Brachialis Research Articles

TRANSFER OF BRACHIALIS MUSCLE TO TRICEPS FOR RESTORATION OF ELBOW EXTENSION IN PATIENTS WITH OBSTETRIC PALSY SEQUELAE

Objective: Elbow extension deficit following brachial plexus injuries can sometimes be overlooked. Elbow flexion deficit is more prominent in the early stages of obstetric paralysis and is used as an indication for early nerve surgery. However, in the future extension deficits may become more numerous. Residual disabilities following obstetric paralyses can be dynamically addressed by tendon transfers. In patients with obstetric paralysis, canonical donor muscles such as the deltoid or biceps may be insufficient for restoration of elbow extension. The brachialis muscle, because of its deep and secluded position, may be considered as one of the more recent options for selection as a donor in these patient groups. In this study, the efficiency of brachialis to triceps transfer both in elbow extension and in shoulder abduction was assessed. Materials and Methods: Seven obstetrical palsy patients with varying degrees of sequelae around the shoulder and elbow underwent a brachialis to triceps transfer procedure. All patients had previously undergone a modified Hoffer procedure. Ranges of motion in shoulder and elbow joints were recorded before and after the transfer. A minimum of M3+ in elbow flexion was set as a prerequisite for the transfer. Results: The elbow extension was improved from a median of -70° (interquertile range, IQR: 20º) to a median of -10° (IQR: 35º) in the follow-up (p<0.05). Shoulder abduction was improved from a median of 140° (IQR: 5º) to a median of 170° (IQR: 15º) (p<0.05). Elbow flexion power was found to be diminished from median M4 (Q1: M3+, Q3: M5) to M3 (Q1: M3, Q3: M3+) (p<0.05). Conclusions: Brachialis to triceps transfer was found to be a suitable alternative in palliative surgery of obstetric palsy patients in terms of elbow extension. Loss of elbow flexion power was within acceptable range.

Radial Nerve Innervation of the Brachialis Muscle in the Ghanaian Population

Radial Nerve Innervation of the Brachialis Muscle in the Ghanaian Population

Brain activity and upper limb movement analysis in children with Down syndrome undergoing transcranial direct current stimulation combined with virtual reality training: study protocol for a randomized controlled trial

BackgroundChildren with Down syndrome have poorer functional and sensory skills compared to children with typical development. Virtual reality (VR) training could help improve these skills. Moreover, transcranial direct current stimulation (tDCS) has achieved promising results in terms of enhancing the effects of physical and sensory therapy by modulating cortical excitability.Methods/designTwo investigations are proposed: (1) an observational study with a convenience sample consisting of children with Down syndrome (group 1—cognitive age of 6 to 12 years according to the Wechsler Abbreviated Scale of Intelligence) and children with typical development 6 to 12 years of age (group 2). Both groups will undergo evaluations on a single day involving a three-dimensional analysis of upper limb movements, an analysis of muscle activity of the biceps and brachial triceps muscles and an analysis of visuospatial and cognitive-motor variables. (2) Analysis of clinical intervention: a pilot study and clinical trial will be conducted involving individuals with Down syndrome (cognitive age of 6 to 12 years according to the Wechsler Abbreviated Scale of Intelligence). The sample will be defined after conducting a pilot study with the same methodology as that to be used in the main study. The participants will be randomly allocated to two groups: An experimental group submitted to anodal tDCS combined with a VR game and a manual motor task and a control group submitted to sham tDCS combined with a VR game and a manual motor task. The training protocol will involve 10 sessions of active or sham tDCS during memory and motor task games. Three 20-min sessions will be held per week for a total of 10 sessions. Evaluations will be performed on three different occasions: pre-intervention, post-intervention (after 10 sessions) and follow-up (1 month after the intervention). Evaluations will consist of analyses of electroencephalographic signals, electromyographic signals of the biceps and triceps brachii, and the three-dimensional reconstruction of the reaching movement. The results will be analyzed statistically with the significance level set at 5% (p ≤ 0.05).DiscussionThe optimization of the results obtained with virtual reality training is believed to be related to the interactive experience with a wide range of activities and scenarios involving multiple sensory channels and the creation of exercises, the intensity of which can be adjusted to the needs of children. Therefore, the proposed study aims to complement the literature with further information on tDCS and VR training considering different variables to provide the scientific community with clinical data on this combination of interventions.Trial registrationBrazilian Clinical Trials Registry (REBEC) protocol number RBR-43pk59 registered on 2019 March 27 https://ensaiosclinicos.gov.br/rg/RBR-43pk59 and Human Research Ethics Committee number 3.608.521 approved on 2019 September 30. Protocol version 2021 October 20. Any changes to the protocol will be reported to the committees and approved. Informed consent will be obtained from all participants by the clinical research coordinator and principal investigator.

Gross anatomy of the musculature of the thoracic limb of the aulacod.

ObjectiveThe cane rat is a wild rodent appreciated for its meat. Currently domesticated, its breeding is expanding in sub‐Saharan Africa where it originates. However, the pathological problems already identified during the domestication phase of the cane rat on station still constitute a major constraint to the development of aulacodiculture. Our study aims at filling the lack of illustrations on the myology of the thoracic limb of the cane ratMethodologyWe used 16 adults cane rats ranging in age from 3 to 4 yearsResultsThe study of the different muscles of the thoracic limb reveals many similarities in the Glires (rodents and lagomorphs). However, some particularities are noteworthy. Indeed, in the cane rat, the deltoid muscle, as well as the muscles of the forearm, are very developed with its three portions, the biceps brachii and brachialis muscles are fusiform and the triceps brachii muscle has a very bulky long part (caput longum)ConclusionThese illustrations will be very effective tools for understanding the muscles of the thoracic limbs and a reliable technical support for veterinary students and practitioners.

Subpial delivery of adeno-associated virus 9-synapsin-caveolin-1 (AAV9-SynCav1) preserves motor neuron and neuromuscular junction morphology, motor function, delays disease onset, and extends survival in hSOD1G93A mice.

Elevating neuroprotective proteins using adeno-associated virus (AAV)-mediated gene delivery shows great promise in combating devastating neurodegenerative diseases. Amyotrophic lateral sclerosis (ALS) is one such disease resulting from loss of upper and lower motor neurons (MNs) with 90-95% of cases sporadic (SALS) in nature. Due to the unknown etiology of SALS, interventions that afford neuronal protection and preservation are urgently needed. Caveolin-1 (Cav-1), a membrane/lipid rafts (MLRs) scaffolding and neuroprotective protein, and MLR-associated signaling components are decreased in degenerating neurons in postmortem human brains. We previously showed that, when crossing our SynCav1 transgenic mouse (TG) with the mutant human superoxide dismutase 1 (hSOD1G93A) mouse model of ALS, the double transgenic mouse (SynCav1 TG/hSOD1G93A) exhibited better motor function and longer survival. The objective of the current study was to test whether neuron-targeted Cav-1 upregulation in the spinal cord using AAV9-SynCav1 could improve motor function and extend longevity in mutant humanized mouse and rat (hSOD1G93A) models of familial (F)ALS.Methods: Motor function was assessed by voluntary running wheel (RW) in mice and forelimb grip strength (GS) and motor evoked potentials (MEP) in rats. Immunofluorescence (IF) microscopy for choline acetyltransferase (ChAT) was used to assess MN morphology. Neuromuscular junctions (NMJs) were measured by bungarotoxin-a (Btx-a) and synaptophysin IF. Body weight (BW) was measured weekly, and the survival curve was determined by Kaplan-Meier analysis.Results: Following subpial gene delivery to the lumbar spinal cord, male and female hSOD1G93A mice treated with SynCav1 exhibited delayed disease onset, greater running-wheel performance, preserved spinal alpha-motor neuron morphology and NMJ integrity, and 10% increased longevity, independent of affecting expression of the mutant hSOD1G93A protein. Cervical subpial SynCav1 delivery to hSOD1G93A rats preserved forelimb GS and MEPs in the brachial and gastrocnemius muscles.Conclusion: In summary, subpial delivery of SynCav1 protects and preserves spinal motor neurons, and extends longevity in a familial mouse model of ALS without reducing the toxic monogenic component. Furthermore, subpial SynCav1 delivery preserved neuromuscular function in a rat model of FALS. The latter findings strongly indicate the therapeutic applicability of SynCav1 to treat ALS attributed to monogenic (FALS) and potentially in sporadic cases (i.e., SALS).

Identification of muscle movements and activity by experimental methods for selected cases – stage #2

Purpose: The aim of the performed tests and static measurements was to determine the torque and to determine the activity curve for individual muscle heads during the flexion-extension movement in the elbow joint. Methods: Both heads of the biceps branchial muscle and the triceps muscle of the arm – long head and lateral head – were examined. Static measurements were carried out for four selected positions of the upper limb. For each pose, a measurement series consisting of five attempts of ten seconds of effort was performed. Isometric contraction was performed as 100% of the maximum voluntary MVC contraction. Dynamic measurements were carried out when working in isokinetic conditions. In both stages, an EMG and a Biodex isokinetic dynamometer were used. Results: During the analyses, it was assumed that the average value of the torque is equal to the approximate value of the torque of a given head under static conditions. The value of the torque of the biceps brachial muscle, long head was 48.04 Nm and for the short head – 45.82 Nm. For the triceps muscle of the long head, this value was 52.52 Nm and for the lateral head – 38.06 Nm. On the basis of dynamic measurements, four activation curves were determined for each of the heads during the 7-second task. For the curves, the sum value of muscle activity in a given period of time was calculated as the area under the curve. Conclusions: Both parts of the series of articles present a series of experimental studies conducted in order to determine the parameters for one patient, for whom a personalized numerical model of the upper limb was ultimately created. Static measurements were carried out to determine the maximum values of the moments of forces. Dynamic measurements allowed for the determination of activity curves during the movement of the upper limb.

Identification of muscle movements and activity by experimental methods for selected cases – stage#1

Purpose This study aimed to determine the position where the most activated and isolated individual muscles were. In the next steps, the selected limb positions will be used to determine the maximum values of isometric forces of the individual muscle heads based on the Hill model. Methods In order to determine the sought muscle activation, an electromyograph was used. Measurements of the isometric contraction were carried out for seven series of tests. Isometric contraction was performed as 100% MVC. Results For the long head of the biceps muscle, in the case of bending in the shoulder joint, selected angle of 75 degrees, and for abduction in the shoulder joint, the angle of 90 degrees. Internal rotation in the shoulder joint was omitted because of lower activation values. For the short head of the biceps muscle, the angle characterized by the greatest activity of the head, is the angle of 115 degrees in flexion at the elbow joint. The selected angle is 30 degrees for shoulder extension and 110 degrees for shoulder adduction. For the lateral head of the triceps brachial muscle, measurements showed that the angle at which the lateral head is most activated is 115 degrees. Conclusions The presented research and results concern one specific person for whom a personalized numerical model will be developed. The performed tests can also be a preliminary assessment of the upper limb positions, for which wider conclusions could be drawn in the case of measurements on a larger number of participants.

Changes in muscle architecture on ultrasound in patients early after stroke.

Early muscle changes are believed to occur in patients with stroke. However, there are insufficient data on the changes in muscle mass and architecture of these patients. This study investigates differences in ultrasound-derived muscle architecture parameters of the hemiplegic upper and lower limbs in patients with subacute stroke. This is a prospective observational study, which recruited 40 adult patients who had experienced a first ever unilateral stroke (ischemic or hemorrhagic), with a duration of < 1 month post stroke. The brachialis, vastus lateralis and medial gastrocnemius on both the hemiplegic and normal side were evaluated via ultrasound. We recorded clinical variables including Motricity Index, Modified Ashworth Scale (MAS) and Functional Independence Measure (FIM)-walk. We found reduced mean muscle thickness (p < 0.001) and increased echo intensity (p < 0.001) in the brachialis muscle, increased echo intensity (p = 0.002) in the vastus lateralis muscle, and reduced muscle thickness (p < 0.001) with increased echo intensity (p < 0.001) in the medial gastrocnemius muscle compared to the normal side. There were no significant correlations between ultrasound findings and Motricity Index. We report changes in ultrasound-derived muscle architecture in the hemiplegic limbs of patients with subacute stroke, with consistent findings of decreased muscle mass and increased echo intensity.

Brachialis Muscle Activity Can Be Measured With Surface Electromyography: A Comparative Study Using Surface and Fine-Wire Electrodes.

Muscle activities of the elbow flexors, especially the brachialis muscle (BR), have been measured with intramuscular electromyography (EMG) using the fine-wire electrodes. It remains unclear whether BR activity can be assessed using surface EMG. The purpose of this study was to compare the EMG patterns of the BR activity recorded during elbow flexion using surface and fine-wire electrodes and to determine whether surface EMG can accurately measure the BR activity. Six healthy men were asked to perform two tasks—a maximum isometric voluntary contractions (MVICs) task and an isotonic elbow-flexion task without lifting any weight. The surface and intramuscular EMG were simultaneously recorded from the BR and the long and short heads of the biceps brachii muscle (BBLH and BBSH, respectively). The locations of the muscles were identified and marked under ultrasonographic guidance. The peak cross-correlation coefficients between the EMG signals during the MVICs task were calculated. For the isotonic elbow-flexion task, the EMG patterns for activities of each muscle were compared between the surface and the fine-wire electrodes. All cross-correlation coefficients between the surface EMG signals from the muscles were lower than 0.3. Furthermore, the EMG patterns of the BR activity were not significantly different between the surface and the fine-wire electrodes. The BR has different EMG pattern from the BBLH and the BBSH. The BR activity, conventionally measured with intramuscular EMG, can be accurately accessed with surface EMG during elbow flexion performed without lifting any weight, independent from the BBLH and BBSH activities.

Parsonage–Turner recurrent acute idiopatic neuralgic amyotrophy case. Case report

Recurrent ParsonageTurner syndrome is a hereditary form of a syndrome from neuralgic amyotrophic group, with a characteristic clinical picture in the form of severe pain syndrome with remission and subsequent development of upper shoulder girdle atrophy, proceeding with the accumulation of neurological deficit. Despite the characteristic clinical picture, the syndrome requires a differential diagnosis with a number of conditions, in which electroneuromyography helps along with other techniques. Wherein neuropathic sings of the upper extremity nerves are usually detected, and the long thoracic and suprascapular nerves are most often affected, at that more often by axonopathic type. Electromyography reveals denervation sings in the upper brachial muscles. This article describes ParsonageTurner recurrent acute neuralgic amyotrophy case, discusses the issues of the clinical picture, diagnosis and treatment of this disease.

Incidence of Accessory Brachialis Muscle, Variations in its Insertion and Relation with Surrounding Neurovascular Structures

Incidence of Accessory Brachialis Muscle, Variations in its Insertion and Relation with Surrounding Neurovascular Structures

A novel treatment for prevention of post-traumatic elbow stiffness using onaBotulinum toxin type A: a prospective placebo controlled randomized trial

Approximately 30% of all upper extremity fractures are elbow fractures which may result elbow stiffness. This study aimed to investigate the efficacy of onaBotulinum Toxin type A injection to prevent post-traumatic pain and elbow-stiffness. All patients were included who presented to a single surgeon with supracondylar/ intraarticular distal humerus fractures, proximal ulna and radius fractures. The study was developed in a randomized placebo controlled study between 2003-2007. The Disabilities of the Arm, Shoulder, and Hand (DASH) score as well as the arc-of-motion (AOM) were assessed after three, six, twelve-months and final follow up for evaluation. Of the 31-patients included, 15-patients (48.4%) received Botox injections. In all patients no complication was observed when injecting a dosage 100-units for the brachialis and biceps brachii muscles. Furthermore, it was an effective method to prevent post-traumatic elbow stiffness, lasting six- months. Significant differences in DASH, VAS-score and ROM after three-months between the Botox and control group (DASH 21.6±11.0 vs. 55.3±11.0 ; VAS 1.2±5.2 vs. 5.7±21.9 ; ROM 103±7.6 vs. 73±6.3 ; p>0.05) were identified in the prospective group. Botulinum toxin is a safe, reliable and effective treatment to prevent post-traumatic elbow stiffness. Our study demonstrates improved early range-of- motion (p<0.05), better extension after 6 weeks and improved functional outcome including VAS and DASH score (p<0.05).

Skeletal Muscle Ultrasound Changes in Patients With Early Stroke

<h3>Research Objectives</h3> To investigate differences in muscle mass and architecture in the affected upper and lower limbs in patients with subacute stroke, compared to the normal side, through the use of skeletal muscle ultrasound. <h3>Design</h3> Prospective observational study. <h3>Setting</h3> Tertiary-level rehabilitation facility. <h3>Participants</h3> We recruited 40 consecutive adult patients who had experienced a first ever unilateral stroke (ischemic or hemorrhagic) with a duration of < 1 month post stroke and presence of hemiplegic weakness in both upper and lower limbs. <h3>Interventions</h3> None. <h3>Main Outcome Measures</h3> Muscles chosen for ultrasound evaluation were the brachialis, vastus lateralis and medial gastrocnemius on both the hemiplegic and normal side. The pennation angle, fascicle length, muscle thickness and echo intensity was assessed for each muscle. We recorded clinical variables including the Motricity Index, Modified Ashworth Scale (MAS) and Functional Independence Measure (FIM)-walk. <h3>Results</h3> The average duration after stroke when the patients were recruited was 17.7±6.73 days, with 25 (65.0%) patient having stroke of an ischemic etiology. All patients had a premorbid mRS score of 0 or 1. For the brachialis muscle, we found a reduced mean muscle thickness (p < 001) and increased echo intensity (p < 0.001) compared to the normal side. For the vastus lateralis muscle, we found an increased fascicle length (p=0.002) and echo intensity (p=0.011) compared to the normal side. For the medial gastrocnemius muscle, we found a reduced pennation angle (p=0.035), reduced muscle thickness (p < 0.001) and increased echo intensity (p < 0.001) compared to the normal side. There were no significant correlations between ultrasound findings and Motricity Index, MAS or FIM-walk scores. <h3>Conclusions</h3> Changes in ultrasound-derived muscle measurements in the hemiplegic limbs occurs in patients with subacute stroke, with decreased muscle mass and increased echo intensity being the consistent findings. <h3>Author(s) Disclosures</h3> None.

CHANNELOPATHIES AND RELATED DISORDERS: EP.227 Novel compound heterozygous mutations in CLCN1 in a patient with myotonia congenita

Myotonia congenita (MC) is a rare hereditary chloride channel neuromuscular disorder. It caused by CLCN1 mutations which encodes chloride channel CLC1 for skeletal muscle. MC is characterized by transient muscle weakness, generalized muscle hypertrophy, non-progressive painless myotonia, and impaired muscle relaxation after contraction which resulting in muscle stiffness. We report a clinical case of an affected 14-year-old boy with athletic appearance due to generalized muscle hypertrophy, calf and brachial muscle stiffness, weakness especially in the legs, and normal deep tendon reflexes. He was born after uneventful pregnancy and delivery, with non-consanguineous marriage of his parents. There was no family history of neuromuscular disorders. He had numbness in the legs, getting tired quickly while walking, difficulties in starting voluntary activities such as walking and running. He had also delayed relaxation of hand grip after forceful holding. The neurological examination showed percussion-activated myotonia in the tongue, upper arms and legs. Plasma creatine kinase level was mildly elevated (200 UI/L, reference range: 0-190 UI/L), and transaminase levels were normal. We identified novel compound heterozygous mutations of CLCN1 [c.1673C>T (p.Pro558Leu) in exon 15, paternal and c.1886T>C (p.Leu629Pro) in exon 16, maternal] with next generation sequencing. Molecular genetic analysis is an accurate option for diagnosing MC. The present case expands the genotypic spectrum of MC.

The role of the brachialis muscle in elbow stability with collateral ligament injury: A biomechanical investigation

BackgroundThe brachialis muscle lies in close anatomic relation to the anterior capsule of the elbow joint. The contribution of the brachialis muscle to elbow stability has not yet been fully investigated. Therefore, the aim of this biomechanical in-vitro study was to analyze its influence on joint stability. MethodsNine fresh frozen cadaveric elbows were evaluated for stability against valgus and varus/posterolateral rotatory forces. Brachialis loading was measured indirectly using strain gauges. Three distinct scenarios were analyzed: A) with intact lateral ulnar and ulnar collateral ligaments B) with a ruptured lateral ulnar collateral ligament C) with ruptured lateral ulnar and ulnar collateral ligaments. FindingsIn all scenarios, an increased strain was observed under posterolateral rotatory/varus forces. The maximum measured strain occurred with elbow flexion of 30° and pronation of the forearm. The strain was significantly higher with dual-ligament rupture (mean - 210.5 μm/m; min. 97.8 μm/m; max. -310 μm/m; SD 107.8 μm/m; p = .034) compared to intact ligaments (mean − 106.9 μm/m; min. -32.51 μm/m, max. -287 μm/m; SD 100.2 μm/m) and single-ligament rupture (mean – 109.5 μm/m; min. - 96.7 μm/m; max - 130.4 μm/m; SD 18.2). InterpretationA strain of the brachialis muscle was observed under varus/posterolateral rotatory forces with a pronated forearm and the strain increased significantly in the event of a dual-ligament rupture. This suggests that the brachialis muscle may influence varus/posterolateral rotatory stability of the elbow. Hence, a concomitant tear of the brachialis muscle might result in pronounced instability following simple elbow dislocation. Level of evidenceBasic Science Study, Biomechanics.

Cross-education and detraining effects of eccentric vs. concentric resistance training of the elbow flexors

BackgroundUnilateral resistance training increases the strength of the contralateral non-trained homologous muscles known as the cross-education effect. We tested the hypothesis that unilateral eccentric resistance training (ET) would induce greater and longer-lasting cross-education effect when compared with concentric resistance training (CT).MethodsYoung (20–23 y) participants were allocated to ET (5 males, 4 females) or CT (5 males, 4 females) group that performed unilateral progressive ET or CT of the elbow flexors, twice a week for 5 weeks (10 sessions) followed by a 5-week detraining, and control group (7 males, 6 females) that did not perform any training. Maximum voluntary isometric contraction torque of the elbow flexors (MVIC), one-repetition maximum of concentric dumbbell curl (1-RM), and biceps brachii and brachialis muscle thickness (MT) were measured from the trained and non-trained arms before, several days after the last training session, and 5 weeks later. A ratio between the trained and non-trained arms for the change in MVIC or 1-RM from pre- to post-training (cross-body transfer ratio) was compared between ET and CT groups.ResultsThe control group did not show significant changes in any variables. Both ET and CT increased (P < 0.05) MVIC (22.5 ± 12.3 % vs. 26.0 ± 11.9 %) and 1-RM (28.8 ± 6.6 % vs. 35.4 ± 12.9 %) of the trained arm without a significant difference between groups. MVIC was maintained after detraining for ET but returned to the baseline for CT, and 1-RM was maintained after detraining for both ET and CT. For the non-trained arm, MVIC (22.7 ± 17.9 % vs. 12.2 ± 10.2 %) and 1-RM (19.9 ± 14.6 % vs. 24.0 ± 10.6 %) increased similarly (P > 0.05) after ET and CT, and MVIC returned to the baseline after detraining, but 1-RM was maintained for both groups. An increase (P < 0.05) in MT was found only after ET for the trained arm (7.1 ± 6.1 %). The cross-body transfer ratio for MVIC was greater (P < 0.05) for ET (90.9 ± 46.7 %) than CT (49.0 ± 30.0 %).ConclusionsThese results did not support the hypothesis and showed similar changes in the most of the variables between ET and CT for the trained and non-trained arms, and strong cross-education effects on MVIC and 1-RM, but less detraining effect after ET than CT on MVIC of the trained arm.Trial registrationUniversity Hospital Medical Information Network Clinical Trials Registry (UMIN000044477; Jun 09, 2021).

A proposal for a new classification of the Coracobrachialis longus: A rare case or a new, distinct muscle?

BackgroundThe coracobrachialis muscle, along with the brachialis and biceps brachii muscles, belong to the anterior group of the brachial region. It is characterized by high level of morphological variabilities, with a common variation being the coracobrachialis longus (CBL) muscle. The CBL may be recognized as a distal part of the coracobrachialis muscle, originating from the anteromedial surface of the humerus, however, the two muscles are distinct from each other, and the distal attachment of the CBL is longer and located closer to the elbow joint. The CBL muscle may also be inserted on to various structures. The aim of the present study was to determine the frequency of the CBL muscle among a studied population, and to prepare a classification based on its morphological features. Material and MethodsClassical anatomical dissection was performed on 100 upper limbs from fifty human cadavers (30 female and 20 male) fixed in 10% formalin solution. ResultsThe coracobrachialis muscle was found in all individuals, and the CBL muscle was present in 11%, i.e. 11 upper limbs: four women, and seven men; five left and six right. Significantly, in all cadavers in which the coracobrachialis longus was found, its presence was unilateral (five left and six right). A new classification of the CBL can be proposed based on its insertion: Type I characterized by a distal attachment located on the medial epicondyle (73% of all cases of the CBL) and Type II by an insertion into the olecranon (27% of all cases of the CBL). ConclusionThe CBL muscle is morphologically variable. More studies focused on the course of this muscle among various populations are needed. Nevertheless, our findings indicate that the CBL muscle could be classified as a distinct muscle.

Whole-body muscle MRI characteristics of LAMA2-related congenital muscular dystrophy children: An emerging pattern

Merosin-deficient or LAMA2-related congenital muscular dystrophy (CMD) belongs to a group of muscle diseases with an overlapping diagnostic spectrum. MRI plays an important role in the diagnosis and disease-tracking of muscle diseases. Whole-body MRI is ideal for describing patterns of muscle involvement. We intended to analyze the pattern of muscle involvement in merosin-deficient CMD children employing whole-body muscle MRI. Ten children with merosin-deficient CMD underwent whole-body muscle MRI. Eight of which were genetically-confirmed. We used a control group of other hereditary muscle diseases, which included 13 children (mean age was 13 SD +/- 5.5 years), (8 boys and 5 girls) for comparative analysis. Overall, 37 muscles were graded for fatty infiltration using Mercuri scale modified by Fischer et al. The results showed a fairly consistent pattern of muscle fatty infiltration in index group, which differs from that in control group. There was a statistically significant difference between the two groups in regard to the fatty infiltration of the neck, serratus anterior, intercostal, rotator cuff, deltoid, triceps, forearm, gluteus maximus, gluteus medius, gastrocnemius and soleus muscles. Additionally, the results showed relative sparing of the brachialis, biceps brachii, gracilis, sartorius, semitendinosus and extensor muscles of the ankle in index group, and specific texture abnormalities in other muscles. There is evidence to suggest that whole-body muscle MRI can become a useful contributor to the differential diagnosis of children with merosin deficient CMD. The presence of a fairly characteristic pattern of involvement was demonstrated. MRI findings should be interpreted in view of the clinical and molecular context to improve diagnostic accuracy.

The Distance of the Median Nerve from the Brachialis Muscle Changes Significantly with Elbow and Forearm Movements

The Distance of the Median Nerve from the Brachialis Muscle Changes Significantly with Elbow and Forearm Movements

Brachial muscle injury resulting in acute compartment syndrome of the upper arm: a case report and literature review

BackgroundAcute compartment syndrome (ACS) is a potentially devastating condition. ACS is rare in the upper arm.Case presentationWe report a case of acute compartment syndrome of the anterior compartment of the upper arm due to brachial muscle injury. The patient experienced abnormal progressive swelling and pain in his right upper arm, and passive pulling pain of the right wrist and right hand. It was highly suspected to be right upper arm compartment syndrome, and was confirmed by surgery. The patient transferred to the emergency operating room for fasciotomy that was performed under general anesthesia using the anterolateral approach. The brachial muscle was found to be heavily swollen and had the greatest tension. The brachial muscle fibers were split lengthwise, and a large amount of hematoma was cleared. The brachial muscles were injured and partly ruptured. After full decompression, a negative pressure drainage device was used to cover the wound in the first stage. Ten days after injury, the swelling of the affected limb subsided and the wound was sutured. The patient’s limbs completely recovered to normal. The shoulder and elbow joints could move freely and the patient resumed normal farming work ability.ConclusionClinicians should fully recognize the fact that acute compartment syndrome can occur in the upper arm, rather than only the forearm and leg, and therefore avoid serious consequences caused by missed diagnosis and misdiagnosis.