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      Anatomic Motor Point Localization of the Biceps Brachii and Brachialis Muscles

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          Abstract

          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. A reference line was defined as a line connecting the coracoid process with the lateral epicondyle of the humerus. The location of the motor points of the biceps brachii and brachialis muscles was identified in reference to the reference line. The motor point of the biceps brachii muscle was found to be approximately half of the reference line. In the brachialis muscle, the location of the motor point was 70% of the reference line from the coracoid process and 2 cm medial to the line. The results are expected to facilitate effective localization of the motor point block of these muscles in selective motor nerve block.

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          Most cited references23

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          Impairment of voluntary movement by spasticity.

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            Hollinshead’s Functional Anatomy of the Limbs and Back

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              Neurolysis of the musculocutaneous nerve with alcohol to treat poststroke elbow flexor spasticity.

              To evaluate the effectiveness of alcohol in neurolysis of the musculocutaneous nerve for the treatment of elbow flexor spasticity in individuals with a stroke. Case series. Outpatient clinic of a tertiary rehabilitation facility. Twenty patients with a mean age of 62.8 years and poststroke duration of 12.3 months with elbow flexor spasticity. Musculocutaneous nerve block of the hemiplegic upper extremity with 50% ethyl alcohol. The severity of spasticity as assessed by the modified Ashworth scale (MAS) score and the elbow passive range of motion (PROM). The mean baseline MAS score was 3.7 +/- 0.6, and this improved to 1.7 +/- 1.0, 2.0 +/- 0.8, and 2.1 +/- 0.8 at 4 weeks, 3 months, and 6 months postneurolysis, respectively. The elbow PROM was 87.3 degrees +/- 20.2 degrees, 104.3 degrees +/- 20.1 degrees, 103.8 degrees +/- 18.9 degrees, and 101.6 degrees +/- 19.7 degrees, respectively. These improvements were statistically significant (p < .05). Four subjects had concomitant improvement of finger flexor spasticity and another four had relief of shoulder pain. Three subjects developed temporary dysesthetic pain over the lateral forearm. Neurolysis of the musculocutaneous nerve with alcohol provides good relief of elbow flexion spasticity in hemiplegic individuals.
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                Author and article information

                Journal
                J Korean Med Sci
                JKMS
                Journal of Korean Medical Science
                The Korean Academy of Medical Sciences
                1011-8934
                1598-6357
                June 2007
                30 June 2007
                : 22
                : 3
                : 459-462
                Affiliations
                Department of Rehabilitation Medicine, Pusan National University School of Medicine, Busan, Korea.
                [* ]Department of Physical Medicine & Rehabilitation, Korea University College of Medicine, Seoul, Korea.
                []Department of Rehabilitation Medicine, HakjangKeunsol Medical Hospital, Busan, Korea.
                []Department of Anatomy, Pusan National University School of Medicine, Busan, Korea.
                Author notes
                Address for correspondence: Yong Beom Shin, M.D. Department of Rehabilitation Medicine, Pusan National University School of Medicine, Medical Research Institute, Pusan National University Hospital, 1-10 Ami-dong, Seo-gu, Busan 602-739, Korea. Tel: +82.51-240-7485, Fax: +82.51-247-7485, yi0314@ 123456medimail.co.kr
                Article
                10.3346/jkms.2007.22.3.459
                2693638
                17596654
                5eb63ba2-6ad0-4394-b821-f1aa280a7ac8
                Copyright © 2007 The Korean Academy of Medical Sciences

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 05 June 2006
                : 20 October 2006
                Categories
                Original Article

                Medicine
                nerve endings,muscle spasticity,elbow,nerve block,flexor
                Medicine
                nerve endings, muscle spasticity, elbow, nerve block, flexor

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