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Upper 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
Breisch (1986) states that an accessory subscapularis muscle can create a myotendinous tunnel through which the axillary and subscapular nerves pass, which may lead to nerve entrapment and its associated neurological symptoms. Pires et al. (2017) similarly state that an accessory subscapularis passing over the axillary nerve can contribute to quadrangular space compression syndrome.
Surgery of the Shoulder
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Nick Aresti, Omar Haddo, Mark Falworth
A retractor can be placed over the coracoid process to enhance the exposure and the clavipectoral fascia is then split vertically starting just lateral to the coracoid. This exposes the conjoint tendon. If required, the lateral third of the conjoint tendon can be divided to allow better exposure (by not detaching the coracoid or the tendon fully, the musculocutaneous nerve is protected from excessive traction). A self-retainer is placed between the coracoid/conjoint tendon medially and the deltoid muscle laterally. The arm is externally rotated to expose the subscapularis muscle. The upper two-thirds of the subscapularis can then be tenotomized approximately 1 cm from its insertion in the lesser tuberosity and dissected free of the underlying capsule. This plane is more easily found inferiorly and becomes easier as the dissection progresses medially. Alternatively, the subscapularis can be split horizontally and retracted, exposing the underlying capsule.
Musculoskeletal system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Ultrasound is especially useful in the shoulder for the high incidence of rotator cuff disorders. The four rotator cuff muscles are the subscapularis muscle at the anterior aspect of the shoulder, the supraspinatus at its superior aspect and the infraspinatus and teres minor, which are situated at the posterior aspect.
Anatomical feasibility study of the infraspinatus muscle neurotization by lower subscapular nerve
Published in Neurological Research, 2023
Aneta Krajcová, Michal Makel, Gautham Ullas, Veronika Němcová, Radek Kaiser
LSN seems to be an ideal donor nerve for neurotization, because the larger pectoralis and latissimus dorsi muscles would compensate for the loss of internal rotation typically provided by the subscapularis and teres major muscles [26]. However, if the entire nerve was used for neurotization, the subscapularis muscle would be still partially innervated by upper subscapular nerve [27]. Samardzic et al. found in their clinical series that sectioning of the LSN does not alter shoulder and arm movement significantly [28]. Moreover, Tubbs et al. showed that the teres major branch can be used as a donor for neurotization of musculocutaneous or axillary nerve without disconnecting the branch to the subscapularis muscle. They found that the mean length of the terminal branch of the LSN was 6 cm (3.3–8.9) [5]. These data are similar to our results (mean length 6.64 cm). We found that the nerve transfer was feasible in more than 94% of the cases without denervation of the subscapularis muscle. In one case (No 12), however, both nerve stumps were so short that direct end-to-end suture would not be possible without using a nerve graft.
Electromyographic analysis of select eccentric-focused rotator cuff exercises
Published in Physiotherapy Theory and Practice, 2022
Takumi Fukunaga, Karl F. Orishimo, Malachy P. McHugh
Surface EMG electrodes were attached to each participant’s skin on the side of the dominant arm, over 5 muscles: supraspinatus, infraspinatus, upper trapezius, lower trapezius, and middle deltoid. Out of the four muscles composing the rotator cuff, supraspinatus and infraspinatus were selected for study because most cases of rotator cuff disease involve the tendons of these two muscles and subscapularis muscle is difficult to study with surface EMG (McCrum, 2020). Before electrode attachment, each participant’s skin was prepared by shaving, cleaning with an alcohol pad, and lightly abrading with sandpaper. Disposable Ag/AgCl passive dual electrodes (2.0 cm inter-electrode distance; Noraxon, Scottsdale, AZ, USA) were placed over the 5 muscles at previously described sensor placement locations (Waite, Brookham, and Dickerson, 2010). Surface EMG data were sampled at 1000 Hz using a 16-channel BTS FREEEMG 1000 system (CMRR: >110 dB at 50–60 Hz; input impedance: >10 GΩ; BTS Bioengineering, Quincy, MA, USA).
Shoulder abduction reconstruction for C5–7 avulsion brachial plexus injury by dual nerve transfers: spinal accessory to suprascapular nerve and partial median or ulnar to axillary nerve
Published in Journal of Plastic Surgery and Hand Surgery, 2022
Gavrielle Hui-Ying Kang, Fok-Chuan Yong
The distal nerve transfer (with either a partial median or ulnar nerve) to the axillary nerve was performed via an anterior axillary approach. The axillary nerve was identified anteriorly at the inferior border of the subscapularis muscle just before it entered the quadrangular space. (Figure 1) Zhao et al. [14] reported that although the nerve has not yet divided into branches at this level, two fascicular groups can be identified: one lateral and one medial. They are enclosed within an outer-epineurium. The lateral fascicular group continues as the anterior branch of the axillary nerve while the medial fascicular group continues as the posterior branch. A vessel loop was similarly placed around the nerve for later identification, after the prepared donor nerve is ready for coaptation to the axillary nerve. For the neurorrhaphy, the recipient fascicular groups of the axillary nerve were prepared by performing a transverse partial outer-epineurotomy on the anterior wall of the nerve and neurotomy of the fascicular groups. The posterior wall of the outer-epineurium was kept intact, such that there would be minimal retraction of the fascicular groups at their cut ends (Figure 2) – which facilitated the nerve coaptation.