PubMed · 14686555
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A M Atkins, S T Nedorost. Swollen upper extremities.. https://doi.org/10.1177/000992280304200909
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This article reviews the surgical options available for reconstruction of the upper extremity following tumor resection. In order to achieve maximum function and limb salvage a multidisciplinary approach to patient care is emphasized. With proper preoperative planning, salvage of limb form and function can be accomplished in over 95% of cases. Successful reconstruction is measured by preservation of patient health, limb function, limb sensation and cosmesis and stable wound coverage. Important adjuncts to reconstruction include adequate postoperative splinting and aggressive rehabilitation to maximize long-term upper extremity function.
BACKGROUND: There is no universally accepted way of labelling or defining upper-extremity musculoskeletal disorders. A variety of names are used and many different classification systems have been introduced. OBJECTIVE: To agree on an "unambiguous language" concerning the terminology and classification that can be used by all relevant medical and paramedical disciplines in the Netherlands. METHODS: A Delphi consensus strategy was initiated. The outcomes of a multidisciplinary conference were used as a starting point. In total, 47 experts in the field of upper-extremity musculoskeletal disorders were delegated by 11 medical and paramedical professional associations to form the expert panel for the Delphi consensus strategy. Each Delphi round consisted of a questionnaire, an analysis and a feedback report. RESULTS: After three Delphi rounds, consensus was achieved. The experts reported the consensus in a model. This so-called CANS model describes the term, definition and classification of complaints of arm, neck and/or shoulder (CANS) and helps professionals to classify patients unambiguously. CANS is defined as "musculoskeletal complaints of arm, neck and/or shoulder not caused by acute trauma or by any systemic disease". The experts classified 23 disorders as specific CANS, because they were judged as diagnosable disorders. All other complaints were called non-specific CANS. In addition, the experts defined "alert symptoms" on the top of the model. CONCLUSIONS: The use of the CANS model can increase accurate and meaningful communication among healthcare workers, and may also have a positive influence on the quality of scientific research, by enabling comparison of data of different studies.
It has been observed that the motion of the arm end-point (the hand, fingertip or the tip of a pen) is characterized by a number of regularities (kinematic invariants). Trajectory is usually straight, and the velocity profile has a bell shape during point-to-point movements. During drawing movements, a two-thirds power law predicts the dependence of the end-point velocity on the trajectory curvature. Although various principles of movement organization have been discussed as possible origins of these kinematic invariants, the nature of these movement trajectory characteristics remains an open question. A kinematic model of cyclical arm movements derived in the present study analytically demonstrates that all three kinematic invariants can be predicted from a two-joint approximation of the kinematic structure of the arm and from sinusoidal joint motions. With this approach, explicit expressions for two kinematic invariants, the two-thirds power law during drawing movements and the velocity profile during point-to-point movements are obtained as functions of arm segment lengths and joint motion parameters. Additionally, less recognized kinematic invariants are also derived from the model. The obtained analytical expressions are further validated with experimental data. The high accuracy of the predictions confirms practical utility of the model, showing that the model is relevant to human performance over a wide range of movements. The results create a basis for the consolidation of various existing interpretations of kinematic invariants. In particular, optimal control is discussed as a plausible source of invariant characteristics of joint motions and movement trajectories.