DOCSLIB.ORG

Serratus Anterior Muscle Fatigue Effects on Scapular Kinematics

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Serratus Anterior Muscle Fatigue Effects on Scapular Kinematics SERRATUS ANTERIOR MUSCLE FATIGUE EFFECTS ON SCAPULAR KINEMATICS A Thesis Presented in Partial Fulfillment of the Requirements for the Degree Master of Science in the Graduate School of The Ohio State University By Oren Costantini, B.S.M.E. Graduate Program in Graduate Program in Mechanical Engineering The Ohio State University 2011 Master’s Examination Committee: Dr. John H. Bolte, Advisor Dr. John D. Borstad c Copyright by Oren Costantini 2011 Abstract Background : Shoulder pain accounts for an average of 8.6 million physician visits each year in the United States. Subacromial Impingement syndrome is the most common diagnosis of shoulder pain, accounting for 44% to 65% of all complaints of shoulder pain during a physician’s office visits. Methods: A protocol to bias fatigue the Serratus Ante- rior was used in conjunction with an electromagnetic motion capture system to track the 3D motion of the scapula and the electromyography signal of 4 muscles bilaterally in 17 subjects. The skin based motion sensors tracked humeral elevation and scapular upward rotation, internal rotation, and tilting relative to the thorax in 2 planes of elevation. The skin based electromyography sensors recorded signal from pectoralis major, serratus an- terior, and upper and lower trapezius. Subjects performed 2 fatigue tasks and 3 sets of 2 kinematic tasks. Analysis: Scapular orientations relative to the thorax and electromyog- raphy signals for 3 fatigue conditions (Pre, Mid, Post) were analyzed in 10◦ increments for humeral elevations of 30◦ to 120◦ in the scapular plane and 30◦ to 110◦ in flexion. Electromyography signals were also analyzed while subjects held the two isometric fa- tigue tasks. All data were analyzed with repeated measure analysis of variance. Results: Non-dominant arms showed consistent increases in internal rotation, decreases in upward rotation, and increases in anterior tilting of the scapula relative to the thorax in flexion and the scapular plane as fatigue progressed. Dominant arms had a wider variety of motions, showing both increases and decreases in all scapular rotations. Indications of progressive ii muscle fatigue were found qualitatively from the first fatigue task; however, the quantitative data was inconclusive. A state of global shoulder fatigue was reached following the second fatigue task. Individual muscle contributions to motion were inconclusive. Conclusions : Non-dominant arms, when fatigue, show consistent kinematic alterations similar to those found in patients with subacromial impingement syndrome. Dominant arms show a variety of kinematic alterations, some of which similar to patients with subacromial impingement syndrome, suggesting compensation strategies are learned. If this is true, rehabilitation can affect these compensation strategies and, possibly, return patients to more healthy motions. Further studies are needed to validate the fatigue task and protocol. iii To my friends and loved ones. You have helped to keep my dreams alive. iv Acknowledgments This research would not have been possible without the mentoring of my advisors, the loving support of my parents, and the help of my friends. First, I want to thank my advisors, Dr. John Borstad and Dr. John Bolte. Thank you for allowing me the freedom to make this project truly my own. Dr. Borstad, thank you for your hours of mentoring, your patience, and for teaching me how to be a bio-mechanist. Next, I want to thank my parents for supporting me through this process and allowing me to develop my interests in orthopedics, musculature, and biomechanics. Truly, I do not know if I would have had the ability to do this without you. Finally, I want to thank all of my friends. Our conversations on a myriad of topics helped me to learn more about the world as well as myself. Our discussions and experiences together were as much a part of graduate school for me as the classes and my research. To my friends outside of graduate school, thank you for bearing with my long absences and keeping in touch. I cannot thank you enough for your continued support. Special thanks go to: Amitabh Dashottar, your advice and help were vital to this project. Your friendship, in and out of the lab, kept me sane even when I thought things might have fallen apart. Bruce Noskowiak, your help and friendship were invaluable. Anytime I needed tech- nical help or advice you were there for me, and our conversations always lifted my spirits. Thank you. v Vita January 10, 1987 . Born - Cincinnati, Ohio June 2005 . B.S. Mechanical Engineering, The Ohio State University Fields of Study Major Field: Mechanical Engineering vi Table of Contents Page Abstract . ii Dedication . iv Acknowledgments . v Vita ........................................... vi List of Tables . x List of Figures . xiii List of Acronyms and Abbreviations . xv 1. Introduction . 1 1.1 Background and Significance . 1 1.1.1 Rotator Cuff Pathology in the General Population . 1 1.1.2 Cost of Rotator Cuff Treatment . 2 1.1.3 Rotator Cuff Etiology . 2 1.1.4 Subacromial Impingement Syndrome and the Anatomy of the Subacromial Space . 3 1.1.5 Pathogenesis of Subacromial Impingement . 5 1.1.6 Scapular Dyskinesis . 6 1.2 The Scapula . 6 1.2.1 Normal and Altered Scapular Motions . 8 1.2.2 Rotations of the Scapula . 9 1.2.3 Reduction and Compression of the Subacromial Space . 10 1.3 Muscles of the Shoulder Girdle . 11 1.3.1 Muscular Control of the Shoulder Girdle . 16 vii 1.3.2 Muscle Fatigue . 17 1.3.3 Serratus Anterior and Trapezius: Force Couples of Scapular Sta- bility . 18 1.3.4 Reasons For Examining Serratus Anterior . 19 1.4 Hypotheses . 21 1.4.1 Hypothesis 1: . 21 1.4.2 Hypothesis 2: . 22 2. Methods . 23 2.1 Subjects . 23 2.1.1 Sample Size Calculations . 23 2.1.2 Subject Recruitment . 23 2.2 Instrumentation and Equipment . 24 2.3 Procedure . 25 2.3.1 Setup . 25 2.3.2 Subject Preparation . 26 2.3.3 Testing . 33 2.4 Data Reduction and Processing . 37 2.4.1 MVC Task . 37 2.4.2 Kinematic Tasks . 37 2.4.3 Fatigue Tasks . 38 2.5 Data Analysis . 39 2.5.1 Verification of Data . 39 2.5.2 Analysis . 40 3. Results . 44 3.1 Hypothesis 1: Alterations in scapular muscle fatigue will be inconsistent between the dominant and non-dominant arms of subjects. This will result in differing kinematic and fatigue profiles between the dominant and non-dominant arms of subjects . 44 3.1.1 Hypothesis 1.1: Kinematic alteration of the scapula, relative to the thorax, will vary across fatigue conditions between the dom- inant and non-dominant arm as the arms are elevated in flexion and the scapular plane. 44 3.1.2 Hypothesis 1.2: Patterns of normalized EMG activation levels for the dominant and non-dominant arms will be different and vary across condition, phase of motion, and humeral elevation. 45 3.1.3 Hypothesis 1.3: Median power frequency (MPF) of EMG acti- vation levels for the dominant and non-dominant arms will differ across conditions. 47 viii 3.2 Hypothesis 2: Serratus anterior fatigue will lead to a decrease in scapular upward rotation, posterior tilting, and scapular internal rotation . 48 3.2.1 Hypothesis 2.1: Scapular upward rotation, internal rotation, and posterior tilting will decrease progressively across fatigue con- ditions . 48 3.2.2 Hypothesis 2.2: Normalized EMG activation levels of the serra- tus anterior muscle will rise between fatigue conditions at a great rate than those of the upper and lower trapezius muscles . 62 3.2.3 Hypothesis 2.3: Median power frequency of EMG activation levels of the serratus anterior muscle will have a higher per- cent decline across fatigue conditions than those of the upper and lower trapezius muscles . 63 4. Discussion . 73 4.1 Primary Kinematic Findings . 73 4.1.1 Hypothesis: 1.1 . 74 4.1.2 Hypothesis: 2.1 . 75 4.2 Primary Fatigue Findings . 77 4.2.1 Hypothesis: 1.2 . 77 4.2.2 Hypothesis: 1.3 . 78 4.2.3 Hypothesis: 2.2 . 79 4.2.4 Hypothesis: 2.3 . 80 4.3 JASA Findings . 81 4.4 Limitations and Future Work . 83 4.4.1 Subjects . 83 4.4.2 Instrumentation . 83 4.5 Conclusions . 87 Appendices 89 A. Bi-Lateral Kinematic & EMG Testing Protocol Version 1.3 . 89 Bibliography . 100 ix List of Tables Table Page 1.1 Upward/Downward Rotators & Stabilizers of The Scapula . 12 1.2 Extrinsic Dynamic Stabilizers . 13 1.3 Intrinsic Dynamic Stabilizers . 14 2.1 Subject Demographics . 24 3.1 Subject Demographics: Borg Scores . 44 3.2 Summary of Arm Dominance P-Values . 45 3.3 Summary of P-Values for Normalized EMG During Lifting Task . 46 3.4 Summary of % Change for Normalized EMG During Lifting Task by Side 47 3.5 Summary of P-Values for Normalized EMG During Waving Task . 47 3.6 Summary of Humeral Elevation Differences for Normalized EMG During Waving Task . 48 3.7 EMG Amplitude: Summary of Arm Dominance P-Values . 48 3.8 EMG MPF: Summary of Arm Dominance P-Values . 49 3.9 EMG MPF: Summary of Arm Dominance Mean Percent Change . 49 3.10 General P-Values of Condition . 50 3.11 Comparison of Mean IR Change: Non-Dominant . 50 x 3.12 Comparison of Mean IR Change: Dominant . 52 3.13 Comparison of Mean UR Change: Non-Dominant . 53 3.14 Comparison of Mean UR Change: Dominant . 53 3.15 Comparison of Mean Tilt Change: Non-Dominant . 55 3.16 Comparison of Mean Tilt Change: Dominant . 55 3.17 Summary of Wave Task Results . 56 3.18 General P-Values of Condition . 56 3.19.
Load more

Recommended publications
  • Netter's Musculoskeletal Flash Cards, 1E
    Netter’s Musculoskeletal Flash Cards Jennifer Hart, PA-C, ATC Mark D. Miller, MD University of Virginia This page intentionally left blank Preface In a world dominated by electronics and gadgetry, learning from fl ash cards remains a reassuringly “tried and true” method of building knowledge. They taught us subtraction and multiplication tables when we were young, and here we use them to navigate the basics of musculoskeletal medicine. Netter illustrations are supplemented with clinical, radiographic, and arthroscopic images to review the most common musculoskeletal diseases. These cards provide the user with a steadfast tool for the very best kind of learning—that which is self directed. “Learning is not attained by chance, it must be sought for with ardor and attended to with diligence.” —Abigail Adams (1744–1818) “It’s that moment of dawning comprehension I live for!” —Calvin (Calvin and Hobbes) Jennifer Hart, PA-C, ATC Mark D. Miller, MD Netter’s Musculoskeletal Flash Cards 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 NETTER’S MUSCULOSKELETAL FLASH CARDS ISBN: 978-1-4160-4630-1 Copyright © 2008 by Saunders, an imprint of Elsevier Inc. All rights reserved. No part of this book may be produced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system, without permission in writing from the publishers. Permissions for Netter Art figures may be sought directly from Elsevier’s Health Science Licensing Department in Philadelphia PA, USA: phone 1-800-523-1649, ext. 3276 or (215) 239-3276; or e-mail [email protected].
    [Show full text]
  • Scapular Winging Is a Rare Disorder Often Caused by Neuromuscular Imbalance in the Scapulothoracic Stabilizer Muscles
    SCAPULAR WINGING Scapular winging is a rare disorder often caused by neuromuscular imbalance in the scapulothoracic stabilizer muscles. Lesions of the long thoracic nerve and spinal accessory nerves are the most common cause. Patients report diffuse neck, shoulder girdle, and upper back pain, which may be debilitating, associated with abduction and overhead activities. Accurate diagnosis and detection depend on appreciation on comprehensive physical examination. Although most cases resolve nonsurgically, surgical treatment of scapular winging has been met with success. True incidence is largely unknown because of under diagnosis. Most commonly it is categorized anatomically as medial or lateral shift of the inferior angle of the scapula. Primary winging occurs when muscular weakness disrupts the normal balance of the scapulothoracic complex. Secondary winging occurs when pathology of the shoulder joint pathology. Delay in diagnosis may lead to traction brachial plexopathy, periscapular muscle spasm, frozen shoulder, subacromial impingement, and thoracic outlet syndrome. Anatomy and Biomechanics Scapula is rotated 30° anterior on the chest wall; 20° forward in the sagittal plane; the inferior angle is tilted 3° upward. It serves as the attachment site for 17 muscles. The trapezius muscle accomplishes elevation of the scapula in the cranio-caudal axis and upward rotation. The serratus anterior and pectoralis major and minor muscles produce anterior and lateral motion, described as scapular protraction. Normal Scapulothoracic abduction: As the limb is elevated, the effect is an upward and lateral rotation of the inferior pole of scapula. Periscapular weakness resulting from overuse may manifest as scapular dysfunction (ie, winging). Serratus Anterior Muscle Origin From the first 9 ribs Insert The medial border of the scapula.
    [Show full text]
  • Relationship Between Shoulder Muscle Strength and Functional Independence Measure (FIM) Score Among C6 Tetraplegics
    Spinal Cord (1999) 37, 58 ± 61 ã 1999 International Medical Society of Paraplegia All rights reserved 1362 ± 4393/99 $12.00 http://www.stockton-press.co.uk/sc Relationship between shoulder muscle strength and functional independence measure (FIM) score among C6 tetraplegics Toshiyuki Fujiwara1, Yukihiro Hara2, Kazuto Akaboshi2 and Naoichi Chino2 1Keio University Tsukigase Rehabilitation Center, 380-2 Tsukigase, Amagiyugashima, Tagata, Shizuoka, 410-3215; 2Department of Rehablitation Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-0016, Japan The degree of disability varies widely among C6 tetraplegic patients in comparison with that at other neurological levels. Shoulder muscle strength is thought to be one factor that aects functional outcome. The aim of this study was to examine the relationship between shoulder muscle strength and the Functional Independence Measure (FIM) motor score among 14 complete C6 tetraplegic patients. The FIM motor score and American Spinal Injury Association (ASIA) motor score of these patients were assessed upon discharge. We evaluated muscle strength of bilateral scapular abduction and upward rotation, shoulder vertical adduction and shoulder extension by manual muscle testing (MMT). The total shoulder strength score was calculated from the summation of those six MMT scores. The relationships among ASIA motor score, total shoulder strength score and FIM motor score were analyzed. The total shoulder strength score was signi®cantly correlated with the FIM motor score and the score of the transfer item in the FIM. In the transfer item of the FIM, the total shoulder strength score showed a statistically signi®cant dierence between the Independent and Dependent Group.
    [Show full text]
  • Axillary Arch Muscle
    International Journal of Research in Medical Sciences Nikam VR et al. Int J Res Med Sci. 2014 Feb;2(1):330-332 www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012 DOI: 10.5455/2320-6012.ijrms20140263 Case Report Axilla; a rare variation: axillary arch muscle Vasudha Ravindra Nikam, Priya Santosh Patil, Ashalata Deepak Patil, Aanand Jagnnath Pote, Anita Rahul Gune* Department of Anatomy, Dr. D. Y. Patil Medical College, D. Y. Patil University, Kolhapur, Maharashtra, India Received: 11 September 2013 Accepted: 22 September 2013 *Correspondence: Dr. Anita Rahul Gune, E-mail: [email protected] © 2014 Nikam VR et al. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Axillary arch muscle or the Langer’s muscle is one of the rare muscular variation in the axillary region. It is the additional muscle slip extending from latissimus dorsi in the posterior fold of axilla to the pectoralis major or other neighbouring muscles and bones. In the present article a case of 68 yrs old female cadaver with axillary arch in the left axillary region is reported. It originated from the anterior border of lattissimus dorsi and merged with the short head of biceps and pectoralis major muscles. The arch was compressing the axillary vein as well as the branches of the cords of brachial plexus. The presence of the muscle has important clinical implications, as the position, unilateral presence, axillary vein entrapment, multiple insertions makes the case most complicated.
    [Show full text]
  • Pectoral Region and Axilla Doctors Notes Notes/Extra Explanation Editing File Objectives
    Color Code Important Pectoral Region and Axilla Doctors Notes Notes/Extra explanation Editing File Objectives By the end of the lecture the students should be able to : Identify and describe the muscles of the pectoral region. I. Pectoralis major. II. Pectoralis minor. III. Subclavius. IV. Serratus anterior. Describe and demonstrate the boundaries and contents of the axilla. Describe the formation of the brachial plexus and its branches. The movements of the upper limb Note: differentiate between the different regions Flexion & extension of Flexion & extension of Flexion & extension of wrist = hand elbow = forearm shoulder = arm = humerus I. Pectoralis Major Origin 2 heads Clavicular head: From Medial ½ of the front of the clavicle. Sternocostal head: From; Sternum. Upper 6 costal cartilages. Aponeurosis of the external oblique muscle. Insertion Lateral lip of bicipital groove (humerus)* Costal cartilage (hyaline Nerve Supply Medial & lateral pectoral nerves. cartilage that connects the ribs to the sternum) Action Adduction and medial rotation of the arm. Recall what we took in foundation: Only the clavicular head helps in flexion of arm Muscles are attached to bones / (shoulder). ligaments / cartilage by 1) tendons * 3 muscles are attached at the bicipital groove: 2) aponeurosis Latissimus dorsi, pectoral major, teres major 3) raphe Extra Extra picture for understanding II. Pectoralis Minor Origin From 3rd ,4th, & 5th ribs close to their costal cartilages. Insertion Coracoid process (scapula)* 3 Nerve Supply Medial pectoral nerve. 4 Action 1. Depression of the shoulder. 5 2. Draw the ribs upward and outwards during deep inspiration. *Don’t confuse the coracoid process on the scapula with the coronoid process on the ulna Extra III.
    [Show full text]
  • Sonographic Tracking of Trunk Nerves: Essential for Ultrasound-Guided Pain Management and Research
    Journal name: Journal of Pain Research Article Designation: Perspectives Year: 2017 Volume: 10 Journal of Pain Research Dovepress Running head verso: Chang et al Running head recto: Sonographic tracking of trunk nerve open access to scientific and medical research DOI: http://dx.doi.org/10.2147/JPR.S123828 Open Access Full Text Article PERSPECTIVES Sonographic tracking of trunk nerves: essential for ultrasound-guided pain management and research Ke-Vin Chang1,2 Abstract: Delineation of architecture of peripheral nerves can be successfully achieved by Chih-Peng Lin2,3 high-resolution ultrasound (US), which is essential for US-guided pain management. There Chia-Shiang Lin4,5 are numerous musculoskeletal pain syndromes involving the trunk nerves necessitating US for Wei-Ting Wu1 evaluation and guided interventions. The most common peripheral nerve disorders at the trunk Manoj K Karmakar6 region include thoracic outlet syndrome (brachial plexus), scapular winging (long thoracic nerve), interscapular pain (dorsal scapular nerve), and lumbar facet joint syndrome (medial branches Levent Özçakar7 of spinal nerves). Until now, there is no single article systematically summarizing the anatomy, 1 Department of Physical Medicine sonographic pictures, and video demonstration of scanning techniques regarding trunk nerves. and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, In this review, the authors have incorporated serial figures of transducer placement, US images, Taipei, Taiwan; 2National Taiwan and videos for scanning the nerves in the trunk region and hope this paper helps physicians University College of Medicine, familiarize themselves with nerve sonoanatomy and further apply this technique for US-guided Taipei, Taiwan; 3Department of Anesthesiology, National Taiwan pain medicine and research.
    [Show full text]
  • An Unusual Case of Axillary Arch Bridging Across the Anterior and Posterior Axillary Folds in the Distal Part of Axilla
    eISSN 1308-4038 International Journal of Anatomical Variations (2011) 4: 128–130 Case Report An unusual case of axillary arch bridging across the anterior and posterior axillary folds in the distal part of axilla Published online June 28th, 2011 © http://www.ijav.org Mohandas RAO KG ABSTRACT Somayaji SN Axillary arch is an additional muscle slip extending usually from the latissimus dorsi in the posterior fold of the axilla, to Narendra PAMIDI the pectoralis major or other neighboring muscles and bones. In the present case presence of such unusual axillary arch Surekha D SHETTY innervated by the fine twigs of musculocutaneous nerve has been reported. During routine dissection of axilla region in one of the upper limbs, the occurrence of axillary arch was observed. The muscle fibers were posteriorly continuous with the belly of latissimus dorsi and anteriorly were merging with fleshy fibers of pectoralis major on its deeper surface. The fibers of the axillary arch were innervated by fine twigs from the musculocutaneous nerve. Position of the axillary arch and its critical relationship with neurovascular bundle has been discussed. Further, a detailed literature review was Department of Anatomy, Melaka Manipal Medical College, Manipal University, Manipal, INDIA. done and the surgical and clinical importance of the case was discussed. © IJAV. 2011; 4: 128–130. Dr. Mohandas Rao KG Associate Professor of Anatomy Melaka Manipal Medical College (Manipal Campus) Manipal University Manipal, 576 104, INDIA. +91 984 4380839 [email protected] Received September 30th, 2010; accepted June 14th, 2011 Key words [axillary arch] [musculocutaneous nerve] [axilla] [latissimus dorsi] [pectoralis major] Introduction the belly of latissimus dorsi just proximal to its insertion.
    [Show full text]
  • Appendicular Muscles 355
    MUSCULAR SYSTEM OUTLINE 12.1 Muscles That Move the Pectoral Girdle and Upper Limb 355 12.1a Muscles That Move the Pectoral Girdle 355 12 12.1b Muscles That Move the Glenohumeral Joint/Arm 360 12.1c Arm and Forearm Muscles That Move the Elbow Joint/Forearm 363 12.1d Forearm Muscles That Move the Wrist Joint, Appendicular Hand, and Fingers 366 12.1e Intrinsic Muscles of the Hand 374 12.2 Muscles That Move the Pelvic Girdle and Lower Limb 377 Muscles 12.2a Muscles That Move the Hip Joint/Thigh 377 12.2b Thigh Muscles That Move the Knee Joint/Leg 381 12.2c Leg Muscles 385 12.2d Intrinsic Muscles of the Foot 391 MODULE 6: MUSCULAR SYSTEM mck78097_ch12_354-396.indd 354 2/14/11 3:25 PM Chapter Twelve Appendicular Muscles 355 he appendicular muscles control the movements of the upper 2. Identify the muscles that move the scapula and their actions. T and lower limbs, and stabilize and control the movements 3. Name the muscles of the glenohumeral joint, and explain of the pectoral and pelvic girdles. These muscles are organized how each moves the humerus. into groups based on their location in the body or the part of 4. Locate and name the muscles that move the elbow joint. the skeleton they move. Beyond their individual activities, these 5. Identify the muscles of the forearm, wrist joint, fingers, muscles also work in groups that are either synergistic or antago- and thumb. nistic. Refer to figure 10.14 to review how muscles are named, and Muscles that move the pectoral girdle and upper limbs are recall the first Study Tip! from chapter 11 that gives suggestions organized into specific groups: (1) muscles that move the pectoral for learning the muscles.
    [Show full text]
  • Intramuscular Neural Distribution of the Serratus Anterior Muscle: Guidelines to the Injective Method for Treating Myofascial Pain Syndrome
    Intramuscular Neural Distribution of the Serratus Anterior Muscle: Guidelines to the Injective Method for Treating Myofascial Pain Syndrome Kyu-Ho Yi Yonsei University Ji-Hyun Lee Yonsei University Kyle K Seo Modelo Clinic Hee-Jin Kim ( [email protected] ) Yonsei University Research Article Keywords: myofascial pain syndrome, sihler’s method, serratus anterior, trigger point injection Posted Date: February 15th, 2021 DOI: https://doi.org/10.21203/rs.3.rs-190375/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/16 Abstract The serratus anterior muscle is commonly involved in myofascial pain syndrome and is treated with many different injective methods. Currently, there is no denite injection point for the muscle. This study provides an ideal injection point for the serratus anterior muscle considering the intramuscular neural distribution using the whole mount staining method. A modied Sihler method was applied to the serratus anterior muscles (15 specimens). The intramuscular arborization areas were identied in terms of the anterior (100%), middle (50%), posterior axillary line (0%), and from the rst to the ninth ribs. The intramuscular neural distribution for the serratus anterior muscle had the largest arborization patterns in the 5th to 9th rib portion between 50% and 70%, and the 1st to 4th rib portion had between 20% and 40%. Clinicians can administer safe and effective treatments with botulinum neurotoxin injections and other types of injections, following the methods in our study. We propose optimal injection sites in relation to the external anatomical line for the frequently injected facial muscles to facilitate the eciency of botulinum neurotoxin injections.
    [Show full text]
  • Muscle Manual
    Neck Contents Cervical Kinematics .................... 74 Thyrohyoid & Sternothyroid ....... 92 Cervical AROM ............................. 75 Sternohyoid .................................. 93 Cervical Bones ............................. 76 Omohyoid ..................................... 94 Cervical Ligaments ...................... 77 Rectus Capitis Ant. & Lateralis .. 95 Posterior Neck Muscles .............. 78 Longus Capitis ............................. 96 Anterior & Lateral Neck .............. 79 Longus Cervicis (colli) ................ 97 Trapezius (upper fibers) .............. 80 Scalene Muscle Group ................ 98 Levator Scapulae ......................... 82 Scalenus Minimus ....................... 100 Splenius Capitis & Cervicis ........ 84 Anterior Scalene .......................... 101 Suboccipital Muscles .................. 86 Middle Scalene ............................. 102 Sternocleidomastoid (SCM) ........ 88 Posterior Scalene ........................ 103 Suprahyoid Muscles .................... 90 Larynx ........................................... 104 Neck References ................................... 106 Surface anatomy Myofascial Bony Landmarks Video Demo Palpation Checklist prohealthsys.com □ Mandible & TMJ □ Clavicle/SC joint □ Semispinalis cerv./cap. □ Masseter/Parotids □ Suprasternal notch □ Suboccipitals □ Submandibular gland □ Scalenes/brachial plexus □ Facet joints / Articular pillars □ Submental gland □ SCM & mastoid □ Spinous processes (C2-C7) □ Hyoid bone □ Carotid pulse □ T1 SP & upper rib motion □ Trachea
    [Show full text]
  • Bilateral Muscular Axillary Arch: an Anatomic Study and Clinical Considerations
    Journal of College of Medical Sciences-Nepal, 2014, Vol-10, No-3 Bilateral muscular axillary arch: An anatomic study and clinical considerations Chunder R1, Guha R2 1Associate Professor, Dept. of Anatomy, K.P.C. Medical College & Hospital, 1F, Raja S.C. Mullick Road, Jadavpur, Kolkata-700032 2Professor & HOD, Dept. of Anatomy, CMS-TH, Bharatpur, Chitwan, Nepal ABSTRACT The axillary arch is a variative muscular slip encountered in the axillary region which usually connects latissimus dorsi to pectoralis major. Reported here is a rare case of bilateral axillary arch splitting the radial nerve into two roots in each side as observed during routine dissection of the axillary region of an old male cadaver. The anatomy, surgical implications, and embryology of the anomalous muscle have been discussed. Clinicians should be aware of its existence as it can give rise to different pathologies. It should be recognised and excised to expose the axillary artery and vein in patients with trauma and to perform axillary lymphadenectomy or axillary bypass. It should be considered in the differential diagnosis of axillary masses or in a history of intermittent axillary vein obstruction. KEYWORDS: Axillary arch, latissimus dorsi, radial nerve. INTRODUCTION dorsi in the posterior fold of the axilla, to the pectoralis Anatomical variations of the axilla are of great relevance major in the anterior fold, to the short head of the biceps due to increasing surgical importance of the region for brachii or to the coracoid process creating a close breast cancer surgery, reconstruction procedures and relationship with the elements of the axillary axillary bypass operations. Axillary arch, differently neurovascular bundle.
    [Show full text]
  • Abnormal Muscles That May Affect Axillary Lymphadenectomy: Surgical Anatomy K
    Abnormal muscles that may affect axillary lymphadenectomy: surgical anatomy K. Natsis, K. Vlasis, T. Totlis, G. Paraskevas, G. Noussios, P. Skandalakis, J. Koebke To cite this version: K. Natsis, K. Vlasis, T. Totlis, G. Paraskevas, G. Noussios, et al.. Abnormal muscles that may affect axillary lymphadenectomy: surgical anatomy. Breast Cancer Research and Treatment, Springer Verlag, 2009, 120 (1), pp.77-82. 10.1007/s10549-009-0374-5. hal-00535350 HAL Id: hal-00535350 https://hal.archives-ouvertes.fr/hal-00535350 Submitted on 11 Nov 2010 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Breast Cancer Res Treat (2010) 120:77–82 DOI 10.1007/s10549-009-0374-5 PRECLINICAL STUDY Abnormal muscles that may affect axillary lymphadenectomy: surgical anatomy K. Natsis Æ K. Vlasis Æ T. Totlis Æ G. Paraskevas Æ G. Noussios Æ P. Skandalakis Æ J. Koebke Received: 5 January 2009 / Accepted: 9 March 2009 / Published online: 21 March 2009 Ó Springer Science+Business Media, LLC. 2009 Abstract Purpose The present study aimed at summa- unilaterally in three cadavers (2.8%). One cadaver had both rizing and presenting the anomalous muscles that a surgeon an axillary arch and a pectoralis quartus muscle in the right might encounter during axillary lymphadenectomy (AL).
    [Show full text]