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. 2025 Aug 1;37(8):408–414. doi: 10.1589/jpts.37.408

Reliability and validity of the measurement of interdigital muscle thickness using a caliper gauge

Hajime Tomita 1, Yumiko Shimizu 2, Jumpei Kawakami 3, Daisuke Tashiro 4, Masahiro Ogawa 4,*, Hitoshi Tanimukai 5
PMCID: PMC12314092  PMID: 40757019

Abstract

[Purpose] The measurement of muscle mass and thickness to improve preventive care for older adults in community and clinical settings has recently gained attention. Several studies have focused on the thickness of large muscles, such as the trunk and lower limb muscles. However, studies investigating hand muscle atrophy, which hampers daily occupations, are lacking. Therefore, there is a need to measure intrinsic muscle atrophy. This study aimed to investigate the reliability and validity of interdigital muscle thickness measurements using a caliper gauge. [Participants and Methods] This study included 41 healthy young participants. The interdigital muscle thickness was measured in two limb positions with muscle relaxation and contraction using a caliper gauge. Reliability and validity were assessed using the intraclass correlation coefficient and between the interdigital muscle thickness results and other relevant scales. [Results] The results showed high inter- and intra-rater reliability. Additionally, a significant moderate correlation was observed between the interdigital muscle thickness and the other tests regarding criterion-related validity. [Conclusion] Measuring the interdigital muscle thickness using a caliper gauge is a reliable way to evaluate intrinsic muscle thickness. Muscle atrophy between the thumb and index finger is commonly observed in clinical practice. Therefore, measuring muscle atrophy during interdigital muscle thickness or observing finger muscle atrophy may provide useful information in rehabilitation settings.

Keywords: Interdigital muscle, Caliper gage, Muscular atrophy

INTRODUCTION

Daily occupations using fingers and hand function are often evaluated in occupational therapy clinical settings. Muscles responsible for hand movements are divided into two types: forearm muscles (hand extrinsic muscles), which have a muscle belly in the forearm, and hand intrinsic muscles, which have starting and stopping points in the hand1). Intrinsic muscles are responsible for Fine finger movement in daily life.

Many older patients with advanced hand disuse due to nonuse of the fingers may experience difficulties in performing daily occupations. Patients with severe atrophy of the hand intrinsic muscles are frequently observed in occupational therapy clinical settings. Previous studies have shown an association between decreased hand motor function and disabilities in activities of daily living (ADL) and instrumental activities of daily living (IADL), such as moving objects, changing clothes, eating, and writing2, 3). This finding indicates that hand function affects the quality of life3). Therefore, atrophy of hand intrinsic muscles may be associated with disabilities in ADL and quality of life. In this context, the present measurement method is intended to non-invasively visualize age-related atrophy of the intrinsic muscles, providing supplementary information for assessing hand function and planning therapeutic interventions in older adults.

With the aging of the global population, sarcopenia and frailty have become increasingly prevalent. Sarcopenia and frailty have been reported to increase the risk of falls, hospitalization, and mortality4,5,6,7). Therefore, assessment is essential for early prevention. In addition to the assessment of muscle mass8), the assessment of muscle thickness9,10,11,12,13,14) has attracted attention. Many studies have focused on the thickness of large muscles such as the trunk14) and lower limb muscles9,10,11,12,13). However, no study has focused on hand muscles, which are frequently used to perform ADL.

Evaluating atrophy of hand muscles may be useful for detecting deterioration in daily activities in older adults with frailty. Therefore, developing a useful method for assessing atrophy of hand intrinsic muscles is necessary. In clinical practice, grip and pinch strength are commonly used as indices of basic hand function. However, these indices evaluate both extrinsic and intrinsic muscles15) and do not specifically reflect the condition of intrinsic muscles. This method may offer a more muscle-specific assessment of intrinsic muscle condition than conventional strength tests such as grip or pinch force. Since intrinsic muscles play a critical role in fine motor control and are more susceptible to disuse-related atrophy, especially in the early stages of motor decline, a method that specifically targets intrinsic muscle atrophy may provide clinically valuable information for early detection and intervention in frail older adults. Compared to conventional strength tests such as grip or pinch force, this method may enable a more localized evaluation of intrinsic muscle condition, which could improve early detection of fine motor decline.

Recently, the measurement of the cross-sectional area of muscle16) and muscle thickness17) using ultrasonography has been advocated as a method for evaluating hand intrinsic muscles. Although ultrasonography has the advantages of being noninvasive and real-time, it requires expensive equipment and specialized knowledge, making it difficult to introduce in clinical settings, especially in facilities for older people. Therefore, it is necessary to develop a new, simple method for assessing atrophy of hand muscles that can be performed by anyone with little practice and without expensive equipment.

This study focused on the thickness of the muscles between the first and second metacarpals at the base of the thumb and index finger. The reason for choosing this muscle group is that soft tissues, including muscles, mainly reflect the thickness of this body part, and the absence of bone precludes its influence. The adductor pollicis muscle contribute to the abduction and flexion of the thumb at the metacarpophalangeal joint18). Thus, these muscles are thought to be involved in grip and pinch movements15, 19).

In this study, the muscle thickness in this region was named the interdigital muscle thickness (IDMT). This preliminary study aimed to develop a method for assessing the thickness of hand intrinsic muscles and verify the reliability and validity of IDMT measurement using a caliper gage in young participants. If this measurement method of IDMT were established through this study, it could be useful to evaluate or observe muscle atrophy between the thumb and index finger in routine occupational therapy. Therefore, this study would also contribute to clinical occupational therapy.

PARTICIPANTS AND METHODS

This study included healthy young adults. The inclusion criteria included healthy students aged 18–30 years and those enrolled in Kyoto University or Kobe Gakuin University. The exclusion criteria included those who had a severe injury or underwent surgery in the forearm or hand and those with a history of neuromuscular or orthopedic disease of the forearm or hand.

All participants were informed of the study purpose and procedures, and written consent was obtained from all participants before participation in the study. This study was approved by the Medical Ethics Committee of Kyoto University Graduate School of Medicine, Faculty of Medicine, and Faculty of Medicine Hospital (Approval No. R3209) and the Research Ethics Review Committee of Kobe Gakuin University (Reception No. 21-13).

Data, including gender, age, height, weight, dominant hand, and medical history, were collected from the participants. IDMT was measured twice to verify the test-retest reliability. Additionally, three other measurements, including grip strength, pinch strength, and ultrasonography, were used to evaluate criterion-related validity. The first IDMT measurement was performed, followed by the grip strength test, pinch force test, and ultrasonography. Finally, the second IDMT measurement was performed. The study participants were divided into two groups to test inter- and intrarater reliability. Half of them had the first and second IDMT measurements taken by different examiners, which were used for interrater reliability analysis. For the other group, the same examiner took both IDMT measurements, which were used for intrarater reliability analysis.

Stickers were first placed on the palmar and dorsal surfaces of the intersection of two lines, an extended line of the medial side of the thumb and an extended line of the radial side of the index finger, to measure the thickness of the interdigital muscle between the thumb and the index finger. Next, a digital caliper gage (Niigata Seiki Co., Ltd., Niigata, Japan) was used to measure the muscle thickness between the first and second metacarpals by clamping the area where the stickers were placed (Fig. 1). The unit of measurement was mm, and measurements were taken in 0.1 mm increments.

Fig. 1.

Fig. 1.

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Interdigital muscle thickness (IDMT) measurement positions.

Measurements were taken during relaxation and contraction of the muscles. Measurements during relaxation were performed with the radial abduction of the thumb and the neutral position of the forearm (Fig. 1a). During contraction, the participant’s thumb was pressed against the radial side of the proximal interphalangeal joint with the neutral position of the forearm (Fig. 1b). Previous studies have shown that muscle thickness can be measured by ultrasonography in two ways: during relaxation and contraction20). Furthermore, muscle thickness during relaxation captures morphological characteristics, whereas muscle thickness during contraction captures functional characteristics20). Thus, these two measurement positions were used in this study. In this study, the validity of IDMT measurement was related to muscle strength, such as grip and pinch strength.

Grip strength was measured using a Smedley’s hand dynamometer (Matsumiya Medical Equipment Manufacturing Co., Ltd., Tokyo, Japan). The unit of measurement was kg. The grip width was adjusted before the test, and the test was performed in the standing position with the elbow joint extended and the neutral position of the forearm. Measurements were performed twice alternately on each side21).

The pinch strength was measured using a pinch meter (Fuji Seiko Co., Ltd., Aichi, Japan). The unit of measurement was kg. The pinch strength was measured at two positions: lateral and tip pinch. Both pinch strengths were measured twice alternately in a sitting position with the elbow joint flexed at 90° and the neutral position of the forearm22).

Ultrasonography was used to measure the thickness of the adductor pollicis muscle using a portable ultrasonography system (Pocket Echo Miruco, Nippon Sigmax Co., Ltd., Tokyo, Japan). A 10 MHz linear probe was used. The measurement position was with the thumb in approximately 45° radial abduction relative to the third metacarpal (Fig. 2).

Fig. 2.

Fig. 2.

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Measurement by ultrasonography.

The measurement position was with the thumb in approximately 45° radial abduction relative to the third metacarpal.

The probe was placed dorsally between the first and second metacarpals to visualize the adductor pollicis muscle. A representative ultrasound image of the measurement site is shown in Fig. 3.

Fig. 3.

Fig. 3.

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Ultrasound image of interdigital muscle thickness (IDMT) measurement site.

A: First dorsal interosseous muscle; B: Adductor pollicis muscle.

Only the thickness of the adductor pollicis muscle was used for analysis in this study.

Intraclass correlation coefficients (ICCs) were calculated from IDMT values measured twice by the same examiner to examine the intrarater reliability of IDMT measurements. ICCs were calculated from the IDMT values measured once by different examiners to examine interrater reliability. ICC values within the ranges of 0.0–0.20, 0.21–0.40, 0.41–0.60, 0.61–0.80, and 0.81–1.00 were characterized as “minimal”, “poor”, “moderate”, “substantial”, and “almost perfect”, respectively23).

Correlation analysis was performed between the IDMT value and mean value of two grip strength tests, the IDMT value and mean value of two pinch force tests, and the IDMT value and muscle thickness during the relaxation of the adductor pollicis muscle by ultrasound examination to examine the validity of the IDMT measurement. Pearson’s product-moment correlation coefficient was used for grip and pinch strength tests, and Spearman’s rank correlation coefficient was used for IDMT and ultrasonography measurements. A correlation coefficient of 0.00–0.19 indicated almost no correlation, 0.20–0.39 indicated weak correlation, 0.40–0.69 indicated moderate correlation, and 0.70–1.00 indicated strong correlation24). Statistical analysis was performed using SPSS Statistics version 27 for Windows (IBM Corp., Armonk, NY, USA). The significance level was set at 5%.

RESULTS

A total of 41 participants were included in this study. Of the 41 participants, 17 (41.5%) were males, and 24 (58.5%) were females. Their mean age was 20.0 ± 0.8 years (mean ± standard deviation), and their height and weight were 163.1 ± 9.7 cm and 56.2 ± 8.9 kg, respectively. Of the 41 participants, 3 were left-handed. All were Japanese.

The IDMT relaxation values for the first and second IDMT measurements were 24.7 ± 2.9 mm and 24.8 ± 2.9 mm, respectively. The IDMT contraction values for the first and second IDMT measurements were 24.9 ± 3.1 mm and 35.2 ± 3.0 mm, respectively. The ICCs (1, 1), a measure of intrarater reliability, were 0.948 (95% confidence interval CI): 0.902–0.973) during IDMT relaxation and 0.900 (95% CI: 0.814–0.948) during IDMT contraction (Table 1).

Table 1. Intrarater and interrater reliability of interdigital muscle thickness (IDMT) (n=41).

1st (mm) 2nd (mm) ICC CI
Intrarater reliability IDMT relaxation 24.7 ± 2.9 24.8 ± 2.9 0.948 0.902–0.973
IDMT contraction 34.9 ± 3.1 35.2 ± 3.0 0.900 0.814–0.948
Interrater reliability IDMT relaxation 26.7 ± 3.4 27.3 ± 3.0 0.809 0.674–0.891
IDMT contraction 34.5 ± 4.1 35.1 ± 3.3 0.690 0.504–0.815
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ICC: intraclass correlation coefficient; CI: confidence interval.

The values for the first IDMT measurement were 26.7 ± 3.4 mm during relaxation and 34.5 ± 4.1 mm during contraction. The values for the second IDMT measurement were 27.3 ± 3.0 mm during relaxation and 35.1 ± 3.3 mm during contraction. The ICCs (2, 1), a measure of interrater reliability, were 0.809 (95% CI: 0.674–0.891) during relaxation and 0.690 (95% CI: 0.504–0.815) during contraction (Table 1).

The mean value of the grip strength was 30.2 ± 7.8 kg. The correlation coefficients between the values of IDMT relaxation and contraction and the mean value of the grip strength were 0.372 and 0.482, respectively (Table 2).

Table 2. Correlation coefficients of interdigital muscle thickness (IDMT) with other variables (n=41).

IDMT relaxation IDMT contraction
Grip strength 0.372 (p=0.003) 0.482 (p<0.001)
Lateral pinch (Pinch force) 0.230 (p=0.037) 0.388 (p<0.001)
Tip pinch (Pinch force) 0.348 (p=0.001) 0.409 (p<0.001)
Ultrasonography (Adductor pollicis muscle) 0.498 (p<0.001) 0.405 (p<0.001)
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The correlation coefficients between the values of IDMT relaxation and contraction and the average value of lateral pinch were 0.230 and 0.388, respectively. Furthermore, the correlation coefficients between the values of IDMT relaxation and contraction and the average value of fingertip pinch were 0.348 and 0.409, respectively.

Ultrasonography revealed that the mean muscle thickness was 8.9 ± 1.9 mm during the relaxation of the adductor pollicis muscle. The correlation coefficient between the IDMT relaxation value and muscle thickness during the relaxation of the adductor pollicis muscle on ultrasonography was 0.498. The correlation coefficient between the IDMT contraction value and muscle thickness during the contraction of the adductor pollicis muscle was 0.405.

DISCUSSION

In this study, the reliability and validity of IDMT measurements using a caliper gage were examined in young participants as a preliminary study to evaluate hand intrinsic muscle atrophy. The results generally showed high inter- and intrarater reliability of IDMT measurements and a relatively strong positive correlation with respect to criterion-related validity. Therefore, measuring IDMT using a caliper gage may be useful as a new, simple method for measuring hand intrinsic muscle thickness. Chino et al.25) reported that quantitative measurement of quadriceps muscle thickness using ultrasonography is useful for assessing muscle hypertrophy and atrophy. IDMT, along with ultrasonography, is proficient in assessing muscle thickness, making it a suitable method for quantitatively assessing atrophy and hypertrophy of hand intrinsic muscles. Therefore, as aging continues to advance globally, measurements of IDMT can be used as part of the assessment for preventive care.

Additionally, measurements of IDMT during relaxation were performed without the active involvement of the participants in a passive limb position. Consequently, IDMT can be measured even in cases of consciousness disorders or paralysis. A previous study estimated whole-body skeletal muscle mass from hand grip strength26). Therefore, IDMT may be valuable for estimating muscle strength in such situations and for estimating overall muscle mass. Gonzalez et al.27) showed a significant correlation between the thickness of the adductor pollicis muscle of the thumb and nutritional status. Because the measurement position of the IDMT includes the adductor pollicis muscle of the thumb, it is necessary to further deepen the characteristics of the IDMT after determining the relationship between the IDMT and nutritional status. A previous study showed a strong correlation between malnutrition and frailty in older adults28, 29), with approximately 90% of malnourished older individuals being either frail or prefrail28). Considering the association between IDMT and nutritional status, further studies are needed to investigate the relationship between IDMT and frailty. Although the present study does not aim to directly assess frailty or sarcopenia, atrophy of the hand intrinsic muscles may serve as an early marker of functional decline. Further studies are warranted to investigate its association with established frailty or sarcopenia indices.

This study revealed that the IDMT measurement method is related to muscle strength in the hand and finger. Although these strength measures mainly reflect extrinsic muscle function, we explored their relationship with IDMT to assess whether intrinsic muscle atrophy could be associated with overall hand function. Muscle atrophy between the thumb and index finger is commonly observed in clinical practice. Therefore, measuring muscle atrophy of IDMT may provide useful information in clinical occupational therapy settings. However, the relationships between the muscle atrophy and daily occupations are still unknown. Therefore, the relationship between IDMT and ADL and IADL should be examined. Previous studies involving healthy older adults have shown that individuals engaged in hand-related activities exhibit significantly higher hand function than those who do not30). Therefore, a more detailed examination of the correlation between hand intrinsic muscle function and ADL/IADL could elucidate its impact on daily life. Therefore, IDMT studies targeting older adults are needed to achieve this goal.

This study has some limitations. This study included a younger age group. For method exploration, younger individuals were chosen as participants because they are more easily accessible for introducing the study, and muscle thickness was expected to be more easily measured in this age group compared with older adults. Since the reliability and validity of IDMT for young adults were established in this study, further studies including other age groups are needed to determine whether this measurement method can be applied to different age groups, including older adults. Additionally, in this preliminary study, digital calipers were used for measurements to measure IDMT accurately, and adhesive stickers were used for IDMT measurement. Considering measurements in clinical settings with constraints on time and costs, it should be more convenient. Therefore, further studies are needed to measure IDMT using an analog caliper gage without the step of putting on stickers.

The results of this study showed that using a caliper gage to measure IDMT in younger individuals is a reliable and valid method for assessing the thickness of hand intrinsic muscles. Compared with ultrasound examinations, this method proves to be cost-effective and time-efficient and requires low expertise. Therefore, it can serve as a novel and simplified method for assessing muscle atrophy in hand intrinsic muscles. Further studies targeting older adults are needed.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by JSPS KAKENHI Grant Number 23k10222.

Conflicts of interest

The authors have no conflicts of interest to declare.

Acknowledgments

We would like to express our deepest gratitude to all the research participants who agreed to participate in the study.

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