a test-retest methodology was utilized to determine the reliability of the measurements in a sample of 20 healthy subjects. While sitting with the arm flexed 120°, the SA of each subject was imaged at rest, during an active hold and while holding a three pound weight. On Day 1, images were repeated three times for each condition by the same examiner. On Day 2, Examiner 1 and Examiner 2 repeated the scans. Images were examined offline by Examiner 1 with SA thickness measured superior to the most distal rib in the image. Reliability was evaluated using intraclass correlation coefficients (ICCs) and Bland-Altman plots. The intra-examiner reliability (same day) during rest, active hold and active hold with resistance was ICC3,3  = 0·892; ICC3,3  = 0·951; and ICC3,3  = 0·869-0·971, respectively. Intra-examiner reliability between days ranged from ICC3,2  = 0·613 at rest to ICC3,2  = 0·736 during active hold with resistance. Interexaminer reliability was moderate during active hold (ICC2,2  = 0·526) and active hold with resistance (ICC2,2  = 0·535) and poor during rest (ICC2,2  = 0·425). This study demonstrates that SA thickness can be measured reliably using RUSI by the same examiner and suggests that active movements may increase that reliability.