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PubMed1975

Colles' fractures. Functional bracing in supination.

The classic position of immobilization of Colles' fractures with the elbow in flexion, the forearm in pronation, and the wrist in volar flexion and ulnar deviation is probably the main reason for the common and rapid recurrence of the original deformity. Such a position places the brachioradialis muscle, a strong flexor of the elbow and the only muscle attached to the distal fracture fragment, in an ideal physiological position to exert a deforming force on the fracture fragments. Based on this assumption, further supported by electromyographic studies, a method of treatment was developed which calls for the initial immobilization of the arm in an above-the-elbow cast with the elbow in flexion, the forearm in supination, and the wrist inmoderate ulnar and volar flexion. This cast is changed a few days after application for an Orthoplast brace that permits motion of the elbow and volar flexion of the wrist while preventing pronation and supination of the forearm and dorsiflexion of the wrist. The proposed method did not prevent collapse of the fragments in all instances. However, the degree of collapse was minimum. The position of supination of the forearm and the freedom of motion of all joints seemed to reduce the swelling, stiffness, and incapacitation frequently found during active treatment of these fractures.

Braces↗

PubMed2002

[Treatment of epicondylitis by deep fasciotomy of the extensor carpi radialis brevis and supinator: a review of 18 cases].

PURPOSE OF THE STUDY: Epicondylalgia is a frequent condition although the cause and appropriate treatment remain a subject of debate. We present our experience with surgical treatment based on the hypothesis that the condition results from excessive tension on the deep aponeurosis of the carpal and digital extensors. MATERIAL AND METHODS: Between 1996 and 1998, sixteen patients underwent surgical treatment of epicondylalgia unresponsive to medical treatment. There were six men and ten women, men age 43 years, two underwent bilateral procedures. The dominant side was involved in 75% of the cases. For ten patients, heavy manual work led to epicondylalgia. For two others it was related to sports activities. Mean duration of medical treatment prior to surgery was 16 months. A double deep transverse fasciotomy of the extensor carpi radialis brevis (ECRB) was performed in all cases, alone for 3, and associated with section of the Fröhse arcade in 5, supinator fasciotomy in 9, and complete section of the superficial head of the supinator in 4. For five recent cases, double fasciotomy of the extensor digitorum communis (EDC) was also performed. The epicondyle was left intact as were all tendons. All patients were reviewed at a mean 20 months. The Roles and Maudsley classification was recorded. Motor force was measured comparatively with a Jamar dynometer. RESULTS: Outcome was excellent in 7 cases, good in 7 and acceptable in 4. All patients improved. Outcome was excellent in 2 cases and fair in 3 cases with double fasciotomy of the EDC. The period of work loss was 3 months on the average. Forty-six percent of the patients resumed their former activity at 6 weeks. Muscle force was globally reduced 21.5% compared with the contralateral side (range 0-60%). DISCUSSION: This surgical technique is based on the hypothesis that epicondylalgia results from excessive tension on the epicondylar area leading to enthesitis or aponeuritis, or both. Deep fasciotomy allowed distension and clinical improvement in all cases. Associated deep fasciotomy of the EDC in addition to the transverse fasciotomy of the ECRB and supinator appears to improve functional outcome.

Absenteeism↗

PubMed1992

Predictive value of transcutaneous oxygen pressure and amputation success by use of supine and elevation measurements.

The purpose of this study was to determine if transcutaneous oxygen pressure (tcPO2) measurements can be used to predict amputation site healing in lower limbs with arterial occlusive disease. We measured tcPO2 (supine and with limb elevation) in 90 limbs before amputation and reviewed their subsequent clinical course. Of these, 52 (57%) successfully healed, 21 (23%) failed, and 17 (18%) exhibited delayed healing. Limbs with delayed healing or failure had significantly lower tcPO2 values than values of those that healed. A tcPO2 greater than or equal to 40 torr was associated with primary or delayed healing in 51 of 52 limbs (98%), and a tcPO2 value of less than 20 torr was universally associated with failure. For patients with a tcPO2 between 20 and 40 torr, tcPO2 measurements obtained during limb elevation improved the predictability of outcome. We conclude that supine tcPO2 measurements can help predict amputation site healing, and that tcPO2 measurement during limb elevation improves predictability in limbs with borderline supine tcPO2 values.

Adult↗

PubMedDate not supplied

Alterations in brain-stem auditory responses induced by head down tilting in hypertensives with supine brain-stem disorders.

The influence of head down (HD) tilting on brain-stem auditory evoked responses (BAER) was studied in hypertensives with supine brain-stem disorders (occipital headache, vertigo, nausea, diplopia, blurred vision occurring after night recumbency), in hypertensives without such phenomena and in normotensives. In the latter two categories of subjects HD tilting had no effect on BAER. On the contrary, in hypertensives with supine brain-stem disorders the manoeuvre induced a constant prolongation of I-V and III-V intervals and a depression in the amplitude of wave V; the alterations of BAER produced by HD tilting reveal probably a dysfunction of the superior brain-stem area and might be due to the impaired cerebral venous draining subsequent to the manoeuvre. The study of BAER after HD tilting seems to be a proper means to attest the supine brain-stem disorders displayed by some hypertensives.

Brain Ischemia↗

PubMed1989

SK&F 86466, a novel alpha-adrenolytic drug: effects on heart rate, blood pressure, and neuroendocrine function in supine resting position and in response to postural and cold stimulation in normal humans.

SK&F 86466 is a novel alpha-adrenoceptor blocking drug shown in preclinical profiling to have relative selectivity for the pre- and postjunctional alpha 2-adrenoreceptor. In the present clinical study, the effects of single oral doses of 10, 25, and 50 mg SK&F 86466 on supine and stimulated circulatory and neuroendocrine function were assessed in eight normal subjects studied in a placebo-controlled balanced cross-over design with the drugs administered in double-blind fashion. SK&F 86466 caused a dose-related increase in stimulated (postural and cold challenge) and supine plasma norepinephrine (NE) concentrations. This increase was associated with an increase in supine heart rate (HR) and plasma renin activity and orthostatically stimulated HR, with little increase in systolic blood pressure (SBP) and no increase in diastolic blood pressure (DBP). Assuming that no changes occurred in catecholamine clearance, SK&F 86466 thus appeared to have a prejunctional alpha 2-adrenoreceptor blocking effect, which was countered by a post-junctional alpha-adrenoreceptor blocking effect at the level of the resistance vessels, whereas this latter effect did not alter the pressor responses to cold and postural challenge.

Adrenergic alpha-Antagonists↗

PubMed1977

Argon laser treatment in supine position.

When using an argon laser photocoagulator it is often advantageous and sometimes indispensable to treat the patient in a supine position. Stabilization of the laser beam requires the use of a microscope equipped with a beam manipulator (joystick) that maintains the orientation of the laser beam wherever it is placed, without the operator having to hold the joystick. A low-vacuum contact lens or a three-mirror lens, and a microscope suspended from a floor stand are used. The patient is placed in the supine position on a stretcher of adjustable height with his head in a foam rubber conformer. Local anesthesia may not be necessary, but if indicated, the patient should not be treated in an upright position. A lid block is rarely required. General anesthesia is used with patients who cannot cooperate. There are 4 main indications for treatment in the supine position: (1) cases in which great accuracy is needed, such as treatment near the macula; (2) all cases in which retrobulbar anesthesia is necessary, with or without a lid block; (3) cases in which the patient is unable to cooperate; and (4) cases that require prolonged photocoagulation.

Adult↗

PubMed1983

Morphological variations in ulnar supinator crests and fossae as identifying markers of occupational stress.

Recent morphometric studies of ulnae of prehistoric skeletal remains from populations known to have used spears, atlatls, and similar projectile weapons for hunting and warfare reveal a high incidence of hypertrophy of the ulnar crest, to which the supinator muscle is attached, along with pronounced depth of the adjacent supinator fossa, especially in the upper extremities of males. Similar features occur in the right ulnae of living persons of both sexes who are habitually engaged in certain occupational and athletic activities involving angular displacement of the forearm as a result of medial rotation of the arm at the shoulder, shoulder and arm rapid extension, and abrupt shifts from forearm supination to pronation. Aside from its forensic science implications in determination of right- or left-handedness as a trait peculiar to the individual, observation of these markers of stress on the proximal end of the ulna are significant in identification of skeletal remains of persons known to have engaged in specific brachial activities during life. The biomechanics of these movement patterns and activities in which they occur, when properly interpreted, are relevant to forensic science problems of individual identification and paleoanthropological studies of occupational stress factors in extinct populations for which a skeletal record is available.

Anthropology, Physical↗

PubMed1984

Comparison of AP supine vs PA upright methods of chest roentgenography in infants and young children.

Various arguments have been advanced for preferring either the AP recumbent projection or the PA upright projection in chest roentgenography of infants and young children. One prominent argument for PA projection is that it shows less magnification.In a search of the literature, no study could be identified that statistically compares the cardiothoracic ratios in a series of patients with simultaneous PA upright and AP supine chest roentgenograms. This study addresses that point and also examines other factors in the two different projections.A survey of pediatric radiology departments in the United States shows an overall preference for the AP supine projection by a factor of 2:1. Statistical analysis of the two methods in this study demonstrates no significant difference in the cardiothoracic ratios. All other factors considered, the authors are of the opinion that the AP supine projection is more desirable in the infant and young child.

Child↗

PubMed1978

Inclined or conventional supine position in ultrasonic examinations in late pregnancy.

Ultrasonic examinations were made on 22 patients in late pregnancy both in the conventional supine position and in an inclined position. The findings give rise to the following conclusions: 1) The inclined position prevents the development of the vena cava inferior syndrome. 2) The examinations can be made as easily and accurately in the inclined as in the conventional supine position. 3) In cases where the head is in the occipito-posterior position the inclined position may increase the reliability of the measurement of the biparietal diamter. The authors consider it recommendable to use the inclined position instead of the conventional supine position in ultrasonic examinations to maintain both maternal and fetal well-being during the procedure.

Female↗

PubMed1982

The effect of hydrostatic pressure on the interpretation of the supine pressor test.

To assess the effects of hydrostatic pressure on the interpretation of the supine pressor test (SPT), blood pressure (BP) measurements were made with a mercury sphygmomanometer in 35 normotensive primigravid patients between 28 and 32 weeks' gestation. BP was recorded in both left lateral recumbent and supine positions. Blood pressure was also recorded in both arms simultaneously by separate observers. A positive supine pressor test was defined as a diastolic BP rise of 20 mm Hg. There were no positive SPTs when BP was recorded in the lower arm despite the development of preeclampsia in eight patients. When BP was corrected for the hydrostatic effect of position, no correlation was seen between position change and blood pressure (p greater than 0.05). Diastolic BP was significantly higher (p less than 0.01) in patients who later developed preeclampsia than in patients who remained normotensive.

Blood Pressure↗

PubMed2002

Effects of supine intermittent compression on arterial inflow to the lower limb.

HYPOTHESIS: Intermittent pneumatic compression will affect the arterial blood flow in the lower limb at moderate pressure, without requiring dependency. DESIGN: Before-after trial. SETTING: Vascular ultrasound unit of a university hospital. PATIENTS: A volunteer sample of 19 healthy subjects without symptoms or history of vascular disease and 17 patients with peripheral arterial disease were studied. Six patients and 1 healthy volunteer were not included in the study group because of measurement difficulties or refusal when approached. INTERVENTIONS: Common femoral artery blood flow velocities were measured with Doppler ultrasound during 10 minutes of intermittent compression of the calf and thigh at 60 mm Hg, while the subject was supine. The data were collected every 5 seconds from 4 minutes before to 4 minutes after the therapy period, and toe temperatures were also measured with an infrared radiometer. MAIN OUTCOME MEASURES: Resting to postcompression percentage increases in flow velocity were measured, along with more representative measures of the total flow change during the intermittent compression period. RESULTS: On compression, the blood flow velocity decreased slightly (15% in healthy subjects and 6% in patients) and increased on release (21% and 29%, respectively). Overall, blood flow did not decrease during therapy as expected (increases of 1% and 2%, respectively), and the toes of the patients warmed (by 2.2 degrees C). CONCLUSIONS: This work confirms the initial hypothesis in both subject groups. There appears to be physiological justification for investigating intermittent compression as a therapy for patients with intermittent claudication and rest pain in the supine position as well as seated.

Adult↗

PubMedDate not supplied

MR imaging of the female pelvic floor in the supine and upright positions.

The goal of this study was to determine whether a .5-T open configuration magnet system could be used to evaluate the female pelvic floor support structures and their functional changes in the upright and supine positions. We evaluated five normal volunteers with full bladders in the supine and sitting positions. Multiple measurements were obtained, including distance between symphysis and urethra, bladder neck to fixed pubococcygeal line, and posterior urethrovesical angle. The pelvic floor was evaluated for integrity of the urethra, vagina, and supporting ligaments. High quality, interpretable images were obtained for all five patients in both positions. Most of the pelvic floor structures were stable, with the exception of the posterior urethrovesical angle, which increased in the sitting position. We conclude that the vertically open configuration magnet system shows promise for evaluation of the female pelvic floor, including urinary stress incontinence and prolapse.

Adult↗

PubMed2006

Prone versus supine positioning in the well preterm infant: effects on work of breathing and breathing patterns.

Premature infants with respiratory distress oxygenate better and have improved breathing synchrony when they are nursed in the prone position. We investigated whether work of breathing (WOB) is decreased in the prone position in healthy premature infants nearing discharge from the neonatal intensive care unit. Nineteen convalescing premature infants in room air were studied in both supine and prone position. Positioning order was randomized. Mean birth weight was 1358 +/- 332 (SD) g, gestational age 29.7 +/- 2.1 weeks, weight at study 1757 +/- 248 g, and age at study 33.6 +/- 1.4 days. Calibrated respiratory inductance plethysmography (RIP) was used to measure tidal volume; an esophageal catheter estimated pleural pressure. Inspiratory, elastic, and resistive WOB were calculated and were unaffected by prone versus supine positioning (P = 0.46, 0.36, and 0.87, respectively). Similarly, respiratory rate, tidal volume, minute ventilation, and lung compliance did not differ between positions. These data suggest that sleep position recommendations for healthy premature infants discharged home without oxygen should be no different than for term infants.

Female↗

PubMed1995

Hemodynamics during laparoscopy in the supine or prone position. An experimental study.

During laparoscopy elevations in arterial pressure and a decrease in cardiac output have been reported. Laparoscopic surgery performed in the prone position may be advantageous for some surgical procedures, but the hemodynamic effects of pneumoperitoneum in this position have not been studied. We studied the effects of different levels of increased intraabdominal pressure on hemodynamics and oxygen transport in eight pigs in the prone and the supine position. Increases in intraabdominal pressure did not result in decreased cardiac output or in a reduction of oxygen transport and consumption in either position. These results suggest that laparoscopy in the prone position does not result in more severe hemodynamic depression than laparoscopy in the supine position.

Analysis of Variance↗

PubMed1989

Impedance-derived cardiac indices in supine and upright exercise.

Impedance cardiography was used to determine the classical systolic time intervals (STI's) (i.e., pre-ejection period (PEP), left ventricular ejection time (LVET) and the quotient PEP/LVET), in young, healthy, male subjects during supine and seated exercise. With increasing exercise, there was a tendency toward decreases in PEP, LVET, and PEP/LVET. In the seated position, there was an increase in transthoracic Zo incident to the caudal migration of thoracic blood--a result of the postural change. With seated exercise, there were--in contrast to supine exercise-greater decreases in PEP/LVET and greater increases in the Heather index. Similarly, there was a tendency toward increases in dZ/dtmin and the Rapid Ejection Index. We suggest that these differences are related to increased myocardial contractility resulting from the postural augmentation of cardio-sympathetic activity, added to that of exercise per se. This study, as well as previous ones, indicates that impedance cardiography is reliable, effective, and more practicable than the arteriographic method for monitoring STI's. We also believe that certain impedance-derived indices (i.e., transthoracic Zo, dZ/dtmin and the Heather Index) have considerable potential value for physiologic and clinical investigation.

Adult↗

PubMed1998

Emergency tracheal intubation of patients lying supine on the ground: influence of operator body position.

PURPOSE: To evaluate the influence of operator body position during emergency intubation of patients lying on the ground. METHODS: This study was carried out in the prehospital setting by French mobile intensive care units. Two operator body positions (left lateral decubitus and kneeling) for emergency intubation of patients lying supine on the ground were compared in a observational prospective study. Each operator completed a questionnaire regarding conditions of intubation after patient completion. RESULTS: The incidence of laryngoscopic difficulty was lower in the left lateral decubitus group compared to the kneeling group (11.1% vs 26.9% respectively; P < 0.01). The number of attempts required for successful intubation was (P < 0.05) higher in the kneeling group than in the left lateral decubitus group. CONCLUSION: Emergency tracheal intubation of supine patients on the ground may be greatly facilitated by the use of the left lateral decubitus position of the operator.

Adolescent↗

PubMed2003

The anterior combined approach via a single skin injection site allows lower limb anesthesia in supine patients.

PURPOSE: Lower limb anesthesia (LLA) requires the combination of, at least, three-in-one and sciatic nerve (SCN) blocks. Anterior approaches are easier to perform with minimal discomfort in supine patients, specially for traumatology. Feasibility of a single needle entry combined approach is reported. CLINICAL FEATURES: The combined landmark was applied in 119 ASA I and II patients (32-68 yr) scheduled for surgery below the knee. Needle (nerve stimulation applied through a single 150-mm long b-bevelled insulated needle) was inserted at the midpoint between the two classical approaches. Thirty and 15 mL of 0.5% ropivacaine were injected close to the femoral and the SCN, respectively. During the following 45 min, the extent of sensory block and knee and ankle motor block were assessed. Landmarks were determined within 1.7 min (0.7-2.2 min). The entire procedure was performed within 4.2 min (2.9-7.1 min) from the determination of the landmark to the SCN infiltration. The three-in-one technique was successful in 89.9% while SCN was successful in 94.9%. Femoral and tibial nerves were always blocked. Blockade of the posterior cutaneous femoral nerve was observed in 78% of patients. The extent and the quality of the sensory block always allowed surgery. Additional iv sedation was needed in 32.6% of patients. Motor block (adapted Bromage's scale > 2) was observed in the femoral (98.3%), the obturator (84.8%), the tibial (97.4%) and the common peroneal (85.7%) nerve distributions. No important adverse effects were recorded. CONCLUSION: The anterior combined approach via a single needle entry represents a technically easy and reliable technique to perform LLA in the supine patient.

Adult↗

PubMed2003

Sciatic nerve blockade in the supine position: a novel approach.

PURPOSE: Sciatic nerve block is useful for surgery below the knee both intra- and postoperatively. Several techniques to insert a catheter at the knee level or higher have been described but need mobilization (lateral decubitus) of the patient. We describe novel landmarks, using a high lateral approach, to block the sciatic nerve without moving the patient. CLINICAL FEATURES: One hundred seven ASA I, II and III ASA patients scheduled for major foot or ankle surgery were studied prospectively. With patients awake and lying in the supine position, the catheter was introduced along novel landmarks in the peri-nervous adipose space using specifically designed material and nerve stimulation (< 0.5 mA). After a negative test dose (1% lidocaine with 1/200.000 epinephrine), 10 mL of 0.5% bupivacaine and 10 mL of 2% lidocaine were injected. Thirty minutes after performance of the block, the cutaneous and dermatomal sensory blockade were assessed using cold and pinprick tests while motor block was assessed using a modified Bromage scale. Complications and incidents were recorded. The tibial and superficial peroneal nerve were always blocked, while the deep peroneal and postero-femoral cutaneous nerves were blocked in only 97% and 83% of the patients, respectively. Anesthesia, was always present in the dermatome L5 and in the S1 dermatome in 98% of the patients. No major incidents or complications were noted. Three catheters could not be inserted and the anesthestic solution was injected through the needle. CONCLUSION: The lateral technique for sciatic nerve anesthesia and catheter insertion allows patients to remain in the supine position for performance of the block and catheter insertion, and results in a high rate of homogeneous anesthesia and a low incidence of side effects.

Adult↗