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Clinical Assessment and Management of Spasticity and Contractures in Traumatic Brain Injury
Published in Anand D. Pandyan, Hermie J. Hermens, Bernard A. Conway, Neurological Rehabilitation, 2018
He had previously received oral tizanidine, but had to discontinue due to drowsiness. He has been receiving botulinum toxin injections to his finger flexors over the last several years (dose range 50–100 units of onabotulinumtoxinA). While spasticity of digits III–V has improved to the point that he is able to once again type on a keyboard, tightness of the digit II flexor has made it impossible to use all fingers for this particular activity. He subsequently received 100 units of onabotulinumtoxinA chiefly to the part of the flexor digitorum superficialis muscle that appeared to represent fibres to digit II (as visualised on ultrasound). This resulted in relaxation of this digit, allowing him to re-train bimanual keyboard use. His Ashworth score improved from 2 to 1. When the spasticity recurred about 3 months later, i.e., the Ashworth score increased to 2 and he became unable to actively extend digit II, he received 125 units of onabotulinumtoxinA. The injection was once again limited to the part of the flexor digitorum superficialis muscle to digit II, confirmed by ultrasound. About 3 weeks later, the Ashworth score improved to 0, and although the patient felt some weakness in finger flexion, he was able to resume training on bimanual keyboard use.
The neurological examination
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Flexor digitorum superficialis muscle (Figure 11.1k) Innervation: Median nerve (C7-T1).Function: Flexion of middle and proximal phalanges of medial four digits; flexion of wrist joint.Physical examination: With the proximal phalanx fixed, the patient flexes the proximal interphalangeal joint (arrow) against resistance.
The Antebrachium
Published in Gene L. Colborn, David B. Lause, Musculoskeletal Anatomy, 2009
Gene L. Colborn, David B. Lause
The flexor digitorum superficialis muscle is the sole “occupant” of the second layer of muscles of the forearm and is often considered simply as another muscle of the superficial layer. This approach to the “layering” of the muscles is especially understandable if there is not a palmaris longus muscle present.
Deficits underlying handgrip performance in mildly affected chronic stroke persons
Published in Topics in Stroke Rehabilitation, 2021
Esther Prados-Román, Irene Cabrera-Martos, Laura López-López, Janet Rodríguez-Torres, Irene Torres-Sánchez, Araceli Ortiz-Rubio, Marie Carmen Valenza
Jung et al.4 demonstrated that persons with weakness of the ipsilesional upper limb maximally recovered within 1-month poststroke but remained impaired in comparison with controls. Persistent impaired reaction time within the first year poststroke has been shown, indicating that ipsilesional upper limbs deficits might not be a temporary event.39,40 It has been shown that both the precision- and power-grip tasks activated the primary sensorimotor cortex contralateral to the grasping hand. The activations extended into the dorsal premotor cortex and the postcentral sulcus. Furthermore, the ventral premotor cortex showed bilateral activation with peaks of activity in the inferior part of the precentral gyrus.41 Among common assumptions motor deficits caused by disruption of ipsilesional projections of the corticospinal tract42 and changes in ipsilesional motor performance after nonaffected primary motor cortex disinhibition43 are included. However, little is known about the time course evolution of ipsilesional handgrip assessment, and even less about its implications for rehabilitation.40,44 Previous studies45,46 have reported difficulties in most clinical tests to detect fine changes in motor performance, specially the subtle ipsilesional motor deficits. Our study found significant differences on grip and pinch resistance to fatigue in the ipsilesional hand in comparison with controls. Moreover, significant differences were found on flexor digitorum superficialis muscle fatigue during a sustained handgrip contraction.