The Impact of Muscular Variation on the Neurodynamic Test for the Median Nerve in a Healthy Population With Langer's Axillary Arch

Hoof, Tom Van; Vangestel, Carl; Forward, Malcolm; Verhaeghe, B. J.; Thilborgh, Lien Van; Plasschaert, Frank; Muynck, Martine De; Vanderstraeten, Guy; D’Herde, Katharina

doi:10.1016/j.jmpt.2008.06.007

Cited by 15 publications

(10 citation statements)

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“…The swelling in axilla caused by the axillary arch may be apparent with an inspection in most cases (van Hoof et al, 2008). In the physical examination of the axillary arch, it can easily be confused with lymphadenomegaly or soft tissue tumor (Besana-Ciani & Greenall).…”

Section: Discussionmentioning

confidence: 99%

The Existence of Axillary Arch in Human Fetus and Applied Importance and Clinical Implications in the Axillary Brachial Plexus Blocks

2012

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SUMMARY:Axillary arch is the most common muscle variation of axillary fossa that gains importance for regional interventional procedures, screening methods and physical examination. In order to avoid malpractice the variations must be borne in mind. This study has been planned to research the frequency and the features of the axillary arch in human fetus, to mention the potential clinical and functional significance of axillary arch while applying axillary brachial plexus block and reflect on possible complications. Axillary fossa was examined with a stereomicroscope in 20 upper extremities of ten human fetuses. The gestation ages ranged from 16 to 36 weeks. Axillary arch was determined in 2/20 specimen unilaterally. In both specimen, muscular slip detached from latissimus dorsi, passed anterior neurovascular bundle and ended posterior pectoralis major tendon and lateral border of intertubercular groove. In one specimen axillary arch was innervated with medial pectoral nerve whereas the other one did not have a particular innervating nerve branch. The possible effects of axillary arch in the axillary brachial plexus block applications are discussed. Arcus axillaris may have a potential clinical and functional significance with regard the axillary brachial plexus block applications and may have possible effects on failure rate and acute complications. Also, we think that this fetus study which the pure structure of the muscles without any usage effect can be observed will be beneficial regarding this topic.

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Section: Discussionmentioning

confidence: 99%

The Existence of Axillary Arch in Human Fetus and Applied Importance and Clinical Implications in the Axillary Brachial Plexus Blocks

2012

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“…Subjects were seated and, as with other investigations into neurodynamic tests, overall consistency in posture was achieved by means of a custom-made device designed to prevent scapular elevation and cervical movements [27–29]. …”

Section: Methodsmentioning

confidence: 99%

Effect of glenohumeral forward flexion on upper limb myoelectric activity during simulated mills manipulation; relations to peripheral nerve biomechanics

Rade

Shacklock²,

Rissanen

et al. 2014

BMC Musculoskelet Disord

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BackgroundIt is generally accepted that muscles may activate via the common nociceptive flexion reflex (NFR) in response to painful stimuli associated with tensile or compressive forces on peripheral nerves. Following the basic assumption that the radial nerve may be stressed around the elbow during the execution of the Mills manipulation, t wo positions considered to have different mechanical effects on the radial nerve and the brachial plexus were tested in order to i) explore whether muscles are activated in certain patterns with concomitant changes in nerve tension, ii) establish whether muscle responses can be modified with mechanical unloading of the brachial plexus.MethodsMuscle responses were quantified bilaterally in eight subjects (N = 16) during Mills Manipulation (MM) pre-manipulative positioning and a Varied position that putatively produces less mechanical tension in the brachial plexus. End range pre-manipulative stretch was used in order to simulate the effects of Mills manipulation. Electromyographic signals were recorded with a 16 channel portable EMG unit and correlated with kinematic data from three charge-coupled device adjustable cameras which allowed for precise movement tracking.ResultsCompared with the Standard Mills manipulation position, the Varied position produced significantly reduced myoelectric activity (P ≤ .001) in all test muscles. Additional subjective data support the notion that certain muscle activity patterns were protective.ConclusionIt seems that protective muscles are selectively activated in a specific pattern in order to protect the radial nerve from mechanical tension by shortening its pathway, suggesting integration of muscle and neural mechanisms. Furthermore, the significantly decreased myoelectric activity with reduced mechanical tension in the brachial plexus may help controlling collateral effects of the Mills manipulation itself, making it potentially safer and more specific.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-288) contains supplementary material, which is available to authorized users.

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“…The axillopectoral muscle (axillary arch or Langer's muscle), a variant muscle, can cause neurovascular compression and consequent neuropathy of the median nerve (Van Hoof et al 2008). This muscle arises from the latissimus dorsi tendon, crosses the axillary neurovascular bundle, and inserts on the pectoralis major tendon.…”

Section: Variations Causing Median Nerve Entrapmentmentioning

confidence: 99%

Nerves of the Upper Extremity

Mahan

Spinner

2016

Bergman's Comprehensive Encyclopedia of Human Anatomic Variation

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The Impact of Muscular Variation on the Neurodynamic Test for the Median Nerve in a Healthy Population With Langer's Axillary Arch

Cited by 15 publications

References 43 publications

The Existence of Axillary Arch in Human Fetus and Applied Importance and Clinical Implications in the Axillary Brachial Plexus Blocks

The Existence of Axillary Arch in Human Fetus and Applied Importance and Clinical Implications in the Axillary Brachial Plexus Blocks

Effect of glenohumeral forward flexion on upper limb myoelectric activity during simulated mills manipulation; relations to peripheral nerve biomechanics

Nerves of the Upper Extremity

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