强的松龙局部封闭治疗肱二头肌长头腱腱鞘炎

目的 评价强的松龙混悬液加利多卡因局部封闭治疗肱二头肌长头腱腱鞘炎的效果。方法 对４７例确诊为肱二头肌长头腱腱鞘炎的患者进行强的松龙混悬液加利多卡因局部封闭治疗,并进行半年至一年半的随访。结果 根据患者局封前后症状及体征来评价治疗效果,４７例全部治愈。结论 强的松龙混悬液局部封闭对肱二头肌长腱腱鞘为有良好的治疗效果。     

Supernumerary humeral heads of the biceps brachii muscle revisited

Supernumerary humeral heads of the biceps brachii muscle were found in 27 (15.4%) of 175 cadavers. They were bilateral in five cadavers and unilateral in 22 (8 left, 14 right), giving a total of 32 examples in 350 arms (9.1%). Depending on their origin and location, the supernumerary heads were classified as superior, infero-medial, and infero-lateral humeral heads. Previous studies were reviewed using this classification. The infero-medial humeral head was observed in 31 of 350 (9%) arms and was therefore the most common variation. The superior humeral head was observed in five (1.5%). The infero-lateral humeral head was the least common variation, observed only in one (0.3%) of 350 arms. A biceps brachii with three heads was observed in 27 of 350 (7.7%) arms and with four heads in five (1.4%) arms.     

Unusual variation of a third head of the biceps brachii muscle

A human cadaver was studied which presented a biceps brachii with three heads of origin in the left arm. The third or humeral head presented an unique area of insertion into the bicipital aponeurosis (lacertus fibrosus).     

Two bellies of the coracobrachialis muscle associated with a third head of the biceps brachii muscle.

Reports that describe the abnormalities and complexities of the anatomy of the arm are important with regard to surgical approaches. This case study reports a combined abnormal form of the coracobrachialis and biceps brachii muscles of the left arm of an adult male cadaver that was detected during the educational gross anatomy dissections of embalmed cadavers. The coracobrachialis muscle demonstrated two bellies which formed shortly inferior to its origin from the coracoid process of the scapula. One belly inserted into the middle of the antero-medial surface of the humerus, whereas the other belly inserted into the medial head of the triceps brachii muscle. The musculocutaneous nerve passed between the two bellies, giving a separate branch to each. We suggest that the two bellies of the coracobrachialis muscle may represent the incompletely fused short heads of the ancestral muscle. The biceps brachii muscle showed a third head, which originated mainly from the antero-medial surface of the humerus and partially from an aponeurosis belonging to the medial head of the triceps brachii muscle. These observations were confined to the left upper limb and were not accompanied by any other abnormality.     

The electrically evoked long latency reflex of the biceps brachii muscle: The impact of train stimuli, preceding stimuli, and voluntary muscle contraction

Long latency reflex (LLR) responses were examined over the biceps brachii (BB) at different contraction levels after electrical single or train stimuli over the ipsilateral superficial radial nerve with an inter-stimulus interval of 3ms. Two constant motor waves were present, LLR2 with a peak latency value of 53±4ms and LLR3 with 85±10ms. LLR responses showed a significant increase (twofold) in amplitudes after train stimuli compared to up to a fourfold increase after train stimuli were combined with a weight load of 1.5kg. When LLR were investigated after subsequent (1/s) stimuli by selective averaging, a significant increase in LLR2 amplitude values was seen after the third compared with the first stimulus for trains of 3 stimuli. In the present study, 3 factors exerted an influence on LLR, namely temporal summation of synaptic potentials (by train stimuli), facilitation (with higher stimulus repetition rates), and volition (resulting in muscle contraction). The augmentation behaviour of LLR may be useful for the investigation of central nervous system diseases such as e.g. movement disorders.     

Third head of biceps brachii: A rare occurrence in the Indian population

A study of the incidence of the third head of the biceps brachii (caput accessorium) was carried out in the Department of Anatomy, Kasturba Medical College, Mangalore, India. The observations were made during routine cadaveric dissections to teach the undergraduate students. Forty-eight cadavers were included in the study. The occurrence of this anomaly and its morphology are discussed.     

Proximal attachment of long head of biceps brachii to the bicipital tubercle of scapula and its functional significance

Introduction

Lesions affecting the tendon of Long Head of Biceps brachii (LHB) are among the more frequent causes of pain and disability in the region of shoulder joint. Shoulder arthroscopy has shown that there is dual attachment of LHB to the Supraglenoid tubercle (SGT) and glenoid labrum, but the origin from the bony prominence on upper part of dorsal surface of neck of scapula has not been described in the literature reviewed. This bony elevation has been named as “Bicipital Tubercle (BT)”. What is astonishing is the fact that such a prominent BT has been either missed or ignored by earlier workers.

肱骨结节间沟形态在肱二头肌长头肌腱损伤中的作用

目的　提供详尽的肱骨结节间沟形态资料。方法　使用不同地区肱骨 80只 ,将结节间沟分为近侧水平段和远侧垂直段 ,用量角器和卡尺测量二段的长度及其移行处的角度 ;结节间沟的深度和宽度分五个部位测量 ;观察结节间沟的变异和异常。结果　结节间沟近侧段和远侧段的长度及移行处角度分别为 9.4mm、2 9.7mm和 119.9° ;总长度、深度和宽度分别为 39.2mm、0 .7mm和 2 .6mm ;结节上嵴出现率为 11.2 % ,内、外侧骨刺 16 .2 % ,钙化 45 %。结论　肱骨结节间沟的局部形态与肱二头肌长头腱损伤关系密切。     

Unusual formation of the median nerve associated with the third head of biceps brachii

Unilateral variations in the formation of the median nerve, with the presence of the third head of the biceps brachii entrapping the nerve are very rare. These variations were observed on the right side, of a 30‐year‐old male cadaver during routine dissection at the Department of Human Anatomy, University of Nairobi. The median nerve was formed by the union of three contributions; two from the lateral cord and one from the medial cord. An additional head of the biceps brachii looped over the formed median nerve. On the left side, the median nerve was formed classically by single contributions from the medial and the lateral cords. These variations are clinically important because symptoms of high median nerve compression arising from similar formations are often confused with more common causes such as radiculopathy and carpal tunnel syndrome. Clin. Anat. 25:961–962, 2012. © 2012 Wiley Periodicals, Inc.     

肱二头肌短头腱喙肱肌腱喙肩韧带重建喙锁韧带的应用解剖

目的为肱二头肌短头腱、喙肱肌腱和喙肩韧带复合转位修复肩锁关节脱位提供解剖学基础.方法用50侧成人尸体标本,对喙锁韧带(锥状韧带和斜方韧带),肱二头肌短头腱、喙肱肌腱、喙肩韧带的形态结构进行解剖学观察.结果锥状韧带基底宽(1.3±0.3)cm,高(1.5±0.4)mm,斜方韧带长、宽、厚分别为(1.1±0.2)、(1.3±0.2)、(2.4±0.8)mm;肱二头肌短头和喙肱肌联合腱的长、宽、厚分别为(7.1±0.7)、(1.7±0.4)、(1.1±0.3)mm;喙肩韧带前、后缘长为(3.1±0.5)、(2.5±0.2)cm,喙锁间隙为(0.5±0.1)cm.结论以肱二头肌短头腱、喙肱肌腱和喙肩韧带复合转位重建喙锁韧带可有效地治疗肩锁关节脱位.     

Supernumerary head of biceps brachii and branching pattern of the musculocutaneus nerve in Japanese

Summary Out of 546 upper limbs (273 cadavers), supernumerary heads of the biceps brachii were found in 75 limbs (13.7%) of 58 cadavers (21.3%). The form, origin, and insertion of the supernumerary heads, and branching pattern of the musculocutaneus nerve were studied. In addition, the dimensions of the heads were measured. In many cases, the supernumerary head arose from the humerus, between the insertion of the coracobrachialis and the upper part of the origin of the brachialis, and/or from the medial intermuscular septum. In a few cases, a supernumerary head arose from the tendon of the pectoralis major or the deltoid, or from the articular capsule, or from the crest of the greater tubercle. The supernumerary heads typically joined the common belly, or the aponeurosis of the biceps brachii. Some heads joined the belly of the long head or that of the short head. In the examination of the branching pattern of the musculocutaneus nerve, communication between the musculocutaneus nerve and the median nerve was found in 43 out of the 75 limbs (57.3%). The communicating branch ran from the musculocutaneus nerve to the median nerve in 24, from the median nerve to the musculocutaneus nerve in 12, in both directions in 5, or in another type of pattern in 2 out of 43 limbs. Sometimes a branch of the musculocutaneus nerve ran around a supernumerary head and then fused with the present trunk. The presence of a supernumerary head seemed to affect the course and branching of the musculocutaneus nerve.

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Chef surnuméraire du biceps brachial et organisation du nerf musculo-cutané chez les japonais

Résumé A partir de l'étude de 546 membres supérieurs (273 cadavres) nous avons trouvé 75 cas (chez 58 cadavres) de chef surnuméraire de muscle biceps brachial (21.3%). Nous en avons étudié la forme, le trajet, la taille et les insertions ainsi que l'organisation des divisions du nerf musculo-cutané. Dans de nombreux cas le chef surnuméraire provient soit de l'humérus où il s'insère entre le m. coraco-brachial et la partie proximale du muscle brachial soit/et du septum intermusculaire médial. Dans quelques cas un chef surnuméraire a été observé à partir du tendon du m. grand pectoral ou du m. deltoïde ou encore de la capsule articulaire, voire du tubercule majeur. II rejoint habituellement le chef commun du m. biceps brachial ou son aponévrose. Parfois la jonction se fait sur l'un ou l'autre des deux corps musculaire. L'étude du n. musculo-cutané montre une anastomose avec le nerf médian dans 43 des 75 membres concernés (57.3%). Cette branche anastomotique va du n. musculo-cutané au nerf médian dans 24 cas et du n. médian au n. musculo-cutané dans 12 cas, elle va dans les deux directions dans 5 cas; dans les 2 cas restant le modèle d'anastomose est variable. Parfois une branche du n. musculo-cutané entoure le chef surnuméraire et fusionne ensuite avec le tronc du nerf. La présence d'un chef surnuméraire semble donc modifier le trajet et les connexions du nerf musculo-cutané.

     

肱二头肌短头肌腱转位修复肩锁关节脱位的解剖及临床应用

目的 :探讨肩锁关节完全脱位治疗的解剖学基础。方法 :观测 12侧喙突及其周围结构、肌皮神经、肱二头肌短头腱的形态及血供。结果 :喙突至肩峰距离为 (4 .6± 0 .5 )cm ,喙突尖至锁骨肩峰端距离为(4 .2± 0 .5 )cm ,肱二头肌短头长约 (2 0 .0± 2 .3 )cm ,肱二头肌短头腱长 (8.3± 1.2 )cm ,中部宽 (1.1± 0 .3 )cm ,中部厚 (1.0± 0 .5 )cm ,喙突上和各肌腱的血供为多源性。结论 :用肱二头肌短头肌修复肩锁关节脱位具有可行性。临床应用 4例 ,效果满意     

Ulnar nerve innervation of the medial head of the triceps brachii muscle: A cadaveric study

Although the ulnar nerve is closely associated with the triceps brachii muscle, the literature does not normally describe it as supplying this muscle. However, recent research has examined the ulnar nerve in the upper arm and identified branches supplying the medial head of the triceps brachii muscle. This study aims to expand upon this research by describing the course and incidence of these branches in a larger sample size. We examined 50 specimens in 25 cadavers. Ulnar innervation of the medial head of the triceps brachii was identified in 14 specimens (28%). The mean distance of the ulnar nerve branch midpoint was 26% along a line between the surgical neck and an epicondyle line, with a range of 11–39%. Innervation of the triceps brachii muscle by the ulnar nerve has important clinical and surgical implications. Clin. Anat. 26:1028–1030, 2013. © 2013 Wiley Periodicals, Inc.     

An unusual origin for the accessory head of biceps brachii muscle

During the superficial dissection of the pectoral region and the arm, an abnormal biceps brachii muscle was observed unilaterally. This muscle had three heads. Whereas the short and long heads had their normal origin, the accessory head originated from the anterior surface of the distal part of the pectoralis major muscle, which formed the anterior axillary fold. To our knowledge, this variation has not been previously described. Innervation and vascular supply of this accessory head was from the musculocutaneous nerve and the brachial artery, respectively. © 1996 Wiley-Liss, Inc.     

Electrophysiological studies of muscles in the human upper limb: The biceps brachii

The biceps brachii (BB) belongs to elbow flexors. However, because the BB acts not only as the flexor, but also as a forearm supinator in humans, its activities are much different from those of the other flexors (the brachialis and brachioradialis: BR and BRR, respectively). The present paper describes unique characteristics of the BB that emerged from recent studies using electrophysiological techniques (i.e. electromyography (EMG), electrical neuromuscular stimulation (ENS), Hoffmann (H)-reflex and post-stimulus time-histogram (PSTH)) in normal human subjects. The EMG studies have shown reciprocal contractions between the BB and the other flexors during forearm pronation/supination movements. Comparisons of EMG activities of the flexors between the pronated and supinated positions of the forearm have indicated clear differences of contraction properties between the BB and the other flexors. The ENS studies have shown that reciprocal activation between the BB and BRR following stimulation can produce a motion of supination with maintenance of flexion. This finding supports the theory that the reciprocal contractions should occur to keep constant force in flexion for supporting weight below the elbow. Studies using H-reflex and PSTH techniques have shown neural connections, which are spinal reflex arcs modulating motoneuron excitabilities with excitatory and inhibitory inputs from low-threshold muscle afferent fibers, among muscles in the human upper limb. These studies have demonstrated inhibitory neural connections between the BB and BRR. Moreover it has been shown that the connections concerning the BB differ from those concerning the BRR. Several reports have shown differences in connections between humans and animals. Therefore, the BB in humans has been compared with that in animals.     

关节镜下两种肌腱固定治疗肱二头肌长头近端腱损伤的比较

背景:对于年轻及上肢活动要求高的肱二头肌长头腱近端损伤患者,常用的腱固定包括挤压螺钉固定、带线锚钉固定,目前对于两者临床疗效的对比较少且尚无定论。目的:比较关节镜下界面挤压螺钉固定及带线锚钉捆扎固定治疗肱二头肌长头腱近端损伤的临床疗效。方法:选择南昌市洪都中医院2019年1月至2020年12月收治的肱二头肌长头腱近端损伤伴肩袖撕裂患者,共52例,按照随机数字表法分为挤压钉组(n=29)、锚钉组(n=23),在关节镜下分别进行界面挤压螺钉固定与带线锚钉捆扎固定治疗。术前及术后1,3,6,12个月、末次随访时,比较两组患者肩关节目测类比评分、美国肩肘外科协会评分、肩关节前屈及屈肘90°时内外旋角度;末次随访时,对比两组患者肘关节屈曲肌力、再手术率及并发症发生率(大力水手征)。结果与结论:(1)两组术后的肩关节目测类比评分、美国肩肘外科协会评分、肩关节前屈及屈肘90°时内外旋角度均较术前明显改善(P<0.05);术前及术后各时间点,两组间肩关节目测类比评分、美国肩肘外科协会评分、肩关节前屈及屈肘90°时内外旋角度比较差异均无显著性意义(P>0.05);(2)末次随访时,两组患者肘关节屈曲肌力均达到IV级以上,两组间无差异;挤压钉组大力水手征发生率为14%、再手术率为7%,带线锚钉组大力水手征发生率为4.3%、再手术率为0%,两组间大力水手征发生率与再手术率比较差异无显著性意义(P>0.05);(3)对于肱二头肌长头腱近端损伤,关节镜下采用界面挤压螺钉固定和带线锚钉缝合捆扎固定均可在1年内有效缓解肩关节疼痛、改善肩关节功能,且两种方法临床疗效相当。     

Acoustic myography reflects force changes during dynamic concentric and eccentric contractions of the human biceps brachii muscle

Summary The relationship between acoustic myography (AMG), electromyography (EMG) and force during submaximal dynamic contractions was examined in the biceps brachii muscles of eight healthy males (aged 17–26 years). Different weights were lifted and lowered at a constant speed, using a wall pulley system, to perform concentric and eccentric contractions, respectively. Integrated AMG (iAMG) and integrated EMG (iEMG) activity both increased linearly with force during concentric (iAMGr=0.94; iEMGr=0.99) and eccentric (iAMGr=0.90; iEMGr=0.94) contractions. The slopes of the concentric regression lines were significantly different from the eccentric slopes (P<0.01) for both iAMG and iEMG with concentric contractions showing greater levels of activity. The results indicated that AMG can be used to detect changes in force during dynamic contractions which has important implications for the use of AMG in rehabilitation. The differences in iAMG activity between concentric and eccentric contractions are discussed in relationship to the origin of the AMG signal.     

Facilitation and habituation of the startle reflex over the tonically active biceps brachii muscle contralateral to electrical stimuli

The aim of the present investigation was to explore the impact of muscle contraction on startle reflex responses after electrical stimuli (single or trains of 3) and to study startle reflex habituation. The electromyogram was recorded over the tonically active biceps brachii muscle in 19 healthy subjects contralateral to electrical stimuli (9–12 mA) that were delivered at 1.0 and 0.4 Hz over the superficial radial nerve. The muscle contraction level was varied by loading weight on the subject's bent arm (0.0, 1.0 or 1.5 kg). Furthermore, short term reflex habituation was investigated using 30 blocks of 5 subsequent stimuli. Startle response amplitudes gained significantly (p < 0.05) after (i) train stimuli as compared with single stimuli, during (ii) high versus low levels of muscle contraction, and at (iii) 0.4 Hz versus 1.0 Hz stimuli. Startle reflex amplitudes decreased significantly by the influence of preceding stimuli (p < 0.05). This study provides evidence that the startle reflex can be significantly influenced by weight load, i.e. by volitional influences. Startle reflex investigation over a contracted limb muscle results in a high probability of startle release and thereby improved detection of SR habituation following preceding stimuli.