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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
The musculocutaneous nerve is a terminal branch arising from the lateral cord and contains contributions from C5 to C7. Prior to becoming a terminal sensory nerve, it gives off branches to innervate the coracobrachialis, the biceps brachii and a large portion of the brachialis, which has a dual innervation. Thus, the musculocutaneous nerve helps to power both elbow flexion and forearm supination. Its terminal branch, the lateral antebrachial cutaneous nerve provides sensibility to the anterolateral aspect of the forearm.
RLE Orthopaedic Injury Management
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Jowan Penn-Barwell, Daniel Christopher Allison
HumerusProximal pinsPlaced anterolaterally. Care must be taken to avoid the axillary and musculocutaneous nerves.Distal pinsPlaced directly laterally. The radial nerve is at significant risk (traversing from posterior to anterior in this location) and an open incision with direct visualisation of all bone and soft tissue should be performed.
Diseases of the Peripheral Nerve and Mononeuropathies
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Diana Mnatsakanova, Charles K. Abrams
Course of the musculocutaneous nerve: Arises from the lateral cord of the brachial plexus, carrying fibers from the C5 and C6 nerve roots.Passes through the axilla, pierces the coracobrachialis muscle (giving off branches to it), descends between the biceps and brachialis muscles, giving off branches to both parts of the biceps muscle and the brachialis muscle, and terminates as the lateral antebrachial cutaneous nerve.The sensory branch (lateral antebrachial cutaneous nerve) innervates the skin of the lateral aspect of the forearm from the elbow to the wrist.
Efficacy of tramadol versus dexamethasone in ultrasound guided supraclavicular block for forearm fractures. Does it make a difference?
Published in Egyptian Journal of Anaesthesia, 2023
Wesam Nashat Ali, Mohamed Hassan Bakri, Marwa Mahmoud AbdelRady, Norhan M Bakri, Esraa Gamal Abdel Nasser Fathy, Ola Wahba
Patients were asked to elevate their arms (circumflex nerve), abduct, or adduct their thumbs (radial/ulnar nerve), oppose their thumbs (median nerve), and flex their forearms on their arms (musculocutaneous nerve) to test for motor block (musculocutaneous nerve). Patients were regarded to have a complete motor block when they could not actively raise their hands or move them. This moment was documented and recorded as the beginning of the motor blockade. If required, fentanyl I.V. incremental boluses were added to the intraoperative analgesia 50 ug up to a 100 ug maximum dose. The supraclavicular block was considered unsuccessful if a patient required more than 100 ug of fentanyl to complete the surgery. If fentanyl augmentation wasn’t enough to finish the procedure, propofol intravenously was used to administer general anesthesia (GA): Laryngeal mask airway and infusion. Those patients with unsuccessful blocks were excluded from the study.
Brachial distal biceps injuries
Published in The Physician and Sportsmedicine, 2019
Drew Krumm, Peter Lasater, Guillaume Dumont, Travis J. Menge
The biceps brachii muscle is made up of a short head and a long head. The short head originates on the coracoid process, while the long head originates on the supraglenoid tubercle. They each insert on the radial tuberosity. This muscle’s main action is to supinate the forearm, but it also assists in elbow flexion. Since the short head has a more distal attachment on the tuberosity than the long head, it is a greater contributor to elbow flexion. The long head attaches to the apex of the tuberosity and is a greater contributor to supination than the short head. The biceps is innervated by the musculocutaneous nerve and receives its blood supply from branches of the brachial artery. On clinical exam, the distal biceps tendon may be mistaken for the lacertus fibrosus, also known as the bicipital aponeurosis, which originates from the short head of the biceps and helps protect the neurovascular bundle in the antecubital fossa. The lateral antebrachial cutaneous nerve (LABCN), which is the terminal cutaneous branch of the musculocutaneous nerve, is at risk for injury in operative repair of distal biceps avulsion injuries. It is located between the biceps and brachialis muscles and pierces the deep fascia just lateral to the distal biceps tendon. The nerve is located in the subcutaneous tissue of the antecubital fossa and supplies sensation to the lateral aspect of the forearm. The radial nerve is also at risk for injury. The radial nerve is located between the brachioradialis and brachialis near the distal humerus. It bifurcates into the posterior interosseous nerve and radial sensory nerve in the antecubital fossa [6].
Fascicular turnover flap in the reconstruction of facial nerve defects: an experimental study in rats
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Miyuki Uehara, Wu Wei Min, Moriaki Satoh, Fumiaki Shimizu
The clinical utility of fascicular components as the source of axonal regeneration is well recognized [21,22]. In 1994, Oberlin et al. reported the successful reconstruction of elbow flexion using a separated fascicular flap from an ulnar nerve wherein the distal end was sutured to the musculocutaneous nerve in brachial plexus injury patients [21]. Terzis et al. reported the utility of a separated nerve fascicle of the hypoglossal nerve as the motor source for facial nerve reconstruction [21]. However, the clinical utility of the retrograde fascicular component in reconstructing the nerve gap had not been reported. Koshima et al. [19,20] reported the clinical utility of a fascicular turnover flap. In this report, a digital nerve defect, as well as a the facial nerve gap, was reconstructed with a fascicular turnover flap. Ito et al. [23] successfully applied this procedure to reconstruct a nerve gap after a nerve biopsy. However, the clinical indications and mechanism underlying this procedure remain unclear, and to our knowledge, no comparative study has yet been performed between a traditional autologous nerve graft and a fascicular turnover flap.