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Surgery of the Peripheral Nerve
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Ravikiran Shenoy, Gorav Datta, Max Horowitz, Mike Fox
A clavicular osteotomy may be required to facilitate access, especially if there is a vascular injury. In this case a plate should be precontoured and holes predrilled for easy fixation at the end of the procedure, remembering that the bone will be shortened by the thickness of the saw blade. Distally the pectoralis major muscle is detached from the humerus in its upper portion or, if required, its entirety. The muscle is then reflected medially exposing the clavicle, pectoralis minor muscle and clavipectoral fascia (Figure 5.12). The pectoralis minor muscle is divided at its tendon taking care not to damage the musculocutaneous nerve. The subclavius muscle is divided with the suprascapular vessels (once ligated). This exposes the entire plexus and vasculature from the first rib to the axilla.
Thoracic outlet syndromes
Published in Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson, Operative Thoracic Surgery, 2017
Hugh A. Gelabert, Erdogan Atasoy
On reaching the apex of the axilla, the subclavian vein is identified. In front of this lies the subclavius muscle ligament attaching onto the first rib. Behind the vein lies the anterior scalene muscle. These are dissected free of surrounding tis- sue using a Kitner dissector. The anterior scalene muscle is divided over a right angle. The subclavius muscle tendon is elevated over a tonsil clamp and divided.
Axillo-subclavian venous thrombosis in the setting of thoracic outlet syndrome
Published in Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki, Handbook of Venous and Lymphatic Disorders, 2017
Aurelia T. Calero, Karl A. Illig
The original problem is caused by compression of the subclavian vein by the anterior junction of the clavicle and first rib at the CCJ (Figures 24.1 and 24.2), and less commonly by a cervical rib, hypertrophied anterior scalene muscle, elongated C7 process, or hypertrophied subclavius muscle. Stents in this area have been definitively proven to have insufficient radial force and strength to withstand this pressure,1 and virtually all agree that bony decompression is required. While the clavicle can be resected with surprisingly little morbidity,13 it is easiest and cosmetically appropriate to remove the first rib. There is a minority opinion that the rib can be left alone after a first episode of thrombosis,14 but short-term recurrence rates approach 30% when the underlying condition responsible for the venous occlusion is neglected.7 A recent meta-analysis clearly shows that removing the rib after successful lysis results in significantly improved outcomes,15 and this is the policy followed by most clinicians today.
Muscle co-contraction in an upper limb musculoskeletal model: EMG-assisted vs. standard load-sharing
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
Ehsan Sarshari, Matteo Mancuso, Alexandre Terrier, Alain Farron, Philippe Mullhaupt, Dominique Pioletti
The origins/insertions, via points, and wrapping objects of 42 muscles spanning the upper extremity joints were defined from the MRI scans, including subclavius, serratus anterior upper/middle/lower, trapezius C1-C6/C7/T1/T2-T7, levator scapulae, rhomboid minor/major T1-T2/major T3-T4, pectoralis minor/major clavicular/major sternal/major ribs, latisimuss dorsi thoracic/lumbar/Iliac, deltoid clavicular/acromial/scapular, supraspinatus, infraspinatus, subscapularis, teres minor/major, coracobrachialis, triceps brachii long/medial/lateral, biceps brachii short/long, brachialis, brachioradialis, supinator, pronator Teres, flexor carpi radialis/ulnaris, and extensor carpi radiali long/radialis bervis/ulnaris (Ingram 2015). Each muscle group of the model can be represented by up to 20 strings (Figure 3). Three strings per muscle were considered for the simulations of this study.
Paget-Schroetter Syndrome: a case report of diagnosis, treatment, and outcome in a healthy 18-year-old athletic swimmer
Published in The Physician and Sportsmedicine, 2020
Almaan El-Attrache, Eric Kephart
PSS is a subdivision of thoracic outlet syndrome (TOS), specifically, venous thoracic outlet syndrome (VTOS). TOS is a collection of symptoms that arises from compression of the neurovascular bundle (brachial plexus and subclavian vessels) of the thoracic outlet. Common sites of compression in the thoracic outlet are the costoclavicular space enclosed by the first rib and clavicle (where the subclavian vein is most vulnerable to compression), the anterior and middle scalene muscles, subclavius muscles, and the angle between the coracoid process and pectoralis minor. In order of frequency of presentation, neurogenic TOS (90-95%), VTOS (5%), and arterial TOS (1%) are the subdivisions that arise depending on structures compressed. The clinical presentation of TOS is often a combination of all 3 subdivisions. In the setting of an isolated venous presentation, VTOS arises from compression of or an obstruction in the axillary-subclavian vein via 3 further subdivisions/mechanisms: intermittent/positional compression due to repetitive motions without obstructive thrombosis, primary obstruction via spontaneous thrombosis as in PSS, or secondary obstruction via induced thrombosis as a consequence of catheter or pacemaker lead insertion [2,3].
Flexibility and strength training in asthma: A pilot study
Published in Journal of Asthma, 2018
Sara Olenich, Graeme Waterworth, Gary J. Badger, Bruce Levy, Elliot Israel, Helene M. Langevin
Breathing retraining does not typically include attention to posture and dysfunction of the chest wall and shoulder girdle musculature, including chronic shortened (or lengthened) muscles and associated connective tissues. It is well recognized that the pathophysiology and symptomatology of asthma are complex and extend beyond the lung to involve psychosocial factors and neuroimmune stress responses (22). It is also clear that the uncomfortable sensations experienced by asthmaFigure 1 patients during an exacerbation are complex and have strong affective overlays (23). Although the typical chest “tightness” described by asthmatic patients is believed to be primarily due to bronchoconstriction (23), the possibility that dysfunction and “tension” of skeletal muscles may contribute to this sensation of tightness has received little attention. The diaphragm and intercostal muscles are used in breathing, and depending on the degree of respiratory effort, other muscles can participate as well, including classical accessory muscles of breathing (sternocleidomastoid and scalene) and some less commonly recognized including: serratus anterior and posterior, pectoralis major and minor, trapezius, latissimus dorsi, levatores costarum, transversus thoracis, and subclavius (24). These same muscles are involved in maintaining posture, as well as performing voluntary movements of the trunk, neck, and shoulder girdle. A study comparing subjects with and without asthma found that asthmatics had more postural abnormalities including forward head and shoulder position, lower chest wall expansion, decreased shoulder internal rotation, decreased thoracic spine flexibility, and muscle shortening (25). Although these musculoskeletal and postural dysfunctions might be a consequence of asthma, it is also possible that they contribute to its disease manifestations. If this is true, correcting posture and improving muscular function might lead to an improvement of asthma symptoms.