Laxity of the Ulnar Nerve During Elbow Flexion and Extension

2012 ◽  
Vol 37 (6) ◽  
pp. 1163-1167 ◽  
Author(s):  
Christine B. Novak ◽  
Hossein Mehdian ◽  
Herbert P. von Schroeder
Keyword(s):  
Ulnar Nerve ◽  
Elbow Flexion ◽  
Flexion And Extension

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 ◽  
2011 ◽  
Vol 70 (2) ◽  
pp. E516-E520 ◽  
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.

Contralateral motor rootlets and ipsilateral nerve transfers in brachial plexus reconstruction

2004 ◽  
Vol 101 (5) ◽  
pp. 770-778 ◽  
Author(s):  
Jayme Augusto Bertelli ◽  
Marcos Flávio Ghizoni
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Phrenic Nerve ◽  
Cranial Nerve ◽  
External Rotation ◽  
Elbow Flexion ◽  
Content Type ◽  
Nerve Transfers ◽  
Contralateral Motor ◽  
Fine Print

Object. The goal of this study was to evaluate outcomes in patients with brachial plexus avulsion injuries who underwent contralateral motor rootlet and ipsilateral nerve transfers to reconstruct shoulder abduction/external rotation and elbow flexion. Methods. Within 6 months after the injury, 24 patients with a mean age of 21 years underwent surgery in which the contralateral C-7 motor rootlet was transferred to the suprascapular nerve by using sural nerve grafts. The biceps motor branch or the musculocutaneous nerve was repaired either by an ulnar nerve fascicular transfer or by transfer of the 11th cranial nerve or the phrenic nerve. The mean recovery in abduction was 90° and 92° in external rotation. In cases of total palsy, only two patients recovered external rotation and in those cases mean external rotation was 70°. Elbow flexion was achieved in all cases. In cases of ulnar nerve transfer, the muscle scores were M5 in one patient, M4 in six patients, and M3+ in five patients. Elbow flexion repair involving the use of the 11th cranial nerve resulted in a score of M3+ in five patients and M4 in two patients. After surgery involving the phrenic nerve, two patients received a score of M3+ and two a score of M4. Results were clearly better in patients with partial lesions and in those who were shorter than 170 cm (p < 0.01). The length of the graft used in motor rootlet transfers affected only the recovery of external rotation. There was no permanent injury at the donor sites. Conclusions. Motor rootlet transfer represents a reliable and potent neurotizer that allows the reconstruction of abduction and external rotation in partial injuries.

Nerve transfers to the biceps and brachialis branches to improve elbow flexion strength after brachial plexus injuries

2004 ◽  
Vol 16 (5) ◽  
pp. 313-318
Author(s):  
Thomas H. Tung ◽  
Christine B. Novak ◽  
Susan E. Mackinnon
Keyword(s):  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Elbow Flexion ◽  
Musculocutaneous Nerve ◽  
Nerve Transfers ◽  
Brachialis Muscle ◽  
Nerve Fascicle ◽  
The Mean ◽  
Mean Time ◽  
Flexion Strength

Object In this study the authors evaluated the outcome in patients with brachial plexus injuries who underwent nerve transfers to the biceps and the brachialis branches of the musculocutaneous nerve. Methods The charts of eight patients who underwent an ulnar nerve fascicle transfer to the biceps branch of the musculocutaneous nerve and a separate transfer to the brachialis branch were retrospectively reviewed. Outcome was assessed using the Medical Research Council (MRC) grade to classify elbow flexion strength in conjunction with electromyography (EMG). The mean patient age was 26.4 years (range 16–45 years) and the mean time from injury to surgery was 3.8 months (range 2.5–7.5 months). Recovery of elbow flexion was MRC Grade 4 in five patients, and Grade 4+in three. Reinnervation of both the biceps and brachialis muscles was confirmed on EMG studies. Ulnar nerve function was not downgraded in any patient. Conclusions The use of nerve transfers to reinnervate the biceps and brachialis muscle provides excellent elbow flexion strength in patients with brachial plexus nerve injuries.

Excitotoxic acid lesions of the primate subthalamic nucleus result in reduced pallidal neuronal activity during active holding

1992 ◽  
Vol 68 (5) ◽  
pp. 1859-1866 ◽  
Author(s):  
I. Hamada ◽  
M. R. DeLong
Keyword(s):  
Subthalamic Nucleus ◽  
Neuronal Activity ◽  
Elbow Flexion ◽  
Ibotenic Acid ◽  
Excitatory Input ◽  
Behavioral Task ◽  
Discharge Rates ◽  
Before And After ◽  
The Mean ◽  
Flexion And Extension

1. To gain a better understanding of the pathophysiology of hemiballismus in primates, and to test directly the hypothesis that the subthalamopallidal projection is excitatory, we studied the effects of lesions of the subthalamic nucleus (STN) on neuronal activity in the globus pallidus (GP) of monkeys during performance of a motor behavioral task. 2. Animals were trained to position and hold a manipulandum to which torque pulses were applied, producing elbow flexion and extension. The activity of neurons in the external (GPe) and internal (GPi) segments of GP was recorded in two monkeys during task performance before and after STN lesions. The STN was lesioned by the fiber-sparing neurotoxins ibotenic acid and/or kainic acid. 3. After lesioning, the firing rate of neurons in both segments of GP, which was measured during the period of holding before torque application, was significantly decreased in both animals. The mean of discharge rates of GPi neurons decreased (P < 0.001) from 69.8 (n = 169, SD = 21.6) to 47.4 spikes/s (n = 180, SD = 22.6) after lesioning. The mean of discharge rates of GPe neurons decreased from 63.6 spikes/s (n = 218, SD = 25.1) before lesions to 41.0 spikes/s (n = 208, SD = 18.1) after lesioning. 4. These results provide further evidence that STN gives rise to a major excitatory input to both segments of the GP and support the hypothesis that dyskinesias result from decreased GPi output.

scholarly journals A Pilot Study of Individual Muscle Force Prediction during Elbow Flexion and Extension in the Neurorehabilitation Field

Sensors ◽  
2016 ◽  
Vol 16 (12) ◽  
pp. 2018 ◽  
Author(s):  
Jiateng Hou ◽  
Yingfei Sun ◽  
Lixin Sun ◽  
Bingyu Pan ◽  
Zhipei Huang ◽  
...  
Keyword(s):  
Pilot Study ◽  
Muscle Force ◽  
Elbow Flexion ◽  
Force Prediction ◽  
Individual Muscle ◽  
Flexion And Extension

scholarly journals Design and Implement an Exoskeleton Arm for Reinforcement the Human Muscles after Stroke

2019 ◽  
Vol 22 (4) ◽  
pp. 252-258
Author(s):  
Duha Qais Abd-ul-Amir ◽  
Auns Qusai Hashim ◽  
Abdulnasir Hussin Ameer
Keyword(s):  
Stroke Rehabilitation ◽  
Elbow Flexion ◽  
Mobility Limitations ◽  
Basic Principles ◽  
Robotic Exoskeleton ◽  
Human Muscles ◽  
Negative Impacts ◽  
Exoskeleton Device ◽  
Flexion And Extension

Mobility limitations in stroke survivors yield negative impacts on the quality of life for such individuals. Rehabilitation is needed to help them recover and regain mobility. Accordingly, this study aims to design and validate a “Robotic Exoskeleton” intended for stroke rehabilitation. The basic principles of this robotic exoskeleton device are its dependence on electromyography signal and electronic microcontroller to provide an efficient physiotherapy exercises system.The robotic exoskeleton is a one degree of freedom which performs the flexion and extension of the elbow joint. After the design was completed, 19 subjects participated in this study: 4 healthy subjects, and 15 post-stroke patients.The results showed the benefit of robotic exoskeleton in increasing the elbow range of motion, where angle of elbow flexion was raised from the first physiotherapy session to maximum elbow flexion in the last session.

scholarly journals Post-Operative Assessment of Ulnar Nerve Tension Using Shear-Wave Elastography

2021 ◽  
Vol 13 (3) ◽  
pp. 469-476
Author(s):  
Sebastien Durand ◽  
Wassim Raffoul ◽  
Thierry Christen ◽  
Nadine Pedrazzi
Keyword(s):  
Elastic Modulus ◽  
Shear Wave ◽  
Ulnar Nerve ◽  
Shear Wave Elastography ◽  
Elbow Flexion ◽  
Ulnar Nerve Compression ◽  
Nerve Decompression ◽  
Shear Elastic Modulus ◽  
Anterior Transposition ◽  
Operative Assessment

Background: Ulnar nerve compression at the elbow level is the second-most common entrapment neuropathy. The aim of this study was to use shear-wave elastography for the quantification of ulnar nerve elasticity in patients after ulnar nerve decompression with anterior transposition and in the contralateral non-operative side. Method: Eleven patients with confirmed diagnosis and ulnar nerve decompression with anterior transposition were included and examinations were performed on an AixplorerTM ultrasound system (Supersonic Imagine, Aix-en-Provence, France). Results: We observed significant differences at 0-degree (p < 0.001), 45-degree (p < 0.05), 90-degree (p < 0.01) and 120-degree (p < 0.001) elbow flexion in the shear elastic modulus of the ulnar nerve in the operative and non-operative sides. There were no statistically significant differences between the elasticity values of the ulnar nerve after transposition at 0-degree elbow flexion and in the non-operative side at 120-degree elbow flexion (p = 0.39), or in the ulnar nerve after transposition at 120-degree elbow flexion and in the non-operative side at 0-degree elbow flexion (p = 0.09). Conclusion: Shear-wave elastography has the potential to be used postoperatively as a method for assessing nerve tension noninvasively by the estimation of mechanical properties, such as the shear elastic modulus.

Free gracilis muscle transfer with ulnar nerve neurotization for elbow flexion restoration

2020 ◽  
Author(s):  
Marcelo R. De Rezende ◽  
Bruno A. Veronesi ◽  
Renata G. Paulos ◽  
Alvaro B. Cho ◽  
Samuel Ribak ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Elbow Flexion ◽  
Gracilis Muscle ◽  
Muscle Transfer

Minimum Ten-Year Outcomes of Partial Ulnar Nerve Transfer for Restoration of Elbow Flexion in Patients with Upper Brachial Plexus Injury

2019 ◽  
Vol 24 (03) ◽  
pp. 283-288
Author(s):  
Yusuke Nagano ◽  
Daisuke Kawamura ◽  
Alaa Terkawi ◽  
Atsushi Urita ◽  
Yuichiro Matsui ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Brachial Plexus ◽  
Ulnar Nerve ◽  
Functional Outcomes ◽  
Brachial Plexus Injury ◽  
Nerve Transfer ◽  
Elbow Flexion ◽  
The Mean ◽  
Flexion Strength

Background: Partial ulnar nerve transfer to the biceps motor branch of the musculocutaneous nerve (Oberlin’s transfer) is a successful approach to restore elbow flexion in patients with upper brachial plexus injury (BPI). However, there is no report on more than 10 years subjective and objective outcomes. The purpose of this study was to clarify the long-term outcomes of Oberlin’s transfer based on the objective evaluation of elbow flexion strength and subjective functional evaluation of patients. Methods: Six patients with BPI who underwent Oberlin’s transfer were reviewed retrospectively by their medical records. The mean age at surgery was 29.5 years, and the mean follow-up duration was 13 years. The objective functional outcomes were evaluated by biceps muscle strength using the Medical Research Council (MRC) grade at preoperative, postoperative, and final follow-up. The patient-derived subjective functional outcomes were evaluated using the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire at final follow-up. Results: All patients had MRC grade 0 (M0) or 1 (M1) elbow flexion strength before operation. Four patients gained M4 postoperatively and maintained or increased muscle strength at the final follow-up. One patient gained M3 postoperatively and at the final follow-up. Although one patient achieved M4 postoperatively, the strength was reduced to M2 due to additional disorder. The mean score of QuickDASH was 36.5 (range, 7–71). Patients were divided into two groups; three patients had lower scores and the other three patients had higher scores of QuickDASH. Conclusions: Oberlin’s transfer is effective in the restoration of elbow flexion and can maintain the strength for more than 10 years. Patients with upper BPI with restored elbow flexion strength and no complicated nerve disorders have over ten-year subjective satisfaction.

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