Shoulder reflexes.

Dynamic shoulder stability is dependent on muscular coordination and sensory inputs. In the shoulder, mechanoreceptors are found in the coracoacromial ligament, the rotator cuff tendons, the musculotendinous junctions of the rotator cuff and in the capsule. The number of receptors in the capsule is small compared to the number in the other shoulder structures. Proprioceptive information from numerous receptors in muscles and tendons is mediated via fast conducting nervefibers and probably contribute more to kinaestethic sensation than information from capsule and ligaments. Therefore it seems likely that the joint receptors have a more distinct role for the kinaestethic sense than muscle receptors. In cats a direct reflex from the afferents innervating the shoulder to the muscles around the shoulder has been presented. The reflex had an extremely short latency (2.7-3.1 ms). In man, a very long latency (300 ms) excitatory reflex has been found when nerves in the capsule were stimulated electrically during shoulder surgery. In addition, when the anterior-inferior capsule was excited in conscious humans with modest amplitude electrical stimuli during muscle activity, a strong inhibition was found with an average latency of 33 ms. Stimulation of the sensory nerves in the coracoacromial ligament has also been found to modify muscle activity strongly. Even though our understanding of the control of shoulder motion is incomplete, it is clear that sensory inputs can strongly modify muscle activity around the shoulder. This has implications for rehabilitation and shoulder surgery.     

Cruciate ligament reflexes.

The idea of muscular reflexes elicited from sensory nerves of the cruciate ligaments is more than 100 years old, but the existence of such reflexes has not been proven until the recent two decades. First in animal experiments, a muscular excitation could be elicited in the hamstrings when the anterior cruciate ligament (ACL) was pulled, and tension in the ligament caused activity of the gamma motor neurones of the muscles around the knee. Impulses from the sensory nerves in ACL were activated during motion of the knee, in particular overstretching and combined extension and rotation. In humans, proprioception in the knee is decreased after ACL rupture. By mechanical or electrical stimulation of the ACL, an excitation in the hamstrings muscles can be elicited. During muscular activity, stimulation of the ACL or PCL results in a clear inhibition of the ongoing activity, both during static isometric and isokinetic muscle work, and also during dynamic activity (gait). This inhibitory reflex subjectively resembled giving way. The latency of the reflex was short in animals (about 3 ms) and long in humans (60-120 ms), probably caused by differences in the experimental setup and between species. The long latency in humans makes it unlikely that it is a directly protective reflex. Instead it may be involved in the updating of motor programs. Further research may characterize the reflex in details and map its pathways. The existence of this reflex indicate that the cruciate ligaments have an afferent function, which influences knee dynamics.     

Rhinoplasty: the light reflexes

The physical characteristics of the light reflexes of the nasal tip are defined in large part by the studio lighting configuration. By varying the lighting configuration, it is possible to alter the light reflexes as regards their number, distance apart, symmetry, and size. For the plastic surgeon, the quarter light system of the medical photographer has definite advantages over the key light system of the portrait photographer. The quarter light system consists of two lights of equal intensity with symmetrical angles of incidence placed at 45 degrees to the camera-subject axis. Measuring changes in the light reflexes as a method of determining the efficacy of surgical techniques is valid under very controlled conditions.