DOCSLIB.ORG

Supplemental Methods

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
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. Each author independently graded motor strength, and it was then discussed and a consensus grade was obtained if there were disagreements. In order to obtain a BMRC grade of 3, the patient had to have active motion against gravity equal to passive motion. Additionally, a greater grade could not be obtained unless the criteria were met for the lower grade Table 13,16. Functional outcome assessments at follow-up visits included BMRC grade finger flexion, functional grasp – defined as the ability to hold a fixed object placed in the palm, grip strength, range of motion, functional outcomes utilizing the Disabilities of the Arm, Shoulder and Hand (DASH) Score and patient self-reported satisfaction. Total operative time, complications, number of subsequent surgeries related to the brachialis tendon transfer and factors affecting outcomes (motor strength of remaining forearm musculature, type of tendon graft, BMI, time from injury, associated non-nerve injuries) were also evaluated. Statistics: Descriptive statistics were used to summarize data, including percentages and counts for categorical and ordinal data and means with interquartile ranges for continuous data with variability presented as standard error of the mean. Differences between groups were compared using the two-sample t-test for continuous variables and the chi-square test (or Fisher’s exact test) for categorical variables. All analyses were carried out using the JMP statistical software package (Version 8, SAS Institute Inc., Cary, NC). A p-value less than 0.05 were considered statistically significant. Operative Technique: Under general anesthesia, patients were positioned supine with a sterile tourniquet placed on the upper arm. A 10 cm incision is created 2 cm proximal to the medial epicondyle extending proximally anterior to the bicipital groove [Figure 1A]. The medial antebrachial cutaneous nerves are identified and protected, and the dissection is carried through the antebrachial fascia. The median nerve and brachial vessels are then identified and protected [Figure 1B]. The biceps is identified as well as the lateral antebrachial cutaneous nerve and protected. The entire brachialis muscle is isolated and the radial nerve identified and protected. The distal insertion of the brachialis is taken off the coronoid and elbow capsule with care to protect the lateral antebrachial cutaneous nerve [Figure 1C]. The brachialis is elevated off the distal anterior humerus from distal to proximal to the level of the distal third of the humerus [Figure 1D]. The broad brachialis tendon is then tubularized, and an autograft or allograft tendon is Pulvertaft woven into the brachialis and augmented with non-absorbable sutures as needed.[Figure 1D]. Gracilis tendon allografts were used two thirds of the time (n=11) with the remainder of patients receiving gracilis tendon autografts (n = 2), semitendinosus allografts (n = 2), or posterior tibialis allografts (n = 3). A longitudinal incision 8 cm incision in the volar forearm is used to isolate the FDP tendons at the level of the musculotendinous junction [Figure 1E and F]. The elongated brachialis tendon is passed into the forearm, under the lacertus fibrosis and under the FDS which acted as the pulley to prevent bowstringing with transfer excursion [Figure 1G]. The FDP tendons are tensioned individually until symmetric flexion of the fingers is achieved and a side to side tenodesis of the FDP tendons is performed with three nonabsorbable size 0 sutures. The brachialis-tendon graft construct is appropriately tensioned to achieve full finger flexion with the elbow in 30 degrees of extension and the wrist in 30 degrees of extension. The brachialis-tendon graft and FDP transfer is completed in the forearm exposure with three Pulvertaft weaves [Figure 1H-J]. Following brachialis to FDP tendon transfer, additional procedures may be performed to augment prehension, including: thumb interphalangeal (IP) arthrodesis, thumb carpometacarpal (CMC) arthrodesis, brachioradialis (BR) to flexor pollicis longus (FPL) tendon transfer, pronator teres (PT) to abductor pollicis brevis (APB) tendon transfer, and PT to FPL tendon transfer. After all concomitant procedures had been performed, the tension on the brachialis muscle to FDP transfer is re-assessed; in elbow and wrist flexion, passive extension of the fingers and thumb should be easily produced and in elbow extension and wrist extension, the fingers should form a tight grasp with the thumb resting on the index finger. The patients are then placed in a bulky dressing and long arm splint with the elbow flexed at 90 degrees and the wrist in 30 degrees of extension, which is exchanged at two weeks for an above elbow cast. The patients are immobilized in a long arm cast for six weeks during which passive finger range of motion with gentle active flexion (by light elbow flexion in the cast). At six weeks, the patients commence hand therapy with protective resting splints worn for 3-4 weeks. .
Load more

Recommended publications
  • 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
    [Show full text]
  • Anatomical Considerations of Fascial Release in Ulnar Nerve Transposition: a Concept Revisited
    LABORATORY INVESTIGATION J Neurosurg 123:1216–1222, 2015 Anatomical considerations of fascial release in ulnar nerve transposition: a concept revisited Mark A. Mahan, MD,1 Jaime Gasco, MD,2 David B. Mokhtee, MD,3 and Justin M. Brown, MD4 1Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona; 2Division of Neurological Surgery, University of Texas Medical Branch, Galveston, Texas; 3Tulsa Bone and Joint Associates, Tulsa, Oklahoma; and 4Division of Neurosurgery, University of California, San Diego, La Jolla, California OBJECT Surgical transposition of the ulnar nerve to alleviate entrapment may cause otherwise normal structures to become new sources of nerve compression. Recurrent or persistent neuropathy after anterior transposition is commonly attributable to a new distal compression. The authors sought to clarify the anatomical relationship of the ulnar nerve to the common aponeurosis of the humeral head of the flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS) muscles following anterior transposition of the nerve. METHODS The intermuscular septa of the proximal forearm were explored in 26 fresh cadaveric specimens. The fibrous septa and common aponeurotic insertions of the flexor-pronator muscle mass were evaluated in relation to the ulnar nerve, with particular attention to the effect of transposition upon the nerve in this region. RESULTS An intermuscular aponeurosis associated with the FCU and FDS muscles was present in all specimens. Transposition consistently resulted in angulation of the nerve during elbow flexion when this fascial septum was not released. The proximal site at which the nerve began to traverse this fascial structure was found to be an average of 3.9 cm (SD 0.7 cm) from the medial epicondyle.
    [Show full text]
  • 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.
    [Show full text]
  • Nerve Entrapment Syndromes 1091
    1090 Part VIII Septic and Nontraumatic Conditions may present with well-defi ned symptoms of ulnar CHAPTER 80 nerve compression at the elbow; electrical studies, however, may have normal results in the ulnar nerve but reveal changes of carpal tunnel syndrome (which Nerve Entrapment may be either subclinical or less symptomatic to the patient). Post-traumatic thickening of the brachial Syndromes fascia in the distal arm can produce a simultaneous median and lateral antebrachial nerve compression. When more than one nerve is suspected in the neural Robert J. Spinner compression process, a more proximal lesion such as the brachial plexus, must be ruled out as the site of the pathologic process. 2. A nerve can be compressed at more than one level; INTRODUCTION that is, a “double crush” lesion may exist. This most commonly occurs at the neck and the wrist but can The diagnosis of a nerve entrapment lesion arising at also occur at other locations such as the thoracic the elbow can be relatively straightforward if the history, outlet and the cubital tunnel. physical examination, electromyographic (EMG), and 3. Two separate neurologic processes may coexist. For imaging studies, when indicated, all confi rm the diagno- example, a patient who is wheelchair-bound from a sis and the localization of the lesion.12,32,47,87,93,138 However, syrinx may develop hand atrophy, which represents when the history and physical examination do not cor- new bilateral ulnar nerve compression rather than respond or the electrophysiologic or imaging studies do progression of the syrinx. Thus, on occasion, it is nec- not support a specifi c clinical diagnosis, then problems essary to direct one’s conservative or surgical atten- can arise.
    [Show full text]
  • Fascia, Septa, Tendon Sheaths and the Potential Spaces of the Hand These Fascial Layers Are Continuous with the Fascial Sleeve of the Forearm
    This document was created by Alex Yartsev ([email protected]); if I have used your data or images and forgot to reference you, please email me. Fascia, Septa, Tendon Sheaths and the Potential Spaces of the Hand These fascial layers are continuous with the fascial sleeve of the forearm. Centrally the fascia of the palm thickens in the centre, where the palmaris Palmaris Longus tendon longs tendon attaches to it, which is All merge into the also where it merges with the flexor Palmar Aponeurosis Antebrachial Fascia retinaculum. This whole thickened Flexor retinaculum area is called the palmar aponeurosis. Distally, the palmar aponeurosis divides into four bands which attach to the bases of the proximal phalanges, and there it becomes a part of the digital sheaths The Thenar Space Palmar Aponeurosis so thick and tough that any infections in the palmar spaces will actually cause the weaker DORSAL fascia to bulge out. In Dupuytren’s contracture, the palmar aponeurosis becomes nodular, Thenar fascia fibrosed, and thickened The Midpalmar Space Palmar Aponeurosis Unlike the thenar space, this one is Hypothenar fascia continuous with the anterior compartment of the forearm- it communicates with it via the carpal tunnel. Lateral fibrous septum of the palm Medial fibrous septum of Digital Synovial Sheaths which stretches from the palmar the palm which stretches from the palmar aponeurosis to the 3rd metacarpal aponeurosis to the 5th metacarpal Of the two septa, the LATERAL is the strongest The common flexor sheath continues to the th 5 digit. The other digits have their own Digital Synovial Sheaths Synovial sheath for Flexor Pollicis Longus Common flexor sheath: FDS and FDP Synovial sheath for Flexor Carpi Radialis .
    [Show full text]
  • Anatomical Study of Myofascial Continuity in the Anterior Region of the Upper Limb
    ARTICLE IN PRESS Journal of Bodywork and Movement Therapies (2009) 13,53–62 Journal of Bodywork and Movement Therapies www.intl.elsevierhealth.com/journals/jbmt HUMAN ANATOMY Anatomical study of myofascial continuity in the anterior region of the upper limb Antonio Steccoa, Veronica Macchib, Carla Steccoc, Andrea Porzionatob, Julie Ann Dayd, Vincent Delmase, Raffaele De Carob,Ã aPhysical Medicine and Rehabilitation Clinic, University of Padova, Italy bSection of Anatomy, Department of Human Anatomy and Physiology, University of Padova, Italy cSection of Orthopedics, Department of Medical Surgical Specialisations, University of Padova, Italy dPhysical Medicine and Rehabilitation Clinic, Ospedale dei Colli, Padova, Italy eInstitut d’Anatomie, Universite´ Paris Descartes, France Received 18 March 2007; received in revised form 27 April 2007; accepted 27 April 2007 KEYWORDS Summary Fifteen unembalmed cadavers were dissected in order to study the Myofascial ‘‘anatomical continuity’’ between the various muscles involved in the movement of continuity; flexion of the upper limb. This study demonstrated the existence of specific Fascia; myofascial expansions, with a nearly constant pattern, which originate from the Proprioception; flexor muscles and extend to the overlying fascia. The clavicular part of the Chaıˆnes musculaires; pectoralis major sends a myofascial expansion, with a mean length of 3.6 cm, to Meridians; the anterior region of the brachial fascia, and the costal part sends one to the Anatomy trains; medial region of the brachial fascia (mean length: 6.8 cm). The biceps brachii Sequences presents two expansions: the lacertus fibrosus, oriented medially, with a mean height of 4.7 cm and a base of 1.9 cm, and a second, less evident, longitudinal expansion (mean length: 4.5 cm, mean width: 0.7 cm).
    [Show full text]
  • A Study of Variations of the Triceps Brachii Muscle in North Karnataka Population
    Original Research Article DOI: 10.18231/2455-846X.2017.0030 A study of variations of the triceps brachii muscle in north Karnataka population Pratik Khona1, Ashwini C2,* 1,2Assistant Professor, Dept. of Anatomy, Gadag Institute of Medical Sciences, Gadag, Karnataka *Corresponding Author: Email: [email protected] Abstract Introduction: Triceps brachii muscle is the only muscle of posterior compartment of arm, consisting of three heads–long, lateral and medial. Radial nerve and profunda brachii artery run in the radial groove that separate lateral and medial head. Triceps brachii is a site for intramuscular injections. Evolutionarily triceps has many sub heads which have either fused or disappeared. Therefore, the knowledge of muscle is essential anthropologically and clinically and this study aims to study the anatomical variations of triceps brachii muscle. Materials & Methods: In the present study, 60 upper limbs from the Department of Anatomy, Belagavi Institute of Medical Sciences, Belagavi and Gadag Institute of Medical Sciences, Gadag were examined for the variations of triceps brachii muscle during routine dissections of undergraduate students. The variations found where neatly dissected and photographs taken wherever necessary. Result: Out of 60 upper limbs dissected 2 specimens presented with variations of triceps muscle. Discussion: Both variations seen were fourth head of origin of muscle seen in two different male cadavers in respectively right and left arm. The variations present were seen only unilaterally in both cadavers. The details of these variations will be discussed in the article. Conclusion: The variations of triceps brachii muscles are mentioned in literature, but are uncommon and if tendinous fourth head are present over the neurovascular bundles they may lead to compression syndrome.
    [Show full text]
  • Incidence of Palamris Longus Muscle and Tendon Variations: a Cadaveric Study
    Original Research Article DOI: 10.5958/2394-2126.2016.00125.0 Incidence of palamris longus muscle and tendon variations: a cadaveric study Pabbati Raji Reddy Associate Professor, RVM Institute of Medical Sciences & Research Center, Telangana Email: [email protected] Abstract Introduction: Palmaris longus muscle is one of the most variable muscles of the human body. Complete agenesis, variation in the location and form of the fleshy portion, aberrancy in attachment, duplication or triplication, accessory tendinous slips, replacing elements are some of the variations commonly encountered. Due to the large variability of the Palmaris longus muscle, we had undertaken this study to estimate the prevalence of this variation in our geographical area. Materials and Methods: A total of 32 cadavers, i.e. 64 upper limbs were dissected for the assessment of Palmaris longus muscle. The length and the circumference of the muscle belly of the Palmaris longus muscle, was noted. The most distal point on the muscle tendon to the point where the tendon crosses the line joining the pisiform bone and the tubercle of the scaphoid bone was measured to assess the length of the muscle. The width of the tendon was measured based on the aponeurosis. Finally, the length of the forearm was measured from the tip of the olecranon process to the styloid process of the ulna. Results: Out of the 32 cadavers, 23 were males with a total of 46 upper limbs which were used for discussion, 9 were females with 18 upper limbs. The mean length of the muscle in males was 124mm while in females, it was only 86.2mm.
    [Show full text]
  • Special Areas in the Upper Limb and Their Borders the AXILLA O a PYRAMIDAL Space: Has a Flat Apex, 4 Walls, and a Base
    This document was created by Alex Yartsev ([email protected]); if I have used your data or images and forgot to reference you, please email me. Special Areas in the Upper Limb and their Borders THE AXILLA o A PYRAMIDAL space: has a flat apex, 4 walls, and a base. Superior border of scapula APEX First rib Clavicle Scapula POSTERIOR Subscapularis WALL Teres major Clavipectoral fascia LATERAL WALL Pectoralis minor ANTERIOR WALL Intertubercular groove of Pectoralis major the humerus; Thus also the tendon of Anterior axillary fold the long head of biceps MEDIAL WALL Chest wall and serratus anterior CONTENTS Axillary artery and its branches Axillary vein and its tributaries- brachial vein, basilic vein and thoracoepigastric vein Lymphatic vessels and axillary lymph nodes Cords and branches of the brachial plexus BOUNDARIES - Apex Medial wall – o Cervicoaxillary canal; passageway into the neck - Rib cage, chest wall – ribs 1-4 and o Bounded by the 1st rib, clavicle, and superior edge of the scapula the intercostal muscles o The vessel and nerve’s gateway into the arm - Serratus anterior - Base o Axillary fossa: fat, fascia, skin Lateral wall – - Anterior Wall– - Narrow wall; intertubercular groove o Pectoralis major, pectoralis minor, pectoral and clavipectoral fascia of the humerus o The inferior part is the anterior axillary fold - Posterior wall – o Scapula and subscapularis o Inferior border is the teres major and latissmus dorsi This document was created by Alex Yartsev ([email protected]); if I have used your data or images and forgot to reference you, please email me. The Medial Triangular Space, Lateral Triangular Space, and the Quadrangular Space These are gaps in the posterior wall of the axilla.
    [Show full text]
  • The Pronator Teres Syndrome: Compressive Neuropathy
    ;ry " he tO Copyright1981 by The Journalof Boneand Joint Surgery, Incorporated hy ar- The Pronator Teres Syndrome: ior tal Compressive Neuropathy of the Median Nerve* .~nt dl, BY CHARLES R. HARTZ, M.D.’~, RONALD L. LINSCHEID, M.D.’~, R. REED GRAMSE, M.D.’~, AND JASPER R. DAUBE, M.D.J’, ROCHESTER, MINNESOTA ior in From the Departments of Orthopedics, Physical Medicine and Rehabilitation, and Neurology, MayoClinic and MayoFoundation, Rochester at- ~re ABSTRACT:Thirty-nine patients with a clinical gically g, an anomalous fibrous band that compressed the the diagnosis of the pronator teres syndrome were seen median nerve was identified and cut. Since then, the syn- during a seven-year period. They typically complained drome has been recognized with increasing frequen- FIS, of aching discomfort in the forearm, weakness in the cy2,’,’,9,1e, ¯ it hand, and numbness in the thumb and index finger. We are reporting a study of thirty-nine patients in as Cyclic stress usually brought on the symptoms. The whomwe diagnosed the pronator teres syndrome and at- the distinctive physical finding was tenderness overthe tempted to identify the factors by which one can differ- ’ tO proximal part of the pronator teres, which was aggra- entiate this disorder from other lesions. SO vated by resisted pronation of the forearm, flexion of To the elbow, and occasionally by resisted contraction of Clinical Material ~al- the flexor superficialis of the long finger..Elec- From 1972 to 1979, thirty-nine patients seen at the der trophysiological testing of the median nerve showed Mayo Clinic were diagnosed as having the pronator teres caft abnormalities in a few patients, but localization of the syndrome.
    [Show full text]
  • Characteristics of Fascia in Reference to Treatment Possibilities of Chosen Hand Diseases
    Mini Review ISSN: 2574 -1241 DOI: 10.26717/BJSTR.2020.29.004874 Characteristics of Fascia in Reference to Treatment Possibilities of Chosen Hand Diseases Alicja Jurecka1*, Maciej Papież2 and Artur Gądek1 1Jagiellonian University Medical College, Faculty of Health Sciences, Department of Orthopedics and Physiotherapy, Poland 2Emirates Specialty Hospital, Dubai Healthcare City, Dubai *Corresponding author: Alicja Jurecka, Jagiellonian University Medical College, Faculty of Health Sciences, Department of Orthopedics and Physiotherapy, Poland ARTICLE INFO ABSTRACT Received: August 13, 2020 The patomechanism of changes encountered in many movement system dysfunctions gives a basis for applying manual techniques, which have an impact on fascia’s structure, Published: August 31, 2020 onKeywords: treatment Fascia; of chosen Orthopedics; orthopedics Hand afflictions. diseases; Myofascial therapy; Physiotherapy Citation: Reference Alicjato Treatment Jurecka, PossibilitiesMaciej Papież, of ChosenArtur Gądek. Hand Diseases.Characteristics Biomed of J SciFascia & Tech in Res 29(5)-2020. BJSTR. MS.ID.004874. Introduction and plastic, and also resistant to mechanic stimulus. The current An architecture of fascia and its precise connections with many od movement system components creates a basis for putting transmission [5]. Collagen layers of the fascia are separated from forward presumptions of prospects of applying a fascial modelling definition of the fascia emphasizes its meaning in tensional force each other by fatty tissue [2]. The outermost layer of the fascia is Three-dimensional fascial web covers and penetrates such as an important element in many orthopedic afflictions treatment. is the investing fascia, also known as the deep fascia [6]. The structures as: muscles, intermuscular septum’s, tendons, ligaments, known as pinnacular or superficial.
    [Show full text]
  • The Course of Posterior Antebrachial Cutaneous Nerve: Anatomical and Sonographic Study with a Clinical Implication
    International Journal of Environmental Research and Public Health Article The Course of Posterior Antebrachial Cutaneous Nerve: Anatomical and Sonographic Study with a Clinical Implication Jose García-Martínez 1,2,*, Maribel Miguel-Pérez 2,*, Albert Pérez-Bellmunt 3,4 , Sara Ortiz-Miguel 2,3,4 and Ginés Viscor 5 1 Horta Osteopathic Clinic, 08031 Barcelona, Spain 2 Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Bellvitge Campus), University of Barcelona, 08907 Hospitalet del Llobregat, Spain; [email protected] 3 Basic Sciences Department, Universitat Internacional de Catalunya, 08017 Barcelona, Spain; [email protected] 4 ACTIUM Functional Anatomy Group, 08017 Barcelona, Spain 5 Physiology Section, Department of Cell Biology, Physiology and Immunology, Faculty of Biology, University of Barcelona, 08028 Barcelona, Spain; [email protected] * Correspondence: [email protected] (J.G.-M.); [email protected] (M.M.-P.) Abstract: The course of the posterior antebrachial cutaneous nerve (PACN) was studied via ultra- sound (US) and dissection. The aim of this study was to reveal the anatomical relationships of PACN with the surrounding structures along its pathway to identify possible critical points of compression. Nineteen cryopreserved cadaver body donor upper extremities were explored via US and further dissected. During US exploration, two reference points, in relation with the compression of the nerve, were marked using dye injection: (1) the point where the RN pierces the lateral intermuscular septum Citation: García-Martínez, J.; (LIMS) and (2) the point where the PACN pierces the deep fascia. Anatomical measurements referred Miguel-Pérez, M.; Pérez-Bellmunt, A.; to the lateral epicondyle (LE) were taken at these two points.
    [Show full text]