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Forearm pronation and supination, and increased muscular activity in the wrist extensors have been both linked separately to work-related injuries of the upper limb, especially humeral epicondylitis. However, there is a lack of information on forearm torque strength at ranges of elbow and forearm angles typical of industrial tasks. There is a need for strength data on forearm torques at different upper limb angles to be investigated. Such a study should also include the measurement of muscular activity for the prime torque muscles and also other muscles at possible risk of injury due to high exertion levels during tasks requiring forearm torques.Twenty-four male subjects participated in the study that involved maximum forearm torque exertions for the right arm, in the pronation and supination directions, and at four elbow and three forearm rotation angles. Surface EMG (SEMG) was used to evaluate the muscular activity of the pronator teres (PT), pronator quadratus (PQ), biceps brachi (BB), brachioradialis (BR), mid deltoid (DT) and the extensor carpi radialis brevis (ECRB) during maximum torque exertions. Repeated measures ANOVA indicated that both direction and forearm angle had a significant effect on the maximum torques (p<0.05) while elbow angle and the interactions were highly significant (p<0.001). The results revealed that supination torques were stronger overall with a mean maximum value of 16.2 Nm recorded for the forearm 75% prone. Mean maximum pronation torque was recorded as 13.1 Nm for a neutral forearm with the elbow flexed at 45 degrees. The data also indicated that forearm angle had a greater effect on supination torque than pronation torque. Supination torques were stronger for the mid-range of elbow flexion, but pronation torques increased with increasing elbow extension. The strength profiles for the maximum torque exertions were reflected in the EMG changes in the prime supinators and pronators. In addition, the EMG data expressed as the percentage of Maximum Voluntary Electrical activity (MVE), revealed high muscular activity in the ECRB for both supination (26-43% MVE) and pronation torques (17-55% MVE). The results suggest that the ECRB acts as a stabiliser to the forearm flexors for gripping during pronation torques depending on forearm angle, but acts as a prime mover in wrist extension for supination torques with little effect of elbow and forearm angle. This indicates a direct link between forearm rotations against resistance and high muscular activity in the wrist extensors, thereby increasing stress on the forearm musculo-skeletal system, especially the lateral epicondyle.
BACKGROUND: The information available on innervation pattern of the human forearm muscles in standard anatomy texts, although adequate for routine procedures, is not detailed enough for surgical reconstruction in complex injuries of the limb and for paralytic conditions of the forearm from peripheral nerve and spinal cord injuries. METHODS: The innervation pattern in 10 cadaveric forearms was studied. The contributions of the main nerve trunks to each forearm muscle was examined. The location and number of the primary motor nerve branching points and of the terminal nerve entry points to each muscle were investigated. The location of both the primary nerve branching points and terminal nerve entry points was presented as a percentage of forearm length measured from the lateral humeral epicondyle to the radial styloid. RESULTS: Seven of 19 forearm muscles were innervated from a single branch from the main nerve trunk. The remaining 12 received more than one primary branch. Two of 19 forearm muscles had only one terminal nerve entry point. The others had two or more each. In 13 of 19 forearm muscles, the statistical median location of the primary motor nerve branching points was within the proximal one-third of the forearm length and either more proximally or distally for the remainder. The statistical median location of the terminal nerve entry points was within the proximal one-third in 9 forearm muscles and within the middle one-third of the forearm in 8 forearm muscles. In two, it was located proximal to the elbow and in the distal one-third of the forearm, respectively. CONCLUSIONS: In lacerations across the forearm, where main nerve trunks are divided, mere repair of the nerve trunks would not address the denervation of muscle or segments of muscle by the division of the primary (or secondary) nerve branches traversing the wound and which took origin proximal to the laceration either from the divided nerve trunks or from other undamaged nerve trunks. Although the main nerve trunks may be intact, segmental crush injuries will defunction muscles by direct muscle damage or by damage to the terminal nerve entry points to the muscle. Knowledge of the location of the nerve branches and the terminal nerve entry points facilitates the insertion of electrodes at the motor points of forearm muscles for functional electrical stimulation in upper motor neuron lesions. The information in this study may also be usefully applied in selective denervation procedures to balance muscles in spastic upper limbs.
The human forearm is a well established model to study local vascular reactivity in humans in vivo, using strain-gauge venous occlusion plethysmography to measure blood flow and changes in blood flow in the forearm. To reduce the intra-individual variability of the forearm blood flow (FBF), it has been advocated that simultaneous measurements of contralateral forearm blood flow is obligatory. Therefore, the use of the calculated forearm ratio (FR) is recommended instead of using the actual FBF. In the present study we compared the intra-individual variability of forearm blood flow measurements and the forearm ratio, by using computerized R-wave triggered strain-gauge venous occlusion plethysmography, to test if bilateral expression of measurements is better than unilateral. Results were obtained in eight volunteers. Intra-arterial infused sodium nitroprusside induced a dose dependent increase in forearm blood flow and a dose dependent increase in the calculated forearm ratio. Intra-arterial infused norepinephrine induced a dose dependent decrease in forearm blood flow and a dose dependent decrease in the calculated forearm ratio. The differences between the variation coefficients of the forearm blood flow measurements and the calculated forearm ratio were different. These results support our hypothesis that by using a computerized, R-wave triggered system for unilateral forearm blood flow measurement is a more reliable outcome than the calculated forearm ratio derived from bilateral measurements.
OBJECTIVES: To assess, in patients with well-compensated pre-ascitic cirrhosis, (1) the extent of vasodilatation, if any, in the forearm circulation and (2) the effect of sodium status on its response to reflex sympathetic stimulation. DESIGN: Case-control study. SETTING: Clinical investigation unit of the Toronto Hospital, a tertiary referral hospital. PATIENTS: Eight male, alcoholic patients with pre-ascitic cirrhosis and 10 age- and sex-matched controls. INTERVENTIONS: Patients and controls were given a diet containing 20 mmol of sodium per day for 7 days, then a diet containing 200 mmol of sodium per day for the subsequent 7 days. On the seventh day of each diet, systemic hemodynamics, forearm circulation and effective arterial blood volume were assessed. A cold pressor test was performed after both diets to assess the response of the forearm circulation to reflex sympathetic stimulation. OUTCOME MEASURES: Heart rate, mean arterial pressure, forearm blood flow, forearm vascular resistance, central venous pressure, atrial natriuretic factor concentrations and neurohumoral pressor levels (plasma renin activity, aldosterone and plasma norepinephrine levels). RESULTS: No forearm vasodilatation was evident in the patients with pre-ascitic cirrhosis; their forearm blood flow and forearm vascular resistance were similar to those of the controls. Sodium loading did not influence baseline forearm blood flow. Cold pressor stimulus resulted in a significant decrease in forearm blood flow and a significant increase in forearm vascular resistance, mean arterial pressure, heart rate and plasma norepinephrine levels in both groups after the low-sodium diet. High sodium intake resulted in significantly greater reduction in forearm blood flow (-19%, standard error of the mean [SEM] 3% v. -8%, SEM 3%; p < 0.05) and significantly greater increase in forearm vascular resistance (+46%, SEM 7% v. +25%, SEM 8%; p < 0.05) in the patients with cirrhosis than in the controls. CONCLUSIONS: Well-compensated pre-ascitic cirrhotic patients do not have forearm vasodilatation. Sodium loading does not increase baseline forearm blood flow in these patients, but it does lead to a heightened response to reflex sympathetic stimulation. Sodium loading, with the associated sympathetic hyper-responsiveness, may therefore contribute to further sodium retention in these patients.
OBJECTIVES: The aims of this study were to assess the potential of CGRP8-37, the C-terminal fragment of calcitonin gene-related peptide (CGRP), to inhibit CGRP-induced vasodilation in the human forearm and to evaluate a pharmacodynamic model to aid the clinical development of novel CGRP-receptor antagonists. METHODS: Forearm blood flow (FBF) responses to intra-arterial CGRP infusions were measured via venous occlusion plethysmography in 21 healthy subjects. Dose response to CGRP was assessed during graded infusion of CGRP (1, 3, and 10 ng.min(-1).dL(-1) forearm; n = 6). After a 90-minute washout period, CGRP infusions were repeated during coinfusion of CGRP8-37 (333 ng.min(-1).dL(-1) forearm) to assess inhibition by CGRP8-37. To determine the antagonistic potency of CGRP8-37, a 4-period, placebo-controlled crossover study was conducted in 6 subjects, in which CGRP (10 ng.min(-1).dL(-1) forearm) was infused for 20 minutes together with placebo or CGRP8-37 (300, 600, or 1200 ng.min(-1).dL(-1) forearm). In addition, the effect of each dose of CGRP8-37 on resting FBF was evaluated. RESULTS: CGRP8-37 significantly inhibited the CGRP-induced increase in FBF compared with placebo (from 3.2 +/- 1.1 mL.min(-1).dL(-1) forearm at baseline to 4.8 +/- 1.0, 7.7 +/- 1.9, and 12.3 +/- 3.8 mL.min(-1).dL(-1) forearm versus 3.1 +/- 0.7 mL.min(-1).dL(-1) forearm to 3.8 +/- 0.6, 5.2 +/- 1.5, and 8.5 +/- 3.0 mL.min(-1).dL(-1) forearm for placebo and CGRP8-37, respectively; P < .001). The FBF response during the 20-minute infusion of CGRP was dose-dependently inhibited by CGRP8-37 (area under the curve, 200 +/- 51 mL.dL(-1) forearm for placebo versus 181 +/- 23, 160 +/- 40, and 132 +/- 56 mL.dL(-1) forearm for CGRP8-37, 300, 600, and 1200 ng.min(-1).dL(-1) forearm, respectively; P < .001). CGRP8-37 did not affect resting FBF. CONCLUSIONS: CGRP8-37 inhibits CGRP-induced vasodilation in the human forearm without affecting resting FBF. Venous occlusion plethysmography combined with brachial artery administration of CGRP provides a suitable pharmacodynamic model to aid the clinical development of CGRP-receptor antagonists.
Although angina pectoris in patients with coronary heart disease often occurs when their forearms are in an elevated position for a prolonged period, and sympathetic activation is a major cause of this condition, little is known about the physiological effects of forearm elevation on sympathetic activity during forearm exercise. We hypothesized that forearm elevation augments sympathetic activation during the static handgrip exercise in humans. A total of 10 healthy male volunteers performed 2 min of static handgrip exercise at 30% of maximal voluntary contraction followed by 2 min of post-exercise muscle ischaemia (PEMI; specific activation of the muscle metaboreflex) with two forearm positions: the exercising forearm was elevated 50 cm above the heart (forearm-elevated trial) or fixed at the level of the heart (heart-level trial). Muscle sympathetic nerve activity (MSNA), blood pressure and heart rate were monitored. MSNA increased during handgrip exercise in both forearm positions (P<0.001); the increase was 51% greater in the forearm-elevated trial (516+/-99 arbitrary units) than in the heart-level trial (346+/-44 units; P<0.05). The increase in mean blood pressure was 8.4 mmHg greater during exercise in the forearm-elevated trial (P<0.05), while changes in heart rate were similar in both forearm positions. The increase in MSNA during PEMI was 71% greater in the forearm-elevated trial (393+/-71 arbitrary units/min) than in the heart-level trial (229+/-29 units/min; P<0.05). These results support the hypothesis that forearm elevation augments sympathetic activation during handgrip exercise. The excitatory effect of forearm elevation on exercising MSNA may be mediated primarily by increased activation of the muscle metaboreflex.
OBJECTIVE: To examine the existence of presynaptic beta-adrenoceptors modulating forearm norepinephrine release in 31 healthy volunteers. METHODS: The spillover rate of norepinephrine in forearm venous plasma and the total plasma appearance rate of norepinephrine in the forearm were estimated using intra-arterial infusion of [3H]-norepinephrine. Isoprenaline was infused intra-arterially to stimulate beta-adrenoceptors, terbutaline to stimulate beta 2-adrenoceptors, propranolol to block beta-adrenoceptors, metoprolol to block beta 1-adrenoceptors, isoprenaline combined with metoprolol to stimulate beta 2-adrenoceptors, epinephrine to stimulate alpha- and beta-adrenoceptors, yohimbine to block alpha 2-adrenoceptors and sodium nitroprusside to increase forearm blood flow directly. RESULTS: No systemic hemodynamic effects or changes in arterial plasma norepinephrine level were noted during the intra-arterial infusions. Metoprolol and propranolol decreased norepinephrine spillover and its rate of appearance in the forearm without affecting forearm blood flow. Isoprenaline and sodium nitroprusside increased and epinephrine decreased forearm norepinephrine spillover. Terbutaline increased forearm norepinephrine spillover and its rate of appearance in the forearm. Terbutaline increased the forearm rate of appearance and spillover of norepinephrine more than did sodium nitroprusside or isoprenaline at the same level of forearm blood flow. Infusion of isoprenaline failed to increase norepinephrine spillover or its forearm appearance rate more than would be expected from the increase in forearm blood flow. Administration of epinephrine increased spillover and forearm appearance rate of norepinephrine during intra-arterial infusion of yohimbine. CONCLUSIONS: The terbutaline, propranolol, metoprolol and yohimbine plus epinephrine results suggest that beta-adrenoceptors enhance release of norepinephrine from vascular sympathetic nerve endings in humans.
The purpose of this study was to determine a preferred coordinate system for representation of forearm orientation in 3-dimensional space. In one experiment, the ability of human subjects to perceive angles of the forearm in 3-dimensional space (forearm elevation and yaw--extrinsic coordinate system) was compared to their ability to perceive elbow joint angle (intrinsic coordinate system). While blindfolded, subjects performed an angle reproduction task in which the experimenter first positioned the upper limb in a reference trial. This was followed, after movement of the subject's entire upper limb to a different position, by an attempt to reproduce or match a criterior angle of the reference trial by motion of the forearm in elbow flexion or extension only. Note that matching of the criterion forearm angle in the new upper limb position could not be accomplished by reproducing the entire reference upper limb position, but only by angular motion at the elbow. Matching of all 3 criterion angles was accomplished with about equal accuracy in terms of absolute constant errors and variable errors. Correlation analysis of the perceptual errors showed that forearm elevation and elbow angle perception errors were not biased but that forearm yaw angle matching showed a bias toward elbow angle matching in 7 of 9 subjects. That is errors in forearm yaw perception were attributed to a tendency toward a preferred intrinsic coordinate system for perception of forearm orientation. These results show that subjects can accurately perceive angles in both extrinsic and intrinsic coordinate systems in 3-dimensional space. Thus, these data conflict with previous reports of highly inaccurate perception of elbow joint angles in comparison to perception of forearm elevation. In an attempt to resolve this conflict with previous results, a second experiment was carried out in which perception of forearm elevation and elbow joint angles with the forearm motion constrained to a vertical plane. Results of this experiment showed that during a two-limb elbow angle matching task, four of five subjects exhibited a clear bias toward forearm elevation angle. During a one-limb angle reproduction task only two of five subjects exhibited such a bias. Perception of elevation angles show little bias toward elbow angle matching.(ABSTRACT TRUNCATED AT 400 WORDS)
BACKGROUND: There is little information on the effects of radial artery harvesting on postoperative forearm function and blood flow. We evaluated the early changes in forearm neural sensation, circumference, grip power, cyclical exercise fatigue, and blood flow after radial artery harvesting for coronary artery bypass graft (CABG) surgery. METHODS: Twenty-three patients with negative Allen's test of the nondominant forearm were recruited preoperatively and underwent assessment of bilateral forearm function (soft touch and pin-prick neural sensation, circumference, handgrip power, cyclical exercise fatigue) and blood flow measurements (forearm plethysmography). All vasoactive drugs were stopped 24 hours before assessments. Identical follow-up assessments were conducted (mean +/- SEM) 3.4 +/- 0.4 months postoperatively. RESULTS: At the time of postoperative assessment all harvested forearm wounds were healed. There was no reduction of postoperative soft touch sensation but in 3 patients objective pinprick sensation was reduced in the distribution of the lateral antebrachial cutaneous nerve of the harvested forearms. Postoperative forearm circumference (p < 0.05) and grip power (p < 0.05) were significantly reduced in both forearms, however cyclical exercise fatigue was improved in both forearms. Preoperative and postoperative forearm blood flow at rest and in exercise-induced ischemic reperfusion were not significantly different in both forearms. CONCLUSIONS: In patients with a negative Allen's test, harvesting of the radial artery does not adversely affect subsequent forearm function or blood flow to a clinically significant degree.
This experiment investigated maximum forearm pronation and supination torques and forearm discomfort, for intermittent torque exertions in supine and prone forearm angles for the right arm. Twenty-two subjects participated in the study that comprised two parts, the first of which involved measurement of maximum forearm torque in both twisting directions at five forearm angles including neutral. This was followed by endurance tests at 50% maximum voluntary contraction (MVC) in both directions. The second part of the study involved subjects performing 5-min duration of intermittent isometric torque exercises at 20% MVC in both directions at 11 forearm angles. Regression equations were developed that accurately predict torques as a function of forearm angle expressed as a percentage of maximum motion. Analysis of the discomfort data for the intermittent isometric torque exertions indicated that both forearm angle and twisting direction significantly affected forearm discomfort (p < 0.001). A significant two-way interaction (p < 0.01) was identified between forearm angle and direction for supine forearm angles only. The results provide important strength and discomfort models for the design of tasks involving static or repetitive forearm twisting. Such tasks have a strong association with forearm injuries including lateral and medial epicondylitis. These results provide needed data on the risk factors associated with these injuries so they can be prevented.
OBJECTIVE: To evaluate the influence of blood flow on measurements of regional sympathetic nerve activity by radiotracer methodology ([3H]noradrenaline). DESIGN: Ten healthy men were studied under two conditions of elevated forearm blood flow: mental stress (Stroop colour word conflict test) and an intra-arterial infusion of sodium nitroprusside. METHODS: Arterial blood pressure was measured invasively and forearm blood flow with strain-gauge plethysmography. Arterial and venous plasma adrenaline and noradrenaline were measured with high-performance liquid chromatography, and regional and total noradrenaline spillover were calculated. RESULTS: During mental stress, mean arterial pressure increased by 17%, heart rate by 16 beats/min, forearm blood flow by 117%, while forearm vascular resistance decreased by 44% (P < 0.001 for all). Sodium nitroprusside increased forearm blood flow dose-dependently, but elicited only minor effects on systemic haemodynamics. Mental stress increased arterial plasma noradrenaline by 52% (P < 0.001), and total body noradrenaline spillover by 75% (P < 0.001). During sodium nitroprusside infusion, arterial plasma noradrenaline increased only slightly and total body noradrenaline spillover was unaffected Forearm noradrenaline overflow increased from 5.4 +/- 0.9 to 16.9 +/- 2.6 pmol/min per I (P < 0.001) during mental stress and from 6.6 +/- 0.8 to 16.9 +/- 3.7 pmol/min per I (P < 0.001) during the second dose-step of sodium nitroprusside infusion. By intra-individual comparisons of forearm noradrenaline overflow increases during mental stress and during sodium nitroprusside infusion, with similar forearm blood flow increases, the flow dependence of forearm noradrenaline overflow was estimated. During mental stress, about 60% (median value, range 29-112%) of the increase in forearm noradrenaline overflow was attributed to the increase in forearm blood flow, whereas 40% was considered to reflect increased sympathetic nerve activity. CONCLUSIONS: There seems to be a considerable flow dependence of the regional overflow of noradrenaline, that is, a component of simple wash-out of noradrenaline from the forearm tissues during vasodilation. However, the present results still indicate that sympathetic nerve activity in the forearm is increased during mental stress, justifying the radiotracer technique for semiquantitative measurements, also during vasodilation.