The influence of posture variation on electromyographic signals in females obtained during maximum voluntary isometric contractions: A shoulder example

Surface electromyography (sEMG) is commonly used to estimate muscle demands in occupational tasks. To allow for comparisons, sEMG amplitude is normalized to muscle specific maximum voluntary contractions (MVCs) performed in a standardized set of postures. However, maximal sEMG amplitude in shoulder muscles is highly dependent on arm posture and therefore, normalizing task related muscular activity to standard MVCs may lead to misinterpretation of task specific muscular demands. Therefore, the purpose of this study was to investigate differences in commonly monitored shoulder muscles using normalized sEMG amplitude between maximal exertions at different hand locations and across force exertion directions relative to standard MVCs. sEMG was recorded from the middle deltoid, pectoralis major sternal head, infraspinatus, latissimus dorsi, and upper trapezius. Participants completed standardized muscle-specific MVCs and two maximal exertions in 5 hand locations (low left, low right, high left, high right, and central) in each of the four force directions (push, pull, up, and down). Peak sEMG was analyzed in the direction(s) that elicited the highest signal for each muscle. All muscles differed by location (p < 0.05). Latissimus dorsi had the greatest activation during pulls (32–135% MVC); upper trapezius and middle deltoid while exerting upwards (73–103% and 42–78% MVC, respectively); infraspinatus while pushing (38–79% MVC); and pectoralis major activation was the highest during downwards exertions (48–84% MVC). Normalization of location specific maximal exertions to standard muscle specific MVCs underestimated maximal activity across 90% of the tasks in all shoulder muscles tested, except for latissimus dorsi where amplitudes were overestimated in low right hand location. Normalization of location specific muscle activity to standard muscle specific MVCs often underestimates muscle activity in task performance and is cautioned against if the goal is to accurately estimate muscle demands.     

Muscular responses to handle perturbation with different glove condition

Effect of wearing gloves on timely muscle reaction to stabilize handle perturbation was investigated. Thirteen adults gripped a horizontal overhead handle to which an upward force was applied at a random time. Muscle reaction time, integrated EMGs for eight muscles, and handle displacement were compared among three glove conditions affecting the coefficient of friction (COF = 0.32, 0.50, and 0.74 for the polyester glove, bare hand, and latex glove, respectively). Lower COF increased the integrated EMGs and handle displacement until stabilization of the perturbed handle. The low-friction glove resulted in 16% (p = .01) greater muscular effort and 20% (p = .002) greater handle displacement, compared to the high-friction glove. Muscle reaction time was not influenced by glove condition. Cutaneous sensation and reflex eliciting forearm muscle activity appear to play an important role in detecting and responding to the perturbation initially, while the forearm and latissimus dorsi muscles primarily contribute to stabilizing the perturbed handle compared to other shoulder and upper arm muscles. Therefore, low-friction gloves, cutaneous sensory dysfunction, and weakened forearm and latissimus dorsi muscles may jeopardize persons’ ability to stabilize a grip of a handle after perturbation.     

Effect of the upper limbs muscles activity on the mechanical energy gain in pole vaulting

The shoulder muscles are highly solicited in pole vaulting and may afford energy gain. The objective of this study was to determine the bilateral muscle activity of the upper-limbs to explain the actions performed by the vaulter to bend the pole and store elastic energy. Seven experienced athletes performed 5-10 vaults which were recorded using two video cameras (50Hz). The mechanical energy of the centre of gravity (CG) was computed, while surface electromyographic (EMG) profiles were recorded from 5 muscles bilateral: deltoideus, infraspinatus, biceps brachii, triceps, and latissimus dorsi muscles. The level of intensity from EMG profile was retained in four sub phases between take-off (TO1) and complete pole straightening (PS). The athletes had a mean mechanical energy gain of 22% throughout the pole vault, while the intensities of deltoideus, biceps brachii, and latissimus dorsi muscles were sub phases-dependent (p<0.05). Stabilizing the glenohumeral joint (increase of deltoideus and biceps brachii activity) and applying a pole bending torque (increase of latissimus dorsi activity) required specific muscle activation. The gain in mechanical energy of the vaulter could be linked to an increase in muscle activation, especially from latissimusdorsi muscles.     

Interlimb Reflexes Induced by Electrical Stimulation of Cutaneous Nerves after Spinal Cord Injury

Whether interlimb reflexes emerge only after a severe insult to the human spinal cord is controversial. Here the aim was to examine interlimb reflexes at rest in participants with chronic (>1 year) spinal cord injury (SCI, n = 17) and able-bodied control participants (n = 5). Cutaneous reflexes were evoked by delivering up to 30 trains of stimuli to either the superficial peroneal nerve on the dorsum of the foot or the radial nerve at the wrist (5 pulses, 300 Hz, approximately every 30 s). Participants were instructed to relax the test muscles prior to the delivery of the stimuli. Electromyographic activity was recorded bilaterally in proximal and distal arm and leg muscles. Superficial peroneal nerve stimulation evoked interlimb reflexes in ipsilateral and contralateral arm and contralateral leg muscles of SCI and control participants. Radial nerve stimulation evoked interlimb reflexes in the ipsilateral leg and contralateral arm muscles of control and SCI participants but only contralateral leg muscles of control participants. Interlimb reflexes evoked by superficial peroneal nerve stimulation were longer in latency and duration, and larger in magnitude in SCI participants. Interlimb reflex properties were similar for both SCI and control groups for radial nerve stimulation. Ascending interlimb reflexes tended to occur with a higher incidence in participants with SCI, while descending interlimb reflexes occurred with a higher incidence in able-bodied participants. However, the overall incidence of interlimb reflexes in SCI and neurologically intact participants was similar which suggests that the neural circuitry underlying these reflexes does not necessarily develop after central nervous system injury.     

A kinetic and electromyographic comparison of the standing cable press and bench press

This study compared the standing cable press (SCP) and the traditional bench press (BP) to better understand the biomechanical limitations of pushing from a standing position together with the activation amplitudes of trunk and shoulder muscles. A static biomechanical model (4D Watbak) was used to assess the forces that can be pushed with 2 arms in a standing position. Then, 14 recreationally trained men performed 1 repetition maximum (1RM) BP and 1RM single-arm SP exercises while superficial electromyography (EMG) of various shoulder and torso muscles was measured. The 1RM BP performance resulted in an average load (74.2 +/- 17.6 kg) significantly higher than 1RM single-arm SP (26.0 +/- 4.4 kg). In addition, the model predicted that pushing forces from a standing position under ideal mechanical conditions are limited to 40.8% of the subject's body weight. For the 1RM BP, anterior deltoid and pectoralis major were more activated than most of the trunk muscles. In contrast, for the 1RM single-arm SP, the left internal oblique and left latissimus dorsi activities were similar to those of the anterior deltoid and pectoralis major. The EMG amplitudes of pectoralis major and the erector muscles were larger for 1RM BP. Conversely, the activation levels of left abdominal muscles and left latissimus dorsi were higher for 1RM right-arm SP. The BP emphasizes the activation of the shoulder and chest muscles and challenges the capability to develop great shoulder torques. The SCP performance also relies on the strength of shoulder and chest musculature; however, it is whole-body stability and equilibrium together with joint stability that present the major limitation in force generation. Our EMG findings show that SCP performance is limited by the activation and neuromuscular coordination of torso muscles, not maximal muscle activation of the chest and shoulder muscles. This has implications for the utility of these exercise approaches to achieve different training goals.     

Augmentation of partially regenerated nerves by end-to-side side-to-side grafting neurotization: experience based on eight late obstetric brachial plexus cases

Objective

The effect of end-to-side neurotization of partially regenerated recipient nerves on improving motor power in late obstetric brachial plexus lesions, so-called nerve augmentation, was investigated.

Methods

Eight cases aged 3 – 7 years were operated upon and followed up for 4 years (C5,6 rupture C7,8T1 avulsion: 5; C5,6,7,8 rupture T1 avulsion:1; C5,6,8T1 rupture C7 avulsion:1; C5,6,7 ruptureC8 T1 compression: one 3 year presentation after former neurotization at 3 months). Grade 1–3 muscles were neurotized. Grade0 muscles were neurotized, if the electromyogram showed scattered motor unit action potentials on voluntary contraction without interference pattern. Donor nerves included: the phrenic, accessory, descending and ascending loops of the ansa cervicalis, 3^rd and 4^th intercostals and contralateral C7.

Results

Superior proximal to distal regeneration was observed firstly. Differential regeneration of muscles supplied by the same nerve was observed secondly (superior supraspinatus to infraspinatus regeneration). Differential regeneration of antagonistic muscles was observed thirdly (superior biceps to triceps and pronator teres to supinator recovery). Differential regeneration of fibres within the same muscle was observed fourthly (superior anterior and middle to posterior deltoid regeneration). Differential regeneration of muscles having different preoperative motor powers was noted fifthly; improvement to Grade 3 or more occurred more in Grade2 than in Grade0 or Grade1 muscles. Improvements of cocontractions and of shoulder, forearm and wrist deformities were noted sixthly. The shoulder, elbow and hand scores improved in 4 cases.

Limitations

The sample size is small. Controls are necessary to rule out any natural improvement of the lesion. There is intra- and interobserver variability in testing muscle power and cocontractions.

Conclusion

Nerve augmentation improves cocontractions and muscle power in the biceps, pectoral muscles, supraspinatus, anterior and lateral deltoids, triceps and in Grade2 or more forearm muscles. As it is less expected to improve infraspinatus power, it should be associated with a humeral derotation osteotomy and tendon transfer. Function to non improving Grade 0 or 1 forearm muscles should be restored by muscle transplantation.

Level of evidence

Level IV, prospective case series.     

Myosin light chain phosphorylation during contraction of chicken fast and slow skeletal muscles

A modified automatic freezing apparatus (K. M. Kretzschmar and D. R. Wilkie, 1962, J. Physiol. (London), 202, 66–67) was used for studying light chain phosphorylation during the early phase of contraction of the fast, posterior latissimus dorsi, and slow, anterior latissimus dorsi, muscles of chicken at 37 °C. The frozen muscles were worked up under conditions which avoid artifacts in quantitating the level of light chain phosphorylation in contracting and resting muscles. The posterior latissimus dorsi muscle reached 80% of its maximal isometric tension at 0.1 s of tetanic stimulation. At the same time, light chain phosphorylation increased by 60% of its maximal extent. The peak tension of the posterior muscle at 0.2 s of stimulation was accompanied by maximal light chain phosphorylation. In case of the slow anterior latissimus dorsi muscle, maximal tetanic tension was developed in 2.5 – 5 s and light chain phosphorylation also proceeded at a much slower rate than in the fast posterior muscle. When contralateral posterior latissimus dorsi muscles were stimulated for 0.2 s and one muscle was frozen at the height of tetanus while the other muscle was allowed to relax and frozen 0.4 s after terminating the stimulation, both contracted and relaxed muscles exhibited maximal light chain phosphorylation. However, when the muscle was allowed to relax for 0.8 s before freezing, half of the phosphorylated light chain became dephosphorylated. The resting level of phosphate content of the light chain was restored in both the posterior and anterior muscles during a longer time after relaxation.     

Obtaining maximum muscle excitation for normalizing shoulder electromyography in dynamic contractions

Muscle specific maximal voluntary isometric contractions (MVIC) are commonly used to elicit reference amplitudes to normalize electromyographic signals (EMG). It has been questioned whether this is appropriate for normalizing EMG from dynamic contractions. This study compares EMG amplitude when shoulder muscle activity from dynamic contractions is normalized to isometric and isokinetic maximal excitation as well as a hybrid approach currently used in our laboratory. Anterior, middle and posterior deltoid, upper and lower trapezius, pectoralis major, latissimus dorsi and infraspinatus were monitored during (1) manually resisted MVICs, and (2) maximum voluntary dynamic concentric contractions (MVDC) on an isokinetic dynamometer. Dynamic contractions were performed (a) at 30°/s about the longitudinal, frontal and sagittal axes of the shoulder, and (b) during manual bi-rotation of a tilted wheel at 120°/s. EMG from the wheel task was normalized to the maximum excitation from (i) the muscle specific MVIC, (ii) from any MVIC (MVIC_ALL), (iii) for any MVDC, (iv) from any exertion (maximum experimental excitation, MEE). Mean EMG from the wheel task was up to 45% greater when normalized to muscle specific isometric contractions (method i) than when normalized to MEE (method iv). Seventy-five percent of MEE’s occurred during MVDCs. This study presents an 20 useful and effective process for obtaining the greatest excitation from the shoulder muscles when normalizing dynamic efforts.     

Targeted gripping reduces shoulder muscle activity and variability

The purpose of this study was to determine if the effect of visually targeted gripping on shoulder muscle activity was maintained with repeated exposures. Eleven healthy males had eight shoulder muscles monitored via surface electromyography while maintaining shoulder elevation at 90° in the scapular plane with and without a 30% grip force. Three non-gripping trials were followed by 15 gripping trials and another 3 non-gripping control trials. Gripping significantly decreased the activity of the anterior deltoid, trapezius, and latissimus dorsi over the exposure of 15 trials. Gripping also reduced variability in all muscles' activity. The changes in shoulder muscle activity are likely in response to forces being transferred through multi-articular muscles spanning from the forearm to the shoulder. Targeted gripping during shoulder elevation resulted in small but significant decreases in muscle activity and reduced variability which supports previous evidence for increased risk of upper extremity disorders in occupational settings.     

Electromyography of pongid shoulder muscles III. Quadrupedal positional behavior

Electromyographic (EMG) recordings were taken from 14 shoulder muscles (or major parts of them) in a gorilla, a chimpanzee and an orangutan as they stood quadrupedally and tripedally, descended from elevated substrates, crutch-walked, and progressed quadrupedally on inclined and level substrates. In the African apes, low potentials commonly (but not always) occurred in the sternocostal pectoralis major, anterior deltoid, supraspinatus and subscapularis muscles during quadrupedal stance. The quadrupedal orangutan always exhibited low potentials in the pectoralis major muscle and EMG activity commonly occurred in her supraspinatus and subscapularis muscles. Quiescent tripedal stances were not accompanied by striking changes in EMG patterns from those which characterized quadrupedal stances. Per contra, eccentric loadings of the forelimb during descents from elevated substrates generally recruited notable EMG activity in the deltoid, supraspinatus and, to a lesser extent, infraspinatus muscles of the three pongid apes. The pectoralis major and caudal serratus anterior muscles were much more active in Pongo and Pan during these descents. Supportive segments of quadrupedal locomotive cycles were generally accompanied by EMG activity in the pectoralis major, intermediate and posterior deltoid and supraspinatus muscles. The intermediate and posterior deltoid muscles were characteristically active during pre-release of the hand and early swing phase. The cranial trapezius and supraspinatus muscles also may act during early swing phase. We conclude that the pectoralis major and perhaps the supraspinatus and subscapularis might serve regularly as postural muscles during static terrestrial quadrupedalism in pongid apes. The lack of dramatic differences between the EMG patterns exhibited during fist-walking versus knuckle-walking indicates that an evolutionary transformation from a shoulder complex like that of Pongo to ones like Pan or vice versa need not entail major changes in myological features.     

Static optimization underestimates antagonist muscle activity at the glenohumeral joint: A musculoskeletal modeling study

Static optimization is commonly employed in musculoskeletal modeling to estimate muscle and joint loading; however, the ability of this approach to predict antagonist muscle activity at the shoulder is poorly understood. Antagonist muscles, which contribute negatively to a net joint moment, are known to be important for maintaining glenohumeral joint stability. This study aimed to compare muscle and joint force predictions from a subject-specific neuromusculoskeletal model of the shoulder driven entirely by measured muscle electromyography (EMG) data with those from a musculoskeletal model employing static optimization. Four healthy adults performed six sub-maximal upper-limb contractions including shoulder abduction, adduction, flexion, extension, internal rotation and external rotation. EMG data were simultaneously measured from 16 shoulder muscles using surface and intramuscular electrodes, and joint motion evaluated using video motion analysis. Muscle and joint forces were calculated using both a calibrated EMG-driven neuromusculoskeletal modeling framework, and musculoskeletal model simulations that employed static optimization. The EMG-driven model predicted antagonistic muscle function for pectoralis major, latissimus dorsi and teres major during abduction and flexion; supraspinatus during adduction; middle deltoid during extension; and subscapularis, pectoralis major and latissimus dorsi during external rotation. In contrast, static optimization neural solutions showed little or no recruitment of these muscles, and preferentially activated agonistic prime movers with large moment arms. As a consequence, glenohumeral joint force calculations varied substantially between models. The findings suggest that static optimization may under-estimate the activity of muscle antagonists, and therefore, their contribution to glenohumeral joint stability.     

Effects of shoulder muscle fatigue caused by repetitive overhead activities on scapulothoracic and glenohumeral kinematics.

The purpose of this study was to determine the effects of shoulder muscle fatigue on three dimensional scapulothoracic and glenohumeral kinematics. Twenty healthy subjects participated in this study. Three-dimensional scapulothoracic and glenohumeral kinematics were determined from electromagnetic sensors attached to the scapula, humerus, and thorax. Surface electromyographic (EMG) data were collected from the upper and lower trapezius, serratus anterior, anterior and posterior deltoid, and infraspinatus muscles. Median power frequency (MPF) values were derived from the raw EMG data and were used to indicate the degree of local muscle fatigue. Kinematic and EMG measures were collected prior to and immediately following the performance of a shoulder elevation fatigue protocol. Following the performance of the fatigue protocol subjects demonstrated more upward and external rotation of the scapula, more clavicular retraction, and less humeral external rotation during arm elevation. All muscles with the exception of the lower trapezius showed EMG signs of fatigue, the most notable being the infraspinatus and deltoid muscles. In general, greater scapulothoracic motion and less glenohumeral motion was observed following muscle fatigue. Further studies are needed to determine what effects these changes have on the soft tissues and mechanics of the shoulder complex.     

Effects of posture,movement and hand load on shoulder muscle activity

The influence of external factors such as arm posture, hand loading and dynamic exertion on shoulder muscle activity is needed to provide insight into the relationship between internal and external loading of the shoulder joint. Surface electromyography was collected from 8 upper extremity muscles on 16 participants who performed isometric and dynamic shoulder exertions in three shoulder planes (flexion, mid-abduction and abduction) covering four shoulder elevation angles (30°, 60°, 90° and 120°). Shoulder exertions were performed under three hand load conditions: no load, holding a 0.5 kg load and 30% grip. It was found that adding a 0.5 kg load to the hand increased shoulder muscle activity by 4% maximum voluntary excitation (MVE), across all postures and velocities. Performing a simultaneous shoulder exertion and hand grip led to posture specific redistribution of shoulder muscle activity that was consistent for both isometric and dynamic exertions. When gripping, anterior and middle deltoid activity decreased by 2% MVE, while posterior deltoid, infraspinatus and trapezius activity increased by 2% MVE and biceps brachii activity increased by 6% MVE. Increased biceps brachii activity with gripping may be an initiating factor for the changes in shoulder muscle activity. The finding that hand gripping altered muscle activation, and thus the internal loading, of the shoulder may play an important role in shoulder injury development and rehabilitation.     

Numbers of myonuclei and satellite cell nuclei in latissimus dorsi muscles of the chicken

Summary In the 3-, 33- and 66-day-old chicken, two muscles, the oxidative slow tonic anterior latissimus dorsi and the glycolytic fast twitch posterior latissimus dorsi were compared by the measurement of muscle fibre diameter and the fraction of total muscle tissue nuclei which were either myonuclei or satellite cell nuclei. Between 3 and 33 days there was a period of rapid growth (more marked in the posterior latissimus dorsi) which coincided with a sharp fall in numerical density of myonuclei and satellite cell nuclei (number per cubic millimetre muscle tissue). The fraction of all nuclei which were satellite cell nuclei declined steadily.The higher levels of myonuclei and satellite cell nuclei in the anterior latissimus dorsi were thought to be a reflection of its oxidative metabolism and the presence of multiple endplates.The volume of sarcoplasm occupied by single myonuclei in anterior and posterior latissimus dorsi muscles was shown to be considerably greater than that occupied by nuclei in other cell systems.     

Neural Mechanisms Influencing Interlimb Coordination during Locomotion in Humans: Presynaptic Modulation of Forearm H-Reflexes during Leg Cycling

Presynaptic inhibition of transmission between Ia afferent terminals and alpha motoneurons (Ia PSI) is a major control mechanism associated with soleus H-reflex modulation during human locomotion. Rhythmic arm cycling suppresses soleus H-reflex amplitude by increasing segmental Ia PSI. There is a reciprocal organization in the human nervous system such that arm cycling modulates H-reflexes in leg muscles and leg cycling modulates H-reflexes in forearm muscles. However, comparatively little is known about mechanisms subserving the effects from leg to arm. Using a conditioning-test (C-T) stimulation paradigm, the purpose of this study was to test the hypothesis that changes in Ia PSI underlie the modulation of H-reflexes in forearm flexor muscles during leg cycling. Subjects performed leg cycling and static activation while H-reflexes were evoked in forearm flexor muscles. H-reflexes were conditioned with either electrical stimuli to the radial nerve (to increase Ia PSI; C-T interval  = 20 ms) or to the superficial radial (SR) nerve (to reduce Ia PSI; C-T interval  = 37–47 ms). While stationary, H-reflex amplitudes were significantly suppressed by radial nerve conditioning and facilitated by SR nerve conditioning. Leg cycling suppressed H-reflex amplitudes and the amount of this suppression was increased with radial nerve conditioning. SR conditioning stimulation removed the suppression of H-reflex amplitude resulting from leg cycling. Interestingly, these effects and interactions on H-reflex amplitudes were observed with subthreshold conditioning stimulus intensities (radial n., ∼0.6×MT; SR n., ∼ perceptual threshold) that did not have clear post synaptic effects. That is, did not evoke reflexes in the surface EMG of forearm flexor muscles. We conclude that the interaction between leg cycling and somatosensory conditioning of forearm H-reflex amplitudes is mediated by modulation of Ia PSI pathways. Overall our results support a conservation of neural control mechanisms between the arms and legs during locomotor behaviors in humans.     

Does supraspinatus initiate shoulder abduction?

PurposeIt is commonly stated that supraspinatus initiates abduction; however, there is no direct evidence to support this claim. Therefore, the aims of the present study were to determine whether supraspinatus initiates shoulder abduction by activating prior to movement and significantly earlier than other shoulder muscles and to determine if load or plane of movement influenced the recruitment timing of supraspinatus.MethodsElectromyographic recordings were taken from seven shoulder muscles of fourteen volunteers during shoulder abduction in the coronal and scapular planes and a plane 30° anterior to the scapular plane, at 25%, 50% and 75% of maximum load. Initial activation timing of a muscle was determined as the time at which the average activation (over a 25 ms moving window) was greater than three standard deviations above baseline measures.ResultsAll muscles tested were activated prior to movement onset. Subscapularis was activated significantly later than supraspinatus, infraspinatus, deltoid and upper trapezius, while supraspinatus, infraspinatus, upper trapezius, lower trapezius, serratus anterior and deltoid all had similar initial activation times. The effects of load or plane of movement were not significant.ConclusionsSupraspinatus is recruited prior to movement of the humerus into abduction but not earlier than many other shoulder muscles, including infraspinatus, deltoid and axioscapular muscles. The common statement that supraspinatus initiates abduction is therefore, misleading.     

The effect of fatigued internal rotator and external rotator muscles of the shoulder on the shoulder position sense

The purpose of this study was to investigate which muscle group, the agonist or antagonist, contributes most to the shoulder position sense (SPS). The SPS was tested under 2 conditions: fatigued shoulder internal rotator (IR) muscles (pectoralis major and latissimus dorsi) and fatigued external rotator (ER) muscles (infraspinatus). In each condition, the SPS was measured before and after a fatiguing task involving the IR or ER muscles by repeating shoulder joint rotation. SPS was measured using a method in which subjects reproduced a memorized shoulder joint rotation angle. The position error values in all conditions (fatigued IR and ER muscles) and measurement periods (before- and after-fatigue task) were compared using 2-way analysis of variance with repeated measures (IR/ER × before/after). Position error increased significantly after both fatigue tasks (before- vs. after-fatigue: IR muscle, 2.68° vs. 4.19°; ER muscle, 2.32° vs. 4.05°). In other words, SPS accuracy decreased when either the agonist or antagonist muscle was fatigued. This finding indicated that SPS may be affected by an integrated information of the afferent signals in the agonist and antagonist muscles.     

Reversed forearm island flap supplied by the septocutaneous perforator of the radial artery: anatomical basis and clinical applications

The cutaneous perforators of the radial artery adjacent to the superficial branch of the radial nerve and the lateral antebrachial cutaneous nerve were investigated, and the vascular anatomical features of the reversed forearm island flap supplied by those accompanying perforators were documented. Ten fresh cadavers were systemically injected with lead oxide, gelatin, and water. Twenty forearms were then dissected, and an overall map of the cutaneous vasculature and source vessels was constructed. The accompanying arteries were observed to lie along the lateral antebrachial cutaneous nerve and the superficial branch of the radial nerve and to nourish the skin through cutaneous branches. Vascular communication among these cutaneous vessels was evaluated, to determine the cutaneous vascular territory of the radial forearm flap. This anatomical information facilitates flap design in the forearm region. Clinical experience regarding the usefulness of the reversed forearm island flap for hand reconstruction for a series of five patients is presented.     

Suprascapular nerve block results in a compensatory increase in deltoid muscle activity

A balance exists between the deltoid and rotator cuff contribution to arm elevation. Both cadaver and computer models have predicted an increase in deltoid muscle force with dysfunction of the rotator cuff. The goal of the present study was to verify this phenomenon in vivo by examining the effects of paralysis of the supraspinatus and infraspinatus muscles with a suprascapular nerve block on the electrical activity of seven shoulder muscles. Electromyographic data were collected before and after the administration of the block. The block resulted in a significant increase in muscle activity for all heads of the deltoid, with a higher percentage increase noted at lower elevation angles. Although the deltoid activity was reduced as the subjects recovered from the block, even low levels of cuff dysfunction were found to result in increased deltoid activity. These results suggest that even small disruptions in the normal function of some rotator cuff muscles (e.g., due to fatigue or impingement syndrome), may result in an increase in deltoid activity. It is possible that such compensation may result in higher superior loads at the glenohumeral joint, possibly increasing the risk of tendon damage.     

Differential activation of parts of the latissimus dorsi with various isometric shoulder exercises

As no study has examined whether the branches of the latissimus dorsi are activated differently in different exercises, we investigated intramuscular differences of components of the latissimus dorsi during various shoulder isometric exercises. Seventeen male subjects performed four isometric exercises: shoulder extension, adduction, internal rotation, and shoulder depression. Surface electromyography (sEMG) was used to collect data from the medial and lateral components of the latissimus dorsi during the isometric exercises. Two-way repeated analysis of variance with two within-subject factors (exercise condition and muscle branch) was used to determine the significance of differences between the branches, and which branch was activated more with the exercise variation. The root mean squared sEMG values for the muscles were normalized using the modified isolation equation (%Isolation) and maximum voluntary isometric contraction (%MVIC). Neither the %MVIC nor %Isolation data differed significantly between muscle branches, while there was a significant difference with exercise. %MVIC was significantly higher with shoulder extension, compared to the other isometric exercises. There was a significant correlation between exercise condition and muscle branch in the %Isolation data. Shoulder extension and adduction and internal rotation increased %Isolation of the medial latissimus dorsi more than shoulder depression. Shoulder depression had the highest value of %Isolation of the lateral latissimus dorsi compared to the other isometric exercises. Comparing the medial and lateral latissimus dorsi, the medial component was predominantly activated with shoulder extension, adduction, and internal rotation, and the lateral component with shoulder depression. Shoulder extension is effective for activating the latissimus dorsi regardless of the intramuscular branch.