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PubMed2000

Compartment syndrome in ipsilateral humerus and forearm fractures in children.

Ipsilateral fractures of the humerus and forearm are uncommon injuries in children. The incidence of compartment syndrome in association with these fractures is controversial. The authors reviewed 978 consecutive children admitted to the hospital with upper extremity long bone fractures during a 13-year period. Forty-three children with ipsilateral fractures of the humerus and forearm were identified. Of 33 children with a supracondylar humerus fracture and ipsilateral forearm fracture, three children (7%) had compartment syndrome develop and required forearm fasciotomies. All three cases of compartment syndrome occurred among nine children with ipsilateral displaced extension supracondylar humerus and displaced forearm fractures; the incidence of compartment syndrome was 33% in this group. These findings suggest that children who sustain a displaced extension supracondylar humerus fracture and displaced forearm fracture are at significant risk for compartment syndrome. These children should be monitored closely during the perioperative period for signs and symptoms of increasing intracompartmental pressures in the forearm.

Adolescent↗
PubMed1984

The effects of angular and rotational deformities of both bones of the forearm. An in vitro study.

UNLABELLED: In intact fresh cadaver specimens, we experimentally studied angular and rotatory deformities at the distal and middle levels of the forearm. The remaining pronation and supination motions were measured. When both bones of the forearm were angulated with a combined deformity (radio-ulnar or dorsovolar, or both) of 10 degrees, a loss of pronation-supination of 12.5 +/- 4.5 per cent occurred in the forearms with a distal-third fracture; in the forearms with a middle-third fracture the average loss was 16.0 +/- 5.7 per cent. Pronation losses were similar for both distal and middle-third deformities. However, supination losses were much less affected (p less than 0.01) in forearms with deformities at the distal-third level while the losses were considered drastic for middle-third deformities. Rotatory deformities produced losses of pronation-supination that were equal to the degree of deformity. CLINICAL RELEVANCE: Study of the artificially created deformities in cadavera indicated that angular and rotatory deformities of the forearm of 10 degrees or less result in minimum limitation of pronation-supination. These degrees of limitation of motion in clinical practice are easily compensated for and are cosmetically acceptable. The fact that the perfect anatomical restoration of fracture alignment that often is obtained with internal fixation does not always result in complete restoration of motion suggests that: (1) this residual impairment of function is due to soft-tissue scarring, and (2) the mild angular and rotatory deformities resulting from nonsurgical treatment of fractures of the forearm may produce limitations of motion of an equally acceptable degree.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomechanical Phenomena↗
PubMed1998

The distal radioulnar joint capsule: clinical anatomy and role in posttraumatic limitation of forearm rotation.

Posttraumatic limitation of forearm rotation can be the result of pathology at any location along the forearm axis. Scar contracture of the distal radioulnar joint (DRUJ) capsule, independent of the triangular fibrocartilage complex (TFCC), is one of the sources that may influence the pronosupination arc. We dissected the wrists of 8 fresh-frozen cadaver specimens to characterize the precise anatomy, relationships, and dynamic characteristics of the entire DRUJ capsule. Additionally, we performed surgical DRUJ capsulectomy in 9 patients with recalcitrant limited forearm pronosupination that was unattributable to dysfunction at any other anatomic forearm location. We conclude that (1) the DRUJ capsule is a defined entity, separate from the triangular fibrocartilage, that is highly specialized to accommodate the distal ulna in forearm rotation; (2) in patients who have restored osseous anatomy after trauma, but have failed to regain pronosupination after maximal rehabilitation, the DRUJ capsule can be identified as the source of the limitation; and (3) DRUJ capsulectomy can markedly improve the arc of forearm rotation in carefully selected patients.

Biomechanical Phenomena↗
PubMedDate not supplied

The forearm complex: anatomy, biomechanics and clinical considerations.

The forearm complex is comprised of the proximal radioulnar joint, middle radioulnar joint/interosseous membrane, and the distal radioulnar joint. These three areas function in a coordinated manner to rotate the hand in space and allow performance of functional tasks. If a structure or structures in one of these three areas is disrupted, this can adversely affect the function at any of the other two remaining areas. Surgical intervention focuses on restoring anatomical alignment to preserve the function of the forearm complex. Rehabilitation is guided by the relationships between the three areas of the forearm complex and the awareness of clinical signs, symptoms, and complications. The purposes of this paper are to 1) describe the anatomy and biomechanical function of the forearm complex and 2) discuss clinical correlates pertaining to select forearm injuries (excluding peripheral nerve injuries) that may affect forearm function.

Biomechanical Phenomena↗
PubMed2003

Reliability of 2 functional goniometric methods for measuring forearm pronation and supination active range of motion.

STUDY DESIGN: Test-retest reliability study. OBJECTIVES: To determine intra- and intertester reliability of the hand-held pencil (HHP) and the plumbline goniometer (PLG) methods for measuring active forearm pronation and supination motions in individuals with and without injuries. BACKGROUND: The distal forearm method has been considered the gold standard for measuring forearm pronation and supination motion. The HHP and PLG, however, are 2 more functional methods for measuring forearm motions, though limited information on the psychometric properties of these tests is currently available. METHODS AND MEASURES: Intra- and intertester reliability of the HHP and PLG methods were determined in 40 subjects of convenience (20 injured and 20 noninjured). Two testers performed 3 repeated measurements for each motion and method on all subjects. Intraclass correlation coefficients (ICC3,1 for intratester reliability, ICC2,3 for intertester reliability) and standard error of measurements (SEMs) were determined. RESULTS: The ICCs for the measurements of pronation and supination using the HHP and PLG methods were high (range, 0.86-0.98) for individuals with and without injuries, with the reliability for the PLG method being equal or slightly greater than the HHP method for the majority of pronation and supination measurements. Intratester ICCs were higher (SEMs were conversely lower) than intertester ICCs for nearly all measurements. The ICC values were generally the same or higher for individuals with injuries compared to individuals without injuries. CONCLUSIONS: The HHP and PLG are highly reliable methods for measuring functional forearm pronation and supination. Because plumbline goniometers are not commercially available and the instrumentation for the HHP method is readily accessible, clinicians should consider the latter as their method of choice for measuring functional forearm pronation and supination.

Adult↗
PubMed1993

Forearm 3-methylhistidine efflux in myotonic dystrophy.

Myotonic dystrophy is associated with progressive muscular atrophy. To define the mechanism of muscle wasting in this disease, we studied myofibrillar proteolysis in vivo in 8 men moderately affected with myotonic dystrophy, and compared the results with those of 10 normal men. Myofibrillar proteolysis was estimated by measuring the 3-methylhistidine arteriovenous difference (A-V) and efflux (Q) across the forearm in the postabsorptive state. Plasma 3-methylhistidine concentrations were determined by high-performance liquid chromatography with postcolumn o-phthalaldehyde derivatization and fluorescence detection. Plasma flow to the forearm muscles (F) was estimated to represent 85% of total forearm plasma flow as determined by the indicator-dilution technique. Forearm 3-methylhistidine efflux was calculated as: Q = F(A-V). Mean muscle mass (24-hour creatinine excretion), lean body mass, and forearm volume were decreased in the patients with myotonic dystrophy, confirming the presence of muscle atrophy. Mean forearm 3-methylhistidine arteriovenous difference and efflux were not significantly different in the two groups. We conclude that myofibrillar protein degradation is not increased in myotonic dystrophy, even when measured in a muscle compartment selectively affected by wasting. Muscle atrophy in myotonic dystrophy is probably the result of defective anabolism rather than accelerated catabolism.

Adult↗
PubMed2001

Ulnar versus radial forearm flap in head and neck reconstruction: an experimental and clinical study.

BACKGROUND: To consider the pros and cons of the microvascular ulnar forearm flap compared with its radial counterpart, this study compares the use of these two flaps for head and neck reconstruction. METHODS: In 75 patients, 51 ulnar and 24 radial forearm flaps were used. Both groups were compared regarding flap dissection, suitability of the flap for the recipient region, complication rate, and secondary morbidity in the donor region. Furthermore, in 40 healthy volunteers, the thickness of the subcutaneous tissue layer was measured by use of ultrasonography. RESULTS: Flap survival rate, respectively wound healing, in the recipient region showed no differences. Clinical and experimental results demonstrated a thinner subcutaneous layer in the ulnar aspect of the forearm. Compared with its radial equivalent, closure of the ulnar donor side by skin grafting resulted in a significantly lower complication rate. CONCLUSIONS: The ulnar forearm flap is favored because of the less hairy skin of the ulnar forearm region, the thinner layer of subcutaneous tissues, and the more conveniently located donor area. The ulnar forearm pedicle is long compared with alternative transplants but shorter than the radial equivalent.

Adult↗
PubMed2006

In vivo three-dimensional motion analysis of the forearm with radioulnar synostosis treated by the Kanaya procedure.

Attempts to separate congenital radioulnar synostosis and restore forearm rotation had been disappointing until a new mobilization technique was developed by Kanaya and colleagues using free vascularized fascio-fat graft interposition. This technique provides a functional rotation arc, but postoperative forearm motion is difficult to evaluate given the inaccuracies in determining the range of motion and rotational axis using conventional x-rays or computed tomography. This study represents an attempt to analyze in vivo three-dimensional motion of the forearm with radioulnar synostosis treated by Kanaya's operation using a markerless bone registration technique. Six patients with seven postoperative forearms (six with congenital and one with posttraumatic radioulnar synostosis) underwent 3D computed tomography with the forearm in neutral, fully pronated, and fully supinated positions. Range of motion according to this method was 30 +/- 18 degrees, significantly smaller than the 82 +/- 29 degrees from manual examination. Improvements in range of motion were significantly greater in cases without dislocation of the radial head (46 +/- 13 degrees) than in cases with dislocation (19 +/- 10 degrees). Dislocation of the radial head was also significantly correlated with an abnormal axis of rotation of the forearm.

Adipose Tissue↗
PubMed1985

Postural forearm changes induced by predictable in time or voluntary triggered unloading in man.

Human subjects sitting in a chair were asked to maintain their right forearm in a horizontal position in half supination. The forearm was loaded with a constant weight of one kilogram. Vertical force at the wrist level, angular position of the elbow and EMG activity of biceps, brachio-radialis and triceps muscles were recorded. Unloading was tested under four different conditions, the first two having been used in a previous study (Hugon et al. 1982): Voluntary unloading by the subject's other hand. An "anticipatory" deactivation of the load bearing forearm flexors is observed preventing the elbow rotation of that arm. Unpredictable passive unloading. This results in an upward forearm rotation which provokes the classical "unloading reflex". Two new conditions were tested in the present paradigm: Imposed unloading predictable in time (tone signal preceding unloading by a fixed interval). Unloading being actively triggered when the subject presses a key. Under the two latter conditions, no anticipatory deactivation of the flexor supporting muscles preceding the onset of unloading as in situation A was observed. During the first 120 ms after the onset of unloading, the forearm rotation was the same as in situation B (unpredictable passive unloading). Thereafter, the rotation was smaller in some subjects, apparently due to an ameliorated reflex action. It is concluded that temporal information concerning the precise time of the unloading or the triggering of the load release by a voluntary movement (key press) was not by itself able to induce the anticipatory deactivation of the forearm flexors that was seen with a coordinated voluntary release of the load by the contralateral arm.

Adult↗
PubMed1993

Geometric variables from DXA of the radius predict forearm fracture load in vitro.

The purpose of this investigation was to determine the cross-sectional geometry of the radius in female and male cadaveric specimens using dual-energy X-ray absorptiometry (DXA), to measure the accuracy of this technique compared with a digitizing procedure, and to measure the correlation between these DXA-based geometric variables and the load required to produce a forearm fracture. Paired intact forearms were scanned at a distal site and at a site approximately 30% of the forearm length from the distal end. The cross-sectional area and the moments of inertia of two sections at 10 and 30% of the forearm length were computed from the X-ray attenuation data. One member of each pair was then sectioned at the 30% location, which is mostly cortical bone, and the section was traced on a digitizing pad. The other forearm was loaded to failure in a servohydraulic materials test system. The DXA-based area and moment of inertia at 30% correlated significantly with the digitized results (r2 = 0.93 for area; r2 = 0.95 for moment; P < 0.001). The conventional bone mineral density from DXA did not associate significantly with failure load, but the minimum moment of inertia and the cross-sectional area at 10% correlated in a strong and significant manner with the forearm fracture force (r2 = 0.67 for area; r2 = 0.66 for moment; P < 0.001). The determination of radial bone cross-sectional geometry, therefore, should have better discriminatory capabilities than bone mineral density in studies of bone fragility and fracture risk.

Absorptiometry, Photon↗
PubMed1992

Effects of C-peptide on blood flow, capillary diffusion capacity and glucose utilization in the exercising forearm of type 1 (insulin-dependent) diabetic patients.

Microvascular dysfunction is frequently seen in patients with Type 1 (insulin-dependent) diabetes. The present study was undertaken to examine whether skeletal muscle microcirculation in Type 1 diabetic patients is influenced by C-peptide. Forearm blood flow, capillary diffusion capacity and substrate exchange were studied during strenuous rhythmic forearm exercise on a hand ergometer. Measurements were made before and during i.v. infusion for 60 min of C-peptide or 0.9% NaCl in Type 1 diabetic patients and healthy subjects. During infusion the C-peptide levels in the diabetic patients increased from less than 0.05 nmol/l to 1.32 +/- 0.08 nmol/l. Prior to infusion forearm blood flow and capillary diffusion capacity during exercise were lower in the diabetic patients than the control subjects. During C-peptide infusion both variables increased in the diabetic patients (blood flow +27 +/- 4%, capillary diffusion capacity +52 +/- 9%) to levels similar to those in the healthy subjects, while no significant change was seen in the healthy control subjects or the diabetic patients given NaCl. Forearm uptake of oxygen and glucose in the diabetic patients increased markedly after C-peptide administration but were unchanged after NaCl infusion. Significant uptake of C-peptide to the deep forearm tissues was observed in the resting state; approximately 7 +/- 2% of the arterial C-peptide concentration was extracted by forearm tissues in diabetic patients as well as in healthy control subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1979

Measurement of forearm blood flow by venous occlusion plethysmography: influence of hand blood flow during sustained and intermittent isometric exercise.

The requirement for using an arterial occlusion cuff at the wrist when measuring forearm blood flows by plethysmography was tested on a total of 8 subjects at rest and during and after sustained and intermittent isometric exercise. The contribution of the venous effluent from the hand to the forearm flow during exercise was challenged by immersing the arm in water at 20, 34, and 40 degrees C. Occlusion of the circulation to the hand reduced the blood flow through the resting forearm at all water temperatures. There was an inverse relationship between the temperature of the water and the proportion in the reduction of forearm blood flow upon inflation of the wrist-cuff, ranging from 45 to 19% at 20 degrees to 40 degrees C, respectively. However, during sustained isometric exercise at 10% of the subjects maximum voluntary contraction (MVC) there was no reduction in the measured forearm flow when an arterial occlusion cuff was inflated aroung the wrist. Similarly, there was no alteration in the blood flow measured 2 s after each of a series of intermittent isometric contractions exerted at 20% or 60% MVC for 2 s whether or not circulation to the hand was occluded nor of the post-exercise hyperemia following 1 min of sustained contraction at 40% MVC. These results indicate that a wrist-cuff is not required for accurate measurement of forearm blood flows during or after isometric exercise.

Forearm↗
PubMed1993

Comparison of muscle sympathetic nerve activity during exercise in dominant and nondominant forearm.

To determine whether or not muscle endurance training alters exercise-induced sympathetic nerve response, we recorded muscle sympathetic nerve activity (MSNA) microneurographically during forearm exercise and compared MSNA between dominant (D) and non-dominant (ND) forearms of players of racket sports. Three kinds of forearm exercise were conducted on each side; static (SHG) and dynamic (DHG, at a rate of 1 Hz) handgrip exercise at a loading of 25% of maximal voluntary contraction until exhaustion, and 10-min submaximal dynamic handgrip (at a rate of 1 Hz) at an intensity of 0.9 W. Heart rate, ventilation and blood pressure were also monitored at rest and during SHG and DHG exercises. During the last minute of SHG exercise, MSNA burst rate had increased on average by 290 (SEM 46)% in D and 330 (SEM 46)% in ND, while during DHG it increased by 288 (SEM 38)% in D and 344 (SEM 36)% in ND, respectively. There were no significant differences in the MSNA responses between D and ND forearms in either exercise modes. Significant increases in heart rate, ventilation and blood pressure during the last minute of fatiguing SHG and DHG were observed, but there were no significant differences between the two forearms. During submaximal DHG, while MSNA increased significantly above control values in both D and ND, the MSNA response was less in D than that in ND forearm. The results would suggest that exercise-induced MSNA responsiveness is influenced little by muscle endurance training but the intensity of response may be due to the magnitude of metaboreceptor stimulation in the exercising muscle.

Adult↗
PubMed1992

Venous responses to rhythmic exercise in contralateral forearm and calf.

Ten normal healthy subjects performed a rhythmic handgrip at 30% MVC (maximal voluntary contraction) with and without arterial occlusion of the same limb. Contralateral forearm and calf venous capacitance were simultaneously measured by venous occlusion plethysmography. During rhythmic handgrip at 30% MVC contralateral venous capacitance decreased by -7.17% in the forearm and by -5.14% in the calf. With arterial occlusion the decreases in venous capacitance were even more pronounced: contralateral forearm -14.4% and calf -13.1%. In a second set of experiments (n = 5) rhythmic handgrip at 30% MVC with arrest of the forearm circulation 5 s prior to the cessation of contraction was applied to examine the influence of chemically sensitive metaboreceptors per se on the evoked limb venoconstriction. During the postexercise arterial occlusion forearm venous volume decreased further to -30.6% whereas calf venous volume increased slightly but remained below the control value. After the cessation of the arterial occlusion both forearm and calf capacitance returned to baseline values. Thus, this study provided evidence that as well as a chemically generated reflex arising from the working muscle, central command was found to be involved in the increase in venomotor tone in the nonexercising limbs during rhythmic handgrip at 30% MVC.

Adult↗
PubMed1995

Early postmenopausal diminution of forearm and spinal bone mineral density: a cross-sectional study.

Diminution of bone mineral density (BMD) in the spine and forearm was studied cross-sectionally in 363 women who were 6 months to 10 years postmenopausal. BMD was determined by dual-energy X-ray absorptiometry (DXA) (Hologic QDR-2000) in the lumbar spine, in both the supine lateral (LAT) and anteroposterior (AP) projections, and in the distal third of the forearm. The postmenopausal diminution of BMD was best described by an exponential fit. The initial rate of postmenopausal diminution of BMD was highest in the most trabecular sites (LAT > AP > forearm), but 10-year diminution was similar at all sites (12%-13%, corresponding to about 1.0-1.5 SD), and extrapolation suggested reverse order of the rates of diminution thereafter (forearm > AP > LAT). When bone mineral content of the entire L3 vertebra (tBMC) was measured in vivo, AP tBMC could account for only 67% of the variation in LAT tBMC, compared with r2 = 0.997 in vitro. This observation suggests an accuracy problem in vivo in one of the spine measurement methods. We conclude that the initial rate of BMD diminution after the menopause seems to be highest in the spine, especially when measured laterally, but that this rate levels off within the first decade. The lower precision error of a forearm measurement (0.8% v 1.6 for AP and 3.1 for LAT) therefore implies that this method may require a shorter observation period than spine measurements for the detection of bone loss 5-10 years after menopause. Long-term longitudinal spine and forearm measurements are, however, needed to confirm these conclusions.

Absorptiometry, Photon↗
PubMed1998

Forearm vascular responses during semierect dynamic leg exercise in patients following myocardial infarction.

We assessed forearm vascular and blood pressure responses to dynamic leg exercise in patients 7 and 28 days postmyocardial infarction. To determine a possible association between abnormal exercise vascular responses and baroreflex dysfunction, integrated and carotid baroreflex sensitivity and forearm vascular responses (during application of subhypotensive lower body negative pressure) were assessed. On day 7, 42 patients were compared with 21 age- and sex-matched controls. All subjects were assessed for (1) forearm vascular resistance during semierect exercise, (2) blood pressure measurements during erect treadmill exercise, and (3) integrated, cardiopulmonary, and carotid baroreceptor sensitivity. These studies were repeated in 13 patients on day 28. Forearm vascular resistance increased during exercise by 36% +/- 63% in patients versus 121% +/- 105% in controls (P = 0.0001), and fell in 15 patients, a response seen in none of the controls. Exercise hypotension was demonstrated in 5 patients, all of whom had abnormal vasodilator vascular responses. Those patients with vasodilator responses had a lower left ventricular ejection fraction (52% +/- 12% vs 62% +/- 9%; P = 0.007), and lower cardiopulmonary mechanoreceptor sensitivity (-6.6 +/- 3.9 units vs +6.4 +/- 10.4 units, P = 0.02) than those with constrictor responses, respectively. In the 13 patients studied on day 28, the change in forearm vascular resistance was similar to that observed on day 7 (36% +/- 63% vs 46% +/- 73%). Paradoxical vasodilation of forearm vessels during leg exercise is common in patients studied 7 and 28 days postmyocardial infarction, and is associated with lower left ventricular ejection fraction and abnormal vascular responses during subhypotensive lower body negative pressure.

Adult↗
PubMed1990

Limited maximal vasodilator capacity of forearm resistance vessels in patients with hypertrophic cardiomyopathy.

It is not known whether hypertrophic cardiomyopathy (HCM) is accompanied by an abnormality in vascular smooth muscles. In this study, we examined the maximal vasodilator capacity of forearm resistance vessels by measuring minimal forearm vascular resistance (min. FVR) during peak reactive hyperemia after 10 min of arterial occlusion in patients with HCM (n = 15, 41 +/- 4 years old) and age-matched control subjects (n = 12, 42 +/- 3 years old). Forearm blood flow (FBF) was measured by a mercury-in-silastic strain gauge plethysmograph and FVR was calculated by dividing mean blood pressure by FBF. Resting FBF was lower (P less than 0.05) and resting FVR was higher (P less than 0.01) in patients with HCM than in control subjects. Min. FVR was significantly greater in patients with HCM than in control subjects (2.7 +/- 0.2 vs 1.5 +/- 0.2 units, P less than 0.005). We also examined vasoconstrictive responses to intra-arterially infused angiotensin II (20 and 40 ng/min); responses were greater in patients with HCM than in control subjects (P less than 0.05). These results indicate that forearm circulation is altered in patients with HCM. The result that the maximal vasodilator capacity of forearm resistance vessels is limited in patients with HCM as compared with that in age-matched control subjects suggests that there may be abnormalities in forearm resistance vessels in patients with HCM, which might involve increased wall thickness or intrinsic abnormalities in vascular smooth muscle.

Adult↗
PubMed1998

Quantitative bone mineral assessment at the forearm: a review.

Bone mineral density and geometric properties of the human forearm can be measured to determine the amount of bone or bone loss at the scanning site and to predict the risk of forearm fractures. These forearm measurements are also used to estimate bone mass at remote anatomical locations and thereby estimate the risk for spine, hip and other fractures. The peripheral location of the human forearm, with its relatively small amount of surrounding soft tissue, improves the accuracy and the precision of bone mass measurement and has made this site an early choice for the assessment of a subject's bone mineral status. Furthermore, the anatomy of the human radius enables the examination of both cortical and cancellous bone. This review describes the procedures for non-invasive bone assessment at peripheral sites including some of the more recently developed systems dedicated to assessment of the distal radius. The accuracy, precision and normative values they provide are presented. Responses to different forms of therapies as well as the ability to discriminate or predict osteoporotic fractures are also assessed. Low radiation dose, comfortable and fast handling, moderate cost, and a strong association with the risk of non-spine fractures, promote the use of forearm scanning as a widely applied screening procedure for the detection of generalised osteoporotic bone loss. However, a higher accuracy of fracture risk prediction at the spine or at the hip can be achieved by a direct bone density measurement at these sites. The monitoring of treatment at the distal forearm appears to require a longer follow-up time due to its decreased responsiveness compared with such highly trabecular load-bearing sites as the spine and the proximal femur.

Absorptiometry, Photon↗