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1.
This study sought to resolve a longstanding debate of the function of anconeus. Intramuscular and surface electromyography electrodes recorded muscle activity from two regions of anconeus and from typical elbow flexion and extension muscles. Eleven participants performed pronation–supination around the medial and lateral axes of the forearm, elbow flexion–extension in pronation, supination and neutral positions of the forearm, and gripping. Maximal voluntary contractions (MVC) and submaximal (10% MVC) force-matching tasks were completed. Activity varied between longitudinal (AL) and transverse (AT) segments of anconeus. Although both muscle regions were active across multiple directions (including opposing directions), AL was more active during pronation than supination, whereas AT showed no such difference. During pronation, activity of AL and AT was greatest about the lateral forearm axis. AT was more active during elbow extension with the forearm in pronation, whereas AL did not differ between pronated and neutral forearm alignment. These findings are consistent with the proposal that AL makes a contribution to control of abduction of the ulna during forearm pronation. Different effects of forearm position on AL and AT activity during elbow extension may be explained by the anatomical differences between the regions. These data suggest anconeus performs multiple functions at the elbow and forearm and this varies between anatomically distinct regions of the muscle.  相似文献   

2.
Abstract

Purpose/Aim: There have been conflicting results regarding which muscle contribute most to the elbow spastic flexion deformity. This study aimed to investigate whether flexor spasticity of the elbow changed according to the position of the forearm, and to determine the muscle or muscles that contributed most to the elbow spastic flexion deformity by clinical examination.

Methods: This study is a single group, observational and cross-sectional study. Sixty patients were assessed for elbow flexor spasticity in different forearm positions (pronation, neutral and supination) with Modified Tardieu Scale. The primary outcome measure was a domain of the Modified Tardieu Scale, the dynamic component of spasticity (spasticity angle).

Results: In general, there was a significant difference between forearm positions regarding spasticity angle (p?<?.001). In pairwise comparisons, median spasticity angles in pronation (70 degrees) and neutral position (60 degrees) were significantly higher than those in supination (57.5 degrees) (adjusted p?<?.001 and adjusted p?=?.003, respectively). However, median spasticity angle in pronation did not differ significantly from those in neutral position in favour of pronation (adjusted p?=?.274).

Conclusions: The severity of spasticity changes according to the elbow position which suggests that the magnitude of contribution of each elbow flexor muscle to spastic elbow deformity is different. Reduction of spasticity from pronation to supination leads us to consider brachialis as the most spastic muscle. Since biceps was suggested to be the least spastic muscle in this study, and also to avoid spastic pronation deformity of the forearm, it should be rethought before performing chemodenervation into biceps muscle.  相似文献   

3.
Forearm pronation and supination, and increased muscular activity in the wrist extensors have been both linked separately to work-related injuries of the upper limb, especially humeral epicondylitis. However, there is a lack of information on forearm torque strength at ranges of elbow and forearm angles typical of industrial tasks. There is a need for strength data on forearm torques at different upper limb angles to be investigated. Such a study should also include the measurement of muscular activity for the prime torque muscles and also other muscles at possible risk of injury due to high exertion levels during tasks requiring forearm torques.Twenty-four male subjects participated in the study that involved maximum forearm torque exertions for the right arm, in the pronation and supination directions, and at four elbow and three forearm rotation angles. Surface EMG (SEMG) was used to evaluate the muscular activity of the pronator teres (PT), pronator quadratus (PQ), biceps brachi (BB), brachioradialis (BR), mid deltoid (DT) and the extensor carpi radialis brevis (ECRB) during maximum torque exertions. Repeated measures ANOVA indicated that both direction and forearm angle had a significant effect on the maximum torques (p<0.05) while elbow angle and the interactions were highly significant (p<0.001). The results revealed that supination torques were stronger overall with a mean maximum value of 16.2 Nm recorded for the forearm 75% prone. Mean maximum pronation torque was recorded as 13.1 Nm for a neutral forearm with the elbow flexed at 45 degrees. The data also indicated that forearm angle had a greater effect on supination torque than pronation torque. Supination torques were stronger for the mid-range of elbow flexion, but pronation torques increased with increasing elbow extension. The strength profiles for the maximum torque exertions were reflected in the EMG changes in the prime supinators and pronators. In addition, the EMG data expressed as the percentage of Maximum Voluntary Electrical activity (MVE), revealed high muscular activity in the ECRB for both supination (26-43% MVE) and pronation torques (17-55% MVE). The results suggest that the ECRB acts as a stabiliser to the forearm flexors for gripping during pronation torques depending on forearm angle, but acts as a prime mover in wrist extension for supination torques with little effect of elbow and forearm angle. This indicates a direct link between forearm rotations against resistance and high muscular activity in the wrist extensors, thereby increasing stress on the forearm musculo-skeletal system, especially the lateral epicondyle.  相似文献   

4.
The purpose of this study was to determine if the repeatability and pattern of elbow kinematics are affected by changing the relative magnitudes of loads applied to muscles around the elbow in vitro. In eight cadaveric upper extremities, passive and three methods of simulated active elbow flexion were tested with the forearm maintained in both pronation and supination. Passive flexion involved moving the elbow manually through a full arc of motion. Simulated active flexion used a custom designed loading system to generate elbow motion by applying loads to various tendons via pneumatic actuators. Three different simulated active loading protocols, with loading ratios based on muscle activity and physiologic cross-sectional area, were tested. Testing was performed initially on an intact elbow, and then an unstable elbow model created by transection of the lateral collateral ligament (i.e. the radial and lateral ulnar collateral ligaments). An electromagnetic tracking device was used to measure rotation of the ulna relative to the humerus. Varus-valgus angulation and internal-external rotation were less repeatable during passive flexion than simulated active flexion, regardless of the loading ratio used, in both the intact (p<0.05) and unstable (p<0.05) elbows. Throughout the arc of flexion, the motion pathways were similar for the three simulated active motion protocols employed in this study (p>0.05). The pathways followed during passive motion were different from those generated with simulated active motion, especially in the unstable elbow with the forearm supinated (p<0.001). These results suggest that using simulated active motion rather than manual passive motion can improve the repeatability of elbow kinematics generated in the laboratory, and that a wide range of muscle loading ratios may produce similar kinematic output.  相似文献   

5.
Motions of the forearm induced by electrical stimulation to two elbow flexors (brachioradialis: BR, biceps brachii: BB) were examined in five healthy human subjects. Stainless steel wire electrodes were implanted percutaneously into each motor point of the muscles. The muscles were stimulated separately with a computer-controlled multi-channel stimulator. The motions were taken with a digital video system. Angular changes of the motions in elbow flexion/extension and forearm pronation/supination were measured. Electromyograms (EMG) of BR, BB, and the triceps brachii (TB) were recorded. Electrical stimulation to BR induced a motion of flexion and that to BB motions of flexion and supination. The stimulation to BR with an adequate intensity provided holding of flexion with the prone forearm in all the subjects. In this situation, additional stimulation to BB resulted in motions of flexion and supination. However, the additional stimulation accompanied with a decrease of the stimulation intensity for BR provided a motion of supination with maintenance of the flexion in all the subjects. Since during the stimulation BR, BB, and TB showed no voluntary contraction in EMG, it is suggested that modulation of contraction between BR and BB by the stimulation can produce force in supination with keeping constant force in flexion to support the weight below the elbow.  相似文献   

6.
This study aimed to provide quantitative activation data for muscles of the forearm during pronation and supination while using a power grip. Electromyographic data was collected from 15 forearm muscles in 11 subjects while they performed maximal isometric pronating and supinating efforts in nine positions of forearm rotation. Biceps brachii was the only muscle with substantial activation in only one effort direction. It was significantly more active when supinating (µ = 52.1%, SD = 17.5%) than pronating (µ = 5.1%, SD = 4.8%, p < .001). All other muscles showed considerable muscle activity during both pronation and supination. Brachioradialis, flexor carpi radialis, palmaris longus, pronator quadratus and pronator teres were significantly more active when pronating the forearm. Abductor pollicis longus and biceps brachii were significantly more active when supinating. This data highlights the importance of including muscles additional to the primary forearm rotators in a biomechanical analysis of forearm rotation. Doing so will further our understanding of forearm function and lead to the improved treatment of forearm fractures, trauma-induced muscle dysfunction and joint replacements.  相似文献   

7.
Usual human motion capture systems are designed to work in controlled laboratory conditions. For occupational health, instruments that can measure during normal daily life are essential, as the evaluation of the workers' movements is a key factor to reduce employee injury- and illness-related costs. In this paper, we present a method for joint angle measurement, combining inertial sensors (accelerometers and gyroscopes) and magnetic sensors. This method estimates wrist flexion, wrist lateral deviation, elbow flexion, elbow pronation, shoulder flexion, shoulder abduction and shoulder internal rotation. The algorithms avoid numerical integration of the signals, which allows for long-time estimations without angle estimation drift. The system has been tested both under laboratory and field conditions. Controlled laboratory tests show mean estimation errors between 0.06° and of 1.05°, and standard deviation between 2.18° and 9.20°. Field tests seem to confirm these results when no ferromagnetic materials are close to the measurement system.  相似文献   

8.
For the purpose of treatment, obstetric brachial plexus palsy can be subdivided into two distinct phases: initial obstetric brachial plexus palsy, and late obstetric brachial plexus palsy. In the latter, nerve surgery is no longer practical, and treatment often requires palliative surgery to improve function of the shoulder, elbow, forearm, and hand. Late obstetric brachial plexus palsy in the forearm and hand includes weakness or absence of wrist or metacarpophalangeal or interphalangeal joint extension; weakness or absence of finger flexion; forearm supination, or less commonly pronation contracture; ulnar deviation of the wrist; dislocation of the radial or ulnar head; thumb instability; or sensory disturbance of the hand. Palliative reconstruction for these forearm and hand manifestations is more difficult than for the shoulder or elbow because of the lack of powerful regional muscles for transfer. This report reviews the authors' experience performing more than 100 surgical procedures in 54 patients over a 9-year period (between 1988 and 1997) with a minimum of 2 years' follow-up. Surgical treatment is highly individualized, but the optimal age for forearm and hand reconstruction is usually later than for shoulder and elbow reconstruction because of the requirement for a preoperative exercise program. Multiple procedures for forearm and hand function were often performed on any given patient. Frequently, these were done simultaneously with reconstructive procedures for improving shoulder and/or elbow function. Traditional tendon transfer techniques do not provide satisfactory reconstruction for those deformities. Many of the authors' patients required more complex techniques such as nerve transfer and functioning free-muscle transplantation to augment traditional techniques of tendon and/or bone management. Sensory disturbance of the forearm and hand in late obstetric brachial plexus palsy seems a minor problem and further sensory reconstruction is unnecessary.  相似文献   

9.
In order to elucidate the functional significance of excitatory spinal reflex arcs (facilitation) between musculus (M.) pronator teres (PT) and M. extensor carpi radialis (ECR, longus: ECRL, brevis: ECRB) in humans, activities of the muscles were studied with electromyography (EMG) and electrical neuromuscular stimulation (ENS). In EMG study, activities of PT, ECRL, ECRB, and M. flexor carpi radialis during repetitive static (isometric) wrist extension and a series of a dynamic motion of wrist flexion/extension in the prone, semiprone, and supine positions of the forearm were recorded in 12 healthy human subjects. In the prone, semiprone, and supine positions, PT and ECR showed parallel activities during the static extension in all, eight, and eight subjects, respectively, and at the extension phase during the dynamic motion in all, eight and five subjects, respectively. These findings suggest that co-contraction of PT and ECR occurs during wrist extension movements at least with the prone forearm. The facilitation must be active during the co-contraction. In ENS study, ENS to PT was examined in 11 out of the 12 and that to ECRL was in the 12 subjects. Before ENS, the forearm was in the prone, semiprone, and supine positions. In all the subjects, ENS to PT induced a motion of forearm pronation to the maximum pronation. ENS to ECRL induced motions of wrist extension to the maximum extension and abduction (radial flexion) to 5-20 degrees of abduction regardless of the positions of the forearm. Moreover, it induced 30-80 degrees supination of the forearm from the prone position. Consequently, combined ENS to PT and ECRL resulted in motions of the extension and abduction while keeping the maximum pronation. These findings suggest that the co-contraction of PT and ECR during wrist extension movements occurs to prevent supinating the forearm. Forearm supination from the prone position should be added to one of the actions of ECRL.  相似文献   

10.
PURPOSE: The aetiology of tennis elbow has remained uncertain for more than a century. To examine muscle imbalance as a possible pathophysiological factor requires a reliable method of assessment. This paper describes the development of such a method and its performance in healthy subjects. We propose a combination of surface and fine-wire EMG of shoulder and forearm muscles and wrist strength measurements as a reliable tool for assessing muscle imbalance relevant to the pathophysiology of tennis elbow. METHODS: Six healthy volunteers participated. EMG data were acquired at 50% maximal voluntary isometric contraction from five forearm muscles during grip and three shoulder muscles during external rotation and abduction, and analysed using normalized median frequency slope as a fatigue index. Wrist extension/flexion strength was measured using a purpose-built dynamometer. RESULTS: Significant negative slope of median frequency was found for all muscles, with good reproducibility, and no significant difference in slope between the different muscles of the shoulder and the wrist. (Amplitude slope showed high variability and was therefore unsuitable for this purpose.) Wrist flexion was 27+/-8% stronger than extension (mean+/-SEM, p=0.006). CONCLUSION: This is a reliable method for measuring muscle fatigue in forearm and shoulder. EMG and wrist strength studies together can be used for assessing and identifying the muscle balance in the wrist-forearm-shoulder chain.  相似文献   

11.
Transhumeral amputation has a significant effect on a person’s independence and quality of life. Myoelectric prostheses have the potential to restore upper limb function, however their use is currently limited due to lack of intuitive and natural control of multiple degrees of freedom. The goal of this study was to evaluate a novel transhumeral prosthesis controller that uses a combination of kinematic and electromyographic (EMG) signals recorded from the person’s proximal humerus. Specifically, we trained a time-delayed artificial neural network to predict elbow flexion/extension and forearm pronation/supination from six proximal EMG signals, and humeral angular velocity and linear acceleration. We evaluated this scheme with ten able-bodied subjects offline, as well as in a target-reaching task presented in an immersive virtual reality environment. The offline training had a target of 4° for flexion/extension and 8° for pronation/supination, which it easily exceeded (2.7° and 5.5° respectively). During online testing, all subjects completed the target-reaching task with path efficiency of 78% and minimal overshoot (1.5%). Thus, combining kinematic and muscle activity signals from the proximal humerus can provide adequate prosthesis control, and testing in a virtual reality environment can provide meaningful data on controller performance.  相似文献   

12.
Extensor carpi radialis brevis (ECRB) sarcomere length was measured in seven patients using intraoperative laser diffraction. Sarcomere length was measured with the forearm in one of four positions: wrist in neutral with regard to radial-ulnar deviation and forearm in neutral rotation, wrist in ulnar deviation and forearm in neutral rotation, wrist in neutral and forearm in pronation, and wrist in ulnar deviation and forearm in pronation. Two-way ANOVA comparing sarcomere length between the four positions revealed a significant effect of ulnar deviation (p < 0.05), no significant effect of pronation (p > 0.7) and no significant interaction (p > 0.9). These results demonstrate that the axes of forearm rotation and wrist radial-ulnar deviation act independently, at least with regard to the ECRB and have implications regarding the etiology of tennis elbow.  相似文献   

13.
This study examined the effect of the polar moment of inertia of a tennis racket on upper limb loading in the serve. Eight amateur competition tennis players performed two sets of 10 serves using two rackets identical in mass, position of center of mass and moments of inertia other than the polar moment of inertia (0.00152 vs 0.00197 kg.m2). An eight-camera motion analysis system collected the 3D trajectories of 16 markers, located on the thorax, upper limbs and racket, from which shoulder, elbow and wrist net joint moments and powers were computed using inverse dynamics. During the cocking phase, increased racket polar moment of inertia was associated with significant increases in the peak shoulder extension and abduction moments, as well the peak elbow extension, valgus and supination moments. During the forward swing phase, peak wrist extension and radial deviation moments significantly increased with polar moment of inertia. During the follow-through phase, the peak shoulder adduction, elbow pronation and wrist external rotation moments displayed a significant inverse relationship with polar moment of inertia. During the forward swing, the magnitudes of negative joint power at the elbow and wrist were significantly larger when players served using the racket with a higher polar moment of inertia. Although a larger polar of inertia allows players to better tolerate off-center impacts, it also appears to place additional loads on the upper extremity when serving and may therefore increase injury risk in tennis players.  相似文献   

14.
The aim of this study was to assess whether cerebral palsy patients can use biceps brachii for supination during movement tasks requiring supination and pronation. 3D upper extremity kinematic and EMG-data of 12 patients (mean age 13 y 8 mo ± 36 mo) were compared to 10 healthy age-matched controls. Significant difference in biceps brachii activation between maximal isolated pronation and supination in both groups showed that it is possible for CP patients to use biceps brachii for supination. Performance of reach-to-grasp with either pronation or supination showed similar activation patterns as during isolated tasks in both groups, although increased biceps brachii activation likely also hampered performance of reach-to-grasp in the patient group by causing increased, and possibly unwanted elbow flexion. However, the functional effect of this flexion for supination purposes cannot be ruled out. Therefore, one should be cautious with simply weakening biceps brachii when the purpose is to improve functional reach. Ideally treatment might focus more on changing the flexion moment/supination moment ratio of biceps toward a stronger supination function.  相似文献   

15.
Movements of forelimb joints and segments during walking in the brown lemur (Eulemur fulvus) were analyzed using cineradiography (150 frames/sec). Metric gait parameters, forelimb kinematics, and intralimb coordination are described. Calculation of contribution of segment displacements to stance propulsion shows that scapular retroversion in a fulcrum near the vertebral border causes more than 60% of propulsion. The contribution by the shoulder joint is 30%, elbow joint 5%, and wrist joint 1%. Correlation analysis was applied to reveal the interdependency between metric and kinematic parameters. Only the effective angular movement of the elbow joint during stance is speed-dependent. Movements of all other forelimb joints and segments are independent of speed and influence, mainly, linear gait parameters (stride length, stance length). Perhaps the most important result is the hitherto unknown and unexpected degree of scapular mobility. Scapular movements consist of ante-/retroversion, adduction/abduction, and scapular rotation about the longitudinal axis. Inside rotation of the scapula (60 degrees -70 degrees ), together with flexion in the shoulder joint, mediates abduction of the humerus, which is not achieved in the shoulder joint, and is therefore strikingly different from humeral abduction in man. Movements of the shoulder joint are restricted to flexion and extension. At touch down, the shoulder joint of the brown lemur is more extended compared to that of other small mammals. The relatively long humerus and forearm, characteristic for primates, are thus effectively converted into stride length. Observed asymmetries in metric and kinematic behavior of the left and right forelimb are caused by an unequal lateral bending of the spinal column.  相似文献   

16.
The activity of certain muscles that cross the elbow joint complex (EJC) are affected by forearm position and forearm movement during elbow flexion/extension. To investigate whether these changes are based on the musculoskeletal geometry of the joint, a three-dimensional musculotendinoskeletal computer model of the EJC was used to estimate individual muscle activity in multi-degree-of-freedom (df) rapid (ballistic) elbow movements. It is hypothesized that this model could reproduce the major features of elbow muscle activity during multi-df elbow movements using dynamic optimal control theory, given a minimum-time performance criterion. Results from the model are presented and verified with experimental kinematic and electromyographic data from movements that involved both one-df elbow flexion/extension and two-df flexion/extension with forearm pronation/supination. The model demonstrated how the activity of particular muscles is affected by both forearm position and movement, as measured in these experiments and as previously reported by others. These changes were most evident in the flexor muscles and least evident in the extensor muscles. The model also indicated that, for specific one- and two-df movements, activating a muscle that is antagonistic or noncontributory to the movement could reduce the movement time. The major features of muscle activity in multi-df elbow movements appear to be highly dependent on the joint's musculoskeletal geometry and are not strictly based on neural influences or neuroanatomical substrates. Received: 9 May 1997 / Accepted in revised form: 8 December 1998  相似文献   

17.
Wrist rotations about one wrist axis (e.g. flexion/extension) can affect the strength about another wrist axis (e.g. radial/ulnar deviation). This study used a musculoskeletal model of the distal upper extremity, and an optimization approach, to quantify the interaction effects of wrist flexion/extension (FE), radial/ulnar deviation (RUD) and forearm pronation/supination (PS) on wrist strength. Regression equations were developed to predict the relative changes in strength from the neutral posture, so that the changes in strength, due to complex and interacting wrist and forearm rotation postures, can be incorporated within future ergonomics assessments of wrist strength.  相似文献   

18.
In this paper, we quantify the extent to which shoulder orientation, upper-arm electromyography (EMG), and forearm EMG are predictors of distal arm joint angles during reaching in eight subjects without disability as well as three subjects with a unilateral transhumeral amputation and targeted reinnervation. Prior studies have shown that shoulder orientation and upper-arm EMG, taken separately, are predictors of both elbow flexion/extension and forearm pronation/supination. We show that, for eight subjects without disability, shoulder orientation and upper-arm EMG together are a significantly better predictor of both elbow flexion/extension during unilateral (R2=0.72) and mirrored bilateral (R2=0.72) reaches and of forearm pronation/supination during unilateral (R2=0.77) and mirrored bilateral (R2=0.70) reaches. We also show that adding forearm EMG further improves the prediction of forearm pronation/supination during unilateral (R2=0.82) and mirrored bilateral (R2=0.75) reaches. In principle, these results provide the basis for choosing inputs for control of transhumeral prostheses, both by subjects with targeted motor reinnervation (when forearm EMG is available) and by subjects without target motor reinnervation (when forearm EMG is not available). In particular, we confirm that shoulder orientation and upper-arm EMG together best predict elbow flexion/extension (R2=0.72) for three subjects with unilateral transhumeral amputations and targeted motor reinnervation. However, shoulder orientation alone best predicts forearm pronation/supination (R2=0.88) for these subjects, a contradictory result that merits further study.  相似文献   

19.
The purpose of this study was to compare passive to active testing on the kinematics of the elbow and forearm using a load-controlled testing apparatus that simulates muscle loading. Ten fresh-frozen upper extremities were tested. Active control was achieved by employing computer-controlled pneumatic actuators attached to the tendons of the brachialis, biceps, triceps, brachioradialis and pronator teres. Motion of the radius and ulna relative to the humerus was measured with an electromagnetic tracking system. Active elbow flexion produced more repeatable motion of the radius and ulna than when tested passively (p<0.05). The decrease in variability, as determined from the standard deviation of five successive trials in each specimen, was 76.5 and 58.0% for the varus-valgus and internal-external motions respectively (of the ulna relative to the humerus). The variability in flexion during simulated active forearm supination was 30.6% less than during passive testing. Thus under passive control, in the absence of stability provided by muscular loading across the joint, these uncontrolled motions produce increased variability amongst trials. The smooth and repeatable motions resulting from active control, that probably model more closely the physiologic state, appear to be beneficial in the evaluation of unconstrained kinematics of the intact elbow and forearm.  相似文献   

20.
The earliest eutherian mammals were small-bodied locomotor generalists with a forelimb morphology that strongly resembles that of extant rats. Understanding the kinematics of the humerus, radius, and ulna of extant rats can inform and constrain hypotheses concerning typical posture and mobility in early eutherian forelimbs. The locomotion of Rattus norvegicus has been extensively studied, but the three-dimensional kinematics of the bones themselves remains under-explored. Here, for the first time, we use markerless XROMM (Scientific Rotoscoping) to explore the three-dimensional long bone movements in Rattus norvegicus during a normal, symmetrical gait (walking). Our data show a basic kinematic profile that agrees with previous studies on rats and other small therians: rats maintain a crouched forelimb posture throughout the step cycle, and the ulna is confined to flexion/extension in a parasagittal plane. However, our three-dimensional data illuminate long-axis rotation (LAR) movements for both the humerus and the radius for the first time. Medial LAR of the humerus throughout stance maintains an adducted elbow with a caudally-facing olecranon process, which in turn maintains a cranially-directed manus orientation (pronation). The radius also shows significant LAR correlated with manus pronation and supination. Moreover, we report that elbow flexion and manus orientation are correlated in R. norvegicus: as the elbow angle becomes more acute, manus supination increases. Our data also suggest that manus pronation and orientation in R. norvegicus rely on a divided system of labor between the ulna and radius. Given that the radius follows the flexion and extension trajectory of the ulna, it must rotate at the elbow (on the capitulum) so that during the stance phase its distal end lies medial to ulna, ensuring that the manus remains pronated while the forelimb is supporting the body. We suggest that forelimb posture and kinematics in Juramaia, Eomaia, and other basal eutherians were grossly similar to those of rats, and that humerus and radius LAR may have always played a significant role in forelimb and manus posture in small eutherian mammals.  相似文献   

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