vendex and Forearm-Injuries

This study quantified pain (visual analog pain scale [VAPS]), disability (Disabilities of the Arm, Shoulder and Hand [DASH]) and isometric supination torque at 3 forearm positions in a prospective cohort of biceps-deficient arms to assess the potential for functional return with nonoperative treatment.. Twenty-three men (50 ± 11 years) with complete unilateral distal biceps avulsion underwent isometric supination strength testing of both limbs at 60° of supination, 0° (neutral), and 60° of pronation. After exclusion of 1 outlier patient, the mean time from injury to evaluation was 44 days (range, 4-455 days). Pain level (VAPS) and functional outcome (DASH) were assessed; supination strength was normalized to the uninjured arm.. The uninjured arm was stronger (P < .001), and peak torque varied with forearm position (P < .043). Peak torque was greater in pronation compared with supination, regardless of injury (P < .002). No differences were detected in supination strength as a result of forearm position or arm dominance. Supination strength did not correlate with time from injury to evaluation. One patient regained supination strength (115%) at 60° of pronation and 72% in neutral with a lengthy time from injury. VAPS (5 of 10) and DASH (39 of 100) scores decreased with time and did not relate to supination strength.. Biceps tendon rupture led to a 60% decrease in supination strength in the neutrally oriented forearm. Peak torque observations can be explained using forearm moment arms. VAPS and DASH scores decreased with time but did not affect strength. We speculate that supination strength from pronation to neutral can improve as one strengthens the brachioradialis but strength deficits from neutral to supination are more difficult to overcome.

Topics: Adult; Aged; Forearm Injuries; Humans; Male; Middle Aged; Muscle Strength; Muscle, Skeletal; Pronation; Prospective Studies; Range of Motion, Articular; Recovery of Function; Rupture; Supination; Tendon Injuries; Torque; Treatment Outcome

A 32-year-old man presented with chronic closed transection of the biceps brachii of the right arm after 30 months of conservative treatment. Magnetic resonance imaging showed atrophy of both long and short heads of the biceps brachii, with a 5-cm defect secondary to proximal and distal retraction on either side of the tear. There was a similar defect in the coracobrachialis, but the triceps brachii was normal. The self-rated overall arm status was 4 out of 10 (using a visual analogue scale). Objective functional deficit was measured using a dynamometer. Forearm flexion and supination strength of each arm at 120º/s was tested. The patient had a 34% deficit (40 vs. 61 Nm) in peak torque during forearm flexion and a 22% deficit (10 vs. 12 Nm) during forearm supination. The patient could not maintain maximal torque throughout the range of motion, with an approximately 50% deficit in the later part of the range of motion. The patient underwent reconstruction of the biceps brachii using an interposition Achilles tendon allograft.

Topics: Achilles Tendon; Adult; Aerospace Medicine; Forearm Injuries; Humans; Magnetic Resonance Imaging; Male; Military Personnel; Muscle Strength Dynamometer; Muscle, Skeletal; Supination; Torque; Transplantation, Homologous

Computer simulation was used to predict the extent to which age-related muscle atrophy may adversely affect the safe arrest of a forward fall onto the arms. The biomechanical factors affecting the separate risks for wrist fracture or head impact were examined using a two-dimensional, 5-link, forward dynamic model. The hypothesis was tested in older females that age-related loss in muscular strength renders the use of the arms ineffective in arresting a forward fall without either a torso impact exceeding 0.5m/s or distal forearm loads sufficient to fracture the wrist. The results demonstrate that typical age-related decline in arm muscle strength substantially reduces the ability to arrest a forward fall without the elbows buckling and, therefore, a risk of torso and/or head impact. The model predicted that older women with below-average bone strength risk a Colles fracture when arresting typical falls, particularly with an extended arm.

Topics: Accidental Falls; Adult; Aged; Aging; Computer Simulation; Elasticity; Female; Forearm; Forearm Injuries; Humans; Male; Middle Aged; Models, Biological; Movement; Posture; Sensitivity and Specificity; Sex Factors; Statistics as Topic; Stress, Mechanical; Torque; Upper Extremity