Reconstruction of Bilateral Chronic Triceps Brachii Tendon Disruption Using a Suture-Mediated Anatomic Footprint Repair in a Dog.

A 2-year-old, intact female Pomeranian presented with bilateral forelimb lameness, characterized by the olecranon making contact with the ground. The patient experienced two separate incidents of falling, occurring four and three weeks before admission, respectively. Following each episode, non-weight-bearing lameness was initially observed in the left forelimb, followed by the development of crouch gait. Based on the physical examination, radiographic, and ultrasonographic findings, bilateral triceps brachii tendon disruption was diagnosed. Intraoperatively, excessive granulation tissue at the distal end of the tendon was excised. The footprint region of each triceps brachii tendon was decorticated with a high-speed burr until bleeding was observed. The triceps brachii tendon was reattached to completely cover its footprint on the olecranon using the Krackow suture technique. This method involves anchoring the suture through bone tunnels in the ulna. Trans-articular external skeletal fixation was applied to both forelimbs to immobile and stabilize the elbow joints for nine weeks. Subsequently, the dog gradually increased its walking activities while on a leash over a six-week period. At the three-year follow-up, the patient exhibited improved forelimb function and maintained a normal gait without signs of lameness. Suture-mediated anatomic footprint repair proved useful in this single case and may be an effective surgical alternative for the management of chronic triceps brachii tendon disruption in dogs.

Triceps Tendon Avulsion in a Soldier: A Case Report.

Background: Clinical assessment of triceps brachii tendon tears is challenging, and conventional imaging methods have limitations. Timely surgical referral is important in high-grade tears to maximize patient outcomes, and musculoskeletal ultrasound (MSK US) can be used at the time of clinical examination to identify such injuries requiring advanced imaging and orthopedic referral. Hypothesis/Purpose: The purpose of this case report is to describe how MSK US was used to facilitate advanced imaging and timely orthopedic referral for a patient presenting to a physical therapist with a high-grade triceps tendon avulsion. Study Design: Case Report. Case Description: A 35-year-old male soldier presented to a direct access sports physical therapist with acute-on-chronic right elbow pain. Physical examination and MSK US were used to identify a high-grade partial triceps brachii tendon tear. The MSK US findings informed the physical therapist's decision-making process to refer the subject for timely advanced imaging studies as well as referral to an orthopedic physician. Outcomes: A high-grade partial triceps tendon avulsion was confirmed on magnetic resonance imaging (MRI). The subject was then seen by an orthopedic surgeon and underwent surgical repair of the tendon within the recommended three-week timeframe for optimal outcomes. The subject completed a post-operative rehabilitation program and returned to full physical and occupational activities. Conclusion: MSK US can assist in the diagnosis of challenging triceps tendon injuries, facilitating timely advanced imaging and orthopedic referrals for high-grade injuries to optimize patient outcomes. Level of Evidence: 5.

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.

Options for Restoring Finger Extension in Mangled Forearm Injuries.

Restoration of finger extension in mutilating hand injuries is crucial for restoring prehension and independent use of the hand. Patients often express desire to restore finger extension once finger flexion is achieved. However, the extensive forearm injury precludes use of any of conventional donors like the wrist or finger flexors for transfer to restore finger extension. Two patients with sequelae of mangled forearm injuries, underwent biceps and long head of triceps transfer to the finger extensors to improve opening up of the fingers. We discuss the treatment considerations while planning these transfers and provide the technical details, rehabilitation and outcome of these patients. Both the patients expressed dramatic improvement of their hand function and were satisfied with the outcome. Biceps and long head of triceps could serve as an effective second-line donor for restoration of finger extension when the conventional donors are not available. Level of Evidence: Level V (Therapeutic).

Effects of dietary minerals deficiency and supplementation on different parts of muscle minerals content in grazing Mongolian sheep.

Objective: The objective of this study was to investigate the impact of dietary deficiency and supplementation of calcium, zinc, copper, cobalt, manganese or selenium on minerals content in the longissimus dorsi (LD), biceps femoris (BF) and triceps brachii (TB) of grazing Mongolian sheep. Methods: We randomly divided 98 sheep into 7 treatment groups and fed them specific diets for 60 days: a total mineral nutrition diet (LCG), a calcium deficiency diet (LCa), a zinc deficiency diet (LZn), a copper deficiency diet (LCu), a cobalt deficiency diet (LCo), a manganese deficiency diet (LMn) and a selenium deficiency diet (LSe). Then 7 sheep from each group were slaughtered and samples of LD, BF and TB were collected for mineral content analysis. The remaining sheep in each group were subsequently fed specific diets for an additional 41 days: a total mineral nutrition diet (SCG), a calcium supplementation diet (SCa), a zinc supplementation diet (SZn), a copper supplementation diet (SCu), a cobalt supplementation diet (SCo), a manganese supplementation diet (SMn) and a selenium supplementation diet (SSe). Afterward, all sheep were slaughtered, and muscle samples were collected and analyzed. Results: Significant findings emerged that LCa decreased sulfur (S) content in BF and increased Ca content in LD and BF, while SCa increased S and Ca content in BF and TB, respectively (P < 0.05). LZn decreased Zn, S, and potassium (K) content in LD and BF, while SZn increased Zn and S content in LD and BF, respectively (P < 0.05). LCu decreased Cu and iron (Fe) content in LD and TB, while SCu increased Fe content in TB (P < 0.05). LCo decreased phosphorus, S, K, Ca, Mn, Fe, Cu, and Zn content in LD (P < 0.05). LMn decreased Mn content and increased K content in TB, while SMn decreased K content in BF and TB (P < 0.05). LSe and SSe decreased and increased Se content in LD, BF, and TB, respectively (P < 0.05). Conclusion: Dietary mineral levels have varying effects on lamb meat minerals content. It is important to ensure an adequate intake of minerals in the diet to enhance the mineral nutrition of lamb meat.

Does the articularis cubiti muscle really exist? Anatomical, histological, and magnetic resonance imaging study with a narrative review of literature.

Although the term articularis cubiti muscle is incorporated in the official anatomical nomenclature, only sparse data about its appearance are available. It is usually described as few fibres originating from the medial head of the triceps brachii muscle and inserting to the capsule of the elbow joint. However, the most recent observations regarding the morphological relations in the posterior elbow region point towards the absence of a well-defined muscle. Therefore, this study was designed to verify the existence of the articularis cubiti muscle in question and to compile more data on the topographical features of the subtricipital area near the posterior aspect of the elbow. To address these questions, 20 embalmed upper limbs were dissected, and seven samples were collected for histological analysis. The laboratory findings were then correlated with 20 magnetic resonance imaging (MRI) scans of the elbow. Consequently, a narrative review of literature was performed to gain more information on the discussed muscle in a historical context. Upon the anatomical dissection, muscular fibres running from the posterior aspect of the shaft of the humerus to the elbow joint capsule and olecranon were identified in 100% of cases. Histologically, the connection with the joint capsule was provided via winding bands of connective tissue. On MRIs, the muscular fibres resembled a well-demarcated thin muscle located underneath the medial head of the triceps brachii muscle. Combined with the review of literature, we concluded that the constant articularis cubiti muscle originates from the posterior shaft of the humerus and attaches indirectly to the posterior aspect of the elbow joint capsule and directly to the superior portion of the olecranon. The obtained results slightly differ from the modern description, but are in agreement with the original publication, which has become misinterpreted throughout time. Presumably, the misused description has led to questioning the existence of an independent muscle. Moreover, our findings attribute to the articularis cubiti muscle, a function in pulling on the posterior aspect of the elbow joint capsule to prevent its entrapment, and possibly also a minor role in extension of the forearm. The presented results should be taken into consideration when intervening with the posterior aspect of the elbow joint because the articularis cubiti muscle poses a consistently appearing landmark.

The orderly recruitment of motor units may be modified when a muscle is acting as an antagonist.

Despite the perceived importance of antagonist muscle activity, it is unknown if motor unit (MU) behavior at recruitment differs when a muscle acts as an antagonist versus agonist. Fourteen healthy participants performed ramped, isometric elbow flexor or extensor contractions to 50% or 100% maximal voluntary contraction (MVC) torque. Surface and fine-wire intramuscular electromyographic (EMG) recordings were sampled from biceps and triceps brachii. During agonist contractions, low-threshold MUs (recruited at <10% MVC torque) were sampled in all participants, with a total of 107 and 90 for biceps and triceps brachii, respectively. For ramped MVCs, antagonist surface EMG coactivation (% amplitude during agonist MVC) was 8.3 ± 6.6% for biceps and 15.2 ± 7.3% for triceps brachii. However, antagonist single MU activity was recorded from only four participants, with only one of these individuals having antagonist MUs recorded from both muscles. All antagonist MUs were successfully detected during agonist contractions, but many (∼40%) had a recruitment threshold >10% MVC torque. For MUs recorded during both agonist and antagonist contractions, discharge rate at recruitment was seemingly lower for antagonist than agonist contractions. Coexistence of typical levels of surface EMG-derived coactivation with scant antagonist MU recordings suggests that coactivation in these muscles is primarily the result of cross talk. Based on the limited antagonist MU data detected, MUs recruited early during an agonist contraction are not necessarily among those first recruited during an antagonist contraction. These findings highlight the possibility of a modification of orderly recruitment when a motoneuron pool is acting as an antagonist.NEW & NOTEWORTHY Modest levels of coactivation are widely considered essential for appropriate motor control; however, minimal attention has been given to recruitment patterns of motor units (MUs) from antagonist muscles. Despite the successful recording of many low-threshold MUs during agonist contractions, we recorded no antagonist MUs in most participants. Of the units recorded, only ∼60% matched those recruited at <10% of maximal torque when the muscle acted as an agonist, which suggests a modified recruitment order for antagonist MUs.

Is the radial groove a myth? Is the radial nerve in direct contact with the posterior humerus?

BACKGROUND: The radial groove is known as a sulcus on the posterior humerus and protects the radial nerve from adjacent muscle and soft tissue. In the literature, there exists heterogeneity regarding the presence of an actual radial groove and the radial nerve's interaction with the periosteum of the humerus. This study aimed to determine if there is a real radial groove, "sulcus," and define the relationship between the radial nerve and the periosteum of the posterior humerus. METHODS: Eighteen fresh-frozen cadaveric specimens were dissected using a posterior triceps splitting approach. The radial nerve's interaction with the periosteum of the humerus was determined. The presence of a visible and palpable radial groove was also examined. RESULTS: In 56% of specimens, the radial nerve was directly seated over the periosteum of the posterior humerus (direct contact between the nerve and bone). In comparison, 44% of specimens had a layer of the medial head of the triceps brachii muscle fibers interposition between the nerve and bone. 89% of specimens had no visible or palpable radial groove. In 11% of specimens, there was mild palpable depression. CONCLUSION: This study shows that the radial groove may not exist and is probably not a true anatomical structure. In addition, the nerve is in direct contact with the posterior periosteum of the humerus in most specimens. These anatomic relationships and findings add to the anatomical understanding of the radial nerve, which helps during operative approaches and fixation of the humerus.

Distribution of the intramuscular innervation of the triceps brachii: Clinical importance in the treatment of spasticity with botulinum neurotoxin.

This study aimed to identify ideal sites for botulinum toxin injection by analyzing the intramuscular nerve patterns of the triceps brachii muscles. A modified Sihler's method was applied to the triceps brachii muscle (15 specimens), with long, medial, and lateral heads. The intramuscular arborization areas of the long, medial, and lateral heads of the triceps brachii muscle were measured as a percentage of the total distance from the midpoint of the olecranon (0%) to the anteroinferior point of the acromion (100%), by dividing the medial and lateral parts based on the line connecting the midpoint of the olecranon and the anteroinferior point of the acromion. Intramuscular arborization patterns were observed at the long head at two medial regions, proximally 30%-50% and distally 60%-70%; medial head of 30%-40%; and lateral head of 30%-60%. These results suggest that the treatment of spasticity of the triceps brachii muscles involves botulinum toxin injections in specific areas. The areas corresponding to the areas of maximum arborization are recommended as the most effective and safe points for botulinum toxin injection.

Generation and analysis of synthetic surface electromyography signals under varied muscle fiber type proportions and validation using recorded signals.

The magnitude and duration of muscle force production are influenced by the fiber type proportion. In this work, surface electromyography (sEMG) signals of muscles with varied fiber type proportions, are generated. For this, relevant components of existing models reported in various literature have been adopted. Also, a method to calculate the motor unit size factor is proposed. sEMG signals of adductor pollicis (AP) and triceps brachii (TB) muscles are simulated from the onset of force production to muscle fatigue state at various percentages of maximal voluntary contraction (MVC) values. The model is validated using signals recorded from these muscles using well-defined isometric exercise protocols. Root mean square and mean power spectral density values extracted from the simulated and recorded signals are found to increase for TB and decrease for AP with time. A linear variation of the features with %MVC values is obtained for simulated and experimental results. The Bland-Altman plot is used to analyze the agreement between simulated and experimental feature values. Good agreement is obtained for the feature values at various %MVCs. The mean endurance time calculated using the model is found to be comparable to that of the experimental value. This method can be used to generate sEMG signals of different muscles with varying fiber type ratios under various neuromuscular conditions.

Elbow Extensor Muscles in Humans and Chimpanzees: Adaptations to Different Uses of the Upper Extremity in Hominoid Primates.

The anatomical and functional characteristics of the elbow extensor muscles (triceps brachii and anconeus) have not been widely studied in non-human hominoid primates, despite their great functional importance. In the present study, we have analyzed the muscle architecture and the expression of the myosin heavy chain (MHC) isoforms in the elbow extensors in humans and chimpanzees. Our main objective was to identify differences in these muscles that could be related to the different uses of the upper extremity in the two species. In five humans and five chimpanzees, we have analyzed muscle mass (MM), muscle fascicle length (MFL), and the physiological cross-sectional area (PCSA). In addition, we have assessed the expression of the MHC isoforms by RT-PCR. We have found high MM and PCSA values and higher expression of the MHC-IIx isoform in the triceps brachii of chimpanzees, while in humans, the triceps brachii has high MFL values and a higher expression of the MHC-I and MHC-IIa isoforms. In contrast, there were no significant differences between humans and chimpanzees in any of the values for the anconeus. These findings could be related to the participation of the triceps brachii in the locomotion of chimpanzees and to the use of the upper extremity in manipulative functions in humans. The results obtained in the anconeus support its primary function as a stabilizer of the elbow joint in the two species.

Nerve transfers in a patient with asymmetrical neurological deficit following traumatic cervical spinal cord injury: simultaneous bilateral restoration of pinch grip and elbow extension. Illustrative case.

BACKGROUND: Cervical spinal cord injury (CSCI) causes severe motor deficit in upper extremities. The mixed segmental CSCI pattern is reflected in the combination of time-sensitive (TS) and non-TS myotomes in the upper extremities. Nerve transfers (NTs) restore upper extremity function yet remain TS procedures. A combination of neurological, magnetic resonance imaging (MRI), and electromyography (EMG) studies allows the identification of TS and non-TS myotomes in the upper extremities. OBSERVATIONS: Nineteen months after NTs, flexor pollicis longus (FPL) and deep flexor of the index finger (FDP2) recovered to M4 (right UE), FPL recovered to M3 and FDP2 to M2 (left EU). The long head of the triceps brachii muscle recovered to M4 bilaterally. The Capabilities of Upper Extremity Questionnaire (CUE-Q) score for unilateral arm functionality increased by 44% (right) and 112.5% (left) and for bilateral arm functionality by 400%; the CUE-Q score for unilateral hand and finger function increased by 283% (right) and 166% (left). LESSONS: The combination of neurological, MRI, and EMG studies before surgery and data obtained during surgery provides reliable information on the CSCI pattern, specifically the availability of motor donor nerves. Simultaneous bilateral restoration is required in the event of CSCI and significantly improves the unilateral and bilateral function of the UEs.

The anatomic - magnetic resonance imaging study of distal triceps brachii tendon.

PURPOSE: The study aimed to describe the distal triceps brachii insertion on the olecranon and to correlate the findings with those seen in normal MR (Magnetic Resonance) anatomy of the triceps brachii insertion. MATERIALS AND METHODS: 14 un-paired fresh frozen elbows were included according to the institution guidelines and dissected. Histologic examination was performed to the distal triceps brachii insertion. The dimension of the distal triceps brachii tendon insertion was measured and defined based on its layer. The measurement of distal triceps brachii insertion was performed with image processing program (Image J, National Institute of Health, Bethesda, Maryland). T1-weighted elbow MR images (3.0 T) of a 102 patients were acquired and analyzed according to its sagittal plane. RESULTS: All specimens shows that distal triceps brachii tendon is with three distinct insertional areas in the olecranon which are: (1) capsular, (2) deep muscular, (3) superficial tendinous insertion with the areas of 80.7 mm2, 56.4 mm2, and 175.2 mm2, respectively. The superficial tendinous insertion was observed with a thickened portion, the "central cord" with 0.5 occupation ratio. MR analysis showed that 30% (31/102) of the distal biceps brachii insertion was with a cleft between the bipartite insertion of the superficial tendinous and the deep muscular insertion on olecranon which designated as the "lacuna" which was also found in 35% (5/14) of the specimens. CONCLUSIONS: The distal triceps brachii has three distinct insertion on the olecranon. The superficial tendinous layer was separated with the deep muscular layer by a cleft in one third of the cases. Knowledge of this anatomy will help surgeon to understand the partial triceps injury and to avoid iatrogenic injury to the distal triceps tendon during surgery.

Histological composition, physiochemical parameters, and organoleptic properties of three muscles from Fleckvieh bulls and heifers.

The histochemical characteristics, physical attributes, chemical composition, and sensory profile of three muscles (longissimus thoracis et lumborum - LTL, rectus abdominis - RA, triceps brachii - TB) from Fleckvieh (N = 24) bulls and heifers were compared. Samples of each muscle were taken within 1 h of slaughter to assess muscle fibre traits, while physio-chemical meat quality was assessed in each muscle at 48 h post mortem, followed by the sensory assessment of the muscles after 7 days of ageing. Despite identical raising conditions, bulls showed more favourable growth and slaughter performance, but heifers produced meat with more favourable sensory characteristics, as a result of a higher proportion of IIB fibres in their muscles, as well as a higher intramuscular fat content, and lower collagen content.

Musculocutaneous flap of the medial head of the triceps brachii: pedicled flap to cover the posterior cubital region.

INTRODUCTION: The medial head of the triceps brachii flap is already described as a local muscular or as a free flap. It allows coverage of defects of the posterior cubital region. The aim of this study was to describe the vascular anatomy of the musculocutaneous medial triceps brachii pedicled flap. METHODS: Eleven fresh-frozen upper limbs (6 come from women and 5 from men) were proximally injected with Indian ink agar solution. The medial head of the triceps brachii muscle was dissected and the superior ulnar collateral artery (SUCA) was isolated with its collaterals. The collateral arteries were dissected to determine whether there were septocutaneous or musculocutaneous arteries for vascularization of the skin in front of the medial head. Lengths of those collaterals arteries were measured. RESULTS: The average number of collaterals arteries from the SUCA supplying the medial head of the triceps brachii is 4.5 (from 3 to 6 arteries). Among these collaterals' arteries, there are one average 1.5 (0.6-4.5) septocutaneous arteries and 3 (1-4.8) musculocutaneous arteries. DISCUSSION AND CONCLUSION: A musculocutaneous flap with the medial head of the triceps brachii muscle can be described with the muscle. The SUCA gives perforator arteries musculocutaneous and septocutaneous for the vascularization of the triceps brachii medial head. The use of local pedicled flap with similar tissue maximizes healing with a minimal morbidity of the donor site. This study demonstrated the feasibility of the medial head triceps brachii musculocutaneous flap to cover defect of the posterior aspect of the elbow.

Mass effect of the distal triceps brachii muscle on ulnar nerve movement during elbow flexion.

INTRODUCTION/AIMS: Hypertrophic triceps brachii contributes to ulnar nerve movement, but the location of the mass effect of the triceps brachii muscle is not known. In this study we aimed to determine the mass effect of the distal medial head of the triceps brachii (DMTB) muscle on ulnar nerve movement. METHODS: In 48 arms, movement of the ulnar nerve at the medial epicondyle and muscle thickness (medial and long head of the triceps brachii [MLTB], medial head of the triceps brachii [MTB], DMTB, and biceps brachii [BB]) were measured using ultrasonography. RESULTS: Ulnar nerve movement at the elbow was consistently correlated with the DMTB muscle thickness (horizontal ulnar nerve movement at the elbow [HM] / vertical ulnar nerve movement at the elbow [VM] with 90° elbow flexion: r = 0.668 / r = 0.313, HM/VM with full elbow flexion: r = 0.481 / r = 0.391). With multiple linear regression, the DMTB was the most important muscle with regard to contribution of thickness to ulnar nerve movement. Individuals with partial and complete dislocation showed a thicker DMTB than those without dislocation. DISCUSSION: Our data suggest that the mass effect of the triceps brachii muscle is exerted primarily by its distal portion. When ulnar nerve dislocation is observed, thickness and anatomical variation of DMTB in the retrocondylar area during elbow flexion should be assessed.

The effect of targeted resistance training on bench press performance and the alternation of prime mover muscle activation patterns.

Targeted muscle strengthening might improve performance or help overcome training stagnation; therefore, the aim of the present study was to investigate changes in muscle activity patterns before and after six weeks of targeted resistance training. Twenty-seven resistance-trained men were divided into three groups according to their prime mover activity, as measured by surface electromyography during a bench press (BP). Each group underwent a six-week block of targeted exercises for one of the following muscles: anterior deltoid (AD), pectoralis major (PM) or triceps brachii (TB). ANOVA showed that each group increased their 1 repetition maximum (1RM) (p < 0.05) and the activity of the exercised muscle group during an isometric bench press (p < 0.01) and during a dynamic bench press (p < 0.01) at 85% of the 1RM. During the isometric BP, the TB training group had an increase in TB activity in comparison to the other groups. Targeted muscle training is a useful method for muscle activity increase and increasing the maximum strength in complex exercise, when applied in activity-deficient muscle groups. Strengthening the TB elicits changes in all prime movers and results in TB activity domination during a bench press.

The morphological and morphometric analysis of the variant patterns of the tricipital aponeurosis: a new anatomical classification with possible clinical implications.

BACKGROUND: Tricipital aponeurosis (TA) has gained attraction as a constant and reliable landmark to identify the location of radial nerve in the setting of fracture distal humeri. The aponeurosis itself shows variant anatomical patterns. In this study, we intend to provide a comprehensive description and functional classification of observed anatomical variations with possible clinical implications. MATERIALS AND METHODS: Sixty arms belonging to 30 adult cadavers were studied. TA was examined grossly to document variations in its shape and classified accordingly. Subsequently, length and breadth of TA were measured. The distance of the radial nerve (RN) from the point of confluence and from the lateral border of TA was also measured (tricepso-radial distance [TRD]). These distances were correlated with the different patterns of TA obtained. RESULTS: Based on the shape of the proximal apex of TA or point of confluence and frequency of their occurrence, we propose a new classification of 4 patterns for the TA anatomy. Pattern I: classically seen as the triangular proximal apex (76.67%); pattern II: tongue shaped or blunt proximal apex (18.33%); pattern III: bifurcated or dual proximal apex (3.33%); pattern IV: as the absence of TA (1.67%). The mean of length and breadth of TA was 16.58 ± 2.05 cm and 3.61 ± 0.61 cm, respectively. The mean distance of RN from point of confluence and lateral border of TA was 3.57 ± 0.19 cm and 2.04 ± 0.56 cm, respectively. The length, breadth of TA and TRD differs amongst the different patterns of TA. CONCLUSIONS: Anatomical variations in the shape and size of TA are frequently encountered. The proposed, hitherto undescribed, classification may make operating surgeon aware of these morphological variations and help prevent iatrogenic injury to RN. Such classification is simple and unique; however, its success relies upon universal acceptance.

Traumatic injury to the axillary nerve associated with paralysis of triceps brachii: A case report.

Although many textbooks reported the innervation of three heads of the triceps muscle with the radial nerve, some studies showed the axillary nerve supply to this muscle. Herein, we report a 21-year-old male patients with a traumatic injury to the axillary nerve associated with paralysis of his triceps muscle. Based on the electrophysiological findings, it could be reasonable to conclude that the main branch innervating all heads of the triceps muscle originated from the axillary nerve. It is vital to look for concomitant paralysis of the triceps in patients with an axillary nerve injury in terms of surgical management, prognosis, and nerve repair.

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.