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Brachial Plexus Examination
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Janice He, Bassem Elhassan, Rohit Garg
Elbow flexion and extension, and forearm rotation should be tested. Elbow flexion strength has contributions from three muscles: The biceps brachii (musculocutaneous nerve), brachialis (dually innervated by the musculocutaneous and radial nerves) and brachioradialis (radial nerve). To test elbow flexion, the patient's arm should be adducted and elbow flexed to 90°. The examiner should stabilize the patient's elbow with one arm while providing resistance with the other. The brachialis has the greatest contribution to elbow flexion when the forearm is in a pronated position. The biceps brachii is the major flexor with the forearm supinated. The brachioradialis is a major flexor with the forearm in a neutral to slightly pronated position. It is challenging to isolate the individual effect of each of these muscles and thus it is important to palpate the biceps and brachioradialis (Figure 12.9) for contraction while testing elbow flexion and to test with the forearm pronated, neutral and supinated. The brachialis is unable to be palpated. If the patient is unable to flex against gravity, the arm can be abducted to 90° such that elbow flexion is within the plane of gravity. It is important to assess the contraction of the biceps and brachioradialis muscle to assess their function. The brachioradialis has contributions from the C5–C6 roots and hence the presence or absence of its function can differentiate between an upper plexus injury from an isolated musculocutaneous palsy.
Fascia and the Circulatory System
Published in David Lesondak, Angeli Maun Akey, Fascia, Function, and Medical Applications, 2020
Anita Boser, Kirstin Schumaker
Compression is not limited to the lower limbs. Perforating neurovascular tracts that pass through hypertonic brachialis muscle can be impinged by chronic muscle contraction or high muscle tone, creating nerve ischemia and nociception that leads to inhibition of movement that would lengthen or stretch the small neurovascular tract.43 Other vascular entrapment syndromes involve the renal arteries, the superior mesenteric artery, celiac artery, and iliac vein.38 We suggest that hypertonicity in other muscles, such as the coracobrachialis, extensor digitorum longus, and psoas, can also compress vessels that accompany the perforating nerves.
Upper limb
Published in Aida Lai, Essential Concepts in Anatomy and Pathology for Undergraduate Revision, 2018
Attachments of brachialis muscle– origin: ant. humerus– insertion: tuberosity of ulna– nerve SS: musculocutaneous n. (C5–7)– function: flex elbow
Reverse lateral upper arm flaps for treating large soft tissue defects extending from the elbow to the forearm
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Hideki Okamoto, Yohei Kawaguchi, Shinji Miwa, Hisaki Aiba, Hiroya Senda, Satona Murakami, Kazuo Hayakawa, Yuji Joyo, Hideki Murakami, Hiroaki Kimura
The flaps were designed along an axis from the deltoid insertion to the lateral epicondyle after Doppler ultrasound was used to confirm the course of the vessels. Dissection was performed with the patients in the supine position. A posterior incision was made before the flap was subfascially elevated to the intermuscular septum. The pedicle of the posterior collateral artery was easily identified within the septum and was divided proximally. Subsequently, an anterior incision was made, and the fascia was separated from the brachialis and brachioradialis, until the intermuscular septum was reached. The distal region of this flap was not separated to preserve the distal pedicle of the interosseous recurrent artery and vein. The reverse lateral upper arm flap was then transferred to the elbow and forearm with the elbow in a flexed position. The cast was fixed for 2 weeks; after the flap was settled, the patients performed elbow flexion and extension training exercises.
Elucidating factors influencing machine learning algorithm prediction in spasticity assessment: a prospective observational study
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Natiara Mohamad Hashim, Jingye Yee, Nurul Atiqah Othman, Khairunnisa Johar, Cheng Yee Low, Fazah Akhtar Hanapiah, Noor Ayuni Che Zakaria
In the anatomical point of view, the elbow joint's flexion consists not only of biceps short and long head, but also by brachioradialis, brachialis, and pronator teres. In upper limb spasticity, it is ubiquitous that all of these three muscles are affected (Gharbaoui et al. 2016). Brachioradialis muscle has been shown to be the most spastic of these flexors (Keenan et al. 1990). Total isolation of biceps during evaluation is difficult, and recruitment of other muscles involvement cannot be avoided (Gharbaoui et al. 2016). Hence, sEMG recording on biceps alone might not give true value of spasticity leads to incorrect prediction (Keenan et al. 1990; Gharbaoui et al. 2016). However, this can be overcome by evaluating the reactive resistive magnitude, which gives more reliable value of spasticity, in which this resistance aids in providing subjective appreciation during traditional clinical examination (Kumar et al. 2006; Fleuren et al. 2010).
Bilateral Transcranial Direct Stimulation Over the Primary Motor Cortex Alters Motor Modularity of Multiple Muscles
Published in Journal of Motor Behavior, 2020
JaeHyuk Lee, Yan Jin, BumChul Yoon
We recorded the surface EMG signal of 12 upper extremity muscles using 12-channel surface electrodes (Noraxon Telemyo DTS) which were placed as follows, based on the kinematics of the reaching movements of interest: anterior deltoid (AD), middle deltoid (MD), posterior deltoid (PD), biceps brachii (BB), triceps brachii (TR), brachioradialis (BR), brachialis (BC), upper trapezius (UT), lower trapezius (LT), infraspinatus (IS), latissimus dorsi (LD), and pectoralis major (PM). We prepared the skin to minimize the effect of the skin barrier and fixed the electrodes with adhesive tape to minimize movement-related artifacts. To keep the EMG placement consistent between experimental sessions, we followed the SENIAM recommendations (Hermens, Freriks, Disselhorst-Klug, & Rau, 2000) for seven muscles (anterior, middle, posterior deltoid; biceps brachii; triceps brachii; and upper and lower trapezius) and other previous references for the five muscles (brachioradialis; brachialis; infraspinatus; latissimus dorsi; and pectoralis major) that were not included in the SENIAM study (Staudenmann & Taube, 2015).