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Lower 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, Malynda Williams
The second and third plantar interosseous muscles may receive a slip from the tendon of fibularis longus (Edama et al. 2020). The interossei may have accessory origins from the plantar ligaments and/or the fascia of adjacent muscles (Kalin and Hirsch 1987). The first plantar interosseous muscle may extend into the dorsal part of the second interosseous space (Manter 1945). The second and third plantar interossei may originate from the sheath of the fibularis longus tendon (Ochiltree 1912). The second plantar interosseus may take partial origin from adductor hallucis (Kalin and Hirsch 1987). Accessory slips may be present connecting the plantar and dorsal interossei (Manter 1945). The plantar and dorsal interossei may also be fused (Manter 1945). The tendons of the interossei may be bifurcated upon insertion and attach to two separate digits (Hallisy 1930; Manter 1945). The insertions into the dorsal digital expansions may be missing in some cases (Manter 1945; Oukouchi et al. 1992).
A to Z Entries
Published in Clare E. Milner, Functional Anatomy for Sport and Exercise, 2019
The muscles of the hand can be divided into three groups; those of the thumb (thenar muscles), the little finger (hypothenar muscles), and the palmar region between the metacarpals. The muscles of the thumb are abductor pollicis brevis, opponens pollicis, adductor pollicis, and flexor pollicis brevis, which variously abduct, adduct, and flex the thumb. Opponens pollicis also rotates the first metacarpal to bring the thumb in front of the palm facing the fingers, the opposed position that enables the hand to grip objects firmly between the thumb and fingers. The muscles of the little finger are the abductor digiti minimi, flexor digiti minimi brevis, and opponens digiti minimi. These muscles abduct and flex the little finger. The opponens digiti minimi also rotates the fifth metacarpal, so that the little finger faces the thumb; like the opposition of the thumb, this contributes to the ability of the hand to grasp effectively. The muscles of the palmar region are the lumbricals and the dorsal and palmar interossei, which flex the metacarpophalangeal joints (knuckles) and extend the interphalangeal joints of the fingers. The palmar interossei also adduct the fingers towards the middle finger and the dorsal interossei have the opposite function of abducting the fingers.
Exercise-Induced Improvement in Motor Learning
Published in Henning Budde, Mirko Wegner, The Exercise Effect on Mental Health, 2018
While the previously reported studies examined LTP-like neuroplasticity, one study assessed LTD-like plasticity mechanisms by means of excitability decreasing theta burst stimulation (cTBS) (McDonnell, Snow, Campbell, Ross, & Boyd 2013). The authors tested 25 subjects that went through three experimental conditions: moderate-intensity cycling (15 min at 77% of age-predicted HRmax), low-intensity cycling (30 min at 57%), and an inactive control condition. Interestingly, the results showed that low-intensity cycling suppressed MEPs of the first dorsal interosseus muscle, while moderate intensity exercise as well as the control condition failed to do so. While neither exercise condition produced an increase in BDNF levels, a 10% increase in cortisol levels was exclusively registered in the moderate exercising group. Given this, the authors hypothesized that elevated cortisol levels may have interfered with BDNF expression and plasticity induction. However, this finding contrasts the observations of Mang et al. (2014), where a positive effect of acute high-intensity exercise on neuroplasticity was found.
Facial diplegia with paresthesia associated with anti-GD1a antibodies
Published in Baylor University Medical Center Proceedings, 2022
Jason Strawbridge, Katherine A. Fu, Joy Chan, William Flavin, Joss Cohen, Inna Keselman, Perry Shieh
A 26-year-old previously healthy man presented to his physician with a sore throat for 1 week. He completed a course of amoxicillin for presumed pharyngitis. One week later, he awoke with right-sided facial paralysis and was prescribed prednisone and acyclovir for a presumed Bell’s palsy. Over the following week, he developed bilateral facial paralysis, numbness in his fingers and toes, and mild weakness of his right hand and leg. The patient’s medical, social, and family histories were unremarkable. On presentation, neurologic exam revealed symmetric facial diplegia with no movement when attempting to smile, purse lips, raise eyebrows, or close eyelids (Figure 1). Examination of all other cranial nerves revealed no abnormalities. Motor exam was notable for 4/5 strength in the interossei of the right hand and all muscle groups of the right lower extremity. He was areflexic throughout, with sensory deficits to pinprick in a stocking-glove distribution bilaterally.
Simultaneous ALS and SCA2 associated with an intermediate-length ATXN2 CAG-repeat expansion
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2021
Helia Ghahremani Nezhad, John P. Franklin, James J. P. Alix, Tobias Moll, Michael Pattrick, Johnathan Cooper-Knock, Priya Shanmugarajah, Nick J. Beauchamp, Marios Hadjivissiliou, David Paling, Christopher Mcdermott, Pamela J. Shaw, Thomas M. Jenkins
We present a previously well, 67-year old Caucasian female, with no family history of neurological disease. She presented with a two month history of difficulty walking; examination revealed evidence of cerebellar dysfunction including limb ataxia and horizontal nystagmus on lateral gaze; accompanied by evidence of motor neuron degeneration including weakness of right hip flexion and right-sided brisk reflexes. Six months after symptom onset she had developed bilateral wasting of the dorsal interossei, globally reduced power with increased muscle tone and brisk reflexes, and dysarthria with tongue fasciculations. MRI with single-photon emission computed tomography revealed bilateral atrophy of the cerebellar vermis and hemispheres. EMG confirmed active and chronic denervation in three segments, fulfilling Awaji-Shima electrodiagnostic criteria for ALS. Genetic testing revealed a heterozygous ATXN2 expansion: she carried an uninterrupted 32 CAG-repeat expansion and a normal length allele containing 22 repeats with one interruption of CAA at position 9. No significant mutation was identified in any other ALS gene contained within our clinical genetic panel (https://www.sheffieldchildrens.nhs.uk/download/321/ngs/9291/next-generation-sequencing-v7.pdf). Eighteen months after symptom onset she required noninvasive ventilation for respiratory failure.
A Natural History of Silent Brain Syndrome over 36 Years: A case report
Published in Orbit, 2021
Nathan Pirakitikulr, David T. Tse
Given the prior medical history and unusual constellation of clinical findings, the patient was referred to neurosurgery and endocrinology for evaluation. The consulting neurosurgeon found no indication of shunt failure or over-drainage based on clinical exam and therefore did not recommend shunt revision or removal. A review of the patient’s neurosurgical records revealed that 1 year after shunt placement the patient had undergone a pneumoencephalogram to determine shunt patency and identify any obstructions in the ventricular system. No abnormalities were noted in this report. An endocrinological evaluation, which included an assessment of adrenocortical, thyroid and insulin function, was normal except for a low leptin hormone level (0.6 ng/mL, reference: 1.2–9.5 ng/mL BMI-adjusted). On physical exam, he was noted to have significant loss of subcutaneous adipose tissue on the face and neck, temporalis fossa, and moderately diminished fat on the chest, abdomen and extremities. Atrophy of the dorsal interossei of the hand was a prominent feature (Figure 2a). The consulting endocrinologist described the patient’s appearance as “gaunt” owing to the sunken cheeks and hollowed temples, in addition to the enophthalmos. The patient was started on pioglitazone, a diabetes drug aimed to promote subcutaneous fat deposition by restoring the body’s proper response to insulin. The treatment had no beneficial effect and was discontinued. No further systemic workups or treatments were recommended.