Possibility of simultaneous transposition of segments of the pectoralis major muscle to restore flexion in the shoulder and elbow joints (clinical observation)

MedAlliance ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 61-68

The pectoralis major is a widely used muscle in reconstruction surgery for replacement soft tissue defects of a head, neck, thorax, upper limbs and restoration of muscle active function. The peculiarities of anatomy of the pectoralis major makes it possible to divide the muscle into several segments with their own innervations and supply and use them independently from each other. This article describes the anatomy of the pectoralis major and the opportunity for clinical applications of different segments of this muscle. The authors demonstrate the result of the restoration of shoulder and elbow flexion in a patient with arthrogryposis due to simultaneous transfer of the proximal part of pectoralis major to the anterior part of the deltoid muscle and the distal part of pectoralis major to the biceps with good functional results. The article will be useful for plastic surgeons, orthopedic surgeons and physiotherapists.

2018 ◽  
Vol 27 (11) ◽  
pp. e330-e336 ◽  
Author(s):  
Adeline Cambon-Binder ◽  
Arnaud Walch ◽  
Pierre-Sylvain Marcheix ◽  
Zoubir Belkheyar

2021 ◽  
Vol 9 (4) ◽  
pp. 407-416
Author(s):  
Olga E. Agranovich ◽  
Ekaterina V. Petrova ◽  
Sergey F. Batkin ◽  
Evgeniya I. Ermolovich ◽  
Igor A. Komolkin ◽  
...  

BACKGROUND: One of the main problems that limited or made the self-ability of patients with arthrogryposis impossible is the lack of active elbow flexion due to hypoplasia (or aplasia) of the forearm flexors and, especially the m. biceps brachii. AIM: To evaluate the possibility of active forearm flexion restoration in children with arthrogryposis by partial monopolar transposition of the pectoralis major muscle. MATERIALS AND METHODS: Elbow active flexion restoration by partial monopolar transposition of the pectoralis major muscle to biceps brachii was conducted in 34 children with arthrogryposis (39 upper limbs) from 2011 to 2020. The muscle autograft included a fragment of the fascia of the m. rectus abdominis. Clinical examinations of patients were performed before and after the operation. Statistical data processing was performed using the software packages Statistica 10 and SAS JMP 11. RESULTS: The follow-up results were estimated from 6 to 99 months (44.53 31.72) postoperative. The mean age of patients was 6.24 4.24 years. The active postoperative elbow motion was 0120 (71.94 33.40). The passive postoperative elbow motion did not change and was 90130 (104.12 12.40). Muscles strength after the operation was grade 25. Elbow extension was limited in 30 cases (76.9%) from 0 to 40 (21.70 12.27) without problem in the activities of daily living. Good results were determined in 15 cases (38.5%), satisfactory in 8 (20.5%), and poor in 16 (41%). CONCLUSIONS: This study revealed that our partial monopolar transfer of pectoralis major to biceps brachii technic restored sufficient forearm flexion and improved self-ability without forming severe elbow flexor contractures of more than half of the patients with arthrogryposis.


2019 ◽  
Vol 2019 ◽  
pp. 1-15 ◽  
Author(s):  
Robert Haładaj ◽  
Grzegorz Wysiadecki ◽  
Edward Clarke ◽  
Michał Polguj ◽  
Mirosław Topol

Background. The presented study attempts to classify individual anatomical variants of the pectoralis major muscle (PM), including rare and unusual findings. Rare cases of muscular anomalies involving the PM or its tendon have been presented. An attempt has also been made to determine whether anatomical variations of the PM may affect the innervation pattern of the lateral and medial pectoral nerves. Material and Methods. The research was carried out on 40 cadavers of both sexes (22 males, 18 females), owing to which 80 PM specimens were examined. Results. Typical PM structure was observed in 63.75% of specimens. The most frequently observed variation was a separate clavicular portion of the PM. In one female cadaver (2.5% of specimens) the hypotrophy of the clavicular portion of the PM was noticed. In two male cadavers (5% of specimens) the fusion between the clavicular portion of the PM and the deltoid muscle was observed. In one of those cadavers, small sub-branches of the lateral pectoral nerve bilaterally joined the clavicular portion of the deltoid muscle. The detailed intramuscular distribution of certain nerve sub-branches was visualized by Sihler’s stain. PM is mainly innervated by the lateral pectoral nerve. In all specimens stained by Sihler’s technique, the contribution of the intercostal nerves in PM innervation was confirmed. Conclusions. Surgeons should be aware of anatomic variations of the PM both in planning and in conducting surgeries of the pectoral region.


2019 ◽  
Vol 4 (6) ◽  
pp. 248-253 ◽  
Author(s):  
Laurent Nové-Josserand

Glenoid exposure should offer frontal access to the glenoid to allow the ancillary tools to be used freely and thus facilitate the good positioning of the glenoid implant. The two classically recognized approaches for shoulder arthroplasty are the deltopectoral and the transdeltoid approach. The axillary nerve is the most important anatomical structure in the glenoid, passing down the anterior part of the subscapularis, the inferior pole of the joint and the deep face of the deltoid muscle. Inferior glenohumeral release is the key step that allows the humerus to be retracted back or downwards thereby exposing the glenoid face on. In difficult and stiff cases, once pectoralis major release, osteophyte resection and posterior capsulectomy have been performed, a compression fracture, produced by using a retractor to push against the upper extremity of the humerus, can provide the extra few millimetres of space required to use the ancillary tools without hindrance. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180057


Author(s):  
S.A. Moiseev

The question of physiological function variability is of great theoretical interest, since it is a part of the theory of human voluntary movement control. The skeletal muscle control system should probably have a mechanism to reduce or limit the range of its possible variations. Presumably, the organization of the motor system elements according to the principle of muscular synergy is of such a nature. The objective of the work is to study variations and signs of the coordinated bioelectric activity of skeletal muscles in one of the resulting archery phases. Materials and Methods. The study enrolled 5 highly qualified sportsmen (Master of Sport, International Master of Sport). Archers shot 10 series of 3 shots, target distance 18 m, indoors. Simultaneous recording of electrical activity of 12 skeletal muscles of the upper limb girdle and a 3D video sequence was made. The authors analyzed indicators of distribution, descriptive and variation statistics for grouped data. Multiple regression analysis was used to identify signs of consistent muscle activity. Results. Variability magnitudes, characterized by statistical parameters, established for the turn-off-peak characteristics of various muscles, did not have an explicit dependence. Muscles with relatively high scattering parameters in terms of the EMG average amplitude could have a small variation in the average number of EMG turns. The radial flexor of the left hand wrist was a part of muscular synergy in 90 % of cases, the anterior part of the left limb deltoid muscle – in 80 % of cases, the lower and upper beams of the right and left cowl muscle – in 70 % of cases. Other muscles under consideration were their part in less than 60 % of cases. Conclusion. The system of skeletal muscles that are actively involved in the resulting phases of precision movement can be controlled according to the mechanism of functional synergy formation, which probably helps to reduce the range of possible variations in the parameters of muscle electroactivity. Keywords: variability, archery, electromyography, coordination structure, muscle synergy. Вопрос вариативности физиологических функций представляет интерес в теоретическом плане, поскольку является частью теории управления произвольными движениями человека. Система управления скелетными мышцами, вероятно, должна иметь механизм, позволяющий сократить или ограничить диапазон возможных ее вариаций. Таковым, предположительно, является организация элементов моторной системы по принципу мышечных синергий. Цель работы – изучение вариаций и признаков согласованной биоэлектрической активности скелетных мышц в одной из результирующих фаз выстрела из лука. Материалы и методы. В исследованиях приняли участие 5 высококвалифицированных спортсменов (МС, МСМК). Лучники выполняли 10 серий по 3 выстрела с дистанции 18 м в крытом помещении. Производилась синхронная регистрация электрической активности 12 скелетных мышц верхнего плечевого пояса и 3D-видеоряда. Анализировались показатели распределения, описательной и вариационной статистики для сгруппированных данных. Для выявления признаков согласованной активности мышц применялся множественный регрессионный анализ. Результаты. Величины вариативности, характеризуемые статистическими параметрами, установленные для турн-аплитудных характеристик различных мышц, не имели явной зависимости. Мышцы, имеющие относительно высокие параметры разброса значений по показателю средней амплитуды ЭМГ, могли иметь небольшую вариативность среднего числа турнов ЭМГ. Лучевой сгибатель кисти левой руки являлся частью мышечной синергии в 90 % случаев, передняя часть дельтовидной мышцы левой конечности – в 80 %, нижние и верхние пучки трапециевидной мышцы правой и левой сторон – в 70 %. Другие исследуемые мышцы являлись их частью в менее чем 60 % случаев. Выводы. Управление системой скелетных мышц, принимающих активное участие в реализации одной из результирующих фаз точностного движения, может осуществляться по механизму образования функциональных синергий, что, вероятно, способствует снижению диапазона возможных вариаций параметров электроактивности мышц. Ключевые слова: вариативность, стрельба из лука, электромиография, координационная структура, мышечные синергии.


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