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Clin Orthop Relat Res 2018 01;476(1):30-36

J. J. Kavolus, D. E. Attarian, P. F. Lachiewicz Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA D. Sia, H. G. Potter, Department of Radiology and Imaging, MRI Research, Hospital for Special Surgery, New York, NY, USA.

Background: Surgeon-performed periarticular injections and anesthesiologist-performed femoral nerve or adductor canal blocks with local anesthetic are in common use as part of multimodal pain management regimens for patients undergoing TKA. However, femoral nerve blocks risk causing quadriceps weakness and falls, and anesthesiologist-performed adductor canal blocks are costly in time and resources and may be unreliable. We investigated the feasibility of a surgeon-performed saphenous nerve ("adductor canal") block from within the knee at the time of TKA. Read More

J Neural Eng 2017 06 30;14(3):036011. Epub 2017 Mar 30.

Department of Biomedical Engineering, University of Houston, Houston, TX 77204, United States of America.

Objective: To localize neuromuscular junctions in skeletal muscles in vivo which is of great importance in understanding, diagnosing and managing of neuromuscular disorders.

Approach: A three-dimensional global innervation zone imaging technique was developed to characterize the global distribution of innervation zones, as an indication of the location and features of neuromuscular junctions, using electrically evoked high-density surface electromyogram recordings.

Main Results: The performance of the technique was evaluated in the biceps brachii of six intact human subjects. Read More

Muscle Nerve 2017 08 20;56(2):237-241. Epub 2017 Feb 20.

Center for Anatomy and Cell Biology & Medical Imaging Cluster, Medical University Vienna, Austria.

Introduction: Ulnar neuropathy at the elbow (UNE) is a common peripheral compression neuropathy and, in most cases, occurs at 2 sites, the retroepicondylar groove or the cubital tunnel. With regard to a potential therapeutic approach with perineural corticosteroid injection, the aim of this study was to evaluate the distribution of injection fluid applied at a standard site.

Methods: We performed ultrasound-guided (US-guided) perineural injections to the ulnar nerve halfway between the olecranon and the medial epicondyle in 21 upper limbs from 11 non-embalmed cadavers. Read More

J Shoulder Elbow Surg 2016 Oct 1;25(10):1704-9. Epub 2016 Aug 1.

Department of Orthopaedic Surgery, CHA Bundang Medical Center, School of Medicine, CHA University, Gyeonggi, Republic of Korea.

Background: Angiofibroblastic changes of a musculotendinous origin at the medial epicondyle characterize medial epicondylitis of the elbow. Although nonsurgical treatment is the primary approach for medial epicondylitis, surgical treatment should be considered when conservative therapy fails. This study reports the results of surgical treatment of medial epicondylitis monitored for more than 5 years. Read More

Pain Physician 2015 Sep-Oct;18(5):E899-904

Gülhane Military Medical Academy, Department of Physical Medicine and Rehabilitation, Turkish Armed Forces Rehabilitation Center, Ankara, Turkey.

Background: Genicular nerve block has recently emerged as a novel alternative treatment in chronic knee pain. The needle placement for genicular nerve injection is made under fluoroscopic guidance with reference to bony landmarks.

Objective: To investigate the anatomic landmarks for medial genicular nerve branches and to determine the accuracy of ultrasound-guided genicular nerve block in a cadaveric model. Read More

Dev Med Child Neurol 2015 May 2;57(5):476-83. Epub 2015 Jan 2.

Department of Orthopaedics, University Hospital Leuven, Leuven, Belgium; KU Leuven Department of Development and Regeneration, Leuven, Belgium.

Aim: Intramuscular botulinum toxin-A (BoNT-A) injections reduce spasticity by blocking neurotransmission at the motor endplate (MEP). The goal of this study was to assess the reduction in spasticity achieved by injecting BoNT-A at different sites of the gracilis muscle.

Method: Thirty-four gracilis muscles, in 27 children (10 females and 17 males, mean age of 8. Read More

Am J Phys Med Rehabil 2014 Apr;93(4):282-6

From the Department of Rehabilitation Medicine, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (DHS, MEC, SYK, HKP); Department of Rehabilitation Medicine, National Health Insurance Corporation Ilsan Hospital, Ilsan, Republic of Korea (Z-AH); and Department of Rehabilitation Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea (YJS).

Objective: The aim of this study was to determine the location of the motor points and the intramuscular branches of the wrist flexors in relation to bony landmarks.

Design: Sixteen limbs from eight adult cadavers were anatomically dissected. The motor branch points of the flexor carpi radialis and flexor carpi ulnaris muscles and the proximal limit points and the distal limit points in relation to a reference line connecting the medial epicondyle and the pisiform bone or one connecting the medial epicondyle and the base of the second metarcarpal bone were identified. Read More

PM R 2013 Mar 9;5(3):169-75. Epub 2013 Feb 9.

Emory Orthopedic & Spine Center, Atlanta, GA 30329, USA.

Objective: To determine whether ultrasound-guided platelet-rich plasma (PRP) injections are an effective treatment for chronic tendinopathies.

Design: A retrospective, cross-sectional survey.

Setting: Four academic sports medicine centers from across the United States. Read More

J Comput Assist Tomogr 2012 Jan-Feb;36(1):157-60

Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Center for Trauma Rehabilitation Research, Quentin Mease Hospital, Harris County Hospital District, Houston, TX, USA.

This is the second in a series of papers related to procedure-oriented joint anatomy. This article will review the anatomy of the elbow and its relationship to procedures in the clinical setting. Needle procedures of the elbow joint include medial and lateral epicondyle injections, olecranon bursa injection, elbow joint aspiration, phlebotomies in the antecubital fossa, and intramuscular injections such as trigger point and botulinum toxin injections. Read More

Muscle Nerve 2012 Feb;45(2):217-21

Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Introduction: The aim of this study was to determine the anatomical location of the motor points of the flexor hallucis longus (FHL) and brevis (FHB) muscles for an effective motor point block.

Methods: Twenty cadavers were used for this study. For the FHL, we identified the line between the medial and lateral epicondyle of the femur and the line joining the prominent point on the surface of the medial malleolus of the tibia and the lateral malleolus of the fibula. Read More

Surg Radiol Anat 2011 Sep 22;33(7):601-7. Epub 2011 Jan 22.

Department of General Surgery, First Hospital, University of Jilin, Changchun, China.

Purpose: The aim of this study was to determine the motor entry points (MEPs) and the precise intramuscular nerve distribution of the flexor digitorum superficialis (FDS) and to provide accurate injection regions for botulinum toxin.

Methods: This study was performed on 46 fresh cadaveric arms with exposed intramuscular innervation of the FDS. For each main motor branch of the FDS, MEPs, where the nerve branch first pierced the muscle belly, and the proximal and distal limit points (PLPs and DLPs, respectively) of the terminal intramuscular nerve endings were located. Read More

PM R 2010 Jul;2(7):642-6

Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.

Objective: To determine if ultrasound (US) localization is equivalent to surface landmark localization to identify botulinum toxin injection targets for forearm muscle spasticity.

Design: Observational.

Setting: Outpatient spasticity clinic in a tertiary care center. Read More

Surg Radiol Anat 2010 Jul 10;32(6):529-37. Epub 2010 Jan 10.

Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, 505, Banpo-dong, Seocho-gu, Seoul, 137701, Korea.

Purpose: To elucidate the location of motor entry points (MEPs) and intramuscular nerve endings of the hamstring muscles.

Methods: We dissected 50 cadaveric lower extremities to identify the MEPs, where the nerve branch first pierced the muscle belly, and the proximal and distal limit points (PLPs and DLPs, respectively) of the terminal intramuscular nerve endings. These points were measured in relation to a reference line, expressed in x-coordinate, which connected the superior medial aspect of ischial tuberosity to the proximal aspect of the medial femoral epicondyle. Read More

J Bone Joint Surg Am 2009 Oct;91 Suppl 2:191-9

Division of Orthopaedic Surgery, Duke University Medical Center, Durham, NC 27707, USA.

Background: The medial collateral ligament provides valgus stability to the elbow. The purpose of the present study was to describe the pathoanatomy of acute traumatic medial collateral ligament ruptures and to report the rationale and results of direct repair.

Methods: Between 1996 and 2006, eleven athletes presented with acute rupture of the medial collateral ligament of the elbow and no history of dislocation. Read More

J Bone Joint Surg Am 2008 Nov;90(11):2416-22

Division of Orthopaedic Surgery, Duke University Medical Center, 3609 Southwest Durham Drive, Durham, NC 27707, USA.

Background: The medial collateral ligament provides valgus stability to the elbow. The purpose of the present study was to describe the pathoanatomy of acute traumatic medial collateral ligament ruptures and to report the rationale and results of direct repair.

Methods: Between 1996 and 2006, eleven athletes presented with acute rupture of the medial collateral ligament of the elbow and no history of dislocation. Read More

J Med Case Rep 2007 Nov 7;1:128. Epub 2007 Nov 7.

Department of Anatomy, Faculty of medicine, Ragama, Sri Lanka.

The superficial ulnar artery is a rare variation of the upper limb arterial system that arises from the brachial or axillary artery and runs superficial to the muscles arising from the medial epicondyle 123. The incidence is about 0.7 to 7% 145. Read More

J Korean Med Sci 2007 Jun;22(3):459-62

Department of Physical Medicine & Rehabilitation, Korea University College of Medicine, Seoul, Korea.

Injection of the neurolytic agents into motor points of the biceps brachii or brachialis muscles is an effective treatment of spasticity of the elbow flexors in many stroke survivors. Accurate localization of the motor points of each muscle is necessary for enhancing the efficacy of motor point blocks. To identify the precise locations of the motor points (terminal nerve endings) of the biceps brachii and brachialis muscles in relation to anatomic surface landmarks for motor point blocks, we dissected 23 limbs from 12 cadavers. Read More

Arch Orthop Trauma Surg 2007 May 23;127(4):303-6. Epub 2006 May 23.

Department of Orthopaedic Surgery, Police General Hospital, Bangkok, 10330, Thailand,

Iliotibial band friction syndrome is an overuse injury caused by repetitive friction of the iliotibial band across the lateral femoral epicondyle. It has been reported to afflict long-distance runners, cyclists and military personnel. Initial treatments include rest, anti-inflammatory medication, modalities (ice or heat), stretching, physical therapy, and possibly a corticosteroid injection. Read More

Tech Hand Up Extrem Surg 2003 Dec;7(4):190-6

Department of Orthopaedic Surgery Thomas Jefferson University Philadelphia, Pennsylvania, USA.

Medial epicondylitis of the elbow involves pathologic alteration in the musculotendinous origins at the medial epicondyle. Although commonly referred to as "golfer's elbow", the condition may in fact be caused by a variety of sports and occupational activities. Accurate diagnosis requires a thorough understanding of the anatomic, epidemiologic, and pathophysiologic factors. Read More

Pain 2005 Aug;116(3):238-42

Department of Rehabilitation Medicine, Korea University College of Medicine, 516 Gozan Dong, Ansan City, Kyonggi Province 425-707, South Korea.

Pain patterns of the myofascial trigger points (TrP) for most muscles of the forearm have been documented. However, there are no published reports on the referred pain patterns for the pronator quadratus (PQ) muscle. The purpose of this study was to determine the referred pain pattern of the TrP in the PQ. Read More

Phys Sportsmed 2000 Jul;28(7):93-4

MinnHealth Family Physicians, White Bear Lake, MN, USA.

Lateral epicondylitis, also known as tennis elbow, is a restricting injury for active people that sometimes requires an injection of corticosteroid and local anesthetic for pain relief. The chief symptom is that activities that supinate or dorsiflex the wrist usually cause pain at the origin of the extensor muscle group (figure 1: not shown). This muscle group acts in extension of the wrist, hand, and digits, and in supination of the wrist. Read More

Muscle Nerve 1997 Aug;20(8):1041-3

Department of Physical Therapy, Faculty of Medicine, University of Toronto, Ontario, Canada.

Twenty-two Flexor Digitorum Superficialis (FDS) muscles from 18 cadavers were dissected to find the "Optimal Injection Site" (OIS) for botulinum toxin injections to individual bellies of FDS. Coordinates are given as a percentage of the distance along a landmarking line from the medial epicondyle to the pisiform and in millimetres (mm) lateral to it. The OIS were: FDS2: 72%, 14 mm; FDS3: 54%, 17mm; FDS4: 49%, 7mm; FDS5: 76%, 6mm. Read More

Reg Anesth 1996 Mar-Apr;21(2):89-92

Department of Anesthesia, Northwestern University Medical School, Chicago, Illinois, USA.

Background And Objectives: Injections of neurolytic agents designed to block the musculocutaneous nerve often eliminate all elbow flexion movements, leaving the patient with a flail arm. In such patients, motor point blocks of the biceps brachii or brachialis muscle, or both, may be indicated. By virtue of its relative cross-section area, the brachialis is the largest contributor to elbow flexion. Read More

J Am Acad Orthop Surg 1994 Jan;2(1):1-8

Department of Orthopaedics, University of Southern California School of Medicine, Los Angeles.

Epicondylitis of the elbow involves pathologic alteration in the musculotendinous origins at the lateral or medial epicondyle. Although commonly referred to as "tennis elbow" when it occurs laterally and "golfer's elbow" when it occurs medially, the condition may in fact be caused by a variety of sports and occupational activities. The accurate diagnosis of these entities requires a thorough understanding of the anatomic, epidemiologic, and pathophysiologic factors. Read More

J Hand Surg Am 1993 May;18(3):433-8

Department of Plastic and Reconstructive Surgery, Medical College of Wisconsin, Milwaukee 53226.

The extrinsic vasculature of the ulnar nerve as it relates to the treatment of cubital tunnel syndrome has not previously been described in detail. For a study of the anatomy, 18 fresh-frozen cadaver upper limbs were dissected after intra-arterial injection of latex. Two major pedicles were present in all 18 specimens--the superior ulnar collateral artery proximally and the posterior ulnar recurrent artery distally. Read More

Surg Radiol Anat 1993 ;15(3):163-8

Laboratoire d'Anatomie Appliquée, Faculté de Médecine Rangueil, Université Paul Sabatier, Toulouse III.

The aim of this study was to specify certain anatomic features of the gracilis m. with a view to the use of muscular or myocutaneous flaps. It was based on dissection of 84 gracilis muscles in 42 subjects as well as selective injection of the main pedicle of 20 muscles. Read More

Clin Orthop Relat Res 1992 May(278):73-80

Bergmannsheil Hospital, Bochum Ruhr-University, Department of Traumasurgery, West Germany.

From 1978 through 1987, 86 patients with epicondylitis were admitted for surgery after failed conservative treatment. The Wilhelm technique was performed either alone or in combination with an intraarticular procedure. The Wilhelm technique involves denervation of the epicondyle. Read More

Sports Med 1990 Mar;9(3):173-91

Department of General Practice, University of Western Australia, Perth.

Tennis elbow is due to a torque injury or sudden overstretching of tendons which insert into the epicondyles of the humerus. The predominant lesion is an enthesopathy--a pathological lesion at the insertion of tendon into bone. The most common site is at the lateral epicondyle and this is 3 times as frequent as at the medial epicondyle. Read More

Can J Surg 1989 Sep;32(5):366-7, 369

Upper Extremity Reconstructive Service, St. Michael's Hospital, Toronto, Ont.

A 35-year-old man who had chronic elbow pain due to medial epicondylitis received a steroid injection into the medial epicondyle. This was followed immediately by increased pain and symptoms of dysesthesia in the distribution of the medial antebrachial cutaneous nerve. On surgical exploration 9 months later, the nerve was found to lie directly over the medial epicondyle and appeared to have sustained an injection injury. Read More

Am Fam Physician 1977 Jul;16(1):95-102

The evidence that tennis elbow is caused by poor muscle strength and improper tennis stroke is strong. The lesion may be at the lateral epicondyle (70 to 80% of patients), at the musculotendinous junction at the level of the radial head or, rarely, at the medial condyle. Anti-inflammatory steroid injections in the condylar lesions are helpful. Read More

Clin Orthop Relat Res 1975 May(108):168-73

Recurring luxation of the ulnar nerve at the elbow is not uncommon (16.2%), occurring about equally in young and old, male and female, athletes and non-athletes but the greater mobility is usually at the dominant arm. The probable cause of such dislocation is congenital laxity of supporting ligaments. Read More