Forced Shoulder Abduction and Elbow Flexion Test: A New Simple Clinical Test to Detect Superior Labral Injury in the Throwing Shoulder

OBJECTIVEHuman acellular nerve allograft applications have increased in clinical practice, but no studies have quantified their influence on reconstruction outcomes for high-level, greater, and mixed nerves, especially the brachial plexus. The authors investigated the functional outcomes of human acellular nerve allograft reconstruction for nerve gaps in patients with brachial plexus injury (BPI) undergoing contralateral C7 (CC7) nerve root transfer to innervate the upper trunk, and they determined the independent predictors of recovery in shoulder abduction and elbow flexion.METHODSForty-five patients with partial or total BPI were eligible for this retrospective study after CC7 nerve root transfer to the upper trunk using human acellular nerve allografts. Deltoid and biceps muscle strength, degree of shoulder abduction and elbow flexion, Semmes-Weinstein monofilament test, and static two-point discrimination (S2PD) were examined according to the modified British Medical Research Council (mBMRC) scoring system, and disabilities of the arm, shoulder, and hand (DASH) were scored to establish the function of the affected upper limb. Meaningful recovery was defined as grades of M3–M5 or S3–S4 based on the scoring system. Subgroup analysis and univariate and multivariate logistic regression analyses were conducted to identify predictors of human acellular nerve allograft reconstruction.RESULTSThe mean follow-up duration and the mean human acellular nerve allograft length were 48.1 ± 10.1 months and 30.9 ± 5.9 mm, respectively. Deltoid and biceps muscle strength was grade M4 or M3 in 71.1% and 60.0% of patients. Patients in the following groups achieved a higher rate of meaningful recovery in deltoid and biceps strength, as well as lower DASH scores (p < 0.01): age < 20 years and age 20–29 years; allograft lengths ≤ 30 mm; and patients in whom the interval between injury and surgery was < 90 days. The meaningful sensory recovery rate was approximately 70% in the Semmes-Weinstein monofilament test and S2PD. According to univariate and multivariate logistic regression analyses, age, interval between injury and surgery, and allograft length significantly influenced functional outcomes.CONCLUSIONSHuman acellular nerve allografts offered safe reconstruction for 20- to 50-mm nerve gaps in procedures for CC7 nerve root transfer to repair the upper trunk after BPI. The group in which allograft lengths were ≤ 30 mm achieved better functional outcome than others, and the recommended length of allograft in this procedure was less than 30 mm. Age, interval between injury and surgery, and allograft length were independent predictors of functional outcomes after human acellular nerve allograft reconstruction.

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Transfer of a Motor Fascicle From the Ulnar Nerve to the Branch of the Radial Nerve Destined to the Long Head of the Triceps for Restoration of Elbow Extension in Brachial Plexus Surgery

Neurosurgery ◽

10.1227/neu.0b013e31822ac120 ◽

2011 ◽

Vol 70 (2) ◽

pp. E516-E520 ◽

Cited By ~ 11

Author(s):

Leandro Pretto Flores

Keyword(s):

Computed Tomography ◽

Brachial Plexus ◽

Ulnar Nerve ◽

Radial Nerve ◽

Nerve Transfer ◽

Elbow Flexion ◽

Shoulder Abduction ◽

Elbow Extension ◽

Long Head ◽

Brachial Plexus Surgery

Abstract BACKGROUND AND IMPORTANCE: Restoration of elbow extension has not been considered of much importance regarding functional outcomes in brachial plexus surgery; however, the flexion of the elbow joint is only fully effective if the motion can be stabilized, what can be achieved solely if the triceps brachii is coactivated. To present a novel nerve transfer of a healthy motor fascicle from the ulnar nerve to the nerve of the long head of the triceps to restore the elbow extension function in brachial plexus injuries involving the upper and middle trunks. CLINICAL PRESENTATION: Case 1 is a 32-year-old man sustaining a right brachial extended upper plexus injury in a motorcycle accident 5 months before admission. The computed tomography myelogram demonstrated avulsion of the C5 and C6 roots. Case 2 is a 24-year-old man who sustained a C5-C7 injury to the left brachial plexus in a traffic accident 4 months before admission. Computed tomography myelogram demonstrated signs of C6 and C7 root avulsion. The technique included an incision at the medial border of the biceps, in the proximal third of the involved arm, followed by identification of the ulnar nerve, the radial nerve, and the branch to the long head of the triceps. The proximal stump of a motor fascicle from the ulnar nerve was sutured directly to the distal stump of the nerve of the long head of the triceps. Techniques to restore elbow flexion and shoulder abduction were applied in both cases. Triceps strength Medical Research Council M4 grade was obtained in both cases. CONCLUSION: The attempted nerve transfer was effective for restoration of elbow extension in primary brachial plexus surgery; however, it should be selected only for cases in which other reliable donor nerves were used to restore elbow flexion.

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Clinical findings in C5-C6 and C5-C7 root palsies with brachial plexus traction lesions

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193412471009 ◽

2012 ◽

Vol 38 (3) ◽

pp. 237-241 ◽

Cited By ~ 8

Author(s):

J. A. Bertelli ◽

M. F. Ghizoni

Keyword(s):

Brachial Plexus ◽

External Rotation ◽

Elbow Flexion ◽

Clinical Findings ◽

Hand Strength ◽

Shoulder Abduction ◽

Finger Extension ◽

Root Injury ◽

Flexion Extension

Stretch injuries of the C5-C7 roots of the brachial plexus traditionally have been associated with palsies of shoulder abduction/external rotation, elbow flexion/extension, and wrist, thumb, and finger extension. Based on current myotome maps we hypothesized that, as far as motion is concerned, palsies involving C5-C6 and C5-C7 root injuries should be similar. In 38 patients with upper-type palsies of the brachial plexus, we examined for correlations between clinical findings and root injury level, as documented by CT tomomyeloscan. Contrary to commonly held beliefs, C5-C7 root injuries were not associated with loss of extension of the elbow, wrist, thumb, or fingers, but residual hand strength was much lower with C5-C7 vs C5-C6 lesions.

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GAMBARAN KEKUATAN OTOT PADA LANSIA DI BPLU SENJA CERAH PANIKI BAWAH

Jurnal e-Biomedik ◽

10.35790/ebm.3.1.2015.6618 ◽

2015 ◽

Vol 3 (1) ◽

Author(s):

Prisilia M. Pinontoan ◽

Sylvia R. Marunduh ◽

Herlina I. S. Wungouw

Keyword(s):

Muscle Strength ◽

Elderly Women ◽

Elbow Flexion ◽

Knee Extension ◽

Shoulder Abduction ◽

Elderly Men ◽

Cross Sectional ◽

Purposive Sampling ◽

Shoulder Flexion ◽

Cross Sectional Design

Abstract: The aim of this study was to find out the profile of muscle strength on elderly at BPLU Senja Cerah Paniki Bawah. This was a descriptive study with cross sectional design. There were 26 respondents who met the inclusion criteria, consisted of 10 elderly men and 16 elderly women. Respondents were selected by using purposive sampling method. The measurements of the muscle strength were done by using 1 RM method while doing elbow flexion, elbow extension, shoulder flexion, shoulder extension, shoulder abduction, knee flexion, knee extension and dorsoflexion. Data were analyzed manually and computerized then presented in tabular form. The result shows that the average muscle strength in elderly men were greater than women and the average muscle strength of respondents that were included in the age group 60-79 years old were greater than those in 80-99 years.Keywords: muscle strength, elderly.1 RMAbstrak: Tujuan dari penelitian ini yaitu untuk mengetahui gambaran kekuatan otot pada Lansia di BPLU Senja Cerah Paniki Bawah. Penelitian ini merupakan peneliltian deskriptif dengan rancangan potong lintang. Responden yang memenuhi kriteria inklusi terdiri dari 26 orang yang terdiri dari 10 orang laki-laki dan 16 orang perempuan. Sampel dipilih menggunakan cara purposive sampling. Kekuatan otot pada lansia diukur dengan menggunakan metode 1 RM yang diukur pada gerakan fleksi siku, ekstensi siku, fleksi bahu, ekstensi bahu, abduksi bahu, fleksi lutut, ekstensi lutut serta dorsofleksi. Data yang sudah didapatkan kemudian dikumpul dan diolah secara manual dan komputerisasi serta disajikan dalam bentuk tabel. Hasil penelitian menunjukkan rerata kekuatan otot responden laki-laki lebih besar dibanding perempuan dan rerata kekuatan responden yang termasuk dalam kelompok umur 60-79 tahun lebih besar dibanding kelompok umur 80-99 tahun.Kata kunci: kekuatan otot, lansia, 1 RM.

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Double Fascicular Transfer Using Partially Injured Donor Nerves: Is It Powerful Enough to Restore Elbow Flexion in Acute Brachial Plexus Injuries?

Journal of Reconstructive Microsurgery ◽

10.1055/s-0041-1736320 ◽

2021 ◽

Author(s):

Tommy Nai-Jen Chang ◽

Johnny Chuieng-Yi Lu ◽

Che-Hsiung Lee ◽

Yu-Ching Lin ◽

Yenpo Lin ◽

...

Keyword(s):

Brachial Plexus ◽

Demographic Data ◽

Preoperative Evaluation ◽

Elbow Flexion ◽

Shoulder Abduction ◽

Postoperative Rehabilitation ◽

Strength Assessment ◽

Group I ◽

Healthy Side ◽

Group Ii

Abstract Background Loss of elbow flexion is a common sequela of acute brachial plexus injuries (BPIs). The Mackinnon/Oberlin-II double fascicular transfer (DFT) is a widely used method to restore this function in acute C5–6 or C5–7 injuries. This study attempted to evaluate if this technique can be applied reliably for cases involving C8 and/or T1 injuries. Methods Adult patients with acute BPIs who underwent the Mackinnon/Oberlin-II DFT in our center between 2008 and 2018 were retrospectively identified. Group I (n = 37) included patients with only C5–6 or C5–7 injury, while group II (n = 32) patients presented C5–8 ± T1 injuries. The demographic data, pre- and postoperative neurologic evaluations, electrodiagnostic studies, and grip strength assessment were collected. Results A total of 69 patients met the inclusion criteria. Preoperatively, the patients in group II presented poorer nerve conduction and electromyography in both the median and the ulnar nerves and the supply muscles. The percentage of M3 achievement in both groups was 91.9 versus 87.5% and M4 was 73.0 and 71.9%, respectively, which both were not statically significant but the achievement of group II was slower than the group I, 1 to 2 months slower, respectively. Both groups had 57.57 and 46.0% of the postoperative grip power compared with the healthy side, the result of shoulder abduction was not different (p = 0.480). Conclusion With careful preoperative evaluation, early intervention, appropriate intraoperative functional fascicle selection, and aggressive postoperative rehabilitation, indications for the Mackinnon/Oberlin-II DFT technique can safely include acute C5–8 injuries and even partial T1 acute BPIs.

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639 Maximizing Safe Positioning of Upper Extremities after Axillary Burn Injuries to Prevent Contractures and Maintain Function

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.289 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S175-S176

Author(s):

Connie Greiser ◽

David Lorello ◽

Dan Lyons ◽

Karen J Richey ◽

Derek Murray ◽

...

Keyword(s):

Healthy Subjects ◽

Elbow Flexion ◽

Primary Objective ◽

Burn Injuries ◽

Shoulder Abduction ◽

Shoulder Injury ◽

Shoulder Range Of Motion ◽

History Of ◽

The Right ◽

Shoulder Range

Abstract Introduction Burns crossing over a joint can result in a contracture of that joint. Axillary burns and subsequent contractures are common and may impact negatively on burn survivor rehabilitation. Positioning of burned extremities at the most lengthened position is ideal for maintenance of function and contracture prevention, 90 degrees of abduction is the most accepted position for axillary burn injuries. However, many activities of daily living require shoulder range of motion (ROM) greater than 90 degrees. The primary objective of this study was to describe and examine the incidence of paresthesia, pain, and intolerance in healthy subjects when the shoulder was placed in a position of 90 degrees or greater of shoulder abduction. Methods The subject’s nondominant upper extremity (NDE) was randomly placed in a series three of positions, including: (1) 90 degrees shoulder abduction, 30 degrees horizontal adduction with elbow extension, forearm neutral; (2) 130 degrees shoulder abduction, 30 degrees horizontal adduction, 30 degrees elbow flexion, forearm neutral; (3) 150 degrees shoulder abduction, 30 degrees horizontal adduction, 30 degrees elbow flexion, forearm neutral. Each position was maintained for a maximum of 2 hours. Subjects experiencing subjective symptoms including paresthesia lasting longer than 1 minute, pain rated greater than 3/10, and/or intolerance 2/5 was removed from the position. All subjects received at least 30 minutes of rest between positions. Results A total of 25 subjects were enrolled, mean age was 25.8 years, the majority were female (60%) and 20% had a history of NDE shoulder injury. The right arm was the dominant extremity (DE) in 88% of subjects. There were no significant differences in ROM between the DE and NDE extremity with the exception of external shoulder rotation, 94.96⁰ vs 84.8⁰ (p=.0142). Average total splint time was 136 minutes with a range of 40 – 360 minutes. Only 1 subject successfully completed all 3 splinting periods. There were 75 individual splinting events over the 3 splinting periods, and 90% of the time the splinting was stopped early. The most common reason for stopping early was paresthesia (88%) followed by pain (7%). Conclusions The positions selected represent the routine and usual care at our burn center. Patients are routinely positioned from hours to days depending on patient need. This study demonstrated that healthy subjects were unable to tolerate positioning for even two hours.

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Shoulder internal rotation elbow flexion test for diagnosing cubital tunnel syndrome

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2011.10.015 ◽

2012 ◽

Vol 21 (6) ◽

pp. 777-781 ◽

Cited By ~ 14

Author(s):

Kensuke Ochi ◽

Yukio Horiuchi ◽

Aya Tanabe ◽

Makoto Waseda ◽

Yasuhito Kaneko ◽

...

Keyword(s):

Internal Rotation ◽

Elbow Flexion ◽

Cubital Tunnel Syndrome ◽

Cubital Tunnel ◽

Tunnel Syndrome ◽

Flexion Test

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Upper brachial plexus injury in adults: comparative effectiveness of different repair techniques

Journal of Neurosurgery ◽

10.3171/2014.9.jns132823 ◽

2015 ◽

Vol 122 (1) ◽

pp. 195-201 ◽

Cited By ~ 48

Author(s):

Zarina S. Ali ◽

Gregory G. Heuer ◽

Ryan W. F. Faught ◽

Shriya H. Kaneriya ◽

Umar A. Sheikh ◽

...

Keyword(s):

Brachial Plexus ◽

Controlled Trial ◽

Treatment Strategies ◽

Nerve Transfer ◽

Elbow Flexion ◽

Surgical Approaches ◽

Shoulder Abduction ◽

Nerve Grafting ◽

Nerve Transfers ◽

Repair Techniques

OBJECT Adult upper trunk brachial plexus injuries result in significant disability. Several surgical treatment strategies exist, including nerve grafting, nerve transfers, and a combination of both approaches. However, no existing data clearly indicate the most successful strategy for restoring elbow flexion and shoulder abduction in these patients. The authors reviewed the literature to compare outcomes of the three surgical repair techniques listed above to determine the optimal approach to traumatic injury to the upper brachial plexus in adults. METHODS Both PubMed and EMBASE databases were searched for English-language articles containing the MeSH topic “brachial plexus” in conjunction with the word “injury” or “trauma” in the title and “surgery” or “repair” as a MeSH subheading or in the title, excluding pediatric articles and those articles limited to avulsions. The search was also limited to articles published after 1990 and containing at least 10 operated cases involving upper brachial plexus injuries. The search was supplemented with articles obtained through the “Related Articles” feature on PubMed and the bibliographies of selected publications. From the articles was collected information on the operation performed, number of operated cases, mean subject ages, sex distribution, interval between injury and surgery, source of nerve transfers, mean duration of follow-up, year of publication, and percentage of operative success in terms of elbow flexion and shoulder abduction of the injured limb. The recovery of elbow flexion and shoulder abduction was separately analyzed. A subanalysis was also performed to assess the recovery of elbow flexion following various neurotization techniques. RESULTS As regards the restoration of elbow flexion, nerve grafting led to significantly better outcomes than either nerve transfer or the combined techniques (F = 4.71, p = 0.0097). However, separating the Oberlin procedure from other neurotization techniques revealed that the former was significantly more successful (F = 82.82, p < 0.001). Moreover, in comparing the Oberlin procedure to nerve grafting or combined procedures, again the former was significantly more successful than either of the latter two approaches (F = 53.14; p < 0.001). In the restoration of shoulder abduction, nerve transfer was significantly more successful than the combined procedure (p = 0.046), which in turn was significantly better than nerve grafting procedures (F = 5.53, p = 0.0044). CONCLUSIONS According to data in this study, in upper trunk brachial plexus injuries in adults, the Oberlin procedure and nerve transfers are the more successful approaches to restore elbow flexion and shoulder abduction, respectively, compared with nerve grafting or combined techniques. A prospective, randomized controlled trial would be necessary to fully elucidate differences in outcome among the various surgical approaches.

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Impact of experimental long head of biceps tendon pain on shoulder abduction and elbow flexion strength

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2018.05.008 ◽

2018 ◽

Vol 27 (8) ◽

pp. 1535-1536

Author(s):

Masashi Izumi ◽

Yutaka Morisawa ◽

Yoshitaka Muramatsu ◽

Yukihiro Kajita ◽

Yusuke Iwahori ◽

...

Keyword(s):

Biceps Tendon ◽

Elbow Flexion ◽

Shoulder Abduction ◽

Long Head Of Biceps ◽

Long Head ◽

Flexion Strength

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Effect of Pitching Consecutive Days in Youth Fast-Pitch Softball Tournaments on Objective Shoulder Strength and Subjective Shoulder Symptoms

The American Journal of Sports Medicine ◽

10.1177/0363546516688657 ◽

2017 ◽

Vol 45 (6) ◽

pp. 1413-1419 ◽

Cited By ~ 17

Author(s):

S. Andrew Skillington ◽

Robert H. Brophy ◽

Rick W. Wright ◽

Matthew V. Smith

Keyword(s):

Shoulder Pain ◽

External Rotation ◽

Elbow Flexion ◽

Strength Loss ◽

Complete Recovery ◽

Progressive Increase ◽

Shoulder Abduction ◽

Shoulder Injury ◽

Level Of Evidence ◽

Cross Sectional

Background: The windmill pitching motion has been associated with risk for shoulder injury. Because there are no pitching limits on youth fast-pitch softball pitchers, these athletes often pitch multiple games across consecutive days. Strength changes, fatigue levels, and shoulder pain that develop among female fast-pitch pitchers over the course of consecutive days of pitching have not been investigated. Hypothesis: Over the course of 2- and 3-day fast-pitch softball tournaments, pitchers will develop progressive objective weakness and increased subjective shoulder fatigue and pain without complete recovery between days. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Fourteen female fast-pitch softball pitchers between the ages of 14 and 18 years were evaluated for strength and fatigue changes across 2- and 3-day tournaments. At the beginning and end of each day of tournament play, pitchers were asked to quantify shoulder fatigue and shoulder pain levels of their dominant throwing arm using a 10-point visual analog scale (VAS). Shoulder abduction, flexion, external rotation, internal rotation, elbow flexion, and elbow extension strength measurements were gathered using a handheld dynamometer. Results: Over the course of an average single day of tournament participation, pitchers developed significant increases in VAS scores for shoulder fatigue (median, 2.0; 95% CI, 1.3-3.0) and pain (median, 1.3; 95% CI, 0.5-2.3) and significant strength loss in all tested motions. Pitchers also developed significant increases in VAS shoulder fatigue (median, 3.5; 95% CI, 1.5-5.5), VAS shoulder pain (median, 2.5; 95% CI, 1.0-4.5), and strength loss in all tested motions over the entire tournament. Shoulder pain, fatigue, and strength do not fully recover between days. The accumulation of subjective shoulder pain and fatigue over the course of tournament play were closely correlated. Conclusion: Among youth female fast-pitch softball pitchers, there is a progressive increase in shoulder fatigue, pain, and weakness over the course of 2- and 3-day tournaments without full recovery between consecutive days of pitching.

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