Anatomical Considerations of Fascial Release in Ulnar Nerve Transposition: a Concept Revisited
Total Page:16
File Type:pdf, Size:1020Kb
Load more
Recommended publications
-
Cubital Tunnel Syndrome
Cubital Tunnel Syndrome What many people call the “funny bone” really is a nerve. This ulnar nerve runs behind a bone in the elbow through a space Figure 1: Ulnar Nerve at elbow joint (inner side of elbow) called the “cubital tunnel” (Figure 1). Although “banging the funny bone” usually causes temporary symptoms, chronic pressure on or stretching of the nerve can affect the blood supply to the ulnar nerve, causing numbness or tingling in the ring and small fingers, pain in the forearm, and/or weakness in the hand. This is called “cubital tunnel syndrome.” Humerus Causes There are a few causes of this ulnar nerve problem. These include: Pressure. Because the nerve runs through that “funny bone” groove and has little padding over it, direct pressure (like leaning your arm on an arm rest) can compress the nerve, causing your arm and hand—especially the ring and small fingers—to Ulnar Nerve “fall asleep.” Stretch. Keeping the elbow bent for a long time can stretch Medial Epicondyle the nerve behind the elbow. This usually happens during sleep. Anatomy. Sometimes, the ulnar nerve does not stay in its place and snaps back and forth over a bony bump as the elbow is moved. Repetitive snapping can irritate the nerve. Sometimes, the soft tissues over the nerve become thicker or there is an Ulna “extra” muscle over the nerve that can keep the nerve from working correctly. Treatment Signs and Symptoms The first treatment is to avoid actions that cause symptoms. Cubital tunnel syndrome can cause pain, loss of sensation, Wrapping a pillow or towel around the elbow or wearing a splint and/or tingling. -
Musculoskeletal Ultrasound Technical Guidelines II. Elbow
European Society of MusculoSkeletal Radiology Musculoskeletal Ultrasound Technical Guidelines II. Elbow Ian Beggs, UK Stefano Bianchi, Switzerland Angel Bueno, Spain Michel Cohen, France Michel Court-Payen, Denmark Andrew Grainger, UK Franz Kainberger, Austria Andrea Klauser, Austria Carlo Martinoli, Italy Eugene McNally, UK Philip J. O’Connor, UK Philippe Peetrons, Belgium Monique Reijnierse, The Netherlands Philipp Remplik, Germany Enzo Silvestri, Italy Elbow Note The systematic scanning technique described below is only theoretical, considering the fact that the examination of the elbow is, for the most, focused to one quadrant only of the joint based on clinical findings. 1 ANTERIOR ELBOW For examination of the anterior elbow, the patient is seated facing the examiner with the elbow in an extension position over the table. The patient is asked to extend the elbow and supinate the fore- arm. A slight bending of the patient’s body toward the examined side makes full supination and as- sessment of the anterior compartment easier. Full elbow extension can be obtained by placing a pillow under the joint. Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint, a Pr perpendicular to the humeral shaft. Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis mu- Br scles. Alongside and medial to these muscles, follow the brachial artery and the median nerve: * the nerve lies medially to the artery. * Legend: a, brachial artery; arrow, median nerve; arrowheads, distal biceps tendon; asterisks, articular cartilage of the Humerus humeral trochlea; Br, brachialis muscle; Pr, pronator muscle 2 distal biceps tendon: technique The distal biceps tendon is examined while keeping the patient’s forearm in maximal supination to bring the tendon insertion on the radial tuberosity into view. -
Structure of the Flexor Digitorum Superficialis
Okajimas Folia Anat. Jpn., 56(5) : 277-288, December 1979 Structure of the Flexor Digitorum Superficialis By OSAMU OHTANI Department of Anatomy, Okayama University Medical School, Okayama 700, Japan (Director : Prof. Dr. H. Outi) —Received for Publication, March 9, 1979— Key Words: Flexor digitorum superficialis, Striated muscle, Forearm musculature. Summary. Fifty-two forearms of 26 Japanese adult cadavers were examined. The flexor digitorum superficialis can be separated into two layers: a superficial layer and a deep layer. The superficial layer is composed of the radial head and the superficial part of the humeroulnar head. It forms two muscle bellies which give rise to the tendons for the third and fourth digits, respectively. The deep layer is composed of the deep part of the humeroulnar head. After forming an inter- mediate tendon, the deep layer also divides into two fleshy bellies which give rise to the tendons for the second and fifth digits, respectively. Based on the mode of occurrence of the communicating muscle fasciculi between the superficial layer and the deep layer, the flexor digitorum superficialis can be classified into four types. Type I muscle has no communicating fasciculus (4/52, 7.7%). Type II muscle has a communicating muscle fasciculus between the intermediate tendon and the muscle belly for the fourth digit (muscle fasciculus A) (29/52, 55.8%). Type III muscle has the muscle fasciculus A as well as another communicating muscle fasciculus between the intermediate tendon and the belly for the third digit (muscle fasciculus B) (18/52, 34.6%). Type IV muscle has the muscle fasciculus B only (1/52, 1.9%). -
Disclosures Flexor Pronator Strain
11/19/2018 Flexor Pronator Strain, Epicondylitis, Avulsions Lee Kaplan, MD Director, UHealth Sports Medicine Institute Professor, Department of Orthopaedics, Kinesiology & Sports Science, Biomedical Engineering Medical Director and Head Team Physician, University of Miami Athletics Medical Director and Head Team Physician, Miami Marlins Josue Acevedo, MD Orthopaedics Sports Medicine fellow Disclosures • I have no conflicts of interest in relation to this presentation 2 Flexor Pronator Strain • Anatomy • Function • Forces • Clinical Presentation • Imaging Studies • Treatment 3 1 11/19/2018 Anatomy • Common Flexor Tendon origin - Medial Epicondyle Pronator Teres FCR Palmaris Longus FDS FCU 4 Function • Provides dynamic support to valgus stress during throwing motion • Contraction during early arm acceleration resists valgus and flexes wrist during ball release 5 Elbow Forces • Elbow valgus torque peaks at late cocking phase - during maximal shoulder external rotation (MER) • Can approach torque up to 120 N.m • Significantly higher torque in pitchers who enduring an injury Sawbick et al. JSES, 2004 Adam WA. AJSM, 2010. 6 2 11/19/2018 • Fastballs caused the greatest torque • Curveballs produced the greatest arm speed . • Predictors of increased elbow torque • Increased ball velocity • Higher BMI • Decreased arm slot • Protectors against elbow torque. • Increasing age • longer arm length • greater elbow circumference were independent 7 • VAS fatigue scores increased 0.72 points per inning • Medial elbow torque increased beyond inning 3, increase of 0.84 N·m each inning. • Pitch velocity decreased (0.28 mph per inning) • There were no differences in arm rotation or arm speed as the game progressed. • Arm slot decreased with each successive inning (0.73° on average per inning) ***These findings signify a possible relationship between fatigue and injury risk. -
Cubital Tunnel Syndrome)
DISEASES & CONDITIONS Ulnar Nerve Entrapment at the Elbow (Cubital Tunnel Syndrome) Ulnar nerve entrapment occurs when the ulnar nerve in the arm becomes compressed or irritated. The ulnar nerve is one of the three main nerves in your arm. It travels from your neck down into your hand, and can be constricted in several places along the way, such as beneath the collarbone or at the wrist. The most common place for compression of the nerve is behind the inside part of the elbow. Ulnar nerve compression at the elbow is called "cubital tunnel syndrome." Numbness and tingling in the hand and fingers are common symptoms of cubital tunnel syndrome. In most cases, symptoms can be managed with conservative treatments like changes in activities and bracing. If conservative methods do not improve your symptoms, or if the nerve compression is causing muscle weakness or damage in your hand, your doctor may recommend surgery. This illustration of the bones in the shoulder, arm, and hand shows the path of the ulnar nerve. Reproduced from Mundanthanam GJ, Anderson RB, Day C: Ulnar nerve palsy. Orthopaedic Knowledge Online 2009. Accessed August 2011. Anatomy At the elbow, the ulnar nerve travels through a tunnel of tissue (the cubital tunnel) that runs under a bump of bone at the inside of your elbow. This bony bump is called the medial epicondyle. The spot where the nerve runs under the medial epicondyle is commonly referred to as the "funny bone." At the funny bone the nerve is close to your skin, and bumping it causes a shock-like feeling. -
Cubital Tunnel Syndrome
Cubital Tunnel Syndrome What is it? Signs and Symptoms Cubital tunnel syndrome is a condition brought on by Cubital tunnel syndrome symptoms usually include increased pressure on the ulnar nerve at the elbow. pain, numbness, and/or tingling. The numbness or There is a bump of bone on the inner portion of the tingling most often occurs in the ring and little fingers. elbow (medial epicondyle) under which the ulnar The symptoms are usually felt when there is pressure on nerve passes. This site is commonly called the “funny the nerve, such as sitting with the elbow on an arm rest, bone”(see Figure 1). At this site, the ulnar nerve lies or with repetitive elbow bending and straightening. directly next to the bone and is susceptible to pressure. Often symptoms will be felt when the elbow is held in a When the pressure on the nerve becomes great enough bent position for a period of time, such as when holding to disturb the way the nerve works, then numbness, the phone, or while sleeping. Some patients may notice tingling, and pain may be felt in the elbow, forearm, weakness while pinching, occasional clumsiness, and/ hand, and/or fingers. or a tendency to drop things. In severe cases, sensation may be lost and the muscles in the hand may lose bulk What causes it? and strength. Pressure on the ulnar nerve at the elbow can develop in several ways. The nerve is positioned right next to the bone and has very little padding over it, Figure 1: Ulner nerve at elbow joint (inner side of elbow) so pressure on this can put pressure on the nerve. -
Ultrasonograpic Assessment of Relationship Between the Palmaris Longus Tendon and the Flexor Retinacular Ligament and the Palmar Aponeurosis of the Hand
Original Article Ultrasonograpic Assessment of Relationship Between the Palmaris Longus Tendon and the Flexor Retinacular Ligament and the Palmar Aponeurosis of the Hand Kadir Ertem1, Ahmet Sığırcı2, Salih Karaca1, Aykut Sığırcı3, Yunus Karakoç4, Saim Yoloğlu5 İnonu University, Faculty of Medicine, ABSTRACT Departments of Orthopedics and Trauma- tology1, Radioloy2, Physiology4 and Biosta- Aim: This study aimed to evaluate the presence of the Palmaris Longus tistics5, Malatya, Turkey Tendon (PLT) and the relationship between the Flexor Retinacular Ligament (FRL) and the Palmar Aponeurosis (PA) of the hand. 319 Mayıs University, Faculty of Medicine, Departments of Orthopaedics and Trauma- Method: 62 voluntary subjects (31 female, 31 male students and per- tology, Samsun, Turkey sonnel from the Inonu University, at the average age 28.38 ± 6.86 years ranging from 19 to 48 years) took part in this study using ultrasound. Eur J Gen Med 2010;7(2):161-166 Received: 16.05.2009 Result: Significant differences were found in the PA p-m-d diameters of subjects between with and without PLT bilaterally, on the right Accepted: 06.07.2009 and the left hand (p<0.05), whereas there was no meaningful differ- ence considering FRL diameters (p>0.05). Furthermore, this ultraso- nographic assessment revealed the continuity of collagen bunches of the PL tendon up to FRL, but not PA. Conclusion: Although not demonstrated by ultrasonography here, the increased thickness of the PA in subjects with a PLT supports the find- ings in the literature in which the structural -
Cubital Tunnel Syndrome: Diagnosis and Management Samir K
Cubital Tunnel Syndrome: Diagnosis and Management Samir K. Trehan, MD, John R. Parziale, MD, and Edward Akelman, MD CUB I TAL TU nn EL SY N DROME IS, AFTER C ARPAL During elbow flexion, the ulnar nerve Populations at risk for cubital tunnel tunnel syndrome, the second most com- is stretched 4.5 to 8 mm (since it lies pos- syndrome include patients with diabetes, mon compression neuropathy of the up- terior to the axis of motion of the elbow) obesity, as well as occupations involving per extremity. Patients often present with and the cubital tunnel cross-sectional area repetitive elbow flexion and extension, pain, paresthesias and/or weakness that if narrows by up to 55% as intraneural pres- holding tools in constant positions and left untreated may lead to significant dis- sures increase up to 20-fold.2, 3 As a result, using vibrating tools. The prevalence ability. This article reviews the etiology, repeated and sustained elbow flexion can within these populations ranges from diagnosis and management of cubital irritate the ulnar nerve and eventually lead 2.8% among workers whose occupations tunnel syndrome. to cubital tunnel syndrome. This relation- require repetitive work (e.g., assembly ship between prolonged elbow flexion line workers, packagers and cashiers) to AN ATOMY A N D ET I OLOGY and cubital tunnel syndrome has been 6.8% in floor cleaners to 42.5% among The ulnar nerve originates from reported in patients who habitually sleep vibrating tool operators.4 branches of the C8 and T1 spinal nerve in the fetal position or sleep in the prone roots and is the terminal branch of the me- position with their hands tucked under CLinicAL EVALUAT I O N A N D dial cord of the brachial plexus. -
Cubital Tunnel Anatomy
Ultrasound Imaging of the Ulnar Nerve Cubital Tunnel Syndrome Benjamin M. Sucher, D.O., FAOCPMR-D, FAAPMR EMG LABs of AARA [email protected] North Phoenix, Mesa, Glendale, West Phoenix Cubital Tunnel Anatomy Arcade of Struthers Ulnar Groove ME (‘sulcus’) Cubital Tunnel O Authors also think it includes the ulnar groove Retroepicondylar (RTC) groove Humeroulnar aponeurotic arcade (HUA) Deep forearm Flexorpronator Aponeurosis Why Ulnar Nerve is so Vulnerable at the Elbow? 1. Frequent motion exposes nerve to excess mechanical force 2. Flexion stretches/tethers nerve against medial epicondyle 3. Ulnar collateral ligament bulges medially against nerve 4. FCU aponeurosis tightens against nerve – adds to pressure 5. Subluxation exposes to friction against medial epicondyle 6. Less connective tissue protecting nerve funiculi; topography 7. Triceps intrusion compresses nerve and increases pressure 8. ‘Snapping triceps’ ‘pushes’ nerve out of the groove 1 Cubital Tunnel FCU - Proximal aponeurotic compression of ulnar nerve; During elbow flexion, FCU tightens against nerve Cubital Tunnel Snapping Triceps Spinner & Goldner, JBJS, 1998 Snapping Triceps Syndrome Spinner and Goldner, JBJS, 1998 2 Triceps Intrusion Into the Ulnar Sulcus and Ulnar Nerve Subluxation Ulnar nerve Extension Ulnar nerve (subluxed) Flexion Miller and Reinus, AJR, 2010 DIAGNOSTIC ULTRASOUND of NORMAL Ulnar Nerves Normal CSA: 8-10mm 2 maximum upper limit [Mild = 10-14; Mod = 15-19; Severe >20] Axonal loss = larger nerve size Bayrak, et al: M&N; 2010 Normal CSA: Beekman, et al: M&N, 2011 <7mm 2 definitely normal in Females Omejec and Podnar: M&N; 2015 (8-11 mm 2) <8mm 2 definitely normal in Males Peer and Bodner, 2008 Normal CSA: Strakowski, 2014 8-9mm 2 maximum upper limit [9 = males; 8 = females] Cartwright, et al: Arch Phys Med Rehabil; 2007 DIAGNOSTIC ULTRASOUND OF Ulnar Nerve Injury Patient H&P: 55 y/o male complains of pain, numbness and weakness in the hand for 4 months. -
Cubital Tunnel Syndrome Multimedia Health Education
Cubital Tunnel Syndrome Multimedia Health Education Disclaimer This movie is an educational resource only and should not be used to manage Orthopaedic Health. All decisions about Cubital Tunnel Syndrome must be made in conjunction with your Physician or a licensed healthcare provider. Cubital Tunnel Syndrome Multimedia Health Education MULTIMEDIA HEALTH EDUCATION MANUAL TABLE OF CONTENTS SECTION CONTENT 1 . Introduction a. Introduction b. Normal Elbow Anatomy c. Biomechanics 2 . Cubital Tunnel Syndrome a. What is Cubital Tunnel Syndrome? b. Signs and Symptoms c. Causes d. Diagnosis e. Conservative Treatment Options 3 . Surgical Procedure a. Introduction b. Surgical Treatment c. Post Operative Care d. Risks and Complications Cubital Tunnel Syndrome Multimedia Health Education INTRODUCTION The cubital tunnel is a narrow, fixed passageway in the elbow that houses and protects the ulnar nerve. This is the nerve responsible for the sensation you feel when you hit your “funny bone”. Cubital Tunnel Syndrome, also called Ulnar Nerve Entrapment, involves tearing or inflammation of the ulnar nerve. To learn more about Cubital Tunnel Syndrome, it is important to understand the normal anatomy of the elbow. Cubital Tunnel Syndrome Multimedia Health Education Unit 1: Introduction Introduction The elbow in the human body consists of Bones Joints Muscles Ligaments and Tendons Numerous blood vessels, nerves, and soft tissue. Bones (Refer fig. 1) (Fig. 1) Joints (Refer fig. 2) (Fig. 2) Muscles (Refer fig. 3) (Fig. 3) Cubital Tunnel Syndrome Multimedia Health Education Unit 1: Introduction Ligaments and Tendons (Refer fig. 4) (Fig. 4) Numerous Blood vessels, nerves, and soft tissue. (Refer fig. 5) (Fig. 5) Normal Elbow Anatomy The arm in the human body is made up of three bones that join together to form a hinge joint called the elbow. -
Supplemental Methods
Supplemental Methods: Patients: Inclusion criteria were patients 18 years of age and older with a lower trunk or C8-T1 pattern of brachial plexus injury and a minimum of 6 months postoperative follow-up. The indication for brachialis to FDP muscle transfer was a lack of active finger flexion in patients with a history of lower trunk or C8-T1 pattern of brachial plexus injury at greater than 9 months from injury with no sign of nerve recovery on clinical exam as well as electromyogram. Additionally, triceps motor function of BRMC grade 2+ or greater was required to provide significant antagonist force to balance the elbow flexion force generated with firing of the brachialis muscle transfer. Patients were excluded if they were younger than 18 years of age, had a triceps of grade 2 or less, or sustained other injuries which precluded the use of the brachialis or FDP for tendon transfers. Patient demographic data including age, sex, BMI, smoking status, age at time of injury, mechanism of injury, co-morbidities, and history of previous reconstructive surgery. Patients were follow-up at regular intervals following surgery for functional assessment until their functional level had plateaued. Patients initially received a full evaluation for motor strength by the three senior authors (AYS, ATB, RJS), including but not limited to trapezius, supraspinatus, infraspinatus, deltoid, biceps, triceps, pronator teres, flexor digitorum profundus, extensor digitorum communis, extensor carpi radialis longus and brevis, and first dorsal interosseous motor strength. Motor strength was graded using a modified British Medical Research Council Grade (BMRC) 2,15. BMRC grading is reported as follows: M0 – no contraction, no joint motion, and no EMG reinnervation; M1 – EMG reinnervation, but no joint motion; M2 – perceptible joint motion, however insufficient power to act against gravity; M3 – muscle act against gravity; M4 – muscle acts against resistance; and M5 – muscle acts against strong resistance. -
The Impact of Palmaris Longus Muscle on Function in Sports: an Explorative Study in Elite Tennis Players and Recreational Athletes
Journal of Functional Morphology and Kinesiology Article The Impact of Palmaris Longus Muscle on Function in Sports: An Explorative Study in Elite Tennis Players and Recreational Athletes Julie Vercruyssen 1,*, Aldo Scafoglieri 2 and Erik Cattrysse 2 1 Faculty of Physical Education and Physiotherapy, Master of Science in Manual therapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium 2 Faculty of Physical Education and Physiotherapy, Department of Experimental Anatomy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; [email protected] (A.S.); [email protected] (E.C.) * Correspondence: [email protected]; Tel.: +32-472-741-808 Academic Editor: Giuseppe Musumeci Received: 21 February 2016; Accepted: 24 March 2016; Published: 13 April 2016 Abstract: The Palmaris longus muscle can be absent unilateral or bilateral in about 22.4% of human beings. The aim of this study is to investigate whether the presence of the Palmaris longus muscle is associated with an advantage to handgrip in elite tennis players compared to recreational athletes. Sixty people participated in this study, thirty elite tennis players and thirty recreational athletes. The presence of the Palmaris longus muscle was first assessed using different tests. Grip strength and fatigue resistance were measured by an electronic hand dynamometer. Proprioception was registered by the Flock of Birds electromagnetic tracking system. Three tests were set up for measuring proprioception: joint position sense, kinesthesia, and joint motion sense. Several hand movements were conducted with the aim to correctly reposition the joint angle. Results demonstrate a higher presence of the Palmaris longus muscle in elite tennis players, but this was not significant.