Application of free serratus anterior muscle-fascial composite tissue flap and facial lipofilling in repairing progressive hemifacial atrophy

INTRODUCTION

Progressive hemifacial atrophy (PHA) is a nonnegligible disease, and its treatment currently lacks consensus. We aim to conduct an analysis of PHA patients to summarize the postoperative effect. Moreover, we introduced the free serratus anterior muscle-fascial composite tissue flap as a safe and novelty surgical procedure for moderate-severe PHA.

METHODS

This clinical study included four patients who received a free serratus anterior muscle-fascial composite tissue flap and 19 patients who received Coleman fat transplantation. Preoperative (preoperative photograph and imageological examination) and postoperative (postoperative photograph, complications, therapeutic effect, and satisfaction) assessments were performed for all PHA patients. Body Image Concern Inventory (BICI), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS) were performed preoperatively and postoperatively.

RESULTS

All the cases were cured with a good appearance with two kinds of operations. Free serratus anterior muscle-fascial composite tissue flap could correct face defects in one surgery and achieve good long time and short-time postoperative satisfaction in moderate-severe PHA. Fat transplantation could also enhance appearance in numerous operations for mild-moderate PHA. The volume of free-fat grafts decreased obviously after implantation in many cases. So, many patients (42.11%) accepted a series of operations to achieve satisfied postoperative effect. BICI, SAS, SDS score decreased a year later in all patients.

CONCLUSION

Free serratus anterior muscle-fascial composite tissue flap transplantation is an effective and safe treatment for moderate to severe PHA.

Epimuscular myofascial force transmission between the levator scapulae muscle and the upper fiber of the serratus anterior or rhomboid minor muscles

BACKGROUND

This study investigated the epimuscular myofascial force transmission between the levator scapulae, serratus anterior, and rhomboid minor muscles.

METHODS

The participants included 10 healthy males (a total of 20 shoulders). Differences in the shear moduli of the levator scapulae, serratus anterior, and rhomboid minor muscles were measured in the resting and levator scapulae stretching positions using shear wave elastography. The correlation between the rates of change for each muscle was also verified.

FINDINGS

The results demonstrated a notable increase in the shear modulus from the resting to stretching positions for levator scapulae (42.9 ± 17.6 kPa vs. 52.4 ± 15.2 kPa) and serratus anterior (32.8 ± 12.9 kPa vs. 58.4 ± 18.5 kPa) (P = 0.02, P < 0.01). However, there was no significant difference in the shear modulus for the rhomboid minor between the resting (44.0 ± 19.2 kPa) and stretching (41.0 ± 20.2 kPa) positions (P = 0.40). Moreover, a significant positive correlation was observed between rates of change for the levator scapulae and serratus anterior muscles (P = 0.04, r = 0.459).

INTERPRETATION

These findings indicate that the shear modulus of the serratus anterior increased with the stretching of the levator scapulae, suggesting the occurrence of epimuscular myofascial force transmission between these two muscles with different muscle insertions.

Electromyographic analysis of shoulder-complex muscles performing overhead presses with dumbbell, kettlebell, and bottom-up kettlebell

INTRODUCTION

Kettlebell exercises, specifically the bottom-up grip, have become increasingly popular in training programs. The purpose of this research was to determine if a bottom-up kettlebell grip favorably alters the electromyography (EMG), activity in the medial deltoid (MD), serratus anterior (SA), and lower trapezius (LT), muscles compared to using a dumbbell or traditional kettlebell grip during overhead shoulder presses.

METHODS

Twenty-eight healthy, male, Division III collegiate baseball players (mean age = 19.8 ± 1.28 years) performed five overhead presses of equal weight, 11.34 kg (25 lbs), using a dumbbell (DB), kettlebell w/traditional grip (KB), and kettlebell held with a bottom-up grip (KBU).

RESULTS

For the MD, there was significantly greater EMG activity using the DB compared to KBU, but no significant differences between the DB and KB, or KB and KBU. For the SA, greater EMG activity was noted using the KBU compared to KB, and KBU compared to DB, but no differences between KB and DB. For the LT, greater EMG activity was noted using the DB compared to KB, but no differences between DB and KBU, or KB and KBU.

CONCLUSION

The KBU press only elicited greater EMG activity in the SA. The DB elicited greater EMG activity in both the MD and LT. Shoulder-complex EMG activity varies with different types of overhead presses using equivalent loads.

Electromyography activation of shoulder and trunk muscles is greater during closed chain compared to open chain exercises

BACKGROUND

To compare the activation of shoulder and trunk muscles between six pairs of closed (CC) and open chain (OC) exercises for the upper extremity, matched for performance characteristics. The secondary aims were to compare shoulder and trunk muscle activation and shoulder activation ratios during each pair of CC and OC exercise.

METHODS

Twenty-two healthy young adults were recruited. During visit 1, the 5-repetition maximum resistance was established for each CC and OC exercise. During visit 2, electromyography activation from the infraspinatus (INF), deltoid (DEL), serratus anterior (SA), upper, middle and lower trapezius (UT, MT, LT), erector spinae (ES) and external oblique (EO) muscles was collected during 5-repetition max of each exercise. Average activation was calculated during the concentric and eccentric phases of each exercises. Activation ratios (DEL/INF, UT/LT, UT/MT, UT/SA) were also calculated. Linear mixed models compared the activation by muscle collapsed across CC and OC exercises. A paired t-test compared the activation of each muscle and the activation ratios (DEL/INF, UT/LT, UT/MT, UT/SA) between each pair of CC and OC exercises.

RESULTS

The INF, LT, ES, and EO had greater activation during both concentric (p = 0.03) and eccentric (p < 0.01) phases of CC versus OC exercises. Activation ratios were lower in CC exercises compared to OC exercises (DEL/INF, 3 pairs; UT/LT, 2 pairs; UT/MT, 1 pair; UT/SA, 3 pairs).

CONCLUSION

Upper extremity CC exercises generated greater activation of shoulder and trunk muscles compared to OC exercises. Some of the CC exercises produced lower activation ratios compared to OC exercises.

Scapular winging secondary to serratus anterior dysfunction: analysis of clinical presentations and etiology in a consecutive series of 96 patients

BACKGROUND

This study aimed to establish the relative incidence of etiologies causing serratus anterior (SA) dysfunction in patients with proven abnormality on needle electromyography.

METHODS

This was a retrospective review of patients with scapular winging secondary to SA dysfunction. Each patient underwent a detailed clinical, radiological, and neurophysiological assessment to arrive at the precise etiological diagnosis. Patients with atypical clinical features were referred for a neurologist's assessment. Hematological and genetic testing were requested at the discretion of the neurologist. A scapular winging severity score based on clinical signs was devised to aid clinical grading.

RESULTS

Between 2014 and 2020, a consecutive series of 108 patients with suspected SA dysfunction were assessed, of whom 96 met the inclusion criteria. There were 34 females and 62 males, with a mean age of 38 years (range, 15-77 years). Winging affected the right scapulae in 69 patients, the left scapulae in 17 patients, and was bilateral in 10 patients. This was caused by a myopathic disorder in 12 (12%) patients. Eighty-four (88%) patients had a long thoracic nerve lesion, caused by cervical pathology (2), iatrogenic injury (2), trauma (33), and neuralgic amyotrophy (NA) (47). Among those with NA, winging resolved spontaneously within 3 years of onset in 22 patients (mean duration, 16 months; range, 3-36 months). No patients recovered fully if their duration of winging lasted longer than 3 years. Patients with palsy secondary to NA tended to have a worse severity of winging than those due to a traumatic cause (P = .04).

CONCLUSION

NA accounted for approximately half of the patients with SA dysfunction; therefore, it is essential to also consider the differentials of myopathy, trauma, iatrogenic injury, and spinal pathology. We recommend the judicious employment of ancillary tests and a low threshold of referral to a neurologist, in order to arrive at the exact diagnosis to accurately guide patient treatment.

Scapula alata: diagnosis and treatment by nerve surgery and tendon transfers

Scapula alata, also known as winged scapula, can lead to severe upper limb impairment. The shoulders' function is altered because the scapula, which supports the upper limb, is no longer stable. Typical scapula alata is described for serratus anterior palsy; however, any scapulothoracic muscle impairment may lead to scapular winging, particularly trapezius palsy, which is easy to miss, thus needed to be considered as a differential diagnosis. The diagnosis is difficult and based on various clinical tests and a thorough examination as well as electroneuromyography and MRI. The treatment ranges from conservative treatments for spontaneous recovery, nerve surgery including neurolysis, nerve transfers and nerve grafts for acute cases, to tendon transfers for more chronic cases and when nerve procedures are no longer feasible. Tendon transfers in serratus anterior palsy produce excellent results with a high rate of patient satisfaction and are described with the sternal or clavicular head of the pectoralis major; we describe our preferred technique in this article. Tendon transfers in trapezius palsy are performed with the levator scapulae, rhomboid minor and major muscles. Our preferred method is the Elhassan triple transfer. Scapula alata is a frequent and often misdiagnosed condition. Appropriate management can yield excellent results. Patients should be referred right away to specialized centers for surgery if recovery is not spontaneous.

EMG activity of the serratus anterior and trapezius muscles during elevation and PUSH UP exercises

BACKGROUND

Elevation and push up (Pu) exercises are considered to be beneficial for the rehabilitation of shoulder complex pathology. Despite their clinical utility, there is a lack of evidence comparing scapulothoracic muscles recruitment during these exercises.

OBJECTIVE

To evaluate the EMG activity of upper trapezius (UT), Lower Trapezius (LT), Upper Serratus anterior (USa) and Lower Serratus anterior (LSa) muscles during a variety of elevation and Pu exercises.

METHODS

Thirteen healthy participants (non, athlete, male, mean ± standard deviation; age: 21.1 ± 1.8 years; height: 1.80 m ± 0.04; weight: 79 ± 12 kg) were assessed. EMG data was collected during Scaption, wall slide and elevation with external rotation (EleEr) with and without load. Pu classic, Pu plus (PuP) on stable/unstable surfaces and Pu with shoulder internal rotation were also assessed.

RESULTS

UT had a significant higher activity during 'Scaption load' (p < .05) and LT in 'EleEr load' and 'Scaption load' (p < .05). USa and LSa had a significant higher activity on 'PuP unstable surface' and 'PuP internal rotation' compared to elevation exercises (p < .05). Scaption had greater activity ratio compared to the other exercises on UT/LT (p < .05). Pu variations had lower results in UT/USa and UT/LSa ratios compared to shoulder elevation exercises (p < .05).

CONCLUSIONS

Elevation exercises produce significant effects on upper and lower trapezius activation while Pu exercises on Sa muscles. Wall slide exercise notes the lowest activation in all muscles. A descending order of muscle activity during different variations of elevation and Pu exercises is provided in order to guide exercise selection in everyday clinical practice.

Complex bone and soft tissues defect reconstruction with a chimeric flap: Latissimus dorsi, serratus anterior and ribs: Case report

Treatment of tibial defects with important soft tissue involvement after bilateral lower limb trauma are challenging for both orthopedic and plastic surgeons. Several therapeutic options are described in armamentarium of reconstructive surgeons such as bone grafts, bone substitutes, distractions osteogenesis, limb prosthesis, free flaps, negative pressure therapy and unfortunately amputation. We describe a patient with tibial and soft tissue defect reconstructed using a chimeric flap composed of latissimus dorsi, serratus anterior muscle and two ribs. At the 1-year follow-up the patient is able to walk with a walker and is still enrolled in rehabilitation program.

Determining safe teaching board heights through electromyographic analysis of the shoulder muscles

BACKGROUND

Adjustable teaching boards have been recommended as an ergonomic practice geared at reducing the incidences of teaching-related shoulder musculoskeletal disorders among teachers. However, there are no standards guiding choice of appropriate teaching board heights. This study was aimed at evaluating shoulder muscle activities in response to five teaching board heights.

METHODS

Thirty participants performed writing activities on five different board heights (Diff10 = standing height minus 10% of standing height; NormH = participant's standing height; Sum10 = standing height plus 10% of standing height; Sum20 = standing height plus 20% of standing height; Sum25 = standing height plus 25% of standing height). Electromyographic analysis of the anterior deltoid (AD), upper trapezius (UT), serratus anterior (SA) and pectoralis major (PM) muscles were performed simultaneously during each task. Data were analyzed with one-way ANOVA and independent T-test at p < 0.05.

RESULTS

Sum20 board height significantly (p < 0.001) elicited the highest activities in the AD (19.35 ± 11.26%) and UT (29.06 ± 29.53%) muscles while SA (20.37 ± 10.87%) and PM (20.86 ± 12.17%) muscles were most active at Sum25 board height. SA and PM muscles progressively increased with increasing board heights while AD and UT muscles showed alternating patterns of activation at increasing board heights. For safe ergonomic practices, recommended teaching board heights should be within the range of NormH and Sum10.

CONCLUSION

Extremely high or low teaching boards have tendencies of inducing musculoskeletal shoulder discomforts.

Validity and reliability of serratus anterior hand held dynamometry

BACKGROUND

Strength testing of the serratus anterior muscle with hand held dynamometry (HDD) in supine subjects has low reproducibility, and is influenced by compensatory activity of other muscles like the pectoralis major and upper trapezius. Previously, two manual maximum voluntary isometric contraction tests of the serratus anterior muscle were reported that recruited optimal surface electromyography (sEMG) activity in a sitting position. We adapted three manual muscle tests to make them suitable for HHD and investigated their validity and reliability.

METHODS

Twenty-one healthy adults were examined by two assessors in one supine and two seated positions. Each test was repeated twice. Construct validity was determined by evaluating force production (assessed with HHD) in relation to sEMG of the serratus anterior, upper trapezius and pectoralis major muscles, comparing the three test positions. Intra- and interrater reliability were determined by calculating intra-class correlation coefficients (ICC) smallest detectable change (SDC) and standard error of measurement (SEM).

RESULTS

Serratus anterior muscle sEMG activity was most isolated in a seated position with the humerus in 90° anteflexion in the scapular plane. This resulted in the lowest measured force levels in this position with a mean force of 296 N (SEM 15.8 N). Intrarater reliability yielded an ICC of 0.658 (95% CI 0.325; 0.846) and an interrater reliability of 0.277 (95% CI -0.089;0.605). SDC was 127 Newton, SEM 45.8 Newton.

CONCLUSION

The results indicate that validity for strength testing of the serratus anterior muscle is optimal with subjects in a seated position and the shoulder flexed at 90° in the scapular plane. Intrarater reliability is moderate and interrater reliability of this procedure is poor. However the high SDC values make it difficult to use the measurement in repeated measurements.

Electromyographic activity of the serratus anterior and pectoralis major during isometric scapular protraction at different resistance intensities in subjects with and without a winged scapula

BACKGROUND

During maximal isometric protraction, it is important to determine the optimal resistance intensity in subjects with a winged scapula, for inducing isolated activity of the serratus anterior against the pectoralis major, which is activated as a synergistic muscle. The aim of the present study was to determine electromyographic activities of the serratus anterior and pectoralis major muscles during isometric shoulder protraction at different levels in subjects with and without a winged scapula.

METHODS

Thirty male subjects performed isometric shoulder protraction in a sitting position at different resistance intensity levels (100%, 80%, and 60% of maximal protraction strength). Surface electromyographic data of the serratus anterior and pectoralis major muscles were gathered simultaneously using fixed instrumentation to measure isometric shoulder protraction.

FINDINGS

Muscle activity of the serratus anterior in subjects without a winged scapula was significantly greater than that of subjects with a winged scapula across all three conditions, whereas muscle activity of the pectoralis major was lower in subjects without a winged scapula. In addition, winged scapula muscle activity corresponding to maximal protraction was significantly greater than that in the submaximal condition.

INTERPRETATION

In a clinical setting, submaximal resistance can be more optimal than maximal effort during isometric shoulder protraction in individuals with a winged scapula.

Surface electromyographic analysis of differential effects in kettlebell carries for the serratus anterior muscles

The purpose of this study was to examine differences in the Electromyography (EMG) amplitude of the serratus anterior between 45° kettlebell carries and 90° kettlebell carries. Thirty-three men aged roughly between 19 and 23 and who were either college or professional baseball pitchers were chosen and randomly assigned to either perform the 45° kettlebell carry followed by the 90° kettlebell carry (n = 17) or the 90° kettlebell carry followed by the 45° kettlebell carry (n = 16). Each pitcher was instructed in the proper usage of the exercise and assigned a short break between the two carries. Changes in EMG amplitude were examined after proper band-pass filtering, normalization, and moving average-smoothing of the raw EMG signal. Differences of the EMG amplitude mean frequencies were examined between each subject’s individual carries and the clumped groups of all 45° and 90° carries. Among each individual comparison, eight pitchers had “large” Effect Size differences between the EMG amplitudes of their two carries, with seven of them signaling the 45° carry as the larger value. In addition, when examining the grouped mean differences of the EMG amplitudes, we found the 45° carries to be significantly higher (p-value of 0.018).

Effects of horizontal shoulder abduction and adduction on the activity and strength of the scapular protractors

Increased activity of the serratus anterior (SA) muscle combined with decreased activity of the pectoralis major (PM) muscle during scapular protraction exercise is a widely used method for selective strengthening of the former muscle. However, the role played by the PM during maximal scapular protraction remains unclear. The objective of our study was to investigate the effects of horizontal shoulder abduction (decreasing PM activity) and adduction (increasing activity) on the strength and activity of the scapular protractors (the SA and PM) during maximal protraction. Twenty-nine healthy males performed maximal scapular protraction combined with horizontal shoulder abduction or adduction. The strength and activity of the PM and SA decreased significantly (both p < 0.01) during maximal scapular protraction combined with horizontal shoulder abduction, compared with maximal scapular protraction alone, but increased significantly (both p < 0.01) when maximal scapular protraction was combined with horizontal shoulder adduction. We thus conclude that the PM stabilizes the activated SA during maximal scapular protraction, which effectively increases SA activity and scapular protraction strength in the serratus punch posture.

The effect of the push-up plus on shoulder muscle activation while using a sling with a pulley

[Purpose] This study was conducted to investigate the effects of the push-up plus while using a balance ball, a sling, and a sling with a pulley in a creeping position on an unstable floor. [Subjects and Methods] The subjects were divided into three groups of 15 members each who performed the different three type methods of push-up plus (with scapulae protruding) in a random order while in a creeping posture. The muscle activity of each group in the push-up plus posture was measured using electromyography, and the measurement values were compared among the groups using one-way analysis of variance (ANOVA). [Results] The intergroup comparison revealed that the activation of the pectoralis major muscle of the balance ball exercise group was significantly decreased. In this comparison, the activity ratio for the pectoralis major muscles of the balance ball exercise group significantly decreased, and the activity ratio of their serratus anterior muscles significantly increased. From the post analysis, the differences in the activity ratios of the pectoralis major and serratus anterior muscles for the balance ball exercise group were significant when compared with those of the other groups. [Conclusion] Among the three different exercise methods in unstable situations presented in this study, the push-up plus exercise in a creeping posture using the balance ball can be recommended for the selective strengthening of the serratus anterior muscle.

Effect of the push-up plus guide and resistance device (PPGRD) on the serratus anterior during push-up plus

[Purpose] This study developed a push-up plus guide and resistance device and investigated the effectiveness of the device. [Subject and Methods] A 39-year-old man presented with moderate pain with left scapular dyskinesis. A newly designed assistance device was used as a push-up plus guide and resistance device (PPGRD). The subject performed the push-up plus exercise without and then with the PPGRD for 2 weeks each. [Results] After performing the push-up plus exercise with the PPGRD for 2 weeks, the serratus anterior muscle power was increased, the pain score was decreased, and the absence of scapular dyskinesis was confirmed. [Conclusion] The PPGRD provided appropriate guidance and prevented excessive trunk flexion during the push-up plus exercise.

Alterations of scapular kinematics and associated muscle activation specific to symptomatic dyskinesis type after conscious control

BACKGROUND

Scapular orientation and movements can affect the function of the shoulder. However, evidence is limited on whether symptomatic subjects can actively maintain the scapula in a neutral position through conscious control.

OBJECTIVE

To investigate whether symptomatic subjects with scapular dyskinesis can achieve optimal scapular movements and associated muscle activities through conscious control.

DESIGN

A cross-sectional study.

METHODS

Sixty subjects with scapular dyskinesis (16 inferior angle pattern I, 16 medial border pattern II, and 28 mixed pattern) performed 3 selected exercises (arm elevation, side-lying elevation, and side-lying external rotation) with and without conscious control. Three-dimensional electromagnetic motion and electromyography were used to record the scapular kinematics and muscle activation during the exercises.

RESULTS

For scapular kinematics, significant increases in scapular external rotation (4.6 ± 3.2°, p < 0.0125) were found with conscious control during arm elevation and side-lying elevation in three groups. Significant increases in activation of the middle and lower trapezius (MT: 4.9 ± 2.4% MVIC; LT: 10.2 ± 6.8% MVIC, p < 0.0 25) were found with conscious control in 3 exercises among the 3 dyskinesis groups. Increased serratus anterior activation (SA: 11.2 ± 4.8% MVIC, p < 0.0 25) was found in the concentric phase of side-lying external rotation in the pattern I and I + II groups.

CONCLUSION

Conscious control of the scapula can alter scapular orientation and MT, LT, and SA activation during 3 selected exercises in subjects with symptomatic dyskinesis. Specifically, conscious control during side-lying external rotation can be applied to increase SA activity in pattern I and I + II dyskinesis.

A novel cadaveric study of the morphometry of the serratus anterior muscle: one part, two parts, three parts, four?

The serratus anterior is portrayed as a homogeneous muscle in textbooks and during functional activities and rehabilitation exercises. It is unclear whether the serratus anterior is composed of subdivisions with distinctive morphology and functions. The purpose of this study was to determine whether the serratus anterior could be subdivided into different structural parts on the basis of its segmental architectural parameters. Eight formalin-embalmed serratus anterior muscles were dissected and the attachments of each fascicle documented. Orientation and size of each fascicle were measured and the physiological cross-sectional area (PCSA) calculated. Three subdivisions of the serratus anterior were identified. A new finding was the discovery of two distinctive fascicles attached to the superior and inferior aspects of rib 2. The rib 2 inferior fascicle had the largest PCSA (mean 1.6 cm²) and attached, with the rib 3 fascicle, along the medial border of the scapula to form the middle division. The rib 2 superior and rib 1 fascicles attached to the superior angle of the scapula (upper division). Fascicles from ribs 4-8/9 attached to the inferior angle of the scapula (lower division). Mean fascicle angle relative to a vertical midline reference and PCSA for each division were 29° and 1.3 cm² (upper), 90° and 2.2 cm² (middle) and 59° and 3.0 cm² (lower). This novel study demonstrated the presence of morphologically distinct serratus anterior subdivisions. The results of this study will inform the development of optimal techniques for the assessment, treatment and rehabilitation of this architecturally complex muscle in shoulder and neck pain.

Different weight bearing push-up plus exercises with and without isometric horizontal abduction in subjects with scapular winging: A randomized trial

The aim of the present study was to determine whether the application of isometric horizontal abduction (IHA) differentially affected two weight-bearing push-up plus exercises by examining activation of the scapulothoracic muscles in subjects with scapular winging. Fifteen male subjects performed standard push-up plus (SPP) and wall push-up plus (WPP), with and without IHA. Two-way analyses of variance using two within-subject factors were used to determine the statistical significance of observed differences in upper trapezius (UT), pectoralis major (PM), and serratus anterior (SA) muscle activities and UT/SA and PM/SA muscle activity ratios. UT and SA muscle activities were greater during SPP than WPP. PM muscle activity was lower with IHA application. The UT/SA and PM/SA muscle activity ratios were lower during SPP than WPP. The PM/SA muscle activity ratio was lower with IHA application. The results suggest that IHA application using a Thera-Band can effectively reduce PM muscle activity during SPP and WPP exercises. Moreover, the SPP exercise can be used to increase UT and SA muscle activity and reduce the UT/SA and PM/SA muscle activity ratios in subjects with scapular winging.

Strength and muscle activity of shoulder external rotation of subjects with and without scapular dyskinesis

[Purpose] This study aimed to clarify the relationship between scapular dyskinesis and shoulder external rotation strength and muscle activity. [Subjects and Methods] Both shoulders of 20 healthy males were evaluated. They were classified into 19 normal, 8 subtly abnormal, and 13 obviously abnormal shoulders using the scapular dyskinesis test. Subtly abnormal shoulders were subsequently excluded from the analysis. Shoulder external rotation strength and muscle activity (infraspinatus, serratus anterior, upper, middle, and lower trapezius) were measured in 2 positions using a handheld dynamometer and surface electromyography while sitting in a chair with shoulder 0° abduction and flexion (1st position), and while lying prone on the elbows with the shoulders elevated in the zero position (zero position). The strength ratio was calculated to quantify the change in strength between the positions (zero position / 1st position). [Results] In the obviously abnormal shoulder group, the strength in the 1st position was significantly stronger, the strength ratio was significantly smaller, and the serratus anterior in the zero position showed significantly lower activity than the normal shoulder group. [Conclusion] In shoulder external rotation in the zero position, in obviously abnormal shoulders, the serratus anterior is poorly recruited, weakening the shoulder external rotation strength.

Electromyographic analysis of the infraspinatus and scapular stabilizing muscles during isometric shoulder external rotation at various shoulder elevation angles

[Purpose] This study aimed to clarify activation of the infraspinatus and scapular stabilizing muscles during shoulder external rotation at various shoulder elevation angles. [Subjects] Twenty subjects participated in this study and all measurements were performed on the right shoulder. [Methods] Isometric shoulder external rotation strength and surface electromyographic data were measured with the shoulder at 0°, 45°, 90°, and 135° elevation in the scapular plane. The electromyographic data were collected from the infraspinatus, upper trapezius, middle trapezius, lower trapezius, and serratus anterior muscles. These measurements were compared across the various shoulder elevation angles. [Results] The strength measurements did not differ significantly by angulation. The infraspinatus activity was 92%, 75%, 68%, and 57% of the maximum voluntary contraction, which significantly decreased as shoulder elevation increased. The serratus anterior activity was 24%, 48%, 53%, and 62% of the maximum voluntary contraction, which significantly increased as shoulder elevation increased. [Conclusion] Shoulder external rotation torque was maintained regardless of shoulder elevation angle. The shoulder approximated to the zero position as the shoulder elevation increased so that infraspinatus activity decreased and the scapular posterior tilting by the serratus anterior might generate shoulder external rotation torque.

[Reconstruction of lower limb involving free serratus anterior with rib myo-osseous composite flap: 20 patients followed for 5 years]

INTRODUCTION

In our team, free flap and especially serratus anterior muscle is the first option for the coverage of lower limb post-traumatic defects. For complex tissue loss, it may be advantageous to harvest the free serratus anterior with rib myo-osseous composite flap. We performed 20 osteomuscular serratus anterior composite flap between 2008 and 2010.

MATERIALS AND METHODS

We retrospectively studied the records of 20 patients, by separately analyzing the characteristics of the bone defect and the soft tissue loss. Patients have been recently reviewed by an independent operator. We compared our results to other reconstruction techniques and other similar series reported in the literature.

RESULTS

The average age of our patients was 43 years and 11 months. In all cases, defect was traumatic. The average follow-up was 5 years (4.5 to 5.8). The average flap area was 135cm(2) and the average rib length was 9.21cm. Our microsurgical success rate is 95%. Our global consolidation rate is 82%.

DISCUSSION

Use of vascularized rib in the treatment of lower limb traumatic defects is rare. The bone quality of rib is lower than fibula, but the coverage provided is better, due to serratus anterior muscle. The length and diameter of the vascular pedicle is very useful too. Our results are comparable to other series using this flap. Its coverage properties and the possibility of simultaneous bone reconstruction is useful. It allows one stage procedure for complex tissue losses with satisfactory results in the short and long term. The further realization of a free fibular transfer in cases of persistent non union remains possible.

Effect of various hand position widths on scapular stabilizing muscles during the push-up plus exercise in healthy people

[Purpose] The purpose of this study was to determine the effect of various hand position widths during the push-up plus (PUP) exercise on the activity of the scapular stabilizing muscles and other upper-extremity muscles involved in the exercise. [Subjects and Methods] Nine healthy men participated in our study. The PUP exercise was performed on a stable surface in seven different hand positions, namely shoulder width (SW), and narrower SW (NSW) and wider SW (WSW) at 10%, 20%, and 30%. Surface electromyography was used to measure the muscle activities and muscle ratio of the upper trapezius (UT), middle trapezius, lower trapezius (LT), serratus anterior (SA), pectoralis major, deltoid anterior, latissimus dorsi (LD), and triceps muscles. [Results] The SA and LD muscle activities significantly decreased in the 30% NSW and 20% WSW hand positions, respectively. The UT/LT muscle ratio significantly increased in the 30% WSW hand position. [Conclusion] The results of this study suggest that during the PUP exercise, the SW hand position should be used. In the 30% NSW hand position, the SA muscle activity decreased, and the UT/ LT ratio increased in the 30% WSW hand position.

The effects of shoulder joint abduction angles on the muscle activity of the serratus anterior muscle and the upper trapezius muscle while vibrations are applied

[Purpose] The purpose of this study was to examine the ratio between the upper trapezius and the serratus anterior muscles during diverse shoulder abduction exercises applied with vibrations in order to determine the appropriate exercise methods for recovery of scapular muscle balance. [Subjects and Methods] Twenty-four subjects voluntarily participated in this study. The subjects performed shoulder abduction at various shoulder joint abduction angles (90°, 120°, 150°, 180°) with oscillation movements. [Results] At 120°, all the subjects showed significant increases in the muscle activity of the serratus anterior muscle in comparison with the upper trapezius muscle. However, no significant difference was found at angles other than 120°. [Conclusion] To selectively strengthen the serratus anterior, applying vibration stimuli at the 120° shoulder abduction position is considered to be appropriate.

Effect of the Shoulder Flexion Angle in the Sagittal Plane on the Muscle Activities of the Upper Extremities when Performing Push-up plus Exercises on an Unstable Surface

[Purpose] The purpose of this study was to investigate the effect of the shoulder flexion angle on the muscle activities of the upper extremities when performing the push-up plus exercise (PUPE) on an unstable surface with the forearm in the external rotation position. [Subjects] The subjects were conducted on 15 normal male adults. [Methods] A sling device was used for the unstable surface, and PUPE was performed with the forearm in the external rotation position. The shoulder flexion angles measured in the sagittal plane were 110°, 90°, and 70°. Electromyography was used for a comparitive analysis of the muscle activities of the serratus anterior (SA), the pectoralis major (PM), and the upper trapezius (UT). [Results] In the intra-group comparison, the muscle activity of SA was statistically the highest when the shoulder-flexion angle was 110°. [Conclusion] performing PUPE on an unstable surface, the muscle activity of the SA is activated the most when the shoulder flexion angle is 110° and the forearm is in the external rotation position.

Reliability of measures of scapular protraction strength in the supine and seated positions

[Purpose] The purpose of this study was to investigate the intra-rater reliability of measures of scapular protraction strength using a novel method. [Subjects] Forty-nine healthy subjects participated in this study. [Methods] Subjects performed maximal isometric scapular protraction on the left and right sides in the supine and seated positions. During scapular protraction, resistance was applied to the olecranon, and the strength of scapular protraction was measured using a load cell. Intra-rater reliability was calculated as the intra-class correlation coefficient (ICC_3,1). [Results] High intra-rater reliability scores (0.97–0.98) for scapular protraction strength were observed in the supine and seated positions. [Conclusion] These findings demonstrate that the method described herein may provide a more reliable and convenient method to measure scapular protraction strength than common current practice does.

Effect of Vibration Frequency on Serratus Anterior Muscle Activity during Performance of the Push-up Plus with a Redcord Sling

[Purpose] We investigated the effect of vibration at various frequencies on serratus anterior (SA) muscle activity. [Subjects] Ten male subjects were recruited. [Methods] The subjects performed the push-up plus exercise supported by straps above the surface and vertical ropes in the Redcord sling. During the push-up plus, vibrations of 0, 30, 50, or 90 Hz were applied to the Redcord sling using a mechanical vibration apparatus attached to the rope. SA muscle activity was recorded using electromyography. [Results] SA muscle activity at the 50 Hz vibration frequency was significantly higher than that of no vibration. [Conclusion] Performing the push-up plus using a Redcord sling with mechanical vibration of 50 Hz effectively increased SA muscle activity.

Scapulothoracic Muscle Activity during Use of a Wall Slide Device (WSD), a Comparison with the General Wall Push up Plus

[Purpose] The purpose of this study was to evaluate the effect of the wall slide device on activation of the scapulothoracic musculature. [Subjects] We recruited 15 healthy male subjects. [Methods] The subjects performed the general wall push-up plus (WPUP) and the wall slide with device (WSD) exercises. During the exercises, the muscle activities of the upper and lower trapezius (UT, LT), middle and lower serratus anterior (MSA, LSA), and pectoralis major (PM) were measured. [Results] The normalized muscle activity data of the WSD were significantly higher in UT, MSA and LSA than the WPUP. [Conclusion] Our results suggest that exercise using the WSD can more effectively activate the scapulothoracic musculature than the general WPUP.

Effects of Push-up Exercise with Hip Adduction on the COP Deviation and the Serratus Anterior and L1 Paraspinal Muscles

[Purpose] This study investigated the effect of push-up exercise with hip adduction on the COP deviation and SA and L1 spinal muscle activation. [Subjects] Twelve males aged 20–30 years were recruited. [Methods] We measured the COP deviation and SA and L1 spinal muscle activities during push-up exercise with and without hip adduction [Results] The COP deviation significantly decreased and the SA and L1 spinal muscles were significantly increased during push-ups with hip adduction when compared with push-ups without hip adduction. [Conclusion] We thought that the push-up exercise with hip adduction might help to selectively strengthen the SA.

[Reconstruction of complex foot defects by serratus anterior-rib osteomuscular free flap: about four cases]

SUBJECT

The foot is a region of the lower limb presenting some functional and aesthetic particularities. Free flap surgery is often indicated in complex traumatic foot defects (bony and soft tissue) of the foot. In this kind of trauma, we prefer to use the serratus anterior-rib free flap. We report four cases with this technique while analyzing the long-term functional aspects of the reconstruction.

PATIENTS AND METHODS

We have reviewed four cases treated from 2008 to 2010. These patients have been reexamined recently in order to judge the functional and aesthetic aspects of this reconstructive technique.

RESULTS

The mean age of our patients was 50 years and 3 months. The defect concerned the metatarsal bones in three cases and the calcaneus in one case. The soft tissue defect measured a mean of 60 cm(2) and the bony defect 5.75 cm. Our current mean follow-up is of 4 years and 3 months and only one of four patients needs occasionally one crutch for walking.

DISCUSSION

The serratus anterior-rib flap is well suited for the foot region because of the length of its pedicle, the quality and the thinness of the obtained muscular coverage. The possibility of a synchronous bony reconstruction is a major advantage thus permitting an all-inclusive treatment.