Lateral Epicondyle Of Humerus Research Articles

Wearable Accelerometer and Gyroscope Sensors for Estimating the Severity of Essential Tremor.

Several validated clinical scales measure the severity of essential tremor (ET). Their assessments are subjective and can depend on familiarity and training with scoring systems. We propose a multi-modal sensing using a wearable inertial measurement unit for estimating scores on the Fahn-Tolosa-Marin tremor rating scale (FTM) and determine the classification accuracy within the tremor type. 17 ET participants and 18 healthy controls were recruited for the study. Two movement disorder neurologists who were blinded to prior clinical information viewed video recordings and scored the FTM. Participants drew a guided Archimedes spiral while wearing an inertial measurement unit placed at the mid-point between the lateral epicondyle of the humerus and the anatomical snuff box. Acceleration and gyroscope recordings were analyzed. The ratio of the power spectral density between frequency bands 0.5-4 Hz and 4-12 Hz, and the sum of power spectrum density over the entire spectrum of 2-74 Hz, for both accelerometer and gyroscope data, were computed. FTM was estimated using regression model and classification using SVM was validated using the leave-one-out method. Regression analysis showed a moderate to good correlation when individual features were used, while correlation was high ([Formula: see text] = 0.818) when suitable features of the gyro and accelerometer were combined. The accuracy for two-class classification of the combined features using SVM was 91.42% while for four-class it was 68.57%. Potential applications of this novel wearable sensing method using a wearable Inertial Measurement Unit (IMU) include monitoring of ET and clinical trials of new treatments for the disorder.

Localisation of the centre of the highest region of muscle spindle abundance of anterior forearm muscles.

The centre of the highest region of muscle spindle abundance (CHRMSA) in the intramuscular nerve-dense region has been suggested as the optimal target location for injecting botulinum toxin A to block muscle spasms. The anterior forearm muscles have a high incidence of spasticity. However, the CHRMSA in the intramuscular nerve-dense region of the forearm anterior muscle group has not been defined. This study aimed to accurately define the body surface position and the depth of CHRMSA in an intramuscular nerve-dense region of the anterior forearm muscles. Twenty-four adult cadavers (57.7 ± 11.5 years) were included in this study. The curved line close to the skin connecting the medial and lateral epicondyles of the humerus was designated as the horizontal reference line (H line), and the line connecting the medial epicondyle of the humerus and the ulnar styloid was defined as the longitudinal reference line (L line). Modified Sihler's staining, haematoxylin-eosin staining and computed tomography scanning were employed to determine the projection points (P and P') of the CHRMSAs on the anterior and posterior surfaces of the forearm. The positions (PH and PL) of point P projected onto the H and L lines, and the depth of each CHRMSA, were determined using the Syngo system. The PH of the CHRMSA of the ulnar head of pronator teres, humeral head of pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris, ulnar part of flexor digitorum superficialis, radial part of flexor digitorum superficialis, flexor pollicis longus, ulnar part of flexor digitorum profundus, radial portion of flexor digitorum profundus and pronator quadratus muscles were located at 42.48%, 45.52%, 41.20%, 19.70%, 7.77%, 25.65%, 47.42%, 53.47%, 12.28%, 38.41% and 51.68% of the H line, respectively; the PL were located at 18.38%, 12.54%, 28.83%, 13.43%, 17.65%, 32.76%, 57.32%, 64.12%, 20.05%, 45.94% and 88.71% of the L line, respectively; the puncture depths were located at 21.92%, 27.25%, 23.76%, 18.04%, 15.49%, 31.36%, 26.59%, 41.28%, 38.72%, 45.14% and 53.58% of the PP' line, respectively. The percentage values are the means of individual values. We recommend that the body surface puncture position and depth of the CHRMSA are the preferred locations for the intramuscular injection of botulinum toxin A to block anterior forearm muscle spasms.

Movement Component Analysis of Reaching Strategies in Individuals With Stroke: Preliminary Study.

Upper limb motor paresis is a major symptom of stroke, which limits activities of daily living and compromises the quality of life. Kinematic analysis offers an in-depth and objective means to evaluate poststroke upper limb paresis, with anticipation for its effective application in clinical settings. This study aims to compare the movement strategies of patients with hemiparesis due to stroke and healthy individuals in forward reach and hand-to-mouth reach, using a simple methodology designed to quantify the contribution of various movement components to the reaching action. A 3D motion analysis was conducted, using a simplified marker set (placed at the mandible, the seventh cervical vertebra, acromion, lateral epicondyle of the humerus, metacarpophalangeal [MP] joint of the index finger, and greater trochanter of the femur). For the forward reach task, we measured the distance the index finger's MP joint traveled from its starting position to the forward target location on the anterior-posterior axis. For the hand-to-mouth reach task, the shortening of the vertical distance between the index finger MP joint and the position of the chin at the start of the measurement was measured. For both measurements, the contributions of relevant upper limb and trunk movements were calculated. A total of 20 healthy individuals and 10 patients with stroke participated in this study. In the forward reach task, the contribution of shoulder or elbow flexion was significantly smaller in participants with stroke than in healthy participants (mean 52.5%, SD 24.5% vs mean 85.2%, SD 4.5%; P<.001), whereas the contribution of trunk flexion was significantly larger in stroke participants than in healthy participants (mean 34.0%, SD 28.5% vs mean 3.0%, SD 2.8%; P<.001). In the hand-to-mouth reach task, the contribution of shoulder or elbow flexion was significantly smaller in participants with stroke than in healthy participants (mean 71.8%, SD 23.7% vs mean 90.7%, SD 11.8%; P=.009), whereas shoulder girdle elevation and shoulder abduction were significantly larger in participants with stroke than in healthy participants (mean 10.5%, SD 5.7% vs mean 6.5%, SD 3.0%; P=.02 and mean 16.5%, SD 18.7% vs mean 3.0%, SD 10.4%; P=.02, respectively). Compared with healthy participants, participants with stroke achieved a significantly greater distance via trunk flexion in the forward reach task and shoulder abduction and shoulder girdle elevation in the hand-to-mouth reach task, both of these differences are regarded as compensatory movements. Understanding the characteristics of individual motor strategies, such as dependence on compensatory movements, may contribute to tailored goal setting in stroke rehabilitation.

Effect of harness design on the biomechanics of domestic dogs (Canis lupus familiaris)

ABSTRACT Harnesses have become increasingly popular and whilst there are benefits to harnesses, the impact of harness design on canine biomechanics, and thus physical health and welfare is largely unknown. The purpose of this study was to assess the effect of three popular commercially available harnesses on canine locomotion in 66 domestic dogs. Dogs were filmed moving on a loose lead over a Tekscan Strideway gait analysis system. Stride length as a proportion of limb length (calculated as distance from the elbow to the floor), body weight distribution in the front versus the hind limbs (%), and minimum and maximum apparent angles of the lateral epicondyle of humerus (LEH) and greater tubercle of humerus (GTH) during the motion cycle were measured. Except for GTH angles, there were significant differences in all the investigated metrics. Differences varied across breeds/breed types. It is recommended that, when purchasing and fitting harnesses for dogs, owners and harness fitters treat dogs on an individual basis. The impact of pulling in harness on dog gait requires investigation as dogs may experience greater restrictions when pulling than during locomotion on a loose lead.

A Clinical Overview of the Natural Course and Management of Lateral Epicondylitis.

Lateral epicondylitis (LE), also often called tennis elbow, is a frequent cause of elbow pain. The most characteristic symptom of LE is pain and burning around the lateral epicondyle of the humerus that may radiate to the forearm or to the upper arm. Ultrasonography is a quick and noninvasive tool used to confirm (or exclude) the diagnosis of LE. Management of LE symptoms should be directed to the management of pain, protection of movement, and improvement of arm performance. Treatment of LE includes nonoperative techniques and surgery. [Orthopedics. 2023;46(4):e210-e218.].

Minimally Invasive Plate Osteosynthesis (MIPO) Through the Posterior Approach for the Humerus: A Cadaveric Study.

Background Minimally invasive plate osteosynthesis (MIPO) has been effectively used in femur and tibia fractures. MIPO in the humerus is conducted by anterior (most commonly used), lateral, and posterior approaches. However, in the anterior approach, in distal humeral diaphyseal fractures, there is a lack of adequate room for screw placement in the distal fragment for good stability. In such cases, the posterior approach for MIPO may be a propitious treatment method. However, the literatureon MIPO using the posterior approach for humeral diaphyseal fractures is limited. This study aimed to evaluate the feasibility of MIPOthrough the posterior approachand study the association of radial nerve injury with MIPOthrough the posterior approach for the humerus. Methodology This experimental study was conducted in the Department of Orthopedics, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India, and 20 cadaveric arms (10 right and 10 left) of 11 embalmed (formalin) cadavers were included (seven males and four females). Cadavers were placed prone on the dissection table. The posterolateral tip of the acromion and lateral epicondyle of the humerus were used as bony landmarks that were marked under C-Arm (Ziehm Imaging, Orlando, FL, USA) using K wires (Kirschner wires, Surgical Holdings, Essex, UK). Two incisions on theposterior part of the arm were made, and the radial nerve was identified at the proximal incision. After creating a submuscular tunnel, a 3.5 mm extraarticular distal humerallocking compression plate (LCP) was introduced over the posterior surface of the humerus and fixed to the humerus distally with one screw and then adjusted proximally and fixed to the humerus with another screw in the proximal window, followed by placement of couple more screws under C-Arm. After plate fixation, the dissection was completed to meticulously explore the radial nerve. The radial nerve was examined thoroughly for any injury sustained after completion of dissection, from the triangular interval to the lateral intermuscular septum where the nerve enters the anteriorchamber. The position of the radial nerve with respect to plate holes was noted.The distance from the posterolateral tip of the acromion to the lateral epicondyle was measured as humeral length.The medial and lateral points where radial nerve passed over the posterior surface of the humerus were measured from the posterolateral tip of the acromion and compared with the humeral length. Results In this study, the radial nerve was lying over the posterior surface of the humerus for a mean distance of 52.161 ± 5.16 mm. The mean distance at which the radial nerve crossed the medial and lateral borders of the posterior surface of the humerus, measured from the posterolateral tip of the acromion, was 118.34 ± 10.86 mm (40.07% of humeral length) and 170 ± 12.30 mm (57.57% of humeral length), respectively, and the mean humeral length in this study was 295.27 ± 17.94 mm. The radial nerve and its branches were found to be intact in all cases. The radial nerve was related to the fifth, sixth, and seventh holes, with the nerve lying most commonly over the sixth hole (3.5 mm extraarticular distal humerus locking plate). Conclusions The posterior approach of MIPO in humeral fractures is a safe and reliable treatment modality with minimal risk of radial nerve injury. The radial nerve can be safely identified at the spiral groove using the bony landmarks described in our study.

BEDA PENGARUH ECCENTRIC EXERCISE DAN PASSIVE STRETCHING PADA PENERAPAN ULTRASOUND TERHADAP PENURUNAN NYERI PENDERITA TENNIS ELBOW TIPE II DI KAMPUS JURUSAN FISIOTERAPI POLTEKKES MAKASSAR

Background : Tennis Elbow is a complaint of pain in the forearm which usually radiates to the dorsum of the hand due to inflammation or non-specific degeneration of the extensor carpi radialis brevis (ECRB) muscle in the lateral epicondyle of the humerus. It is diagnosed clinically by the sensation of pain and tenderness over the lateral epicondyle of the humerus which is aggravated during dorsiflexion of the restricted wrist.Methods: This type of research is a quasi experiment with a ramdomized pre test-post test two group design. This study consisted of 2 sample groups, namely treatment group 1 which was given Eccentric Exercise and Ultrasound interventions and treatment group 2 which was given Passive Streaching and Ultrasound interventions. The sample of this study were students of the Makassar Health Ministry Polytechnic majoring in Physiotherapy who suffered from Type II Tennis Elbow with inclusion and exclusion criteria in sampling.Results: the mean value of tennis elbow in the First Treatment group (Ultrasound and Eccentric Exercise) is the value of P = 0.012 &lt;0.05 where the pre test is 6.650 ± 1.046 and the post test is 4.150 ± 0.594 with an average difference of 4.49 ± 1.035 which means there is an increase the average Tennis Elbow is 4.49 after intervention (Ultrasound and Eccentric Exercise). The mean value of the Tennis Elbow pre test in the Treatment Two group (Ultrasound and Passive Stretching) had a value of P = 0.022 &lt;0.05 and the pre test value was 4.180 ± 0.925 and the post test was 2.490 ± 1.080 with an average difference of 2.69 ± 1.178, which means that there was an average increase in Tennis Elbow by 2.69 after the intervention (Ultrasound and Passive Stretching). The results of the Mann-Withney test were p &lt;0.05 which means that there was a significant difference in the mean between the first treatment group (Ultrasound and Eccentric Exercise) and the second treatment group (Ultrasound and Passive Stretching). This shows that Ultrasound and Eccentric Exercise are significantly more effective than Ultrasound and Passive Stretching in reducing VAS in Type II Tennis Elbow sufferers.Conclusion: Ultrasound Intervention and Eccentric Exercise have a more significant effect than Ultrasound and Passive Stretching on Reducing Pain in Patients with Type II Tennis Elbow.Keywords: Ultrasound, Eccentric Exercise, Passive Streaching, Type II Tennis Elbow.

Variations in the Terminal Branches of Brachial Artery- A Cadaveric Cross-sectional Study

Introduction: Brachial Artery (BA) begins as a continuation of axillary artery at the distal border of teres major, it appears in the cubital fossa, where it ends at the level of the neck of radius by dividing into radial and ulnar arteries. Common Interosseous Artery (CIA) is the largest branch of Ulnar Artery (UA) and arises in the cubital fossa. The terminal branches of BA at elbow are clinically important since they are responsible for the arterial supply to the forearm and hand. These arteries may get damaged during fractures of the elbow. Aim: To know the variations in the terminal branches of the BA at elbow. Materials and Methods: The present cross-sectional cadaveric study was done on 40 upper limbs from embalmed adult human cadavers in the Department of Anatomy, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India, from August 2017 to August 2019. Dissection of BA in arm and cubital fossa was carried out according to Cunningham’s manual of practical anatomy. The distance of division of BA into radial and UA and distance of origin of CIA from Inter Epicondylar Line (IEL) of humerus were noted. Results: In present study, 20 right-side specimens and 20 left- side specimens were obtained. Among 20 cadavers used, 16 were male cadavers and four were female cadavers. The mean distance (D1) of normal division of BA into the Radial Artery (RA) and UA at elbow was 2.8 cm below the imaginary line joining the medial and IEL. The mean distance (D2) of normal origin of CIA was 6.8 cm below the imaginary line joining the medial and lateral epicondyles of the humerus (IEL). CIA arising from the UA was present in 37 specimens (92.5%) and in the rest three specimens Anterior Interosseous Artery (AIA) and Posterior Interosseous Artery (PIA) arose directly from the UA. Conclusion: The present study has found variations in site of division of terminal branches of the BA at elbow in three specimens

Psoriatic arthritis successfully treated with second-line anti-interleukin-6 treatment: a case report and review of the literature

BackgroundPsoriatic arthritis treatment with antitumor necrosis factor has been shown to reduce disease activity. Nonetheless, more than 30% of patients do not achieve a sufficient response to tumor necrosis factor blockers. Currently, treatment with interleukin-6 inhibitors is expected to be effective and suppress the joint destruction in patients with psoriatic arthritis; however, evidence regarding their efficacy is limited to a few reports.Case presentationA 78-year-old Japanese woman with psoriatic arthritis associated with rapid joint destruction was successfully treated with a second-line anti-interleukin-6 receptor agent. In this case, a tumor necrosis factor inhibitor induced an inadequate response, and the right knee and left hip joints required artificial joint replacement surgery. However, second line treatment with anti-interleukin-6 treatment was effective, and the right elbow joint function was preserved.ConclusionsWe experienced a case of psoriatic arthritis, in which anti-interleukin-6 treatment repaired a bone cyst in the lateral epicondyle of the humerus and enthesitis of the distal interphalangeal joints. The patient is currently in clinical remission with no restrictions in daily life activities. Anti-interleukin-6 treatment may address the unmet needs of patients with psoriatic arthritis who are resistant or intolerant to antitumor necrosis factor treatment, with rapidly destructive large joints but with well-managed skin manifestations.

Cutaneous perforators of the arm and anatomical landmarks for defining the flap donor sites.

There are few studies searching for possible perforator flap donor sites on the arm. This study aimed to identify the locations of cutaneous perforators of the arm according to anatomical landmarks. Thirteen Thiel-fixed and latex-filled upper extremities of bodies donated to science were used. The distance between the acromion and medial or lateral epicondyle of the humerus was defined as the Y-axis, and the axis that cut the Y-axis perpendicularly through the epicondyles of the humerus was identified as the X-axis. The Y-axis was then divided into three parts Cutaneous arterial perforators were found using surgical dissection. The locations of the perforators were determined according to the defined lines and regions. On the lateral side, there were 6.00 ± 2.08 perforators per arm, of which 56.4% were septocutaneous and 43.6% muscular. In all extremities, with in the distal 1/3 of the lateral arm, there were 1-4 radial collateral artery-based perforators. The mean distance of these perforators to the Y-axis was 1.16 ± 0.53cm. On the medial side, there were 5.05 ± 1.44 perforators per arm, which were all septocutaneous perforators. In 85% of the extremities, within the middle 1/3 of the medial arms, there were 1-2 superior ulnar collateral artery-based perforators. The mean distance of these perforators to the Y-axis was 1.53 ± 0.61cm. There are always perforators from the radial collateral artery with in the distal third of the lateral arm. Within the middle third of the medial arm, it is usually possible to find a perforator from the superior ulnar collateral artery.

Effectiveness of local injection of autologous blood versus corticosteroid in treatment of tennis elbow

Background: Tennis elbow or lateral epicondylitis is characterised by pain and tenderness at the lateral epicondyle of humerus. There are various treatment modalities recommended, but there is no universally accepted therapeutic modality yet. Objectives: To compare the functional outcomes of local injection of corticosteroid versus autologous whole blood for tennis elbow. Methods: This was a non-randomised trial conducted from May 2020 to January 2021 after ethical clearance. Patients attending orthopaedic surgery outpatient department, Kathmandu Medical College with lateral epicondylitis of the humerus were included by convenience sampling into corticosteroid group or autologous blood injection group based on whether they presented on odd or even calendar days respectively. There were 38 patients in corticosteroid group and 36 patients in autologous blood group. The visual analogue scale (VAS) and Nirschl staging system were calculated before injection, and then at one week, six weeks, and six months after injection. Results: Patients in both groups showed statistically significant decrease in pain from preinjection scores on both VAS and Nirschl scale at all follow-ups. There was no statistically significant difference between the two groups up to six weeks. At six months, autologous blood injection group showed statistically significant decrease in pain compared with corticosteroid injection group on both scoring systems. Conclusion: Both groups showed comparable improvement up to six-week follow-up. Autologous blood injection group had significantly better improvement at six months. Autologous blood injection was more effective than corticosteroid injection at midterm follow-up, and had lower recurrence rate.

The Gantzer transfer – Assessment of the feasibility of using the nerve supplying the Gantzer muscle for end-to-side supercharging of the ulnar nerve

Our study aimed at assessing the anatomical feasibility of using the nerve supplying the Gantzer muscle (GM) to supercharge the ulnar nerve following injury. The GM nerve was dissected and measured in 36 forearms. The distance between its origin and the lateral epicondyle of humerus and between the GM nerve and the ulnar nerve was measured. The GM was present in 15 forearms (47%). The average distance between the origin of the GM nerve and the lateral epicondyle was 7.34 cm (range 3.3–9.1 cm). The average length of the GM nerve was 3.05 cm (range 1.6–4.5 cm) from origin to neuromuscular junction. The average distance from the ulnar nerve was 2.56 cm (range 1.8–13 3.4 cm). The length of the GM nerve was significantly greater (p < 0.05) than the perpendicular distance between its origin and the ulnar nerve, allowing ample margin for side-to-side or end-to-side supercharging of the ulnar nerve with minimal or no need for further translocation or dissection. The use of the GM nerve as donor following ulnar nerve injury may provide an alternative to the pronator quadratus nerve for supercharged end-to-side transfer, or as an addition, thus supercharging the ulnar nerve twice.

Acromion-axillary nerve distance and its relation to the arm length in the prediction of the axillary nerve position: a clinical study

BackgroundBecause of the broad anatomic variation in the course of the axillary nerve, several cadaveric studies have investigated the acromion-axillary nerve distance and its association with the humeral length to predict the axillary nerve location. This study aimed to analyze the acromion-axillary nerve distance (AAND) and its relation to the arm length (AL) in patients who underwent internal plate fixation for proximal humerus fractures.MethodsThe present prospective study involved 37 patients (15 female, 22 male; the mean age = 51 years, age range 19–76) with displaced proximal humerus fractures treated by open reduction and internal fixation. After anatomic reduction and fixation were achieved, the following parameters were measured in each patient before wound closure without making an extra incision or dissection: (1) the distance from the anterolateral edge of the acromion to the course of the axillary nerve was recorded as the acromion-axillary nerve distance and (2) the distance from the anterolateral edge of the acromion to the lateral epicondyle of the humerus was recorded as arm length. The ratio of AAND to AL was then calculated and recorded as the axillary nerve index (ANI).ResultsThe mean AAND was 6 ± 0.36 cm (range 5.5–6.6), and the mean arm length was 32.91 ± 2.9 cm (range 24–38). The mean axillary nerve ratio was 0.18 ± 0.02 (range 0.16 to 0.23). There was a significant moderate positive correlation between AL and AAND (p = 0.006; r = 0.447). The axillary nerve location was predictable in only 18% of the patients.ConclusionDuring the anterolateral deltoid-splitting approach to the shoulder joint, 5.5 cm from the anterolateral edge of the acromion could be considered a safe zone to prevent possible axillary nerve injury.

Relationship between the Branching Patterns of the Radial Nerve and Supinator Muscle.

The posterior interosseous nerve (PIN) innervates the posterior compartment muscle of the forearm and is a continuation of the deep branch of the radial nerve. The anatomic descriptions of PIN vary among different authors. This study investigated the distribution patterns of PIN and its relationships to the supinator muscle. This study investigated which nerves innervate the posterior compartment muscles of the forearm, the radial nerve, and the PIN, using 28 nonembalmed limbs. Also, the points where the muscle attaches to the bone were investigated. The measured variables in this study were measured from the most prominent point of the lateral epicondyle of the humerus (LEH) to the most distal point of the radius styloid process. For each specimen, the distance between the above two points was assumed to be 100%. The measurement variables were the attachment area of the supinator and branching points from the radial nerve. The attachment points of the supinator to the radius and ulna were 47.9% ± 3.6% and 31.5% ± 5.2%, respectively, from the LEH. In 67.9% of the specimens, the brachioradialis and extensor carpi radialis longus (ECRL) were innervated by the radial nerve before superficial nerve branching, and the extensor carpi radialis brevis (ECRB) innervated the deep branch of the radial nerve. In 21.4% of the limbs, the nerve innervating the ECRB branched at the same point as the superficial branch of the radial nerve, whereas it branched from the radial nerve in 7.1% of the limbs. In 3.6% of the limbs, the deep branch of the radial nerve branched to innervate the ECRL. PIN was identified as a large branch without divisions in 10.7% and as a deep branch innervating the extensor digitorum in 14.3% of the limbs. The anatomic findings of this study would aid in the diagnosis of PIN syndromes.

Whole-body magnetic resonance imaging vs. clinical evaluation of enthesitis in patients with spondyloarthritis

Whole-body magnetic resonance imaging vs. clinical evaluation of enthesitis in patients with spondyloarthritis

Effects of Middle Trapezius, Lower Trapezius, and Serratus Anterior Strengthening on Pain and Functional Status in Lateral Epicondylalgia

Background: Lateral Epicondylalgia (LE) is described as a tendinopathy at the common extensor origin at the lateral epicondyle of the humerus 1. Approximately 40% of people will experience LE at some point in their life. Recent studies highlighted the importance of assessing Middle Trapezius (MT), Lower Trapezius (LT) and Serratus Anterior (SA) muscle strength and also the importance of strength training in LE. CONTEXT AND PURPOSE: LE is the most common chronic musculoskeletal pain condition, causing significant pain, disability and lost productivity. Various studies focusing on scapular muscle strength and endurance give some indication that scapular muscle may need to be screened and treated. RESULT: There was significant effect on middle trapezius, lower trapezius and serratus anterior strengthening on reducing pain and improving functional status in patients with LE. CONCLUSION: The study primarily tried to analyze the effects of strengthening exercises to MT, LT, and SA along with conventional therapy on pain and functional status in LE patients. And this study reveals that addition of strengthening exercises to MT, LT and SA to the regimen enhances faster recovery in patients with LE. KEY WORDS: Lateral Epicondylalgia, Middle Trapezius, Lower Trapezius, Serratus Anterior.

P133 Clinical and ultrasonographic enthesitis in inflammatory bowel disease patients with and without psoriasis

Abstract Background Previous studies have reported the association between psoriasis (PsO) and inflammatory bowel disease (IBD). Coexistence of IBD and PsO has been associated with significant higher prevalence of enthesitis and dactylitis. The aim of the study was to compare the prevalence of clinical and ultrasonographic peripheral enthesis abnormalities in a consecutive series of patients with IBD and psoriasis (PsO) as compared to a group of IBD patients without psoriasis (IBD). Methods 174 IBD consecutive patients [36 PsO and 138 IBD, M/F 91/83, mean age 42.6±14.7 years, mean disease duration 110 ±12.3 months] were recruited. A complete clinical examination, MASES and LEI scores, BASDAI, and dactylitis count, was performed at study entry. Laboratory markers (namely ESR, CPR, Hb, fecal calprotectin) were collected. Axial or peripheral spondyloarthritis (SpA) diagnosis was made using ASAS criteria. US examination was performed by a rheumatologist blind to clinical data. Lateral epicondyle of the humerus, distal quadriceps femoris insertion into the patella, inferior pole of the patella, tibial distal insertion of the patellar tendon, calcaneal insertion of the Achilles tendon, and plantar aponeurosis insertion were examined bilaterally. Knee and ankle joints were evaluated for synovial hypertrophy, PD signal and fluid effusion. Enthesitis was defined according to OMERACT and scored as 0–36 for GUESS and 0–136 for MASEI. Results 146 patients (83.4%) showed structural damage at &amp;gt; 1 enthesis, 44 patients (25%) had at least 1 active enthesitis, with no significant difference between the two groups. PsO group showcased a significantly increased prevalence of patients having &amp;gt; 1 thickened enthesis (86.1% vs 63.9%, p=0.009) and of PD signal at knee examination (11.1% vs 2.2%, p= 0.034). Enthesis thickness was significantly increased in PsO, in every examined site. Enthesophyte length was significantly increased in PsO group at quadriceps tendon, patellar distal insertion and Achilles tendon. Conclusion Presence of PsO and/or familiar history of PsO in IBD patients might represent a predisposing factor for the development of subclinical enthesytis as an extra-intestinal manifestation of IBD, during the disease course.

Anatomical landmarks for peripheral neural blocks of the forearm and the wrist: A cadaveric study

There are no data ensuring a standardized landmark-based-technique for blocking sensitive nerves of the forearm. To identify locations were with use of good palpable bony landmarks and lines between them sensitive nerve blocks on the forearm can be done with great success. Dissection of the superficial branch of the radial nerve (SBRN), the dorsal branch of the ulnar nerve (DBUN), the lateral, medial and dorsal antebrachial cutaneous nerve (LACN, MACN, and DACN) as well as the palmar branch of the median nerve (PBMN) was performed on five upper limbs of five different Caucasian cadavers. With respect to radius and ulnar styloid, Lister's tubercle, and the medial and lateral epicondyle of the humerus as well as connecting lines between these bony landmarks locations were defined, where the mentioned nerves can be found and blocked. The six nerves can be safely blocked at the following sites: the SBRN 85 mm proximal to Lister's tubercle on a line drawn between the latter and the medial humeral epicondyle; the LACN 38 mm and the dorsal one 32 mm ulnar from the lateral epicondyle; the MACN 14 mm radial to the medial epicondyle; the DBUN 27 mm proximal to the ulnar styloid in direction to the lateral epicondyle; the PBMN 45 mm proximal to the radial styloid following a line between the latter and the medial epicondyle and 21 mm ulnarwards perpendicular to this line. Using superficial good palpable landmarks at the wrist and elbow as well as connecting lines between them the SBRN, DBUN, PBMN, LACN, MACN, and DACN can easily be located.

Evaluation of enthesitis in patients with juvenile idiopathic arthritis by power color and spectral Doppler ultrasonography.

Ultrasonography in patients with juvenile idiopathic arthritis (JIA) could potentially be useful for evaluation of enthesitis. The aim of this study was to evaluate enthesitis in patients with JIA quantitatively by power color and spectral Doppler ultrasonography by determining color fraction (CF) and resistive index (RI). A cross-sectional single-center study was performed in 15 (61 entheseal sites) patients with JIA with clinical enthesitis. A total of 9 age and sex matched healthy controls (53 entheseal sites) were also examined and compared. Entheseal sites (quadriceps tendon, patellar tendon, tendo-Achilles, medial and lateral epicondyles of humerus) were examined on USG B mode for tendon thickening, hypo- and hyper-echogenicity, enthesophytes, and cortical erosions/irregularities by power Doppler ultrasound for the presence of Doppler signal and by power color Doppler and spectral Doppler ultrasonography to derive CF and RI respectively. The mean thickness of entheseal site in patients and controls were 3.55±0.82 mm and 2.8±0.37 mm, respectively (p<0.001). The power Doppler signal was present in 93.4% of patients (p<0.001). The pooled data of all entheseal sites revealed a significantly higher CF in patients (0.08±0.03) than in controls (0.006±0.008) (p<0.001). The mean RI in patients (0.61±0.09) was significantly lower than that in controls (0.92±0.12) (p<0.001). The cut-off of RI (0.7) and CF (0.029) determined by receiver operating curve analysis revealed a diagnostic accuracy of 94.7% and 96.5%, respectively. Evaluation of enthesitis by determining CF and RI via power color Doppler and spectral Doppler is possible in JIA patients.

Prediction of the location of radial nerve in arm to avoid iatrogenic injury: Cadaveric study in Indian population

Background: The radial nerve arises from posterior cord of brachial plexus and descends distally to spiral groove, our aim is to study upper and lower margins of groove with respect of bony landmark like posterolateral aspect of Acromian process, medial and lateral epicondyle of humerus, which helps to identify radial nerve during humerus fracture fixation surgery and hence will reduce iatrogenic radial nerve injury.Methods: Twenty formalin preserved cadaveric upper limbs obtained from anatomy department of Government medial collage, Surat. Dissection done, Radial nerve isolated from low triangular space to lateral inter muscular septum and various measurements done for each specimen.Result: Without sex or age differentiation the results of this study are: The mean humeral length was 30.6 ± 1.86 cm. Mean Distance of medial epicondyle to entry of radial nerve into spiral groove was 18.3±1.48 cm. Mean Distance of lateral epicondyle to exit of radial nerve into spiral groove was 11.49±1.46 cm. The mean length of radial nerve groove/spiral groove was 4.29±1.28 cm.Conclusion: Radial nerve is at the risk of injury with fracture & fixation in two areas. First along the spiral groove & second along the lateral aspect of humerus in distal third from proximal to lateral epicondyle to level of proximal aspect of metaphyseal flare. Our study has identified the point of intersection of radial nerve to humerus in Indian population. Understanding the safe zones and zone of danger of humerus provide more safety during surgical interference of humerus. To do this, radial nerve must be identified and protected. Wide incision and blunt dissection is still recommended to minimize the risk of radial nerve damage.