The Accessory Muscular Head of the Triceps Brachii Muscle with Tendinous Attachment / Cabeza Muscular Accesoria del Músculo Triceps Braquial con Inserción Tendinosa

SUMMARY: Variations in the triceps brachii muscle are uncommon, and especially limited reports exist on the accessory heads of tendinous origin that attach near the upper medial part of the humerus. During anatomical training at Nagasaki University School of Medicine, the accessory head of the triceps brachii muscle was observed on the right upper arm of a 72-year-old Japanese female. It arose tendinously from the medial side of the upper humerus, then formed a muscle belly and joined the distal side of the long head. This accessory head had independent nerve innervation, and the innervating nerve branched from a bundle of the radial nerve, which divided the nerve innervating the long head and the posterior brachial cutaneous nerve. The origin of the innervation of the accessory head was the basis for determining that this muscle head was an accessory muscle to the long head of the triceps brachii muscle. Embryologically, we discuss that part of the origin of the long head of the triceps brachii muscle was separated early in development by the axillary nerve and the posterior brachial circumflex artery, and it slipped into the surgical neck of the humerus and became fixed there. The accessory head crossed the radial nerve and deep brachial artery. When clinicians encounter compression of the radial nerve or profunda brachii artery, they should consider the presence of accessory muscles as a possible cause.

Las variaciones en el músculo tríceps braquial son poco comunes y existen informes especialmente limitados sobre las cabezas accesorias de origen tendinoso que se insertan cerca de la parte medial superior del húmero. Durante un entrenamiento anatómico en la Facultad de Medicina de la Universidad de Nagasaki, se observó la cabeza accesoria del músculo tríceps braquial en la parte superior del brazo derecho de una mujer japonesa de 72 años. Se originaba tendinosamente desde el lado medial de la parte superior del húmero, luego formaba un vientre muscular y se unía al lado distal de la cabeza larga. Esta cabeza accesoria tenía inervación nerviosa independiente, cuyo nervio se ramificaba a partir de un ramo del nervio radial, que dividía el nervio que inervaba la cabeza larga y el nervio cutáneo braquial posterior. El origen de la inervación de la cabeza accesoria fue la base para determinar que esta cabeza muscular era un músculo accesorio de la cabeza larga del músculo tríceps braquial. Embriológicamente, discutimos que parte del origen de la cabeza larga del músculo tríceps braquial se separó temprananamente en el desarrollo por el nervio axilar y la arteria circunfleja braquial posterior, y se deslizó hacia el cuello quirúrgico del húmero y quedó fijado allí. La cabeza accesoria cruzaba el nervio radial y la arteria braquial profunda. Cuando los médicos encuentran compresión del nervio radial o de la arteria braquial profunda, deben considerar la presencia de mús- culos accesorios como una posible causa.

Uncommon-parasitic-infection-isolated-intramuscular-cysticercosis-a-case-report

Human cysticercosis is caused by cysticercus cellulosae, larvae of a tapeworm, taenia solium. Cysticercois can involve any tissue in the body even it has maximum tendency towards neural tissue. The most common affected sites are central nervous system, subcutaneous tissue, eyes and muscles. An isolated case of intramuscular cysticercosis is a rare presentation. Here we present the case of a 35 year old female with a swelling on the posterolateral aspect of right arm and was diagnosed as myocysticercosis which was abuting to the extensor muscle that is triceps muscle on high resolution ultrasound and ct scan and it was managed by antihelminthic medications followed by surgical excision.

Surgical treatment of ulnar olecranon avulsion fracture complicated with radial head fracture / 中华创伤骨科杂志

Objective:To evaluate the surgical treatment of ulnar olecranon avulsion fracture complicated with radial head fracture.Methods:A retrospective study was conducted to analyze the clinical data of 13 patients who had been treated at Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital for ulnar olecranon avulsion fracture complicated with radial head fracture from July 2016 to February 2022. There were 9 males and 4 females with an age of (38.1±11.7 years), and 6 cases on the dominant side and 7 cases on the non-dominant side. According to Mason classification of radial head fractures, there were 1 case of type Ⅰ, 1 cases of type Ⅱ and 11 cases of type Ⅲ. All patients were treated surgically and their radial head fractures were prioritized. For radial head fractures, 10 patients were treated with open reduction and internal fixation, and 3 patients with radial head replacement. For ulnar olecranon avulsion fractures, 11 patients were treated with repair of tendon insertions, and 2 patients with tendon repair only. At the last follow-up, the elbow mobility was recorded, and Mayo elbow performance score (MEPS), visual analogue scale (VAS) for pain, and Disabilities of the Arm, Shoulder and Hand (DASH) scoring were applied to assess the elbow function, pain, and subjective upper extremity function. Complications and secondary surgeries were also followed up.Results:The 13 patients were followed up for (37.6±18.5) months after operation. At the last follow-up, the flexion and extension was 102.3°±19.6° (from 70° to 130°), and the pronation-supination was 149.6°±20.0° (from 110° to 170°). Nonunion of the radial head fracture occurred in 1 patient, stiffness of the elbow in 3 patients, and ulnar nerve dysfunction in 1 patient. A total of 4 secondary surgeries were performed in 3 patients. At the last follow-up, in the 13 patients, the MEPS score was 100.0 (85.0, 100.0) points with a range from 75 to 100 points; the VAS score was 0.0(0.0, 2.0) point with a range from 0 to 3 points; the DASH score was 2.5 (1.3, 8.3) points with a range from 0 to 21 points.Conclusions:As ulnar olecranon avulsion fracture complicated with radial head fracture is not common, timely identification and clear diagnosis of such injury is very important. Surgical treatment may result in fine outcomes.

Symptomatic Unilateral Triceps Medial Head Snapping and Subluxating Ulnar Nerve without Neuropathy after Push-Ups: A Case Report

@#The coexistence of ulnar nerve subluxation and snapping medial head triceps is an uncommon occurrence. There have been few studies and case reports since it was first described in 1970. In this article, we present a case in which the condition occurred after a push-up. We analysed the pathoanatomy of the condition, and reviewed the literature regarding potential causes, typical presentations of the coexistence of both ulnar nerve subluxation and medial snapping triceps and describe our surgical technique in treatment. Elbow pain is very often under evaluated as many physicians may not be aware that elbow pain could be attributed to the coexistence of both ulnar nerve subluxation and medial snapping triceps. A thorough evaluation with physical examination and imaging are recommended. Early surgery with an appropriate rehabilitation programme may hasten recovery and return to sports in patients who continue to remain symptomatic following a trial of conservative therapy.

The effect of combining extracorporeal shock waves with continuous static stretching in treating triceps spasticity after a stroke / 中华物理医学与康复杂志

Objective:To observe any effect of supplementing continuous static stretching (CSS) with extracorporeal shock wave therapy (ESWT) in treating triceps surae spasm after a stroke.Methods:Sixty-four stroke survivors with triceps surae spasm were randomly divided into a conventional rehabilitation group, a shock wave group and a combined treatment group. In addition to conventional rehabilitation, the shock wave group received extracorporeal shock wave therapy twice a week and the combined treatment group received the shock waves during continuous static stretching. After 6 weeks of treatment all of the subjects were assessed using the Modified Ashworth Scale (MAS), the Fugl-Meyer Assessment (FMA) and Brunnstrom classification of their functional recovery stage.Results:Before treatment there was no significant difference among the three groups. After the 6 weeks of treatment the average triceps surae tension in all three groups had eased significantly. At that point the average MAS and FMA scores of the shock wave group and the combined treatment group were significantly better than those of the conventional group. The combined treatment group then showed significantly better therapeutic effect than the shock wave group.Conclusions:Applying extracorporeal shock waves during continuous static stretching can significantly improve the stretching′s ability to reduce spasticity and improve motor functioning, at least of the triceps surae. Combining shock waves with modern traction methods is recommended for clinical application.

Bilateral triceps tendon approach is flexible and efficient in the treatment of type C distal humerus fractures / 中华创伤杂志(英文版)

PURPOSE@#The purpose of this study was to assess and compare elbow range of motion, triceps extension strength and functional results of type C (AO/OTA) distal humerus fractures treated with bilateral triceps tendon (BTT) approach and olecranon osteotomy (OO). At the same time, we are also trying to know whether BTT approach can provide sufficient vision for comminuted intra-articular fractures of the distal humerus, and whether it is convenient to convert to the treatment to total elbow arthroplasty (TEA) or OO.@*METHODS@#Patients treated with OO and BTT approaches for type C distal humerus fractures between July 2014 and December 2017 were retrospectively reviewed. Inclusion criteria include: (1) patients' age were more than 18 years old, (2) follow-up was no less than 6 months, and (3) patients were diagnosed with type C fractures (based on the AO/OTA classification). Exclusion criteria include: (1) open fractures (Gustillo type 2 or type 3), (2) treated by other approaches, and (3) presented with combined injuries of ipsilateral upper extremities, such as ulnar nerve. Elbow range of motion and triceps extension strength testing were completely valuated, when the fractures had healed. Assessment of functional results using the Mayo elbow performance score and complications were conducted in final follow-up. The data were compared using the two tailed Student's t-test. All data were presented as mean ± standard deviation.@*RESULTS@#Eighty-six patients of type C distal humerus fractures, treated by OO and BTT approach were retrospectively reviewed between July 2014 and December 2017. Fifty-five distal humerus fractures (23 males and 32 females, mean age 52.7 years) treated by BTT approach or OO were included in this study. There were 10 fractures of type C1, 16 type C2 and 29 type C3 according to the AO/OTA classification. Patients were divided into two surgical approach groups chosen by the operators: BTT group (28 patients) and OO group (27 patients). And the mean follow-up time of all patients was 15.6 months (range, 6-36 months). Three cases in BTT group were converted to TEA, and one converted to OO. Only one case in BTT group presented poor articular reduction with a step more than 2 mm. There were not significantly different in functional outcomes according to the Mayo elbow performance score, operation time and extension flexion motion are values between BTT group and OO group (p > 0.05). Complications and reoperation rate were also similar in the two groups. Triceps manual muscle testing were no significant difference in the two groups, even subdivided in elder patients (aged >60 years old).@*CONCLUSION@#BTT is a safe approach to achieve similar functional result comparing with OO. BTT were not suitable for every case with severe comminuted pattern, but it avoids the potential complications related to OO, and has no complications concerning with triceps tendon. It is convenient for open reduction internal fixation and flexible to be converted to OO, as well as available to be converted to TEA in elder patients.

Localization of the centre of the highest region of the triceps brachii muscle spindle abundance and its significance in muscle spasticity block / Localización del centro de la región más alta del huso del músculo tríceps braquial y su importancia en el bloqueo de la espasticidad muscular

SUMMARY: This study aimed to accurately localize the location and depth of the centre of the highest region of muscle spindle abundance (CHRMSA) of the triceps brachii muscle. Twenty-four adult cadavers were placed in the prone position. The curve connecting the acromion and lateral epicondyle of the humerus close to the skin was designed as the longitudinal reference line (L), and the curve connecting the lateral and the medial epicondyle of the humerus was designed as the horizontal reference line (H). Sihler's staining was used to visualize the dense intramuscular nerve region of the triceps brachii muscle. The abundance of muscle spindle was calculated after hematoxylin and eosin stain. CHRMSA was labelled by barium sulphate, and spiral computed tomography scanning and three- dimensional reconstruction were performed. Using the Syngo system, the projection points of CHRMSA on the posterior and anterior arm surface (P and P' points), the position of P points projected to the L and H lines (PL and PH points), and the depth of CHRMSA were determined. The PL of the CHRMSA of the long, medial, and lateral heads of the triceps brachii muscle were located at 34.83 %, 75.63 %, and 63.93 % of the L line, respectively, and the PH was located at 63.46 %, 69.62 %, and 56.07 % of the H line, respectively. In addition, the depth was located at 34.73 %, 35.48 %, and 35.85 % of the PP' line, respectively. These percentage values are all the means. These body surface locations and depths are suggested to be the optimal blocking targets for botulinum toxin A in the treatment of triceps brachii muscle spasticity.

RESUMEN: Este estudio tuvo como objetivo localizar con precisión la ubicación y la profundidad del centro de la región más alta del huso muscular (CHRMSA) del músculo tríceps braquial. Se colocaron veinticuatro cadáveres adultos en posición prona y se designó la curva que conecta el acromion y el epicóndilo lateral del húmero cerca de la piel como la línea de referencia longitudinal (L), y la curva que conecta los epicóndilos lateral y medial del húmero fue designada como la línea de referencia horizontal (H). Se usó la tinción de Sihler para visualizar la región nerviosa intramuscular densa del músculo tríceps braquial. La abundancia de huso muscular se calculó después de la tinción con hematoxilina y eosina. CHRMSA se marcó con sulfato de bario y se realizó una tomografía computarizada espiral y una reconstrucción tridimensional. Usando el sistema Syngo, fueron determinados los puntos de proyección de CHRMSA en la superficie posterior y anterior del brazo (puntos P y P'), la posición de los puntos P pro- yectados en las líneas L y H (puntos PL y PH) y la profundidad de CHRMSA. Los PL de la CHRMSA de las cabezas larga, medial y lateral del músculo tríceps braquial se ubicaron en el 34,83 %, 75,63 % y 63,93 % de la línea L, respectivamente, y el PH se ubicó en el 63,46 %, 69,62 %, y 56,07 % de la línea H, respectivamente. La profundidad se ubicó en el 34,73 %, 35,48 % y 35,85 % de la línea PP', respectivamente. Estos valores porcentuales son todas las medias. Se sugiere que estas ubicaciones y profundidades de la superficie corporal son los objetivos de bloqueo óptimos para la toxina botulínica A en el tratamiento de la espasticidad del músculo tríceps braquial.

A clinicoradiological classification and a treatment algorithm for traumatic triceps tendon avulsion in adults / 中华创伤杂志(英文版)

PURPOSE@#Triceps tendon avulsion (TTA) is an uncommon injury, and there are no classifications or treatment guidelines available. This study aims to describe a clinicoradiological classification and treatment algorithm for traumatic TTA in adults. The functional outcome of surgical repair has been evaluated too.@*METHODS@#A retrospective analysis of adult patients with traumatic TTA treated in our institution between January 2012 and December 2017 was done. We only included complete TTA injuries. Children below 15 years, with open injuries, associated fractures, or partial TTA were excluded. The data were obtained from hospital records. The intraoperative findings were correlated with the clinicoradiological presentation for classifying TTA. The functional outcome was analyzed using the Mayo Elbow Performance index and Hospital for Special Surgery elbow score. ANOVA test was used to assess the statistical significance.@*RESULTS@#There were 15 patients included, 11 males and 4 females. The mean age was (31.5 ± 9.15) years, and the mean follow-up was (22.4 ± 8.4) months. Fall on outstretched hand was the mode of injury. In 6 patients, diagnosis was missed on the initial visit. TTA were classified as Type I: palpable soft-tissue defect without bony mass; Type II: palpable soft-tissue defect with a wafer-thin/comminuted bony fragment on X-ray; Type III: palpable soft-tissue defect with a bony mass and a large bony fragment on X-ray without extension to the articular surface; and Type IV: an olecranon fracture with less than 25% of the articular surface. An algorithm for treatment was recommended, i.e. transosseous suture repair/suture anchor for Type I, transosseous suture repair for Type II, and tension band wiring or steel wire sutures for Types III and IV. All the patients achieved good to excellent outcome: the mean Mayo Elbow Performance index was 100 and Hospital for Special Surgery score was 98.26 ± 2.60 on final follow-up.@*CONCLUSION@#Our clinicoradiological classification and treatment algorithm for TTAs is simple. Surgical treatment results in excellent functions of the elbow. Since it is a single-center study involving a very small number of cases, a multicenter study with a larger number of patients is required for external validation of our classification and treatment recommendations.

Contribution Of Axillary Nerve In The Innervation Of Long Head Of Triceps Brachii: A Cadaveric Study

Background: Traditionally the axillary nerve innervates the Deltoid and the Teres minor(TM) muscle. Axillarynerve injuries are common in shoulder dislocation, fracture surgical neck of humerus, brachial plexus injuriesand neuropathies. Traumatic injuries of axillary nerve have also shown weakness of Long head of triceps and insurgical practice, the nerve to long head of triceps is utilized for nerve transfer to neurotise the deltoid muscle inpatients with axillary nerve injuries. Hence the aim of the study was to find out the prevalence of contribution ofaxillary nerve to the innervation of Long head of triceps brachii (LHT).Materials and Methods: Nine embalmed adult human cadavers (bilaterally) and twelve disarticulated upperextremities were dissected. Total of thirty upper extremities were dissected. The axillary nerve was observedemerging from the quadrangular space. Anterior and posterior branches of axillary nerve were noted. Themuscular branches to deltoid, TM and LHT were traced to their point of innervation. The focus was on the branchof axillary nerve supplying the LHT. The branching configuration was classified into three types. Type I- posteriorbranch of axillary nerve supplying the LHT, Type II- Branch to TM supplying the LHT and Type III- A branch from thebifurcation of anterior & posterior branch of axillary nerve supplying LHT.Results: The present study showed that axillary nerve innervated the LHT in 8 out of 30 limbs (26.66%). Amongstthese, in 4 limbs(50%) posterior branch of axillary nerve supplied the LHT(type I ), in 3 limbs(37.5%) branch to TMsupplied the LHT(type II) and in 1 limb(12.5%) a branch from the bifurcation of axillary nerve into anterior andposterior branch supplied the LHT( type III). It was also observed that in 2 (6.66%) specimens, axillary nerve wasthe only supply to LHT and in 6 (20%) specimens both axillary nerve & radial nerve supplied the LHT and in theremaining 22 (73.3%) specimens, only the radial nerve supplied the LHT.Conclusion: Awareness of the variation of axillary nerve supplying the LHT is important for surgeons,orthopaedicians and anaesthetists for surgical treatment of traumatic nerve injuries.

Application of Ultrasound Shear Wave Elastography in Rehabilitaion Assessment of Triceps Surae and Achilles Tendon after Stroke / 中国康复理论与实践

Objective:To apply the ultrasonic shear wave elastography to evaluate triceps surae and Achilles tendon for patients with lower extremity dyskinesia after stroke. Methods:Thirty-two inpatients during 2018 and 2019 with unilateral lower extremity dyskinesia after stroke were studied with 2-D ultrasound and shear wave elastography on the bilateral triceps surae and Achilles tendons before and after rehabilitation. Shear wave velocity (SWV) of the triceps surae and the Achilles tendons, the length and thickness of Achilles tendon (soleus tendon) were measured. Results:Before rehabilitation, the SWV of the Achilles tendons and the triceps surae increased more in the affected side than in the unaffected side (t > 2.426, P < 0.05), as well as the length of the Achilles tendons (t = 11.801, P < 0.001). After rehabilitation, the SWV of the triceps surae decreased (t > 2.447, P < 0.05), as well as the length of the Achilles tendons (t = 8.577, P < 0.001). Conclusion:Ultrasound shear wave elastography can be used to evaluate the elastic characteristics of the Achilles tendon and the triceps surae, to guide the rehabilitation for stroke patients.

Rehabilitation Treatment after Extensive Tumor Resection Including Triceps Resection for a Malignant Right Arm Soft Tissue Tumor：A Case Report / The Japanese Journal of Rehabilitation Medicine

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.

Rehabilitation Treatment after Extensive Tumor Resection Including Triceps Resection for a Malignant Right Arm Soft Tissue Tumor：A Case Report / The Japanese Journal of Rehabilitation Medicine

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.

Luxación del vientre medial del tríceps (Snapping triceps) / Dislocation of the medial triceps belly (Snapping triceps)

Resumen La luxación del vientre medial del tríceps braquial es una rara condición que ocurre sobre el epicóndilo medial durante la flexión activa de este sobre el codo y a menudo está asociada a inestabilidad del nervio cubital, ocasionando síntomas de compresión de este.

Abstract The dislocation of the medial belly of the triceps is a rare occurrence that occurs on the medial epicondyle during active flexion of this over the elbow and is often associated with an instability of the ulnar nerve, causing symptoms of compression of this nerve.

Body fat indices for identifying risk of hypertension in Indian children

Background: Studies in India shown high body fat indices were strongly associated with hypertension in Indian children, but such studies mostly not done in southern states of India. So, authors include children in Tamilnadu measure body fat indices and blood pressure to find which body fat index correlates closely with hypertension.Methods: Standing height was measured using stadiometer. Weight was measured using electronic scale. WC measured in standing position, by a stretch resistant.' WC above 90th centile will be considered as Adipose. Waist to height ratio optimal cut-off value is 0.44 for children. TSFT recorded using Harpenden caliper, on the non-dominant upper arm. Wrist circumference measured using stretch resistant tape.Results: In this study 2000 children were participated. More hypertensives are seen in 10 to 12 years(62) and 16 to 18 years(31).Increased weight correlated with hypertension. Study indicates waist circumference is significantly correlated with systolic BP p<0.003, diastolic BP p<0.000. This study shows significant correlation p<0.003 for systolic and p<0.000 for diastolic BP with triceps skin fold thickness estimation. In multivariate analysis with systolic blood pressure and diastolic blood pressure shows very strong correlation with waist circumference, waist to height ratio and triceps skin fold thickness.Conclusions: In this study we investigate the correlation between body fat indices and blood pressure correlation was statistically analyzed which shows that waist circumference, waist to height ratio and triceps skin fold thickness were strongly correlated with systolic and diastolic BP.

Study Of Variations In Muscular Branches Of Radial Nerve In Axilla And Posterior Compartment Of Arm

Background: Radial nerve originates from posterior cord of brachial plexus at axilla. It supplies extensor musclesof upper limb.Objectives: To know the variations in muscular branches of radial nerve in axilla and posterior compartment ofarm.Methods: Dissection was done on 44 upper limbs from embalmed cadavers and 6 upper limbs from embalmeddead fetuses in the Department of Anatomy, J J M Medical College, Davangere. Dissection of Radial nerve and itsbranches in the axilla and posterior compartment of the arm was carried out according to Cunningham’s manualof practical anatomy.Results: The site of origin of nerve to long head of tricep (N-LHT) was axilla in 48 specimens (96%) and lowertriangular space( LTS) in 2 specimens (4%). The site of origin of nerve to lateral head of tricep( N-LTHT) was radialgroove(RG) in 49 specimens (98%) and lower triangular space(LTS) in 1 specimens (2%). The site of origin ofnerve to medial head of tricep -ulnar collateral nerve(UCN) was axilla in 38 specimens (76%) and lower triangularspace(LTS) in 12 specimens (24%). The site of origin of nerve to medial head of tricep-nerve to anconeus(NA) wasradial groove(RG) in 49 specimens (98%) and lower triangular space(LTS) in 1 specimens (2%). The additionalbranches to long head of tricep(LHT) was found in 20 specimens (40%). The additional branches to lateral headof tricep( LTHT) was found in 10 specimens (20%). The additional branches to medial head of tricep(MHT) wasfound in 7 specimens (14%).Interpretation and Conclusion: The present study is important for Surgeons, Orthopedicians, and Neurophysiciansas it provides the knowledge of variations in muscular branches of radial nerve in axilla and posteriorcompartment of arm to prevent possible complications.

Localización biométrica de los puntos motores en el músculo tríceps braquial de individuos brasileños / Biometric location of motor points in the brachial triceps muscle of Brazilian individuals

RESUMEN: El músculo tríceps braquial, es el motor primario para el movimiento de extensión de codo, por lo que una lesión que afecte su función perjudicaría enormemente la calidad de vida de los afectados. El conocimiento de su inervación y la localización biométrica de sus puntos motores, es una herramienta útil en terapias de electro estimulación muscular. El objetivo del estudio fue determinar el número y localización de los puntos motores de este músculo. Para ello, se utilizaron 30 miembros superiores de individuos brasileños, a los cuales se les realizó una disección detallada del compartimiento posterior del brazo. Se registró el número de ramos, puntos motores y localización biométrica de cada uno de los ramos destinados a las cabezas del músculo triceps braquial. Se utilizó como punto de referencia una Línea biepicondilar, trazada entre los epicóndilos humerales. En todos los casos este músculo estaba inervado por el nervio radial. El promedio de puntos motores (PM) para la cabeza larga del músculo (CL) fue de 3,9 ± 1,4; 4,8 ± 1,2 para la cabeza medial (CM) y 4,1 ± 1,4 para la cabeza lateral (CLat). Los puntos motores se concentraron preferentemente en el tercio medio del brazo, tanto a nivel general, como también por cada cabeza. Los datos biométricos aportados complementarán el conocimiento de la inervación de este músculo y favorecerá una mejor comprensión y elección de tratamientos frente a una patología.

SUMMARY: The triceps brachii muscle is the primary motor for elbow extension movement, so a lesion that affects its function would greatly harm the quality of life of those affected. The knowledge of its innervation and the biometric localization of its motor points is a useful tool in electro-stimulation muscular therapies. The objective of the study was to determine the number of branches and location of the motor points of this muscle. To this end, 30 superior members of Brazilian individuals were used, to whom a detailed dissection of the posterior compartment of the arm was performed. The number of branches, motor points and biometric location of each of the branches destined for the three heads of the brachial triceps muscle was recorded. A biepicondilar line, traced between the humeral epicondyles, was used as a reference point. In all cases, this muscle was innervated by the radial nerve. The average motor points for the long head of the muscle (LH) was 3.9 + 1.4; for the medial head (MH) was 4.8 + 1.2 and for the lateral head (LatH) was 4.1+1.4. The motor points were concentrated mainly in the middle third of the arm, both at a general level, and also for each head. The biometric data provided will complement the knowledge of the innervation of this muscle and will favor a better understanding and choice of treatments for a pathology.

Biometría del musculo tríceps braquial y de sus puntos motores: un estudio anatómico directo en una muestra de población colombiana / Biometry of the brachial triceps muscle and its motor points: a direct anatomical study in a sample of colombian population

Las características anatómicas del músculo tríceps braquial (MTB) determinan la velocidad de reparación y capacidad de generación de torque. El MTB es inervado típicamente por el nervio radial (NR), pero existen reportes de inervación por parte del nervio axilar. El propósito de este estudio fue evaluar los componentes musculotendinosos y nerviosos del MTB. Mediante disección directa en una muestra de 48 brazos de población mestiza colombiana, se evaluó morfometría musculotendinosa, ramos nerviosos, puntos motores (PM) y origen de la inervación del MTB. Las longitudes de las cabezas medial, lateral y larga del MTB correspondieron al 77,3 %, 86 % y 97 % respectivamente de la longitud del brazo. El MTB fue inervado en la totalidad de la muestra por el NR quien emitió entre dos y cinco ramos motores. El primer ramo inervó la cabeza larga en el 100 % de los casos y emergió lateral a la banda tendinosa de inserción del músculo latísimo del dorso. La cabeza larga recibió con mayor frecuencia tres PM (26,6 %), ubicados en el 85 % de los especímenes a 4-10 cm del origen muscular; mientras que la cabeza lateral recibió tres PM en el 44,4 % de la muestra. No hubo diferencias estadísticamente significativas entre el número de PM del MTB izquierdo con relación al derecho (p=0,578). El área de dispersión de PM, así como la morfometría del MTB, son de relevancia clínica, debido a su uso en la estimulación eléctrica neuromuscular y transferencias nerviosas. Los resultados presentados en el presente estudio se constituyen en guía que facilita realizar estas acciones terapéuticas.

The anatomical characteristics of the triceps brachii (TBM) muscle determine the repair speed and torque generation capacity. The TBM is typically innervated by the radial nerve (RN), but there are reports of innervation by the axillary nerve. The aim of this study was to evaluate musculotendinous and nervous components of TBM. Through direct dissection in a sample of 48 arms of the Colombian mestizo population, we evaluated musculotendinous morphometry, nerve branches, motor points (MP) and origin of TBM innervation. The lengths of the medial, lateral and long heads of the TBM corresponded to 77.3 %, 86 % and 97 % of the arm length respectively. The TBM was innervated in the whole sample by the NR who issued between two and five motor branches. The first branch innervated the long head in 100 % of cases and emerged laterally to the tendinous band insertion of the latissimus dorsi muscle. The long head received three MP (26.6 %), located in 85 % of the specimens at 4 - 10 cm of muscular origin; while the lateral head received three MP in 44.4 % of the sample. There were no statistically significant differences between the number of MP of the left TBM in relation to the right (p = 0.578). The dispersion area of MP, as well as TBM morphometry are clinically relevant due to their use in neuromuscular electrical stimulation and nerve transfers. The findings presented in this study are a guide to facilitate results in this type of therapeutic action.

Extracorporeal shock wave therapy alleviates spasticity in the triceps surae after stroke / 中华物理医学与康复杂志

Objective To evaluate the effect of applying extracorporeal shock wave therapy (ESWT) to alleviate triceps surae spasticity after a stroke and to explore the electrophysiological mechanisms involved.Methods Sixty hemiplegic stroke patients with triceps surae spasticity were recruited and randomly assigned to either an ESWT group or a control group,each of 30.Both groups were given routine medication and rehabilitation training.The ESWT group additionally received 3000 shots of ESWT at 0.089 mJ/mm2,1.5 bars and 8 Hz applied once a week for 4 weeks.Before the treatment,immediately afterward,and then 1 and 4 weeks later the subjects were assessed using the composite spasticity scale (CSS),passive range of motion (PROM) measurements,the 10-meter walk test (10MWT),H reflex latency and the Hmax/Mmax ratio.Results The ESWT group showed significant improvement in their average CSS,PROM and 10MWT results at t1,t2 and t3 compared with t0,while the control group had significant improvement in their average CSS and 10MWT scores,but their average PROM score improved significantly only at t1 and t2.The ESWT group showed significantly better progress in terms of their average CSS score at t1 and t2.The groups' average PROM scores were not significantly different,but the ESWT group had faster 10MWT times at t1,t2 and t3.In the ESWT group H reflex latency had lengthened significantly by t1 and the Hmax/Mmax ratio had decreased significantly,but the only significant difference from the controls was in the average H reflex latency at t1.The ESWT was well tolerated and did not cause any severe adverse effects.Conclusions ESWT improves triceps surae spasticity effectively after stroke quite safely.

Neglected Anterior Dislocation of the Elbow Joint: Case Report of a Rare Injury

@#anterior dislocation of the right elbow joint in a 19-year oldman. The patient had been initially treated by a traditionalbone setter, but the elbow remained unreduced. He presentedto us with pain, deformity and limited range of motion of hisright elbow joint. Radiographs revealed an unreducedanterior dislocation of the right elbow joint. We describe theproblems encountered during open reduction andrehabilitation and result one year after the operation with thepatient having a stable elbow and a functional range ofmotion.

Inervación de la cabeza larga del músculo tríceps braquial / Innervation of the long head of triceps brachii muscle

Clásicamente, la inervación del músculo tríceps braquial se atribuye al nervio radial. Sin embargo, reportes clínicos han observado parálisis de la cabeza larga del músculo tríceps braquial posterior a lesiones del nervio axilar, ocurridas luego de una luxación de la articulación glenohumeral, poniendo en duda la inervación de la cabeza larga del músculo tríceps braquial. El objetivo del presente estudio es verificar la inervación de la cabeza larga del músculo tríceps braquial por parte del nervio axilar. Se disecaron 12 regiones posteriores de hombro y brazo, previamente fijadas en solución fijadora conservadora, identificando ramos de inervación del nervio axilar hacia la cabeza larga del músculo tríceps braquial, luego se obtuvieron muestras para estudio histológico con Hematoxilina-Eosina. Fue posible identificar en todos los casos ramos del nervio axilar, penetrando en la mitad superior de la cabeza larga del músculo tríceps braquial. El estudio histológico mostró una imagen compatible con tejido nervioso en todas las muestras analizadas. Estos resultados contrastan con las descripciones realizadas en textos clásicos respecto a la inervación del músculo tríceps braquial, el cual podría presentar una doble inervación proveniente de los nervios radial y axilar, o una inervación diferente para cada cabeza. Los hallazgos presentados aportan información a la hora de analizar las lesiones del nervio axilar post luxaciones de hombro, al realizar procedimientos quirúrgicos en esta región o en la planificación de la rehabilitación de estos pacientes.

Primarily, innervation of the triceps brachii muscle has been attributed to the axillary nerve. However, clinical reports have observed paralysis from the long head of the triceps brachii muscle following axillary nerve lesions which occurred after dislocation of the glenohumeral joint. This has raised questions about the innervation of the long head of triceps brachii muscle. The objective of this study was to verify the innervation of the long head of the triceps brachii muscle by the axillary nerve. Twelve previously fixed posterior areas of shoulder and arm were dissected and branches of innervation of the axillary nerve towards the long head of triceps brachii muscle were identified. Subsequently, samples were taken for histological hematoxylin-eosin study. In all cases, we observed branches of the axillary nerve penetrating the upper half of the long head of the triceps brachii muscle. The histological study showed an image compatible with nerve tissue in each sample analyzed. The results contrast with the description in classic texts regarding innervation of the triceps brachii muscle, which could present with double innervation from the radial and axillary nerves, or a separate innervation for each head. These results provide information for axillary nerve lesion analysis following shoulder dislocation, at the time of performing surgical procedures in the area, or when planning rehabilitation for these patients.