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Concept: Elbow


Forces exerted by fibrous structures on the medial aspect of the canine elbow joint have been reported to be involved in elbow pathology. The purpose of this paper is to assess the relationships of the ligamentous and muscular structures of this region of the canine elbow joint, and how they relate to the medial coronoid process. Six cadavers of adult German shepherd cross-breed dogs were used in this study to make intra-articular and vascular injections of this region. Some joints were dissected and some were frozen to saw sagittal or dorsal cryosections to assess the relationships of the myotendinous structures. The brachialis muscle tendon passed through the division of the bicipital tendon of insertion which formed a fibrous tendon sheath that was reinforced by the oblique ligament. The biceps' brachii’s main insertion is the radial tuberosity where it inserts along with the cranial branch of the oblique ligament and the cranial branch of the medial collateral ligament. Rotational and compression forces exerted by the insertion of the biceps brachii-brachialis tendon complex onto the ulna might influence medial coronoid disease. Therefore, sectioning these tendons could be considered as a treatment for medial coronoid disease.

Concepts: Elbow, Joints, Triceps brachii muscle, Muscle, Brachialis muscle, Coronoid process of the ulna, Tendon, Ligament


The aim of this study was to compare different endurance parameters of elbow extensors between senior and junior athletes. A group of 23 junior (16.2±0.8years, BMI 21.8±2.9 kg/m2) and 16 senior athletes (23.1±6.2y, BMI 23.6±4.2 kg/m2) volunteered for the study. Strength measurements were performed on the isoacceleration dynamometer (5 sets of 10 maximal elbow extensions, 1 min resting period between each set). The following strength parameters were measured: maximal strength (MS), endurance strength (ES), fatigue rate (FR) and decrease in strength (DS). Both arms triceps brachii muscle mass (MM) was calculated using a series of cross-sectional images of upper arms obtained by the MRI. Triceps brachii muscle mass for both arms in senior athletes showed significantly higher values (1286.9±323.7 g) compared to young athletes (948.9±171.1 g, p<0.01). ES was 50% higher in seniors, while FR was 10% higher in juniors. MS was 35% higher in seniors, but no difference was discovered when this parameter was expressed in relation to muscle mass. DS was significantly different between juniors and seniors, except in absolute values. No significant correlation was found between triceps brachii muscle mass and FR or DS. Different values of strength decrease throughout multiple contractions could be attributed to different characteristics of various sports.

Concepts: Ulna, Elbow, Triceps brachii muscle, Biceps brachii muscle


Objective: The purpose of this study was to describe computed tomography (CT) features of the ununited anconeal process and relate them with the following elbow dysplasia signs: medial coronoid disease, medial humeral condyle changes, osteoarthritis (OA), and radioulnar incongruence. Methods: Computed tomographic images of dogs older than six months with an ununited anconeal process were evaluated (n = 13). Ununited anconeal process features were described as being complete or incomplete, and the degree of displacement, volume, and presence of cysts and sclerosis were also evaluated. Medial coronoid disease was defined as an irregular medial coronoid process shape, presence of sclerosis and fragmentation. Medial humeral condyle changes were defined as subchondral bone flattening, lucencies, and sclerosis. Osteoarthritis was graded depending on the osteophytes size. Radioulnar incongruence was measured on a sagittal view at the base of the medial coronoid process. Results: Eleven elbows had a complete and two had an incomplete ununited anconeal process. All ununited anconeal processes had cystic and sclerotic lesions. Seven ununited anconeal processes were displaced and six were non-displaced. Mean ununited anconeal process volume was 1.35 cm3 (0.61 cm³ - 2.08 cm³). Twelve elbows had signs of medial coronoid disease (4 of them with a fragmented medial coronoid process), and one elbow did not show any evidence of medial coronoid disease. Ten elbows had medial humeral condyle changes. One elbow had grade 1 OA, seven elbows had grade 2, and five elbows grade 3. All elbows had radioulnar incongruence: three elbows had a negative and 10 elbows had a positive radioulnar incongruence. Mean radioulnar incongruence was 1.49 mm (0.63 mm - 2.61 mm). Computed tomographic findings were similar in the majority of the elbows studied: complete ununited anconeal processes with signs of medial coronoid disease, positive radioulnar incongruence, high grade of OA, sclerotic medial humeral condyle changes, and large ununited anconeal process volumes. Clinical significance: Incomplete small ununited anconeal process volumes could be associated with a lower incidence of medial coronoid disease or medial humeral condyle changes. We recommend performing preoperative CT of elbows with an ununited anconeal process to evaluate concurrent lesions.

Concepts: Brachioradialis, Tomographic reconstruction, Brachialis muscle, Second grade, Humerus, Tomography, Coronoid process of the ulna, Elbow


Moles have modified thoracic limbs with hypertrophied pectoral girdle muscles that allow them to apply remarkably high lateral out-forces during the power stroke when burrowing. To further understand the high force capabilities of mole forelimbs, architectural properties of the thoracic limb muscles were quantified in the Eastern mole (Scalopus aquaticus). Architectural properties measured included muscle mass, moment arm, belly length, fascicle length, and pennation angle, and these were used to provide estimates of maximum isometric force, joint torque, and power. Measurements of muscle moment arms and limb lever lengths were additionally used to analyze the out-force contributions of the major pectoral girdle muscles. Most muscles have relatively long fascicles and little-to-no pennation. The humeral abductor/rotators as a functional group are massive and are capable of relatively high force, power, and joint torque. Of this group, the bipennate m. teres major is the most massive and has the capacity to produce the highest force and joint torque to abduct and axially rotate the humerus. In general, the distal limb muscles are relatively small, but have the capacity for high force and mechanical work by fascicle shortening. The muscle architectural properties of the elbow extensors (e.g., m. triceps brachii) and carpal flexors (e.g., m. palmaris longus) are consistent with the function of these muscles to augment lateral out-force application. The humeral abductor/rotators m. latissimus dorsi, m. teres major, m. pectoralis, and m. subscapularis are calculated to contribute 13.9 N to out-force during the power stroke, and this force is applied in a ‘frontal’ plane causing abduction of the humerus about the sternoclavicular joint. Moles have several specializations of their digging apparatus that greatly enhance the application of out-force, and these morphological features suggest convergence on limb form and burrowing function between New and Old World moles. J. Morphol., 2013. © 2013 Wiley Periodicals, Inc.

Concepts: Scalopini, Muscles of the upper limb, Power, Elbow, Force, Talpidae, Torque, Energy


The present study aimed to examine the effect of short-term training utilizing voluntary co-contraction with maximal efforts. 23 healthy young men (training group: TG, n=13; control group: CG, n=10) participated in this study. TG conducted a 4-week training program (3 days/week), which consisted of 4s simultaneous maximal voluntary contractions of elbow flexors and extensors at 90°of the elbow joint, followed by 4s muscle relaxation (10 repetitions/set, 5 sets/day). Before and after the intervention, maximal voluntary isometric and isokinetic torques and the muscle thicknesses of the elbow flexors and extensors were determined. The electromyograms (EMGs) of the 2 muscle groups during isometric maximal voluntary contraction (MVC) were also recorded. After the intervention, CG did not show any significant changes in all measured variables. In TG, significant increases were found in the agonist EMG activities during MVC, and maximal isometric and isokinetic torques of the elbow flexors and extensors, without significant changes in the muscle thicknesses and involuntary coactivation levels during MVC. The current results indicate that the training mode with maximal voluntary co-contraction is effective for improving the force-generating capabilities of the exercising muscles, without any increases in the level of involuntary coactivation during MVC.

Concepts: Neuromuscular disease, Knee, Acetylcholine, Elbow, Electromyography, Muscle contraction, Extension, Muscle


This study investigated the changes in muscular activity and tissue oxygenation while lifting and lowering a load of 20, 40, 60 or 80 % of one repetition maximum (1RM) with elbow flexor muscles until failure. The surface electromyogram (EMG) was recorded in biceps brachii (BB), brachioradialis (BRD) and triceps brachii (TB). For BB, a tissue oxygenation index (TOI) and a normalized total hemoglobin index (nTHI) were recorded by near-infrared spectroscopy. The number of repetitions decreased with the increase in load (P < 0.001), and the four loading conditions induced a decrease in MVC force immediately after failure (P < 0.001). The average of rectified EMG amplitude (aEMG) of elbow flexors increased for all loads during muscle shortening (SHO) and lengthening (LEN) phases of the movement (P < 0.05), except for the 80 % load during LEN phase. At failure, the aEMG was greater during the SHO than the LEN phase (P < 0.05), except for the 20 % load. TOI decreased for all loads and phases (P < 0.05) but less (P < 0.01) for the 20 % than 60 and 80 % loads (P < 0.01), and for LEN compared with SHO phase. At failure, TOI was negatively associated with aEMG during the SHO (r 2 = 0.99) and LEN (r 2 = 0.82) phases, while TOI and aEMG were positively associated with load magnitude (r 2 > 0.90) in both movement phases. This study emphasizes the influence of load magnitude and movement phase (SHO and LEN) on neuromuscular and oxydative adjustments during movements that involve lifting and lowering a load until failure.

Concepts: Extension, Brachioradialis, Elbow, Flexion, Flexor muscle, Muscle, Triceps brachii muscle, Biceps brachii muscle


Studies have analyzed three-dimensional complex motion of the shoulder in healthy subjects or patients undergoing total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA). No study to date has assessed the reaching movements in patients with TSA or RSA. Twelve patients with TSA (Group A) and 12 with RSA (Group B) underwent kinematic analysis of reaching movements directed at four targets. The results were compared to those of 12 healthy subjects (Group C). The assessed parameters were hand-to-target distance, target-approaching velocity, humeral-elevation angular velocity, normalized jerk (indicating motion fluidity), elbow extension and humeral elevation angles. Mean Constant score increased by 38 points in Group A and 47 in Group B after surgery. In three of the tasks, there were no significant differences between healthy subjects and patients in the study groups. Mean target-approaching velocity and humeral-elevation angular velocity were significantly greater in the control group than in study groups and, overall, greater in Group A than Group B. Movement fluidity was significantly greater in the controls, with patients in Group B showing greater fluidity than those in Group A. Reaching movements in the study groups were comparable, in three of the tasks, to those in the control group. However, the latter performed significantly better with regard to target-approaching velocity, humeral-elevation angular velocity and movement fluidity, which are the most representative characteristics of reaching motion. These differences, that may be related to deterioration of shoulder proprioception after prosthetic implant, might possibly be decreased with appropriate rehabilitation.

Concepts: Elbow, Upper limb, Classical mechanics, Humerus, Group C, Group B, Group A, Velocity


This study compared obese and non-obese drivers in the preferred seat and steering wheel setting and preferred driving posture. Twenty-one extremely obese and twenty-three non-obese drivers participated. Each participant determined the most preferred setting of the interior components using an adjustable vehicle mock-up; the preferred components setting and corresponding preferred driving posture were recorded. The participant groups exhibited significant differences in the preferred interior components setting. The obese group created larger steering wheel-seat space than the non-obese, with greater rearward seat displacement, more upright steering wheel angle and smaller steering wheel column displacement. It also exhibited more upright seatback angle deemed necessary for facilitating steering wheel reach with the increased steering wheel-seat distance. The between-group differences in the preferred driving posture were less pronounced: no significant group mean angle differences were found except for the elbow joint angles. Also, the mean hip joint centre positions did not significantly differ. Practitioner Summary: To contribute to larger driver packaging, this study compared obese and non-obese drivers in the preferred vehicle interior components setting and driving posture. The obese group created significantly larger space between the steering wheel and seat than the non-obese, through interior components adjustments. The between-group postural differences were less pronounced.

Concepts: Hip, Angle, Elbow, British Columbia Interior, Extension, Joints, Steering wheel, Automobile


Non-union of the humeral shaft is infrequently noticed after surgical fixation. Sixty eight patients whose osteosynthesis of humeral shaft had failed leading to non-union were identified over a duration of 10 years from (January 2006 to December 2015). Clinical and radiographical follow-up was available for 64 patients (4 patients were lost for follow-up), with a mean age of 58 years (range 25-78 years). All patients had aseptic atrophic non-union of either: proximal shaft (n=12), mid shaft (n=38), and lower shaft (n=14). All these patients had failure of primary fixation, with a minimum duration from 36 to 110 weeks. Non-unions were operated by excision of non-union, autogenous bone grafting and osteosynthesis by locking compression plating. Adequate fixation of non-union with bone grafting was achieved in all patients. All non-unions healed well at an average of 16 weeks (range 6-36 weeks). The mean length of follow-up was 120 weeks (range 60-250 weeks). The mean range of movements following healing of non-union was forward flexion of 140°, external rotation and internal rotation of 30° at shoulder and average fixed flexion deformity of 10° and flexion of 130° at elbow. Two patients had postoperative radial nerve palsy because of neuropraxia, which recovered in eight weeks. Three patient developed superficial infections at the iliac crest, which settled with antibiotics, dressings in 3 weeks time and two patients had some discomfort over the fibular graft harvest site. In all patients complete clinical and radiological union was achieved with satisfactory outcome in terms of relief of symptoms and functional improvement in the range of movements. The main points in surgical treatment were complete excision of non-union, correction of deformity, use of plenty of corticocancellous graft, furthermore the use of intramedullary fibula and osteosynthesis by long locking compression plating in different modes of fixation provided good to excellent results and clinical outcome.

Concepts: Radial neuropathy, Shoulder, Elbow, Humerus, Excision, Brachioradialis, Arithmetic mean, Surgery


The long-latency stretch reflex (LLSR) in human elbow muscles probably depends on multiple pathways; one possible contributor is the reticulospinal tract. Here we attempted to induce plastic changes in the LLSR by pairing noninvasive stimuli that are known to activate reticulospinal pathways, at timings predicted to cause spike timing-dependent plasticity in the brainstem. In healthy human subjects, reflex responses in flexor muscles were recorded following extension perturbations at the elbow. Subjects were then fitted with a portable device that delivered auditory click stimuli through an earpiece, and electrical stimuli around motor threshold to the biceps muscle via surface electrodes. We tested the following four paradigms: biceps stimulus 10 ms before click (Bi-10ms-C); click 25 ms before biceps (C-25ms-Bi); click alone (C only); and biceps alone (Bi only). The average stimulus rate was 0.67 Hz. Subjects left the laboratory wearing the device and performed normal daily activities. Approximately 7 h later, they returned, and stretch reflexes were remeasured. The LLSR was significantly enhanced in the biceps muscle (on average by 49%) after the Bi-10ms-C paradigm, but was suppressed for C-25ms-Bi (by 31%); it was unchanged for Bi only and C only. No paradigm induced LLSR changes in the unstimulated brachioradialis muscle. Although we cannot exclude contributions from spinal or cortical pathways, our results are consistent with spike timing-dependent plasticity in reticulospinal circuits, specific to the stimulated muscle. This is the first demonstration that the LLSR can be modified via paired-pulse methods, and may open up new possibilities in motor systems neuroscience and rehabilitation.

Concepts: English-language films, Reflex, Flexion, Elbow, Extension, Muscle, Brachioradialis, Biceps brachii muscle