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Upper Limb
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
What movements are provided by the myotomes of the upper limb? – abduction of the arm at the glenohumeral joint– flexion of the forearm at the elbow joint– extension of the arm at the elbow joint– flexion of the fingers– abduction and adduction of the index, middle and ring fingers
Surgical Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Describe any motor weakness found by the myotome and reflex abnormalities: Myotomes in the upper limb. Nerve roots C5 to T1 supply the muscles of the upper limb (see Table 5.3).Use the Medical Research Council scale to grade muscle weakness, so that the same terminology is used by each doctor examining the patient (see Table 5.4).Reflexes in the upper limb: assess for the biceps, triceps and supinator upper limb reflexes, which indicate normal or other functioning of certain motor roots (see Table 5.5 for motor roots of the reflexes) use reinforcement (Jendrassik's manoeuvre) before concluding that a reflex is absent, e.g. ask the patient to clench the teeth hard or hold the knees together when testing a reflex.
The Axilla and Brachium
Published in Gene L. Colborn, David B. Lause, Musculoskeletal Anatomy, 2009
Gene L. Colborn, David B. Lause
The neuronal process of spinal nerves grow out into the limb bud, coming to be associated with primordial muscle masses, the myotomes. The myotomes are arranged in a proximal-distal fashion, resulting in the innervation of proximal muscle groups by the higher spinal nerve contributants to the brachial plexus and of distal muscle masses by lower plexus contributants. This arrangement can be seen rather clearly in the following scheme:
Cervical spine thrust and non-thrust mobilization for the management of recalcitrant C6 paresthesias associated with a cervical radiculopathy: a case report
Published in Physiotherapy Theory and Practice, 2022
Christopher R. Hagan,, Alexandra R. Anderson,
Using the diagnostic test cluster by Wainner et al. (2003) to assist the diagnosis, the patient was found to test positive on 3 tests: cervical rotation <45 degrees, cervical distraction (Sn 0.44, Sp 0.90), and Spurling’s test (Sn 0.50, Sp 0.86). The patient also tested positive for median nerve provocation, but this test was modified due to patient irritability and cannot be included in the diagnostic test cluster. The post-test probability for the presence of cervical radiculopathy is estimated to be 65% with three positive tests (Wainner et al., 2003). After consideration of all examination findings, the clinical impression was cervical radiculopathy affecting the C6 spinal nerve root. This impression was supported by the three positive diagnostic tests, positive neural provocation findings, sensation deficits of the first and second digits, as well as myotomal weakness consistent with the C6 nerve root (Caridi, Pumberger, and Hughes, 2011; Downs and Laporte, 2011; Lee, McPhee, and Stringer, 2008).
Progressive arm muscle weakness in ALS follows the same sequence regardless of onset site: use of TOMS, a novel analytic method to track limb strength
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2021
Nimish J. Thakore, Brian J. Drawert, Brittany R. Lapin, Erik P. Pioro
Multiple factors potentially influence the sequence of weakness of muscles in an extremity: (a) segmental spread of neurodegeneration (1), whereby anterior horn cell loss propagates linearly along the length of the spinal cord with sequential involvement of consecutive segments/myotomes, (b) cortical influences, notably cortical representation of a muscle, and handedness (2–4), (c) distance from the spinal cord, which may be inversely related to efficiency of collateral reinnervation (5), (d) normal baseline muscle-specific innervation ratio (6), and (e) normal baseline strength that varies by muscle. From the time of early reports of the “split hand syndrome” (7), differential patterns of muscle weakness in an extremity in amyotrophic lateral sclerosis (ALS) have received considerable attention. Recently, similar patterns of dissociated muscle atrophy are reported, notably “split leg” (8) and “split elbow” (9) syndromes. Such patterns serve not only as diagnostic markers, but also as windows to understand the pathophysiology of progression of ALS.
A comparison of the efficacy of nonweight-bearing and weight-bearing exercise programmes on function and pain pressure thresholds in knee osteoarthritis: a randomised study
Published in European Journal of Physiotherapy, 2021
Vanessa Martins Pereira Silva Moreira, Fabiana da Silva Soares, Wallisen Tadashi Hattori, Valdeci Carlos Dionisio
To evaluate PPTs (Figure 1), a digital force gauge (Force TEN™; FDX Wagner Instruments, Greenwich, United States of America) was used with a flat head 1-inch in diameter and a pain metre for detection and quantification of mechanical hyperalgesia [12]. PPTs at dermatomes were measured in lumbar and sacral segments (L1, L2, L3, L4, L5, S1, and S2). PPTs at myotomes were measured in nine predetermined sites (vastus medialis, vastus lateralis, adductor longus, rectus femoris, tibialis anterior, peroneus longus, iliacus, quadrates lumborum, and popliteous muscles). In addition, PPTs at the sclerotomes of supraspinous ligaments at lumbar and sacral levels (L1–L2, L2–L3, L3–L4, L4–L5, L5–S1, and S1–S2) were evaluated, as well as sclerotomes in pes anserinus bursae and patellar tendon. These dermatomes, myotomes, and sclerotomes are based on the methodology used by Imamura et al. [12] and were chosen because they originate in the same nerve roots of the spinal cord. Thus, the assessment covered both superficial nerve endings (dermatomes) and deep nerve endings (sclerotomes and myotomes) of the same part of the spinal nerves [12]. The digital force gauge was pressed on each of these sites until the pressure became painful for the person. PPTs were measured in the most affected lower limb and expressed in kgf/cm2, with the highest values indicating less severe symptoms.