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Radial Club Hand
Published in Benjamin Joseph, Selvadurai Nayagam, Randall T Loder, Anjali Benjamin Daniel, Essential Paediatric Orthopaedic Decision Making, 2022
Nicholas Peterson, Christopher Prior, Selvadurai Nayagam
A 10-month-old boy was referred with a deformity of the right upper limb present from birth. He had a short forearm with severe radial deviation of the wrist and the absence of two digits including the thumb (Figure 34.1).1 Movements of the shoulder were normal, and elbow flexion was to 90 degrees. There were no anomalies in the other limbs, and there were no signs of systemic disease. Associated anomalies of the cardiovascular system, the haemopoietic system and the gastrointestinal and genitourinary tracts had been ruled out with appropriate investigations.
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.
The elbow
Published in David Silver, Silver's Joint and Soft Tissue Injection, 2018
Restoration of functional movement following injection can be encouraged with regular movement in a pain-free range repeated every few hours. The initial emphasis should be on improving elbow flexion, as this is vital in many everyday activities, such as eating and personal hygiene.
The reanimation of the elbow functions in avulsive injuries of the upper brachial plexus using the medial cord transfer: nuances of the technique and update
Published in Neurological Research, 2023
Stefano Ferraresi, Elisabetta Basso, Lorenzo Maistrello, Piero Di Pasquale
A British Medical Council (BMC) score of M5, i.e. normal strength, is considered impossible to attain after nerve repair, because fatigue is supposed to appear after prolonged and repetitive muscle contraction. Yet some of our best scores have a power and a volume of the muscle practically indistinguishable from a normal condition. However, to anticipate criticisms, we will label as M4 all the results from good to excellent. Results below M3 are considered failures, because ultimately unable to maintain elbow flexion In the very first phase of recovery , the flexion of the wrist and fingers initiates and then supports the contraction of biceps and brachialis. As muscle power increases, however, the elbow flexion can be obtained without clenching the fist, with wrist and fingers completely outstretched and a supinated forearm.
Biomechanical analysis of wheelchair athletes with paraplegia during cross-training exercises
Published in The Journal of Spinal Cord Medicine, 2022
Carrie Jones, Alyssa J. Schnorenberg, Kristin Garlanger, Joshua M. Leonardis, Sam Kortes, Justin Riebe, Justin Plesnik, Kenneth Lee, Brooke A. Slavens
While the elbow sagittal plane ROM ranged from 40.7 deg for battle ropes to 69.1 deg for overhead press, no one experienced or even appeared to approach a hyperextended state for any of the exercises. While the prevalence of elbow pain and injury in manual wheelchair users is relatively low at 5–31%,5,38–41 many have stated it to be a significant problem. The prevalence of ulnar mononeuropathy at the elbow of those with SCI is 22–45%.5 This is typically caused by repetitive or prolonged elbow flexion. As all of these four exercises required at least 40.0 deg ROM of rapid and repetitive flexion at the elbow that may further exacerbate this overuse injury, highlighting the importance of training, prescription, and dosing of cross-training exercises (particularly exercises with similar joint demands) in the manual wheelchair user population. The elbow was solely supinated during the sled pull, with an average peak angle of 45.3 deg, and was solely pronated during the overhead press with an average peak of 130.3 deg. While the elbow moved between pronation and supination for both the battle ropes and sledgehammer swing, the sledgehammer swing required almost twice the ROM (66.5 deg) and reached a peak supination angle of 32.0 deg. Given that the strongest supinator is the biceps brachii, this could potentially lead to an increased risk of bicipital tendinitis, which is already a commonly reported cause of shoulder pain in manual wheelchair users.42,43
Comparison of maximal isometric forearm supination torque in two elbow positions between subjects with and without limited forearm supination range of motion
Published in Physiotherapy Theory and Practice, 2021
Gyeong-Tae Gwak, Ui-Jae Hwang, Sung-Hoon Jung, Jun-Hee Kim, Moon-Hwan Kim, Oh-Yun Kwon
The first has to do with characteristics of the forearm supinators. The primary forearm supinators are the supinator and the biceps brachii (O’Sullivan and Gallwey, 2005). The supinator muscle, which is weaker than the biceps brachii, is not influenced by elbow position (Bremer, Sennwald, Favre, and Jacob, 2006; Kisner and Colby, 2012). In contrast, the biceps brachii is normally involved during higher-power supination activities or those associated with an elbow-flexed position (Bremer, Sennwald, Favre, and Jacob, 2006; Neumann, 2010). Because of its attachments and the direction of the muscle fibers, the moment arm of the biceps brachii decreases as the elbow is extended (Bremer, Sennwald, Favre, and Jacob, 2006; Murray, Delp, and Buchanan, 1995; Muscolino, 2016). Elbow flexion of 90° is adequate for the biceps brachii to generate powerful forearm supination torque (Bremer, Sennwald, Favre, and Jacob, 2006; O’Sullivan and Gallwey, 2002). Therefore, even though the capacity of the supinator muscle to generate forearm supination torque is reduced in LSR group, the biceps brachii could compensate for this reduced function in the elbow-flexed position. Thus, it might be difficult to assess the capacity to generate forearm supination torque of the supinator muscle with the elbow flexed to 90° (Kendall, McCreary, and Provance, 2010; Kisner and Colby, 2012). However, when the elbow is extended, the biceps brachii is unable to generate adequate torque to compensate for the reduced function of the supinator muscle (Bremer, Sennwald, Favre, and Jacob, 2006).