To find the optimal needle insertion site for needle electromyography of the pronator teres (PT) muscle among commonly used sites.
Fifty forearms of 25 healthy subjects were evaluated. Four expected needle insertion points were designated as follows. Point 0 was positioned at the midpoint between the medial epicondyle and medial border of biceps tendon in the elbow crease. Points 1, 2, and 3 were located 2 cm, 3.5 cm and 5 cm distal to point 0, respectively. We assumed that the thickness of PT and the distances between a vertical line from each point to the medial margin of the PT were significant parameters for finding the optimal site. Thus, we measured these parameters through ultrasonographic examination.
In men, the PT was thickest at point 2, and in women, at point 1. The distance between the expected needle insertion line and medial margin of PT was longest at point 1 in both men and women, and was statistically significant compared to points 2 and 3. Both men and women had neurovascular bundles located lateral to the expected needle insertion line.
The most appropriate and safe needle electromyographic insertional site for the PT is 2-3.5 cm distal to the mid-point between the biceps tendon and medial epicondyle in the elbow crease and the needle should be inserted upward and medial.
Citations
To investigate the anatomic relationship between the superficial radial nerve (SRN) and the cephalic vein (CV) through ultrasonography due to the possibility of SRN injury during cephalic venipuncture.
Both forearms of 51 healthy volunteers with no history of trauma or surgery were examined in proximal to distal direction using ultrasonography. We measured the distance between the radial styloid process (RSP) and the point where the SRN begins contact with the CV, and measured the distance between the RSP and the point where the SRN is separated from the CV. The point where the SRN penetrates the brachioradialis fascia was also evaluated.
The SRN came in contact with the CV at a mean of 9.35±1.05 cm from the RSP and separated from the CV at a mean of 6.29±1.17 cm from the RSP. The SRN pierced the brachioradialis fascia at a mean of 10.31±0.89 cm from the RSP and horizontally 1.35±0.36 cm medial to the radius margin. All parameters had no significant differences in gender or direction.
The SRN had close approximation to the CV in the distal second quarter of the forearm. We recommend for cephalic venipuncture to be avoided in this area, and, if needed, it should be carried out with care not to cause injury to the SRN.
Citations
To establish the safest approach to needle electrode insertion into the flexor pollicis longus (FPL) regarding possible needle injury to the superficial radial nerve (SRN) or radial artery by ultrasonography.
We evaluated 54 forearms of 27 healthy subjects. Three levels were defined in the forearm. Level 1 is the junction of the middle and distal third of the forearm, level 3 is the midpoint of forearm length, and level 2 is the midpoint between two levels. At each level, the distance between the most prominent point of the radius and the SRN (region A), the distance between the SRN and the radial artery (region B), and the depth from the skin surface to the FPL were measured.
The distance of region A was 1.20±0.41 cm in level 1, 1.62±0.45 cm in level 2, and 1.95±0.49 cm in level 3. The distance of region B was 1.02±0.29 cm in level 1, 0.61±0.24 cm in level 2, and 0.37±0.19 cm in level 3. The depth from the skin surface to the FPL was 0.92±0.20 cm in level 1, 1.14±0.26 cm in level 2, and 1.45±0.29 cm in level 3.
The safest needle insertion point to the FPL is the middle of the forearm within approximately 0.8 cm from the most prominent point of the radius. We recommend that the needle is inserted at the above point perpendicular to the skin surface until the needle meets the FPL at a depth of approximately 1.45 cm from the skin surface.
Citations
Objective: This study was designed to investigate the effect of forearm position on the maximal isometric voluntary supination and pronation strengths and EMG activities in the related muscles.
Method: The maximal isometric supination and pronation strengths were measured in 14 normal male subjects using Work simulatorⰒ at 4 different forearm rotation position. EMG activities were simultaneously measured in supinator and biceps brachii during supination and pronator quadratus and pronator teres during pronation.
Results: The maximal isometric supination strength and EMG activities of biceps brachii and supinator were significantly higher as the forearm was more pronated (p＜0.05). The maximal isometric pronation strength and EMG activi-ties of pronator teres were significantly higher as the forearm was more supinated (p＜0.05). The maximal isometric supination and pronation strengths were higher in the dominant side than those of the nondominant side (p＜0.05) and EMG activities of pronator teres and supinator were higher in the dominant side than in the nondominant side (p＜0.05).
Conclusion: The supination and pronation strengths and EMG activities of related muscles were influenced by the forearm rotation position. Therefore the forearm position should be considered in evaluation of upper limb strength and function, and rehabilitation of upper extremity for improving strength and minimizing the overuse of supination and pronation. (J Korean Acad Rehab Med 2002; 26: 432-438)
Objective: To find out the incidence of reduced median conduction velocity of forearm (MNCV-F) in carpal tunnel syndrome (CTS) and to compare clinical and electrophysiologic characteristics of CTS with reduced MNCV-F and to observe the changes of reduced MNCV-F after carpal tunnel release.
Method: One hundred and fifty nine hands with CTS are divided into two groups; MNCV-F of 50 m/sec and above as group I and that of below 50 m/sec as group II. For the electrophysiologic comparison, median sensorimotor distal latency, peak-to-peak amplitudes and abnormal spontaneous activity of abductor pollicis brevis were observed and for clinical comparison, sensorimotor symptoms, Phalen and Tinel sign were observed. Twenty four hands which had successful carpal tunnel release were examined for the changes of MNCV-F.
Results: The hands with reduced MNCV-F were 29 among 159 hands. Sensorimotor distal latency were significantly prolonged and sensorimotor amplitudes also significantly reduced in group II. Sensory change and Phalen signs were more frequently observed in group II. MNCV-F in group I had not changed after carpal tunnel release, but MNCV-F in group II was improved significantly. The changes MNCV-F in group II were much delayed than the improvement of parameters of distal conduction studies.
Conclusion: The incidence of reduced MNCV-F in CTS was 18.24%. Patients with reduced MNCV-F had more severe CTS both electrophysiologically and clinically. Reduced MNCV-F had improved significantly, but there was significant time gap between the electrophysiologic improvements of distal and proximal portions of nerve. This findings may suggest that retrograde degeneration may play a partial role in reduced forearm motor nerve conduction velocity of the median nerve in CTS.
Hand rehabilitation is essential to restore the maximal functional capacity of a patient after the injuries of hand or upper extremity, such as a fracture, tendon tear, crushing, or amputation. To achieve the purpose, hand rehabilitation should begin shortly after the completion of surgery. Especially after the replantation, functional recovery can be achieved by a careful inpatient evaluation providing a proper treatment, detecting problems, and updating treatment programs, and arranging discharge and follow-up cares by a hand rehabilitation team.
We report our experience of a successful hand rehabilitation of patient with a replantation surgery after the complete right forearm amputation. A comprehensive approach and systematized treatment programs are important for a hand rehabilitation.
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