DOCSLIB.ORG

Pronator Teres Myotendinous Tear

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

A Case Report & Literature Review Pronator Teres Myotendinous Tear Usama Qayyum, MBBS, Diego Villacis, MD, and Charles M. Jobin, MD The oblique orientation of the Abstract muscle belly allows it to serve Take-Home Points Pronator teres muscle strain is a rare in its primary rotatory role as the ◾ Pronator teres muscle sporting injury reported thus far only in main pronator of the forearm. In- injuries are rare. cricket and golf players. The injury ap- juries to the soft tissue of the me- ◾ Injury can be mistak- dial forearm are common in both pears to occur when the sporting club or en for MUCL injury in racket strikes the ground during a forceful elite and recreational athletes, es- athletes. pecially in racket and club sports.3 swing and causes the elbow to experi- ◾ Tenderness and weak/ ence an eccentric force during resisted Often, these injuries are related to painful forearm pronation elbow flexion and pronation. On initial overuse and chronic fatigue of the are common findings. surrounding soft tissue—caused presentation, this injury can be mistaken ◾ MRI confirms the diagno- for injury to the medial ulnar collater- by repetitive flexing, gripping, or sis and helps grade the al ligament, or exacerbation of medial swinging. Even when identified muscle strain injury. epicondylitis. On examination, bruising early, these injuries can result in ◾ Conservative treatment is 4 and tenderness distal to the elbow over a significant loss of training time. recommended and prog- the course of the pronator teres are often In this article, we report a case nosis is excellent even for present. Advanced imaging confirms the of pronator teres muscle tear at high-grade strains. diagnosis and can help in grading injury the myotendinous junction. The severity. In this article, we report the case patient provided written informed consent for print and electronic publication of this of a patient who was conservatively treat- case report. ed, and returned to function and sport by 6 weeks after a period of rest and restrict- Case Report ed activities. The prognosis is excellent for A right-hand–dominant 36-year-old man presented even high-grade strains. Complete return to the clinic with pain on the medial side of his to sporting function without residual weakness is expected. ronator teres muscle strain is a rare sporting injury reported only in cricket players, and P now in a golfer whose forearm experienced an eccentric force during resisted elbow flexion and pronation.1,2 The injury occurs when the sporting club or racket strikes the ground during a swing, impeding forward progress and subjecting the pronator teres muscle to eccentric forces in excess of what it can withstand. The pronator teres, one of several muscles that comprise the flexor wad of the forearm, consists of 2 heads, originating proximally from the medical epicondyle and attaching distally to the shaft of the radius on Figure 1. Medial elbow with non-gravity-dependent ecchymosis over course of pronator its lateral surface and just distal to the supinator. teres muscle, 3 days after injury. Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article. www.amjorthopedics.com March/April 2017 The American Journal of Orthopedics ® E105 Pronator Teres Myotendinous Tear A B C Figure 2. (A) Coronal T2-weighted magnetic resonance imaging (MRI) shows isolated edema of pronator teres and partial tearing of muscle belly near the myotendinous junction. (B) Axial T2-weighted MRI of proximal forearm shows edema of pronator teres muscle belly and fluid around the myotendinous zone of injury. (C) Sagittal T2-weighted MRI of the pronator teres injury. right elbow after sustaining an injury to the elbow triceps were uninjured. while playing golf several days earlier. The patient, The patient was instructed to rest the elbow an advertising executive, was playing recreational from strenuous activity, golf in particular, for 4 golf several times a month and had no significant weeks. Physical therapy for ROM and forearm medical history or previous symptoms related to strengthening of the surrounding flexor wad was the elbow. Initial pain symptoms began during a initiated at 2 weeks and continued for 4 weeks. second round of play, immediately after the patient The patient was advised to take over-the-counter miss-hit an iron shot, making contact mostly with nonsteroidal anti-inflammatory drugs as needed for the ground and causing the club to forcefully stop. comfort. On repeat examination at 4 weeks, with The pain was on the medial side of the elbow and tenderness or weakness with pronation absent forearm. The patient noted progressive swelling and full ROM regained, the patient was released and bruising at the pain site and development of back to full activity. He was able to return to golf forearm weakness. Physical examination during and reported being symptom-free and having no the clinic presentation revealed ecchymosis on the sense of weakness or loss of control. anterior medial forearm, medial elbow, and medial triceps (Figure 1). Mild tenderness to palpation Discussion was elicited over the medial elbow, specifically over A tear of the pronator teres is an exceedingly rare the course of the flexor pronator mass. When the injury. Our results with conservative treatment elbow was assessed for tender areas, the medial and a full return to previous activity level are epicondyle was not tender. Range of motion (ROM) consistent with the only other case reported in the testing revealed 120° of flexion and 10° short of full literature.5 In contrast to our patient, the previous extension, attributed to swelling from acute injury. patient sustained a tear of the pronator teres after The patient had full supination and pronation, but a prolonged period of batting during a recreational the pain was reproduced with either movement. cricket match. The pain produced weakness with flexion and pro- Our patient’s pronator teres injury occurred nation. Valgus stress test results were normal; there at the myotendinous junction, a muscle-tendon was no re-creation of symptoms. The median nerve transition zone often susceptible to injury. What is was negative for the Tinel sign, and the rest of the unusual for this athletic medial elbow injury is that neurovascular examination was unremarkable. The the patient reported no previous symptoms, and ipsilateral shoulder was normal on examination. it appears that, though the surrounding muscle Noncontrast magnetic resonance imaging (MRI) may have been fatigued by overuse from the round showed a high-grade partial tear of the pronator of golf earlier that day, the pathology was caused teres myotendinous junction (Figures 2A-2C). In by an acute eccentric force. During a golf swing, the surrounding tissue there was an associated tremendous forces are put on the entire body, increased signal representing edema. Also found from the lower extremities to the forearm and the was a small intramuscular hematoma. The median fingers. Successful completion of the transfer of nerve, medial collateral ligament, distal biceps, and energy from the golf club to the ball requires both E106 The American Journal of Orthopedics ® March/April 2017 www.amjorthopedics.com U. Qayyum et al proper technique and proper functioning of key occur when the sporting club or racket strikes the muscles. Specifically, parameters such as ball po- ground during a forceful swing impeding forward sitioning, club angle, and wrist control play a major progress of the arm. The injury can be confused role.6 Altered forearm positioning or swing arc can with a MUCL injury, or exacerbation of medial significantly affect club head velocity and energy epicondylitis. Physical examination reveals bruising transfer without putting more stress on the golfer.7 and tenderness over the course of the pronator Therefore, it is easy to understand how prolonged teres, often distal to the elbow. Advanced imaging or extended play may fatigue the surrounding confirms the diagnosis and helps grade the sever- elbow muscles, leading to altered technique and ity of muscle strain. Treatment is often conserva- increased susceptibility to acute injury. Biomechan- tive, with return to function and sport after 4 to 6 ical analysis of shoulder motion can provide a help- weeks of rest and restricted activities. The patient ful baseline for assessing injury-related changes in this case report had complete return to sporting in golf swing and developing specific exercise and function, with no residual weakness or pain. rehabilitation programs.8,9 Although injury to the pronator teres is rare, sport physicians should be aware that, after a val- Dr. Qayyum is a Research Fellow, Columbia University De- gus stress or force, bruising and swelling along the partment of Orthopedics, New York, New York. Dr. Villacis is a Clinician Educator, Orthopedic Surgeon, NorthShore medial elbow do not always indicate a medial ulnar University Health System, a teaching affiliate of The Uni- collateral ligament (MUCL) tear or medial epicon- versity of Chicago Pritzker School of Medicine, Glenview, dylitis. The key examination findings that differen- Illinois. Dr. Jobin is Assistant Professor of Orthopaedic tiate this injury from a MUCL injury are the exact Surgery and Residency Program Director, Department of location of pain, the milking maneuver for MUCL Orthopaedic Surgery, New York Presbyterian/Columbia University Medical Center, New York, New York. incompetence, and the extensive bruising over the muscle course of the pronator teres. MRI plays a Address correspondence to: Charles M. Jobin, MD, Department of Orthopaedic Surgery, New York Presbyte- pivotal role in proper diagnosis.4 In addition, MRI rian/Columbia University Medical Center, 622 W 168th St, allows for evaluation of any concomitant injuries New York, NY 10032 (tel, 212-305-6445; fax, 212-305- that may be obscuring the clinical presentation. 4040; email, [email protected]).
Recommended publications
  • Median Nerve Compression at Pronator Teres

    Median Nerve Compression at Pronator Teres

    1 Median Nerve Compression at Pronator Teres Surgical Indications and Considerations Anatomical Considerations: The median nerve and brachial artery travel together down the arm. Therefore, one must be very careful not to interfere with either the median nerve or the brachial artery, especially when conducting surgical procedures. In the area of the pronator teres, there are many tendons as well. It is important to identify, as much as possible, the correct site of compression. Pathogenesis: The median nerve can get entrapped or compressed by several structures in the arm. The pronator teres muscle is the most common. Others entrapment sites include the flexor digitorum superficialis arch, the lacertus fibrosis (bicipital aponeurosis), and ligament of Struthers (frequency occurs in that order). For compression of the median nerve at the pronator teres and flexor digitorum superficialis, the cause is almost always due to hypertrophy of the respected muscle. This hypertrophy is from quick, forceful and repeated movements to the involved muscle. Examples include a carpenter or a baseball batter. As the muscle hypertrophies, the signal from the median nerve is diminished resulting in paresthesias in the median nerve distribution (lateral arm and hand) distal to the site of compression. Pain in the volar part of the forearm, often aggravated by repetitive supination and pronation, is a common symptom of pronator involvement. Another indicator is forearm pain with the compression of muscle such as pain in the volar part of the forearm implicating pronator teres. Onset is typically insidious and diagnosis is usually delayed 9 months to 2 years. Epidemiology: Pronator teres syndrome is the second most common cause of median nerve compression behind carpal tunnel syndrome.
  • Pronator Syndrome: Clinical and Electrophysiological Features in Seven Cases

    Pronator Syndrome: Clinical and Electrophysiological Features in Seven Cases

    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.39.5.461 on 1 May 1976. Downloaded from Journal ofNeurology, Neurosurgery, and Psychiatry, 1976, 39, 461-464 Pronator syndrome: clinical and electrophysiological features in seven cases HAROLD H. MORRIS AND BRUCE H. PETERS From the Department ofNeurology, University of Texas Medical Branch, Galveston, Texas, USA SYNOPSIS The clinical and electrophysiological picture of seven patients with the pronator syndrome is contrasted with other causes ofmedian nerve neuropathy. In general, these patients have tenderness over the pronator teres and weakness of flexor pollicis longus as well as abductor pollicis brevis. Conduction velocity of the median nerve in the proximal forearm is usually slow but the distal latency and sensory nerve action potential at the wrist are normal. Injection of corticosteroids into the pronator teres has produced relief of symptoms in a majority of patients. Protected by copyright. In the majority of isolated median nerve dys- period 101 cases of the carpal tunnel syndrome functions the carpal tunnel syndrome is appropri- and the seven cases of the pronator syndrome ately first suspected. The median nerve can also reported here were identified. Median nerve be entrapped in the forearm giving rise to a conduction velocity determinations were made on similar picture and an erroneous diagnosis. all of these patients. The purpose of this report is to draw full attention to the pronator syndrome and to the REPORT OF CASES features which allow it to be distinguished from Table 1 provides clinical details of seven cases of the median nerve entrapment at other sites.

  • Monday: Back, Biceps, Forearms, Traps & Abs Wednesday

    THE TOOLS YOU NEED TO BUILD THE BODY YOU WANT® Store Workouts Diet Plans Expert Guides Videos Tools BULLDOZER TRAINING 3 DAY WORKOUT SPLIT 3 day Bulldozer Training muscle building split. Combines rest-pause sets with progressive Main Goal: Build Muscle Time Per Workout: 30-45 Mins resistance. Workouts are shorter but more Training Level: Intermediate Equipment: Barbell, Bodyweight, intense. Program Duration: 8 Weeks Dumbbells, EZ Bar, Machines Link to Workout: https://www.muscleandstrength.com/ Days Per Week: 3 Days Author: Steve Shaw workouts/bulldozer-training-3-day-workout-split Monday: Back, Biceps, Forearms, Traps & Abs Exercise Mini Sets Rep Goal Rest Deadlift: Perform as many rest-paused singles as you (safely) can within 10 Mins. Use a weight you could easily perform a 10 rep set with. Rest as needed. When you can perform 15 reps, add weight the next time you deadlift. Barbell Row 5 25 30 / 30 / 45 / 45 Wide Grip Pull Up 5 35 30 / 30 / 30 / 30 Standing Dumbbell Curl 4 25 30 / 30 / 30 EZ Bar Preacher Curl 4 25 30 / 30 / 30 Seated Barbell Wrist Curl 4 35 30 / 30 / 30 Barbell Shrug 5 35 30 / 30 / 30 / 30 Preferred Abs Exercise(s): I recommend using at least one weighted exercise (e.g. Weighted Sit Ups or Cable Crunches). Rest Periods: 30 / 30 / 45 / 45 notates rest periods between each set. Take 30 Secs after the 1st set, 30 Secs after the 2nd set, 45 Secs after the 3rd set, etc. After the final set, rest, and move on to the next exercise.
  • Unusual Cubital Fossa Anatomy – Case Report

    Unusual Cubital Fossa Anatomy – Case Report

    Anatomy Journal of Africa 2 (1): 80-83 (2013) Case Report UNUSUAL CUBITAL FOSSA ANATOMY – CASE REPORT Surekha D Shetty, Satheesha Nayak B, Naveen Kumar, Anitha Guru. Correspondence: Dr. Satheesha Nayak B, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University, Madhav Nagar, Manipal, Karnataka State, India. 576104 Email: [email protected] SUMMARY The median nerve is known to show variations in its origin, course, relations and distribution. But in almost all cases it passes through the cubital fossa. We saw a cubital fossa without a median nerve. The median nerve had a normal course in the upper part of front of the arm but in the distal third of the arm it passed in front of the medial epicondyle of humerus, surrounded by fleshy fibres of pronator teres muscle. Its course and distribution in the forearm was normal. In the same limb, the fleshy fibres of the brachialis muscle directly continued into the forearm as brachioradialis, there being no fibrous septum separating the two muscles from each other. The close relationship of the nerve to the epicondyle might make it vulnerable in the fractures of the epicondyle. The muscle fibres surrounding the nerve might pull up on the nerve and result in altered sensory-motor functions of the hand. Since the brachialis and brachioradialis are two muscles supplied by two different nerves, this continuity of the muscles might result in compression/entrapment of the radial nerve in it. Key words: Median nerve, cubital fossa, brachialis, brachioradialis, entrapment INTRODUCTION The median nerve is the main content of and broad tendon which is inserted into the cubital fossa along with brachial artery and ulnar tuberosity and to a rough surface on the biceps brachii tendon.
  • Anatomical Study of the Branch of the Palmaris Longus Muscle for Its Transfer to the Posterior Interosseous Nerve

    Anatomical Study of the Branch of the Palmaris Longus Muscle for Its Transfer to the Posterior Interosseous Nerve

    Int. J. Morphol., 37(2):626-631, 2019. Anatomical Study of the Branch of the Palmaris Longus Muscle for its Transfer to the Posterior Interosseous Nerve Estudio Anatómico del Ramo del Músculo Palmar Largo para su Transferencia al Nervio Interóseo Posterior Edie Benedito Caetano1; Luiz Angelo Vieira1; Maurício Benedito Ferreira Caetano2; Cristina Schmitt Cavalheiro3; Marcel Henrique Arcuri3 & Luís Cláudio Nascimento da Silva Júnior3 CAETANO, E. B.; VIEIRA, L. A.; FERREIRA, C. M. B.; CAVALHEIRO, C. S.; ARCURI, M. H. & SILVA JÚNIOR, L. C. N. Anatomical study of the branch of the palmaris longus muscle for its transfer to the posterior interosseous nerve. Int. J. Morphol., 37(2):626-631, 2019. SUMMARY: The objective of the study was to evaluate the anatomical characteristics and variations of the palmaris longus nerve branch and define the feasibility of transferring this branch to the posterior interosseous nerve without tension. Thirty arms from 15 adult male cadavers were dissected after preparation with 20 % glycerin and formaldehyde intra-arterial injection. The palmaris longus muscle (PL) received exclusive innervation of the median nerve in all limbs. In most it was the second muscle of the forearm to be innervated by the median nerve. In 5 limbs the PL muscle was absent. In 5 limbs we identified a branch without sharing branches with other muscles. In 4 limbs it shared origin with the pronator teres (PT), in 8 with the flexor carpi radialis (FCR), in 2 with flexor digitorum superficialis (FDS), in 4 shared branches for the PT and FCR and in two with PT, FCR, FDS. The mean length was (4.0 ± 1.2) and the thickness (1.4 ± 0.6).
  • Morphological Study of Palmaris Longus Muscle

    Morphological Study of Palmaris Longus Muscle

    International INTERNATIONAL ARCHIVES OF MEDICINE 2017 Medical Society SECTION: HUMAN ANATOMY Vol. 10 No. 215 http://imedicalsociety.org ISSN: 1755-7682 doi: 10.3823/2485 Humberto Ferreira Morphological Study of Palmaris Arquez1 Longus Muscle ORIGINAL 1 University of Cartagena. University St. Thomas. Professor Human Morphology, Medicine Program, University of Pamplona. Morphology Laboratory Abstract Coordinator, University of Pamplona. Background: The palmaris longus is one of the most variable muscle Contact information: in the human body, this variations are important not only for the ana- tomist but also radiologist, orthopaedic, plastic surgeons, clinicians, Humberto Ferreira Arquez. therapists. In view of this significance is performed this study with Address: University Campus. Kilometer the purpose to determine the morphological variations of palmaris 1. Via Bucaramanga. Norte de Santander, longus muscle. Colombia. Suramérica. Tel: 75685667-3124379606. Methods and Findings: A total of 17 cadavers with different age groups were used for this study. The upper limbs region (34 [email protected] sides) were dissected carefully and photographed in the Morphology Laboratory at the University of Pamplona. Of the 34 limbs studied, 30 showed normal morphology of the palmaris longus muscle (PL) (88.2%); PL was absent in 3 subjects (8.85% of all examined fo- rearm). Unilateral absence was found in 1 male subject (2.95% of all examined forearm); bilateral agenesis was found in 2 female subjects (5.9% of all examined forearm). Duplicated palmaris longus muscle was found in 1 male subject (2.95 % of all examined forearm). The palmaris longus muscle was innervated by branches of the median nerve. The accessory palmaris longus muscle was supplied by the deep branch of the ulnar nerve.
  • Pronator Teres Tear at the Myotendinous Junction in the Recreational Golfer: a Case Report

    Pronator Teres Tear at the Myotendinous Junction in the Recreational Golfer: a Case Report

    International Journal of Orthopaedics Online Submissions: http: //www.ghrnet.org/index.php/ijo Int. J. of Orth. 2021 April 28; 8(2): 1457-1462 doi: 10.17554/j.issn.2311-5106.2021.08.405 ISSN 2311-5106 (Print), ISSN 2313-1462 (Online) CASE REPORT Pronator Teres Tear at the Myotendinous Junction in the Recreational Golfer: A Case Report Alvarho J. Guzman1, BA; Stewart A. Bryant1, MD; Shane M. Rayos Del Sol1, BS, MS; Brandon Gardner1, MD, PhD; Moyukh O. Chakrabarti1, MBBS; Patrick J. McGahan1, MD; James L. Chen1, MD 1 Department of Orthopedic Surgery, Advanced Orthopedics & was expected to make a complete return to pre-injury level athletic Sports Medicine, San Francisco, CA, the United States. activity with conservative management. With this article, we consider biceps rupture on the differential diagnoses associated with pronator Conflict-of-interest statement: The author(s) declare(s) that there teres musculotendinous injuries, emphasize the significance of club is no conflict of interest regarding the publication of this paper. type in relation to golfing injuries, and propose a potential pronator teres rupture non-operative rehabilitation protocol. Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external Key words: Pronator teres; Golf; Biceps; Ecchymosis; Rehabilitation reviewers. It is distributed in accordance with the Creative Com- protocol mons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non- © 2021 The Author(s). Published by ACT Publishing Group Ltd. All commercially, and license their derivative works on different terms, rights reserved.
  • Workout Plan Pdf

    Workout Plan Pdf

    WORKOUT PLAN PDF 17 INCHES – ARMS TRAINING PROGRAM 17 INCHES is a 10 weeks Arm training program to build size of Biceps & Triceps. This will help to gain 1-2 inches arms size and 8-10 pounds of muscle mass in 10 weeks. Follow the exact workout & nutrition plan for the proper results. GURU MANN – Nutritionist & Advanced Fitness Professional United States Guru Mann Fitness Inc. WORKOUT SPLIT OPTION 1 OPTION 2 MONDAY STRENGTH – BICEPS/TRICEPS ------ TUESDAY ------ STRENGTH – BICEPS/TRICEPS WEDNESDAY ------ ------ THURSDAY ENDURANCE – BICEPS/TRICEPS ------ FRIDAY ------ ENDURANCE – BICEPS/TRICEPS SATURDAY ------ ------ SUNDAY REST REST Combine it with other workout plan STRENGTH EXERCISES SETS REPS ALTERNATE EXERCISES 0 WARM UP DB CURL OR EMPLY BARBELL 2-3 15-20 --------- TRICEPS PUSHDOWN 1 SUPER SET 1A. EZ BARBELL CURL 3 8-7-6 STRAIGHT BAR CURL 1B. HAMMER CURL 2 SUPER SET 2A. BARBELL PREACHER CURL 3 8-7-6 DB PREACHER CURL 2B. DB CON. CURL 3 SUPER SET 3A. ROPE CURL 3 8-7-6 CLOSE GRIP BAR 3B. ROPE OVERHEAD EXT. CURL 4 SUPER SET 4A. SKULL CRUSHER 3 8-7-6 ---------- 4B. DB KICKBACK 5 SUPER SET 5A. DB OVERHEAD EXT. 3 8-7-6 5B. WEIGHTED CLOSE GRIP ---------- INCLINE PUSHUP 6 SUPER SET 6A. WRIST CURL (PALM UP) 3 8-7-6 WRIST CURL (PALM 6B. STANDING WRIST CURL FACING DOWN) REST IS 2-3 MIN IN BETWEEN THE SET. THERE IS NO REST IN-BETWEEN THE SUPER SET. ENDURANCE EXERCISES SETS REPS ALTERNATE EXERCISES 0 WARM UP DB CURL OR EMPLY BARBELL 3 15-20 --------- TRICEPS PUSHDOWN 1 SUPER SET 1A.
  • The Lacertus Syndrome of the Elbow in Throwing Athletes

    The Lacertus Syndrome of the Elbow in Throwing Athletes

    The Lacertus Syndrome of the Elbow in Throwing Athletes Steve E. Jordan, MD KEYWORDS Medial elbow pain Differential diagnosis Lacertus syndrome KEY POINTS It is important to take a complete history and perform a careful examination in order to avoid confirmation bias when evaluating throwers with medial elbow pain. Lacertus syn- drome is a postexertional compartment syndrome, and the history can help elucidate this. The Lacertus syndrome is more common than pronator syndrome, which involves the me- dian nerve, and can be distinguished with a careful workup. Other more common pathol- ogies should be ruled out with a routine workup. Include inspection of the flexor pronator muscle group and consider evaluating after throwing when examining a thrower with postexertional elbow pain. HISTORY OF THE TECHNIQUE In 1959, George Bennett summarized his experiences caring for throwing athletes. The following paragraph is excerpted in its entirety from that article.1 “There is a lesion which produces a different syndrome. A pitcher in throwing a curveball is compelled to supinate his wrist with a snap at the end of his delivery. On examination, one will note distinct fullness over the pronator radii teres. These are covered by a strong fascial band, a portion of which is the attachment of the bi- ceps, which runs obliquely across the pronator muscle. A pitcher may be able to pitch for two or three innings but then the pain and swelling become so great that he has to retire. A simple linear and transverse division of the fascia covering the muscles has relieved tension on many occasions and rehabilitated these men so that they were able to return to the game.” This is the first known reference to a condition that has undoubtedly disabled many players and possibly ended careers of an untold number of throwing athletes.
  • Anatomy, Biomechanics, Physiology, Diagnosis and Treatment of Teres

    Anatomy, Biomechanics, Physiology, Diagnosis and Treatment of Teres

    ANATOMY, BIOMECHANICS, PHYSIOLOGY, DIAGNOSIS AND TREATMENT OF TERES MAJOR STRAINS IN THE CANINE Laurie Edge-Hughes, BScPT, CAFCI, CCRT Four Leg Rehabilitation Therapy & The Canine Fitness Centre Ltd, Calgary, AB, Canada The Canadian Horse and Animal Physical Rehabilitation Assn. The Animal Rehab Institute, Loxahatchee, Florida, USA BACKGROUND The canine shoulder apparatus is unique as compared to other canine joints and also when compared to the human shoulder. When compared to the hind limb it is interesting to note that the front limb has no boney attachment to the axial skeleton in that there is no clavicle in the canine. This factor alone means that muscular strength and co-ordination is of utmost importance to full functioning of the front limb. When compared to the human shoulder, one obvious difference is that the shoulder joint is a weight bearing joint. The orientation of the canine scapula and humerus is vertical and the weight distribution is 60 to 65 % on the front legs and 40 – 35% on the hind legs. Essentially dogs are like ‘front wheel drive vehicles’, designed to propel themselves forward by primarily ‘pulling’ from the front end. This is why identification and treatment of front limb muscle injuries is critically important for athletic or just high energy dogs who are most prone to injuring shoulder muscles. The teres major muscle is one that is commonly strained, often unidentified and hence not as effectively treated as it could be in the active canine patient. ANATOMY The teres major muscle originates from the caudal angle and caudal edge of the scapula and inserts into the eminence on the proximal 1/3 of the medial surface of the humerus.
  • Neurotization to Innervate the Deltoid and Biceps: 3 Cases

    Neurotization to Innervate the Deltoid and Biceps: 3 Cases

    SCIENTIFIC ARTICLE Neurotization to Innervate the Deltoid and Biceps: 3 Cases Christopher J. Dy, MD, MSPH, Alison Kitay, MD, Rohit Garg, MBBS, Lana Kang, MD, Joseph H. Feinberg, MD, Scott W. Wolfe, MD Purpose To describe our experience using direct muscle neurotization as a treatment adjunct during delayed surgical reconstruction for traumatic denervation injuries. Methods Three patients who had direct muscle neurotization were chosen from a consecutive series of patients undergoing reconstruction for brachial plexus injuries. The cases are presented in detail, including long-term clinical follow-up at 2, 5, and 10 years with accompanying postoperative electrodiagnostic studies. Postoperative motor strength using British Medical Research Council grading and active range of motion were retrospectively extracted from the clinical charts. Results Direct muscle neurotization was performed into the deltoid in 2 cases and into the biceps in 1 case after delays of up to 10 months from injury. Two patients had recovery of M4 strength, and the other patient had recovery of M3 strength. All 3 patients had evidence on electrodiagnostic studies of at least partial muscle reinnervation after neurotization. Conclusions Direct muscle neurotization has shown promising results in numerous basic science investigations and a limited number of clinical cases. The current series provides additional clinical and electrodiagnostic evidence that direct muscle neurotization can successfully provide reinnervation, even after lengthy delays from injury to surgical treatment. Clinical relevance Microsurgeons should consider direct muscle neurotization as a viable adjunct treatment and part of a comprehensive reconstructive plan, especially for injuries associated with avulsion of the distal nerve stump from its insertion into the muscle.
  • Anatomical Study of Pronator Teres Muscle Innervation and Clinical Significance in Nerve Transfer

    Anatomical Study of Pronator Teres Muscle Innervation and Clinical Significance in Nerve Transfer

    Int. J. Morphol., 36(4):1500-1508, 2018. Anatomical Study of Pronator Teres Muscle Innervation and Clinical Significance in Nerve Transfer Estudio Anatómico de la Inervación del Músculo Pronador Redondo y Significado Clínico en la Transferencia Nerviosa Edie Benedito Caetano1; Luiz Angelo Vieira1; José João Sabongi Neto2; Maurício Benedito Ferreira Caetano2; Rodrigo Guerra Sabongi3; Luca Martinez4; Kelson Koiti Ogata4 & Eduardo Baldy de Sousa Boni4 CAETANO, E. B.; VIEIRA, L A.; SABONGI NETO, J. J. ; CAETANO, M. B. F.; SABONGI, R. G.; MARTINEZ, L.; OGATA, K. K. & BONI, E. B. S. Anatomical study of pronator teres muscle innervation and clinical significance in nerve transfer. Int. J. Morphol., 36(4):1500-1508, 2018. SUMMARY: The anatomical relationship of the median nerve and its innervation pattern are variable and may have direct implications in surgical procedures such as distal nerve transfers. The objective of this study was to evaluate the anatomical variations of pronator teres muscle (PTM) innervation and its clinical significance in nerve transfers. Data were collected regarding the number of median nerve branches, site of their origin, contribution with branches of other muscles and the possibility of transferring expendable branches of PTM to the anterior interosseous nerve (AIN) and radial nerve. The most common origin of the branches was proximal to the humeral intercondylar line. The presence of only one PTM branch was identified in 9 limbs, in which 6 was exclusive for this muscle. The majority of specimens presented more than one branch to the PTM, with two branches in 19, although only 6 of these did not share branches with other muscles.