Blast Your Biceps

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Operative technique of muscle transplantation to the arm for biceps function

Loss of elbow flexion can be a devastating disability. Fortunately, the biceps muscle and the brachialis muscle are capable of performing this function. Thus, the direct loss of one or the other does not eliminate this function. The loss of both and the weakening of both can have significant functional consequences, however. In brachial plexus reconstruction, significant priority is given to elbow flexion. At their center, the authors have not had experience with this but have only performed surgery after localized trauma or The operative procedure is again performed by two teams. The arm is prepared with an incision providing access to the acromion proximally, the brachial artery and the accompanying vein at the junction of the upper and middle thirds of the arm, and, finally, the distal biceps tendon and the bicipital aponeurosis inserting onto the ulna. The gracilis muscle is harvested and transplanted to the arm. It is secured proximally to the acromion, and the vascular and...

Biceps Tendon Ruptures

The biceps brachii muscle has two attachments on the arm a proximal tendinous attachment on the glenoid and coracoid and a distal tendinous attachment on the radial tuberosity. Both attachments are subject to acute or chronic stress. Disruption of the muscle-tendon-bone interface results in a rupture. Ninety to ninety-seven percent of biceps tendon ruptures occur at the proximal attachment.1 Ruptures at the distal biceps tendon attach ment are considered uncommon. Johnson in1897 and Ac-quaviva in 1898 were the first to describe distal biceps tendon ruptures.2'3 This injury most often occurs in men who are in their fifth or sixth decade of life however, it can occur in patients at any age after the early twenties.4-6 The muscles in these patients tend to be well developed, but the patients do not need to have the build of a weight lifter to be at risk for rupture. Ruptures can occur in any persons who have reasonably developed muscles in their arms. The mechanism of injury is an...

Biceps Tendon Injury

Radialbicpital Bursa

Complete tears of the distal biceps are thought to be much more common than partial tears.45,46 MRI is useful in Distal biceps tendinosis is common and has been shown to precede spontaneous tendon rupture.13 Tendi-nosis of the distal biceps is probably a multifactorial process that involves repetitive mechanical impingement of a poorly vascularized distal segment of the tendon. Irregularity of the radial tuberosity and chronic inflammation of the adjacent radial bicipital bursa also may con-tribute.49,50 A zone of relatively poor blood supply exists within the distal biceps tendon approximately 10 mm from its insertion on the radial tuberosity.51 In addition, this hypovascular zone may be impinged between the radius and the ulna during pronation. The space between the radius and ulna progressively narrows by 50 during pronation, with average measurements of approxi- mately 8 mm in supination, 6 mm in neutral position, and 4 mm in pronation recorded in asymptomatic volunteers with CT...

Muscular Movement Of Bones

Generally, skeletal muscles are attached to one end of a bone, stretch across a joint, and are fastened to a point on another bone. Muscles are attached to the outer membrane of bone, the periosteum, either directly or by a tough fibrous cord of connective tissue called a tendon. For example, as shown in Figure 45-13, one end of the large biceps muscle in the arm is connected by tendons to the radius in the forearm, while the other end of the muscle is connected to the scapula in the shoulder. When the biceps muscle contracts, the forearm flexes upward while the scapula remains stationary. The point where the muscle attaches to the stationary bone in this case, the scapula is called the origin. The point where the muscle attaches to the moving bone in this case the radius is called the insertion. Most skeletal muscles are arranged in opposing pairs. One muscle in a pair moves a limb in one direction the other muscle moves it in the opposite direction. Muscles move bones by pulling...

The Neural Tunnels Around the Elbow

Cubital Tunnel

Biceps muscle Biceps tendon and FIGURE 1.8. Cubital fossa. (A) The cubital fossa is the triangular space formed by a line joining the medial and lateral epicondyles and the borders of the brachioradialis and pronator teres muscles. (B) The contents include the nerves, arteries, and biceps tendon. Biceps muscle Biceps tendon and FIGURE 1.8. Cubital fossa. (A) The cubital fossa is the triangular space formed by a line joining the medial and lateral epicondyles and the borders of the brachioradialis and pronator teres muscles. (B) The contents include the nerves, arteries, and biceps tendon.

Appendix B Sample Workout

Biceps Biceps Curl Grab pulldown bar using underhand grip, arms extended shoulder-width apart. Sit on pad and keep back straight. Count 1 Pull bar down until it touches top of chest. Exhale on pull down. Do not swing or rock lower back during movement. Count 2 Return to start position, inhaling as you extend your arms. Works back and biceps. Grab pulldown bar using overhand grip, arms extended shoulder-width apart. Sit on pad and keep back straight. Count 1 Pull bar down by bringing elbows down to your sides until the bar touches your upper chest. Exhale on pull down. Do not arch your lower back during this exercise. Count 2 Return to start position, inhaling as arms extend. Works back and biceps. Place left knee and hand on bench, extend right leg on deck. Keep back straight. Extend right arm straight down below right shoulder and hold dumbbell in right hand. Count 1 Pull dumbbell straight up to rib cage by bringing elbow straight up and behind you. Exhale raising dumbbell. Do not...

Near Infrared Interactance

Matter of minutes (approximately 3 min) by placing an infrared probe over the biceps muscle and measuring optical densities of the underlying tissue. To standardize testing, two specific wavelengths based on the absorption of fat and water are used, and the instrument is calibrated by measuring a signal from a reference block made of Teflon 53 . Additionally, specific equations catered to individual patient populations can be used to help reduce variance 54 .

Stimulus Output and Recruitment Properties

The actual recruitment curves for the BION in feline biceps femoris are shown in Figure 3.3B.14 In this plot and in all of the software used by the clinician, stimulus strength is normalized to a single threshold intensity that is calculated as the product of pulse duration and current, which is stimulus charge. Over the range of about

Ipsilateral or contralateral nerve elongation with a nerve graft as the first stage followed by FFMT for elbow or

In concept, this is similar to the cross-face nerve graft or cross-chest nerve graft as the first stage. Following 1 year of nerve regeneration, detected by an advancing Tinel sign, the FFMT motor nerve can then be coapted to the elongated nerve graft for motor reinnervation. Usually two sural nerve grafts are used. The ipsilateral radial nerve, if it is still available, elongated from the infraclavicular region, or the contralateral C7 dorsal division elongated with cable nerve grafts are commonly used. A nerve passer is used to pass the nerve graft subcutaneously and the cable nerve grafts are embedded into the deltoid muscle or biceps muscle awaiting the second-stage FFMT.

Experience at Shriners Hospital for Children

Shriners Children With Crutches

Four weeks postimplantation, subjects participated in four weeks of strengthening and conditioning of the implanted muscles, followed by 17 to 22 weeks in which the focus was on programming of the upright mobility strategies and training for their functional use. Goals included achieving the transitions between sitting and standing, swing-through and or reciprocal gait with a walker or crutches, and prolonged standing. For reciprocal gait, swing was achieved through stimulation to the iliopsoas, biceps femoris, and or the tibialis anterior to create a flexor withdrawal response. Additional training goals included advanced activities, such as ascending and descending stairs (Figure 17.5A) and the achievement of subject-specific goals (Figure 17.5B). Bilateral ankle-foot orthoses were worn for all upright mobility activities. Three of the fifty-two electrodes placed for lower extremity stimulation experienced changes in the responses of the muscles. One of these was due to a...

Hindlimb Motor Responses Evoked By intraspinal microstimulation In The anaesthetized and acutely prepared cat

Anaesthetized Cat

The end-point forces elicited by intraspinal microstimulation (0.5-s train of 40-Hz 100-pA 100-ps biphasic current pulses) of the L5-L7 spinal cord were measured in adult cats either anaesthetized with chloralose or decerebrated. End-point force vectors in the sagittal plane were measured at 9-12 positions of the hindlimb that spanned the range of knee and ankle angles encountered during locomotion. Bifilar wire electrodes were inserted into four hindlimb muscles (knee flexor, knee extensor, ankle flexor and extensor) to record the EMG activity biceps femoris, vastus medialis or lateralis, tibialis anterior, and medial gastrocnemius, with electrode location verified via post-mortem dissection. The raw EMG signal was amplified, filtered (10-1000 Hz), and sampled at 2500 Hz. The animal's pelvis and femur were held with bone pins, and the paw was attached to a gimbal mounted on a movable six-axis force transducer. The kinematic linkage was thus knee and ankle as opposed to hip and knee...

Physical Examination

Patients who have an acute distal biceps tendon rupture often describe the sensation at the time of injury as tearing, ripping, popping, or electric. The sensation is usually sudden and dramatic. The pain is not excruciating, and it often subsides after several days. Chronic pain in the region of the distal biceps tendon suggests an incomplete or partial tear. Range of motion is normal following an acute distal biceps tendon rupture. Significant swelling and ecchymosis about the medial and anterior elbow regions are common (Fig. 9.1). Ecchymosis is due to the bleeding associated with the rupture from the radial tuberosity. Ecchymosis typically does not appear until 1 or 2 days after injury and begins to resolve within 1 or 2 weeks. It can vary from a small patch that forms in the region of the flexor-pronator origin to an area that extends from the distal third of the medial forearm to the middle portion of the medial upper arm. Because the biceps muscle is the strongest supinator in...

Stimulus strength times threshold

FIGURE 3.3 Recruitment curves for single twitch contractions at various stimulus intensity levels, measured as force normalized to the maximal twitch for 100 recruitment of the muscle. A. Comparison of recruitment of cat medial gastrocnemius by nerve cuff electrodes (open circles) and nerve hook electrodes (open diamonds) on the common sciatic nerve, as opposed to intramuscular electrodes configured as in the BION (solid circles) for acutely implanted (solid lines) and chronically implanted (dashed lines) electrodes (adapted from Singh et al., in press). B. Recruitment of cat posterior biceps muscle by a BION1 implanted acutely in a proximal or distal location in the muscle belly, with stimulus intensity (abscissa) normalized to the threshold for a just palpable twitch at each of two pulse widths (adapted from Cameron et al., 1997). The plateau effects at less than 100 recruitment represent stimulus current levels at which compliance voltage limits were reached for an earlier version...

Strength Training

Bent-Over Row with Band Grab one end of the band in each hand. Step on the middle of the band with your left foot, step back 2 ft. with your right foot. Bend forward slightly at the waist, keep your shoulders and hips facing forward. Count 1 Lift both hands from your thighs to your waist. This should take 2 seconds. Pause for 1 second. Count 2 Return hands to thigh level in 4 seconds. Keep your elbows close to your body throughout the exercise. Works the back and biceps muscles. Seated Row with Band Sit on deck with legs extended, knees slightly bent. Place the center of the band under your feet. Count 1 With arms extended at chest level and hands over knees, bend your elbows and pull your hands back to each side of your chest. This should take 2 seconds. Pause 1 second. Count 2 Return to start position in 4 seconds. Works back and biceps. Biceps Curl with Band Grab one end of the band in each hand. Step on the band with your left foot, step your right foot through the band and...


Distal Bicep Nerve Concern

In the past, nonoperative management of distal biceps tendon ruptures was popular.2,4,6,7,10-12 Authors of numerous case reports suggested that early motion and strengthening exercises could restore normal strength. Authors of subsequent studies in which they used dynamometers demonstrated the deficits of nonoperative treatment.4,6 They found that patients who were treated nonoperatively for their distal biceps tendon ruptures had weaker supination and flexion than patients who had the ruptured tendon reattached to the bicipital tuberosity. If supination strength is not important, nonoperative treatment can be considered. A surprising degree of elbow flexion strength can be restored by strengthening the other muscles that cross the anterior aspect of the elbow. If the distal biceps tendon becomes tethered distally, it too may add to the variable elbow flexion strength that develops. yields unsatisfactory results. Using Cybex testing of nonoperatively treated patients, Baker and...


Long head of biceps tendon Longitudinal view of long head of biceps tendon. H humerus T long head of the biceps tendon * tendon sheath DM deltoid muscle Axial view of pectoralis major tendon. H humerus BM short head of biceps muscle CM coracobrachialis muscle * pectoralis major tendon DM deltoid muscle

Arm Deceleration

The arm-deceleration phase, which only lasts a few hun-dredths of a second, begins at ball release and ends when the shoulder has reached its maximum internal rotation (Fig. 2.1I,J). An eccentric elbow flexion torque of approximately 10 to 35 N-m is produced throughout the arm-deceleration phase to decelerate elbow extension (Fig. 2.2).20,24 Moderate to high eccentric contractions of the elbow flexors have been reported during arm decel-eration.24,26,28 Researchers also have shown that the pronator teres is very active in decelerating elbow extension and pronating the forearm.28,40 The biceps brachii and supinator muscles are responsible for controlling forearm pronation.

Clinical Anatomy

The biceps brachii muscle originates on the scapula at the glenoid rim and coracoid process. It is the most superficial muscle belly' lying in the anterior portion of the middle third of the humerus. This muscle joins the distal tendon in the lower third of the arm. The tendon passes distally into the antecubital fossa. The antecubital fossa is defined by the brachioradialis radially and the pronator teres ulnarly. A sheath surrounds the biceps tendon as it passes through the antecubital fossa toward its insertion on the radial tuberosity. The lateral antebrachial cutaneous nerve lies superficially in the subcutaneous tissue of the antecubital fossa. The nerve parallels the bra-chioradialis. An incision along the anterior edge of the brachioradialis can injure the nerve. While still superficial, the tendon is contiguous with the lacertus fibrosis that becomes confluent medially with the fascia overlying the flexor-pronator mass. The brachial artery lies just beneath the lacertus...

Strength Testing

Strength of the elbow, wrist, and hand motors, particularly when assessing for a neurologic problem or a ten-donapathy. Biceps brachii muscle strength testing is best conducted against resistance with the forearm supinated and the shoulder flexed from 45 to 50 1 (Fig. 3.10). Triceps strength testing, however, is best conducted with the shoulder flexed to 90 and the elbow flexed from 45 to 90 1 (Fig. 3.11). Elbow extension strength is normally 70 of flexion strength.17 Pronation, supination, and grip strength then are studied with the elbow in 90 of flex- FIGURE 3.10. Biceps muscle strength is assessed with the forearm supinated and the shoulder flexed from 45 to 50 . The examiner applies resistance to flexion. FIGURE 3.10. Biceps muscle strength is assessed with the forearm supinated and the shoulder flexed from 45 to 50 . The examiner applies resistance to flexion.

Muscle Function

The major flexors across the elbow joint are the brachi-alis, biceps brachii, brachioradialis, and extensor carpi ra-dialis.89 An et al. determined the physiologic cross-sectional area of each muscle across the elbow joint and concluded that the brachialis had the largest work capacity and potential contractile strength.8 The brachialis is active regardless of elbow position, type of contraction, or rate of movement, and the position of the shoulder does not affect these factors. The muscles involved in supination of the forearm are the supinator and the biceps. Supination is achieved primarily by the supinator muscle, with the biceps acting in a secondary role. The supinator acts independently during slow, unrestrained supination. During unrestrained, rapid supination or resisted supination in any position, the biceps assists the supinator muscle. When the biceps assists supination, the extensors must act antagonistically to cancel any flexion that the activity of the biceps creates.

31 Days To Bigger Arms

31 Days To Bigger Arms

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