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Motor Neurological Examination of the Hand and Upper Limb
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
The patient's arm should be supported. The brachioradialis tendon is identified at the wrist. It inserts at the base of the styloid process of the radius, usually about 1 cm lateral to the radial artery. If it is difficult to identify the tendon, the patient is asked to hold their forearm as in a sling and flex this semi-pronated forearm against resistance offered by the examiner. By this step, the brachioradialis muscle and tendon stand out. The examiner's hand supports the patient's forearm. The examiner then places the thumb of his hand on the biceps tendon while tapping the brachioradialis tendon with the other hand.
Analgesia and Anaesthesia
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
The ulnar nerve lies lateral to the tendon of flexor carpi ulnaris, adjacent to the ulnar artery. The median nerve lies between the tendons of palmaris longus and flexor carpi radialis. The radial nerve is posterolateral to the brachioradialis.
Anterior/Volar (Henry’s) Approach to the Forearm
Published in Raymond Anakwe, Scott Middleton, Trauma Vivas for the FRCS (Tr & Orth), 2017
Raymond Anakwe , Scott Middleton
I would extend the incision down through fat, taking care not to damage the cephalic vein, then identify the deep fascia. I would incise the deep fascia of the forearm in line with the skin incision. I would then identify the ulnar border of brachioradialis and develop the plane between it and flexor carpi radialis (FCR) distally and pronator teres proximally. Brachioradialis is the retracted laterally and pronator teres/FCR is taken medially. It may be necessary to ligate/coagulate the leash of Henry (recurrent branches of the radial artery) to mobilise the brachioradialis laterally and the radial artery medially. The superficial radial nerve runs on the underside of brachioradialis and is retracted laterally with the muscle.
AIN to PIN transfer for PIN palsy following distal biceps tendon repair: a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Jillian A. Fairley, Parham Daneshvar
A lateral incision at the elbow was utilized, extending an existing incision from prior tendon repair proximally to the lateral humeral epicondyle and distally down the forearm. Full-thickness flaps were raised over the extensor mechanism. The extensors were split at the level of the previous surgery (which was a more posterior EDC split), while extending the split proximally and distally (Figure 4(a)). Deep to the extensor mechanism, supinator was identified, and the PIN was found proximally (Figure 4(b)). The radial sensory nerve was seen going deep to brachioradialis. The PIN was then followed distally, and the supinator was split to follow the nerve (Figure 4(c)). About one quarter of the way into the supinator, there was extensive scar tissue and a neuroma. The dissection was continued distally and for a few centimeters there was no identifiable fascicles seen. Near the distal end of the supinator and further distal, multiple branches of the PIN were identified going into the extensor muscles. However, only branches were present and not the PIN as a single bundle. The intact branches were followed further distal, to assess their path, and more proximal toward the zone of injury where they were neurolysed from adhesions. There was no continuity with the proximal extent of the PIN.
COVID-19 and MOG-IgG–associated acquired demyelinating polyneuropathy compatible with chronic inflammatory demyelinating polyneuropathy in a previously healthy girl
Published in Baylor University Medical Center Proceedings, 2022
Asra Akbar, Gregory M. Blume, Sean Creeden, Sharjeel Ahmad
A previously healthy 9-year-old, right-hand–dominant girl presented with an 8-week history of progressive weakness of the bilateral lower extremities with resultant falls. At the time of presentation, she was unable to walk without frequent tripping and falling. She walked with a high-step and “slapping gait.” There was no known history of sick contacts and no recent travel prior to presentation. There was no history of diarrhea, fever, headache, mental status changes, cough, congestion, or bowel and bladder habit changes. Eight weeks after symptom onset, she presented to our facility. Her bilateral hip flexion was 4+/5; bilateral quadriceps and hamstring strength, 4+/5; bilateral ankle flexion and ankle extension, 2/5; ankle inversion and eversion, 2/5; bilateral knee flexion strength, 4/5; bilateral finger flexion, extension, and handgrip, 4-/5; and bilateral deltoids, biceps, and triceps, 5/5. Mentation was normal and there was no cranial nerve involvement or neck and truncal muscle weakness. Reflexes at the bilateral biceps and brachioradialis were diminished at 1+. Reflexes at the ankles and knees were absent bilaterally. Sensation was intact to light touch throughout. Romberg’s sign was positive. Vibration sensation was decreased, and there was a discrepancy with toe proprioception. She was ataxic, had a bilateral foot drop, could not walk steadily without falling, was unable to walk on her toes and her heels, and required a gait training belt with maximum standby assistance. Her blood pressure, heart rate, and negative inspiratory pressure were normal.
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).