Correlation between Elbow Flexor Muscle Strength and Needle Electromyography Parameters after Musculocutaneous Nerve Injury / 法医学杂志

OBJECTIVES@#To explore the changes of elbow flexor muscle strength after musculocutaneous nerve injury and its correlation with needle electromyography (nEMG) parameters.@*METHODS@#Thirty cases of elbow flexor weakness caused by unilateral brachial plexus injury (involving musculocutaneous nerve) were collected. The elbow flexor muscle strength was evaluated by manual muscle test (MMT) based on Lovett Scale. All subjects were divided into Group A (grade 1 and grade 2, 16 cases) and Group B (grade 3 and grade 4, 14 cases) according to their elbow flexor muscle strength of injured side. The biceps brachii of the injured side and the healthy side were examined by nEMG. The latency and amplitude of the compound muscle action potential (CMAP) were recorded. The type of recruitment response, the mean number of turns and the mean amplitude of recruitment potential were recorded when the subjects performed maximal voluntary contraction. The quantitative elbow flexor muscle strength was measured by portable microFET 2 Manual Muscle Tester. The percentage of residual elbow flexor muscle strength (the ratio of quantitative muscle strength of the injured side to the healthy side) was calculated. The differences of nEMG parameters, quantitative muscle strength and residual elbow flexor muscle strength between the two groups and between the injured side and the healthy side were compared. The correlation between elbow flexor manual muscle strength classification, quantitative muscle strength and nEMG parameters was analyzed.@*RESULTS@#After musculocutaneous nerve injury, the percentage of residual elbow flexor muscle strength in Group B was 23.43% and that in Group A was 4.13%. Elbow flexor manual muscle strength classification was significantly correlated with the type of recruitment response, and the correlation coefficient was 0.886 (P<0.05). The quantitative elbow flexor muscle strength was correlated with the latency and amplitude of CMAP, the mean number of turns and the mean amplitude of recruitment potential, and the correlation coefficients were -0.528, 0.588, 0.465 and 0.426 (P<0.05), respectively.@*CONCLUSIONS@#The percentage of residual elbow flexor muscle strength can be used as the basis of muscle strength classification, and the comprehensive application of nEMG parameters can be used to infer quantitative elbow flexor muscle strength.

Six asymmetric bilateral additional heads of biceps brachii muscle observed in a cadaver / Seis cabezas adicionales bilaterales asimétricas del músculo bíceps braquial observadas en un cadáver

SUMMARY: Anatomic variation of the biceps brachii muscle (BBM) is frequently observed; its pattern is diverse and clinically important. During the educational dissection of a 78-year-old Korean male cadaver, six additional asymmetrical heads of the biceps brachii muscle (BBM) were found on both sides. On the right side, two additional heads originated from the humerus; the musculocutaneous nerve passed between these heads and the short head of the BBM. Four additional heads were found on the left side, anterior to the BBM, one of which originated from the pectoralis major muscle. Posterior to the BBM, two heads of tendons originated from the coracobrachialis muscle and one head of the muscle belly originated from the humerus. The left musculocutaneous nerve pierced the coracobrachialis muscle and continued distally passing between the short head of the BBM and the additional heads located posterior to the BBM. It then gave off the variant musculocutaneous nerve to the median nerve. On both sides, the short and long heads of the BBM had normal origins, insertions, and courses. This novel variation has various clinical and embryological implications.

RESUMEN: Con frecuencia se observa una variación anatómica del músculo bíceps braquial (MBB); su patrón es diverso y clínicamente importante. Durante la disección de un cadáver masculino coreano de 78 años, se encontraron seis cabezas asimétricas adicionales del músculo bíceps braquial en ambos lados. En el lado derecho, dos cabezas adicionales se originaban en el húmero; el nervio musculocutáneo atravesaba entre estas cabezas y la cabeza corta del MBB. Se encontraron cuatro cabezas adicionales en el lado izquierdo, anterior al MBB, una de las cuales se originaba en el músculo pectoral mayor. Posterior al MBB, dos cabezas tendinosas se originaban en el músculo coracobraquial y una cabeza de vientre muscular se originaba en el húmero. El nervio musculocutáneo izquierdo perforaba el músculo coracobraquial y continuaba distalmente pasando entre la cabeza corta del MBB y las cabezas adicionales ubicadas por detrás del MBB. Luego emitía la variante el nervio musculocutáneo al nervio mediano. En ambos lados, las cabezas corta y larga del MBB tenían orígenes, inserciones y trayectos normales. Esta nueva variación tiene varias implicaciones clínicas y embriológicas.

Curative effect of intra-tendon sheath hyaluronidase injection guided by ultrasound in treating biceps brachii longitendosynovitis / 中国医师杂志

Objective:To observe the effect of hyaluronidase injection into tendon sheath under muscle bone ultrasound guidance in the treatment of tenosynovitis of long head of biceps brachii.Methods:134 patients with tenosynovitis of the long head of biceps brachii treated in SSL Central Hospital of Dongguan from April 2019 to April 2020 were selected as the research objects. All patients were randomly divided into ordinary injection group and ultrasound-assisted injection group, 67 cases in each group. The general injection group was treated with intra-articular injection of hyaluronidase, and the ultrasound-assisted injection group was treated with intra-tendon sheath injection of hyaluronidase under the guidance of muscle and bone ultrasound. Visual Analog Scales (VAS) score, active flexion joint motion (AFROM), shoulder range of motion (ROM), functional score, flexion strength score, nuclear magnetic resonance imaging (MRI) and local tenosynovitis of the long head of biceps brachii (TLHBB)were measured to evaluate the clinical effect and postoperative complications after treatment.Results:There was no significant difference in gender, age, course of disease, periarthritis of shoulder and disuse atrophy of muscles around shoulder between ordinary injection group and ultrasound-assisted injection group ( P>0.05). After treatment, the AFROM, ROM, function score, forward flexion strength score, and middle wedge angle (MWA) of the two groups were significantly higher than those before treatment ( P<0.05), while the VAS score, humeral head diameter (HHD), biceps long head tendon diameter (BTD), and TLBBB were significantly lower than those before treatment ( P<0.05). The AFROM, ROM, function score, and forward flexion strength score, MWA of the ultrasound-assisted injection group were significantly higher than those of the ordinary injection group ( P<0.05), and the VAS score, HHD, BTD, and TLHBB were significantly lower than those of the ordinary injection group ( P<0.05). The total effective rate of the ultrasound-assisted injection group was higher than that of the ordinary injection group (97.01% vs 85.07%, P<0.05). Conclusions:Intra-tendon sheath hyaluronidase injection guided by ultrasound can effectively treat tenosynouitis of the long head of biceps brachii, relieve shoulder pain and improve shoulder motion.

Additional head of biceps brachii: a cadaveric study

Background: The biceps brachii is an important muscle of anterior compartment of arm. It shows frequent anatomic variability due to presence of supernumerary heads. Knowledge of the existence of the third head of biceps brachii is important for surgeons. Keeping this in mind a study was planned to see the incidence of additional head of biceps brachii in sample Indian population and to compare it with other racial groups.Methods: The study was carried out on 30 cadaveric upper limbs. The upper limbs were dissected and studied for the presence of additional head of biceps brachii. The attachment and nerve supply of the additional head was carefully observed, recorded and documented.Results: Out of 30 limbs which were dissected, additional head of biceps brachii was found only in two limbs. In both the cases the additional head was present only on the right side and arose from the anterior surface of humerus, superomedial to the origin of brachialis. The additional head fused with the common bulk of the muscle and was inserted into the radial tuberosity and bicipital aponeurosis. The extra heads of biceps brachii muscle received branches from musculocutaneous nerve.Conclusions: Biceps brachii is one of the commonest muscles showing variations. The additional head is not only of academic importance, but its knowledge also helps clinicians in managing fractures of humerus and nerve entrapment.

Third head of the biceps brachii muscle originated from the greater tubercle connecting long and short heads: a case report / Tercera cabeza del músculo bíceps braquial originada en la tubrosidad mayor del húmero conectando las cabezas larga y corta: informe de un caso

Variation in the biceps brachii muscle is extremely frequent and has a clinical significance. During an educational dissection, third head of the biceps brachii muscle was found on the left side in a Korean cadaver. The short and long heads showed normal morphology and course: however, additional head originated from the greater tubercle connected to long head of biceps brachii muscle and crossed the musculocutaneous nerve perpendicularly. And then, it was inserted into short head of the biceps brachii muscle. The author describes this previously novel case report and discusses the clinical implications of such a variant.

La variación en el músculo bíceps braquial es extremadamente frecuente y tiene un significado clínico. Durante una disección educativa, se encontró la tercera cabeza del músculo bíceps braquial en el lado izquierdo de un cadáver coreano. Las cabezas cortas y largas mostraron una morfología y curso normales: sin embargo, la cabeza adicional se originó de la tuberosidad mayor conectado a la cabeza larga del músculo bíceps braquial y cruzaba el nervio musculocutáneo perpendicularmente, insertándose en la cabeza corta del músculo bíceps braquial. El autor describe este informe de un caso novedoso y discute las implicaciones clínicas de tal variante.

The third head of the biceps brachii muscle perforated by the musculocutaneous nerve / La tercera cabeza del músculo bíceps braquial perforada por el nervio musculocutáneo

During an educational dissection, the third head of the biceps brachii muscle was found on the left side in a 63-yearold female Korean cadaver. The short and long heads showed normal morphology, and their courses were as follows: The third head was originated from the middle level of the humerus under the short head and inserted in the conjoined tendon of the long and short heads of the biceps brachii muscle. The musculocutaneous nerve penetrated the third head of the biceps brachii muscle and became the lateral cutaneous nerve of the forearm. The authors describe this novel case and discuss the clinical implications of such a variation.

Durante una disección educativa, la tercera cabeza del músculo bíceps braquial se encontró en el lado izquierdo en un cadáver coreano de 63 años de edad. La cabeza corta y la cabeza larga mostraron una morfología normal, y se presentaron de la siguiente forma: La tercera cabeza se originó en el nivel medio del húmero, inferior a la cabeza corta, y se insertó en el tendón unido de las cabezas larga y corta del músculo bíceps braquial. El nervio musculocutáneo penetró en la tercera cabeza del músculo bíceps braquial para transformarse en el nervio cutáneo lateral del antebrazo. Los autores describen este nuevo caso y discuten las implicaciones clínicas de esta variación.

Study Of The Variant Origin Of Long Head Of Biceps Brachii

Objectives: The objective of this study is to identify and categorize the variations in origin of tendon of long headof biceps brachii (LHBB).Methods: The study was carried out on 60 upper limbs of cadaver in the Anatomy department, SMBT IMS & RC,Nashik, India. After exposing the glenoid fossa, we find out the origin of tendon of LHBB from the supraglenoidtubercle and the adjoining glenoid labrum. Labrum is divided into anterior and posterior part.Results: In 11 specimens origin of LHBB was seen from supraglenoid tubercle only, Other specimens has dualorigin of LHBB along with Glenoid labrum. We classified it according to Vangsness et al. Type I: The labralattachment is entirely posterior, with no contribution to anterior labrum, seen in 31 specimens. Type II: Thetendon attached mainly to the posterior part of the Glenoid labrum with also extended up to the anterior labrum,seen in 16 specimens. Type III: There are equal contribution to both the anterior and posterior parts of thelabrum, found in only 2 specimens. Type IV: Most of the labral contribution is anterior, with a small contributionto the posterior labrum. No specimen found.Conclusion: Anatomical variation in origin of LHBB help us to explain the correlation of recurrent shoulderdislocation and labral detachment.This knowledge is necessary to avoid errors in shoulder arthroscopy,radiological investigations and surgical repair

Bilateral Absence Of Musculocutaneous Nerve: Report Of Two Cases

Anatomical variations involving the brachial plexus are not uncommon. Abnormal communications among thebranches of musculocutaneous nerve especially those involving the posterior division are widely reported dueto their significance in various surgical procedures performed in this region. During the routine gross anatomicaldissection, we observed the bilateral absence of musculocutaneous nerve in two male cadavers aged 60 and 65years and the muscles of anterior compartment of arm were innervated by the braches from the Median nerve. Incase 1, it was observed that in the right and left arm, branches from the median nerve supplied the muscles of theanterior compartment namely the coracobrachialis, biceps brachii and brachialis. The branch which innervatedthe brachialis muscle later continued as lateral cutaneous nerve of forearm. In case 2, Absence of MCN observedbilaterally wherein right arm, wherein, a single branch from median nerve supplied the coracobrachialis muscle.Another branch from the median nerve, after passing through the lower end of coracobrachialis, divided into anoblique and a vertical branch which supplied the biceps brachii and brachialis respectively. These anatomicalvariations in the course of musculocutaneous and median nerve should be considered during surgical proceduresand while performing nerve conduction studies.

Propuesta de clasificación de las variaciones del músculo bíceps braquial y estudio en una muestra de población colombiana / Proposal of classification for the variations of the biceps brachii muscle and study in a sample of Colombian population

RESUMEN: Las variaciones anatómicas del músculo bíceps braquial en cuanto a la presencia de cabezas accesorias o supernumerarias pueden tener incidencia importante en los diagnósticos clínicos y radiológicos, así como en procedimientos quirúrgicos. La ausencia de una clasificación adecuada para las variaciones del músculo bíceps braquial y los hallazgos del presente estudio le permitieron a los autores presentar una propuesta de clasificación basada en el número de cabezas accesorias y en el origen de ellas. El objetivo del estudio fue determinar la frecuencia con que se presentan variaciones en el número de cabezas accesorias y proponer una clasificación para las variaciones del músculo bíceps braquial. En el estudio de tipo descriptivo, de corte transversal, se analizaron 90 brazos de 46 cadáveres colombianos. Se encontró una alta frecuencia (19,6 %) en las variaciones del músculo, 4,3 % bilateralmente y 15,2 % unilateralmente. En los 11 brazos (12,2 %) que presentaron la variación del músculo, la presencia de una sola cabeza accesoria fue la más alta (81,8 %), siendo el origen más frecuente en ellas el clasificado por los autores como 3b, 3 para la ubicación inferior medial y b para el intervalo entre la inserción del músculo coracobraquial y el origen del músculo braquial. Por lo detallado de la clasificación propuesta, se recomienda su uso cuando se reporten casos de variaciones anatómicas del músculo bíceps braquial. En los cadáveres de la población colombiana estudiados se encontró una alta frecuencia para la presencia de cabezas accesorias de este músculo, que amerita ser conocida por el personal médico.

SUMMARY: The anatomical variations of the biceps brachii muscle in relation to the number of supernumerary or accessory bellies may have important incidence in clinical and radiological diagnoses, as well as in surgical procedures. The absence of an appropriate classification for the variations that the biceps brachii muscle can present and the findings of the present study, allowed the authors to present a classification proposal based on the number of accessory bellies and their origin. The study aimed to determine with which frequency the variations in the number of accessory bellies of the biceps brachii muscle are present, and to propose a classification for these variations. In the crosssectional, descriptive study 90 arms of 46 Colombian cadavers were analyzed. A high frequency (19.6 %) in the variations of the muscle was found, 4.3 % bilaterally and 15.2 % unilaterally. In the 11 arms (12.2 %) that presented the variation, the presence of only one accessory belly was the highest frequency (81.8 %), being the most frequent origin for them the one classified by the authors as 3b, 3 for the inferomedial situation and b for the interval between the insertion of the coracobrachii muscle and the origin of the brachii muscle. Because the classification proposed is very detailed, its use is recommended whenever cases of biceps brachii muscle variations are reported. In the cadavers of the Colombian population studied, a high frequency was found for the presence of supernumerary or accessory heads of this muscle, which deserves to be known by medical professionals.

Supernumerary Heads Of Biceps Brachii With Median Nerve And Brachial Vessels Passing Through The Third Head

A rare case of four-headed biceps brachii was observed during routine dissection on 60-year -old female oldcadaver. The short head and long head had normal origin. The third head was originating from the humerusbelow the insertion of coracobrachialis, whereas fourth head was coming from the greater tubercle of thehumerus. The median nerve and brachial vessels were passing through the third head. These variations areimportant because they could compress median nerve and brachial vessels

Incidence Of The Third And Fourth Head Of The Biceps Brachii Muscle In Caucasian Race – A Study And Review Of Literature

Anatomic variations in the heads of biceps brachii are not uncommon. It varies from one head to seven heads buttwo heads (long and short) are considered normal. In this study, 56 arms from 28 cadavers were studied for thirdand fourth heads in the anatomy laboratory of Weill Cornell Medicine. We observed supernumerary heads in 5cadavers (8.92%), out of which three heads were seen in 4 cadavers (7.14%) and four heads in only one cadaver(1.78%). Clinically, these kinds of anomalies are important because supernumerary heads could compressneighboring blood vessels and nerves.

Therapeutic effect of slow stretching training combined with extracorporeal shock wave on biceps brachii spasticity in stroke patients / 吉林大学学报(医学版)

Objective: To discuss the curative effect of slow stretching training combined with extracorporeal shock wave in the treatment of spasticity of biceps brachii in the stroke patients, and to provide the clinical evdiences for the application of this therapy. Methods: Fifty-six patients with post-stroke biceps bachii spasticity were randomly divided into observation group (n =28) and control group (n=28) according to random number table method. The patients in two groups received routine treatment (40 min/time, 2 times · d-1, 6 d per week) and slow stretching training (15 min/time, 2 times · d-1, 6 d per week). On the basis of the routine treatment, the patients in observation group were treated with extracorporeal shock wave, while the patients in control group were treated with pseudo-extracorporeal wave therapy. Modified Ashworth scale (MAS), simplified upper limb Fugl-Meyer score (FMA) and modified Barthel index (MBI) were used to evaluate the curative effects before treatment, 2 weeks and 4 weeks after treatment. Results: After 2 weeks of treatment, the FMA score of the patients in observation group was siginificantly increased compared with before treatment (P0.05). Compared with 2 weeks after treatment, the MAS score of the patients in observation group 4 weeks after treatment was significantly decreased (P<0.05), and the FMA and MBI scores were increased (P< 0.05); the FMA score and the MBI score in observation group were significantly higher than those in control group (P<0.05 or P<0.01), and the MAS score was significantly lower than that in control group (P<0.01). Conclusion: Slow stretching training combined with extracorporeal shock wave could effectively improve the post-stroke biceps brachii spasticity, and its therapeutic effect is better than the simple application of slow stretching training.

Therapeutic effect of slow stretching training combined with extracorporeal shock wave on biceps brachii spasticity in stroke patients / 吉林大学学报(医学版)

Objective:To discuss the curative effect of slow stretching training combined with extracorporeal shock wave in the treatment of spasticity of biceps brachii in the stroke patients,and to provide the clinical evdiences for the application of this therapy.Methods:Fifty-six patients with post-stroke biceps bachii spasticity were randomly divided into observation group(n =28)and control group(n=28)according to random number table method.The patients in two groups received routine treatment(40 min/time,2 times·d-1,6 d per week)and slow stretching training(15 min/time,2 times·d-1,6 d per week).On the basis of the routine treatment,the patients in observation group were treated with extracorporeal shock wave,while the patients in control group were treated with pseudo-extracorporeal wave therapy.Modified Ashworth scale(MAS),simplified upper limb Fugl-Meyer score(FMA)and modified Barthel index(MBI)were used to evaluate the curative effects before treatment, 2 weeks and 4 weeks after treatment.Results:After 2 weeks of treatment,the FMA score of the patients in observation group was siginificantly increased compared with before treatment(P<0.05),and the MBI and MAS scores were decreased(P<0.05);the MAS score of the patients in observation group was significantly lower than that in control group(P=0.036),while there were no significant differences in the FMA and MBI scores between two groups(P>0.05).Compared with 2 weeks after treatment,the MAS score of the patients in observation group 4 weeks after treatment was significantly decreased(P<0.05),and the FMA and MBI scores were increased(P<0.05);the FMA score and the MBI score in observation group were significantly higher than those in control group (P<0.05 or P<0.01),and the MAS score was significantly lower than that in control group(P<0.01). Conclusion:Slow stretching training combined with extracorporeal shock wave could effectively improve the post-stroke biceps brachii spasticity,and its therapeutic effect is better than the simple application of slow stretching training.

Prevalencia de cabeza accesoria (humeral) del músculo bíceps braquial: revisión de la literatura / Prevalence of accessory head (humeral) of the biceps brachii: literature review

Las variaciones anatómicas del miembro superior son frecuentes. El músculo bíceps braquial está considerado como uno de los músculos que más variaciones presenta, sobre todo en cuanto al número y morfología de sus cabezas. Su importancia excede lo meramente descriptivo teniendo relevancia clínica y quirúrgica. El objetivo de este trabajo consistió en investigar y revisar la literatura en relación a la prevalencia de la cabeza accesoria del músculo bíceps braquial, su irrigación e inervación así como variaciones anatómicas asociadas. Además se incorporó información de nuestro grupo de investigación, basado en la disección cadavérica de 20 cadáveres adultos formolizados, entre los meses de febrero del 2013 a diciembre del 2016, en la Cátedra de Anatomía Descriptiva y Topográfica de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción, Paraguay. Se realizó el hallazgo de un caso de cabeza accesoria del músculo bíceps braquial de origen humeral en el brazo derecho de un cadáver de sexo masculino que se originaba en el tercio medio de la cara anteromedial del húmero entre la inserción del coracobraquial y el origen del braquial, representando el 5 % de la población estudiada. Su inserción se dio en la superficie posterior del tendón terminal del músculo, no fueron encontradas otras variaciones asociadas. La variación descripta se ubica entre las más frecuentes del miembro superior. Si bien pueden acompañarse de otras variaciones musculares y vasculonerviosos esto no aconteció en el caso presentado. Su presencia daría mayor fuerza a la acción muscular. Su conocimiento tiene importancia clínica y quirúrgica. La cabeza humeral descripta se presenta en su forma más frecuente, es decir en un varón, en el lado derecho y originándose de la cara anteromedial del cuerpo del húmero. Todas sus cabezas incluido la accesoria estaba inervada por el nervio musculocutáneo. No fueron encontradas otras variaciones anatómicas asociadas tanto musculares como vasculonerviosas.

Anatomical variations of the upper limb are frequent. The biceps brachii is considered as one of the muscles that has the most variations, especially in the number and morphology of their heads. Its importance exceeds the merely descriptive having clinical and surgical relevance. The aim of this study was to investigate and review the prevalence of the accessory head of the biceps brachii muscle, its irrigation and innervation as well as associated anatomical variations. Also we add information based on the cadaveric dissection of 20 adult cadavers formolated from February 2013 to December 2016 in the Chair of Descriptive and Topographic Anatomy of the Faculty of Medical Sciences of the National University of Asuncion, Paraguay. A case of accessory head of the biceps brachii of humeral origin was found in the right arm of a male cadaver that originated in the middle third of the anteromedial surface of the shaft of the humerus between the insertion of the coracobrachial and the origin of the brachial, representing 5 % of the studied population. Its insertion occurred on the posterior surface of the terminal tendon of the muscle, no other associated variations were found. The variation described is among the most frequent of the upper limb. Although they can be accompanied by other muscular and vasculonerviosos variations, this did not happen in the presented case. Their presence would give greater force to the muscular action. Their knowledge is of clinical and surgical importance. The humeral head described is presented in its most frequent form, in a male, in the right side and originating from the anteromedial surface of the shaft humerus. All their heads including the accessory was innervated by the musculocutaneous nerve. No other anatomical variations associated with both muscular and vasculonerviosas were found.

Cabeza supernumeraria del músculo biceps brachii / Supernumerary head of musculus biceps brachii

Resumen La variable más común del músculo biceps brachii es la presencia de cabezas supernumerarias. El objetivo del presente reporte de caso es describir la presencia de una tercera cabeza del músculo biceps brachii y su significancia clínica. Las variaciones anatómicas descritas fueron encontradas durante una disección de rutina realizada en el laboratorio de morfología de la Universidad de Pamplona en dos cadáveres masculinos, embalsamados, de 75 y 59 años de edad, respectivamente. Las medidas fueron tomadas usando un calibrador Vernier. Los detalles topográficos de las variaciones fueron examinados, registrados y fotografiados. Han sido descritas compresiones de la arteria braquial, nervio mediano, nervio musculocutáneo entre las cabezas supernumerarias del músculo biceps brachii, su conocimiento es de interés para clínicos, especialistas y profesionales de la salud, en aras de lograr diagnósticos, procedimientos y rehabilitaciones más seguras y eficientes.

Abstract The most common variable of the muscle biceps brachii is the presence of supernumerary heads. The aim of this case report is to describe the presence of a third head of the muscle biceps brachii and its clinical significance. The anatomical variations described were found during routine dissection conducted in the laboratory of Morphology of the University of Pamplona in two male cadavers, embalmed of 75 and 59 years respectively. Measurements were taken using a Vernier caliper. Topographic details of the variations were examined, recorded and photographed. They have been described compression of the brachial artery, median nerve, musculocutaneous nerve between the supernumerary heads of muscle biceps brachii, your knowledge is of interest to clinicians, specialists; and health professionals in order to achieve diagnoses, procedures and safer and efficient rehabilitations.

Ultrasound imaging in women's arm flexor muscles: intra-rater reliability of muscle thickness and echo intensity

ABSTRACT Background Different ultrasound parameters have been frequently used to assess changes associated with training, aging, immobilization, and neuromuscular diseases. However, an exploratory reliability analysis of the echo intensity (EI) and muscle thickness (MT) of the forearm flexors is scarce, especially in women. Objective The purpose of the present study was to determine the intra-rater reliability of MT and EI assessed by ultrasound in young women. Method Ultrasonographic MT and EI were acquired in the forearm flexors of 41 young women (22±2 yrs). Reliability was calculated using intraclass correlation coefficient (ICC2,1), standard error of measurement (SEM), coefficient of variation (CV), smallest detectable change (SDC), and Bland and Altman plot analysis. Results ICC values for MT and EI were 0.88 (95% CI: 0.78-0.93). The SEM and CV values were lower than 10%. Bland and Altman analysis revealed that ultrasound mean differences were 0.27 mm (Limits of Agreement - LOA 95%: - 2.6 to 3.2 mm) and -0.09 a.u. (LOA 95%: - 10.9 to 10.7 a.u.). Conclusion MT and EI assessed by ultrasonography in young women appear to be reliable and may be used to monitor changes in muscle mass induced by strength training when these changes exceed the precision of ultrasound.

Two unreported cartilagines sesamoidea in the elbow of the dog / Dos cartílagos sesamoideos no reportados en el codo del perro

Two unreported sesamoid cartilages were found inside tendon of insertion of both muscle biceps brachii and muscle brachialis in the dog. This find adds remarkable facts envolving Anatomy, Comparative Anatomy and Clinic and Biomechanics of the elbow joint in the dog. Statistics also emphasize the importance of traumatological incidences on elbow joint in veterinary.

Dos cartílagos sesamoideos no reportados se encontraron en el interior del tendón de inserción de los músculos bíceps braquial (M. Biceps brachii) y Braquial (M. Brachialis) en el perro. Este hallazgo se suma a importantes hechos que comprometen la Anatomía, Anatomía Comparada, Clínica y Biomecánica de la articulación del codo en el perro. Además, la casuística veterinaria también hace hincapié en importantes incidencias traumatológicas en dicha articulación.

Bilateral Multiple Variations in the Upper Extremity of a Human Cadaver: A Case Report.

Background: A rare case of bilateral multiple anatomical variations in the upper extremity, was found in a male cadaver, during routine dissection in the Anatomy department at TN Medical College, Mumbai. Observation: The variations included absence of Musculocutaneous nerve of right arm and communication of Musculocutaneous nerve with median nerve in the left arm, bilateral three heads of Biceps Brachii muscle and bilateral multiple tendons of Abductor Pollicis Longus muscle in both the arms. Conclusion: Medical significance of an absent Musculocutaneous nerve and the presence of three heads of Biceps Brachii lies in the fact that it can cause traumatic nerve compressions or complications in anaesthetic block etc. Anatomic variations of tendons of abductor pollicis longus are significant in assessment of hand injuries and surgeons performing hand reconstructive surgery.

Incidence of Third Head of Biceps Brachii in Indian Population.

Background: The biceps brachii is one of the muscles of the anterior compartment of the upper arm. It is characteristically described as a two-headed muscle that originates proximally by a long head and a short head. The present study was carried out to find the occurrence of a third head of biceps brachii among a sample Indian population. Materials and Methods: The arms of 35 adult cadavers were dissected and observed for variations in the origin and insertion of biceps brachii muscle bilaterally. Results: Among the 70 arms studied, three had 3-headed biceps brachii, 2 on the left and 1 on the right side. All the third heads were of humeral origin, which inserted into the radial tuberosity by a common tendon with the long and short heads. Conclusion: Knowledge of the existence of the third head of biceps brachii may enhance pre-operative evaluation, facilitate surgical intervention within the arm and improve postoperative outcomes.

Expression of MuRF1 and MAFbx in donor and recipient muscles after musculocutaneous nerve transection and partial pectoralis major muscle transfer for reconstruction of elbow flexion in rats / Expresión de MuRF1 y MAFbx en músculos donantes y receptores después de transección del nervio musculocutáneo y transferencia parcial del músculo pectoral mayor para la reconstrucción de flexión de codo en ratas

The expression of MuRF1 and MAFbx in a denervated muscle has previously been studied. However, the expression of MuRF1 and MAFbx in the recipient and donor muscles after muscle transfer for reconstruction of joint function has not been sufficiently investigated. Forty-two adult Sprague-Dawley rats were divided into 7 groups: normal, 1 w post-, 2 w post-, and 4 w post-musculocutaneous nerve transection; and 1 w post-, 2 w post-, and 4 w post-reconstruction of elbow flexion. Muscle wet weights were assessed, and MuRF1 and MAFbx mRNA expressions were detected by polymerase chain reaction. The length of the oblique part of the pectoralis major of an SD rat is sufficient for suture to the insertion of the biceps brachii tendon. The muscle wet weight and the wet weight retention rate of the biceps brachii continued to decline after musculocutaneous nerve transection and a gradual increase was noted after the oblique part of the pectoralis major was transferred for reconstruction of elbow flexion. The oblique part of the pectoralis major showed a decrease of only 2­6%. The upregulated expression of MuRF1 and MAFbx in the biceps brachii reached a peak 2 w after denervation and 1 w after elbow flexion reconstruction, with an increase of 15% and 4%, respectively. This was followed by downregulation; however, the expression had not normalized at postoperative 4 w. The increased expression of MuRF1 (17%) and MAFbx (1%) in the oblique part of the pectoralis major at postoperative 1 w had decreased to below normal levels at postoperative 4 w. The transfer of the oblique part of the pectoralis major for elbow flexion reconstruction after musculocutaneous nerve transection can downregulate the expression of MuRF1 and MAFbx in the recipient muscle and causes only transient damage to the donor muscle in rats.

La expresión de MuRF1 y MAFbx en un músculo denervado ha sido estudiada previamente. Sin embargo, la expresión de MuRF1 y MAFbx en los músculos receptores y donantes después de la transferencia del músculo para la reconstrucción de la función articular no se ha investigado lo suficiente. Cuarenta y dos ratas adultas Sprague-Dawley fueron divididas en 7 grupos: normales, 1 semana post-, 2 semanas post- y 4 semanas post-transección del nervio musculocutáneo; y 1 semana post-, 2 semanas post-, y 4 semanas post-reconstrucción de la flexión del codo. Se evaluó el peso de los músculos húmedos, y las expresiones de MuRF1 y MAFbx mRNA fueron detectadas a través de reacción en cadena de la polimerasa. La longitud de la parte oblicua del músculo pectoral mayor de una rata Sprague-Dawley es suficiente para realizar la sutura en la inserción del tendón de músculo bíceps braquial. El peso húmedo del músculo bíceps braquial y su tasa de retención siguieron disminuyendo después de la sección del nervio musculocutáneo y un aumento gradual se observó después de la transferencia de la parte oblicua del músculo pectoral mayor para la reconstrucción de la flexión del codo. La parte oblicua del músculo pectoral mayor mostró una disminución de sólo 2-6%. La expresión regulada por incremento de MuRF1 y MAFbx en el bíceps braquial alcanzó un peak 2 semanas después de la denervación y 1 semana después de la reconstrucción de la flexión del codo, con un incremento del 15% y el 4%, respectivamente. Esto fue seguido por un regulación en baja. Sin embargo, la expresión no se normalizó en el postoperatorio de las 4 semanas. El aumento de la expresión de MuRF1 (17%) y MAFbx (1%) en la parte oblicua del músculo pectoral fue mayor en el postoperatorio de 1 semana, mientras que se encontró por debajo de los niveles normales en el postoperatorio de 4 semanas. La transferencia de la parte oblicua del músculo pectoral mayor para la reconstrucción de la flexión del codo después de la sección del nervio musculocutáneo puede regular a la baja la expresión de MuRF1 y MAFbx en el músculo receptor y provocar solo un daño transitorio en el músculo donado en ratas.