Shoulder muscle function depends on elbow joint position: an illustration of dynamic coupling in the upper limb

Shoulder muscle function has been documented based on muscle moment arms, lines of action and muscle contributions to contact force at the glenohumeral joint. At present, however, the contributions of individual muscles to shoulder joint motion have not been investigated, and the effects of shoulder and elbow joint position on shoulder muscle function are not well understood. The aims of this study were to compute the contributions of individual muscles to motion of the glenohumeral joint during abduction, and to examine the effect of elbow flexion on shoulder muscle function. A three-dimensional musculoskeletal model of the upper limb was used to determine the contributions of 18 major muscles and muscle sub-regions of the shoulder to glenohumeral joint motion during abduction. Muscle function was found to depend strongly on both shoulder and elbow joint positions. When the elbow was extended, the middle and anterior deltoid and supraspinatus were the greatest contributors to angular acceleration of the shoulder in abduction. In contrast, when the elbow was flexed at 90°, the anterior deltoid and subscapularis were the greatest contributors to joint angular acceleration in abduction. This dependence of shoulder muscle function on elbow joint position is explained by the existence of dynamic coupling in multi-joint musculoskeletal systems. The extent to which dynamic coupling affects shoulder muscle function, and therefore movement control, is determined by the structure of the inverse mass matrix, which depends on the configuration of the joints. The data provided may assist in the diagnosis of abnormal shoulder function, for example, due to muscle paralysis or in the case of full-thickness rotator cuff tears.     

Voluntary muscle activation varies with age and muscle group.

The consistency and the number of attempts required to achieve maximal voluntary muscle activation have not been documented and compared between young and old adults. Furthermore, few studies have contrasted activation between functional pairs of muscle groups, and no study has tested upper limb muscles. The purpose of this study was to measure and compare voluntary muscle activation of the elbow flexors and extensors in young and old men over two separate test sessions. With the method of twitch interpolation to measure activation, six young (24 +/- 1 yr) and six old (83 +/- 4 yr) men performed five maximal voluntary contractions (MVC) during each session for each muscle group. Elbow flexion and extension MVC was less (43 and 47%, respectively) in the old men, yet the best maximal voluntary muscle activation was similar between age groups. However, when all 10 attempts at MVC were compared, the mean activation scores were slightly less (approximately 5%) in the elbow extensors but were approximately 11% less (P < 0.001) in the elbow flexors of old men, compared with young men. During the second session, there was a significant improvement of 13% (P < 0.005) in mean elbow flexor activation in the old men. There were no session differences for either muscle group for the young men. The results indicate that, for aged men, elbow flexor maximal activation is achieved less frequently compared with elbow extensors, and thus mean activation for elbow flexors is less than for elbow extensors. However, if sufficient attempts are provided, the best effort for the old men is not different from that of the young men for either muscle group.     

Evidence of changes in load sharing during isometric elbow flexion with ramped torque

This study aimed to: (1) test the repeatability of Supersonic Shear Imaging measures of muscle shear elastic modulus of four elbow flexor muscles during isometric elbow flexion with ramped torque; (2) determine the relationship between muscle shear elastic modulus and elbow torque for the four elbow flexor muscles, and (3) investigate changes in load sharing between synergist elbow flexor muscles with increases in elbow flexor torque. Ten subjects performed ten isometric elbow flexions consisting of linear torque ramps of 30-s from 0 to 40% of maximal voluntary contraction. The shear elastic modulus of each elbow flexor muscle (biceps brachii long head [BB(LH)], biceps brachii short head [BB(SH)], brachialis [BA], and brachoradialis [BR]) and of triceps brachii long head [TB] was measured twice with individual muscles recorded in separate trials in random order. A good repeatability of the shape of the changes in shear elastic modulus as a function of torque was found for each elbow flexor muscle (r-values: 0.85 to 0.94). Relationships between the shear elastic modulus and torque were best explained by a second order polynomial, except BA where a higher polynomial was required. Statistical analysis showed that BB(SH) and BB(LH) had an initial slow change at low torques followed by an increasing rate of increase in modulus with higher torques. In contrast, the BA shear elastic modulus increased rapidly at low forces, but plateaued at higher forces. These results suggest that changes in load sharing between synergist elbow flexors could partly explain the non-linear EMG-torque relationship classically reported for BB during isometric efforts.     

Dependence of elbow joint stiffness measurements on speed,angle, and muscle contraction level

Elbow joint stiffness is critical to positioning the hand. Abnormal elbow joint stiffness may affect a person's ability to participate in activities of daily living. In this work, elbow joint stiffness was measured in ten healthy young adults with a device adapted from one previously used to measure stiffness in other joints. Measurements of elbow stiffness involved applying a constant-velocity rotational movement to the elbow and measuring the resultant displacement, torque, and acceleration. Elbow stiffness was then computed using a previously-established model for joint stiffness. Measurements were made at two unique elbow joint angles, two speeds, and two forearm muscle contraction levels. The results indicate that the elbow joint stiffness is significantly affected by both rotational speed and forearm muscle contraction level.     

In vivo assessment of elbow flexor work and activation during stretch-shortening cycle tasks.

The purpose of this study was to use an electromyography (EMG) based muscle model to investigate the performance enhancement of stretch-shortening cycle (SSC) tasks at different elbow flexion-extension velocities. A torque motor was used to oscillate the forearms of seven healthy male subjects (23-40 years) during SSC and non-SSC contractions at four frequencies of movement (.58, 1.5, 2.4 and 3.3Hz) over a range of 105 degrees -162 degrees of elbow extension. The torque was integrated as a function of joint angle to yield the work produced by the elbow flexors. The elbow flexors were transcutaneously stimulated with a voltage equivalent to 60% maximum voluntary isometric contraction torque for 4s at 50Hz. EMG of the elbow flexors and extensors was recorded from the biceps and triceps respectively. The processed EMG was used to drive a Hill based model to predict the torque of the elbow flexors. Results indicate that muscle work increases from non-SSC to SSC trials. Work decreases for SSC and non-SSC trials with increasing velocity. The simulated constant activation muscle model predicted work well for all trials and conditions, indicating muscle model accuracy. The EMG driven model predicted well for all non-SSC trials, but significantly underestimated the work for SSC tasks, suggesting that the contractile component is directly involved in optimising muscle work during SSC tasks.     

The reconstructive strategy for improving elbow function in late obstetric brachial plexus palsy.

Children with previously untreated obstetric brachial plexus palsy frequently have abnormal elbow function because of motor recovery with aberrant reinnervation, or because of paresis or paralysis. From 1988 to 1997 (9-year period), 62 children with obstetric brachial plexus palsy with resulting elbow deformity underwent various methods of palliative reconstruction to improve elbow function. For motor recovery with aberrant reinnervation, release of aberrantly reinnervated antagonistic muscles and augmentation of paretic muscles form the basis of surgical intervention. The surgical procedures included triceps-to-biceps transfer, biceps-to-triceps transfer, brachialis-to-triceps transfer, or combined biceps- and brachialis-to-triceps transfer. Choice of procedures was individualized and randomly determined on the basis of the degree and pattern of aberrant reinnervation between elbow flexors and extensors. In patients' motor recovery with paresis or paralysis, persistently weak elbow flexion was salvaged with a functioning free muscle transplantation or Steindler's flexorplasty, or regional shoulder muscle transfer. In addition, patients with aberrant reinnervation between shoulder abductors and elbow flexors underwent anterior deltoid-to-biceps transfer with a fascia lata graft. All patients had a minimum follow-up of 2 years. Results are assessed and discussed and a reconstructive algorithm is recommended. In general, reconstruction of elbow extension should precede that of elbow flexion. Biceps-to-triceps transfer with preservation of an intact brachialis muscle, or brachialis-to-triceps transfer with preservation of an intact biceps, allows 50 percent of these patients to achieve acceptable elbow flexion and extension in a single-stage procedure.     

Use of the latissimus dorsi muscle to restore elbow flexion in arthrogryposis

The successful use of ipsilateral pedicle latissimus dorsi muscle to restore elbow flexion in a child with arthrogryposis multiplex congenita is described. In appropriately selected patients, use of the latissimus dorsi muscle for elbow flexor reconstruction is a strong, reliable flexorplasty without significant donor-site morbidity.     

Muscle activity in rapid multi-degree-of-freedom elbow movements: solutions from a musculoskeletal model

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     

Assessment of post-stroke elbow flexor spasticity in different forearm positions

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.     

Changes in movement final position associated with agonist and antagonist muscle fatigue

We have tested the hypothesis that agonist and antagonist muscle fatigue could affect the final position of rapid, discrete movements. Six subjects performed consecutive elbow flexion and extension movements between two targets, with their eyes closed prior to, and after fatiguing the elbow extensor muscles. The results demonstrate that elbow extension movements performed in the post-test period systematically undershot the final position as compared to pre-test movements. However, attainment of the aimed final position in elbow flexion movements was unaffected by fatiguing of the extensor muscles. Undershoot of the final position obtained in extension movements was associated with agonist muscle fatigue, a result that was expected from the point of view of current motor control theories, and that could be explained by a reduced ability of the shortening muscle to exert force. On the other hand, the absence of the expected overshoot of the final position when the antagonist is fatigued, indicates the involvement of various reflex and/or central mechanisms operating around the stretched muscle that could contribute to returning the limb to the standard final position after a brief prominent overshoot.     

A biomechanical model for flexion torques of human arm muscles as a function of elbow angle

The contribution that a muscle makes to a torque in a certain direction depends among other things on the length and on the mechanical advantage of the muscle. In this study a simple model is presented which enables us to calculate the torques exerted by elbow flexor muscles as a function of elbow angle. The model is tested and verified with a method of spike triggered averaging.     

Establishing a new index of muscle cross-sectional area and its relationship with isometric muscle strength

The present study aimed i) to establish an index of muscle cross-sectional area (CSA) based on muscle thickness and circumference through a comparison with muscle CSA determined by magnetic resonance imaging (MRI), and ii) to examine the relationships between muscle strength and the index determined at rest and during the maximal isometric contraction. The muscle CSA of elbow flexors at 60% of the upper arm length (CSA60) and the maximal CSA of elbow flexors (CSAmax) were measured using MRI in 26 men and 8 women. The muscle thickness (MT) of elbow flexors and the circumference (C) of upper arm at 60% of the upper arm length were measured using ultrasonography and anthropometry, respectively, in 29 men and 9 women. The measurements of MT and C were performed in the resting (MT(r) and C(r)) and contracted condition (MT(m) and C(m)), where the subjects performed maximal voluntary contraction (MVC) of isometric elbow joint flexion. The torque developed during MVC was converted into the muscle force (F) of elbow flexors. The MT(r) x C(r) was significantly correlated both with CSA60 and CSAmax (P < 0.001). The F was significantly correlated with MT(m) x C(m) (r = 0.847, P < 0.001) and MT(r) x C(r) (r = 0.839, P < 0.001). However, stepwise multiple regression analysis selected only MT(m) x C(m) as a significant contributor for estimating F. The present study indicates that MT x C reflects muscle CSA, and can be an index for assessing muscle CSA. In addition, the findings obtained here showed a possibility that MT x C during MVC is more closely related to F than that at rest.     

Reduced elbow extension torque during vibrations

Impact sports and vibration platforms trigger vibrations within soft tissues and the skeleton. Although the long-term effects of vibrations on the body have been studied extensively, the acute effects of vibrations are little understood. This study determined the influence of acute vibrations at different frequencies and elbow angles on maximal isometric elbow extension torque and muscle activity. Vibrations were generated by a pneumatic vibrator attached to the lever of a dynamometer, and were applied on the forearm of 15 healthy female subjects. The subjects were instructed to push maximally against the lever at three different elbow angles, while extension torque and muscle activity were quantified and compared between vibration and non-vibration (control) conditions. A change in vibration frequency had no significant effects on torque and muscle activity although vibrations in general decreased the maximal extension torque relative to the control by 1.8% (±5.7%, p>0.05), 7.4% (±7.9%, p<0.01), and 5.0% (±8.2%, p<0.01) at elbow angles of 60°, 90°, and 120°, respectively. Electromyographic activity increased significantly between ～30% and 40% in both triceps and biceps with vibrations. It is speculated that a similar increase in muscle activity between agonist and antagonist, in combination with an unequal increase in muscle moment arms about the elbow joint, limit the maximal extension torque during exposure to vibrations. This study showed that maximal extension torque decreased during vibration exposure while muscle activity increased and suggests that vibrations may be counterproductive during activities requiring maximal strength but potentially beneficial for strength training.     

Relationships between stretch-shortening cycle performance and maximum muscle strength

This study aimed to examine the relationships between muscle power output using the stretch-shortening cycle (SSC) and maximum strength, as measured by the 1 RM (1 repetition maximum) test and the isokinetic dynamometer under elbow flexion. Sixteen trained, young adult males pulled a constant load of 40% MVC (maximum voluntary elbow flexion contraction) by ballistic elbow flexion under the following two preliminary conditions: 1) the static relaxed muscle state (SR condition) and 2) using the SSC (SSC condition). Muscle power was determined from the product of the pulling velocity and load mass by a power measurement instrument with a rotary encoder. The 1 RM bench press (1RM BP) and isokinetic maximum strength under elbow flexion with the Cybex-325 were measured as indicators of dynamic maximum strength. 1) The early power output exerted under the SSC condition showed a significant and high correlation with the 1 RM BP (r = 0.83), but only moderate correlation with the isokinetic muscle strength (r = 0.50-0.67). 2) The contribution of the 1 RM BP to the early muscle contraction velocity exerted under the SSC condition was large. These results suggested that muscle power exerted using the SSC shows a stronger relationship with maximum muscle strength measured by a 1 RM test rather than isokinetic maximum strength.     

Exercise-induced muscle damage: effects of light exercise on damaged muscle.

The effects of performing light eccentric exercise (LB) during the period of recovery from a heavy eccentric exercise bout (HB) were studied. An experimental and a control group, each consisting of nine college age volunteers (seven women, two men) performed two HB--HB1 and HB2--14 days apart, using the elbow flexor and extensor muscles of one arm. The experimental group performed an additional LB on the day following the first HB. HB1 resulted in muscle soreness, muscle weakness, changes in elbow joint flexibility, and large delayed increases in serum creatine kinase (CK) activity. The HB2 produced smaller changes in all parameters, indicating that adaptation to the effects of eccentric exercise had occurred in the muscle. The LB did not alter muscle soreness, strength or elbow flexibility, but did reduce or delay CK activity increase after HB1. The LB had no apparent effect on adaptation to HB2.     

Imaging of skeletal muscle function using 18FDG PET: force production, activation, and metabolism

The purpose of thisstudy was to determine whether [¹⁸F]fluorodeoxyglucose(FDG) positron emission tomography (PET) can be used to evaluate muscleforce production, create anatomic images of muscle activity, andresolve the distribution of metabolic activity within exercisingskeletal muscle. Seventeen subjects performed either elbow flexion,elbow extension, or ankle plantar flexion after intravenous injectionof FDG. PET imaging was performed subsequently, and FDG uptake wasmeasured in skeletal muscle for each task. A fivefold increase inresistance during elbow flexion increased FDG uptake in the bicepsbrachii by a factor of 4.9. Differences in relative FDG uptake weredemonstrated as exercise tasks and loads were varied, permittingdifferentiation of active muscles. The intramuscular distribution ofFDG within exercising biceps brachii varied along the transverse andlongitudinal axes of the muscle; coefficients of variation along theseaxes were 0.39 and 0.23, respectively. These findings suggest FDG PETis capable of characterizing task-specific muscle activity andmeasuring intramuscular variations of glucose metabolism withinexercising skeletal muscle.

     

Methodological issues related to thickness-based muscle size evaluation

The purpose of this study was to highlight the issues related to thickness-based muscle size evaluation that is commonly done in field studies. The cross-sectional area, thickness (the vertical distance from the upper end of the elbow flexors to that of the humerus) and width (the horizontal distance from the left to the right end of the elbow flexors) of the elbow flexors at levels from the reference site (60% of the upper arm length from the acromial process of the scapula to the lateral epicondyle of the humerus) to 5 cm distal to it were determined in 11 young men using magnetic resonance imaging, both at rest and during isometric elbow flexion at 30% of maximal voluntary contraction. During 30% of maximal voluntary contraction, the thickness increased but the width decreased at each measurement site compared with those at rest. This was possibly due to difference in muscle slackness between both conditions. The correlation coefficients between the thickness and cross-sectional area for the elbow flexors were significantly lower at rest (r=0.551-0.856) than during 30% of maximal voluntary contraction (r=0.711-0.922). The present findings indicate that the thickness-based muscle size measurement at rest includes errors owing to the slackness of the resting muscles.     

Strategies used to stabilize the elbow joint challenged by inverted pendulum loading

The stiffness of activated muscles may stabilize a loaded joint by preventing perturbations from causing large displacements and injuring the joint. Here the elbow muscle recruitment patterns were compared with the forearm loaded vertically (a potentially unstable inverted pendulum configuration) and with horizontal loading. Eighteen healthy subjects were studied with the forearm vertical and supinated and the elbow flexed approximately 90 degrees. In the first experiment EMG electrodes recorded activity of biceps, triceps, and brachioradialis muscles for joint torques produced (a) by voluntarily exerting a horizontal force isometrically (b) by voluntarily flexing and extending the elbow while the forearm was loaded vertically with 135N. The relationship between the EMG and the torque generated was quantified by the linear regression slope and zero-torque intercept. In a second experiment a vertical load increasing linearly with time up to 300N was applied.In experiment 1 the EMG-torque relationships for biceps and triceps had an intercept about 10% of maximum voluntary effort greater with the vertical compared to the horizontal force, the inverse was found for Brachioradialis, but the EMG-torque slopes for both agonist and antagonistic muscles were not different. In experiment 2 there were 29 trials with minimal elbow displacement and all the three muscles activated on the order of 11% of maximum activation to stabilize the elbow; 19 trials had small elbow extension and 14 trials small flexion requiring altered muscle forces for equilibrium; 7 trials ended in large unstable displacement or early termination of the test. An analysis indicate that the observed levels of muscle activation would only provide stability if the muscles' short-range stiffness was at the high end of the published range, hence the elbow was marginally stable. The stability analysis also indicated that the small elbow extension increased stability and flexion decreased stability.     

Posture and hand load alter muscular response to sudden elbow perturbations

Joint stiffness and stability are reliant on coordinated muscle activity which may differ depending on initial posture and loading during sudden perturbations. This study investigated the effects of arm posture and hand load on muscle activity during perturbations of the arm. Fifteen male participants experienced perturbations to the wrist causing elbow extension using a combination of three body postures (standing, supine, sitting) and three hand load conditions (no, solid, and fluid loads), with known and unknown timing. Surface EMG was collected from eight muscles of the right upper extremity. The response to sudden loading was examined using muscle activities pre (baseline) and post (reflex) perturbation. During the baseline period, known perturbation timing resulted in greater muscular activity than for unknown timing, while the opposite was found for the reflex period. During the reflex period with fluid load, biceps brachii and brachioradialis demonstrated increased activity of 2.4% and 4.0% of maximum respectively, from supine to standing. During the reflex period, the fluid load resulted in forearm co-contraction 23% and 47% greater than the solid and no load conditions. Body orientation and hand loading influenced muscular response to elbow perturbations. Muscle co-contraction at the elbow during known timing suggests a contribution to elbow joint stability that may reduce injury risk caused by sudden elbow loading.     

The role of the biceps brachii in shoulder elevation.

The biceps brachii is a bi-articular muscle affecting motion at the shoulder and elbow. While its' action at the elbow is well documented, its role in shoulder elevation is less clear. Therefore, the purpose of this project was to investigate the influence of shoulder and elbow joint angles on the shoulder elevation function of the biceps brachii. Twelve males and 18 females were tested on a Biodex dynamometer with the biceps brachii muscle selectively stimulated at a standardized level of voltage. The results indicated that both shoulder and elbow joint angles influence the shoulder joint elevation moment produced by the biceps brachii. Further analysis revealed that the elevation moment was greatest with the shoulder joint at 0 degrees and the elbow flexed 30 degrees or less. The greatest reduction in the elevation moment occurred between shoulder angles of 0 degrees and 30 degrees . The shoulder elevation moment was near zero when shoulder elevation reached or exceeded 60 degrees regardless of elbow angle. These results clarify the role of the biceps in shoulder elevation, as a dynamic stabilizer, and suggest that it is a decelerator of the arm during the throwing motion.