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Distal Conduction Blocks
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand
The median nerve is first lateral to the brachial artery (Figures 1.31B, 1.55, and 1.57). At the level of the insertion of the coracobrachialis muscle, it passes over (or sometimes behind) the artery, reaches its medial side, then descends through the arm within the sulcus bicipitalis medialis. At the elbow, it is separated from the joint by the brachialis muscle. It enters the forearm betwen the two heads of the pronator teres muscle. It supplies the lateral half of the palm and the back of the first fingers (Figure 1.58).
Preoperative Simulation and Three-Dimensional Model for the Operative Treatment of Forearm Double Fracture: A Randomized Controlled Clinical Trial
Published in Journal of Investigative Surgery, 2022
Yin Zhang, Junchao Luo, Li Cao, Shuijun Zhang, Yu Tong, Qing Bi, Qiong Zhang
The patients were required to lay on their backs and were placed under local anesthesia. A tourniquet was applied to the upper limb and the operation was conducted in a sterile area. Henry approach was used on the metacarpal side of the forearm to cut the skin and subcutaneous tissue in order to expose the flexor carpi radialis, radial artery, and separated artery. The surgeon then entered the space between the brachioradialis muscle and the radial carpal flexor muscle, peeled off the starting point of the pronator muscle and the pronator teres muscle under the periosteum, and then exposed the fracture end. For the ulnar fracture, a longitudinal surgical incision was made at the center, and the skin, subcutaneous tissue, and deep fascia were cut. Thereafter, the surgeon entered the space between the ulnar wrist flexor muscle and ulnar wrist extensor muscle to expose the fracture end.
Isolating the Superficial Peroneal Nerve Motor Branch to the Peroneus Longus Muscle with Concentric Stimulation during Diagnostic Motor Nerve Biopsy
Published in The Neurodiagnostic Journal, 2022
Ashley Rosenberg, Rachel Pruitt, Sami Saba, Justin W. Silverstein, Randy S. D’Amico
Motor nerve biopsy is a frequent final diagnostic tool to distinguish motor neuropathy from motor neuron disease and may be performed with associated muscle biopsy to diagnose myopathy in patients with focal or diffuse motor weakness. Accurate diagnosis is critical as treatment with immunoglobulin can be effective in select motor neuropathies (Latov et al. 1988; Pestronk et al. 1988). Biopsy of the gracilis muscle and obturator nerve, and the pronator teres muscle and the motor branch of the median nerve supplying it, have been described for diagnosis in suspected lower or upper extremity disease processes, respectively (Berman et al. 1985; Corbo et al. 1997; Dy et al. 2012; Kinoshita et al. 2014). Recently, a technique to biopsy the motor branch to the peroneus longus muscle was described as adequate and sufficient to enable diagnosis in patients with suspected motor neuropathy (D’Amico and Winfree 2017). We describe our techniques for intraoperative neuromonitoring for preservation of motor function during this approach which, to-date have not been described.