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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
Extensor carpi radialis longus and brevis (radial nerve) and extensor carpi ulnaris (radial nerve) are wrist extensors. Wrist extension can be tested similarly to wrist flexion, except asking the patient to extend. It is important to have the patient make a fist when assessing wrist extension to avoid trick wrist extension by using finger extensors.
Upper Limb Muscles
Published in Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Handbook of Muscle Variations and Anomalies in Humans, 2022
Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo
Extensor carpi radialis longus shares a developmental origin with extensor carpi radialis brevis so these muscles may be completely or partially fused (Macalister 1875; Knott 1883a; Mori 1964; Albright and Linburg 1978; Bergman et al. 1988; Akita and Nimura 2016b; Standring 2016). The muscle belly or tendon of extensor carpi radialis longus can split into multiple slips prior to insertion (Macalister 1875; Knott 1883a; Mori 1964; Bergman et al. 1988; Tountas and Bergman 1993; Akita and Nimura 2016b; Standring 2016). This muscle may send a slip to the first metacarpal, third metacarpal, fourth metacarpal, or the trapezium (Macalister 1875; Knott 1883a; Albright and Linburg 1978; Bojsen-Møller 1978; Bergman et al. 1988; Lewis 1989; Akita and Nimura 2016b; Standring 2016). Its tendon may send a slip to brachioradialis (Macalister 1875). It may also have connections to abductor pollicis longus or to the interosseous muscles (Macalister 1875; Bergman et al. 1988; Akita and Nimura 2016b). Extensor carpi radialis longus may be trigastric and insert onto both the first and second metacarpals (Bergman et al. 1988; Akita and Nimura 2016b). Yang et al. (2018) report a similar case in which the lateral and intermediate heads of a trigastric extensor carpi radialis longus muscle fused and inserted onto the second metacarpal while the medial head merged with extensor carpi radialis brevis.
The effects of pistol grip power tools on median nerve pressure and tendon strains
Published in International Journal of Occupational Safety and Ergonomics, 2022
Ryan Bakker, Mayank Kalra, Sebastian S. Tomescu, Robert Bahensky, Naveen Chandrashekar
The arms were dissected to expose and isolate the wrist flexor and extensor tendons from their muscle bodies. Specifically, those muscle tendons providing the largest individual contributions to wrist stabilization during a maximum gripping task were exposed as described by Rossi et al. [17]. These included the tendons of the FDP, FDS, extensor digitorum communis (EDC), extensor carpi radialis brevis, extensor digitorum indicis, extensor pollicis longus and extensor carpi radialis longus. Tendons from the muscles that contribute to gripping but do not cross the wrist joint, such as the adductor pollicis oblique head and flexor pollicis brevis, were not exposed. Each of the five exposed tendons was sutured to a stainless-steel cable using surgical sutures. The FDS, FDP and EDC muscles each have four individual tendons that were sutured together to their individual cables.
The effect of two types of maximal voluntary contraction and two electrode positions in field recordings of forearm extensor muscle activity during hotel room cleaning
Published in International Journal of Occupational Safety and Ergonomics, 2020
Camilla Dahlqvist, Henrik Enquist, Lotta Löfqvist, Catarina Nordander
The extensor carpi radialis longus and brevis were located in the right forearm by palpation, while the subject performed a voluntary contraction with the forearm resting on a table, with a pronated forearm and an extended wrist. The skin was cleansed with alcohol and rubbed with emery cloth. We applied two Ag/AgCl electrodes (Ambu Neuroline 720, Denmark) to the skin above the most prominent part of the muscles, which was approximately one third of the distance from the lateral epicondyle to the styloid process of the ulna (position 2; Figure 1) [6]. Two additional electrodes were applied proximally to the original pair (position 1; Figure 1). In this way, recordings could be made at two positions for each subject. Position 2 is the location used in our previous studies of workload [2]. Positions 1 and 2 correspond to positions A and C, respectively, in the study by Dahlqvist et al. [12]. The centre-to-centre distance between the electrodes was 20 mm, and the active diameter of the electrodes was 6 mm.
Pull-in suture: a novel reconstruction technique for tendon avulsion injury at the musculotendinous junction associated with forearm open fracture
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Yuta Izawa, Yoshihiko Tsuchida, Hiroko Murakami, Tetsuya Shirakawa, Masahiro Nishida, Kentaro Futamura
A male patient aged 49 years sustained an injury in the right upper extremity when it was caught in an agricultural machine. We diagnosed the patient with right humeral shaft fracture, right forearm open fracture with a Gustilo–Anderson classification of type 3 A, multiple rib fractures, liver injury, and right lung contusion, with associated right radial nerve insufficiency paralysis. On the day of the injury, irrigation and debridement of the open wound and wire fixation for forearm fractures were performed. When the open wound was extended and damaged structure was confirmed, the damage was localized to the dorsal side of the forearm, and no neurovascular injury was observed. The extensor pollicis longus (EPL), extensor digitorum (EDC), extensor digitorum minimi (EDM), and extensor carpi ulnaris (ECU) tendons were pulled out at the musculotendinous junction and completely torn. Although extensor carpi radialis longus (ECRL) and extensor carpi radialis brevis (ECRB) were intact, it was difficult to extend the wrist joint. Since there was a decrease in sensation in the radial nerve region, it was judged to be due to radial nerve insufficiency paralysis associated with a humeral shaft fracture. The open wound was closed. Osteosynthesis was performed for humeral shaft fracture on the 3rd day of injury, and the EPL, EDC, EDM, and ECU were reconstructed using pull-in sutures. On the 10th day of injury, the skin necrosis was debrided, and the wire that had been inserted in the ulnar was replaced with an intramedullary nail. After the tendons repair surgery, strong tension to the tendons was avoided as much as possible, and only passive tenodesis-like motion was allowed for 3 weeks. Active and passive range of motion training was initiated 3 weeks postoperatively. Since there was no flexor tendon injury, range of motion training of the finger and wrist was initiated with the goal being two-stage tendon transfer. Three months after the injury, we planned to perform osteosynthesis for the radial shaft fracture using a plate, along with extensor tendon reconstruction with tendon transfer if required; however, we did not perform the tendon transfer because the range of motion of the fingers had improved (Figure 2). One year after the injury, the TAM of the thumb was good and the TAM of the index finger to the little finger was good to excellent (Table 1). The wrist joint active palmar flexion and active dorsiflexion were 55° and 65°, respectively, and the DASH score was 10.8. The radial nerve palsy had recovered completely. Although mild restriction in wrist flexion remained, the patient resumed his job in agriculture (Figure 3).