Ligamentomuscular protective reflex in the elbow.

Abstract

A reflex are from the medial elbow ligaments to the forearm pronator muscles was shown to exist in the feline model. A single articular branch emerging from the median nerve and converging on the medial collateral ligament was identified and stimulated with supramaximal pulses of 100 microseconds duration at a rate of 10 pulses/s. Stimulation of the articular nerve elicited myoelectric activity in the flexor digitorum superficialis, flexor digitorum profundus, flexor carpi radialis, flexor carpi ulnaris, and pronator teres. Transection of the articular nerve between the electrodes and the median nerve resulted in the disappearance of any myoelectric activity in the muscles, thus confirming the afferent nature of the articular nerve. The mean time delay from the application of the stimulus to the corresponding myoelectric discharge ranged from 3.2 to 5.8 ms for the 5 muscles. The existence of a fast-acting reflex arc from the medial elbow ligaments to the forearm muscles both confirms the concept of ligamentomuscular protective synergy (shown to exist in the knee, shoulder, and ankle joints) and extends it to the elbow. This reflex arc has significant implications for both the planning of elbow surgery while preserving the neural supply of the ligaments and for the planning of postsurgical or conservative therapeutic rehabilitation modalities.