MRI volumetric assessment of renervated elbow flexor muscles following nerve transfer

Author(s):  
Matthew Wilcox
2020 ◽  
Author(s):  
M. Wilcox ◽  
L. D. S. Canas ◽  
M. Modat ◽  
J. Phillips ◽  
R. Hargunani ◽  
...  

2019 ◽  
Vol 101-B (7) ◽  
pp. 867-871 ◽  
Author(s):  
M. Wilcox ◽  
H. Brown ◽  
K. Johnson ◽  
M. Sinisi ◽  
T. J. Quick

Aims Improvements in the evaluation of outcomes following peripheral nerve injury are needed. Recent studies have identified muscle fatigue as an inevitable consequence of muscle reinnervation. This study aimed to quantify and characterize muscle fatigue within a standardized surgical model of muscle reinnervation. Patients and Methods This retrospective cohort study included 12 patients who underwent Oberlin nerve transfer in an attempt to restore flexion of the elbow following brachial plexus injury. There were ten men and two women with a mean age of 45.5 years (27 to 69). The mean follow-up was 58 months (28 to 100). Repeated and sustained isometric contractions of the elbow flexors were used to assess fatigability of reinnervated muscle. The strength of elbow flexion was measured using a static dynamometer (KgF) and surface electromyography (sEMG). Recordings were used to quantify and characterize fatigability of the reinnervated elbow flexor muscles compared with the uninjured contralateral side. Results The mean peak force of elbow flexion was 7.88 KgF (sd 3.80) compared with 20.65 KgF (sd 6.88) on the contralateral side (p < 0.001). Reinnervated elbow flexor muscles (biceps brachialis) showed sEMG evidence of fatigue earlier than normal controls with sustained (60-second) isometric contraction. Reinnervated elbow flexor muscles also showed a trend towards a faster twitch muscle fibre type. Conclusion The assessment of motor outcomes must involve more than peak force alone. Reinnervated muscle shows a shift towards fast twitch fibres following reinnervation with an earlier onset of fatigue. Our findings suggest that fatigue is a clinically relevant characteristic of reinnervated muscle. Adoption of these metrics into clinical practice and the assessment of outcome could allow a more meaningful comparison to be made between differing forms of treatment and encourage advances in the management of motor recovery following nerve transfer. Cite this article: Bone Joint J 2019;101-B:867–871.


Author(s):  
Xin Ye ◽  
Robert J. Benton ◽  
William M. Miller ◽  
Sunggun Jeon ◽  
Jun Seob Song

2000 ◽  
Vol 83 (4) ◽  
pp. 2030-2039 ◽  
Author(s):  
Andrew E. Graves ◽  
Kurt W. Kornatz ◽  
Roger M. Enoka

The purpose of this study was to determine the effect of age on the ability to exert steady forces and to perform steady flexion movements with the muscles that cross the elbow joint. An isometric task required subjects to exert a steady force to match a target force that was displayed on a monitor. An anisometric task required subjects to raise and lower inertial loads so that the angular displacement around the elbow joint matched a template displayed on a monitor. Steadiness was measured as the coefficient of variation of force and as the normalized standard deviation of wrist acceleration. For the isometric task, steadiness as a function of target force decreased similarly for old adults and young adults. For the anisometric task, steadiness increased as a function of the inertial load and there were significant differences caused by age. Old adults were less steady than young adults during both shortening and lengthening contractions with the lightest loads. Furthermore, old adults were least steady when performing lengthening contractions. These behaviors appear to be associated with the patterns of muscle activation. These results suggest that different neural strategies are used to control isometric and anisometric contractions performed with the elbow flexor muscles and that these strategies do not change in parallel with advancing age.


1996 ◽  
Vol 76 (6) ◽  
pp. 586-600 ◽  
Author(s):  
Steven L Wolf ◽  
Richard L Segal ◽  
Pamela A Catlin ◽  
Julie Tschorn ◽  
Tina Raleigh ◽  
...  

2002 ◽  
Vol 88 (6) ◽  
pp. 3087-3096 ◽  
Author(s):  
Sandra K. Hunter ◽  
Daphne L. Ryan ◽  
Justus D. Ortega ◽  
Roger M. Enoka

Endurance time, muscle activation, and mean arterial pressure were measured during two types of submaximal fatiguing contractions that required each subject to exert the same net muscle torque in the two tasks. Sixteen men and women performed isometric contractions at 15% of the maximum voluntary contraction (MVC) force with the elbow flexor muscles, either by maintaining a constant force while pushing against a force transducer (force task) or by supporting an equivalent inertial load while maintaining a constant elbow angle (position task). The endurance time for the force task (1402 ± 728 s) was twice as long as that for the position task (702 ± 582 s, P < 0.05), despite a similar reduction in the load torque at exhaustion for each contraction. The rate of increase in average electromyographic activity (EMG, % peak MVC value) for the elbow flexor muscles was similar for the two tasks. However, the average EMG was greater at exhaustion for the force task (22.4 ± 1.2%) compared with the position task (14.9 ± 1.0%, P < 0.05). In contrast, the rates of increase in the mean arterial pressure, the rating of perceived exertion, anterior deltoid EMG, and fluctuations in motor output (force or acceleration) were greater for the position task compared with the force task ( P < 0.05). Furthermore, the rate of bursts in EMG activity, which corresponded to the transient recruitment of motor units, was greater for the brachialis muscle during the position task. These results indicate that the briefer endurance time for the position task was associated with greater levels of excitatory and inhibitory input to the motor neurons compared with the force task.


2016 ◽  
Vol 9 (1) ◽  
pp. 19-22
Author(s):  
Sumit Kalra ◽  
◽  
Nidhi Kalra ◽  
Davinder K. Gaur ◽  
Savita Tamaria ◽  
...  

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