scholarly journals Extensor Carpi Radialis brevis: Review of Anatomy and Clinical Significance to Orthopedics

2019 ◽  
Vol 2 (1) ◽  
pp. 01-08
Author(s):  
Jennifer L Smith ◽  
Jacob B Stirton ◽  
Nabil A Ebraheim
Keyword(s):  
Clinical Significance ◽  
Radial Nerve ◽  
Lateral Epicondylitis ◽  
Extensor Digitorum ◽  
Surgical Approaches ◽  
Extensor Digitorum Communis ◽  
Lateral Epicondyle ◽  
The Third ◽  
Proper Management ◽  
Extensor Carpi Radialis

The extensor carpi radialis brevis (ECRB) muscle is an integral extensor and abductor of the wrist. It originates from the lateral epicondyle of the humerus, laying deep to the extensor carpi radialis longus and extensor digitorum communis, and superficial to the supinator. Insertion occurs at the base of the third metacarpal. The radial nerve or a derivative supplies innervation. Its significance in orthopedics is highlighted by its involvement in multiple surgical approaches, such as the Thompson and Kaplan approaches for exposure of the radius, as well as its association with several routinely observed pathologies. Many of the associated syndromes, such as lateral epicondylitis, arise from repetitive gripping motions or overuse and are frequently seen in the orthopedic clinic. This review seeks to provide a comprehensive summary of the relevance of the ECRB to the orthopedic setting to broaden knowledge of its anatomy and increase recognition and proper management of associated pathologies.

Attrition of the Extensor Tendon of the Index Finger Following an Avulsion Fracture of the Third Metacarpal

2018 ◽  
Vol 23 (01) ◽  
pp. 144-148
Author(s):  
Hiroshi Yamazaki ◽  
Shunsuke Miyaoka ◽  
Hiroyuki Kato
Keyword(s):  
Avulsion Fracture ◽  
Index Finger ◽  
Extensor Tendon ◽  
Extensor Digitorum ◽  
Extensor Digitorum Communis ◽  
The Third ◽  
Extensor Indicis Proprius ◽  
Extensor Carpi Radialis

We report an avulsion fracture at the base of the third metacarpal involving the extensor carpi radialis brevis insertion and a resulting complication of attritional rupture of the extensor indicis proprius tendon and the extensor digitorum communis to the index finger, in a 67-year-old man.

The Role of the Extensor Digitorum Communis Muscle in Lateral Epicondylitis

2002 ◽  
Vol 27 (5) ◽  
pp. 405-409 ◽  
Author(s):  
S. M. FAIRBANK ◽  
R. J. CORLETT
Keyword(s):  
Tennis Elbow ◽  
Lateral Epicondylitis ◽  
Middle Finger ◽  
Clinical Findings ◽  
Extensor Digitorum ◽  
Common Finding ◽  
Extensor Digitorum Communis ◽  
Lateral Epicondyle ◽  
High Prevalence ◽  
Pain Ratings

A common finding in tennis elbow is pain in the region of the lateral epicondyle during resisted extension of the middle finger (Maudsley’s test). We hypothesized that the pain is due to disease in the extensor digitorum communis muscle, rather than to compression of the radial nerve or disease within extensor carpi radialis brevis. Thirteen human forearm specimens were examined. It was found that the extensor digitorum communis was separable into four parts. The part to the middle finger originated from the lateral epicondyle, but the muscle slips to the other fingers originated more distally. Pain ratings were measured in ten patients diagnosed with lateral epicondylitis during isometric finger and wrist extension tests. The results confirmed the high prevalence of a positive Maudsley’s test in lateral epicondylitis, and also that the patients with tenderness at the site of origin of the extensor digitorum communis slip to the middle finger had the greatest pain during middle finger extension. These anatomical and clinical findings clarify the anatomy of extensor digitorum communis, and suggest that this muscle forms the basis for the Maudsley’s test. The muscle may play a greater role in tennis elbow than previously appreciated.

The Role of Supinator in the Pathogenesis of Chronic Lateral Elbow Pain: A Biomechanical Study

2004 ◽  
Vol 29 (5) ◽  
pp. 461-464 ◽  
Author(s):  
S. ERAK ◽  
R. DAY ◽  
A. WANG
Keyword(s):  
Tensile Force ◽  
Balloon Catheter ◽  
Extensor Tendon ◽  
Biomechanical Study ◽  
Extensor Digitorum ◽  
Moderate Increase ◽  
Extensor Digitorum Communis ◽  
Lateral Epicondyle ◽  
The Common ◽  
Extensor Carpi Radialis

The relative contributions of the forearm extensors to the tensile force at the lateral epicondyle were examined by implanting a force transducer in the common extensor tendon of four soft fixed cadaver elbows and sequentially stretching each muscle arising from the lateral epicondye. Extensor carpi radialis brevis and extensor digitorum communis produced the largest increases while the superficial head of supinator produced a moderate increase in tensile force in the common extensor tendon. Extensor carpi radialis longus and extensor carpi ulnaris had no significant effect. Radial tunnel pressure was measured using a balloon catheter in a separate study of five cadaver elbows. Radial tunnel pressure increased on moving the wrist from neutral to a flexion–pronation position. This positional rise in pressure was reduced by supinator musculotendinous lengthening (77%) while lengthening of the extensor carpi radialis brevis and extensor digitorum communis had no effect. This study demonstrates a biomechanical basis for the superficial head of supinator in the aetiology of both lateral epicondylitis and radial tunnel syndrome.

The Innervation Pattern of the Radial Nerve at the Elbow and in the Forearm

1998 ◽  
Vol 23 (2) ◽  
pp. 167-169 ◽  
Author(s):  
G. BRANOVACKI ◽  
M. HANSON ◽  
R. CASH ◽  
M. GONZALEZ
Keyword(s):  
Radial Nerve ◽  
Sensory Nerve ◽  
Extensor Digitorum ◽  
Sensory Nerves ◽  
Posterior Interosseous Nerve ◽  
Extensor Pollicis Longus ◽  
Abductor Pollicis Longus ◽  
Extensor Carpi Ulnaris ◽  
Wide Variability ◽  
Extensor Carpi Radialis

Sixty paired cadaver forearms were dissected to examine the distribution of the radial nerve branches to the muscles at the elbow and forearm. Emphasis was placed on the innervation of the extensor carpi radialis brevis and the supinator muscles because of discrepancies in the literature concerning these muscles. The most common branching pattern (from proximal to distal) was to brachioradialis, extensor carpi radialis longus, superficial sensory, extensor carpi radialis brevis, supinator, extensor digitorum/extensor carpi ulnaris, extensor digiti minimi, abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus and extensor indicis. The branch to extensor digitorum and extensor carpi ulnaris came off as a common stem often with the branch to extensor digiti minimi. The branch to the ECRB muscle was noted to arise from the posterior interosseous nerve in 45%, superficial sensory nerve in 25% and at the bifurcation of the posterior interosseous and superficial sensory nerves in 30% of specimens. The supinator had an average of 2.3 branches from the posterior interosseous nerve (range 1–6). The branches to the supinator showed a wide variability proximal to and within the supinator.

Resistant Tennis Elbow

1984 ◽  
Vol 9 (1) ◽  
pp. 64-66 ◽  
Author(s):  
G. H. HEYSE-MOORE
Keyword(s):  
Radial Nerve ◽  
Tennis Elbow ◽  
Anatomical Study ◽  
Nerve Entrapment ◽  
Posterior Interosseous Nerve ◽  
Lateral Epicondyle ◽  
Adjacent Structures ◽  
Extensor Carpi Radialis ◽  
Symptoms And Signs ◽  
Results Of Surgery

Fifty cases of resistant tennis elbow were studied, thirty seven of these had been treated by lengthening the tendon of extensor carpi radialis brevis, and thirteen by decompression of the radial tunnel. The two groups were well matched in terms of age, sex and pre-operative symptoms and signs. It was found that the results of surgery were very similar in the two groups and this observation is explained by anatomical study showing that surgical division of the fibrous arch of the superficial leaf of supinator will relieve tension on the lateral epicondyle and its adjacent structures thus allowing relief of symptoms independently of radial or posterior interosseous nerve decompression. This elaborates previously published work showing that there is no clinical or electrical evidence of radial nerve entrapment in resistant tennis elbow.

scholarly journals The Branching and Innervation Pattern of the Radial Nerve in the Forearm: Clarifying the Literature and Understanding Variations and Their Clinical Implications

Diagnostics ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. 366 ◽  
Author(s):  
F. Kip Sawyer ◽  
Joshua J. Stefanik ◽  
Rebecca S. Lufler
Keyword(s):  
Radial Nerve ◽  
Surgical Approaches ◽  
Review Of The Literature ◽  
Innervation Pattern ◽  
Extensor Pollicis Longus ◽  
Branching Order ◽  
Superficial Branch ◽  
Muscular Branch ◽  
Proximal Forearm ◽  
Extensor Carpi Radialis

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. The review of the literature yielded multiple studies employing inconsistent metrics and terminology to define order or innervation.

Anatomic Basis for Individuated Surface EMG and Homogeneous Electrostimulation With Neuroprostheses of the Extensor Digitorum Communis

2008 ◽  
Vol 100 (1) ◽  
pp. 64-75 ◽  
Author(s):  
J.N.A.L. Leijnse ◽  
S. Carter ◽  
A. Gupta ◽  
S. McCabe
Keyword(s):  
Ring Finger ◽  
Surface Emg ◽  
Extensor Digitorum ◽  
Extensor Digitorum Communis ◽  
Lateral Epicondyle ◽  
Fine Wire ◽  
Anatomic Basis ◽  
The Individual ◽  
Emg Electrodes ◽  
Little Finger

The extensor digitorum communis (ED) is generally regarded as a fairly undiversified muscle that gives extensor tendons to all fingers. Some fine wire electromyographic (EMG) investigations have been carried out to study individuation of the muscle parts to the different fingers. However, individuated surface EMG of the ED has not been investigated. This study analyses the anatomy of the ED muscle parts to the different fingers in detail and proposes optimal locations for surface or indwelling electrodes for individuated EMG and for electrostimulation with neuroprostheses. The dissections show that the ED arises from extensive origin tendons (OT), which originate at the lateral epicondyle and reach far in the forearm. The ED OT is V-shaped with shorter central tendon fibers but with a long radial and an even longer ulnar slip. The ED parts to the individual fingers consistently arise from distinct OT locations: the ED3 (medius) arises proximally, the ED2 (index) from the radial slip distal to ED3, the ED4 (ring finger) from the ulnar slip distal to ED3, and the ED5 (to ring/little finger) from the ulnar slip distal to ED4. This lengthwise widely spaced arrangement of ED parts compensates to some degree for the narrow ED width and suggests that ED parts should be individually assessable by indwelling and even by surface EMG electrodes, albeit in the latter case with variable mutual cross-talk. Conversely, the anatomic spacing of ED parts warrants that electromyographic stimulation with neuroprostheses by a single implanted electrode cannot likely homogeneously activate all ED parts.

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