RESUMO
Background Lateral epicondylitis (LE), sometimes referred to as tennis elbow or lateral elbow tendinopathy (LET), is one of the most common repetitive stress disorders in the elbow joint. Often, this involves the attachment of the extensor carpi radialis brevis muscle. This study's primary focus is on treating people with LE, a condition that causes repetitive movements of the upper extremities. There is currently no research on how PowerBall gadget workouts affect the function and pain of individuals with lateral epicondylitis. Exercises using the "PowerBall device," which applies both intrinsic and extrinsic pressure to the wrist, elbow, and shoulder muscles, are thought to be beneficial forms of resistance training. It has been shown that there are improvements in strength, function, range of motion (ROM), discomfort, and quality of life (QOL). On the other side, it has been demonstrated that LE patients have reduced discomfort while using Mulligan Mobilization with Movement (MMWM). Methods The 50 patients with LE were split into two groups for the single-blinded, randomized clinical study after baseline assessment and randomization: Group A was the intervention group, and Group B was the conventional group. The "PowerBall device" exercise was provided to participants in Group A, and MMWM was given to those in Group B. Both groups can benefit from basic workouts and ultrasonography by following the prescribed routine. Quantification of pain, function, grip strength, and range of motion was done at the start and finish of therapy using the Visual Analogue Scale (VAS), Patient Rated Tennis Elbow Evaluation (PRTEE), portable dynamometer, and goniometer. Results After therapy, both groups showed considerable improvement (p<0.05). Both descriptive and inferential statistics were employed in the data analysis. Numerous statistical tests were employed, such as the student's paired and unpaired t-test and the chi-square test. From a statistical and clinical perspective, Group A's outcomes were more significant. On the visual analog scale, there was a decrease in pain intensity for wrist and elbow mobility at rest (p<0.0003), activity (p<0.003), PRTEE (p<0.001), grip strength (p<0.03), and range of motion (p<0.01). Both groups' assessments after rehabilitation indicated increases in pain and function; however, Group A (0.03) benefited more and saw early success with the PowerBall device. Conclusion Findings show that a three-week program incorporating resistance training exercises mediated by a "PowerBall device" enhances upper limb performance beyond traditional exercise treatment and increases grip strength, wrist extension strength, internal and external rotator concentric and eccentric strength. The findings and observations indicate that both groups have significantly improved.
RESUMO
El ramo de inervación para el músculo extensor radial corto del carpo (MERCC) ha sido utilizado para restablecer funciones de la musculatura del miembro superior en pacientes con lesiones medulares, del plexo braquial o de sus ramos terminales. El origen del nervio para el MERCC es variable, pudiendo originarse desde el tronco del nervio radial (NR), del ramo profundo de este nervio (RPNR) o del ramo superficial del mismo (RSNR). Con el propósito de complementar la anatomía sobre el origen y distribución del ramo para el MERCC, se utilizaron 30 miembros superiores, formolizados, de cadáveres de individuos Brasileños, localizados en los laboratorios de Anatomía de la Universidad Estadual de Ciencias da Saude, Maceió, Brasil. A través de disección se localizó el músculo y su inervación, determinando su origen, así como su distribución. Para efectuar la biometría, se consideró como referencia una línea transversal que pasaba entre las partes más prominentes de los epicóndilos lateral y medial del húmero (LBE), registrando la distancia entre esta línea y el punto de origen de este ramo muscular, así como la distancia entre la LBE y los puntos motores. El nervio para el MERCC se originó del RPNR en 50 % de los casos; desde el tronco principal del NR en 26, 7 % y desde el RSNR en 23, 3 %. La distancia entre el origen del ramo en estudio y la LBE fue en promedio de 23 ± 12 mm; la distancia entre el 1º, 2º y 3º punto motor respecto a la LBE fue de 55 ± 17 mm, 66 ± 17 mm y 79 ± 11 mm, respectivamente. La distribución de la inervación fue clasificada en 4 tipos en relación a sus puntos motores. Los resultados obtenidos son un importante aporte al conocimiento anatómico, así como a la neurocirugía en las transferencias nerviosas con propósitos de restauración de las funciones de músculos lesionados en el miembro superior.
The branch of the innervation for the extensor carpi radialis brevis muscle (ECRBm), has been used to reestablish muscle functions in the upper limbs of patients who have spinal cord injury, of the brachial plexus or its terminal branches. The origin of the ECRBm varies, and can originate from the trunk of the radial nerve (RN), from the deep branch of the radial nerve (DBRN), or from the superficial branch of the radial nerve (SBRN). In order to further complement the anatomy related to the origin and distribution of the ECRBm branch, 30 formolized upper limbs from Brazilian individuals, from the Universidad Estadual de Ciencias da Saude, Maiceió, Brazil were used. Through dissection, the muscle and its innervations was located, determining the origin of the branch as well as distribution. To determine biometry, a transversal reference line, which passed through the most prominent areas of the epicondyles of the humerus (BEL) was considered. The nerve for ECRBm originated from DBRN in 50 % of cases; from the main trunk of RN in 26.7 % and from SBRN in 23.3 %. The distance from the origin of the branch studied and the BEL was an average of 23 ± 12 mm; the distance from the first, second and third motor point to the BEL was 55 ± 17 mm, 66 ± 17 mm and 79±11 mm, respectively. The distribution of the innervation was classified in four types in relation to the motor points. The results are an important contribution to anatomical knowledge, as well as neurosurgery during nerve transfers to restore functions of damaged muscles in the upper limb.
Assuntos
Humanos , Adulto , Nervo Radial/anatomia & histologia , Músculo Esquelético/inervação , Extremidade Superior/inervação , CadáverRESUMO
The tendons of the palmaris longus (PL) and radial carpal extensor (RCE) muscles have extensive applications in surgery, yet despite their constant use, information about their morphological and morphometric characteristics remains limited. The aim of this study was to describe the morphological and morphometric characteristics of the PL and RCE muscle tendons and compare them to each other in 30 upper limbs of adult individuals with no apparent deformations from anatomy units at four universities in Chile. The anterior side and lateral margin of the forearm and the back of the hand as far as the tendon plane were dissected. The average length, width at origin level and at the level of the radiocarpal joint line of the PL muscle tendon were 125.48 mm ± 8.93, 4.76 mm ± 1.35 and 3.76 mm ± 0.91, respectively. The average length, width at the levels of origin and insertion of the extensor carpi radialis longus muscle tendon were 180.46 mm ± 15.03, 14.69 mm ± 3.72 and 7.76 mm ± 1.44 respectively, whereas for the extensor carpi radialis brevis muscle they were 115.23 mm ± 11.81, 9.53 mm ± 2.58 and 7.33 mm ±1.17, respectively. The most common origin of the tendons of the PL and extensor carpi radialis longus muscles was at the level of the middle third of the forearm, whereas the most common origin of the extensor carpi radialis brevis muscle tendon was at distal third level. The shape of the tendons of the PL and RCE muscles was broad and flat along their entire length. Simulating the longitudinal division of the tendons of the RCE muscles in two halves, the radial half of the tendons of both muscles has morphological and morphometric characteristics similar to the PL muscle tendon, such that it could be used as a graft in the case of agenesis of the PL muscle, or for tendon transfer where elongation of a tendon in the region is required.
Los tendones de los músculos palmar largo (PL) y extensores radiales del carpo (ERC) tienen extensas aplicaciones en cirugía, pero a pesar de su constante uso, es escasa la información respecto a sus características morfológicas y morfométricas. El objetivo de este estudio fue describir las características morfológicas y morfométricas de los tendones de los músculos PL y ERC y compararlas entre sí, en 30 miembros superiores de individuos adultos, sin deformaciones aparentes, pertenecientes a unidades de anatomía de cuatro universidades de Chile. Se disecó la cara anterior y el margen lateral del antebrazo, y el dorso de la mano, hasta llegar al plano de los tendones. Los promedios de longitud, anchos a nivel del origen y a nivel de la línea articular radiocarpiana del tendón del músculo PL fueron de 125,48 mm ± 8,93, 4,76 mm ± 1,35 y 3,76 mm ± 0,91, respectivamente. Los promedios de longitud, anchos a nivel de origen y a nivel de la inserción del tendón del músculo extensor radial largo del carpo fueron de 180,46 mm ± 15,03, 14,69 mm ± 3,72 y 7,76 mm ± 1,44, mientras que para el tendón del músculo extensor radial corto del carpo fueron de 115,23 mm ± 11,81, 9,53 mm ± 2,58 y 7,33 mm ±1,17, respectivamente. El origen más común de los tendones de los músculos PL y extensor radial largo del carpo fue a nivel del tercio medio del antebrazo, mientras que el origen más común del tendón del músculo extensor radial corto del carpo fue a nivel del tercio distal del antebrazo. La forma de los tendones de los músculos PL y ERC era ancha y plana durante toda su extensión. Al simular la división longitudinal de los tendones de los músculos ERC en dos mitades, la mitad radial de los tendones de ambos músculos presenta características morfológicas y morfométricas similares al tendón del músculo PL, por tanto, eventualmente podrían ser utilizadas para injerto en caso de agenesia del músculo PL, o para transferencia tendinosa, en caso de que se requiera un alargamiento de algún tendón de la región.
