Wrist extension strength required for power grip: a study using a radial nerve block model

2011 ◽  
Vol 37 (5) ◽  
pp. 432-435 ◽  
Author(s):  
T. Suzuki ◽  
T. Kunishi ◽  
J. Kakizaki ◽  
N. Iwakura ◽  
J. Takahashi ◽  
...  
Keyword(s):  
Nerve Block ◽  
Strong Correlation ◽  
Radial Nerve ◽  
Recovery Process ◽  
Wrist Flexion ◽  
Nerve Blocks ◽  
Wrist Extension ◽  
Power Grip ◽  
The Mean ◽  
Healthy Males

The aim of this study was to investigate the correlation of wrist extension strength (WES) and grip strength (GS) using a radial nerve block, and to determine the WES required to prevent the “wrist flexion phenomenon” (antagonistic WES) when making a fist. We tested 14 arms in seven healthy males. WES and GS were measured before blocking as standard WES and standard GS. All participants then had radial nerve blocks with mepivacaine hydrochloride. During the recovery process from radial nerve blockade, WES and GS were recorded every 5 minutes. There was a very strong correlation between WES and GS ( p < 0.0001). The mean antagonistic WES was 51% of standard WES, and the mean GS, recorded at the same time, was 66% of standard GS.

scholarly journals A Cadaveric Study of Radial Nerve Course and its Clinical Implications on Radial Nerve Block at Elbow

2021 ◽  
Author(s):  
Srimathi Ramasamy ◽  
Muthu Kumar Thyagarajan ◽  
Chandrasekar Raju
Keyword(s):  
Peripheral Nerve ◽  
Nerve Block ◽  
Radial Nerve ◽  
Biceps Tendon ◽  
Cross Sectional Study ◽  
Upper Limbs ◽  
Nerve Blocks ◽  
Cross Sectional ◽  
Lateral Epicondyle ◽  
The Mean

Introduction: Upper limb nerve blocks are done commonly by brachial plexus (C5-T1) blocks via supraclavicular, infraclavicular approaches. Sometimes a single peripheral nerve needs additional block with local anaesthetic to achieve adequate block. Peripheral nerve blocks are useful for minor surgical procedures in a single nerve distribution. Aim: To study the course and clinical significance of the radial nerve in 50 cadaveric upper limbs. Materials and Methods: A cross-sectional study was conducted on 50 intact dissected upper limbs. The upper limbs were obtained from the Department of Anatomy, Sri Ramachandra Medical College from August 2020 to December 2020. Radial nerve was exposed by routine dissection in all the upper limbs and its entire course was studied and observed for any variation. The distance from the biceps tendon to the radial nerve at the elbow, distance of the radial nerve in the Lateral Intermuscular Septum (LIS) from the epicondyles at the elbow were measured. The results obtained were statistically analysed using Statistical Package for the Social Sciences (SPSS) version 16.0. Results: In present study, the mean distance of the radial nerve in the LIS to the medial epicondyle was 12.4±0.31 cm and to the lateral epicondyle was 12.1±0.28 cm. The mean distance from the biceps tendon to the radial nerve at the elbow was 1.75±0.22 cm. Conclusion: From the present study, it can be inferred that effective peripheral radial nerve block can be achieved by blocking the nerve 1.75 cm lateral to the biceps tendon at the elbow 3 cm above the elbow crease. This can be made comfortable to the patient and more precise by ultrasound localisation of the radial nerve.

scholarly journals A Rapid and Effective Method to Prolong Pain Relief in Sheep Using Bupivacaine and Intralipid ® Combination

2019 ◽  
Vol 4 (3) ◽  
pp. 1-6
Author(s):  
Farzin Sahebjam
Keyword(s):  
Nerve Block ◽  
Final Concentration ◽  
Noxious Stimulus ◽  
Control Group ◽  
Multiple Time ◽  
Treatment Results ◽  
Time Intervals ◽  
Nerve Blocks ◽  
Duration Of Action ◽  
The Mean

Background : To compare the duration of action of a local anesthetic block using a lipid formulation of bupivacaine to the commercially available aqueous formulation. Bupivacaine 0.5% was mixed with an equal volume of either lipid emulsion (Intralipid, Fresenius Kabi) or normal saline resulting in a final concentration of 0.25% bupivacaine. Eighteen sheep were administered a n erve block of either control or treatment at the metacarpal region of each forelimb to compare the efficacy of the injected formulations. The nociceptive test was determined by applying a blunt noxious stimulus to the foot below the nerve block at multiple time intervals until the sheep responded by withdrawing its foot. The person assessing the response to the noxious stimulus was blinded to the treatment. Results: The Intralipid formulation significantly extended the duration of the nerve block compared to the control group. The mean analgesic period (mean±SD) in the control legs was 4.23±1.8 hr. compared to 5.81±1.78 hr. in the Intralipid injected legs (p=0.013). Conclusions : In conclusion, an Intralipid® - based formulation provided a more prolonged dura tion of local anesthesia after nerve blocks in the sheep metacarpal region compared to aqueous bupivacaine.

scholarly journals Surgical restoration of drop-hand syndrome with tendon transfer in patients injured in the Syrian civil war

2019 ◽  
Vol 6 (1) ◽  
Author(s):  
Murat Ucak
Keyword(s):  
Civil War ◽  
Radial Nerve ◽  
Tendon Transfer ◽  
Cutting Tool ◽  
Gunshot Wounds ◽  
Wrist Flexion ◽  
Wrist Extension ◽  
Extensor Pollicis Longus ◽  
Finger Extension ◽  
Syrian Civil War

Abstract Background The radial nerve is one of the most common war-related injury sites due to penetrating cutting tool injuries or gunshot wounds, resulting in drop-hand syndrome. The aim of this study was to evaluate the outcomes of tendon transfer in patients with drop-hand syndrome who had been injured in the Syrian Civil War. Methods This level-II, prospective, comparative study included 13 civilians injured in the Syrian Civil War 2015 and 2017. The palmaris longus tendon was used for transfer to the extensor pollicis longus for thumb extension. The pronator teres was transferred to the extensor carpi radialis brevis for wrist extension. The flexor carpi radialis was transferred to the extensor digiti communis for 2nd, 3rd, 4th, and 5th finger extension. All outcomes of thumb abduction and extension, wrist extension, wrist flexion, and finger extension were assessed. Results There was a high level of radial nerve injury in all patients included in the study. The time from injury to treatment ranged from 1.5 months to 9 months. The mechanism of injury most commonly observed was a gunshot wound, which was observed in 8 patients (61.5%), followed by a penetrating cutting tool injury (n = 3; 23.1%) and humerus fracture (n = 2; 15.4%). Conclusions In radial nerve injuries, successful results can be achieved with tendon transfer. All patients regained thumb abduction of up to approximately 60°. All the patients were able to bend the wrist, grip, and extend the fingers while in wrist flexion, neutral wrist and wrist extension positions. Although the reason for the radial injury varied, the postoperative outcomes were good for all patients, and the rehabilitation period progressed successfully in patients who underwent tendon transfer repair within 90 days of injury.

Effect of Wrist Position on Power Grip and Key Pinch Strength Following Carpal Tunnel Decompression

2004 ◽  
Vol 29 (4) ◽  
pp. 390-392 ◽  
Author(s):  
K. MATHUR ◽  
P. B. PYNSENT ◽  
S. B. VOHRA ◽  
B. THOMAS ◽  
S. C. DESHMUKH
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Grip Strength ◽  
Carpal Tunnel ◽  
Pinch Strength ◽  
Wrist Flexion ◽  
Wrist Extension ◽  
Local Infiltration ◽  
Power Grip ◽  
Tunnel Syndrome ◽  
Flexion And Extension

Power grip and thumb key pinch strength were measured pre- and immediately postoperatively in 30 patients with carpal tunnel syndrome while the wrist was in flexion and extension. The carpal tunnel decompression was performed under local infiltration with 1% lignocaine. Grip strength decreased more in wrist flexion than in wrist extension. No difference was found in thumb pinch strength. The authors conclude that some of the immediate postoperative loss of grip strength in wrist flexion can be attributed to prolapse of flexor tendons out of the carpal tunnel in this position.

scholarly journals Eutectic mixture of Local Anaesthetic (EMLA) an alternative for painful palatal nerve blocks: Randomised controlled trial

2020 ◽  
Vol 11 (4) ◽  
pp. 6440-6445
Author(s):  
Jones Jayabalan ◽  
Muthusekhar M R ◽  
Senthil Murugan P
Keyword(s):  
Nerve Block ◽  
Soft Tissues ◽  
Controlled Trial ◽  
Eutectic Mixture ◽  
T Test ◽  
Nerve Blocks ◽  
Greater Palatine Foramen ◽  
The Mean ◽  
Group B ◽  
Randomised Controlled

The purpose of this study is to compare the efficacy of EMLA to Palatal nerve blocks in providing anaesthesia to the palatal soft tissues during extraction. Seventy patients who reported for extraction of maxillary premolar and maxillary molar tooth were included in this study. These patients were divided into two groups randomly. One group consisted of patients receiving EMLA (Eutectic mixture of Lidocaine and Prilocaine) over the palatal soft tissues adjacent to the tooth with a cotton swab, and the other group consisted of patients receiving 0.4 – 0.6 ml of 2% lignocaine with 1;2,00,000 dilution adrenaline slightly anterior to the greater palatine foramen with a syringe. The mean score VAS while applying EMLA cream in group A was 0.00. In contrast, while giving palatal nerve block in group B, it was 4.09 that was statistically significant using the independent sample t-test. Likewise, the mean VAS score while extraction in the EMLA group was 0.11, whereas in palatal nerve block group was 0.00 that was not statistically significant using independent sample t-test. EMLA may be advantageous in providing palatal soft tissue anaesthesia during prophylactic extraction, thereby avoiding painful palatal nerve blocks.

Flexor to Extensor Tendon Transfers in the Hand

1995 ◽  
Vol 20 (1) ◽  
pp. 26-28 ◽  
Author(s):  
W. J. DUNNET ◽  
P. L. HOUSDEN ◽  
R. BIRCH
Keyword(s):  
Brachial Plexus ◽  
Radial Nerve ◽  
Tendon Transfer ◽  
Extensor Tendon ◽  
Contralateral Side ◽  
Vascular Injuries ◽  
Wrist Extension ◽  
Power Grip ◽  
Tendon Transfers

We reviewed 49 cases of flexor to extensor tendon transfer following injury to the radial nerve (22) or brachial plexus (27). Post-operative follow-up averaged 5.6 years (0.5–12.5). Function was improved in 84% (41) of patients. 16% (8) reported no improvement; of these, four (50%) had associated vascular injuries. In those with improvement, impaired coordination and dexterity were reported by 79% (15 of 19) of the plexus injuries and in 64% (14 of 22) of the radial nerve palsies. Premature fatigue was noted by 89% (17 of 19) of plexus injuries and in 82% (18 of 22) of radial nerve palsies. The power of wrist extension averaged 22% of the contralateral side (8% to 80%), power of digital extension was 31% (5% to 130%), and power grip was reduced to 40% (5% to 86%).

scholarly journals Ultrasound Guided Popliteal Nerve Block For Various Ankle & Foot Surgeries

2021 ◽  
Vol 23 (2) ◽  
pp. 39-57
Author(s):  
Dipti Anandani ◽  
Manisha Kapdi ◽  
Bhakti Rajani
Keyword(s):  
General Anaesthesia ◽  
Nerve Block ◽  
Age Groups ◽  
Neurological Complications ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
The Mean ◽  
Ultrasonographic Guidance ◽  
Time Required ◽  
Mean Time

Background: Ankle& foot surgeries are very common surgeries in various age groups like young & geriatric as well as in patients with comorbidities. Popliteal nerve block is one of multimodal Anaesthesia & analgesia for same. we have used ultrasound guided block to prevent complications &precise volume at a site for improving Characteristics of block. Aims of study: To study the technique of giving popliteal nerve blocks with ultrasonographic guidance and evaluate it in terms of: No of attempts, Time required for sensory and motor blockade, Quality of Intra operative analgesia, Duration for post-operative analgesia, Supplementation required in form of sedo analgesia/general anaesthesia & Complications encountered. Methods: We performed ultrasonography guided popliteal nerve block in 60 adult patients of ASA grade I/II/III undergoing foot and ankle surgeries. The volume of drug used was 20ml consisting of Lignocaine (1.5%) 10ml and Bupivacaine (0.5%) 10ml; Results: The mean time taken to conduct the block was 4.3±1.4 mins. The mean time taken for sensory onset was 3.8±1.1 mins. The mean time taken for motor onset was 7.0± 1.4 mins. The mean time taken for completing the surgery was 39.2±5.0 mins. The mean time taken for complete motor regression was 143.8±13.5 mins. The mean time taken for complete sensory regression was 184.8± 16.8 mins. The patients first complained of pain at the mean time of 239±22.4 mins. The patients have stable haemodynamic parameters: pulse rate, SBP, DBP throughout the operation. Failure of block was seen in 4 patients where supplementation in the form of Injection Midazolam 1mg IV and Injection Fentanyl 50microgm IV was given in 2 patients and general anaesthesia was given in 2 patients. No other neurological complications were noticed in our study. Conclusion: ultrasound guided Popliteal nerve block is safe& effective block for various ankle &foot surgeries.

Abstract TP141: Combined Cortical and Peripheral Nerve Stimulation Effects in Patients with Stroke and Moderate to Severe Upper Limb Motor Impairments: A Crossover, Randomized Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Isabella Menezes ◽  
Leonardo Cohen ◽  
Eduardo Mello ◽  
Juliana Conti ◽  
Andre Machado ◽  
...  
Keyword(s):  
Upper Limb ◽  
Repeated Measures ◽  
Randomized Study ◽  
Pinch Strength ◽  
Motor Training ◽  
Wrist Flexion ◽  
Somatosensory Stimulation ◽  
Wrist Extension ◽  
The Mean ◽  
Grasp Force

Introduction: Transcranial direct current stimulation (tDCS) and somatosensory stimulation in the form of peripheral sensory stimulation (PSS) have emerged as potential powerful tools to enhance motor performance or increase effects of motor training in stroke victims. Objectives: To compare effects of active PSS+tDCS, tDCS alone, PSS alone and sham PSS+tDCS as add-on interventions to motor training in patients with stroke and moderate to severe upper limb impairments. Methods: Patients > 6 months post-stroke underwent four different interventions, in a cross-over design: repetitive training of wrist extension of the paretic arm preceded by either active PSS (median, ulnar and radial nerves), active anodal tDCS of the affected hemisphere, sham PSS+tDCS or active PSS+tDCS. Before and after each session, the following outcomes were blindly evaluated in the paretic upper limb: range of movement (ROM) of wrist extension (primary outcome); ROM of wrist flexion, grasp and pinch strength. Measures were compared with analysis of variance with repeated measures (ANOVARM) with factors “session” and “time”. Results: After screening 2499 patients, 22 subjects were included in the study (14 men). The mean age (± standard deviation) was 55.2±12.9 years and the mean time from stroke, 5.3±5.6 years. The mean Fugl-Meyer score for the paretic upper limb was 37±7.9. Two patients were excluded (one dropped out and one received botulinum toxin treatment). There was a significant effect of “time” (F=4.6, p=0.046), but no effects of “session” or interaction “session x time” in regard to grasp force. There were no significant effects of “session”, “time” or interaction “session x time” in regard to ROM of wrist extension, wrist flexion, or pinch force. Conclusions: Repetitive training of wrist extension specifically improved grasp force and did not influence other outcomes. PSS+tDCS, tDCS alone or PSS alone did not potentiate the effect of training.

Range of Motion after the Sauvé–Kapandji and Darrach Procedures without Extensor Tendon Rupture

2020 ◽  
Author(s):  
Tomoyuki Kato ◽  
Taku Suzuki ◽  
Makoto Kameyama ◽  
Masato Okazaki ◽  
Yasushi Morisawa ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Tendon Rupture ◽  
Extensor Tendon ◽  
Distal Radioulnar Joint ◽  
Wrist Flexion ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
The Mean ◽  
Therapeutic Study ◽  
Loss Of Motion

Abstract Background Previous study demonstrated that distal radioulnar joint (DRUJ) plays a biomechanical role in extension and flexion of the wrist and suggested that fixation of the DRUJ could lead to loss of motion of the wrist. Little is known about the pre- and postoperative range of motion (ROM) after the Sauvé–Kapandji (S-K) and Darrach procedures without tendon rupture. To understand the accurate ROM of the wrist after the S-K and Darrach procedures, enrollment of patients without subcutaneous extensor tendon rupture is needed. Purpose This study aimed to investigate the pre- and postoperative ROM after the S-K and Darrach procedures without subcutaneous extensor tendon rupture in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Methods This retrospective study included 36 patients who underwent the S-K procedure and 10 patients who underwent the Darrach procedure for distal radioulnar joint disorders without extensor tendon rupture. Pre- and postoperative ROMs after the S-K and Darrach procedures were assessed 1 year after the surgery. Results In the S-K procedure, the mean postoperative ROM of the wrist flexion (40 degrees) was significantly lower than the mean preoperative ROM (49 degrees). In wrist extension, there were no significant differences between the mean preoperative ROM (51 degrees) and postoperative ROM (51 degrees). In the Darrach procedure, the mean postoperative ROM of the wrist flexion and extension increased compared with the mean preoperative ROM; however, there were no significant differences. Conclusion In the S-K procedure, preoperative ROM of the wrist flexion decreased postoperatively. This study provides information about the accurate ROM after the S-K and Darrach procedures. Level of Evidence This is a Level IV, therapeutic study.

COMPARISON OF ‘AIRWAY NERVE BLOCK’ VS ‘SPRAY-AS-YOU-GO’ METHOD USED FOR AWAKE FLEXIBLE BRONCHOSCOPIC INTUBATION IN COMBINATION WITH CONSCIOUS SEDATION – A PROSPECTIVE, RANDOMISED, SINGLE BLIND STUDY

2021 ◽  
pp. 3-6
Author(s):  
Devesh Kumar Gupta ◽  
Shinu Kaur ◽  
Deepti Gupta
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Endotracheal Tube ◽  
Nerve Block ◽  
Conscious Sedation ◽  
Nasotracheal Intubation ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
The Mean ◽  
Lidocaine Spray ◽  
Single Blind

Introduction: Fibreoptic Intubation (FOI) is the gold standard for managing difcult airways. There are various approaches such as: Nebulization with lidocaine; 'Spray as you go'(SAYGO); Airway nerve block - blocking superior laryngeal nerve & recurrent laryngeal nerve & sedation. The present study aims to compare 'airway nerve block' (NB) and 'spray as you go'(SA) method for awake exible bronchoscopic intubation used in combination with conscious sedation. Methods: 60 patients of age group 18 – 65 years with difcult airway undergoing general anaesthesia with nasotracheal intubation, were randomly allocated into two groups. After premedication & nasal preparation, all patients received injection dexmedetomidine at a dose of 1µg/kg in 100ml of 0.9% NS over 10 minutes. In Group SA, 2ml lignocaine 4% was sprayed above and below the cords after visibility of glottic opening via working channel of the bronchoscope and 2 ml lignocaine 4% within trachea before insertion of endotracheal tube. In Group NB, bilateral superior laryngeal nerves & recurrent laryngeal nerve was blocked. Then a exible breoptic bronchoscope preloaded with a exometallic endotracheal tube of appropriate size was then inserted via nasal route. Results: The mean intubation time for Group NB [87.27 ± 7.58 sec] was shorter than that for Group SA [190.33 ± 9.14] (p<0.0001). Conclusion: Awake exible bronchoscopic intubation under sedation with airway nerve block provides better intubating conditions compared to SAYGO

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