Using risk factors, myoelectric signal, and finger tremor to distinguish computer users with and without musculoskeletal symptoms

Most of previous studies use questionnaire to assess risk factors for cumulative trauma disorders of the upper extremity (CTDUE) for computer workers. Few studies combine both physical examination and questionnaire to assess musculoskeletal symptoms. Fifteen symptomatic and 15 non-symptomatic computer users were recruited. Both of them were asked to perform a repetitive tapping task (200 taps/min) as the fatigue task. Tremor of the index finger and surface electromyography (EMG) of the flexor digitorum superficial (FDS) were collected prior and after the tapping task. Muscle strength and range of motion for right wrist were collected before the tapping task. All subjects were asked to fill out the questionnaire about risk factors of CTDUE. Female users in the symptomatic group had weaker wrist extensor strength than those in the non-symptomatic group (P < 0.05). After performing the tapping task, FDS strength and median frequency of the FDS EMG at 25%, and 100% maximal voluntary contraction (MVC) for the symptomatic group decreased (P < 0.05). However, no significant differences were found in strength and median frequency of the FDS EMG between prior and after tapping task in the non-symptomatic group. There was no significant difference for root mean square of the finger tremor between and within groups. Regression analysis revealed that median frequency of the FDS EMG at 25% MVC, age, total time spent on computer, and mouse position were better factors to classify computer users into the symptomatic group compared to other factors obtained from questionnaire and physical exam. Besides, symptomatic computer users seem to have longer experience of computer use than non-symptomatic users. After the fatigue task, the symptomatic users decreased their muscle strength to a larger extent than the non-symptomatic users.     

Synaptic connections from large afferents of wrist flexor and extensor muscles to synergistic motoneurones in man

 Short-latency excitatory Ia reflex connections were determined between pairs of human wrist flexor and extensor muscles. Spindle Ia afferents were stimulated by either tendon tap or electrical stimulation. The activity of voluntarily activated single motor units was recorded intramuscularly from pairs of wrist flexor or extensor muscles. Cross-correlation between stimuli and the discharge of the motor units provided a measure of the homonymous or heteronymous excitatory input to a motoneurone. Homonymous motoneurone facilitation was generally stronger than that of the heteronymous motoneurones. The principal wrist flexors, flexor carpi radialis (FCR) and flexor carpi ulnaris (FCU), were tightly connected through a bidirectional short-latency reflex pathway. In contrast, the extensor carpi ulnaris (ECU) and the extensor carpi radialis (ECR) did not have similar connections. ECU motoneurones received no short-latency excitatory Ia input from the ECR. ECR motoneurones did receive excitatory Ia input from ECU Ia afferents; however, its latency was delayed by several milliseconds compared with other heteronymous Ia excitatory effects observed. The wrist and finger extensors were linked through heteronymous Ia excitatory reflexes. The reflex connections observed in humans are largely similar to those observed in the cat, with the exception of heteronymous effects from the ECU to the ECR and from the extensor digitorum communis (EDC) to the ECU, which are present only in humans. The differences in the reflex organization of the wrist flexors versus the extensors probably reflects the importance of grasping. Received: 19 August 1996 / Accepted: 6 March 1997     

Morphological organization and contractile properties of the wrist flexor muscles in the cat

A comparison of the anatomy, fiber type profiles, and contractile properties of the wrist flexor muscles was undertaken in the cat. Isometric contractile characteristics were measured for each muscle. Three muscle fiber types, FG, FOG, and SO, were differentiated by staining cross sections of each muscle for ATPase, NADH diaphorase, SDH, and α-GPD activities. The wrist flexor muscles ranged from less than 1% to 49% SO fiber content; with two of the five heads of the flexor digitorium profundus (FDP) having 1% or less SO fibers (FDP₁—1.07%, FDP₅—0.81%) and the humeral head of the flexor carpi ulnaris muscle (FCU_h) having the greatest content of SO fibers. The mean contraction time (CT) plus one-half relaxation time for an isometric twitch was correlated with the percentage of SO fibers and ranged from 40.5 to 111.8 ms. Except for the FCU (37 ms), the CT was less than 25 ms for the wrist flexor muscles. The uniarticular wrist flexor muscles, the flexor carpi radialis (FCR), and the FCU had the highest percentage of SO fibers and were more fatigue-resistant that the multiarticular muscles. Considerable differences exist in muscle structure, fiber type proportions, and contractile properties between the FCR and FCU, which may be related to functional differences between the two sides of the wrist that may exist during the placement of the foot during locomotion.     

The cubital tunnel: anatomical study of its distal part

Different levels of ulnar nerve compression have been reported (the medial intermuscular septum, the posterior compartment of the arm, soft tissue or bony abnormalities of the cubital tunnel). In some rare cases, compression can lie in a 10-cm long tunnel, distal to Osborne's ligament, between the humeral head of the ulnar flexor muscle of wrist (FCU) and the medial epicondylar muscles. Only few publications mention this fact as a factor of residual or recurrent symptoms after common surgical procedures. However, a distal pathology of the cubital tunnel has proved to be the only factor of nerve entrapment in our clinical practice. Specific anatomical dissection of this area was carried out to find and classify the anatomical structures that may play a role in ulnar nerve distal compression. Twenty-four embalmed limbs from 13 cadavers were dissected. The purpose of this study was to find anatomical fibrous structures at an average of 10 cm from the medial epicondyle. Anatomical structures were classified into five types: no aponeurosis between the FCU and the medial epicondylar muscles (54.2% of cases), a fibrous band taut between the FCU and the fourth- and fifth-finger ulnar insertions of the flexor digitorum superficialis (FDS) (8.3%), a thin (20.8%) or thick (4.2%) partial aponeurosis between the FCU and the medial epicondylar muscles, and total aponeurosis (12.5%). Anatomical variations of the distal cubital tunnel were divided in five types, but their clinical significance remains unclear.     

Ultrasound findings of finger,wrist and knee joints in Mucopolysaccharidosis Type I

IntroductionMusculoskeletal findings in MPS can progress after enzyme replacement. Our aim was to examine synovial recesses, tendons, retinacula and pulleys using ultrasonography for structural and inflammatory changes.Material and methodsThe wrist, metacarpophalangeal (MCP), proximal and distal interphalangeal (PIP and DIP) joints, the finger flexor tendons and the knee including entheses of quadriceps and patella tendons were assessed clinically.Ultrasonography of the various synovial recesses of the wrist as well as the extensor retinaculum, carpal tunnel, MCP, PIP and DIP joints of the second finger, extensor and flexor tendons, A1-5 pulleys and the knee joint including relevant entheses followed. Significance of differences between patient values and available normative data were assessed using t-tests.ResultsUltrasonography showed significant abnormal intraarticular material in the wrist without a clear distribution to synovial recesses and without effusions. Doppler signals were found in a perisynovial distribution and not intrasynovial as expected in in inflammatory arthritis. Findings were similar in the knee but not the fingers. Flexor and extensor tendons were also mostly normal in their structure but significant thickening of retinaculae and the flexor tendon pulleys was seen (p<0.0001 compared to normal).ConclusionMPS I patients showed intraarticular deposition of abnormal material in the wrist and knee but not in the finger joints where significant thickening of retinaculae/pulleys controlling tendon position was dominant. No ultrasound findings of inflammatory pathology were demonstrated but rather a secondary reaction to abnormal deposition and direct damage of GAG.     

Electrophysiological and clinical assessment of a simple wrist-hand splint for patients with chronic spastic hemiparesis secondary to stroke

PURPOSE: The aim of this study is to assess the effect of a simple wrist-hand splint, made of mesh materials, on the spastic paretic hand. METHODS: The participants were 15 patients with hemiparetic stroke. Time from stroke onset was over 120 days. We assessed integrated EMG of flexor digitorum sublimus (FDS), extensor indicis proprius (EIP), flexor carpi radialis (FCR), extensor carpi radialis (ECR), brachioradialis (BR) and triceps brachii (Tri) during active finger extension and shoulder flexion, without and with the wrist-hand splint. H reflexes and M waves were obtained on FCR by stimulating the median nerve, and H/M ratio was calculated. In another 5 patients who used the splint for 8 weeks, its long-term effects were assessed with clinical measures (active range of motion and muscle tone). RESULTS: With the splint, muscle activities of FCR and BR were reduced during shoulder flexion, and those of FDS, FCR and BR decreased during finger Attaching the splint also reduced the H/M ratio of FCR. In five patients who had worn the wrist-hand splint during daytime for 8 weeks, significant increase in the active range of shoulder flexion and finger extension and decrease in muscle tone were demonstrated. The splint reduced co-activation of antagonists not only in wrist but also in finger and elbow muscles. CONCLUSION: It is suggested that the wrist-hand splint is beneficial to improve upper limb motor function in patients with spastic hemiparesis.     

食指力量对指浅屈肌运动单元募集模式的影响

目的检测不同食指力量水平下指浅屈肌运动单元的募集模式。方法设计食指20%、40%、60%最大随意收缩力量(maximum voluntary contraction,MVC)3个单指力量输出任务,采用8×1(行×列)阵列电极采集8名受试者的指浅屈肌sEMG信号,利用快速独立分量分析算法提取sEMG信号中运动单位动作电位(motor unit action potential,MUAP)信息,分析不同类型MUAP发放模式与力量的相关性。结果在原始信号中成功提取4种MUPA,且随力量水平的增加,MUAP总数目呈现递增趋势;不同力量水平下,4种类型MUAP所占比重不同,且随力量变化趋势不同。结论不同力量水平下,指浅屈肌改变运动单元募集模式以产生相应肌力。     

表面肌电检测系统上位机应用程序设计

表面肌电是反映人体肌肉状态的电信号,是现代医疗中非常有效的诊疗工具。它对医学研究、工效学、运动学等领域的发展有很大影响。本文在Visual C++6.0环境下,设计开发表面肌电(SEMG)检测系统上位机应用程序。程序功能包括利用算法提取表面肌电重要参数、计算SEMG信号功率谱、实时显示SEMG波形、打印计算参数与波形,以及使用MySQL数据库管理记录的SEMG数据。程序开发后期,使用三片电极测试了测试者右手尺侧碗屈肌、桡侧碗屈肌和肱桡肌三个部位,成功获得测试者肌肉静态与动态时的肌电波形和参数。     

Anomalous flexor of the little finger

We report an anomalous palmar muscle belly of the flexor digitorum superficialis muscle (FDS) in the right hand of an 80-year-old female cadaver. The muscle originated from the center of the volar surface of the flexor retinaculum and inserted onto the palmar aspect of the base of the middle phalanx of the little finger. Its tendon of insertion divided into two bands, a pattern typical of the FDS tendon, between which the tendon of flexor digitorum profundus muscle to the little finger passed. The tendon of the usual antebrachial FDS to the little finger was absent. The anomalous muscle belly was innervated by a branch from the median nerve.     

High stiffness of human digital flexor tendons is suited for precise finger positional control

The objective of this study was to define the biomechanical properties of the human digital flexor tendons and to compare these biomechanical properties to other muscle-tendon units in the forearm. Mechanical measurements were performed on fresh-frozen tendons under physiological load and temperature conditions. Loads were determined by first measuring the physiological cross-sectional area of each digital belly of the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) and estimating maximum tension (P(o)) of that specific muscle head. Loading each tendon to the appropriate P(o) resulted in no significant difference in tendon strain among any of the tendons within each muscle (P > 0.05; digits 2-5) or between muscle types (FDP vs. FDS). The one exception to this finding was that a significantly higher strain at Po was observed in the FDP tendon to the small finger (P < 0.05). Average absolute strains observed for the FDP and FDS tendons (1.20 +/- 0.38%, mean +/- SD; n = 39) were significantly lower than those observed previously in a study of the prime movers of the wrist. The measured strain of approximately 1.5% was less than half of that predicted to occur in muscles of this architectural design. Modeling sarcomere shortening magnitudes during FDP or FDS contraction yielded a value of only 0.10 microm, which would have a negligible effect on the force generating capacity of these muscles. Thus the high stiffness of the digital flexor tendons suits them well for fine positional control and would render their muscle spindles quite sensitive to length perturbations at the fingertips.     

Anomalies of the flexor carpi ulnaris: Clinical case report and cadaveric study

Flexor carpi ulnaris (FCU) is an ever‐present muscle of the anterior flexor compartment of the forearm. Variations of FCU are uncommon, with additional slips or heads of muscles described, and only one reported case of an accessory muscle. We describe a unique clinical case report in which an accessory FCU was identified and describe the findings of 5,000 cadaveric dissections of the forearm, performed as part of an ongoing institutional study of anatomical variations. An aberrant accessory forearm flexor muscle was identified incidentally at the wrist during surgery for an anterior interosseous to ulnar nerve transfer for management of ulnar nerve palsy. This muscle was seen running superficial to the ulnar nerve and radial to the FCU proper, arising from the common flexor origin and inserting at the triquetral carpal bone. This was therefore suitably acknowledged as an “accessory FCU”. The anomaly was identified as bilateral using ultrasound imaging, and was found to be anomalously innervated by the median nerve with nerve conduction studies. A subsequent review of 5,000 cadaveric dissections of the forearm did not identify any such variations related to FCU, despite identifying a range of variations of the other forearm flexor musculature. While the scarcity of this anomaly is thus highlighted, consideration of an accessory FCU, and its aberrant innervation is important in a range of surgical approaches. Clin. Anat. 23:427–430, 2010. © 2010 Wiley‐Liss, Inc.     

Intermuscular aponeuroses between the flexor muscles of the forearm and their relationships with the ulnar nerve

Introduction

The aim of this study was to clarify the morphological characteristics of the intermuscular aponeurosis between the flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS; IMAS), and that between the FCU and flexor digitorum profundus (FDP; IMAP), and their topographic relationships with the ulnar nerve.

Materials and methods

Fifty limbs of 38 adult cadavers were studied.

Results

The IMAS extended along the deep surface of the FCU adjoining the FDS, having the appearance of a ladder, giving off “steps” that decreased in width from superficial to deep around the middle of the forearm. Its proximal part divided into two bands connected by a thin membrane, and was attached to the medial epicondyle and the tubercle (the most medial prominent part of the coronoid process of the ulna), respectively. The IMAP extended deep between the FCU and FDP from the antebrachial fascia, and its distal end was located on the posterior border of the FCU. The IMAP became broader toward its proximal part, and its proximal end was attached anterior and posterior to the tubercle and the olecranon, respectively. The ulnar nerve passed posterior to the medial epicondyle and then medial to the tubercle, and was crossed by the deep border of the IMAS at 58.3 ± 14.1 mm below the medial epicondyle.

Conclusion

The deep border of the IMAS and aberrant tendinous structure passing across the ulnar nerve, or the parts of the IMAS and IMAP passing posterior to the ulnar nerve are potential causes of ulnar nerve compression.

     

Disinhibition in the human motor cortex is enhanced by synchronous upper limb movements

The phasic modulation of wrist flexor corticomotor disinhibition has previously been demonstrated during the flexion phase of rhythmical passive flexion-extension of the human wrist. Here we ask if rhythmical bimanual flexion-extension movements of the wrists of neurologically intact subjects, modulate inhibitory activity in the motor cortex. In the first experiment intracortical inhibition was assessed when one wrist was passively flexed and extended on its own, with the addition of the opposite limb voluntarily moving synchronously in a mirror symmetric pattern, and also in a near-symmetric asynchronous pattern. Two subsequent experiments investigated firstly the modulation of spinal reflex pathway activity during the same three movement conditions, and secondly the effect of contralateral wrist movement alone on the excitability of corticomotoneuronal pathways to a static test limb. When the wrist flexors of both upper limbs were shortening simultaneously (i.e. synchronously), intracortical inhibition associated with flexor representations was suppressed to a greater extent than when the two muscles were shortening asynchronously. The results of the three experiments indicate that modulation of inhibitory activity was taking place at the cortical level. These findings may have further application in the study of rehabilitation procedures where the effects of simultaneous activation of affected and unaffected upper limbs in hemiparetic patients are to be investigated.     

Wrist muscle activation patterns and stiffness associated with stable and unstable mechanical loads

Summary The objectives of this study were to examine the effects of load mechanical characteristics and agonist-antagonist muscle cocontraction, on the stretch reflex response of wrist flexor muscles, and to measure the associated wrist stiffness. Subjects were required to maintain a constant wrist angle while operating against flexor loads with different stability characteristics (constant, elastic or unstable). We measured the stretch reflex responses and joint stiffness by applying step displacements of 3° and 10°. Subjects used very little cocontraction of wrist flexor and extensor muscles when the load was constant or elastic, but increased cocontraction dramatically when the load was unstable, in order to increase the wrist stiffness. Although the magnitude of stretch reflex responses also increased with cocontraction, this simply reflected the level of tonic flexor muscle activity. We found no evidence to suggest that phasic stretch reflexes contributed significantly to the joint stiffness in this task. Clear differences in flexor muscle synergy were observed in the presence and absence of cocontraction, particularly when comparing the FCR and FCU muscles.     

Evaluation of muscle fatigue of wheelchair basketball players with spinal cord injury using recurrence quantification analysis of surface EMG

Wheelchair basketball is the most popular exercise activity among individuals with spinal cord injury (SCI). The purpose of this study was to investigate muscular endurance and fatigue in wheelchair basketball athletes with SCI using surface electromyography (SEMG) and maximal torque values. SEMG characteristics of 10 wheelchair basketball players (WBP) were compared to 13 able-bodied basketball players and 12 sedentary able-bodied subjects. Participants performed sustained isometric elbow flexion at 50% maximal voluntary contraction until exhaustion. Elbow flexion torque and SEMG signals were recorded from three elbow flexor muscles: biceps brachii longus, biceps brachii brevis and brachioradialis. SEMG signals were clustered into 0.5-s epochs with 50% overlap. Root mean square (RMS) and median frequency (MDF) of SEMG signals were calculated for each muscle and epoch as traditional fatigue monitoring. Recurrence quantification analysis was used to extract the percentage of determinism (%DET) of SEMG signals. The slope of the %DET for basketball players and WBP showed slower increase with time than the sedentary able-bodied control group for three different elbow flexor muscles, while no difference was observed for the slope of the %DET between basketball and WBP. This result indicated that the athletes are less fatigable during the task effort than the nonathletes. Normalized MDF slope decay exhibited similar results between the groups as %DET, while the slope of the normalized RMS failed to show any significant differences among the groups (p?>?0.05). MDF and %DET could be useful for the evaluation of muscle fatigue in wheelchair basketball training. No conclusions about special training for WBP could be determined.     

Interaction of linear and angular vestibulo-ocular reflexes of human subjects in response to transient motion

Motor potentials (MEPs) evoked by focal (figure-of-eight coil) transcranial magnetic stimulation of the left motor cortex were recorded from the right opponens pollicis (OP) and flexor digitorum superficialis (FDS) of 14 normal subjects during different motor tasks. Changes in motor cortical excitability under behavioural conditions presumably connected with premotor and supplementary motor area (SMA) activation were investigated by comparing the size of the MEPs obtained during: (1) rest, (2) mental calculus, (3) repetitive left thumb-to-index opposition, (4) mental simulation of the same task with the right hand, (5) sequences of left thumb-to-fingers opposition, and (6) mental simulation of the same sequences with the right hand. MEP size significantly increased in both muscles during sequential movements of the left hand and sequence simulation with the right hand, but not during mental calculus or actual or simulated repetitive movements. The H-reflex evoked in the OP and FDS muscles by electrical stimulation of the median nerve (at wrist and elbow, respectively) under the same experimental conditions did not show significant modifications. The increase in MEP size during non-routine actual or imagined sequences of finger movements supports the view that the SMA is activated under these conditions and that it exerts a direct facilitatory influence on the motor cortex.     

Anomalous muscle belly to the index finger.

An unusual variation of flexor digitorum superficialis was observed during the cadaver dissection. The flexor digitorum superficialis (FDS) had a normal origin and insertion, except to the index finger, where a muscle belly replaced the tendon of FDS. The unusual muscle belly originated as a continuation of FDS tendon in the carpal tunnel and inserted normally into the middle phalanx. A branch of the median nerve innervated the anomalous muscle belly. The anomalous muscle belly described here should be considered in the aetiology of carpal tunnel syndrome.     

Enslaving effects in multi-finger force production

When a person produces isometric force with one, two, or three fingers, the other fingers of the hand also produce a certain force. Enslaving is the involuntary force production by fingers not explicitly involved in a force-production task. This study explored the enslaving effects (EE) in multi-finger tasks in which the contributions of the flexor digitorum profundus (FDP), flexor digitorum superficialis (FDS), and intrinsic muscles (INT) were manipulated. A new experimental technique was developed that allows the redistribution of the muscle activity between the FDP, FDS, and INT muscles. In the experiment, ten subjects were instructed to perform maximal voluntary contractions with all possible one-, two-, three-, and four-finger combinations. The point of force application was changed in parallel for the index, middle, ring, and little fingers from the middle of the distal phalanx, to the distal interphalangeal joint, and then to the proximal interphalangeal joint. It was found that: (1) the EE of similar amplitude were present in various experimental conditions that involved different muscle groups for force production; (2) the EE were large on average--the slave fingers could produce forces reaching 67.5% of the maximal forces produced by themselves in a single-finger task; (3) the EE were larger for neighboring fingers; and (4) the EE were non-additive--in most cases, the EE from two or three fingers were smaller than the EE from at least one finger. EE among different muscles suggest a widespread neural interaction among the structures controlling flexor muscles in the hand as the main mechanism of finger enslaving.     

握力及捏力控制的前臂及手部多肌肉协调性递归网络分析

探究握力和捏力控制的前臂及手部多肌肉协调性作用,有24名健康的右利手者参与这项实验.在实验中要求受试者在30％、50％和70％最大自主收缩力(MVC)下进行握力和捏力的准确力量控制,同时采集肱桡肌(BR)、尺侧腕屈肌(FCU)、桡侧腕屈肌(FCR)、指总伸肌(EDC)、指浅屈肌(FDS)、拇短展肌(APB)、第一骨间背...