The Experts below are selected from a list of 324 Experts worldwide ranked by ideXlab platform
Kensuke Ochi - One of the best experts on this subject based on the ideXlab platform.
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shoulder internal rotation Elbow Flexion test for diagnosing cubital tunnel syndrome
Journal of Shoulder and Elbow Surgery, 2012Co-Authors: Kensuke Ochi, Aya Tanabe, Yasuhito Kaneko, Makoto Waseda, Yukio Horiuchi, Takahiro KoyanagiAbstract:Background Shoulder internal rotation enhances symptom provocation attributed to cubital tunnel syndrome. We present a modified Elbow Flexion test—the shoulder internal rotation Elbow Flexion test—for diagnosing cubital tunnel syndrome. Methods Fifty-five ulnar nerves in cubital tunnel syndrome patients and 123 ulnar nerves in controls were examined with 5 seconds each of Elbow Flexion, shoulder internal rotation, and shoulder internal rotation Elbow Flexion tests before and after treatment (surgery in 18; conservative in others). For the shoulder internal rotation Elbow Flexion test position, 90° abduction, maximum internal rotation, and 10° Flexion of the shoulder were combined with the Elbow Flexion test position. The test was considered positive if any symptom for cubital tunnel syndrome developed Results The sensitivities/specificities of the 5-second Elbow Flexion, shoulder internal rotation, and shoulder internal rotation Elbow Flexion tests were 25%/100%, 58%/100%, and 87%/98%, respectively. Sensitivity differences between the shoulder internal rotation Elbow Flexion test and the other two tests were significant. Shoulder internal rotation Elbow Flexion test results and cubital tunnel syndrome symptoms were significantly correlated. Influence of the shoulder internal rotation Elbow Flexion test on the ulnar nerve was seen in 8 of 10 cubital tunnel syndrome nerves but not in controls. Conclusions The 5-second shoulder internal rotation Elbow Flexion test is specific, easy and quick provocative test for diagnosing cubital tunnel syndrome.
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comparison of shoulder internal rotation test with the Elbow Flexion test in the diagnosis of cubital tunnel syndrome
Journal of Hand Surgery (European Volume), 2011Co-Authors: Kensuke Ochi, Aya Tanabe, Kozo Morita, Yukio Horiuchi, Kentaro Takeda, Ken NinomiyaAbstract:Purpose To compare the shoulder internal rotation test—a new, provocative test—with the Elbow Flexion test in the diagnosis of cubital tunnel syndrome (CubTS). Methods Twenty-five patients with CubTS were examined before and after surgery with 10 seconds each of the Elbow Flexion and shoulder internal rotation tests. Fifty-four asymptomatic individuals and 14 neuropathy patients with a diagnosis other than CubTS were also examined as control cases. For the shoulder internal rotation test, the patient's upper extremity was kept at 90° abduction, maximum internal rotation, and 10° Flexion at the shoulder, with 90° Elbow Flexion and neutral position of the forearm and wrist, with finger extension. Test results were considered positive if any slight symptom attributable to CubTS occurred within 10 seconds. Extraneural pressure inside the cubital tunnel was intraoperatively measured with the positions of both the Elbow Flexion and shoulder internal rotation tests, in 15 of the CubTS cases. Statistical analyses were performed using Student's t -test with a confidence level of 95%. Results The preoperative sensitivity in CubTS cases was 80% in the 10-second shoulder internal rotation test and 36% in the 10-second Elbow Flexion test, and these differences were significant. None of the control cases had positive results in either test. All the CubTS cases improved with surgery; after surgery, neither test provoked symptoms in any surgical patient. The extraneural pressure increased in both provocative positions with no significant difference. Conclusions Positive results for the 10-second shoulder internal rotation test were more sensitive than that for the Elbow Flexion test of the same duration and seemed specific to CubTS. Type of study/level of evidence Diagnostic III.
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comparison of shoulder internal rotation test with the Elbow Flexion test in the diagnosis of cubital tunnel syndrome
Journal of Hand Surgery (European Volume), 2011Co-Authors: Kensuke Ochi, Aya Tanabe, Kozo Morita, Yukio Horiuchi, Kentaro Takeda, Ken NinomiyaAbstract:Purpose To compare the shoulder internal rotation test—a new, provocative test—with the Elbow Flexion test in the diagnosis of cubital tunnel syndrome (CubTS). Methods Twenty-five patients with CubTS were examined before and after surgery with 10 seconds each of the Elbow Flexion and shoulder internal rotation tests. Fifty-four asymptomatic individuals and 14 neuropathy patients with a diagnosis other than CubTS were also examined as control cases. For the shoulder internal rotation test, the patient's upper extremity was kept at 90° abduction, maximum internal rotation, and 10° Flexion at the shoulder, with 90° Elbow Flexion and neutral position of the forearm and wrist, with finger extension. Test results were considered positive if any slight symptom attributable to CubTS occurred within 10 seconds. Extraneural pressure inside the cubital tunnel was intraoperatively measured with the positions of both the Elbow Flexion and shoulder internal rotation tests, in 15 of the CubTS cases. Statistical analyses were performed using Student's t -test with a confidence level of 95%. Results The preoperative sensitivity in CubTS cases was 80% in the 10-second shoulder internal rotation test and 36% in the 10-second Elbow Flexion test, and these differences were significant. None of the control cases had positive results in either test. All the CubTS cases improved with surgery; after surgery, neither test provoked symptoms in any surgical patient. The extraneural pressure increased in both provocative positions with no significant difference. Conclusions Positive results for the 10-second shoulder internal rotation test were more sensitive than that for the Elbow Flexion test of the same duration and seemed specific to CubTS. Type of study/level of evidence Diagnostic III.
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association between the Elbow Flexion test and extraneural pressure inside the cubital tunnel
Journal of Hand Surgery (European Volume), 2011Co-Authors: Kensuke Ochi, Noriaki Nakamichi, Kozo Morita, Eijiro Okada, Yukio Horiuchi, Takayuki HasegawaAbstract:Purpose The Elbow Flexion test is a standard, provocative diagnostic test for cubital tunnel syndrome (CubTS). The purpose of this study was to investigate the association between the Elbow Flexion test and the degree of extraneural pressure in the cubital tunnel of CubTS patients. Methods Extraneural pressure on the ulnar nerve in the cubital tunnel was evaluated using 0.7-mm thickness catheter during surgery of 25 CubTS cases and compared with the results of preoperative Elbow Flexion testing. Statistic analysis was performed using Student's t -test with a confidence level of 95% (p Results Forty-eight percent of the patients were positive for the Elbow Flexion test. Mean extraneural pressure was significantly higher in maximum Elbow Flexion than in maximum Elbow extension (p Conclusions Our results suggested that the mechanism of provocation of symptoms of CubTS by the Elbow Flexion could not be explained simply by dynamic pressure in the cubital tunnel, and other pathophysiological factors could also be contributing. Type of study/level of evidence Diagnostic III.
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association between the Elbow Flexion test and extraneural pressure inside the cubital tunnel
Journal of Hand Surgery (European Volume), 2011Co-Authors: Kensuke Ochi, Noriaki Nakamichi, Kozo Morita, Eijiro Okada, Yukio Horiuchi, Takayuki HasegawaAbstract:Purpose The Elbow Flexion test is a standard, provocative diagnostic test for cubital tunnel syndrome (CubTS). The purpose of this study was to investigate the association between the Elbow Flexion test and the degree of extraneural pressure in the cubital tunnel of CubTS patients. Methods Extraneural pressure on the ulnar nerve in the cubital tunnel was evaluated using 0.7-mm thickness catheter during surgery of 25 CubTS cases and compared with the results of preoperative Elbow Flexion testing. Statistic analysis was performed using Student's t -test with a confidence level of 95% (p Results Forty-eight percent of the patients were positive for the Elbow Flexion test. Mean extraneural pressure was significantly higher in maximum Elbow Flexion than in maximum Elbow extension (p Conclusions Our results suggested that the mechanism of provocation of symptoms of CubTS by the Elbow Flexion could not be explained simply by dynamic pressure in the cubital tunnel, and other pathophysiological factors could also be contributing. Type of study/level of evidence Diagnostic III.
Ken Ninomiya - One of the best experts on this subject based on the ideXlab platform.
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comparison of shoulder internal rotation test with the Elbow Flexion test in the diagnosis of cubital tunnel syndrome
Journal of Hand Surgery (European Volume), 2011Co-Authors: Kensuke Ochi, Aya Tanabe, Kozo Morita, Yukio Horiuchi, Kentaro Takeda, Ken NinomiyaAbstract:Purpose To compare the shoulder internal rotation test—a new, provocative test—with the Elbow Flexion test in the diagnosis of cubital tunnel syndrome (CubTS). Methods Twenty-five patients with CubTS were examined before and after surgery with 10 seconds each of the Elbow Flexion and shoulder internal rotation tests. Fifty-four asymptomatic individuals and 14 neuropathy patients with a diagnosis other than CubTS were also examined as control cases. For the shoulder internal rotation test, the patient's upper extremity was kept at 90° abduction, maximum internal rotation, and 10° Flexion at the shoulder, with 90° Elbow Flexion and neutral position of the forearm and wrist, with finger extension. Test results were considered positive if any slight symptom attributable to CubTS occurred within 10 seconds. Extraneural pressure inside the cubital tunnel was intraoperatively measured with the positions of both the Elbow Flexion and shoulder internal rotation tests, in 15 of the CubTS cases. Statistical analyses were performed using Student's t -test with a confidence level of 95%. Results The preoperative sensitivity in CubTS cases was 80% in the 10-second shoulder internal rotation test and 36% in the 10-second Elbow Flexion test, and these differences were significant. None of the control cases had positive results in either test. All the CubTS cases improved with surgery; after surgery, neither test provoked symptoms in any surgical patient. The extraneural pressure increased in both provocative positions with no significant difference. Conclusions Positive results for the 10-second shoulder internal rotation test were more sensitive than that for the Elbow Flexion test of the same duration and seemed specific to CubTS. Type of study/level of evidence Diagnostic III.
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comparison of shoulder internal rotation test with the Elbow Flexion test in the diagnosis of cubital tunnel syndrome
Journal of Hand Surgery (European Volume), 2011Co-Authors: Kensuke Ochi, Aya Tanabe, Kozo Morita, Yukio Horiuchi, Kentaro Takeda, Ken NinomiyaAbstract:Purpose To compare the shoulder internal rotation test—a new, provocative test—with the Elbow Flexion test in the diagnosis of cubital tunnel syndrome (CubTS). Methods Twenty-five patients with CubTS were examined before and after surgery with 10 seconds each of the Elbow Flexion and shoulder internal rotation tests. Fifty-four asymptomatic individuals and 14 neuropathy patients with a diagnosis other than CubTS were also examined as control cases. For the shoulder internal rotation test, the patient's upper extremity was kept at 90° abduction, maximum internal rotation, and 10° Flexion at the shoulder, with 90° Elbow Flexion and neutral position of the forearm and wrist, with finger extension. Test results were considered positive if any slight symptom attributable to CubTS occurred within 10 seconds. Extraneural pressure inside the cubital tunnel was intraoperatively measured with the positions of both the Elbow Flexion and shoulder internal rotation tests, in 15 of the CubTS cases. Statistical analyses were performed using Student's t -test with a confidence level of 95%. Results The preoperative sensitivity in CubTS cases was 80% in the 10-second shoulder internal rotation test and 36% in the 10-second Elbow Flexion test, and these differences were significant. None of the control cases had positive results in either test. All the CubTS cases improved with surgery; after surgery, neither test provoked symptoms in any surgical patient. The extraneural pressure increased in both provocative positions with no significant difference. Conclusions Positive results for the 10-second shoulder internal rotation test were more sensitive than that for the Elbow Flexion test of the same duration and seemed specific to CubTS. Type of study/level of evidence Diagnostic III.
Yukio Horiuchi - One of the best experts on this subject based on the ideXlab platform.
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shoulder internal rotation Elbow Flexion test for diagnosing cubital tunnel syndrome
Journal of Shoulder and Elbow Surgery, 2012Co-Authors: Kensuke Ochi, Aya Tanabe, Yasuhito Kaneko, Makoto Waseda, Yukio Horiuchi, Takahiro KoyanagiAbstract:Background Shoulder internal rotation enhances symptom provocation attributed to cubital tunnel syndrome. We present a modified Elbow Flexion test—the shoulder internal rotation Elbow Flexion test—for diagnosing cubital tunnel syndrome. Methods Fifty-five ulnar nerves in cubital tunnel syndrome patients and 123 ulnar nerves in controls were examined with 5 seconds each of Elbow Flexion, shoulder internal rotation, and shoulder internal rotation Elbow Flexion tests before and after treatment (surgery in 18; conservative in others). For the shoulder internal rotation Elbow Flexion test position, 90° abduction, maximum internal rotation, and 10° Flexion of the shoulder were combined with the Elbow Flexion test position. The test was considered positive if any symptom for cubital tunnel syndrome developed Results The sensitivities/specificities of the 5-second Elbow Flexion, shoulder internal rotation, and shoulder internal rotation Elbow Flexion tests were 25%/100%, 58%/100%, and 87%/98%, respectively. Sensitivity differences between the shoulder internal rotation Elbow Flexion test and the other two tests were significant. Shoulder internal rotation Elbow Flexion test results and cubital tunnel syndrome symptoms were significantly correlated. Influence of the shoulder internal rotation Elbow Flexion test on the ulnar nerve was seen in 8 of 10 cubital tunnel syndrome nerves but not in controls. Conclusions The 5-second shoulder internal rotation Elbow Flexion test is specific, easy and quick provocative test for diagnosing cubital tunnel syndrome.
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comparison of shoulder internal rotation test with the Elbow Flexion test in the diagnosis of cubital tunnel syndrome
Journal of Hand Surgery (European Volume), 2011Co-Authors: Kensuke Ochi, Aya Tanabe, Kozo Morita, Yukio Horiuchi, Kentaro Takeda, Ken NinomiyaAbstract:Purpose To compare the shoulder internal rotation test—a new, provocative test—with the Elbow Flexion test in the diagnosis of cubital tunnel syndrome (CubTS). Methods Twenty-five patients with CubTS were examined before and after surgery with 10 seconds each of the Elbow Flexion and shoulder internal rotation tests. Fifty-four asymptomatic individuals and 14 neuropathy patients with a diagnosis other than CubTS were also examined as control cases. For the shoulder internal rotation test, the patient's upper extremity was kept at 90° abduction, maximum internal rotation, and 10° Flexion at the shoulder, with 90° Elbow Flexion and neutral position of the forearm and wrist, with finger extension. Test results were considered positive if any slight symptom attributable to CubTS occurred within 10 seconds. Extraneural pressure inside the cubital tunnel was intraoperatively measured with the positions of both the Elbow Flexion and shoulder internal rotation tests, in 15 of the CubTS cases. Statistical analyses were performed using Student's t -test with a confidence level of 95%. Results The preoperative sensitivity in CubTS cases was 80% in the 10-second shoulder internal rotation test and 36% in the 10-second Elbow Flexion test, and these differences were significant. None of the control cases had positive results in either test. All the CubTS cases improved with surgery; after surgery, neither test provoked symptoms in any surgical patient. The extraneural pressure increased in both provocative positions with no significant difference. Conclusions Positive results for the 10-second shoulder internal rotation test were more sensitive than that for the Elbow Flexion test of the same duration and seemed specific to CubTS. Type of study/level of evidence Diagnostic III.
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comparison of shoulder internal rotation test with the Elbow Flexion test in the diagnosis of cubital tunnel syndrome
Journal of Hand Surgery (European Volume), 2011Co-Authors: Kensuke Ochi, Aya Tanabe, Kozo Morita, Yukio Horiuchi, Kentaro Takeda, Ken NinomiyaAbstract:Purpose To compare the shoulder internal rotation test—a new, provocative test—with the Elbow Flexion test in the diagnosis of cubital tunnel syndrome (CubTS). Methods Twenty-five patients with CubTS were examined before and after surgery with 10 seconds each of the Elbow Flexion and shoulder internal rotation tests. Fifty-four asymptomatic individuals and 14 neuropathy patients with a diagnosis other than CubTS were also examined as control cases. For the shoulder internal rotation test, the patient's upper extremity was kept at 90° abduction, maximum internal rotation, and 10° Flexion at the shoulder, with 90° Elbow Flexion and neutral position of the forearm and wrist, with finger extension. Test results were considered positive if any slight symptom attributable to CubTS occurred within 10 seconds. Extraneural pressure inside the cubital tunnel was intraoperatively measured with the positions of both the Elbow Flexion and shoulder internal rotation tests, in 15 of the CubTS cases. Statistical analyses were performed using Student's t -test with a confidence level of 95%. Results The preoperative sensitivity in CubTS cases was 80% in the 10-second shoulder internal rotation test and 36% in the 10-second Elbow Flexion test, and these differences were significant. None of the control cases had positive results in either test. All the CubTS cases improved with surgery; after surgery, neither test provoked symptoms in any surgical patient. The extraneural pressure increased in both provocative positions with no significant difference. Conclusions Positive results for the 10-second shoulder internal rotation test were more sensitive than that for the Elbow Flexion test of the same duration and seemed specific to CubTS. Type of study/level of evidence Diagnostic III.
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association between the Elbow Flexion test and extraneural pressure inside the cubital tunnel
Journal of Hand Surgery (European Volume), 2011Co-Authors: Kensuke Ochi, Noriaki Nakamichi, Kozo Morita, Eijiro Okada, Yukio Horiuchi, Takayuki HasegawaAbstract:Purpose The Elbow Flexion test is a standard, provocative diagnostic test for cubital tunnel syndrome (CubTS). The purpose of this study was to investigate the association between the Elbow Flexion test and the degree of extraneural pressure in the cubital tunnel of CubTS patients. Methods Extraneural pressure on the ulnar nerve in the cubital tunnel was evaluated using 0.7-mm thickness catheter during surgery of 25 CubTS cases and compared with the results of preoperative Elbow Flexion testing. Statistic analysis was performed using Student's t -test with a confidence level of 95% (p Results Forty-eight percent of the patients were positive for the Elbow Flexion test. Mean extraneural pressure was significantly higher in maximum Elbow Flexion than in maximum Elbow extension (p Conclusions Our results suggested that the mechanism of provocation of symptoms of CubTS by the Elbow Flexion could not be explained simply by dynamic pressure in the cubital tunnel, and other pathophysiological factors could also be contributing. Type of study/level of evidence Diagnostic III.
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association between the Elbow Flexion test and extraneural pressure inside the cubital tunnel
Journal of Hand Surgery (European Volume), 2011Co-Authors: Kensuke Ochi, Noriaki Nakamichi, Kozo Morita, Eijiro Okada, Yukio Horiuchi, Takayuki HasegawaAbstract:Purpose The Elbow Flexion test is a standard, provocative diagnostic test for cubital tunnel syndrome (CubTS). The purpose of this study was to investigate the association between the Elbow Flexion test and the degree of extraneural pressure in the cubital tunnel of CubTS patients. Methods Extraneural pressure on the ulnar nerve in the cubital tunnel was evaluated using 0.7-mm thickness catheter during surgery of 25 CubTS cases and compared with the results of preoperative Elbow Flexion testing. Statistic analysis was performed using Student's t -test with a confidence level of 95% (p Results Forty-eight percent of the patients were positive for the Elbow Flexion test. Mean extraneural pressure was significantly higher in maximum Elbow Flexion than in maximum Elbow extension (p Conclusions Our results suggested that the mechanism of provocation of symptoms of CubTS by the Elbow Flexion could not be explained simply by dynamic pressure in the cubital tunnel, and other pathophysiological factors could also be contributing. Type of study/level of evidence Diagnostic III.
Alexander Y. Shin - One of the best experts on this subject based on the ideXlab platform.
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Free Functioning Gracilis Muscle Transfer for Elbow Flexion Reconstruction after Traumatic Adult Brachial Pan-Plexus Injury: Where Is the Optimal Distal Tendon Attachment for Elbow Flexion?
Plastic and reconstructive surgery, 2017Co-Authors: Andrés A. Maldonado, Santiago Romero-brufau, Michelle F. Kircher, Robert J. Spinner, Allen T. Bishop, Alexander Y. ShinAbstract:BACKGROUND Reconstruction after pan-plexus root avulsions often includes gracilis free functioning muscle transfer. For Elbow Flexion reconstruction, the free functioning muscle transfer distal tendon is inserted into the biceps tendon or more distally (i.e., flexor digitorum profundus/flexor pollicis longus tendons) for combined Elbow and finger Flexion; the theoretical drawback of the latter approach is weaker Elbow Flexion. The authors compared Elbow Flexion strength with a biceps tendon versus a flexor digitorum profundus/flexor pollicis longus tendon attachment to determine which insertion point resulted in better Elbow Flexion. METHODS Thirty-nine patients underwent free functioning muscle transfer with either a biceps tendon or a distal attachment. Groups were compared on postoperative Elbow Flexion strength, preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire scores, range of motion, and other surgical and demographic characteristics. A biomechanical analysis simulating different tendon attachments determined which reconstruction resulted in optimal Elbow Flexion mechanics. RESULTS Distal tendon attachment was associated with M3 or M4 Elbow Flexion and greater range of motion compared with the biceps tendon attachment (p < 0.05). There were no statistically significant improvements in Disabilities of the Arm, Shoulder, and Hand questionnaire scores. Biomechanical analysis demonstrated that all distal tendon attachments studied generated a 15 to 30 percent greater torque compared with the biceps tendon attachment; this was true for attachments either at the flexor digitorum profundus/flexor pollicis longus tendon, or directly at the radius at 10 cm or 15 cm from the Elbow axis of rotation. CONCLUSIONS The flexor digitorum profundus/flexor pollicis longus tendon attachment of the gracilis free functioning muscle transfer distal tendon was superior in achieving Elbow Flexion strength. Patients with only Elbow Flexion reconstruction may also benefit from a flexor digitorum profundus/flexor pollicis longus tendon attachment or from a more distal attachment to the radius. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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free functioning gracilis muscle transfer versus intercostal nerve transfer to musculocutaneous nerve for restoration of Elbow Flexion after traumatic adult brachial pan plexus injury
Plastic and Reconstructive Surgery, 2016Co-Authors: Andrés A. Maldonado, Michelle F. Kircher, Robert J. Spinner, Allen T. Bishop, Alexander Y. ShinAbstract:After complete five-level root brachial plexus injury, free functional muscle transfer and intercostal nerve transfer to the musculocutaneous nerve are two potential reconstructive options for Elbow Flexion. The aim of this study was to determine the outcomes of free functional muscle transfer versus intercostal nerve-to-musculocutaneous nerve transfers with respect to strength.Sixty-two patients who underwent free functional muscle transfer reconstruction or intercostal nerve-to-musculocutaneous nerve transfer for Elbow Flexion following a pan-plexus injury were included. The two groups were compared with respect to postoperative Elbow Flexion strength according to the British Medical Research Council grading system; preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire scores.In the free functional muscle transfer group, 67.7 percent of patients achieved M3 or M4 Elbow Flexion. In the intercostal nerve-to-musculocutaneous nerve transfer group, 41.9 percent of patients achieved M3 or M4 Elbow Flexion. The difference was statistically significant (p < 0.05). Changes in Disabilities of the Arm, Shoulder, and Hand questionnaire scores were not statistically significant. Average time from injury to surgery was significantly different (p < 0.01) in both groups. The number of intercostal nerves used for the musculocutaneous nerve transfer did not correlate with better Elbow Flexion grade.Based on this study, gracilis free functional muscle transfer reconstruction achieves better Elbow Flexion strength than intercostal nerve-to-musculocutaneous nerve transfer for Elbow Flexion after pan-plexus injury. The role of gracilis free functional muscle transfer should be carefully considered in acute reconstruction.Therapeutic, III.
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free functioning gracilis muscle transfer versus intercostal nerve transfer to musculocutaneous nerve for restoration of Elbow Flexion after traumatic adult brachial pan plexus injury
Plastic and Reconstructive Surgery, 2016Co-Authors: Andrés A. Maldonado, Michelle F. Kircher, Robert J. Spinner, Allen T. Bishop, Alexander Y. ShinAbstract:BACKGROUND After complete five-level root brachial plexus injury, free functional muscle transfer and intercostal nerve transfer to the musculocutaneous nerve are two potential reconstructive options for Elbow Flexion. The aim of this study was to determine the outcomes of free functional muscle transfer versus intercostal nerve-to-musculocutaneous nerve transfers with respect to strength. METHODS Sixty-two patients who underwent free functional muscle transfer reconstruction or intercostal nerve-to-musculocutaneous nerve transfer for Elbow Flexion following a pan-plexus injury were included. The two groups were compared with respect to postoperative Elbow Flexion strength according to the British Medical Research Council grading system; preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire scores. RESULTS In the free functional muscle transfer group, 67.7 percent of patients achieved M3 or M4 Elbow Flexion. In the intercostal nerve-to-musculocutaneous nerve transfer group, 41.9 percent of patients achieved M3 or M4 Elbow Flexion. The difference was statistically significant (p < 0.05). Changes in Disabilities of the Arm, Shoulder, and Hand questionnaire scores were not statistically significant. Average time from injury to surgery was significantly different (p < 0.01) in both groups. The number of intercostal nerves used for the musculocutaneous nerve transfer did not correlate with better Elbow Flexion grade. CONCLUSIONS Based on this study, gracilis free functional muscle transfer reconstruction achieves better Elbow Flexion strength than intercostal nerve-to-musculocutaneous nerve transfer for Elbow Flexion after pan-plexus injury. The role of gracilis free functional muscle transfer should be carefully considered in acute reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
Aya Tanabe - One of the best experts on this subject based on the ideXlab platform.
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shoulder internal rotation Elbow Flexion test for diagnosing cubital tunnel syndrome
Journal of Shoulder and Elbow Surgery, 2012Co-Authors: Kensuke Ochi, Aya Tanabe, Yasuhito Kaneko, Makoto Waseda, Yukio Horiuchi, Takahiro KoyanagiAbstract:Background Shoulder internal rotation enhances symptom provocation attributed to cubital tunnel syndrome. We present a modified Elbow Flexion test—the shoulder internal rotation Elbow Flexion test—for diagnosing cubital tunnel syndrome. Methods Fifty-five ulnar nerves in cubital tunnel syndrome patients and 123 ulnar nerves in controls were examined with 5 seconds each of Elbow Flexion, shoulder internal rotation, and shoulder internal rotation Elbow Flexion tests before and after treatment (surgery in 18; conservative in others). For the shoulder internal rotation Elbow Flexion test position, 90° abduction, maximum internal rotation, and 10° Flexion of the shoulder were combined with the Elbow Flexion test position. The test was considered positive if any symptom for cubital tunnel syndrome developed Results The sensitivities/specificities of the 5-second Elbow Flexion, shoulder internal rotation, and shoulder internal rotation Elbow Flexion tests were 25%/100%, 58%/100%, and 87%/98%, respectively. Sensitivity differences between the shoulder internal rotation Elbow Flexion test and the other two tests were significant. Shoulder internal rotation Elbow Flexion test results and cubital tunnel syndrome symptoms were significantly correlated. Influence of the shoulder internal rotation Elbow Flexion test on the ulnar nerve was seen in 8 of 10 cubital tunnel syndrome nerves but not in controls. Conclusions The 5-second shoulder internal rotation Elbow Flexion test is specific, easy and quick provocative test for diagnosing cubital tunnel syndrome.
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comparison of shoulder internal rotation test with the Elbow Flexion test in the diagnosis of cubital tunnel syndrome
Journal of Hand Surgery (European Volume), 2011Co-Authors: Kensuke Ochi, Aya Tanabe, Kozo Morita, Yukio Horiuchi, Kentaro Takeda, Ken NinomiyaAbstract:Purpose To compare the shoulder internal rotation test—a new, provocative test—with the Elbow Flexion test in the diagnosis of cubital tunnel syndrome (CubTS). Methods Twenty-five patients with CubTS were examined before and after surgery with 10 seconds each of the Elbow Flexion and shoulder internal rotation tests. Fifty-four asymptomatic individuals and 14 neuropathy patients with a diagnosis other than CubTS were also examined as control cases. For the shoulder internal rotation test, the patient's upper extremity was kept at 90° abduction, maximum internal rotation, and 10° Flexion at the shoulder, with 90° Elbow Flexion and neutral position of the forearm and wrist, with finger extension. Test results were considered positive if any slight symptom attributable to CubTS occurred within 10 seconds. Extraneural pressure inside the cubital tunnel was intraoperatively measured with the positions of both the Elbow Flexion and shoulder internal rotation tests, in 15 of the CubTS cases. Statistical analyses were performed using Student's t -test with a confidence level of 95%. Results The preoperative sensitivity in CubTS cases was 80% in the 10-second shoulder internal rotation test and 36% in the 10-second Elbow Flexion test, and these differences were significant. None of the control cases had positive results in either test. All the CubTS cases improved with surgery; after surgery, neither test provoked symptoms in any surgical patient. The extraneural pressure increased in both provocative positions with no significant difference. Conclusions Positive results for the 10-second shoulder internal rotation test were more sensitive than that for the Elbow Flexion test of the same duration and seemed specific to CubTS. Type of study/level of evidence Diagnostic III.
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comparison of shoulder internal rotation test with the Elbow Flexion test in the diagnosis of cubital tunnel syndrome
Journal of Hand Surgery (European Volume), 2011Co-Authors: Kensuke Ochi, Aya Tanabe, Kozo Morita, Yukio Horiuchi, Kentaro Takeda, Ken NinomiyaAbstract:Purpose To compare the shoulder internal rotation test—a new, provocative test—with the Elbow Flexion test in the diagnosis of cubital tunnel syndrome (CubTS). Methods Twenty-five patients with CubTS were examined before and after surgery with 10 seconds each of the Elbow Flexion and shoulder internal rotation tests. Fifty-four asymptomatic individuals and 14 neuropathy patients with a diagnosis other than CubTS were also examined as control cases. For the shoulder internal rotation test, the patient's upper extremity was kept at 90° abduction, maximum internal rotation, and 10° Flexion at the shoulder, with 90° Elbow Flexion and neutral position of the forearm and wrist, with finger extension. Test results were considered positive if any slight symptom attributable to CubTS occurred within 10 seconds. Extraneural pressure inside the cubital tunnel was intraoperatively measured with the positions of both the Elbow Flexion and shoulder internal rotation tests, in 15 of the CubTS cases. Statistical analyses were performed using Student's t -test with a confidence level of 95%. Results The preoperative sensitivity in CubTS cases was 80% in the 10-second shoulder internal rotation test and 36% in the 10-second Elbow Flexion test, and these differences were significant. None of the control cases had positive results in either test. All the CubTS cases improved with surgery; after surgery, neither test provoked symptoms in any surgical patient. The extraneural pressure increased in both provocative positions with no significant difference. Conclusions Positive results for the 10-second shoulder internal rotation test were more sensitive than that for the Elbow Flexion test of the same duration and seemed specific to CubTS. Type of study/level of evidence Diagnostic III.