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At least 649 records · Page 36Linked to original sources
PubMed1992

Use of arm crank exercise in the detection of abnormal pulmonary gas exchange in patients at low altitude.

BACKGROUND: The measurement of arterial blood gases, P(A-a)O2 and VD/VT, during cycle ergometry is the "gold standard" for the assessment of pulmonary gas exchange. However, some patients are unable to perform cycle ergometry because of other medical problems. STUDY OBJECTIVE: To determine whether arm crank exercise could be used to reliably detect gas exchange abnormalities compared to cycle ergometry. PARTICIPANTS: Fifteen patients with a variety of pulmonary disorders, who were referred for exertional dyspnea. DESIGN: All patients performed maximal arm crank and cycle exercise. Arterial blood gases, VO2, VCO2, and VE were measured at rest and during exercise. RESULTS: Compared to peak cycle exercise (mean +/- SD), PaO2 (85 +/- 14 vs 75 +/- 13 mm Hg), SaO2 (94 +/- 2 vs 91 +/- 4 percent), VD/VT (0.21 +/- 0.07 vs 0.19 +/- 0.08), and pH (7.37 +/- 0.04 vs 7.34 +/- 0.03) were significantly higher during peak arm crank exercise. The P(A-a)O2 (18 +/- 13 vs 29 +/- 12 mm Hg) was narrower, and PaCO2 (29 +/- 3 vs 29 +/- 4 mm Hg) and PAO2 (104 +/- 4 vs 103 +/- 4 mm Hg) were similar. Six patients had normal gas exchange during cycle exercise at low altitude (P[A-a]O2 less than or equal to 27 mm Hg, PaO2 greater than or equal to 65 mm Hg, VD/VT less than or equal to 0.18) and nine were abnormal. Utilizing criteria specific for arm crank at low altitude, the same six patients had normal gas exchange (P[A-a]O2 less than or equal to 13 mm Hg, PaO2 greater than or equal to 85 mm Hg, VD/VT less than or equal to 0.26), and the remaining nine were abnormal. The P(A-a)O2 during peak arm crank was the most useful criterion in identifying patients with abnormal gas exchange. CONCLUSION: Proposed criteria for arm crank exercise testing accurately identified all patients with normal and abnormal pulmonary gas exchange during cycle exercise. The data from the present study suggest that arm crank can be an acceptable alternative exercise testing modality for the assessment of pulmonary gas exchange.

Adult↗
PubMed2005

Common encoding of novel dynamic loads applied to the hand and arm.

In manual action, the relationship between a given motor command and the ensuing movement depends on the dynamics of both the arm and hand-held objects. Skilled performance relies on the brain learning both these dynamics, and previous studies have examined how people adapt to novel loads applied to either the hand or the arm. In this study, we ask whether these different kinds of load are represented independently as a result of changes in cutaneous feedback and hand-arm coordination. We used a robotic apparatus that could either apply forces to an object held in the subject's hand or directly to the segments of the arm. We tested whether subjects could retain learning of a force field applied to the hand after subsequently experiencing the opposing field applied to the arm (or vice versa), or whether retrograde interference would be observed. In separate experiments, we used force fields and torque fields that were linearly related to either hand or joint velocities, respectively. Our finding of complete interference between opposing fields suggests that loads applied to the arm and hand are not represented independently by the sensorimotor system. This interference occurred despite markedly different cutaneous inputs that were directly related to the movement task. This result suggests that the brain represents dynamics independently of these sensory inputs. In addition, we found that the rate at which subjects adapted to a given force field, specified either in hand or joint coordinates, was independent of whether the forces were applied to the hand or arm segments.

Adult↗
PubMed2001

Radiation exposure with use of the inverted-c-arm technique in upper-extremity surgery.

BACKGROUND: Intraoperative fluoroscopy is commonly used in surgical procedures on upper extremities. We compared radiation exposure from two possible positions of the mobile digital fluoroscopy unit (c-arm): (1) the standard technique, with the x-ray tube down (near the floor) and the image intensifier at the top of the c-arm, and (2) the inverted position, in which the image intensifier is used as a table and the x-ray tube is up. METHODS: A commercially available c-arm was used to irradiate a phantom hand in one of three configurations. In the first, the phantom hand was placed on an armboard equidistant from the x-ray tube and the image intensifier with the beam directed upward. In the second, the c-arm was inverted with the beam directed downward and the image intensifier used as a table. The third configuration was identical to the second except that a magnified image was used. Radiation exposure was measured at four locations corresponding to the approximate position of the surgeon's head, chest, and groin and the patient's hand. RESULTS: The amount of radiation exposure to both the surgeon and the patient was significantly less when the c-arm was used in the inverted position (p < 0.0001). The dose rate to the patient's hand was reduced by 59%. The radiation exposure to the surgeon's head, body, and groin with the inverted-c-arm technique was 67%, 45%, and 15% of the measured doses with the x-ray-tube-down configuration. When we used the magnification mode of the image intensifier, with its correspondingly smaller field size, the doses were further reduced to 46%, 32%, and 11% of the standard-configuration values. CONCLUSIONS: Use of the inverted-c-arm technique with the image intensifier as an operating table can significantly reduce radiation exposure to the surgeon and the patient during surgical procedures on upper extremities.

Arm↗
PubMed2004

Idiopathic arm pain.

BACKGROUND: Arm pain with little or no objective abnormality (referred to herein as idiopathic arm pain) is a common and frustrating problem for both patients and physicians. We investigated the relative effect of idiopathic arm pain and arm pain due to a discrete diagnosis on upper-extremity-specific health status. METHODS: The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was completed by 3888 patients seen over a twelve-month period. Scores for the entire sample, for 496 patients diagnosed with idiopathic arm pain, and for 1379 patients diagnosed with one of twenty-one discrete conditions were compared. RESULTS: Patients with idiopathic pain reported substantial and highly variable upper-limb-specific dysfunction (average DASH score [and standard deviation], 36 +/- 24 points). Patients with discrete diagnoses also exhibited substantial variation (average standard deviation, 25; range, 6 to 27) as well as long right tails indicating floor effects, particularly for less severe conditions (Pearson correlation of r = -0.87 between the mean DASH score and skewness). Analysis of variance confirmed the ability of the DASH instrument to discriminate among groups of diagnoses of varying severity, but post hoc Tukey analysis identified ten subgroups with substantial overlap of the DASH scores. CONCLUSIONS: Patients with idiopathic arm pain report substantial and highly variable upper-extremity dysfunction. The wide variations observed in the DASH scores of the patients with idiopathic pain and those with discrete diagnoses are greater than would be expected on the basis of the variations in the objective pathological conditions and may reflect the strong influence of psychological and sociological factors on health status measures.

Arm↗
PubMed2005

Mechanical impedance and absorbed power of hand-arm under x(h)-axis vibration and role of hand forces and posture.

The biodynamic responses of the hand-arm system under x(h)-axis vibration are investigated in terms of the driving point mechanical impedance (DPMI) and absorbed power in a laboratory study. For this purpose, seven healthy male subjects are exposed to two levels of random vibration in the 8-1,000 Hz frequency range, using three instrumented cylindrical handles of different diameters (30, 40 and 50 mm), and different combinations of grip (10, 30 and 50 N) and push (0, 25 and 50 N) forces. The experiments involve grasping the handle while adopting two different postures, involving elbow flexion of 90 degrees and 180 degrees, with wrist in the neutral position for both postures. The analyses of the results revealed peak DPMI magnitude and absorbed power responses near 25 Hz and 150 Hz, for majority of the test conditions considered. The frequency corresponding to the peak response increased with increasing hand forces. Unlike the absorbed power, the DPMI response was mostly observed to be insensitive to variations in the excitation magnitude. The handle diameter revealed obvious effects on the DPMI magnitude, specifically at frequencies above 250 Hz, which was not evident in the absorbed power due to relatively low velocity at higher frequencies. The influence of hand forces was also evident on the DPMI magnitude response particularly at frequencies. above 100 Hz, while the effect of hand-arm posture on the DPMI magnitude was nearly negligible. The magnitude of power absorbed within the hand and arm was observed to be strongly dependent upon the excitation level over the entire frequency range, while the influence of hand-arm posture on the total absorbed power was observed to be important. The effect of variations in the hand forces on the absorbed power was relatively small for the bent elbow posture, while an increase in either the grip or the push force coupled with the extended arm posture resulted in considerably higher energy absorption. The results suggested that the handle size, hand-arm posture and hand forces, produce coupled effect on the biodynamic response of the hand-arm system.

Arm↗
PubMed1976

Transmission of vibration in the hand-arm system with special reference to changes in compression force and acceleration.

The transmission of longitudinal vibration in the hand-arm system of five subjects was investigated. Altogether 405 individual tests were made. Vibration was measured with an accelerometer (weight 0.4 g) fixed in turn to the wrist, the elbow, and the upper arm by means of a supporting device (weight 34 g). A handle with strain gauges attached was used to study the effect of compression force (10, 20 and 40 N) and constant acceleration (1, 3 and 10 g) on the transmission of vibration at frequencies from 20 to 630 Hz. In the curves recorded, sharp dips appeared which were evidently caused by resonances from the soft tissues of the hand. However in the hand-arm system no common resonance frequency was observed that would harmfully affect the health of workers. Vibration in the hand-arm system was attenuated at an average of 3 dB per octave at the frequencies between 20 and 100 Hz. Between 100 and 630 Hz the attenuation was about 6 dB per octave in the wrist and 10 dB per octave in the elbow and upper arm. At the frequency of 630 Hz the attenuation was hence about 35 dB in the wrist and about 45 DB in the elbow. The attenuation of vibration in the elbow joint was 2 to 4 dB at all frequencies. The hand-arm system appears to be linear at the acceleration range considered; the increase in handle vibration by, e.g., 10 dB also increased vibration in the hand by 10 dB. When the grip strength was increased fourfold, i.e., 12 dB, vibration increased only 3 to 5 dB in the hand-arm system. Thus changing the weight of a vibrating tool does not reduce vibration enough. Therefore attempts to reduce vibration should concentrate on the mechanical parts of the engines.

Acceleration↗
PubMed2001

[Arm morbidity after axillary dissection for breast cancer].

INTRODUCTION: Axillary dissection for breast cancer is known to leave the patient with arm morbidity. The aim of this study was to describe the occurrence of lymphoedema, subjective swelling, abnormal sensations, and pain in a consecutive group of patients operated for breast cancer. METHODS: From April to October 1992, 140 consecutive women underwent an operation for breast cancer with axillary dissection at levels one and two. Patients with bilateral breast cancer or radiotherapy towards the axilla were excluded. The surviving 124 patients were invited to an investigation on arm morbidity and a questionnaire on subjective complaints was sent to them. Medical records and pathology reports were reviewed. Ninety-five patients (77%) were examined. Oedema of the arm was assessed by circumference measurements at three points. RESULTS: Objective oedema was found in six patients (6%). Subjective swelling was reported by 24 women (25%). Of these, 14 women reported slight swelling, seven had moderate swelling, and three had severe swelling of the arm. Pain within the three months preceding the examination was reported by 31 (33%). Analgesics were taken by 13 women (14%), of whom five used analgesics daily. Abnormal sensations in the ipsilateral arm was reported by 62 (65%). Young patients in the low risk group, with removal of more than ten lymph nodes, suffered a higher degree of arm morbidity. CONCLUSIONS: The only modifiable risk factor identified is the number of lymph nodes removed in axillary dissection. Other methods of staging could probably lessen arm morbidity.

Arm↗
PubMed1992

Subcutaneous interstitial fluid pressure and arm volume in lymphoedema.

Interstitial fluid pressures were measured by the wick in needle method in the swollen and normal arms of 38 patients with lymphoedema resulting from treatment for breast cancer. The mean increase in arm volume, calculated from sequential circumferential measurements, was 33% (range 0.25 to 85.9). Subcutis interstitial fluid pressure in the swollen arm (2.0 cmH2O range -4.5 cmH2O to 6.8 cmH2O) was significantly greater (p < 0.001) than in the contralateral, non-swollen arm (-2.6 cmH2O range -11 cmH2O to 0 cmH2O). Interstitial fluid pressure in the oedematous arm did not correlate with the duration of the swelling (1-324 months), but did correlate with the increase in volume relative to the normal arm (r = 0.38, p < 0.05), the slope ('apparent compliance') being 28 ml.dl-1.cmH2O-1. The pressure-volume curve was less steep than the classic curve for acute oedema of dog limbs (Guyton, 1965). Vascular pressures were normal. The interstitial fluid pressures were not as high as those reported for lymphoedema of the lower extremity (mean 17.9 mmHg, Christensen et al., 1985). Nevertheless, the rise in interstitial fluid pressure by an average of 4.6 cmH2O constitutes a force opposing further microvascular fluid filtration and perhaps promoting fluid drainage out of the arm.

Adult↗
PubMed2004

Severe lymphedema of the arm as a potential cause of shoulder trauma.

The aim of this study was to determine whether lymphedema of the arm is associated with traumatic injury to the shoulder and to assess the role of lymphatic physiotherapy in reducing disabling shoulder pain. The study group consisted of 10 women aged 58-81 years (mean 66.9) with arm lymphedema after surgery for breast cancer. The average interval between the operation and the appearance of lymphedema was 9.8 years. All patients complained of shoulder pain. Five patients had a tear in the supraspinatus muscle diagnosed by ultrasound examination, and 5 had chronic bursitis; the nonaffected arm showed no pathology. The mean volume of the affected arm was 568 ml greater. Treatment consisted of manual lymphatic drainage and intermittent sessions of pneumatic compression with the LymphaPress device. This led to an average decrease in arm volume of 170 ml, with improvement of arm mobility and a drastic reduction in shoulder pain. In conclusion, lymphedema of the arm can cause severe shoulder trauma, pain and disability. Proper physiotherapy can reduce these effects. Patients should be referred for early treatment and follow-up to avoid permanent damage to the shoulder muscles.

Aged↗
PubMed2005

Transcutaneous oxygen tension in arms of women with unilateral postmastectomy lymphedema.

Previous reports suggest that skin blood flow is reduced in arms of women with lymphedema due to breast cancer treatment. Since tissue oxygenation depends on blood flow, we sought to determine if transcutaneous oxygen tension (TcPO2) is also reduced and if so, if therapy that reduces edema has a beneficial effect. TcPO2 was measured in fibrotic areas of affected arms and in corresponding sites on non-affected arms of 15 women with unilateral arm lymphedema before and after CDP therapy sequences. Fibrosis was assessed by indentation recovery times (IRT) after applying an indenter-like device to tissue. Volumes and edema percentages were determined from circumferences using automated software calculations. Treatment significantly (p < 0.01) reduced arm edema from 28.6 +/- 22.9% to 18.1 +/- 17.7% (mean +/- SD) and fibrotic segment edema from 42.6 +/- 30.1% to 25.0 +/- 20.4%, and softened fibrotic tissue judged by reductions in IRT (88.7 +/- 60.7 sec vs. 23.1 +/- 38.8 sec, p < 0.001). TcPO2 did not differ between arms initially and did not change with treatment, being 60.1 +/- 8.8 mmHg at the start and 61.8 +/- 9.2 mmHg at the end of treatment. Thus, despite significant amounts of initial edema, TcPO2 was not initially less in affected arms nor was it changed by therapy that improved both edema and fibrosis.

Aged↗
PubMed1991

Blood pressure responses to different arm positions during vertical head-down ankle suspension.

This study compares the effects of different arm positions on blood pressure during vertical head-down ankle suspension. Eighteen healthy volunteers (10 men and 8 women, aged 20-30 years) were placed first in the upright sitting position for 4 min, and second in the head-down suspension position for 4 min. In the latter position, the arms were first alongside the head and then raised alongside the body at the end of the 4th min. Blood pressure was measured non-invasively during the last 30 s of the 4th min of upright sitting and head-down suspension with the arms alongside the head, and then immediately following the movement of the arms alongside the body. In relation to the upright sitting position, head-down suspension with the arms dangling alongside the head resulted in a significant increase in brachial artery blood pressure (121/78 mm Hg vs. 146/91 mm Hg, respectively). This finding may be explained on the basis of a variable hydrostatic component. Following the immediate movement of the arms to alongside the body while still suspended, there was a significant decrease in blood pressure to 124/79 mm Hg. No significant change in blood pressure occurred from upright sitting to full head-down suspension with the arms alongside the body (121/78 mm Hg vs. 124/79 mm Hg, respectively). Based on previous disparate reports of pressure during head-down suspension, the findings of the present study indicate a need to standardize the method of blood pressure measurement during this procedure.

Adaptation, Physiological↗
PubMed1987

Effects of arm support or suspension on neck and shoulder muscle activity during sedentary work.

The aim of this study was to evaluate the effects on the levels on neck and shoulder muscular activity of ergonomic aids used to support or suspend the arm in different sitting postures, both with and without movement of the arm-hand. Ten skilled women workers performed a standardized simulated work cycle similar to assembling printed circuit boards, in different sitting postures with and without ergonomic aids. The elbow was supported by a loosely-mounted, padded plate. For suspension, a new device, the K-block, was used giving an adjustable, constant suspending force. Full-wave rectified, low-pass filtered, time-averaged and normalized EMG was used. Surface electrodes were applied over six neck and shoulder muscles. The results show that a reduction in the level of activity in neck and shoulder muscles can be obtained with either aid. The reduction, whether caused by suspension or support of the arm, was related to the sitting posture. Elbow support might be more efficient than arm suspension in a sitting posture with the whole spine flexed, while arm suspension might be more efficient when the trunk is inclined slightly backward. Elbow support and, particularly, arm suspension may thus be recommended as technical aids in sedentary assembly work for patients with easily elicited cervical spine and/or shoulder pain. It is also suggested that arm suspension may be used to improve ergonomic conditions at workplaces.

Adult↗
PubMed1982

A correction for the natural asymmetry of the arms in the determination of the volume of oedema.

In 60 right-handed women, significant asymmetry of arm volume has been found, the right arm being, on average, the larger by 1.6 per cent. In 26 ambidextrous and 19 left-handed women the right arm was smaller than the left one by 0.1 and 1.4 per cent respectively. These values differed from zero at low levels of significance. In an early stage of oedema for correcting the error incurred in the estimation of arm volume by asymmetry the regression equation of the form VC = kVM + m is proposed where VC and VM are the volumes of the calculated--oedematous arm in its pre-oedematous state and the unaffected arm, respectively, k and m are constants, which were determined from measurements on samples of the righthanded, ambidextrous and left-handed women. A simplified equation of the form VR = VL + mo where VR and VL are the volumes of the right and left arms, respectively is proposed.

Adolescent↗
PubMed1981

Active muscle force and moment response of the human arm and shoulder.

This paper is concerned with collection of active muscle force and moment response data of the human arm and the shoulder complex when the arm is subjected to various external forces. The major components of the specially designed and built experimental apparatus for this research are a subject restraint system, a force application device which employs three sonic emitters, and an upper arm cuff with four sonic emitters. The sonic emitters are utilized to determine the direction and the location of the force application on the arm and the orientation of the upper arm with respect to the torso. The numerical results are presented from experiments conducted on three male and three female subjects to determine their active muscle resistance against the external forces to dislodge their arms from several initial configurations. Some representative results determining the active muscle force capability of the subjects when their arms are dislodged from the initial configuration are also presented. Incorporation of the results of the present research into the multi-segmented models of the human body should improve the long-time response of capabilities of these models. This type of response capability of the mathematical models is essential for the proper stimulation of the biodynamic events which take place prior to flail injuries.

Anthropometry↗
PubMed1994

Cardiovascular responses to submaximal arm and leg exercise in cardiac transplant patients.

We examined whether an increase in stroke volume (SV) contributes to the increase in cardiac output that occurs when cardiac transplant patients (CT) exercise between 50% and 75% of maximum. Upright arm and leg exercise was performed by 13 CT and 10 normal controls. Cardiac output (CO2 rebreathing), expired air, and catecholamine measures were obtained at rest and at 50% and 75% of maximum. From rest to 50% of maximum both normals and CT increased heart rate (HR) and SV during arm and leg exercise. In normals, HR (arm = +17 +/- 2 min-1; leg = +21 +/- 3 min-1) was increased further at 75% of maximum but not SV (arm = 3 +/- 4 ml; leg = +2 +/- 8 ml). In CT, further increases in both HR (arm = +9 +/- 1 min-1; leg = +13 +/- 1 min-1) and SV (arm = +12 +/- 5 ml; leg = +12 +/- 3 ml) were observed at 75% of maximum. During leg exercise plasma norepinephrine was increased more in CT than in normals. Between 50% and 75% of maximum, an increase in SV is a more important mechanism for increasing cardiac output during upright arm and leg exercise in CT than in normals.

Arm↗
PubMed1993

Arm problems and psychological distress after surgery for breast cancer.

The frequency of problems in the arm affected by surgery for breast cancer and the association of these problems with psychological distress were assessed among 223 women with newly diagnosed breast cancer 3 months after operation and again 15 months later among 201 of these same women. At 3 months after operation, 182 (82%) of the 223 patients reported at least one arm problem. Specific problems reported were swelling (24%), weakness (26%), some limitation in range of movement (32%), stiffness (40%), pain (55%) and numbness (58%), and these percentages had changed little 15 months later. Regardless of the type of mastectomy, women who underwent axillary dissection had more arm problems. Compared with women reporting no arm problems, the adjusted odds ratios of having psychological distress at 3 months for women reporting one to two, three to four and five to six arm problems were 1.2, 2.3 and 3.1 respectively (chi 2 for trend = 9.5, p = 0.002). Arm problems are frequent after operation for breast cancer, and these problems appear to increase the likelihood of psychological distress. Women should be informed that arm problems are expected but non-threatening sequelae of initial surgical treatment for breast cancer.

Arm↗
PubMed1993

Oscillometric blood pressures in the arm, thigh, and calf in healthy children and those with aortic coarctation.

Comparing blood pressure (BP) obtained in the arm with that obtained in the thigh or calf is important in the diagnosis of aortic coarctation. However, normative mean and range of differences in BP between the arm and lower extremity sites are not available for normal children. It is also not known how accurately the differences in BP between the arm and the lower extremity sites predict the pulsed Doppler estimation of systolic pressure (SP) gradient across an aortic coarctation. To resolve these questions, the authors obtained two BP measurements by an oscillometric (Dinamap) method in the arm, thigh, and calf in 74 healthy children aged 4 to 16 years. Oscillometric BP was also obtained in 21 children aged 3 to 17 years with preoperative or postoperative aortic coarctation and BP gradients were compared with that estimated by the pulsed Doppler method. Overall, SP was higher in the thigh and calf than in the arm. The gradients in SP expressed as arm SP minus calf SP [S(A-C)] and arm SP minus thigh SP [S(A-T)] were significantly greater in children 4 through 8 years old than in those 9 to 16 years old. The S(A-C) was -9.3 (+/- 7.4 SD) mm Hg in the 4- through 8-year group and -5.0 (+/- 6.9 SD) mm Hg in the 9- to 16-year group. The S(A-T) was -7.1 (+/- 6.8 SD) mm Hg in the 4- through 8-year group and -2.4 (+/- 7.7 SD) mm Hg in the 9- to 16-year group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Comparison of upper arm and calf oscillometric blood pressure measurement in preterm infants.

Although the practice of using calf blood pressure (BP) measurement is widespread, virtually no information is available about calf site BP measurements in preterm infants. This research compared oscillometric upper arm BP measurements with calf BP measurements in 65 preterm infants with a mean weight of 1629 +/- 437 gm. Differences between arm and calf BP measurements were analyzed with repeated-measures multivariate analysis of variance of systolic, diastolic, and mean arterial pressures. There were no significant differences between arm and calf systolic BP on days 1, 3, and 5 of life. With post hoc testing there was a significant difference on day 7 between systolic arm BP (60.4 +/- 8.4 mm Hg) and calf BP (57.7 +/- 7.1 mm Hg) (t = 3.68, p < 0.01). There were no significant differences between arm and calf measurements for diastolic and mean arterial pressures and no main effect from infant weight on differences between arm and calf BP. It may be reasonable to use either arm or calf BP during the first 5 days of life.

Arm↗