ABSTRACT
Wide resection of malignant bone and soft tissue tumors of the extremities may require resection of muscles, which correspondingly impairs limb movements. We describe a 67-year old man with a malignant soft tissue tumor of the right upper arm. Preoperatively, there was no impairment of right upper extremity function. The patient underwent wide resection of the tumor and triceps muscle. Postoperative rehabilitation included range of motion exercises, residual muscle strength exercises, and activities of daily living (ADL) exercises. One week postoperatively, the patient could independently perform the ADL exercises. Two weeks postoperatively, the patient scored 2 during manual muscle testing (MMT) for elbow extension, indicating a complete range of motion in a gravity-eliminated position. However, the patient could not raise the arm without bending it. Considering the needs of the patient, we prescribed an elbow extension brace to support the upper limb while being raised. With this brace, the patient was able to sustain elbow extension during upper limb elevation. Three months postoperatively, the patient's elbow joint extension remained MMT 2, grip strength was 28 kg, and the International Society of Limb Salvage and Musculoskeletal Tumor Society score was 76.7％．Although the triceps muscle was resected, there was no problem with the patient's ADL. However, the patient could not maintain elbow extension in an anti-gravity position while raising the upper limb. In such cases, prescribing an elbow brace may be useful.
ABSTRACT
Wide resection of malignant bone and soft tissue tumors of the extremities may require resection of muscles, which correspondingly impairs limb movements. We describe a 67-year old man with a malignant soft tissue tumor of the right upper arm. Preoperatively, there was no impairment of right upper extremity function. The patient underwent wide resection of the tumor and triceps muscle. Postoperative rehabilitation included range of motion exercises, residual muscle strength exercises, and activities of daily living (ADL) exercises. One week postoperatively, the patient could independently perform the ADL exercises. Two weeks postoperatively, the patient scored 2 during manual muscle testing (MMT) for elbow extension, indicating a complete range of motion in a gravity-eliminated position. However, the patient could not raise the arm without bending it. Considering the needs of the patient, we prescribed an elbow extension brace to support the upper limb while being raised. With this brace, the patient was able to sustain elbow extension during upper limb elevation. Three months postoperatively, the patient’s elbow joint extension remained MMT 2, grip strength was 28 kg, and the International Society of Limb Salvage and Musculoskeletal Tumor Society score was 76.7％．Although the triceps muscle was resected, there was no problem with the patient’s ADL. However, the patient could not maintain elbow extension in an anti-gravity position while raising the upper limb. In such cases, prescribing an elbow brace may be useful.
ABSTRACT
Objective To study upper limb motor strategies during elbow extension activities in C5-6 spinal cord injury (SCI) patients and compare them with the strategies of normal individuals. Methods A Peak Motus motion analysis system was used to measure the angular displacement and the angular velocity of the shoulder, elbow and wrist of fifteen C5-6 SCI patients and fifteen healthy subjects during four elbow extension activities including grasping a cup, reaching for a light switch, wheelchair ambulation and upper limb weight-bearing. Results Compared with normal individuals, the movement time of the SCI patients was significantly longer during the grasping, reaching and wheelchair ambulation activities. The angular velocity was significantly slower during reaching for a light switch and wheelchair ambulation. The patients with spinal cord injury performed the motor tasks primarily relying on increasing or decreasing the angular displacement of the shoulder during the former three elbow extension activities. They compensated for any functional deficiency by changing the movement direction of the shoulder and elbow in sagittal projection during upper limb weight-bearing activities. Conclusion C5-6 SCI patients utilize different motor patterns and strategies from healthy subjects to complete elbow extension activities.
ABSTRACT
Objective To investigate motor patterns in the upper limbs of C_5 to C_6 spinal cord injury (SCI) patients during elbow extension. Methods Fifteen C_5 and C_6 SCI patients and fifteen healthy subjects formed an SCI group and a control group respectively. A three-dimensional kinematic analysis was performed on videos of the subjects performing four elbow extension activities: grasping a cup, reaching for a light switch, propelling a wheelchair, and upper limb weight bearing. A Peak Motus motion analysis system was employed. Results Compared with controls, the movement time of the SCI group was significantly longer during grasping, reaching for a light switch and wheelchair ambulation. Their angular velocity was significantly slower during reaching for a light switch and during wheelchair ambulation. The patients with spinal cord injury performed the motor tasks primarily by relying on increasing or decreasing the angular displacement of the shoulder. But they compensated for their functional deficiency by changing the movement direction of the shoulder and elbow in sagittal projection during upper limb weight bearing activities. Conclusion C_ 5-6 SCI patients use motor patterns and strategies different from those of control subjects in completing elbow extension activities.
ABSTRACT
Objective To explore how the spared muscles in upper limbs and trunk compensated for elbow extension movements in patients with SCI at the level of C_5 and C_6.Methods Fifteen patients with SCI at the level of C_5 and C_6 and fifteen healthy subjects were divided into an SCI group and a control group respectively.The surface EMG recorded from the anterior dehoid,middle deltoid,posterior deltoid,triceps braehii muscle,biceps braehii muscle,upper peetoralis,serratus anterior and latissimus dorsi during four elbow extension activities including grasp- ing cup,reaching for light-switch,wheelchair ambulation and upper limb weight-bearing.The relative EMG intensi- ties of muscles were expressed as a percentage of maximal voluntary contraction.Results Several muscles partici- pated in the activity simultaneously when both groups of subjects performed every motor task.But the primary muscles involved in the movements were different between the two groups.Furthermore,the SCI group tended to employ more muscles than the controls to perform a activity.The compensatory strategies used in various motor tasks by the spared muscles were different.Conclusion The motorueuron recruitment patterns used by the C_(5～6)SCI patients in per- forming elbow extension activities could be different from those by the healthy subjects.The patients accomplished performing different motor tasks by changing their compensatory strategies.