DOCSLIB.ORG

Upper Extremity Compartmental Anatomy: Fabienne Robertson Nancy M

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Upper Extremity Compartmental Anatomy: Fabienne Robertson Nancy M Skeletal Radiol (2006) 35: 195–201 DOI 10.1007/s00256-005-0063-3 REVIEW ARTICLE Glen A. Toomayan Upper extremity compartmental anatomy: Fabienne Robertson Nancy M. Major clinical relevance to radiologists Brian E. Brigman Abstract Malignant tumors of the Violation of high-resistance compart- Received: 26 April 2005 Revised: 29 September 2005 upper extremity are uncommon, and mental barriers necessitates more Accepted: 13 October 2005 their care should be referred to extensive surgical resection. Biopsy Published online: 18 February 2006 specialized facilities with experience may be performed by the radiologist # ISS 2006 treating these lesions. The Musculo- using imaging guidance. Knowledge G. A. Toomayan . F. Robertson . skeletal Tumor Society (MSTS) stag- of compartmental anatomy allows the N. M. Major ing system is used by the surgeon to radiologist or surgeon to use an easily Department of Radiology, determine appropriate surgical excisable biopsy approach and Duke University Medical Center, P.O. Box 3808 management, assess prognosis, and prevent iatrogenic spread to unaf- Durham, NC 27710, USA communicate with other healthcare fected compartments. Case examples providers. Magnetic resonance are presented to illustrate the impor- . G. A. Toomayan (*) F. Robertson imaging (MRI) is employed pre- tance of compartmental anatomy in N. M. Major . B. E. Brigman ’ Division of Orthopaedic Surgery, operatively to identify a lesion s the management of benign and Department of Surgery, compartment of origin, determine malignant upper extremity tumors. Duke University Medical Center, extent of spread, and plan biopsy and P.O. Box 3808 resection approaches. Involvement of Keywords MRI . Tumor . Upper Durham, NC 27710, USA . e-mail: [email protected] neurovascular structures may result in extremity Compartmental anatomy Tel.: +919-684-7469 devastating loss of upper extremity Fax: +919-684-7138 function, requiring amputation. Introduction management have not been defined as clearly in the upper extremity as in the lower extremity [3]. Tumors of the upper extremity pose diagnostic and For the practicing radiologist, knowledge of upper therapeutic challenges not encountered with lower extrem- extremity compartmental anatomy helps to provide useful ity tumors. Upper extremity malignancies are less common pre-operative staging information to the surgeon. If called than lower extremity malignancies, limiting the experience upon to perform closed biopsy, the radiologist must of the radiologist, pathologist, and orthopaedic surgeon [1]. understand locations of compartments in order to use an The presence of small, highly specialized extrinsic hand easily excisable biopsy tract and prevent iatrogenic tumor muscles located close together and in proximity to critical spread [4]. Principles of extremity sarcoma staging and neurovascular structures makes diagnosis and surgical percutaneous biopsy of the suspicious lower extremity mass excision challenging [2]. Functional deficits that result have been reviewed previously, but briefly include travers- from surgical tumor excision or amputation can be ing the minimum number of compartments, avoiding particularly debilitating in the upper extremity, due to the neurovascular structures, and placing biopsy tracts along profound role the upper extremity plays in performing proposed limb salvage incision lines [5]. Any question activities of daily living. Lastly, definitions of compart- regarding the placement or route of an image-guided biopsy mental anatomy and the role they play in dictating surgical should be discussed with the surgeon ultimately responsible 196 for the surgical treatment of the lesion. This review focuses Table 1 Musculoskeletal Tumor Society (MSTS) sarcoma staging on defining compartmental anatomy of the upper extremity system and highlighting its usefulness in performing biopsies and Stage Grade Site Metastasis communicating important pre-operative information to the surgeon. IA Low (G1) Intracompartmental (T1) None (M0) IB Low (G1) Extracompartmental (T2) None (M0) IIA High (G2) Intracompartmental (T1) None (M0) Epidemiology IIB High (G2) Extracompartmental (T2) None (M0) III Low (G1)or Intracompartmental (T1)or Regional or Malignant tumors of bone and soft tissue are relatively rare. High (G2) Extracompartmental (T2) Distant (M1) In 2004, there were an estimated 2,440 new malignant bone Note: adapted from [12, 15] tumors and 8,680 new malignant soft-tissue tumors diagnosed in the United States [6]. Bone and soft-tissue tumors combined account for less than 1% of all newly to other providers in a concise, yet uniform and reliable diagnosed malignancies. Approximately twice as many fashion [11]. malignant bone and soft tissue neoplasms occur in the The radiologist may be consulted to help establish all lower extremity as compared to the upper extremity [7, 8]. three staging characteristics by interpreting pre-operative Many practitioners therefore have little experience manag- imaging studies and performing the biopsy. Magnetic ing patients with upper extremity malignancies. resonance imaging (MRI) is the imaging modality of Benign upper extremity tumors are more common than choice in staging extremity neoplasms, due to its ability to malignancies and include ganglion cysts, epidermoid image masses in multiple planes and provide excellent soft- inclusion cysts, giant cell tumors of tendon sheath, tissue resolution [11]. In interpreting a pre-operative, pre- lipomas, benign peripheral nerve sheath tumors, and biopsy imaging study, the radiologist must make note of the palmar nodules of Dupuytren’s contracture [9, 10]. Despite size and location of the tumor, as well as its relationship to the likelihood that an upper extremity tumor is benign, the critical neurovascular structures. As surgical excision of physician must approach all upper extremity tumors with any upper extremity neurovascular structures has great the suspicion of malignancy [11]. It is therefore recom- implications for the patient’s overall function, it is mended that the care of patients with these lesions be important to inform the surgeon of possible involvement undertaken by a team of surgeons, radiologists, and of or proximity to these critical structures [2]. Adequate pathologists with experience managing malignant upper pre-operative knowledge and planning may allow for extremity lesions. Often this requires referral to a microsurgical vascular or neural grafting or tendon-transfer specialized multi-disciplinary medical center. procedures to minimize any ultimate loss of function for the patient. The radiologist must also characterize the compartmen- Staging tal location of the tumor. Lesions staged as intracompart- mental (T1), or limited to within the compartment of origin, Bone and soft-tissue sarcomas arising from mesenchymal are surgically treated with wide local resection, whereas tissue are staged for surgery by the Musculoskeletal Tumor extracompartmental (T2) lesions, or those that have spread Society (MSTS) staging system [12]. This system has been beyond the compartment of origin, are generally treated preferred by surgeons, while medical oncologists generally with radical excision (excising the entire anatomic com- use the American Joint Committee on Cancer (AJCC) partment), which often necessitates amputation to achieve a staging system [11, 13]. The MSTS staging system better functional outcome [16]. characterizes musculoskeletal sarcomas other than Ewing’s Anatomic compartments are defined as anatomic regions sarcoma, leukemia, lymphoma, undifferentiated round cell bounded by high-resistance barriers to tumor spread, such tumors, and metastatic carcinoma, by grade (G), site (T), as fascial planes, articular cartilage, and cortical bone. and metastasis (M) (Table 1)[14, 15]. Grade is determined Compartmental definition is possible for 95% of muscu- by histopathology as benign, low-grade malignant, or high- loskeletal tumors, with the remaining tumors occurring in grade malignant. Site is characterized as intracompart- extrafascial planes or poorly compartmentalized spaces mental or extracompartmental. Metastasis is defined as [17]. Tumor spread may occur along neurovascular present or absent. The MSTS staging system is useful for structures in the upper extremity, some of which pass determining appropriate surgical management, providing between compartments [17]. A tumor which has spread prognostic stratification, and communicating information beyond its compartment of origin through a high-resistance 197 barrier will necessitate a more significant surgical proce- axillary artery and vein become the brachial artery and dure than one which is confined within one compartment. vein. These structures descend the arm medially in an Therefore, identification of compartmental location and extracompartmental location along with the median and spread by the radiologist is helpful for surgical planning. ulnar nerves (Fig. 1). As these neurovascular structures pass into the distal arm, the brachial artery and veins along with the median nerve penetrate the anterior compartment Arm Compartments and continue in a location between the biceps and brachialis muscles, while the ulnar nerve remains extra- For purposes of tumor staging, the arm is regarded as compartmental. The radial nerve occupies a position deep composed of three anatomic compartments as well as the within the posterior compartment, in close proximity to the extracompartmental axillary space [17]. The humerus, with posterior humerus
Load more

Recommended publications
  • Wrist Fracture – Advice Following Removal of Your Cast
    Wrist Fracture – advice following removal of your cast A plaster cast usually prevents a fracture from moving, but allows your fingers to move. The cast also reduces pain. What to expect It usually takes four to six weeks for new bone to form to heal your fracture. When the cast is removed most people find that their wrist is stiff, weak and uncomfortable to start with. It may also be prone to swelling and the skin dry or flaky, this is quite normal. It is normal to get some pain after your fracture. If you need painkillers you should take them as prescribed as this will allow you to do your exercises and use your wrist for light activities. You can ask a Pharmacist about over the counter painkillers. If your pain is severe, continuous or excessive you should contact your GP. The new bone gradually matures and becomes stronger over the next few months. It is likely to be tender and may hurt if you bang it. The muscles will be weak initially, but they should gradually build up as you start to use your hand and wrist. When can I start to use my hand and wrist? It is important to try and use your hand and wrist as normally as possible. Start with light activities like fastening buttons, washing your face, eating, turning the pages of books over etc. Build up as pain allows. Avoid lifting a kettle for 4 weeks If I have been given a Wrist splint You may have been given a wrist splint to wear.
    [Show full text]
  • 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.
    [Show full text]
  • Wrist Fracture
    Hand Conditions: WRIST FRACTURE A wrist fracture is a break in one or more of the bones in the wrist. The wrist is made up of the two bones in the forearm called the radius and the ulna. It also includes eight carpal bones. The carpal bones lie between the end of the forearm bones and the bases of the fi ngers. The most commonly fractured carpal bone is called the scaphoid or navicular bone. This fact sheet will focus on fractures of the carpal bones of the wrist. Causes A wrist fracture is caused by trauma to the bones in the wrist. Trauma may be caused by: • Falling on an outstretched arm • Direct blow to the wrist • Severe twist of the wrist Risk Factors Factors that increase your chance of developing a wrist fracture include: • Participating in contact sports, such as football or soccer • Participating in activities such as in-line skating, skateboarding, or bike riding • Participating in any activity which could cause you to fall on your outstretched hand • Violence or high-velocity trauma, such as an automobile accident Symptoms If you have any of these symptoms, do not assume they are due to a wrist fracture. Symptoms of a wrist fracture include. • Pain • Swelling and tenderness around the wrist • Bruising around the wrist • Limited range of wrist or thumb motion • Visible deformity in the wrist For more information visit us online at www.ptandme.com Hand Conditions: WRIST FRACTURE Diagnosis Your doctor will ask about your symptoms, physical activity, and how the injury occurred. The injured area will be examined.
    [Show full text]
  • Identification and Surgical Management of Upper Arm and Forearm Compartment Syndrome
    Open Access Case Report DOI: 10.7759/cureus.5862 Identification and Surgical Management of Upper Arm and Forearm Compartment Syndrome Adel Hanandeh 1 , Vishnu R. Mani 2 , Paul Bauer 1 , Alexius Ramcharan 3 , Brian Donaldson 1 1. General Surgery, Columbia University College of Physicians and Surgeons at Harlem Hospital Center, New York, USA 2. Surgery, Columbia University College of Physicians and Surgeons at Harlem Hospital Center, New York, USA 3. Surgery, Harlem Hospital Center, New York, USA Corresponding author: Adel Hanandeh, [email protected] Abstract Extremity muscles are grouped and divided by strong fascial membranes into compartments. Multiple pathological processes can result in an increase in the pressure within a muscle compartment. An increase in the compartment pressure beyond the adequate perfusion pressure has the potential to cause extremity compartment syndrome. There are multiple sites where compartment syndrome can occur. In this article, an arm and forearm compartment syndrome ensued secondary to a minor crushing injury that lead to supracondylar and medial epicondylar non-displaced fractures. A pure motor radial and ulnar nerve deficits noted on presentation, worsened with progression of the compartment syndrome. Ultimately, a surgical fasciotomy was carried out to release all compartments of the right upper arm and forearm. Categories: General Surgery, Orthopedics, Anatomy Keywords: upper arm compartment syndrome, fasciotomy, forearm compartment syndrome, condylar fracture, pediatric supracondylar humerus fracture Introduction In 1872, the first description of compartment syndrome was published by Richard von Volkmann. His publication described an irreversible contracture of muscles due to ischemic process resulting in the first documented nerve injury and contracture from compartment syndrome.
    [Show full text]
  • Exposure of the Forearm and Distal Radius
    Exposure of the Forearm and Distal Radius Melissa A. Klausmeyer, MDa, Chaitanya Mudgal, MDb,* KEYWORDS Henry approach Thompson approach Flexor carpi radialis approach Dorsal distal radius approach Distal radius approach KEY POINTS The use of internervous planes allow access to the underlying bone without risk of denervating the overlying muscles. The choice of approach is based on the injury pattern and need for exposure. The Henry and Thompson approaches are useful for radial shaft fractures. The distal radius can be approached volarly through the flexor carpi radialis (FCR) approach or dorsally through the extended Thompson approach. The extended FCR approach is useful for intraarticular fractures of the distal radius as well as mal- unions and subacute fractures. INTRODUCTION ANATOMY OF THE FOREARM Muscles Safe operative approaches to the bones of the forearm and wrist include the use of internervous The muscles of the forearm are split into 4 compart- planes. These planes lie between muscles that ments: The superficial volar, the deep volar, the are innervated by different nerves. By utilizing extensor, and the mobile wad (Table 1). The median these planes for dissection, extensive mobilization nerve supplies all of the volar muscles of the forearm of muscles and therefore large areas of exposure except the ulnar half of the flexor digitorum profun- may be obtained without the risk of muscle dus and the flexor carpi ulnaris that are supplied denervation. by the ulnar nerve. The radial nerve proper supplies A successful operative plan also must include the brachioradialis and extensor carpi radialis lon- consideration of the soft tissues, particularly gus.
    [Show full text]
  • Study Guide Medical Terminology by Thea Liza Batan About the Author
    Study Guide Medical Terminology By Thea Liza Batan About the Author Thea Liza Batan earned a Master of Science in Nursing Administration in 2007 from Xavier University in Cincinnati, Ohio. She has worked as a staff nurse, nurse instructor, and level department head. She currently works as a simulation coordinator and a free- lance writer specializing in nursing and healthcare. All terms mentioned in this text that are known to be trademarks or service marks have been appropriately capitalized. Use of a term in this text shouldn’t be regarded as affecting the validity of any trademark or service mark. Copyright © 2017 by Penn Foster, Inc. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner. Requests for permission to make copies of any part of the work should be mailed to Copyright Permissions, Penn Foster, 925 Oak Street, Scranton, Pennsylvania 18515. Printed in the United States of America CONTENTS INSTRUCTIONS 1 READING ASSIGNMENTS 3 LESSON 1: THE FUNDAMENTALS OF MEDICAL TERMINOLOGY 5 LESSON 2: DIAGNOSIS, INTERVENTION, AND HUMAN BODY TERMS 28 LESSON 3: MUSCULOSKELETAL, CIRCULATORY, AND RESPIRATORY SYSTEM TERMS 44 LESSON 4: DIGESTIVE, URINARY, AND REPRODUCTIVE SYSTEM TERMS 69 LESSON 5: INTEGUMENTARY, NERVOUS, AND ENDOCRINE S YSTEM TERMS 96 SELF-CHECK ANSWERS 134 © PENN FOSTER, INC. 2017 MEDICAL TERMINOLOGY PAGE III Contents INSTRUCTIONS INTRODUCTION Welcome to your course on medical terminology. You’re taking this course because you’re most likely interested in pursuing a health and science career, which entails ­proficiency­in­communicating­with­healthcare­professionals­such­as­physicians,­nurses,­ or dentists.
    [Show full text]
  • PE1897 Wrist and Hand Stretches
    Patient and Family Education Wrist and Hand Stretches How can I help my child do the stretches? Use these exercises to help stretch the You play an important role in your child’s therapy. Older children may need wrist and hand. reminders to do their stretches every day. You may need to help position your younger child for the stretches. Or you may need to help stretch your child’s hand or arm. Be sure to pay attention to your child’s alignment and posture to make sure each stretch is performed correctly. How often should my child do the stretches? These stretches should be done twice a day, or as instructed by your therapist: ______________________________________________________________ Stretches Wrist extension Hold arm out in front Use opposite hand to bend wrist up with fingers straight Option to straighten elbow for increased stretch Hold for 30 seconds or _______ Repeat 2 times or ___________ VHI Wrist extension Sit with elbows on table Place palms together Slowly lower wrists to table Hold for 30 seconds or ______ Repeat 2 times or __________ VHI Wrist flexion Hold arm out in front Use opposite hand to bend wrist down Option to straighten elbow for increased stretch Option to curl fingers for increased stretch Hold for 30 seconds or ______ VHI Repeat 2 times or __________ 1 of 2 Wrist and Hand Stretches Wrist radial/ulnar deviation To Learn More Hold arm at side of body with palm • Occupational/Physical facing forward Therapy 206-987-2113 Use opposite hand to straighten wrist toward the thumb side Do not allow the wrist to flex forward to extend backward Free Interpreter Hold for 30 seconds or ______ Services Repeat 2 times or __________ • In the hospital, ask BioEx Systems Inc.* your child’s nurse.
    [Show full text]
  • The Branching and Innervation Pattern of the Radial Nerve in the Forearm: Clarifying the Literature and Understanding Variations and Their Clinical Implications
    diagnostics Article The Branching and Innervation Pattern of the Radial Nerve in the Forearm: Clarifying the Literature and Understanding Variations and Their Clinical Implications F. Kip Sawyer 1,2,* , Joshua J. Stefanik 3 and Rebecca S. Lufler 1 1 Department of Medical Education, Tufts University School of Medicine, Boston, MA 02111, USA; rebecca.lufl[email protected] 2 Department of Anesthesiology, Stanford University School of Medicine, Stanford, CA 94305, USA 3 Department of Physical Therapy, Movement and Rehabilitation Science, Bouve College of Health Sciences, Northeastern University, Boston, MA 02115, USA; [email protected] * Correspondence: [email protected] Received: 20 May 2020; Accepted: 29 May 2020; Published: 2 June 2020 Abstract: Background: This study attempted to clarify the innervation pattern of the muscles of the distal arm and posterior forearm through cadaveric dissection. Methods: Thirty-five cadavers were dissected to expose the radial nerve in the forearm. Each muscular branch of the nerve was identified and their length and distance along the nerve were recorded. These values were used to determine the typical branching and motor entry orders. Results: The typical branching order was brachialis, brachioradialis, extensor carpi radialis longus, extensor carpi radialis brevis, supinator, extensor digitorum, extensor carpi ulnaris, abductor pollicis longus, extensor digiti minimi, extensor pollicis brevis, extensor pollicis longus and extensor indicis. Notably, the radial nerve often innervated brachialis (60%), and its superficial branch often innervated extensor carpi radialis brevis (25.7%). Conclusions: The radial nerve exhibits significant variability in the posterior forearm. However, there is enough consistency to identify an archetypal pattern and order of innervation. These findings may also need to be considered when planning surgical approaches to the distal arm, elbow and proximal forearm to prevent an undue loss of motor function.
    [Show full text]
  • Early Passive Motion After Surgery
    www.western -ortho.com www.denvershoulder.com Early Passive Motion after Shoulder Surgery Passive motion involves someone else moving the affected arm through the motion described. Or, in the case of elbow flexion/extension, you can use your opposite (non-affected arm) to move through the motion. Do 5 repetitions of each stretch 3 times per day. When you feel a slight ‘tightness’ with your arm in the position diagrammed, hold that position for 30 seconds. If lying down is difficult, the stretches can be done while seated. Shoulder Flexion Support arm at the wrist and elbow. With the thumb pointed forward, gently bring the arm up and forward then back to the side. Shoulder Abduction Support arm at wrist and elbow. With the thumb pointed away from the body and palm up, gently bring the arm out to the side. www.western -ortho.com www.denvershoulder.com Shoulder Internal/External Rotation Support arm at wrist and elbow. With the elbow at the side and bent to a 90 degree angle, gently rotate the hand away from the body down toward the table the individual is lying on. Elbow Flexion/Extension Forearm Pronation/Supination Grasp the wrist of your affected arm with your unaffected With your elbow and forearm supported on a table, hand. With your affected elbow against your side and your gently turn forearm so your palm is down, then turn palm up, gently bend and straighten your elbow. forearm so your palm is up. This can be done actively (without assistance from your other hand). .
    [Show full text]
  • Neurology of the Upper Limb
    Neurology of the Upper limb Donald Sammut Hand Surgeon Kings Upper Limb Anatomy plus lecture notes The$Neck$ The$Nerve$roots$which$supply$the$Upper$Limb$are$C5$to$T1$ Pre<fixed$(C4$to$C8)$and$Post<fixed$(C6$to$T2)$plexus$not$uncommon.$ Also$common$contributions$from$C4$and$from$T2$in$a$normally$rooted$plexus.$ $ The$anterior$nerve$roots$emerge$between$the$vertebrae$and$immediately$pass$ $through$the$first$area$of$possible$compression:$ The$root$nerve$canal$is$bounded$$ Anteriorly$by$the$posterior$margin$of$the$intervertebral$disc$and$$ Posteriorly,$by$the$facet$joint$between$vertebrae.$ $ Pathology$of$the$disc,$or$joint,$or$both,$can$narrow$this$channel$and$compress$ $the$nerve$root$ The$roots$emerge$from$the$cervical$spine$into$the$plane$between$$ Scalenius$Anterior$and$Scalenius$Medius.$$ $ Scalenius*Anterior:** Origin:$Anterior$tubercles$of$Cervical$vertebae$C3$to$6$(C6$tubercle$is$the$Carotid$tubercle)$ Insertion:$The$scalene$tubercle$on$inner$border/upper$surface$1st$rib$ $ Scalenius*Medius:* Origin:$Posterior$tubercles$of$all$cervical$vertebrae$ Insertion:$Quadrangular$area$between$the$neck$and$subclavian$groove$1st$rib$ $ Exiting$from$the$Scalenes,$the$trunks$lie$in$the$posterior$triangle$of$the$neck.$ The$posterior$triangle$is$bounded$anteriorly$by$SternoCleidoMastoid$and$$ posteriorly$by$the$Trapezius.$ The$inferior$border$is$the$clavicle$.$ The$apex$of$the$triangle$superiorly$is$at$the$back$of$the$skull$on$the$superior$nuchal$line$ $ $ The$Posterior$Triangle$ SternoCleidoMastoid$ Trapezius$ Scalenius$Medius$ Scalenius$Anterior$
    [Show full text]
  • Standing Shoulder Flexion with Resistance
    Prepared by Samantha Bohy Michigan STEP 1 STEP 2 Standing Shoulder Flexion with Resistance REPS: 15 | SETS: 2 | WEEKLY: 5x | Setup Begin in a standing upright position holding one end of a resistance band anchored under your foot with your thumb pointing forward. Movement Lift your arm straight forward to shoulder height, then slowly lower it back down and repeat. STEP 1 STEP 2 Single Arm Shoulder Extension with Resistance REPS: 15 | SETS: 2 | WEEKLY: 5x | Setup Begin standing tall, holding the end of a band that is anchored in front of you. Movement Pull your arm back, bringing your hand behind you. Return to the starting position and repeat. STEP 1 STEP 2 Standing Single Arm Shoulder Abduction with Resistance REPS: 15 | SETS: 2 | WEEKLY: 5x | Setup Begin in a standing upright position holding one end of a resistance band anchored under your feet with your thumb pointing up. Movement Lift your arm straight out to your side, to shoulder height, then lower it back down and repeat. Tip Make sure to maintain good posture and do not shrug your shoulder during the exercise. STEP 1 STEP 2 Shoulder Adduction with Anchored Resistance REPS: 15 | SETS: 2 | WEEKLY: 5x | Setup Begin in a standing upright position holding the end of a resistance band in one hand with your arm straight and palm facing downward, to the side of the anchor point. Movement Pull your arm down against the resistance band to your side, then slowly return to the starting position and repeat. STEP 1 STEP 2 Shoulder External Rotation with Anchored Resistance REPS: 15 | SETS: 2 | WEEKLY: 5x | Setup Begin standing upright with your elbow bent at 90 degrees and a towel roll tucked under your arm, holding a resistance band that is anchored out to your opposite side.
    [Show full text]
  • 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.
    [Show full text]