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.

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.

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.

Evaluation of carcass and muscle traits in Santa Ines female lambs finished with different agricultural products / Avaliação de características da carcaça e do músculo de cordeiras Santa Inês terminadas com diferentes produtos agrícolas

The aim of this study was to evaluate the effect of different agricultural products on quantitative aspects of carcass, body constituents, cooking loss, shear force and colorimetry of the Longissimus lumborum and Triceps brachii muscles in Santa Ines lambs. 24 Santa Ines female lambs received one of four diets which were isoproteic and isoenergetic with fixed levels of forage (60%) and concentrate (40%) of corn and soybean meal during 45 days. The forages per diet differed: coast-cross hay (HAY), cassava hay (CASS), dehydrated by-product of pea crop (PEA) and sugarcane (SC). The average weight of the lambs at the beginning of the experiment was 26.35kg. Animals were slaughtered in a federally certified abattoir. Initial and final pH, cooking losses, color using the CIELAB system, shear force and the quantity of sarcomeres per 100µm were measured. Hot carcass, cold and half carcass weights were affected by treatments (P<0.05). The sarcomere length of Triceps brachii muscle 24 hours after slaughter differed between diets and coast-cross hay had the lowest value. The sarcomere length differed significantly between diets and the dehydrated by-product of pea crop had the lowest number of sarcomeres immediately after slaughter compared to other diets. There was no influence of diet on colorimetry, cooking loss and shear force. The decrease in pH followed the development of the process of rigor mortis in the Longissimus lumborum and Triceps brachii muscles in the first hour and up to 24 hours after slaughter. Diets did not alter the pH, water holding capacity, colorimetry or shear force. The pea by-product and sugarcane can replace traditional sources of fodder without depreciation of meat characteristics.(AU)

O objetivo deste estudo foi avaliar o efeito de diferentes produtos agrícolas sobre aspectos quantitativos da carcaça, constituintes do corpo, perda por cocção, força de cisalhamento e colorimetria dos músculos Longíssimus lumborum e Tríceps brachii em cordeiras Santa Inês. Vinte e quatro cordeiras Santa Inês receberam uma das quatro dietas, que foram isoproteicas e isoenergéticas, com níveis fixos de forragem (60%) e concentrado (40%) composto por milho e farelo de soja, durante 45 dias. As forragens diferiram entre as dietas: feno de coast cross (FENO), feno da parte aérea da mandioca (MAN), subproduto desidratado da cultura da ervilha (ERV) e cana-de-açúcar (CANA). O peso médio das cordeiras no início do experimento foi de 26,35kg. Os animais foram abatidos em frigorífico com inspeção sanitária federal. Foram avaliados o pH inicial e o final, as perdas por cocção, a cor, por meio do sistema CIELAB, a força de cisalhamento e a quantidade de sarcômeros em 100µm. Os pesos de carcaça quente, de carcaça fria e de meia-carcaça foram afetados pelos tratamentos (P<0,05). O comprimento do sarcômero do músculo Tríceps brachii 24 horas após o abate diferiu entre dietas e o feno coast cross apresentou o menor valor. O comprimento do sarcômero diferiu significativamente entre as dietas, e o subproduto da ervilha apresentou o menor número de sarcômeros imediatamente após o abate em comparação com as outras dietas. Não houve influência da dieta sobre as características de colorimetria, perda por cocção e força de cisalhamento. Houve diminuição do pH, seguido pelo desenvolvimento do processo de rigor mortis nos músculos Longíssimus lumborum e Tríceps brachii da primeira hora até 24 horas após o abate. As dietas não foram capazes de alterar o pH, a capacidade de retenção de água, a colorimetria ou a força de cisalhamento. O subproduto de ervilha e a cana-de-açúcar podem substituir as fontes tradicionais de forragem sem prejudicar as características da carne.(AU)

A unique unreported anomalous muscle of scapular region and its clinical implications - A case report.

Back ground: It is a well documented fact that the lower border of spine of scapula gives origin to deltoid muscle only. We report a case of anomalous muscle arising from the medial aspect of lower border of spine of scapula in the left upper extremity of a 59 year old male cadaver. The anomalous muscle is innervated by axillary nerve which also gave a motor twig to the long head of triceps brachii. This variation was unilateral. The morphological, embryological and clinical significance of the anomalous muscle is discussed.

An Unusual Communication between the Radial and the Ulnar Nerves / 체질인류학회지

This case report describes an unusual communicating branch from radial to ulnar nerves in the axilla region on the right side of the Korean cadaver of a 59-year-old male. The brachial plexus containing the communicating branch were extracted en bloc. The extracted specimens were immersed in Guanidine-HCl (0.2 M) for two weeks and then treated several times with an ultrasonic cleaner for an hour to soften the connective tissue around the nerve bundles. The spinal root origins of this communicating branch were found to be largely C7 and some C8. Unexpectedly, the branches of the ulnar nerve innervated the medial two-third of the medial head of the triceps brachii muscle on the right side in the same cadaver. Numbers of nerve fibers of the communicating branch and the main distributing branch of the ulnar nerve to the triceps brachii muscle were 523 and 525, respectively. This result implies that nerve fibers moving from the radial to the ulnar nerves may innervate the original distributing territories of the radial nerve. Another possibility is that a part of radial muscular branch to the triceps beachii muscle may be fused to the ulnar nerve in their distributing territories.

Electromyographic analysis of upper limbs and trunk during elbow extension activities in C_5 and C_6 SCI patients / 中华物理医学与康复杂志

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.

The angular displacement and angular velocity of the upper limb during elbow extension activities in spinal cord injury patients and normal individuals / 中华物理医学与康复杂志

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.

Kinematic analysis of the upper limbs during elbow extension in C_5 and C_6 spinal cord injury patients / 中华物理医学与康复杂志

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.