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At least 73 records · Page 4Linked to original sources
PubMed2003

Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part II: a report of 7 cases.

PURPOSE: This study reports the results of nerve transfer to the deltoid muscle using the nerve to the long head of the triceps. METHODS: Seven patients with an average age of 25 years with loss of shoulder abduction secondary to upper brachial plexus injuries had nerve transfer using the nerve to the long head of the triceps to the anterior branch(es) of the axillary nerve through the posterior approach. The spinal accessory nerve was used simultaneously for nerve transfer to the suprascapular nerve. The follow-up period ranged from 18 to 28 months (average, 20 mo). RESULTS: All patients recovered deltoid power against resistance (M4) at the last follow-up evaluation. Useful functional recovery was achieved in all 7 patients; 5 had excellent recoveries and 2 had good results. The average shoulder abduction was 124 degrees. No notable weakness of elbow extension was observed. CONCLUSIONS: This method is a reliable and effective procedure for deltoid reconstruction in brachial plexus injury (upper-arm type) and should be combined with spinal accessory nerve transfer to the suprascapular nerve to obtain good shoulder abduction.

Adolescent↗
PubMed2003

The motor-evoked potentials elicited from the deltoid muscle by transcranial magnetic stimulation with a standardized facilitation: the potential diagnostic utility for C5 radiculopathy.

STUDY DESIGN: We investigated the effects of standardized facilitation on stability in amplitude of the motor-evoked potentials from the deltoid muscle after magnetic stimulation over the scalp in normal study participants. OBJECTIVES: To test the potential of this technique in evaluating deltoid weakness and recovery after C5 radiculopathy. SUMMARY OF BACKGROUND DATA: Most previous motor-evoked potential studies have emphasized the value of the latency rather than amplitude, probably because the amplitude varies much more than the latency, even in the same individual. METHODS: Twenty right-handed healthy men underwent deltoid motor-evoked potential studies on three successive occasions at intervals of >2 weeks. A digital readout of the shoulder abduction force allowed the study participant to adjust voluntary contraction to 20% of the maximal force at the moment of stimulation. The deltoid motor-evoked potentials were compared with the M responses recorded from the relaxed deltoid after electrical stimulation of the brachial plexus. RESULTS: Despite considerable individual variability in the amplitude of deltoid motor-evoked potentials, a standardized facilitation yielded a relatively small variation of amplitude between sessions in the same individual, showing an intersession variability index of 9.1 +/- 7.9%. The side-to-side amplitude ratio, averaging 82 +/- 12%, also provides a more reliable measure in evaluating unilateral deltoid weakness than the absolute value. The measures on the left showed significantly higher amplitude than on the right for the deltoid motor-evoked potentials but not for the M responses. CONCLUSIONS: The changes of the motor-evoked potential amplitude exceeding 25% between sessions and side-to-side amplitude ratios <60% can be outside the normal limits. The asymmetry of deltoid motor-evoked potentials in favor of the nondominant side is of physiologic interest.

Adult↗
PubMed1998

Contracture of the deltoid muscle. Results of distal release.

We prospectively studied the results of distal release, performed between February 1989 and December 1994 for the treatment of a contracture of the deltoid muscle, in forty patients (forty-nine shoulders). Forty-seven contractures (in thirty-eight patients) developed after multiple intramuscular injections of various medications. The two remaining contractures (in two patients) were congenital. The average age at the onset of the symptoms was thirty-two years (range, birth to fifty-eight years). The primary symptoms included pain around the neck and the shoulder girdle, dimpling of the skin, a palpable fibrous band, winging of the scapula, difficulty in combing the hair or reaching the contralateral side of the body for grooming, and inability to bring the arm adjacent to the body. The average age at the time of the operation was thirty-nine years (range, fifteen to sixty-three years). The average duration of follow-up was three years and eleven months (range, two years to six years and six months). After the distal release of the contracture, but on the same day, the patients started a physical-therapy program. Postoperatively, the pain, dimpling of the skin, palpable fibrous band, and winging of the scapula resolved in forty-eight shoulders (thirty-nine patients). Six patients (six shoulders) no longer had difficulty in combing the hair or adducting the shoulder. There were no infections or neuromuscular complications. Forty-seven (96 per cent) of the forty-nine shoulders (thirty-eight of the forty patients) had a good clinical result, and two shoulders (two patients) had a poor result. Anterosuperior subluxation of the humeral head, noted on preoperative radiographs of twenty-three shoulders (eighteen patients), was not present postoperatively. Drooping of the acromion, seen in six patients (six shoulders) in whom the contracture had developed before they were sixteen years old, improved postoperatively in five shoulders (five patients). Rotation of the scapula, seen in five shoulders (five patients), resolved after release of the contracture in all five. There were no clinical or radiographic signs of osteoarthrosis due to long-term anterior translation of the shoulder joint in the four patients (six shoulders) who had had the contracture for at least twenty years (average, twenty-three years; maximum, twenty-seven years).

Adolescent↗
PubMed2002

The effect of stepwise increases in vertical dimension of occlusion on isometric strength of cervical flexors and deltoid muscles in nonsymptomatic females.

This mixed, single-double blind study examined the effect of a stepwise increase in vertical dimension of occlusion (VDO) on the isometric strength of cervical flexor and deltoid muscles in 20 asymptomatic females with deep bite (age range 20-40 years). Vertical dimension of occlusion was increased by mandibular acrylic bite plates, 2, 4, 6 and 12 mm. Subjects were instructed to bite while resisting: 1. an increasing horizontal force was applied to the forehead; and 2. an increasing vertical downward force to the wrist of each extended arm. Forces were applied by a hand-held strain gauge until resistance yielded. The force applied at the point of yielding was recorded as isometric peak strength of that trial. The peak strength for each muscle group was measured twice and averaged to produce a mean peak strength measure. This procedure was repeated in the subject's habitual occlusion and for the four increased VDOs. Mean strength of cervical flexors with increased VDO (12.0 kg) was significantly greater than that for existing vertical dimension occlusion (9.6 kg). With the exception of pre-experimental existing VD of occlusion, strength for right and left deltoids did not differ, but mean deltoid strength in the increased condition (8.6 kg) was significantly greater than biting in without a bite plate (6.6 kg). In the peak condition, cervical flexor strength increased 24% and deltoid strength increased an average of 29% from that of biting without an increase. As VDO increased further, strength in all sites was found to diminish. Repeating the strength test without a bite plate, after all trials were administered, did not show differences from pre-experimental levels, indicating that fatigue was not an important factor. The findings demonstrate that isometric strength of the cervical flexors and deltoids increases significantly from habitual occlusion as the VDO is increased, then diminishes as VDO is increased further. The strength of both cervical flexors and deltoids varied in concert with changes of VDO.

Adult↗
PubMed2003

Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part I: an anatomic feasibility study.

PURPOSE: To experimentally evaluate the feasibility of restoring the motor function of the deltoid muscle in patients with complete C5-C6 root injury (upper brachial plexus injury) by transferring the nerve to the long head of the triceps to the anterior branch of the axillary nerve through a posterior approach. METHODS: The study was performed on shoulder girdles of 36 formalin-embalmed cadavers. The number, diameter, and length of the branches of the axillary nerve at the level of the quadrilateral space were noted. The length and diameter of the nerves to the long head and to the lateral head of triceps at the level of triangular space were recorded. The distances from the acromion angle to the bifurcation of the anterior branch of the axillary nerve, to the origins of the nerve to the long head, and to the origin of the lateral head of the triceps were recorded as well. Nerve biopsy specimens of the axillary nerve and the nerve to the long head of the triceps were obtained from 6 fresh cadavers for histomorphometric evaluation. RESULTS: The average length of the anterior branch of the axillary nerve in this study, measured from the quadrilateral space to the innervating site, was 44.5 mm (range, 26-62 mm), and the average length of the nerve to the long head of triceps, measured from its origin to the innervating site, was 68.5 mm (range, 30-69 mm). The average diameter of the anterior branches of the axillary nerve and the nerve to the long head of the triceps were 2.1 and 1.1 mm, respectively. The average number of axon fibers in the anterior branch of the axillary nerve was 2,704 and in the nerve to the long head of the triceps was 1,233. CONCLUSIONS: Using the acromial angle as the landmark, the combined length of the two 2 nerves was longer than the distance between them. The diameter, the number of axons, and the anatomic proximity of the nerve to the long head of the triceps make it a potential source for reinnervation of the anterior branch of the axillary nerve by direct nerve transfer without nerve grafting through posterior approach for the management of upper brachial plexus injuries.

Axilla↗
PubMed1997

Characterisation of human deltoid muscle in patients with impingement syndrome.

Muscle biopsies from the anterior and medial parts of the deltoid of 11 male patients and six male controls were analysed with morphological and immunohistochemical methods. The distribution, area, and capillarization of the muscle fibres were determined, and the amount of connective tissue was measured with staining for type-III collagen. Compared with the controls, the patients with impingement syndrome had more type-I than type-II fibres, but the areas of the different types were almost the same. There was no difference in capillarization per fibre type between patients and controls, but the patients had more connective tissue. The results indicate that patients with impingement syndrome have morphological changes in the deltoid muscle, probably due to immobilisation and pain. They support the hypothesis that the deltoid muscle, the medial part in particular, is affected in patients with impingement syndrome.

Adolescent↗
PubMed2002

[Deltoid muscle flap for massive rotator cuff tears: 41 cases with a mean 7-year (minimum 5 year) follow-up].

PURPOSE OF THE STUDY: The aim of this study was to assess outcome after deltoid muscle flap repair of massive rotator cuff tears. We examined functional and radiological results at least five years after surgery. MATERIAL AND METHODS: We reviewed 41 shoulders operated by three senior surgeons (MC, DK, HT). None of the patients were lost to follow-up. The global Constant score was used for pre- and postoperative functional assessment. Three groups were distinguished by preoperative active flexion (group I<90 degrees, group II 90 degrees -120 degrees, group III > 120 degrees ). AP, double oblique (3 rotation views to measure the subacromial space), and Lamy lateral radiographs were obtained in all patients. Shoulder anatomy was evaluated at last follow-up in eight patients: magnetic resonance imaging (MRI) because of persistent pain in one patient and ultrasonography performed by one radiologist (NC) in seven patients. RESULTS: The study population included 26 men and 15 women, mean age at surgery 59 years (42-78, 8). Mean follow-up was 7 years (5-8.5, 0.9). In the coronal plane, there were no distal tears, the stump was in an intermediate position in 7 cases (17%) and retracted to the glenoid in 34 (83%). In the sagittal plane, the supraspinatus exhibited a full thickness tear in all cases. The tear extended anteriorly or posteriorly in all cases. Thirty-eight patients (92%) were satisfied at last follow-up; their global Constant score had improved from 37 to 62 points. Mean anterior flexion improved from 113 degrees to 148 degrees and flexion force from 1.3 kg to 2.9 kg. When preoperative flexion was less than 90 degrees (11 cases), mean gain was + 89 degrees. Inversely, 7 of the 18 patients with flexion > 120 degrees lost a mean 40 degrees at last follow-up. Twenty-seven patient were reviewed at 12 and 89 months: pain relief and force were maintained. The subacromial space, measured in 88% of the cases, was 7.3 mm preoperatively and 5.5 mm at last follow-up. The subacromial space narrowed in 20 patients (56%); none of the patients exhibited an improvement. The flap was explored by ultrasonography in seven patients and by MRI in one: the flap was continuous in 50% and measured more than 4 mm in thickness. Reviews at 12 then 89 months demonstrated good maintenance of pain relief and progression of active flexion and force. DISCUSSION AND CONCLUSION: This long-term study confirms the usefulness of the deltoid flap for the treatment of full thickness massive tears of the rotator cuff. The flap provides persistent pain relief and good function and force. This technique should be discussed for young patients in good physical condition when preoperative imaging demonstrates and irreparable alteration of the tendinomuscular structures (supraspinatus retraction, fatty degeneration, severe amyotrophy). The technique is particularly useful when preoperative flexion is less than 90 degrees. Although the population size is too small for statistical analysis, indications for deltoid flap repair should probably be limited to tears involving at most two tendons and sparing the subscapularis.

Adult↗
PubMed1999

The position of the axillary nerve in the deltoid muscle. A cadaveric study.

In 134 deltoid preparations taken from 67 fresh cadavers we examined the position of the axillary nerve in relation to the upper border of the muscle. The vertical distances from the upper deltoid border to the nerve in 17 of 67 cadavers was less than 4 cm in both shoulders. The minimal distance, measured from the mid-middle portion of the deltoid to the axillary nerve, was 2 cm. There was a significant negative correlation between the deltoid ratio (width/length) and the vertical distance, measured in all examined sites. The shorter the deltoid length the greater the danger of damaging the nerve in the short distance during surgical splitting of the muscle.

Adolescent↗
PubMed1977

Fibrous replacement of the deltoid muscle: a remediable cause of abduction contracture of the shoulder in scleroderma.

A 32-year-old male with progressive systemic sclerosis developed shoulder abduction contractures secondary to fibrous replacement of the central portions of his deltoid muscles. Surgical release of the fibrous bands resulted in prompt restoration of nearly full shoulder motion. One month later, however, a similar band developed in the triceps muscle. Although the association in this cases may have been coincidental, the neraly simultaneous onset of muscle fibrosis and cutaneous manifestations of progressive systemic sclerosis suggests a causal relationship.

Adult↗
PubMedDate not supplied

Neutralizing antibodies to rabies following injection of rabies immune globulin into gluteal fat or deltoid muscle.

BACKGROUND: This experiment was carried out to determine whether there is any difference in circulating rabies antibody when rabies immune globulin is administered into fat or muscle tissue. METHODS: Blood samples were taken at 24 and 48 hours after administering 40 IU/kg body weight of purified equine rabies immune globulin (ERIG) into deltoid muscle, or fatty gluteal tissue of grossly obese subjects. RESULTS: Both groups revealed barely detectable antibody levels. CONCLUSIONS: No conclusion was possible concerning the absorption kinetics of immune globulin from fat or muscle. However, it was evident that circulating antibody levels, using the recommended 40 IU/kg dose of ERIG, were extremely low and probably less than the required protective level at the possible bite site. This study supports current recommendations for local infiltration of virus inoculation sites with human or equine rabies immune globulin.

Animals↗
PubMed2004

Congenital neuroblastoma arising in the deltoid muscle.

Neuroblastoma almost always arises in association with sympathetic neural crest tissues that flank the spinal axis, including the paravertebral sympathetic ganglia of the neck, mediastinum, retroperitoneum, and pelvis, or in the adrenal glands. Neuroblastoma in the newborn period, which can present as localized or metastatic disease, often resolves spontaneously and requires little or no therapy. The authors describe a 5-week-old infant with an isolated primary neuroblastoma arising in the deltoid muscle. Histologic and biologic characteristics were consistent with a favorable-prognosis stage 1 neuroblastoma. Following a complete local excision, the child remains in complete remission 3 years from diagnosis.

Biomarkers, Tumor↗
PubMed2000

Mechanics of the deltoid muscle. A new approach.

The Inman concept of the mechanics of the deltoid describes a vertical upward oriented traction exerted on the upper end of the humerus at the beginning of arm elevation. However, Duchenne de Boulogne showed that the middle deltoid pushes the head downward. When the arm is at rest, the trajectory of the middle deltoid fibers changes by more than 90 degrees so that the humeral head is enveloped by the muscle; this suggests that the deltoid acts on the humeral head like a cable on a pulley. The authors studied the area of contact between the deltoid and the humeral head in three-dimensional reconstructed shoulders. A new model, which includes the pulley effect, was designed to explore the resultant total force applied by the deltoid onto the humerus. In most cases the resultant vertical force was oriented downward. Thus, the conventional model is not complete. The current model indicates that the deltoid prevents upward migration of the humeral head and compresses it against the glenoid. This explains why many shoulders function well despite a massive cuff tear. This also implies that reeducation of the deltoid is a major aspect of the rehabilitation for patients with a rotator cuff tear.

Biomechanical Phenomena↗