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Injuries of the elbow and forearm
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Adam Watts, David Warwick, Mike Uglow, Joanna Thomas
Nerve injury Nerve injuries are rarely caused by the fracture, but they may be caused by the surgeon! Exposure of the radius in its proximal third risks damage to the posterior interosseous nerve where it is covered by the superficial part of the supinator muscle. The proximal fragment of radius may have rotated so the nerve may not be where it is expected. Surgical technique is particularly important here; the anterior Henry approach is safest.
Compression Neuropathies
Published in Gary W. Jay, Practical Guide to Chronic Pain Syndromes, 2016
This motor syndrome is variably the result of tendinous hypertrophy of the arcade of Frohse and the thickening of the radiocapitellar joint capsule. Vascular compression of the artery of Henry (from the recurrent radial artery) has been described. Repetitive supination motion injury from work activities or from crutches pressing on the supinator muscle may contribute to the condition. The symptoms include a progression of paresis of the extensors of the MCP joints, resulting variably in LOS of the finger extensors and of the thumb abductors. Pain may radiate to the neck and shoulder. Clinical testing for this syndrome may proceed as follows: (a) palpation over the PIN under the supinator muscle may elicit pain; (b) the Tinnel sign, tapping over the radial head immediately distal to the lateral epicondyle, may produce tingling along the radial nerve; (c) passive stretching of the third digit may reproduce pain. EMG studies did not show consistent results. Management of the condition is mainly protective and preventive. Rest and gentle exercise may speed recovery. Anesthetic/steroid injections may offer symptomatic relief. Surgery has been successful in fewer than 50% of cases (35,39).
Injuries of the Forearm and Wrist
Published in Louis Solomon, David Warwick, Selvadurai Nayagam, Apley and Solomon's Concise System of Orthopaedics and Trauma, 2014
Louis Solomon, David Warwick, Selvadurai Nayagam
Nerve injuries are rarely caused by the fracture, but they may be caused by the surgeon! Exposure of the radius in its proximal third risks damage to the posterior interosseous nerve where it is covered by the superficial part of the supinator muscle. Surgical technique is particularly important here; the anterior Henry approach is safest to protect the nerve.
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.
Comparison of maximal isometric forearm supination torque in two elbow positions between subjects with and without limited forearm supination range of motion
Published in Physiotherapy Theory and Practice, 2021
Gyeong-Tae Gwak, Ui-Jae Hwang, Sung-Hoon Jung, Jun-Hee Kim, Moon-Hwan Kim, Oh-Yun Kwon
It has been recommended that forearm supination torque and range of motion be assessed in an elbow-flexed position (Reese and Bandy, 2016; Santos, Pauchard, and Guilloteau, 2017; Wong and Moskovitz, 2010). However, Shaaban, Pereira, Williams, and Lees (2008) reported that both pronation and supination range of motion are related to elbow position (flexed or extended). The results of their study showed that greater elbow flexion range of motion was associated with an increase in forearm supination. Furthermore, the forearm supinators are differentially affected by different elbow positions (Muscolino, 2016). The primary forearm supinators are the supinator muscle and the biceps brachii. The recruitment of the supinator muscle during forearm rotation is not influenced by elbow position (Bremer, Sennwald, Favre, and Jacob, 2006; Kisner and Colby, 2012). However, the biceps brachii is normally recruited during higher power supination activities in an elbow-flexed position (Hale, Dorman, and Gonzalez, 2011). Therefore, the elbow position seems to be important when assessing the function of the forearm supinators (Kendall, McCreary, and Provance, 2010; Kisner and Colby, 2012).