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PubMed1989

Operations for forearm deformity caused by multiple osteochondromas.

We reviewed 36 cases of forearm deformity caused by multiple osteochondromas in 30 patients and classified them into three types: Type I showed a combination of ulnar shortening and bowing of the radius secondary to osteochondromas of the distal ulna (22 forearms). Type II showed dislocation of the radial head, either with osteochondromas of the proximal radius (Type IIa, two forearms) or secondary to more distal involvement (Type IIb, five forearms). Type III had relative radial shortening due to osteochrondromas at the distal radius (seven forearms). Operations were performed on 16 forearms in 13 patients, with 92% of satisfactory results. For Type I deformity, excision of osteochondromas, immediate ulnar lengthening and corrective osteotomy of the radius are recommended. For Type IIa, excision of the radial head is necessary, and for Type IIb, we advise gradual lengthening of the ulna using an external fixator. Excision of osteochondromas alone gave good results in Type III deformity. Our classification gives a reliable indication of the prognosis and is a guide to the choice of surgical treatment.

Adolescent↗
PubMed2006

Treatment of multiple hereditary osteochondromas of the forearm in children: a study of surgical procedures.

We have evaluated the clinical outcomes of simple excision, ulnar lengthening and the Sauvé-Kapandji procedure in the treatment of deformities of the forearm in patients with multiple hereditary osteochondromas. The medical records of 29 patients (33 forearms) were reviewed; 22 patients (22 forearms) underwent simple excision (four with ulnar lengthening) and seven the Sauvé-Kapandji procedure. Simple excision increased the mean supination of the forearm from 63.2 degrees to 75.0 degrees (p = 0.049). Ulnar lengthening did not significantly affect the clinical outcome. The Sauvé-Kapandji technique improved the mean pronation from 33.6 degrees to 55.0 degrees (p = 0.047) and supination from 70.0 degrees to 81.4 degrees (p = 0.045). Simple excision may improve the range of movement of the forearm but will not halt the progression of disease, particularly in younger patients. No discernable clinical or radiological improvement was noted with ulnar lengthening. The Sauvé-Kapandji procedure combined with simple excision of osteochondromas can improve stability of the wrist, movement of the forearm and the radiological appearance.

Adolescent↗
PubMed2000

Precision error of fan-beam dual X-ray absorptiometry scans at the spine, hip, and forearm.

The current study investigated short-term precision of fan-beam dual X-ray absorptiometry scans using a sample of subjects typically seen in a routine practice. Seventy-two women were scanned twice each in array fan-beam mode at the lumbar spine and 71 at the hip on a Hologic QDR 2000. Sixty-five were scanned at the forearm on a Hologic QDR 4500A in array mode. Each of the two scans was analysed without reference to its companion scan (independent analysis). The second assessment was also reanalyzed using the manufacturer's "Compare" function (compared analysis). Coefficients of variation (CVs) were calculated for the two forms of analysis at all the sites measured. Paired t-tests were performed to see whether the "Compare" function improved precision. The CV at the lumbar spine was 1.1% in both forms of analysis. The "Compare" function did not improve precision significantly at this site. The highest precision at the hip was found at the (Total) site of the hip (1.2-1.0%, independent and compared analyses, respectively) and the lowest at Ward's triangle. The Compare function significantly improved precision at Ward's triangle. The forearm had the best precision of all the sites measured with the Total site of the forearm being highest (0.5-0.7%) and the ultradistal site lowest (1.6-1.8%). The Compare function significantly decreased precision at the mid-distal and Total sites of the forearm. In conclusion, the highest precision was found at the Total site of the hip, the Total site of the forearm, and the spine. The Compare function did not significantly improve precision at the spine or hip (with the exception of Ward's triangle) and decreased precision at the forearm.

Absorptiometry, Photon↗
PubMed2001

Relation of forearm's bone and soft tissues to infant's body composition.

Small portable units using the dual X-ray absorptiometry method (pDEXA) are becoming available to evaluate a localized region of the body such as the forearm. The purpose of this study was to evaluate the relationship between infant's forearm measurements of bone mineral, lean, and fat mass and total body composition. Twenty-two infants participated in this study. Mean age of the infants was 21 d with a weight range of 1-3.6 kg. All infants were stable and had their forearm and total body scanned on the same day. The long-term precision error for the pDEXA was 0.4%. The infant's total body was scanned by the XR-26 (Norland Medical Systems, Fort Atkinson,WI). Forearm bone mineral content, bone mineral density (BMD), fat mass, and lean mass correlated to total body mineral content (BMC) (r = 0.84, p < 0.001), total body BMD (r = 0.73, p < 0.001), total fat mass (r = 0.53, p < 0.05), and total body lean mass (r = 0.80, p < 0.001). Forearm BMC, lean, and fat mass correlated significantly with body weight and length (r = 0.73-0.94). In conclusion, forearm measurements of bone mineral, fat, and lean mass reflect total body bone mineral, fat, and lean mass in small infants.

Absorptiometry, Photon↗
PubMed1999

Wrist and forearm postures of users of conventional computer keyboards.

The aim of this study was to perform a comprehensive investigation to document wrist and forearm postures of users of conventional computer keyboards. We instrumented 90 healthy, experienced clerical workers with electromechanical goniometers to measure wrist and forearm position and range of motion for both upper extremities while typing. For an alphabetic typing task, the left wrist showed significantly greater (p < .01) mean ulnar deviation (15.0 degrees +/- 7.7 degrees) and extension (21.2 degrees +/- 8.8 degrees) than the right wrist (10.1 degrees +/- 7.2 degrees and 17.0 degrees +/- 7.4 degrees for ulnar deviation and extension, respectively). Conversely, the right forearm had greater mean pronation (65.6 degrees +/- 8.3 degrees) than the left forearm (62.2 degrees +/- 10.6 degrees). We noted minimal functional differences in the postures of the wrists and forearms between alphabetic and alphanumeric typing tasks. Ergonomists should consider the statistically significant and probable practical difference in wrist and forearm posture between the left and right hand in ergonomic interventions in the office and in the design of computer keyboards. Actual or potential applications of this research include guiding the design of new computer keyboards.

Adult↗
PubMed1986

[Changes in the forearm tcPO2 following the cold water immersion test].

The purpose of this study is to apply changes in forearm transcutaneous PO2 (tcPO2) during the cold water immersion test (5 degrees C, for 10 min) to the diagnosis of vibration syndrome. Forearm tcPO2 in healthy controls increased gradually up to 3 min after the start of the cold water immersion and decreased thereafter. It returned to almost the same level before immersion 5 min after the start. In the workers using vibrating tools manifesting Raynaud's phenomenon, forearm tcPO2 also increased up to 3 min after the start as in healthy controls, but no change was observed thereafter. The difference between the level of forearm tcPO2 at 3 min and that at 10 min after the start of the immersion (Forearm tcPO2 recovery index, newly devised by authors) in workers using vibrating tools was significantly lower than that in healthy controls. Therefore, investigation of changes in forearm tcPO2 following the cold water immersion test is considered to be a useful objective item which can contribute to the diagnosis of vibration syndrome.

Aged↗
PubMed1999

Forearm vasoconstriction in response to noradrenaline and NG-monomethyl-L-arginine in essential hypertension.

A role for abnormal NO production in essential hypertension remains controversial. Blunted vasoconstriction of forearm resistance vasculature in response to N(G)-monomethyl-L-arginine (L-NMMA; an inhibitor of NO biosynthesis), relative to the response to noradrenaline, has been reported in hypertensive patients and interpreted as evidence of reduced basal NO biosynthesis. We sought to determine whether reduced sensitivity of forearm vasculature to the vasoconstrictor action of L-NMMA relative to that of noradrenaline is a consistent finding in essential hypertension. We studied a group of patients (n=32; blood pressure 176+/-4/102+/-2 mmHg; means+/-S.E.M.) and a group of healthy normotensive controls (n=32; blood pressure 130+/-2/75+/-1 mmHg). Noradrenaline (60-240 pmol.min(-1)) and L-NMMA (1-4 micromol.min(-1)) were infused into the brachial artery, and forearm blood flow was measured by venous occlusion plethysmography. The effects of each vasoconstrictor were similar in hypertensive and control subjects. The highest dose of L-NMMA reduced forearm blood flow by 0.75+/-0.12 ml.min(-1).dl(-1) in the control group and by 0.89+/-0.10 ml.min(-1).dl(-1) in the hypertensive group. The study had 90% power (with P=0.05) to detect a 10% difference in forearm blood flow response between the hypertensive and control groups. We conclude that reduced sensitivity of forearm resistance vasculature to the vasoconstrictor action of L-NMMA is not a universal feature of essential hypertension. This argues against a primary role for reduced basal NO biosynthesis in skeletal muscle resistance vessels in the pathogenesis of essential hypertension.

Adult↗
PubMed1999

Local vasodilatation with metacholine, but not with nitroprusside, increases forearm glucose uptake.

Insulin is known to increase blood flow in parallel to glucose uptake in skeletal muscle. However, it is not known if an increase in blood flow by itself is associated with an increase in glucose uptake in the absence of hyperinsulinemia. To investigate further this matter, the effect of increased blood flow on forearm glucose uptake was studied in the fasting state during intra-arterial infusions of two different vasodilators, metacholine and nitroprusside, in 19 hypertensive subjects. Both metacholine (4 microg/min) and nitroprusside (10 microg/min) increased resting forearm blood flow, measured by venous occlusion plethysmography, to a similar degree (180 % and 170 %, respectively, p<0.0001 for both). However, metacholine infusion increased the forearm glucose uptake from 2.0+/-0.9 (S.D.) during rest to 5.5+/-3.0 umol/min/100 ml tissue (p<0.0001), while no significant change in glucose uptake was seen during nitroprusside infusion (2.3+/-1.4 micromol/min/100 ml tissue). In conclusion, vasodilatation induced by metacholine, but not by nitroprusside, increased glucose uptake in the forearm of hypertensive patients. Thus, an increase in forearm blood flow does not necessarily improve glucose uptake in the forearm during the fasting state.

Adult↗
PubMedDate not supplied

Position of immobilization for pediatric forearm fractures.

The purpose of this study was to evaluate the effect of forearm position on residual fracture angulation for pediatric distal-third forearm fractures at the time of union. One hundred nine pediatric distal-third forearm fractures undergoing closed reduction and casting were prospectively randomized to be immobilized in pronated, supinated, or neutral position. Initial angulation and displacements were radiographically compared with healed fracture angulation at a minimum of 6 weeks. With 99 complete patient files, 38 fractures were casted in neutral, 26 in pronated, and 35 in supinated positions. Average initial angulation was 20 degrees; postreduction angulation measured 3 degrees. Final angulation at union averaged 7 degrees for all fractures. Forearm position failed to show a significant effect on fracture angulation at union. Residual fracture angulation at the time of union for pediatric distal-third forearm fractures was not significantly affected by forearm position (pronation, supination, neutral) during cast immobilization.

Casts, Surgical↗
PubMed1986

Verapamil antagonizes forearm vasoconstriction mediated by selective alpha 1- and alpha 2-agonists in hypertensive patients.

Calcium channel blocking agents preferentially antagonize alpha 2-mediated pressor responses in various animal species. Whether the same happens in man is not clear. For this reason we studied the interference exerted by verapamil, a calcium entry blocker, on forearm vasoconstriction mediated by selective alpha 1- (methoxamine) and alpha 2- (B-HT 933) adrenergic agonists in untreated mild-to-moderately hypertensive patients (n = 22). Each patient underwent a single study. Forearm blood flow was recorded by strain gauge venous plethysmography; all drugs were infused into the brachial artery at systemically ineffective rates. Cumulative dose-response curves to intra-arterial methoxamine or B-HT 933 were obtained during saline or two different rates of verapamil infusion (0.9 and 3.1 micrograms/100 ml forearm tissue per min) which increased forearm blood flow dose-dependently without changing systemic blood pressure or heart rate. Either methoxamine or B-HT 933 decreased forearm blood flow during saline infusion, but their effect was blunted in a dose-dependent manner during verapamil. No evidence of preferential alpha 2-antagonism was present. At variance with animal data, calcium entry blockade by verapamil antagonizes either alpha 1- or alpha 2-mediated vasoconstriction in human forearm vessels.

Adrenergic alpha-Agonists↗
PubMed1987

Effects of oral labetalol on forearm and hepatic circulations in normotensive humans.

The effects of single oral labetalol doses (100, 200, and 400 mg) on forearm and hepatic circulations were studied over a 2-hour period in 27 normotensive human subjects by using a double-blind, placebo-controlled design. Labetalol administration resulted in a dose-dependent beta-receptor blockade as determined by an isoproterenol sensitivity test. It also produced a dose-dependent decrease in mean arterial blood pressure that was of greater duration at larger doses. At the lowest dose labetalol produced a transient decrease in arterial pressure followed by a decrease in forearm blood flow and increase in forearm vascular resistance. As the dose of labetalol increased, the hypotensive response became more prolonged, but the changes in forearm blood flow and vascular resistance no longer occurred. Heart rate did not change significantly after any of these doses. Hepatic blood flow also did not change significantly after labetalol. Our results suggest that the increase in forearm vascular resistance after the lowest dose of labetalol probably was caused by unopposed alpha-receptor activation because the agent had a relatively greater beta-receptor blocking action at the low doses, but as the dose increased the alpha-receptor blocking action of the drug became more pronounced and abolished the vasoconstrictor effect in the forearm. Furthermore, our study indicates that despite the significant drop in arterial pressure at doses greater than 100 mg, blood flow is well maintained to the skeletal muscle and splanchnic circulations during labetalol therapy.

Administration, Oral↗
PubMed1987

Usefulness of regional bone measurements in patients with osteoporotic fractures of the spine and distal forearm.

Bone mineral mass was measured in normal subjects and osteoporotic patients at two forearm sites (proximal and distal of the 8 mm site between the two forearm bones) by single photon absorptiometry and in the spine and whole body by dual photon absorptiometry. There were no signs of preferential low spinal bone mass in 28 patients with vertebral fractures. Their bone mass was at all sites 26% to 37% lower than the premenopausal mean value and 7% to 13% lower than in age-matched normal women. In 45 patients with forearm fractures bone reduction was also universal but only 3% to 6% lower than in healthy women of comparable age. The spinal bone mass in all the patients was significantly related to both forearm measurements with coefficients of correlation of 0.58-0.61 and s.e.e. of 18%. Compared to the premenopausal normal range the distal forearm site had a greater sensitivity in identifying patients with vertebral fractures than had the spinal measurement (chi-square test, p less than 0.01). We thus conclude that patients with vertebral fractures have universal osteoporosis and that measurement of spinal BMC had no predictive advantages over that of the forearm bone mass for population studies.

Aged↗
PubMed1983

Separation of forearm hemodynamics into skin and muscle components by means of i-epinephrine iontophoresis.

By a combination of iontophoresis of I-epinephrine into the skin of one arm and simultaneous venous occlusion plethysmography in both treated (muscle only) and untreated forearms (muscle plus skin), we examined in 16 normal volunteers forearm blood flow, capillary filtration coefficient and venous capacity at cuff pressure of 40 mm of mercury (VC(40)) at rest, during tonic finger exercise and after interrupted repetitive finger exercise. Blood pressure did not change during the testing procedure. Forearm muscle conductance was about 60% to 70% of total conductance and was positively correlated with total conductance during rest and exercise. With standard exercises muscle conductance rises to 1(1/2) to 2(1/2) times resting level, and skin conductance rises to 2(1/2) to 4(1/2) times resting level. The capillary filtration coefficient is almost entirely in the muscle. It doubles in value with tonic exercise but decreases to half its resting value after interrupted repetitive exercise despite greatly increased conductance. Therefore, repetitive exercise-induced dissociation between conductance and filtration surface occurs in striated muscle. The mechanism is yet unknown. VC(40) in muscle is about 84% of total forearm VC(40). During tonic exercise muscle VC(40) was reduced, and during interrupted repetitive exercise the values for muscle and skin returned to resting values. A high correlation between muscle only and muscle-plus-skin for forearm blood flow and the identify between arms for measuring capillary filtration coefficient makes iontophoresis unnecessary for determining these values in forearm striated muscle under these experimental conditions.

Adult↗
PubMed1982

The effect on supination-pronation of angular malalignment of fractures of both bones of the forearm.

UNLABELLED: Ten fresh human upper-extremity cadaver specimens were tested for the effect of residual angulation from simulated fractures of both bones of the forearm on the potential for range of rotation of the forearm and for limitations of pronation and supination specifically. Ten and 20-degree angulations for the radius and ulna, such as might be encountered in all reasonable clinical situations, were tested. Little significant loss of forearm rotation resulted from angulations of 10 degrees in any direction. With 20 degrees of angulation, there was statistically significant and functionally important loss of forearm rotation. CLINICAL RELEVANCE: A residual angulation of 10 degrees in mid-shaft fractures of the radius, ulna, or both bones of the forearm will not limit forearm rotation anatomically. Loss in the range of rotation can be expected with residual angeles of 20 degrees or more.

Forearm↗
PubMed1995

Bone mineral density changes in the forearm after immobilization.

This study determined the early natural history of disuse osteoporosis in the ulna and radius. Six women and 2 men (mean age, 48.5 years; range, 35-60 years) having surgery on their wrists or hands had bone mineral density determined by single energy xray absorptiometry at 4 sites of the distal radius and ulna before operation, at cast removal (mean, 4.9 weeks after surgery), and after an average of 4.7 weeks of remobilization and hand therapy. A control group of 4 men and 4 women (mean age, 35.6 years; range, 24-46 years) had bone mineral density measurements of both forearms taken initially and again 5 weeks later. The patients had significant loss in bone mineral density at the ulna and distal sites of the forearm after 4.9 weeks of immobilization. Loss of bone mineral density continued at all 4 sites even after 4.7 weeks of remobilization and hand therapy. Bone mineral density increased significantly at the ultradistal radius of the contralateral forearm (which was not operated on) after 4.9 weeks, but this gain was no longer significant after 4.7 weeks of remobilization of the surgically treated forearm, suggesting that increased activity of the nonimmobilized forearm increased bone mineral density at certain sites. No changes in bone mineral density were seen in the control group. Immobilization of the forearm after hand or wrist surgery significantly decreases bone mass in the distal radius and ulna.

Adult↗
PubMedDate not supplied

Simultaneous human forearm and calf metabolic exchange.

Simultaneous forearm and leg metabolic exchange studies were performed to compare metabolic exchange and change in metabolic activity over time across the forearm and calf skeletal muscle beds in response to nutritional treatment. Seven postoperative upper-gastrointestinal resection patients received intravenous nutrition (IVN) for 10 days. Immediately before IVN was begun, simultaneous ipsilateral forearm and calf blood flow with arterial and venous sampling for plasma glucose and free fatty acids (FFAs), and whole-blood glycerol, lactate, pyruvate, and nitrogen were measured. After 10 days of IVN, these parameters were repeated in carefully standardized steady-state conditions. Although there were no differences between the arm and the leg with mean flux measurements, correlation of arm and leg flux values were only significant for FFA (p < 0.01) and blood nitrogen (p < 0.05). Forearm and leg metabolic exchange results were not in sufficient agreement to permit reliable use of these results interchangeably for individuals. Errors in blood flow measurement appear to be a major determinant of the poor relationship between forearm and leg flux measurements (limits of agreement 3.32-4.72 ml.dl-1 tissue.min-1). In conclusion, both forearm and leg metabolic exchange studies can be used to show the metabolic effects of treatment when groups of subjects are studied, but variability of the methods used result in poor agreement for the measurements of an individual.

Aged↗
PubMed1994

Release of tissue-type plasminogen activator in response to muscarinic receptor stimulation in human forearm.

We have recently shown that mental stress increases local net release of tissue-type plasminogen activator (t-PA) across the forearm vascular bed. However, the mechanisms responsible for the t-PA release in man during stress are undefined. To study the effects of endothelial cell receptor stimulation and fluid shear stress we used the perfused forearm model to characterize the in vivo tissue plasminogen activator (t-PA) response in man to methacholine (Mch) and sodium nitroprusside (SNP), at doses calculated to cause similar degrees of vasodilation. The study was performed in 7 healthy young men (age 22-24 yrs) without hypertension, diabetes mellitus, or hypercholesterolemia. Each subject received double-blind step-wise i. a. infusions of Mch (0.1-0.8-4.0 micrograms/min) and SNP (0.5-2.5-10 micrograms/min) in randomized order. Each dose step was infused for 5 min. Forearm blood flow was assessed by plethysmography. Net release/uptake was expressed as the product of arterio-venous concentration gradient and forearm plasma flow. At pre-infusion baseline, there was a significant net release of t-PA antigen of approximately 0.9 ng x min-1 x 100 ml-1 and t-PA activity of 3.5 fmol x min-1 x 100 ml-1 across the forearm. I.a. infusion of Mch and SNP increased forearm blood flow from 1.9 to 14.9 and from 1.8 to 12.1 ml x min-1 x 100 ml-1, respectively (Mch vs SBP N.S.).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

[An anatomical study on the interosseous membrane of the forearm].

The anatomy of the interosseous membrane (IOM) was studied in 117 forearms from sixty cadavers (average age; 73 years old) for the purpose of optimizing the osteotomy portion in forearm lengthening, or in osteotomy for an old Monteggia fracture. The morphological anatomy of the interosseous membrane, and its relation anatomically to the surrounding structures were investigated. A total of 68.4% of the IOM was classified as Type 1a or 1 b, in which one cord-like portion was observed. The accessory cord-like portion was found in 57.8% of the forearms. The cord-like portion was attached at a position of 39.6-54.8% from the distal end of the radial bone and at 21.9-42.1% from the distal end of the ulnar bone (average rate per forearm length). The accessory cord-like portion was attached at a position of 48.9-53.3% from the distal end of the radial bone and at 56.9-61.8% from the distal end of the ulnar bone. From there results, the optimal portion for osteotomy in forearm lengthening and in old Monteggia fracture was determined to minimize the anatomical and functional damage to the forearm.

Aged↗