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The Spastic Forearm and Hand
Published in Benjamin Joseph, Selvadurai Nayagam, Randall T Loder, Anjali Benjamin Daniel, Essential Paediatric Orthopaedic Decision Making, 2022
Her forearm was pronated, and the wrist was flexed and ulnar deviated (Figure 54.1). Spasticity was noted in the pronator teres, finger flexors and flexor carpi ulnaris. There were no fixed contractures of muscles of the wrist and hand; the deformities could be fully corrected passively. The supinator of the forearm and the extensors of the wrist were weak. The grasp of the right hand was achieved awkwardly with the wrist flexed (Figure 54.2a), and the grip strength was very poor. The release was good with the wrist in flexion (Figure 54.2b). When the wrist was held in dorsiflexion, the grasp of the right hand improved, as did the grip strength. When the wrist was stabilised in 10 degrees of dorsiflexion, she had no problem with release as all her fingers extended fully (Figure 54.3). The fine sensation of the hand was intact with two-point discrimination of less than 10 mm.
Physical Examination of the Hand
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Clinical examination of the patient is not complete without vascular examination. Physical examination is the clinical and primary method to evaluate patients with vascular diseases. It is vital to look for radial pulse in both upper extremities. The radial artery lies more superficial in the forearm running under the anterior aspect of the brachioradialis. It crosses the supinator to enter the anterior and radial aspect of the forearm. We can palpate the radial pulse between the brachioradialis and flexor carpi radialis at the wrist. In 10% of individuals, a persistent median artery is felt along the course of the median nerve. The persistent median artery contributes to form the superficial arch and passes deep to the transverse carpal ligament.
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
If the most proximal portion of the humeral (superficial) head of supinator is tendinous and forms a fibrous arch (arcade of Frohse), this can cause paralysis of the posterior interosseous nerve (Spinner 1968).
Biomechanical analysis of wheelchair athletes with paraplegia during cross-training exercises
Published in The Journal of Spinal Cord Medicine, 2022
Carrie Jones, Alyssa J. Schnorenberg, Kristin Garlanger, Joshua M. Leonardis, Sam Kortes, Justin Riebe, Justin Plesnik, Kenneth Lee, Brooke A. Slavens
While the elbow sagittal plane ROM ranged from 40.7 deg for battle ropes to 69.1 deg for overhead press, no one experienced or even appeared to approach a hyperextended state for any of the exercises. While the prevalence of elbow pain and injury in manual wheelchair users is relatively low at 5–31%,5,38–41 many have stated it to be a significant problem. The prevalence of ulnar mononeuropathy at the elbow of those with SCI is 22–45%.5 This is typically caused by repetitive or prolonged elbow flexion. As all of these four exercises required at least 40.0 deg ROM of rapid and repetitive flexion at the elbow that may further exacerbate this overuse injury, highlighting the importance of training, prescription, and dosing of cross-training exercises (particularly exercises with similar joint demands) in the manual wheelchair user population. The elbow was solely supinated during the sled pull, with an average peak angle of 45.3 deg, and was solely pronated during the overhead press with an average peak of 130.3 deg. While the elbow moved between pronation and supination for both the battle ropes and sledgehammer swing, the sledgehammer swing required almost twice the ROM (66.5 deg) and reached a peak supination angle of 32.0 deg. Given that the strongest supinator is the biceps brachii, this could potentially lead to an increased risk of bicipital tendinitis, which is already a commonly reported cause of shoulder pain in manual wheelchair users.42,43
Stimulated biofeedback training for a child with Becker muscular dystrophy and compartment syndrome in the left forearm
Published in Physiotherapy Theory and Practice, 2022
Merve Kurt, Dilan Savaş, Tülay Tarsuslu Şimşek, Uluç Yiş
NMES is an effective method for improving muscle function in patients with muscular dystrophy (Colson et al., 2010; Scott, Vrbova, Hyde, and Dubowitz, 1986). Biofeedback has been shown to improve function in different disease groups (Dursun, Dursun, and Alican, 2004; Zupan, 1992). Studies have shown that NMES and biofeedback training are effective when used alone (Scott, Vrbova, Hyde, and Dubowitz, 1986; Yoo et al., 2014). We decided to use SBT, combining both NMES and biofeedback training, to treat this child given that NMES and biofeedback methods were both reported to be potentially effective applications for patients with similar diagnoses. Both lower and upper extremities were targeted for SBT treatment. We applied the SBT to the quadriceps and tibialis anterior muscles in the lower extremities because these muscles tend to be affected first and to be weakest in BMD. In the left upper extremity, the SBT was applied to the supinator muscle because of its high impact on function, and since it was the most affected muscle from NCS based on patient complaints. As a precaution, creatine kinase, lactate dehydrogenase, and C-reactive protein were monitored initially and at six and twelve weeks by laboratory testing to ensure the safety of training.
Varicella zoster virus myelitis in a patient with rheumatoid arthritis treated by tofacitinib
Published in Scandinavian Journal of Rheumatology, 2021
T Itamiya, T Komai, Y Tsuchida, H Shoda, K Fujio
A 70-year-old female who had suffered from seropositive RA for 20 years was treated with methylprednisolone 3 mg/day and tofacitinib 10 mg/day. Tofacitinib had been initiated 1.5 years previously owing to adverse reactions associated with or resistance to other conventional and biological DMARDs. She also had diabetes and hypertension. She initially presented with blisters on her right arm, and shingles was diagnosed by her primary care dermatologist. Although oral acyclovir 1000 mg/day was initiated and tofacitinib was ceased, she experienced difficulty in flexing her right arm. Seven days after administration of acyclovir, she came to our hospital and complained of persistent difficulty in flexing her right arm, although all of the blisters had dried up and scabbed over. Neurological examination revealed paresis in the right arm, Medical Research Council (MRC) scores of 1/5 for the right biceps and 3/5 for the right supinator muscle, and absence of a deep tendon reflex of the right biceps, indicating peripheral neuropathy corresponding to the C5–6 levels of the spinal cord.