Avulsion Fracture of Brachioradialis Muscle Origin: an Exceedingly Rare Entity: a Case Report
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Body Mechanics As the Rotator Cuff Gether in a Cuff-Shape Across the Greater and Lesser Tubercles the on Head of the Humerus
EXPerT CONTENT Body Mechanics by Joseph E. Muscolino | Artwork Giovanni Rimasti | Photography Yanik Chauvin Rotator Cuff Injury www.amtamassage.org/mtj WORKING WITH CLieNTS AFFecTED BY THIS COmmON CONDITION ROTATOR CUFF GROUP as the rotator cuff group because their distal tendons blend and attach to- The four rotator cuff muscles are gether in a cuff-shape across the greater and lesser tubercles on the head of the supraspinatus, infraspinatus, the humerus. Although all four rotator cuff muscles have specific concen- teres minor, and subscapularis (Fig- tric mover actions at the glenohumeral (GH) joint, their primary functional ure 1). These muscles are described importance is to contract isometrically for GH joint stabilization. Because 17 Before practicing any new modality or technique, check with your state’s or province’s massage therapy regulatory authority to ensure that it is within the defined scope of practice for massage therapy. the rotator cuff group has both mover and stabilization roles, it is extremely functionally active and therefore often physically stressed and injured. In fact, after neck and low back conditions, the shoulder is the most com- Supraspinatus monly injured joint of the human body. ROTATOR CUFF PATHOLOGY The three most common types of rotator cuff pathology are tendinitis, tendinosus, and tearing. Excessive physi- cal stress placed on the rotator cuff tendon can cause ir- ritation and inflammation of the tendon, in other words, tendinitis. If the physical stress is chronic, the inflam- matory process often subsides and degeneration of the fascial tendinous tissue occurs; this is referred to as tendinosus. The degeneration of tendinosus results in weakness of the tendon’s structure, and with continued Teres minor physical stress, whether it is overuse microtrauma or a macrotrauma, a rotator cuff tendon tear might occur. -
Identification and Surgical Management of Upper Arm and Forearm Compartment Syndrome
Open Access Case Report DOI: 10.7759/cureus.5862 Identification and Surgical Management of Upper Arm and Forearm Compartment Syndrome Adel Hanandeh 1 , Vishnu R. Mani 2 , Paul Bauer 1 , Alexius Ramcharan 3 , Brian Donaldson 1 1. General Surgery, Columbia University College of Physicians and Surgeons at Harlem Hospital Center, New York, USA 2. Surgery, Columbia University College of Physicians and Surgeons at Harlem Hospital Center, New York, USA 3. Surgery, Harlem Hospital Center, New York, USA Corresponding author: Adel Hanandeh, [email protected] Abstract Extremity muscles are grouped and divided by strong fascial membranes into compartments. Multiple pathological processes can result in an increase in the pressure within a muscle compartment. An increase in the compartment pressure beyond the adequate perfusion pressure has the potential to cause extremity compartment syndrome. There are multiple sites where compartment syndrome can occur. In this article, an arm and forearm compartment syndrome ensued secondary to a minor crushing injury that lead to supracondylar and medial epicondylar non-displaced fractures. A pure motor radial and ulnar nerve deficits noted on presentation, worsened with progression of the compartment syndrome. Ultimately, a surgical fasciotomy was carried out to release all compartments of the right upper arm and forearm. Categories: General Surgery, Orthopedics, Anatomy Keywords: upper arm compartment syndrome, fasciotomy, forearm compartment syndrome, condylar fracture, pediatric supracondylar humerus fracture Introduction In 1872, the first description of compartment syndrome was published by Richard von Volkmann. His publication described an irreversible contracture of muscles due to ischemic process resulting in the first documented nerve injury and contracture from compartment syndrome. -
Exposure of the Forearm and Distal Radius
Exposure of the Forearm and Distal Radius Melissa A. Klausmeyer, MDa, Chaitanya Mudgal, MDb,* KEYWORDS Henry approach Thompson approach Flexor carpi radialis approach Dorsal distal radius approach Distal radius approach KEY POINTS The use of internervous planes allow access to the underlying bone without risk of denervating the overlying muscles. The choice of approach is based on the injury pattern and need for exposure. The Henry and Thompson approaches are useful for radial shaft fractures. The distal radius can be approached volarly through the flexor carpi radialis (FCR) approach or dorsally through the extended Thompson approach. The extended FCR approach is useful for intraarticular fractures of the distal radius as well as mal- unions and subacute fractures. INTRODUCTION ANATOMY OF THE FOREARM Muscles Safe operative approaches to the bones of the forearm and wrist include the use of internervous The muscles of the forearm are split into 4 compart- planes. These planes lie between muscles that ments: The superficial volar, the deep volar, the are innervated by different nerves. By utilizing extensor, and the mobile wad (Table 1). The median these planes for dissection, extensive mobilization nerve supplies all of the volar muscles of the forearm of muscles and therefore large areas of exposure except the ulnar half of the flexor digitorum profun- may be obtained without the risk of muscle dus and the flexor carpi ulnaris that are supplied denervation. by the ulnar nerve. The radial nerve proper supplies A successful operative plan also must include the brachioradialis and extensor carpi radialis lon- consideration of the soft tissues, particularly gus. -
The Branching and Innervation Pattern of the Radial Nerve in the Forearm: Clarifying the Literature and Understanding Variations and Their Clinical Implications
diagnostics Article The Branching and Innervation Pattern of the Radial Nerve in the Forearm: Clarifying the Literature and Understanding Variations and Their Clinical Implications F. Kip Sawyer 1,2,* , Joshua J. Stefanik 3 and Rebecca S. Lufler 1 1 Department of Medical Education, Tufts University School of Medicine, Boston, MA 02111, USA; rebecca.lufl[email protected] 2 Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA 94305, USA 3 Department of Physical Therapy, Movement and Rehabilitation Science, Bouve College of Health Sciences, Northeastern University, Boston, MA 02115, USA; [email protected] * Correspondence: [email protected] Received: 20 May 2020; Accepted: 29 May 2020; Published: 2 June 2020 Abstract: Background: This study attempted to clarify the innervation pattern of the muscles of the distal arm and posterior forearm through cadaveric dissection. Methods: Thirty-five cadavers were dissected to expose the radial nerve in the forearm. Each muscular branch of the nerve was identified and their length and distance along the nerve were recorded. These values were used to determine the typical branching and motor entry orders. Results: The typical branching order was brachialis, brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, supinator, extensor digitorum, extensor carpi ulnaris, abductor pollicis longus, extensor digiti minimi, extensor pollicis brevis, extensor pollicis longus and extensor indicis. Notably, the radial nerve often innervated brachialis (60%), and its superficial branch often innervated extensor carpi radialis brevis (25.7%). Conclusions: The radial nerve exhibits significant variability in the posterior forearm. However, there is enough consistency to identify an archetypal pattern and order of innervation. These findings may also need to be considered when planning surgical approaches to the distal arm, elbow and proximal forearm to prevent an undue loss of motor function. -
Neurology of the Upper Limb
Neurology of the Upper limb Donald Sammut Hand Surgeon Kings Upper Limb Anatomy plus lecture notes The$Neck$ The$Nerve$roots$which$supply$the$Upper$Limb$are$C5$to$T1$ Pre<fixed$(C4$to$C8)$and$Post<fixed$(C6$to$T2)$plexus$not$uncommon.$ Also$common$contributions$from$C4$and$from$T2$in$a$normally$rooted$plexus.$ $ The$anterior$nerve$roots$emerge$between$the$vertebrae$and$immediately$pass$ $through$the$first$area$of$possible$compression:$ The$root$nerve$canal$is$bounded$$ Anteriorly$by$the$posterior$margin$of$the$intervertebral$disc$and$$ Posteriorly,$by$the$facet$joint$between$vertebrae.$ $ Pathology$of$the$disc,$or$joint,$or$both,$can$narrow$this$channel$and$compress$ $the$nerve$root$ The$roots$emerge$from$the$cervical$spine$into$the$plane$between$$ Scalenius$Anterior$and$Scalenius$Medius.$$ $ Scalenius*Anterior:** Origin:$Anterior$tubercles$of$Cervical$vertebae$C3$to$6$(C6$tubercle$is$the$Carotid$tubercle)$ Insertion:$The$scalene$tubercle$on$inner$border/upper$surface$1st$rib$ $ Scalenius*Medius:* Origin:$Posterior$tubercles$of$all$cervical$vertebrae$ Insertion:$Quadrangular$area$between$the$neck$and$subclavian$groove$1st$rib$ $ Exiting$from$the$Scalenes,$the$trunks$lie$in$the$posterior$triangle$of$the$neck.$ The$posterior$triangle$is$bounded$anteriorly$by$SternoCleidoMastoid$and$$ posteriorly$by$the$Trapezius.$ The$inferior$border$is$the$clavicle$.$ The$apex$of$the$triangle$superiorly$is$at$the$back$of$the$skull$on$the$superior$nuchal$line$ $ $ The$Posterior$Triangle$ SternoCleidoMastoid$ Trapezius$ Scalenius$Medius$ Scalenius$Anterior$ -
Bone Limb Upper
Shoulder Pectoral girdle (shoulder girdle) Scapula Acromioclavicular joint proximal end of Humerus Clavicle Sternoclavicular joint Bone: Upper limb - 1 Scapula Coracoid proc. 3 angles Superior Inferior Lateral 3 borders Lateral angle Medial Lateral Superior 2 surfaces 3 processes Posterior view: Acromion Right Scapula Spine Coracoid Bone: Upper limb - 2 Scapula 2 surfaces: Costal (Anterior), Posterior Posterior view: Costal (Anterior) view: Right Scapula Right Scapula Bone: Upper limb - 3 Scapula Glenoid cavity: Glenohumeral joint Lateral view: Infraglenoid tubercle Right Scapula Supraglenoid tubercle posterior anterior Bone: Upper limb - 4 Scapula Supraglenoid tubercle: long head of biceps Anterior view: brachii Right Scapula Bone: Upper limb - 5 Scapula Infraglenoid tubercle: long head of triceps brachii Anterior view: Right Scapula (with biceps brachii removed) Bone: Upper limb - 6 Posterior surface of Scapula, Right Acromion; Spine; Spinoglenoid notch Suprspinatous fossa, Infraspinatous fossa Bone: Upper limb - 7 Costal (Anterior) surface of Scapula, Right Subscapular fossa: Shallow concave surface for subscapularis Bone: Upper limb - 8 Superior border Coracoid process Suprascapular notch Suprascapular nerve Posterior view: Right Scapula Bone: Upper limb - 9 Acromial Clavicle end Sternal end S-shaped Acromial end: smaller, oval facet Sternal end: larger,quadrangular facet, with manubrium, 1st rib Conoid tubercle Trapezoid line Right Clavicle Bone: Upper limb - 10 Clavicle Conoid tubercle: inferior -
Trapezius Origin: Occipital Bone, Ligamentum Nuchae & Spinous Processes of Thoracic Vertebrae Insertion: Clavicle and Scapul
Origin: occipital bone, ligamentum nuchae & spinous processes of thoracic vertebrae Insertion: clavicle and scapula (acromion Trapezius and scapular spine) Action: elevate, retract, depress, or rotate scapula upward and/or elevate clavicle; extend neck Origin: spinous process of vertebrae C7-T1 Rhomboideus Insertion: vertebral border of scapula Minor Action: adducts & performs downward rotation of scapula Origin: spinous process of superior thoracic vertebrae Rhomboideus Insertion: vertebral border of scapula from Major spine to inferior angle Action: adducts and downward rotation of scapula Origin: transverse precesses of C1-C4 vertebrae Levator Scapulae Insertion: vertebral border of scapula near superior angle Action: elevates scapula Origin: anterior and superior margins of ribs 1-8 or 1-9 Insertion: anterior surface of vertebral Serratus Anterior border of scapula Action: protracts shoulder: rotates scapula so glenoid cavity moves upward rotation Origin: anterior surfaces and superior margins of ribs 3-5 Insertion: coracoid process of scapula Pectoralis Minor Action: depresses & protracts shoulder, rotates scapula (glenoid cavity rotates downward), elevates ribs Origin: supraspinous fossa of scapula Supraspinatus Insertion: greater tuberacle of humerus Action: abduction at the shoulder Origin: infraspinous fossa of scapula Infraspinatus Insertion: greater tubercle of humerus Action: lateral rotation at shoulder Origin: clavicle and scapula (acromion and adjacent scapular spine) Insertion: deltoid tuberosity of humerus Deltoid Action: -
Evaluation of Humeral and Glenoid Bone Deformity in Glenohumeral Arthritis 5
Evaluation of Humeral and Glenoid Bone Deformity 1 in Glenohumeral Arthritis Brian F. Grogan and Charles M. Jobin Introduction glenoid bone wear helps the surgeon formulate a successful treatment plan and surgical goals Glenohumeral arthritis is the sequela of a vari- to address the pathoanatomy and improve the ety of pathologic shoulder processes, most durability of shoulder arthroplasty. The evalu- commonly degenerative osteoarthritis, but may ation of humeral and glenoid bone deformity also be secondary to post-traumatic conditions, in glenohumeral arthritis has profound surgical inflammatory arthritis, rotator cuff tear arthrop- implications and is fundamental to successful athy, and postsurgical conditions most com- shoulder arthroplasty. monly post-capsulorrhaphy arthritis. Patients with glenohumeral arthritis commonly demon- strate patterns of bony deformity on the glenoid Glenoid Deformity in Osteoarthritis and humerus that are caused by the etiology of the arthritis. For example, osteoarthritis com- Glenoid deformity and glenohumeral subluxation monly presents with posterior glenoid wear, are commonly seen in the setting of primary osteo- secondary glenoid retroversion, and posterior arthritis of the glenohumeral joint. The glenoid humeral head subluxation, while inflammatory wear tends to occur posteriorly and may be best arthritis routinely causes concentric glenoid viewed on axial radiographs or computed tomog- wear with central glenoid erosion. A thorough raphy (CT) axial images. Glenoid erosion, as first history and physical, as well as laboratory and characterized by Walch, is noted to be either central radiographic workup, are keys to understanding or posterior, with varying degrees of wear and pos- the etiology of arthritis and understanding the terior subluxation of the humerus [1, 2] (Fig. -
Humerus Fracture
Portsmouth Hospitals NHS Trust Virtual Fracture Clinic Patient information Humerus Fracture Specialist Support This leaflet can be made available in another language, large print or another format. Please speak to the Virtual Fracture Clinic who can advise you Humerus VFC DCR leaflet 18 5871.indd 1 12/12/2018 09:42:15 This information leaflet follows up your recent conversation with the Fracture Clinic, where your case was reviewed by an orthopaedic Consultant (Bone specialist). You have sustained a fracture (break) to your Humerus (upper arm bone). The Virtual Fracture Clinic letter will detail where the fracture is. This is a very painful injury due to muscle spasms and the bone ends moving. Regular painkillers will be required during your healing stage to aid recovery. The treatment centre you attended will have provided you with a type of sling called a “collar and cuff”. This is the correct type of sling initially for this type of injury. This should be worn at all times. If you are worried that you are unable to follow this rehabilitation plan, or have any questions, then please contact us by using the contact numbers on the front of this leaflet. Healing: It takes approximately 12 weeks to heal. To fully resolve can take up to 1 year. Pain and This can be a painful injury. You are likely to swelling: experience significant swelling & bruising that can track down your chest, arm and into your hand. Take regular painkillers and ensure regular movement of fingers wrist and elbow. You may find it easier to sleep in an upright position. -
Muscles of the Upper Limb.Pdf
11/8/2012 Muscles Stabilizing Pectoral Girdle Muscles of the Upper Limb Pectoralis minor ORIGIN: INNERVATION: anterior surface of pectoral nerves ribs 3 – 5 ACTION: INSERTION: protracts / depresses scapula coracoid process (scapula) (Anterior view) Muscles Stabilizing Pectoral Girdle Muscles Stabilizing Pectoral Girdle Serratus anterior Subclavius ORIGIN: INNERVATION: ORIGIN: INNERVATION: ribs 1 - 8 long thoracic nerve rib 1 ---------------- INSERTION: ACTION: INSERTION: ACTION: medial border of scapula rotates scapula laterally inferior surface of scapula stabilizes / depresses pectoral girdle (Lateral view) (anterior view) Muscles Stabilizing Pectoral Girdle Muscles Stabilizing Pectoral Girdle Trapezius Levator scapulae ORIGIN: INNERVATION: ORIGIN: INNERVATION: occipital bone / spinous accessory nerve transverse processes of C1 – C4 dorsal scapular nerve processes of C7 – T12 ACTION: INSERTION: ACTION: INSERTION: stabilizes / elevates / retracts / upper medial border of scapula elevates / adducts scapula acromion / spine of scapula; rotates scapula lateral third of clavicle (Posterior view) (Posterior view) 1 11/8/2012 Muscles Stabilizing Pectoral Girdle Muscles Moving Arm Rhomboids Pectoralis major (major / minor) ORIGIN: INNERVATION: ORIGIN: INNERVATION: spinous processes of C7 – T5 dorsal scapular nerve sternum / clavicle / ribs 1 – 6 dorsal scapular nerve INSERTION: ACTION: INSERTION: ACTION: medial border of scapula adducts / rotates scapula intertubucular sulcus / greater tubercle flexes / medially rotates / (humerus) adducts -
Discharge Instructions After Humerus/Clavicle Surgery
DISCHARGE INSTRUCTIONS AFTER HUMERUS/CLAVICLE SURGERY INCISIONAL CARE: •Dressings are to be kept clean and dry. A small amount of clear drainage or bleeding may take place. The dressing should be changed daily as instructed by the nursing staff. •Some swelling around the incision is normal. You will find it more comfortable to wear loose clothing to avoid pressure on the incision. •You may shower in 3 days. •Never, ever remove your own stitches or trim what may appear to be excess suture material. We will remove your stitches in the office at your post-op appointment. If you are concerned about your stitches or if they are bothering you, please call us. ICE THERAPY •Apply ice to your shoulder to help decrease pain and swelling. Use your Iceman machine 2-3 times per day for 20 minutes per session. Instructions are on the lid of the Iceman and in handout. ACTIVITY: •The arm should be kept in the shoulder sling until you are seen in the office. •You may want to place a pillow behind your elbow when seated or lying down to keep the surgery area forward to help decrease pain. •Don’t use the arm to push yourself up in bed or from a chair because this requires forceful contraction of muscles. Use the opposite arm. •Don’t lift anything heavier than a glass of water for the first 6 weeks after surgery. •Remember that you will probably tire more easily than usual. You may want to plan a rest period of 30 to 60 minutes mid-morning and midafternoon. -
Midshaft Humerus (Arm) Fractures
Midshaft Humerus (arm) Fractures Patient Information Orthopaedic Clinic, Wellington and Kenepuru Hospitals You have broken the bone of your upper arm Pain relief which is called the Humerus. This is a painful injury As this is a very painful injury it is important that and the following information will be helpful as you take pain medication frequently and correctly you recover. to help control your pain. We recommended that adults take a combination of: This information is on caring for your cast. Read this information carefully before leaving the Paracetamol (Panadol) for pain and fever. 1 Orthopaedic clinic and ask the staff about anything gram (2 tablets) every 4-6 hours. Do not exceed you are unsure of. more than 4 grams (8 tablets) over a 24 hour period An anti- inflammatory medicine such as Treatment voltaren or neurofen morning and night time to Your fractured humerus may be treated in a reduce swelling number of ways. Usually a special cast called a U- slab is applied. This cast fits over your shoulder Please tell us if you are allergic to any medications and goes down to your elbow. or have any reason not to take these medications. You will need to wear a collar and cuff sling to help A prescription should be provided for you to support your wrist whilst still allowing your broken obtain pain relief medication. You can also buy the bone to mend. This collar and cuff sling is an medicines from your local Pharmacy without a important part of your treatment and must always prescription.