Head Of Triceps Research Articles

Options for Restoring Finger Extension in Mangled Forearm Injuries.

Restoration of finger extension in mutilating hand injuries is crucial for restoring prehension and independent use of the hand. Patients often express desire to restore finger extension once finger flexion is achieved. However, the extensive forearm injury precludes use of any of conventional donors like the wrist or finger flexors for transfer to restore finger extension. Two patients with sequelae of mangled forearm injuries, underwent biceps and long head of triceps transfer to the finger extensors to improve opening up of the fingers. We discuss the treatment considerations while planning these transfers and provide the technical details, rehabilitation and outcome of these patients. Both the patients expressed dramatic improvement of their hand function and were satisfied with the outcome. Biceps and long head of triceps could serve as an effective second-line donor for restoration of finger extension when the conventional donors are not available. Level of Evidence: Level V (Therapeutic).

SEMG-based prediction of human forearm movements utilizing a biomechanical model based on individual anatomical/ physiological measures and a reduced set of optimization parameters.

For assistive devices such as active orthoses, exoskeletons or other close-to-body robotic-systems, the immediate prediction of biological limb movements based on biosignals in the respective control system can be used to enable intuitive operation also by untrained users e.g. in healthcare, rehabilitation or industrial scenarios. Surface electromyography (sEMG) signals from the muscles that drive the limbs can be measured before the actual movement occurs and, hence, can be used as source for predicting limb movements. The aim of this work was to create a model that can be adapted to a new user or movement scenario with little measurement and computing effort. Therefore, a biomechanical model is presented that predicts limb movements of the human forearm based on easy to measure sEMG signals of the main muscles involved in forearm actuation (lateral and long head of triceps and short and long head of biceps). The model has 42 internal parameters of which 37 were attributed to 8 individually measured physiological measures (location of acromion at the shoulder, medial/lateral epicondyles as well as olecranon at the elbow, and styloid processes of radius/ulna at the wrist; maximum muscle forces of biceps and triceps). The remaining 5 parameters are adapted to specific movement conditions in an optimization process. The model was tested in an experimental study with 31 subjects in which the prediction quality of the model was assessed. The quality of the movement prediction was evaluated by using the normalized mean absolute error (nMAE) for two arm postures (lower, upper), two load conditions (2 kg, 4 kg) and two movement velocities (slow, fast). For the resulting 8 experimental combinations the nMAE varied between nMAE = 0.16 and nMAE = 0.21 (lower numbers better). An additional quality score (QS) was introduced that allows direct comparison between different movements. This score ranged from QS = 0.25 to QS = 0.40 (higher numbers better) for the experimental combinations. The above formulated aim was achieved with good prediction quality by using only 8 individual measurements (easy to collect body dimensions) and the subsequent optimization of only 5 parameters. At the same time, just easily accessible sEMG measurement locations are used to enable simple integration, e.g. in exoskeletons. This biomechanical model does not compete with models that measure all sEMG signals of the muscle heads involved in order to achieve the highest possible prediction quality.

Distal 1/3 humerus shaft fracture - a lateral paratricipital approach with proximal split window

Patient is a 25yo F following a fall from a height. Closed distal 1/3 diaphyseal fracture with no neurological symptoms. Patient sought a rapid recovery without use of an orthosis so consented and proceeded with open reduction and locking plate fixation. Operation was performed prone with the arm resting on a small side support table, the forearm flexed 90deg towards the floor. Midline posterior approach to the humerus, elevation of a lateral paratricipital window from the lateral intermuscular septum - utilising the ascending course of the posterior antebrachial cutaneous nerve as a guide to find the perforation of the radial nerve through the septum. The fracture was reducible entirely through the lateral window distal to the radial nerve. A small medial paratricipital window anterior to the ulnar nerve was opened for lag screwing before positioning the plate. To facilitate proximal plate fixation without having to mobilise the lateral belly of triceps (and with it the radial nerve) we opened an additional proximal working window between long and lateral heads of triceps. Proximal to the aponeurosis it is a simple matter to identify and mobilise the descending course of the radial nerve bundle, protect it, and proceed with proximal instrumentation and plate fixation.

STUDY OF ORIGIN OF BRANCHES OF THE RADIAL NERVE IN THE AXILLA, A CADAVERIC STUDY

Background: Radial nerve is the continuation of the posterior cord of the brachial plexus in the axilla. To know the mode of origin of Objectives: branches of the radial nerve in the axilla. Dissection was done on 44 upper li Methods: mbs from embalmed adult cadavers and 6 upper limbs from embalmed dead fetuses in the Department of Anatomy, J J M Medical College, Davangere. Dissection of Radial nerve and its branches in the axilla was carried out according to Cunningham's manual of practical anatomy. Results: The order of origin of the branches of the radial nerve in the axilla was posterior cutaneous nerve of arm(PCNA), nerve to long head of tricep( NLHT) and ulnar collateral nerve (UCN). Two types of common trunks were observed. Common trunk 1 (CT1) dividing to give nerve to long head of tricep(NLHT) and ulnar collateral nerve(UCN) in 2 specimens (4%). Common trunk 2 (CT2) dividing to give nerve to long head of tricep(NLHT), ulnar collateral nerve(UCN) and posterior cutaneous nerve of arm (PCNA) in 1 specimens (2%). The origin of Nerve to long head of triceps (NLHT) was directly from the radial nerve (RN) in 47 specimens (94%) , through common trunk 1 (CT1) in 2 specimens (4%) and through common trunk 2 (CT2) in 1 specimens (2%). The origin of ulnar collateral nerve (UCN) was directly from the radial nerve (RN) in 47 specimens (94%) , through common trunk 1 (CT1) in 2 specimens (4%) and through common trunk 2 (CT2) in 1 specimens (2%). The origin of Posterior cutaneous nerve of arm(PCNA) was directly from the radial nerve (RN) in 49 specimens (98%) and through common trunk 2 (CT2) in 1 specimens (2%). The present Interpretation and Conclusion: study is important for Surgeons, Orthopedicians, and Neurophysicians as it provides the knowledge of mode of origin of branches of radial nerve in the axilla.

Posterior Deltoid Function After Transfer of Branch to the Long Head Triceps Brachii of the Radial Nerve to the Anterior Branch of the Axillary Nerve

The aim of this study was to evaluate the function of the posterior part of the deltoid after nerve transfer of the long head triceps branch of the radial nerve to the anterior branch of the axillary nerve in patients with an upper brachial plexus injury or isolated axillary nerve injury. We retrospectively reviewed 26 patients diagnosed with an upper brachial plexus injury or isolated axillary nerve injury who underwent nerve transfer of the long head triceps muscle branch of the radial nerve to the anterior branch of the axillary nerve in our institute between 2012 and 2017. Data on age, sex, the mechanism of injury, the pattern of injury, and operative treatment were collected from medical records. Preoperative and postoperative clinical examinations, including motor powers of shoulder abduction and extension according to Medical Research Council grading, were evaluated. At a minimum of 2 years after the operation, we evaluated the recovery of the posterior deltoid function using the swallow-tail test. Twenty-two patients (84.6%) had recovery of posterior deltoid function confirmed by the swallow-tail test. There were 23 patients (88.5%) who achieved at least Medical Research Council grade 4 of shoulder abduction. Nerve transfer from the branch to the long head triceps to the anterior branch of the axillary nerve is an effective technique for restoring deltoid function in an upper brachial plexus injury or isolated axillary nerve injury. This technique can provide shoulder abduction and shoulder extension, which are the functions of the posterior deltoid muscle. Therapeutic IV.

The Intercostal Nerves Transfer to the Radial Nerve Branch to the Long Head Triceps Muscle: Influencing Factor and Outcome of 55 Cases

The objective of this study was to report the functional outcomes and factors affecting the result of intercostal nerves transfer to the radial nerve branch to the long head triceps muscle for restoration of elbow extension in patients with total brachial plexus palsy or C5 to C7 palsy with the loss of triceps muscle function. Fifty-five patients with total brachial plexus palsy or C5 to C7 palsy with no triceps muscle function had a reconstruction of elbow extension by transferring the third to fifth intercostal nerves to the radial nerve branch to the long head triceps muscle. The functional outcomes determined by the Medical Research Council grading were evaluated. Factors influencing the outcomes were determined using logistic regression analysis. At the follow-up of at least 2 years, 36 patients (65%) had antigravity motor function (Medical Research Council grade, ≥3). Multivariable logistic regression analysis showed that the body mass index, time to surgery, and injury of the dominant limb were associated with the outcome. The third to fifth intercostal nerves transfer to the radial nerve branch to the long head triceps muscle is an effective procedure to restore elbow extension. We would recommend using 3 intercostal nerves without grafts; in cases of nerve root avulsion in which there is no chance of spontaneous recovery, early surgery should be considered. Therapeutic IV.

Musculocutaneous flap of the medial head of the triceps brachii: pedicled flap to cover the posterior cubital region.

The medial head of the triceps brachii flap is already described as a local muscular or as a free flap. It allows coverage of defects of the posterior cubital region. The aim of this study was to describe the vascular anatomy of the musculocutaneous medial triceps brachii pedicled flap. Eleven fresh-frozen upper limbs (6 come from women and 5 from men) were proximally injected with Indian ink agar solution. The medial head of the triceps brachii muscle was dissected and the superior ulnar collateral artery (SUCA) was isolated with its collaterals. The collateral arteries were dissected to determine whether there were septocutaneous or musculocutaneous arteries for vascularization of the skin in front of the medial head. Lengths of those collaterals arteries were measured. The average number of collaterals arteries from the SUCA supplying the medial head of the triceps brachii is 4.5 (from 3 to 6 arteries). Among these collaterals' arteries, there are one average 1.5 (0.6-4.5) septocutaneous arteries and 3 (1-4.8) musculocutaneous arteries. A musculocutaneous flap with the medial head of the triceps brachii muscle can be described with the muscle. The SUCA gives perforator arteries musculocutaneous and septocutaneous for the vascularization of the triceps brachii medial head. The use of local pedicled flap with similar tissue maximizes healing with a minimal morbidity of the donor site. This study demonstrated the feasibility of the medial head triceps brachii musculocutaneous flap to cover defect of the posterior aspect of the elbow.

The influence of testing positions and resistance locations on muscle activities during shoulder internal rotation strength measurements in young healthy adults

BackgroundAlthough some tests of shoulder internal rotator strength including subscapularis are commonly used in clinical practice, the differences in shoulder muscle activities other than subscapularis muscle among those tests are not well understood. The purpose of this study was to examine the activities of the superficial shoulder muscles in addition to internal rotation strength during two belly-press and three lift-off test positions. MethodsThirteen healthy young adult men (age 29.5 ± 5.4 years) were recruited for the present study. They performed isometric shoulder internal rotation against manual resistance during the belly-press test positions with two different resistance locations and the lift-off test with three different arm positions. The surface electromyographic activities of the superficial shoulder muscles, including the deltoid (anterior, middle, posterior), pectoralis major, long head of triceps and latissimus dorsi muscle, were collected and compared between the two belly-press tests, and among the three lift-off test positions (P < 0.05). ResultsThe belly-press test position with resistance to elbow showed significantly greater activities of the anterior and middle deltoid muscle than the original belly-press test; but showed significantly smaller activities of pectoralis major, triceps and latissimus dorsi muscle than the original belly-press test. Among the three lift-off tests, all muscle activities, except for the pectoralis major, were greater in the lift-off at L4/5 than in the lift-off at buttock and thigh. Lift-off at thigh showed significantly smaller activity of pectoralis major than the lift-off at L4/5 and buttock. ConclusionsThe findings of the present study suggest that clinician should give attention to compensatory motions by excessive shoulder extensor and adductor muscle activities for the original belly press test, by excessive deltoid muscle activities for the modified belly-press, and by excessive shoulder extensor muscle activities for the lift off test in the inferior arm positions.

Long head function preserving modification of Somsak’s nerve transfer for the reanimation of shoulder abduction in the adult upper partial brachial plexus injuries: a cadaver and clinical study

We modified the conventional Somsak procedure to preserve the innervation to the long head of triceps, which is an indispensable component of inferior and posterior shoulder stability. The latter is also an extensor and external rotator of the shoulder. Our modification is also based on the finding that normal force of the reinnervated muscle could be achieved with just one-third of the axonal population. Shoulder abduction and external rotation are second priority in adult brachial plexus injury (ABPI) treatment. The aim of this study is to evaluate the functional outcomes of our modification of Somsak’s procedure A preliminary cadaver study was conducted by us to study the anatomy of the donor nerve (the nerve to the long head of triceps-NLHOT) and feasibility for function preserving nerve transfer to the anterior branch of the axillary nerve. We followed this with a retrospective study (2007 to 2017) in which the documents of 46 closed adult upper partial brachial plexus injuries (AUPBPI) patients who had undergone only the modified Somsak’s procedure for the shoulder animation were assessed. All patients had levels 1, 2, and 3 preganglionic or wide gap postganglionic injuries involving the C5 and C6 spinal nerves. The patients also had a simultaneous target neurotization procedure for elbow flexion. The cadaver study highlighted the vasa nervorum and branching patterns of the axillary nerve and NLHOT. The cadaver study also established the ways and means of harvesting the vascularized size-matched branch of NLHOT facilitating target neurotization to the anterior branch of the axillary nerve. On evaluation with the institution objective assessment score, 42 patients (91.3%) had grade 4 scores and four patients (8.7%) had grade 3 scores (p < 0.05). At the end of the follow-up period, patients were assessed with the institutional subjective assessment score, which showed that 43 patients (93.5%) had grade “A” and three patients (6.5%) had grade “B” scores (p < 0.05). Preserving the innervation of the long head of triceps bestows good shoulder stability. A diligent intraneural dissection along the nerve to the long head of triceps fetches a branch of adequate size and length and possibly with a sufficient number of regenerating axons, facilitating a tensionless coaptation of vascularized nerve ends and resulting in useful functional outcomes. Thus the modified Somsak’s procedure can be a useful addendum in the shoulder animation of AUPBPI patients. Level of evidence: Level III, therapeutic study

AXILLARY NERVE SUPPLYING MOTOR BRANCH TO LONG HEAD OF TRICEPS BRACHII MUSCLE: A CASE REPORT AND REVIEW OF LITERATURE

All three heads of the triceps brachii are classically described as being innervated by the radial nerve in the textbooks. Some clinical observations of traumatic injuries of the axillary nerve with associated paralysis of the long head of triceps and cadaveric studies have suggested that the axillary nerve may innervate the long head of triceps. During routine dissection to undergraduate M.B.B.S students, we found axillary nerve giving a motor branch to long head of triceps brachii on right side, in an adult male cadaver aged about 60 years. We conducted extensive literature search to analyse the previous studies reporting such variations and the studies conducted on the radial nerve or triceps brachii innervation pattern. This variation is clinically important for surgeons, orthopedicians and anaesthetist while performing surgeries and pain management therapies on the upper limb.

Comparison between long and lower medial head triceps branches in dual neurotization for shoulder function restoration in upper brachial plexus palsy.

In upper brachial plexus injury (UBPI), restoring shoulder function is crucial. This study compares the transfer of long and lower medial heads of triceps branches to the axillary nerve to achieve proper restoration of function. A retrospective comparative study was conducted between two groups of patients with (UBPI). Group I patients (10) [mean age: 19 ± 10.6 years] were managed by transferring triceps long head branch to axillary nerve while group II patients (8) [mean age: 26 ± 9.6 years] were managed by triceps lower medial head branch transfer. The mean time from injury to surgery was 6 ± 1.3 and 5 ± 1.7 months respectively. All patients were followed up for a minimum of 12 months with the assessment of VAS, DASH score, active range of motion (AROM) and strength of shoulder abduction and external rotation; in addition to shoulder endurance and strengths of donors. Postoperative, three-monthly, electrodiagnostic assessments were performed. Postoperatively, the mean VAS and DASH scores; in addition to endurance time, showed significant enhancement in both groups. Patients in both groups have accomplished a mean abduction (AROM) of 98° ± 27.9 and 97° ± 11.9 respectively. The mean external rotation (AROM) was 48° ± 18.4 and 47° ± 9.2 respectively. Furthermore, group II patients had less triceps morbidity in addition to earlier and enhanced electrophysiological recovery. Dual neurotization for shoulder function restoration in (UBPI) is capable of providing proper functional results with minimal donor morbidity. The triceps lower medial branch provides an excelling donor due to less triceps morbidity, extra length; yet, earlier and enhanced electrophysiological recovery.

Factors Affecting Stability of the Reverse Total Shoulder Arthroplasty: A Cadaveric Biomechanical Study

Background: The overall objective of this study was to investigate whether a reverse shoulder arthroplasty could provide adequate stability to a shoulder even with extreme soft tissue loss. The specific objectives of this study were: to determine if just the deltoid, conjoined tendon, and triceps are sufficient soft tissues to allow a Reverse Shoulder Arthroplasty (RSA) to provide shoulder stability and to determine the influence of load direction, rotation, shoulder position, and polyethylene thickness on RSA stability in this soft-tissue deficient model. Methods: This study utilized six cadaveric shoulders that had all soft tissue removed, with the exception of the deltoid, conjoint tendon, and long head of triceps. A reverse shoulder arthroplasty was then performed (Delta III, DePuy Inc., Warsaw, IN) and an increasing dislocation force was applied perpendicular to the humeral socket centerline until dislocation occurred, or a maximum load of 100 N was reached. This was repeated to measure the effect of four factors: load direction, arm position, polyethylene thickness, and arm rotation on force to dislocation. Results: For load direction, there was an increase in force to dislocate an inferior load direction (p=0.01). There was a lower not dislocated percentage and lower survival for a posterior load direction (p=0.02). For arm position, there was a decrease in force for dislocation and lower survival for both abduction and extension arm positions. There was a higher not dislocated percentage for a flexion arm position (p=0.01). For arm rotation, there was a lower not dislocated percentage and lower survival for an external rotation arm position (p=0.03). There was no statistically significant influence of polyethylene thickness (p=0.26). Conclusion: The deltoid, conjoined tendon, and triceps are sufficient to stabilize an RSA. Load direction, arm position, and arm rotation were all shown to significantly affect stability. Finally, polyethylene thickness may not affect overall RSA stability in this soft-tissue deficient model. Level of Evidence: Basic science study, Biomechanical study.

Reanimation of triceps muscle using ulnar nerve fascicle transfer to the nerve to long head of the triceps muscle

Triceps muscle serves an important role in extension of the elbow. Its action is required for reaching out objects without using the trunk. Elbow extension is an important function for natural stabilization of the elbow. The aim of this study was to evaluate restoration of elbow extension in adults suffering triceps muscle palsy with various causes, by using transfer of a fascicle of ulnar nerve to the long head of triceps branch of the radial nerve. In the present case series, 7 patients with partial brachial plexus injury or posterior cord injury, where triceps muscle was involved, were subjected to motor fascicle of ulnar nerve transfer to the nerve to long head of triceps for restoration of elbow extension. Follow-ups, including EMG-NCV (electromyography-nerve conduction velocity) 6 and 12months after surgery and elbow extension muscle strength using MRC grading, were carried out. Six patients (85.71%) achieved a functional muscle strength of M4 for their elbow extension. In all of the patients, re-innervation was discovered using EMG-NCV. This surgical technique (ulnar nerve fascicle transfer to long head of thetriceps) for improving elbow extension is promising in patients with brachial plexus injury.

Isolated Axillary Nerve Injury following a Blunt Trauma

Introduction: Axillary nerve supplies deltoid muscle long head of triceps and teres minor in the arm and supply regimental batch area over the inferior part of shoulder. Anterior dislocation of shoulder, latrogenic injury to the nerve during shouder injection and brachial plexus injury can cause axillary nerve injury. Case report: We report a rare case of isolated axillary nerve injury in a 20 year old lady. She was admitted following a low speed fall from motorcycle and sustain abrasion wound over the right side of the face and shoulder. There was no direct or tractional injury to the shoulder during the incidence.During admission she complaint of progressive right shoulder weakness with MRC power of 2 and sensory loss over regimental patch area. On examination there was no tenderness to the shoulder area or neck and she was unable to abduct her right shoulder with full passive range of motion. Patient was subjected to nerve conduction study four months later and revealed slower sensory conduction and deltoid muscle amplitude decreased compared the left side. At 7 months post trauma she is recovering with deltoid power of 4 after multiple physiotherapy session. Isolated axillary nerve injury following a blunt trauma is a rare condition with multiple reported cases showed poor recovery. One should wait for regeneration of nerves to complete before offering any surgical intervention to the patient. As in our case, patient showed remarkable improvement after seven months with conservative management thus avoiding the complication of surgery.

Nerve Transfer from the Long Head Triceps Nerve to Posterior Interosseous Nerve for Restoration of Wrist, Finger, and Thumb

Summary:In brachial plexus injuries where the radial nerve is damaged, there is loss of wrist, finger, and thumb extension. Surgical options for treating brachial plexus injuries are case dependent. To restore finger and wrist extension, the median nerve is primarily utilized for nerve transfer. We describe a new technique in a young man who suffered a gunshot wound in the left axilla, injuring the radial, median, and ulnar nerves. To restore wrist, finger, and thumb extension, we designed and performed a new technique consisting of nerve transfer, an interposition sural nerve graft from the motor branch of the long triceps portion to the posterior interosseous nerve. Positive outcomes were seen after 18 months with postoperative recovery of the functionality of finger and wrist extension.

Intramuscular cavernous haemangioma of the triceps brachii: a rare tumour with good prognosis

Intramuscular cavernous hemangiomas are a sub-type of deep soft tissue hemangiomas most commonly presenting in the lower extremities. This report highlights the rare occurrence of these tumours in the upper extremity (triceps muscle) in which only a handful of cases have been reported in literature. The tumour was treated pre-operatively with embolization and sclerotherapy followed by complete excision of the lesion along with the lateral head of triceps. Following complete removal, the patient has been symptom-free for almost one year with no recurrence reported to date. In conclusion, early diagnosis and timely intervention can help prevent complications like neurovascular compromise, minimise recurrence and lead to excellent functional outcomes with minimal morbidity as exemplified in this case.

EMG-Based Real-Time Linear-Nonlinear Cascade Regression Decoding of Shoulder, Elbow, and Wrist Movements in Able-Bodied Persons and Stroke Survivors.

This study aimed to decode shoulder, elbow and wrist dynamic movements continuously and simultaneously based on multi-channel surface electromyography signals, useful for electromyography controlled exoskeleton robots for upper-limb rehabilitation. Ten able-bodied subjects and ten stroke subjects were instructed to voluntarily move the shoulder, elbow and wrist joints back and forth in a horizontal plane with an exoskeleton robot. The shoulder, elbow and wrist movements and surface electromyography signals from six muscles crossing the joints were recorded. A set of three parallel linear-nonlinear cascade decoders was developed to continuously estimate the selected shoulder, elbow and wrist movements based on a generalized linear model using the anterior deltoid, posterior deltoid, biceps brachii, long head triceps brachii, flexor carpi radialis, and extensor carpi radialis muscle electromyography signals as the model inputs. The decoder performed well for both healthy and stroke populations. As movement smoothness decreased, decoding performance decreased for the stroke population. The proposed method is capable of simultaneously and continuously estimating multi-joint movements of the human arm in real-time by characterizing the nonlinear mappings between muscle activity and kinematic signals based on linear regression. This may prove useful in developing myoelectric controlled exoskeletons for motor rehabilitation of neurological disorders.

P93-T EMG and clinical results of Leechavengvongs transfer, our experiences

Background The long head triceps radialis branch to axillary nerve transfer (“Leechavenvongs’ transfer”) is an option of restoring the motor function of the deltoid muscle in case of complete axillary nerve or C5,6 root injury. The most advantages are anatomic proximity, appropriate diameter, intraplexal donor, no grafting, useful functional recovery achieved in other sources. Material and methods Group of 11 patients, who underwent Leechavengvongs’s transfer in last 4 years was analysed. The main inclusion criterium was irreparable axillary nerve injury (simple or as a part of brachial plexus injury) with complete denervation signs in deltoid musle preoperatively. We assessed motor recovery according to MRC scoring system and EMG reinnervation signs every 3 months after surgery. We set the preliminary follow - up period for 18 month, complete for 24 months. Results and conclusions 1 patient was exclude from the results (death from other reasons). The rest of 10 patients had an evidence of partial reinnervation signs 6 months after surgery. We observed good functional recovery by 5 patients, if surgery was performed early after injury (to 6 months at latest). We conclude the Leechavengvongs transfer is reliable and effective procedure. All patients had an evidence of partial muscle reinnervation. In agreement with other sources there was no impairment of the triceps brachii function. We consider the injury-to-surgery time is an important factor of good results. This group of patients is too small to consider general.

Ulnar Nerve Innervation to Triceps: A Cadaveric Study and a Technical Note on Partial Triceps to Biceps Transfer.

Background:The loss of elbow flexion is a routinely encountered problem in clinical practice. There is no literature on ulnar nerve innervation to triceps in addition to the radial nerve which is dual nerve innervation to triceps in the Indian population. We intend to study the incidence of ulnar nerve innervation to the medial head of triceps in Indian population and also the clinical feasibility of transfer of long and medial head of triceps tendon to biceps around the medial aspect of humerus.Materials and Methods:A cross-sectional study was conducted using 32 fresh-frozen skeletally mature cadavers of Indian origin. The possible contribution of the ulnar nerve to medial head of triceps in addition to the radial nerve was recorded. The arm length, the distance where the ulnar nerve pierces the medial intermuscular septum from medial epicondyle; the distance of the ulnar nerve fascicle from the medial epicondyle was also measured.Results:The incidence of ulnar nerve innervation to the medial head of triceps was 43.8%. Mean arm length was 29.13 cm. Mean distance where the ulnar nerve pierced the medial intermuscular septum from medial epicondyle was 9.93 cm. Mean distance of the ulnar nerve branch to the triceps from medial epicondyle was 8.01 cm.Conclusion:This study reveals the presence of dual nerve innervation to triceps in 43.8% of the Indian population. The clinical implication would be to look for the possible contribution of the ulnar nerve fascicle to the medial head of triceps, which will help us to include the medial head along with the long head of triceps while performing partial triceps-to-biceps tendon transfer, and the other use would be as a donor fascicle when performing a nerve transfer.

Comparison of Elbow Extensor Muscle Strength and EMG Activity in Supine and Prone Positions in Healthy Subjects

Background There is little research on the strength and electromyograph (EMG) activity of elbow extensors according to the measuring posture. Purpose We investigated which posture influenced strength and EMG activity of elbow extensors in evaluating postures (supine and prone). Study design Comparative, repeated measures design. Methods Twenty-one healthy subjects performed maximal elbow extension in two postures (supine and prone). EMG activity was measured in the anconeus, long head of triceps (LoT), and lateral of triceps (LT). When measuring EMG activity of elbow extensors, the strength of elbow extensors was also measured by Smart KEMA strength measurement system. Results In supine, EMG activity of anconeus and LT was significant increased. The other way, EMG activity of LoT and strength of elbow extensors were significant increase in the prone position. Conclusions We recommend the prone position to increase EMG activity of LoT and to improve strength of elbow extensors. In addition, supine position should be considered to increase muscle activity of anconeus and LT.