Reference values for the six-minute pegboard and ring test in healthy adults in Brazil / Valores de referência para o teste de argolas de seis minutos em adultos saudáveis no Brasil

ABSTRACT Objective: To determine reference values for the six-minute pegboard and ring test (6PBRT) in healthy adults in Brazil, correlating the results with arm length, circumference of the upper arm/forearm of the dominant arm, and the level of physical activity. Methods: The participants (all volunteers) performed two 6PBRTs, 30 min apart. They were instructed to move as many rings as possible in six minutes. The best test result was selected for data analysis. Results: The sample comprised 104 individuals, all over 30 years of age. Reference values were reported by age bracket. We found that age correlated with 6PBRT results. The number of rings moved was higher in the 30- to 39-year age group than in the > 80-year age group (430.25 ± 77.00 vs. 265.00 ± 65.75), and the difference was significant (p < 0.05). The 6PBRT results showed a weak, positive correlation with the level of physical activity (r = 0.358; p < 0.05) but did not correlate significantly with any other variable studied. Conclusions: In this study, we were able to determine reference values for the 6PBRT in healthy adults in Brazil. There was a correlation between 6PBRT results and age.

RESUMO Objetivo: Determinar valores de referência para o teste de argolas de seis minutos (TA6) em uma amostra de adultos jovens e idosos saudáveis no Brasil e associar os resultados do teste com o comprimento de membros superiores, circunferências de braço e antebraço dominantes e nível de atividade física. Métodos: O TA6 foi realizado duas vezes, com intervalo de 30 min entre os testes. Os voluntários foram instruídos a mover tantas argolas quanto possíveis em seis minutos. O melhor resultado do teste foi escolhido para análise de dados. Resultados: Participaram do estudo 104 indivíduos com idades de 30-80 anos. Os valores de referência foram reportados por faixa etária. Foi observado que a idade se correlacionou com os valores obtidos no TA6. Indivíduos da faixa etária mais jovem (30-39 anos), quando comparados à faixa etária mais idosa (> 80 anos) apresentaram significativamente um maior desempenho (430,25 ± 77,00 vs. 265,00 ± 65,75; p < 0,05). O TA6 apresentou uma correlação fraca e positiva com o nível de atividade física (r = 0,358; p < 0,05), mas não com as outras variáveis analisadas. Conclusões: Este estudo foi capaz de originar valores de referência para o TA6 em uma amostra de adultos jovens e idosos saudáveis no Brasil. Houve uma correlação dos valores obtidos no TA6 com a idade.

Acute static muscle stretching improves manual dexterity in young men / Efeito agudo do alongamento estático sobre a destreza manual de jovens destreinados

OBJECTIVE: This study aimed to evaluate the influence of acute muscle stretching on manual function. METHODS: The sample consisted of 10 untrained men in a randomized, four test session cross-over experimental design. Each session was composed of only one of two protocols: a) control, or b) single series of passive static stretching; followed by either Minnesota Hand dexterity test or hand grip strength test with eletromyographical recording of reaction time. For data comparison, the Student T-test with significance level of p ≤ 0.05 was used. RESULTS: Manual dexterity increased after stretching for both placing and turning tests, with no changes in hand grip strength or reaction time. CONCLUSION: The results show that a 30 second static stretch of the hand decreases time to complete the Minnesota Hand Dexterity test without affecting handgrip strength or hand reaction time; thus it improves manual dexterity of young untrained men.

OBJETIVO: Este estudo objetivou avaliar a influência do alongamento sobre a função manual. MÉTODOS: A amostra foi composta por 10 homens destreinados em um delineamento experimental cross-over randomizado, com quatro sessões de testes. Cada sessão foi constituída apenas por um dos protocolos: a) controle ou b) série única de alongamento estático passivo seguidos pelo minnesota Hand Dexterity Test ou pelo Teste de Preensão Manual com analise eletromiográfica do Tempo de Reação Manual. Para as comparações dos dados, o teste T de Student foi usado, com o índice de significância adotado de p ≤ 0,05. RESULTADOS: O alongamento aumentou a destreza manual em ambos Placing e Turning Tests, sem alterar a força de preensão manual ou o tempo de reação. CONCLUSÃO: Os resultados indicam que o alongamento melhorou a destreza manual de jovens destreinados.

Upper Limb Functionality and Quality of Life in Women with Five-Year Survival after Breast Cancer Surgery / Funcionalidade do membro superior e qualidade de vida em pacientes com sobrevida de cinco anos após tratamento cirúrgico para câncer de mama

Abstract Objective To evaluate the correlation between upper limb functionality and quality of life in women with five-year survival following breast cancer surgical treatment. The secondary objective was to evaluate the function of the ipsilateral upper limb and the quality of life in relation to the type of surgery and the presence of pain. Methods The Disabilities of Arm, Shoulder and Hand (DASH), and the Functional Assessment of Cancer Therapy - Breast plus Arm Morbidity (FACTB + 4) questionnaires were used to evaluate upper limb function and quality of life respectively. Data distribution was verified by the Shapiro-Wilk test. Pearson's correlation coefficient was used for the parametric variables, and Spearman's rank correlation coefficient was used for the distribution of non-parametric variables. The statistical significance was set at 5% (p < 0.05). Results The study included 30 patients, with a mean age of 51.23 (±8.72) years. The most common complications were: pain (50%), adherence (33.3%), and nerve lesion (20.0%). There was a moderate negative correlation between the instruments DASH and FACTB + 4 (total score), r = -0.634, and a strong negative correlation between the DASH and the FACTB + 4 armsubscale, r = -0.829. The scores of both questionnaires showed significant difference on the manifestation of pain. However, there was no significant difference found when comparing the scores considering the type of surgery performed. Conclusions Five years after surgery, the patients showed regular functionality levels on the ipsilateral upper limb and decreased quality of life, especially in the group manifesting pain.

Resumo Objetivo Avaliar se há correlação entre a funcionalidade e a qualidade de vida em pacientes com sobrevida de cinco anos submetidas ao tratamento cirúrgico para câncer de mama e, secundariamente, avaliar a função do membro superior homolateral à cirurgia, e a qualidade de vida em função do tipo de cirurgia mamária e da presença de dor. Métodos Foram utilizados os questionários DASH e FACTB + 4 para avaliar a função do membro superior e a qualidade de vida respectivamente. Os dados foram submetidos ao teste de normalidade de Shapiro-Wilk. O coeficiente de correlação de Pearson foi utilizado para as variáveis com distribuição paramétrica e, para as variáveis com distribuição não paramétrica, o coeficiente de correlação de Spearman. Adotou-se o nível de significância de 5% (p < 0,05). Resultados Foram incluídas 30 pacientes, com média de idade de 51,23 (±8,72) anos. As complicações mais incidentes foram: dor (50%), aderência cicatricial (33,3%), e lesão nervosa (20,0%). Foi observada correlação negativa de magnitude moderada entre os instrumentos DASH e FACTB + 4 (pontuação total), r = -0,634, e de magnitude forte entre o DASH e a subescala braço do FACTB + 4, r = -0,829. As pontuações dos questionários apresentaram diferença significativa em função da presença de dor. Entretanto, não foi observada diferença significativa quando comparadas as pontuações com relação ao tipo de cirurgia. Conclusões Após cinco anos de cirurgia, as pacientes apresentaram grau regular de funcionalidade do membro homolateral à cirurgia e diminuição na qualidade de vida relacionada à saúde, principalmente no grupo que relatava presença de dor.

Median nerve location change evaluated by soft cadaver dissection according to the forearm movement / Cambio de posición del nervio mediano evaluado mediante disección cadavérica blanda según el movimiento del antebrazo

The aim of this study was to examine the change in median nerve location according to forearm movement. Thirty fresh specimens from 15 adult Korean cadavers (10 males and five females; age range, 53­91 years) were examined. We measured the motor entry point according to normal and pronated positions of the forearm. The x and y coordinates of the first motor entry point (MEP) in the normal position were 1.6±0.6 cm and 2.8±1.3 cm, respectively. The depth of the MEP was 1.5±0.3 cm. The x and y coordinates of the second MEP were 1.3±0.3 cm and 4.7±1.7 cm, respectively. The depth of the MEP was 1.4±0.2 cm. The x and y coordinates of first MEP with the forearm in the pronated position were 1.9±0.7 cm and 2.3±0.8 cm. respectively. The depth of the MEP was 1.7±0.4 cm. The x and y coordinates of the second MEP were 1.6±0.7 cm and 4.4±1.7 cm, respectively. The depth of the MEP was 1.6±0.3 cm. The differences in locations according to movement of the nerve branch were 0.3 cm, and depths were 0.2 cm. The pronated position results of this study will be clinically helpful.

El objetivo fue examinar el cambio de posición del nervio mediano de acuerdo con el movimiento del antebrazo. Se examinaron 30 muestras frescas de 15 cadáveres adultos coreanos (10 hombres y 5 mujeres) con edades entre 53­91 años. Se midió el punto de entrada motor de acuerdo con las posiciones normales y pronación del antebrazo. Las coordenadas X e Y del primer punto de entrada motor (PEM) en la posición normal fueron de 1,6±0,6 cm y 2,8±1,3 cm, respectivamente. La profundidad del PEM fue de 1,5±0,3 cm. Las coordenadas X e Y del segundo PEM fueron 1,3±0,3 cm y 4,7±1,7 cm, respectivamente. La profundidad del PEM fue 1,4±0,2 cm. Las coordenadas X e Y del primer PEM del antebrazo en posición de pronación fueron 1,9±0,7 cm y 2,3±0,8 cm, respectivamente. La profundidad del PEM fue 1,7±0,4 cm. Las coordenadas X e Y del segundo PEM fueron 1,6±0,7 cm y 4,4±1,7 cm, respectivamente. La profundidad del PEM fue 1,6±0,3 cm. Las diferencias en las ubicaciones de acuerdo con el movimiento del ramo nervioso fueron de 0,3 cm, y las profundidades fueron de 0,2 cm. Los resultados de la posición de pronación de este estudio serán útiles en trabajos clínicos.

Anthropological and perceptual predictors affecting the ranking in arm wrestling competition / Predictores antropológicos y perceptuales que afectan la clasificación en la competencia de fuerza

The purpose of this study was to investigate the predictors contributing to be in the first three places with right and left arm in armwrestling. Seventy-three male senior armwrestlers competed in Turkish National Championship voluntarily participated in this study. Some participants competed with both arms. Two samples were composed of according to the participant competition category, for right (69 participants) and left arm (65 participants). The data were collected from eight different weight classes. Handgrip strength, auditory reaction time, forearm length, and forearm circumference were determined as the predictors. All the measurements were taken after weigh-ins had been done and before the first day of national championship competition. Logistic regression analysis was conducted to predict whether a competitor in armwrestling would be in the first three places either with right or left arm, to be a winner or non-winner. Relative handgrip strength was found a significant predictor for both right and left arm ranking (p < 0.05). Auditory reaction time was found a significant predictor only for right arm ranking (p < 0.05) and forearm circumference was found a significant predictor only for left arm ranking (p < 0.05). These results suggest that strength can be viewed as the main predictor in left arm ranking; however, auditory reaction time is also an important factor to be in the first three places in right arm ranking. Thus, competitors should also focus to improve this perceptual skill.

El objetivo de este estudio fue investigar los predictores que contribuyen a clasificar en los tres primeros lugares en la lucha de fuerza de brazos (vencidas o pulsadas) con el brazo derecho e izquierdo. Setenta y tres hombres luchadores senior compitieron en el Campeonato Nacional de Turquía y participaron voluntariamente en este estudio. Algunos participantes compitieron con ambos brazos. Dos muestras fueron conformadas de acuerdo con la categoría de competencia del participante, para el brazo derecho (69 participantes) y el brazo izquierdo (65 participantes). Los datos se obtuvieron para 8 categorías de peso. La fuerza de prensión, tiempo de reacción auditiva, largo del brazo y circunferencia del antebrazo se determinaron como predictores. Todas las medidas fueron tomadas después de pesaje clasificatorio y antes del primer día de competición. Un análisis de regresión logística se realizó para predecir si un competidor en lucha de fuerza estaría en los tres primeros lugares ya sea con el brazo derecho o izquierdo, para ser un ganador o no ganador. La fuerza de prensión relativa resultó un predictor significativo para la clasificación tanto en el brazo derecho e izquierdo (p <0,05). El tiempo de reacción auditiva se encontró un predictor significativo sólo para la clasificación del brazo derecho (p <0,05) y la circunferencia del antebrazo un predictor significativo sólo para el brazo izquierdo (p <0,05). Estos resultados sugieren que la fuerza puede ser vista como el principal predictor en la clasificación para el brazo izquierdo, sin embargo, el tiempo de reacción auditiva es también un factor importante para estar en los tres primeros lugares de la clasificación para el brazo derecho. Por lo tanto, los competidores también deben centrarse en mejorar esta habilidad perceptual.

Change in Electromyographic Activity of Wrist Extensor by Cylindrical Brace

PURPOSE: To verify the effect of a newly-developed cylindrical type forearm brace, which was designed to give focal counterforce perpendicularly on the muscle belly of the wrist extensor. MATERIALS AND METHODS: The dominant hands of 24 (12 males, 12 females) healthy subjects were tested. Two types of forearm braces (focal cylindrical type and broad pneumatic type) were examined. The braces were applied at the extensor carpi radialis brevis, 5 to 7 cm distal to the lateral epicondyle. Two surface electrodes were attached to the proximal and distal parts of the brace. By quantitative electromyography, the mean amplitudes of voluntary extensor carpi radialis brevis contraction before and after applying each brace were recorded and analyzed. RESULTS: The mean amplitudes of the focal cylindrical brace and broad pneumatic brace were reduced significantly compared to no brace (p<0.05), with a larger reduction for the cylindrical brace than the pneumatic brace (p<0.05). There was no significant difference between the proximal and distal mean amplitudes with each brace. CONCLUSION: A cylindrical type brace decreased electromyographic activity in the wrist extensor more effectively than did the pneumatic type brace.

Influencia de la postura durante el corte de flores en la fuerza de aprehensión / The influence of posture during flower-cutting on the strength of flower-cutters' apprehension

Objetivo: Los desordenes músculo esqueléticos y especialmente el síndrome del conducto carpiano es uno de los problemas de salud pública más importantes de los últimos años. Es la mayor causa de morbilidad profesional en Colombia, y uno de los ámbitos laborales con mayor incidencia es el sector floricultor. El estudio se propuso establecer si la fuerza de aprehensión en el corte de flores se ve afectada por la altura del corte y la postura del brazo. Método: Participaron 12 operarias y se utilizó un arreglo factorial 2x2 con la altura de corte y postura en pronación o supinación del antebrazo como los factores que influyen en la fuerza de aprehensión. Resultados: El análisis estadístico muestra que no existe interacción entre los factores, pero si efectos importantes sobre la fuerza de aprehensión. La variación de la flexión del brazo tiene un mayor efecto en comparación con el cambio de la postura del antebrazo (pronación o supinación). Conclusiones: La postura ideal para realizar la tarea de corte es la pronación debido a que el esfuerzo necesario para realizar dicha tarea es menor. Se propone que las investigaciones futuras deben estudiar los efectos de las desviaciones de la muñeca en el sector floricultor.

Objective: Musculoskeletal disorders, particularly carpal tunnel syndrome, have been one of the most important public health problems during recent years. It is the leading cause of occupational morbidity in Colombia, the flower industry being one of the areas of work having the highest incidence. This study was thus aimed at ascertaining whether flower-cutters' strength of apprehension has been affected by cutting height and arm posture. Method: The study involved 12 operating personnel; a 22 factorial arrangement was used and the effect of cutting height and posture on forearm pronation or supination ans the factors influencing the strength of apprehension. Results: Statistical analysis showed no interaction between the factors; however, it did reveal a significant effect on the strength of apprehension. Varying how the arm bent had a greater effect than changing the position of the forearm (pronation or supination). Conclusions: Pronation was the ideal flower-cutting posture because it involved less effort to perform such task. Further research should examine the effects of wrist deviation angle in the flower industry.

The surface electromyography analysis of the non-plegic upper limb of hemiplegic subjects / Análise da eletromiografia de superfície do membro superior não plégico de hemiplégicos

Many authors have studied physical and functional changes in individuals post-stroke, but there are few studies that assess changes in the non-plegic side of hemiplegic subjects. This study aimed to compare the electromyographic activity in the forearm muscles of spastic patients and clinically healthy individuals, to determine if there is difference between the non-plegic side of hemiplegics and the dominant member of normal individuals. 22 hemiplegic subjects and 15 clinically healthy subjects were submitted to electromyography of the flexor and extensor carpi ulnaris muscles during wrist flexion and extension. The flexor muscles activation of stroke group (average 464.6 u.n) was significantly higher than the same muscles in control group (mean: 106.3 u.n.) during the wrist flexion, what shows that the non affected side does not present activation in the standart of normality found in the control group.

Muitos autores estudaram as modificações funcionais e físicas em indivíduos pós-acidente vascular cerebral; porém, poucos estudos avaliam alterações no hemicorpo não plégico de indivíduos hemiplégicos. O objetivo deste estudo foi comparar a atividade eletromiográfica nos músculos do antebraço de pacientes espásticos e indivíduos clinicamente saudáveis, para averiguar se há diferença entre o lado não plégico de indivíduos hemiplégicos e o lado dominante de indivíduos clinicamente saudáveis. 22 indivíduos hemiplégicos e 15 clinicamente saudáveis foram submetidos à eletromiografia dos músculos flexor e extensor ulnar do carpo durante a flexão e extensão do punho. A ativação dos músculos flexores dos hemiplégicos (média: 464,6 u.n), foi significantemente maior que nos indivíduos do grupo controle (média: 106,3 u.n) durante o movimento de flexão do punho, o que demonstra que o hemicorpo não acometido dos pacientes estudados não apresenta o comportamento padrão de normalidade encontrado no grupo controle.

Intraobserver and interobserver reliability of radial torsion angle measurements by a new and alternative method with computed tomography

OBJECTIVE: To evaluate the intraobserver and interobserver reliability of radial torsion angle measurement using computed tomography. METHODS: Twelve pairs of cadaver radii and 116 forearms from 58 healthy volunteers were evaluated using axial computed tomography sections measured at the level of the bicipital tuberosity and the subchondral region of the radius. During digital imaging, the angle was formed by two lines, one diametrically perpendicular to the radial tubercle and the other tangential to the volar rim of the distal joint surface. Measurements were performed twice each by three observers. RESULTS: In cadaveric bones, the mean radial torsion angle was 1.48º (-6º - 9º) on the right and 1.62º (-6 º - 8º) on the left, with a mean difference between the right and left sides of 1.61º (0º - 8º). In volunteers, the mean radial torsion angle was 3.00° (-17° - 17°) on the right and 2.91° (-16°- 15°) on the left, with a mean difference between the sides of 1.58º (0º - 7º). There was no significant difference between each side. The interobserver correlation coefficient for the cadaver radii measurements was 0.88 (0.72 - 0.96) and 0.81 (0.58 - 0.93) for the right and left radius, respectively, while for the volunteers, the difference was 0.84 (0.77 - 0.90) and 0.83 (0.75 - 0.89), respectively. Intraobserver reliability was high. CONCLUSION: The described method is reproducible and applicable even when the radial tubercle has a rounded contour.

Anatomy and functional architecture of the anconeus muscle / Anatomía y arquitectura funcional del músculo ancóneo

The anconeus is a small muscle situated at the elbow. Although the anconeus is active during elbow extension its importance for the movement is probably small. It could work as an elbow stabilizer. The object of this study was to investigate some anatomic and architectural characteristics of the anconeus, in the hope of shedding light on its function. We studied twenty adult cadaveric specimens. The anconeus originates by the lateral epicondyle of the humerus and inserts along the proximal ulna. The superficial shape of the anconeus is triangular. Tridimensionally the anconeus resembles a hemisected rectangular-based pyramid, with the base at the ulna and apex at the lateral epicondyle. The muscle fibers arise obliquely from the tendinous expansion and inserts at the ulna. Thus, the architecture of the anconeus is penniform, an architecture able to produce more force then displacement. The design index of 0.3 also suggests a force muscle.

El ancóneo es un pequeño músculo situado en la región del codo. Aunque el músculo ancóneo es activo durante la extensión del codo su importancia para este movimiento es probablemente pequeña. Podría actuar como estabilizador del codo. El objetivo de este trabajo fue investigar algunas características anatómicas y arquitectónicas del músculo ancóneo, con la esperanza de lanzar una cierta luz en su función. Estudiamos 20 cadáveres de adultos. El músculo ancóneo se origina al lado del epicóndilo lateral y se inserta en la ulna. La forma superficial del músculo ancóneo es triangular. Tridimensionalmente, el músculo ancóneo se asemeja a la mitad de una pirámide de base rectangular, con la base en la ulna y el ápice lateral al epicóndilo lateral. Sus fibras musculares describen un trayecto oblicuo con una extensión tendinosa que se insertan en la ulna. Por lo tanto, la arquitectura del músculo ancóneo es peniforme, una arquitectura conveniente para producir mayor fuerza con el desplazamiento. El índice de diseño de 0,3 también lo sugiere como un músculo de fuerza.

Ulnar and humeral heads forming separate bellies: a rare case of digastric flexor carpi ulnaris muscle / Cabezas ulnar y humeral formando vientres separados: un caso raro del músculo flexor ulnar del carpo digástri

Proper knowledge of muscular variations is essential for both anatomists and surgeons. Variations of the flexor carpi ulnaris (FCU) are not very common. We are reporting an unusual case of FCU muscle with two bellies. The two heads (ulnar and humeral) of the muscle continued as two separate bellies and the tendons of which joined each other slightly proximal to the wrist before getting inserted to pisiform bone. Further, detailed literature review of variations of FCU muscle is done and the developmental basis for the variation and its surgical importance are discussed.

El correcto conocimiento de las variaciones musculares es esencial para anatomistas y cirujanos. Variaciones del músculo flexor ulnar del carpo (MFUC) no son muy comunes. Se reporta un caso inusual del MFUC con dos vientres. Las dos cabezas (ulnar y humeral) del músculo continuaron como dos vientres separados. Los tendones se unieron entre sí, ligeramente proximal a la muñeca, antes de llegar a su inserción en el hueso pisiforme. Se hace una detallada revisión de la literatura de las variaciones del MFUC y son discutidas las bases del desarrollo de las variaciones, destacándose además su importancia quirúrgica.

Synergistic control of forearm based on accelerometer data and artificial neural networks

In the present study, we modeled a reaching task as a two-link mechanism. The upper arm and forearm motion trajectories during vertical arm movements were estimated from the measured angular accelerations with dual-axis accelerometers. A data set of reaching synergies from able-bodied individuals was used to train a radial basis function artificial neural network with upper arm/forearm tangential angular accelerations. The trained radial basis function artificial neural network for the specific movements predicted forearm motion from new upper arm trajectories with high correlation (mean, 0.9149-0.941). For all other movements, prediction was low (range, 0.0316-0.8302). Results suggest that the proposed algorithm is successful in generalization over similar motions and subjects. Such networks may be used as a high-level controller that could predict forearm kinematics from voluntary movements of the upper arm. This methodology is suitable for restoring the upper limb functions of individuals with motor disabilities of the forearm, but not of the upper arm. The developed control paradigm is applicable to upper-limb orthotic systems employing functional electrical stimulation. The proposed approach is of great significance particularly for humans with spinal cord injuries in a free-living environment. The implication of a measurement system with dual-axis accelerometers, developed for this study, is further seen in the evaluation of movement during the course of rehabilitation. For this purpose, training-related changes in synergies apparent from movement kinematics during rehabilitation would characterize the extent and the course of recovery. As such, a simple system using this methodology is of particular importance for stroke patients. The results underlie the important issue of upper-limb coordination.

Concentric needle single fiber electromyography: normative jitter values on voluntary activated Extensor Digitorum Communis

Single fiber electromyography (SFEMG) is the most sensitive clinical neurophysiological test for neuromuscular junction disorders, particularly myasthenia gravis. Normal values for jitter obtained with SFEMG electrode have been published, but there are few publications for concentric needle electrode (CNE). The aim of this study was to discuss the possibilities to analyse the jitter in CNE recordings and to get normal values of jitter for voluntary activated Extensor Digitorum Communis using disposable CNE. Fifty normal subjects were studied, 16 male and 34 female with a mean age of 37.1±10.3 years (19-55). The jitter values of action potentials pairs of isolated muscular fibers were expressed as the mean consecutive difference (MCD) after 20 analysed potential pairs. The mean MCD (n=50) obtained was 24.2±2.8 µs (range of mean values in each subject was 18-31). Upper 95 percent confidence limit is 29.8 µs. The mean jitter of all potential pairs (n=1000) obtained was 24.07±7.30 µs (range 9-57). A practical upper limit for individual data is set to 46 µs. The mean interpotential interval (MIPI) was 779±177 µs (range of individual mean values was 530-1412); there were no potentials with impulse blocking. The present study confirms that CNE is suitable for jitter analysis although certain precautions must be mentioned. Our findings of jitter values with CNE were similar to some other few reports in literature.

Eletromiografia de fibra única (SFEMG) é o método eletrofisiológico mais sensível para diagnóstico das desordens de junção neuromuscular, particularmente miastenia gravis. Jitter obtido por meio de eletrodo de SFEMG já foi padronizado, porém há poucas publicações com uso de eletrodo de agulha concêntrica (CNE). O objetivo deste estudo é discutir as possibilidades de analisar o jitter por registro com CNE e obter valores normativos para o músculo Extensor Digitorum Communis por ativação muscular mínima. Foram estudados 50 indivíduos normais, 34 do sexo feminino e 16 do sexo masculino, com média de idade de 37,1±10,3 anos (19-55). Os valores do jitter para pares de potenciais de fibras musculares isoladas foram medidos por meio da média das diferenças consecutivas (MCD) em 20 análises de pares de potenciais. A média de MCD (n=50) foi 24,2±2,8 µs (variação de 18 a 31). O limite superior (95 por cento) foi 29,8 µs. O jitter médio de todos os pares de potenciais obtidos (n=1000) foi 24,07±7,30 µs (variação de 9 a 57). O limite superior de normalidade prático para os dados individuais foi 46 µs. O valor médio dos intervalos interpotenciais (MIPI) foi 779±177 µs (variação de 530 a 1412); não foram obtidos potenciais com bloqueio. O presente estudo confirma a viabilidade da análise do jitter por CNE embora certas precauções devam ser mencionadas. Nossos valores de jitter obtidos por CNE são parecidos com os poucos relatos da literatura.

Teste de estimulação repetitiva no músculo ancôneo para diagnóstico da miastenia grave: mapeamento da sua área de placa motora / Repetitive stimulation test on the anconeus muscle for the diagnosis of myasthenia gravis: the mapping of its motor end-plate area

OBJETIVO: Mapear a área de placa motora do músculo ancôneo para definir a melhor localização dos eletrodos de registro em testes de estimulação repetitiva (TER) no diagnóstico dos distúrbios da transmissão neuromuscular. MÉTODO: Registramos o potencial de ação composto do músculo ancôneo sobre a pele que o recobre, após estimulação do ramo que o inerva. Analisando as formas de onda registradas em cada ponto da pele foi possível definir a área de placa. RESULTADOS: A área de placa motora do ancôneo é uma linha paralela à borda da ulna. O melhor local de colocação do eletrodo "ativo" de registro situa-se cerca de 2 cm distal ao olécrano e 1 cm lateral à borda da ulna. CONCLUSÃO: A realização de TER no músculo ancôneo é simples e bem tolerada. Com a estimulação do ancôneo o antebraço praticamente não se move, sendo o procedimento livre de artefatos de movimento.

PURPOSE: To map the motor end-plate area of the anconeus muscle and define the best place for positioning the recording electrodes in repetitive stimulation tests (RST) for the diagnosis of neuromuscular transmission disorders. METHOD: The compound muscle action potential of the anconeus was recorded after stimulating the motor branch of the radial nerve that innervates it. By analyzing the waveforms registered at each point of the skin we were able to define the motor end-plate area. RESULTS: The motor end-plate area of the anconeus is a line parallel to the ulna border. The best place for placing the "active" recording electrode is about 2cm distal to the olecranon and 1 cm lateral to the border of the ulna. CONCLUSION: Performing RST in the anconeus muscle is simple and well tolerated. Stimulation of the anconeus almost doesn't move the forearm and the procedure is virtually free of movement artifacts.

Electromyographical study on muscle fatigue in repetitive forearm tasks / 华中科技大学学报（医学）（英德文版）

The purpose of this study was to examine whether repetitive muscle tasks in low weight load might influence the fatigue of forearm muscles, and to identify ergonomic risk factors of forearm muscle fatigue in these tasks. Sixteen healthy male volunteers performed eight wrist extensions in different frequency, weight and angle loads while being instructed to keep a dominant upper limb posture as constant as possible. Surface electromyograph (sEMG) was recorded from right extensors digitorium (ED), flexor carpi radialis (FCR), flexor carpi ulnaris (FCU) and extensor carpi ulnaris (ECU) during the task performance. Our results showed that mean power frequency (MPF) and median frequency (MF) values of ED, FCR and FCU were significantly lower (P<0.05) at high frequency load level than at low load level. However, MPF and MF values of ED were significantly lower (P<0.01) in higher load groups of frequency, angle and weight than in lower load groups. These results indicated that the fatigue of muscles varied in the same task, and the number-one risk factor of ECU, ED and FCR was angle load.

Estudo anatômico das inserções distais do tendão extensor longo do polegar / Anatomical studies of the distal insertion of the extensor pollicis longus

Registramos pelo presente estudo que o músculo (ELP) e seu tendão apresentaram poucas variações anatômicas. Não registramos a presença de tendões acessórios e nem a ausência desse músculo ou de seu tendão. Verificamos em todas as preparações a passagem do tendão pelo terceiro compartimento osteofibroso, cruzando sobre os extensor radial curto (ERCC) e longo (ERLC) do carpo e dirigindo-se ao polegar. A alteração no trajeto tendinoso, desviando-se no sentido radial foi verificada em uma das preparações (1,6 por cento). A duplicação parcial do tendão proximal a articulação metacarpofalângica (AMFP) foi verificada em 3 observações (4,8 por cento), sendo 1 bilateral, e distal à articulação em 5 (8,3 por cento), 2 bilateralmente. A inserção óssea na base da falange distal (BFD) foi encontrada em todas as observações. Durante sua passagem pela articulação metacarpofalângica, registramos sua inserção na cápsula articular em 14 observações (23,3 por cento), porém não registramos a inserção óssea nesse local. O padrão mais comum em relação ao músculo ELP foi a presença constante de 1 tendão, passando pelo terceiro compartimento osteofibroso dorsal do punho com inserção óssea na base da falange distal do polegar.

normal carrying angle of the elbow in shiraz

The normal carrying angle in Shiraz population was measured on the basis of sex and age. The right elbow angle of 4266 cases was examined from birth to 30 years old. This study found the carrying angle in 2540 females to be 7.2° [range 2-19] and in 1726 males to be 6.40 [range 2-11], a 0.8° difference. A significant difference [p= 0.05] was found in relation to age. There is a gradual increase in the carrying angle with skeletal maturation

Peripheral glucose metabolism in patients with chronic renal failure

The present study was designed to determine the effect of chronic renal failure on forearm muscle glucose uptake and oxidation during the postabsorptive state and after an oral glucose challenge. Twelve normal subjects and sixteen patients with chronic renal failure were studied after an overnight fast (12-14h) and for 3h after the ingestion of 75g glucose. Peripheral glucose metabolism was analyzed by the forearm technique to estimate muscle exchange of substrate combined with indirect calorimetry. decreased forearm glucose uptake was observed in uremic patients compared to normal subjects (9l.5 ñ 11,4 vs 154.8 ñ 7.8mg 100 ml forearm -1 3h-1) with diminished nonoxidative glucose metabolism (69.4 ñ 12.1 vs 117.2 ñ 12.8mg 100 ml forearm-1 3h-1). Muscle glucose oxidation did not difer significantly between groups. Both serum free fatty acid levels and lipid oxidation rates were similar in the normal subjects and the uremic patients, and declined in a similar fashion after glucose ingestion. Basal serum insulin levels did not differ significantly between normal and uremic patients, whereas the insulinemic response to glucose load was greater among the patients with chronic renal failure. These data show that resistance occurring in patients with chronic renal failure is accompanied by impaired muscle glucose uptake and nonoxidative glucose metabolism

Estudo eletromiográfico do músculo bíceps braquial / Eletromyographic study of the biceps brachialis muscle

O músculo bíceps braquial foi analisado em 30 voluntários adultos de ambos os sexos, sendo 15 praticantes de halterofilismo e 15 nao praticantes, em movimentos de flexao do antebraço em pronaçao; extensao do antebraço em pronaçao e rotaçao lateral do braço com cotovelo fletido (90() e mao em semi-pronaçao. Neste estudo foi utilizado um eletromiógrafo TECA TE4 de dois canais e eletrodos de superfície do tipo Beckman. Os registros elctromiográficos evidenciaram que: 1- nao houve diferença significativa na atividade muscular nos movimentos de carga, em ambos os grupos; 2-a diferença na atividade muscular ocorreu com o aumento da carga.