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Neuromuscular Junction Disorders
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Diana Mnatsakanova, Qin Li Jiang
Congenital MG (see below): Long history of symptoms (often from infancy or childhood) with gradual progression.AChR or anti-MuSK antibodies are absent.May have a positive family history.May have characteristic findings on NCS (repetitive CMAP in slow channel syndrome or acetylcholinesterase deficiency).Requires genetic testing or specialized electrophysiologic testing on intercostal or anconeus muscle.Not responsive to immunotherapies.
Medical Countermeasures for Intoxication by Botulinum Neurotoxin
Published in Brian J. Lukey, James A. Romano, Salem Harry, Chemical Warfare Agents, 2019
Michael Adler, Ajay K. Singh, Nizamettin Gul, Frank J. Lebeda
The basis for poor efficacy of AChE inhibitors in severe wound botulism was provided by Maselli and Bakshi (2000). These authors recorded EPPs in an ex vivo preparation of anconeus muscle obtained from a wound botulism patient who had a sudden onset of respiratory failure requiring artificial ventilation. Microelectrode recording revealed that the quantal content of the EPP (number of ACh quanta released per nerve impulse) in the patient’s muscle was only 22% of control. Although the normal EPP exceeds the threshold required to generate a muscle action potential by a factor of two to three (safety factor), the BoNT-mediated impairment of the EPP was too severe to be surmounted by AChE inhibitors (Adler et al., 1992; Katz and Miledi, 1973).
The Triple Heater (TH)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Radial nerve (C5-C8): Supplies all the muscles in the posterior compartment of the brachium, including the triceps brachii muscle. It divides into superficial and deep branches near the elbow. The deep branch further splits into muscular and articular branches. The posterior interosseous nerve is a continuation of the deep branch. The superficial branch only supplies cutaneous nerves, providing sensation to the dorsum of the hand and the digits. The posterior cutaneous nerve of the forearm is a branch of the radial nerve that supplies the skin along the posterior aspect of the forearm to the wrist. The posterior antebrachial cutaneous nerve arises from the radial nerve to supply the skin along the lateral arm and posterior forearm and wrist. Note in Figure 10-26 that the radial nerve branch deep to TH 10 is on its way to supply the anconeus muscle.
A case of metallosis after total elbow arthroplasty
Published in Modern Rheumatology Case Reports, 2019
Takuto Nozaki, Takuji Iwamoto, Taku Suzuki, Noboru Matsumura, Kazuki Sato, Masaya Nakamura, Morio Matsumoto
Surgery was performed in the lateral decubitus position through a posterior approach to the elbow joint as in the initial surgery. Once the subcutaneous tissue was dissected, significant bulging of the dark tissue was observed in the subfascial layer of the triceps brachii. The triceps was split at the midline, and the anconeus muscle was incised from the proximal ulna. When the joint was opened, we observed a black clay-like lesion that had expanded in the joint (Figure 4). Although mild deformity and abrasion were observed in the anterolateral portion of the polyethylene insert, there was no abrasion or defect on the surface of the metal implant on macroscopic observation. The black clay-like lesion was resected, revealing osteolysis in the distal humerus, but there was no apparent loosening of the humeral stem (Figure 5). Therefore, we considered that removal of the stem was unnecessary. In addition, as this patient was relatively young, we decided to select an unlinked TEA again instead of a linked TEA. A new humeral condylar component was fixed with cement, and the ulnar implant with suspected poor rotational alignment was replaced with a new implant. The wound was closed and a splint was applied with the elbow in 90° flexion. Active-assisted elbow motion was initiated two weeks after surgery. An above-elbow removable splint was applied at 90° flexion for six weeks.
Effect of dry needling on radial tunnel syndrome: A case report
Published in Physiotherapy Theory and Practice, 2019
The patient tested negative for Wainner’s test item cluster, thus helping to rule out cervical radiculopathy (Wainner et al., 2003). A normal neurological screen along with absence of pain during range of motion testing in the upper quarter helped in excluding the cervical spine, thoracic spine, shoulder and wrist as the source of pain. Anconeus muscle tendonitis can present as lateral elbow pain (Abrahamsson et al., 1987) and was ruled out by the normal palpatory and resisted isometrics findings. Normal radiographs and blood work along with the subjective and objective findings ruled out osteoarthritis of the radio-capitellar joint, systemic causes, and superadded central nervous system processing for the patient’s symptoms.