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At least 739 records · Page 41Linked to original sources
PubMed1995

Functional soft-tissue coverage in skeletonizing injuries of the upper extremity using the ipsilateral latissimus dorsi myocutaneous flap.

The concept of early "functional" soft-tissue coverage is demonstrated in three cases of severe skeletonizing avulsion/contusion injuries of the upper extremity, including the replantation of a "frozen" arm. According to the MESS score, all extremities would have been allocated to the amputation group. Therapeutic strategy consisted of primary repair of all neurovascular structures, serial debridements, and early definitive coverage with simultaneous restoration of the elbow flexor or extensor muscles. Flap survival was 100 percent in all patients, and the muscle strength achieved after vigorous physical therapy was rated M3 to M5. One patient was even able to return to competitive tennis.

Adolescent↗
PubMedDate not supplied

A comparison of upper limb amputees and patients with upper limb injuries using the Disability of the Arm, Shoulder and Hand (DASH).

PURPOSE: To use the Disability of the Arm Shoulder and Hand (DASH) scale to measure the disability of patients with upper limb amputation(s) and to compare these to other upper limb injuries. METHOD: All 274 patients over the age of 18 years presenting to Prince Henry Hospital in Sydney over a 4-year time frame were given the DASH assessment tool and asked to complete it under supervision of the Occupational Therapist. RESULTS: Patients with brachial plexus injuries, Complex Regional Pain Syndrome and bilateral upper limb amputations demonstrated significantly higher levels of disability to patients with unilateral upper limb amputations. Partial hand amputees reported a higher level of disability than major unilateral upper limb amputees. For the 48 patients who completed pre- and post-treatment assessments, there was a significant improvement in their health status. CONCLUSIONS: Further research is required to understand the factors that affect a patient's perceptions of their disability. Perhaps the definitive nature of an amputation and the immediate involvement of highly skilled health professionals serve to assist patients to accept their injury and therefore minimizes the level of disability.

Activities of Daily Living↗
PubMed2001

Postural arm control following cervical spinal cord injury.

This study used estimates of dynamic endpoint stiffness to quantify postural arm stability following cervical spinal cord injury (SCI) and to investigate how this stability was affected by functional neuromuscular stimulation (FNS). Measurements were made in the horizontal plane passing through the glenohumeral joint on three SCI-impaired arms, which ranged in functional level from a weak C5 to a strong C6. Endpoint stiffness, which characterizes the relationship between externally imposed hand displacements and the resultant forces, was estimated during the application of planar, stochastic perturbations to each arm. These estimates were used in conjunction with voluntary endpoint force measurements to quantify stability and strength during voluntary contractions and during voluntary contractions in the presence of triceps FNS. The primary findings were: 1) the differences in the force generating capabilities of these arms were due primarily to differences in shoulder strength; 2) measurements of strength alone could not be used to predict arm stability; and 3) triceps FNS improved postural arm stability for all tested conditions. These results suggest strategies for improved control of FNS systems designed to restore arm function following cervical SCI and underscore the importance of examining the effects of FNS on both strength and stability.

Algorithms↗
PubMed1995

The effect of regional trauma care systems on costs.

OBJECTIVE: To assess cost savings from regional trauma care systems. DESIGN: Multivariate regression analysis is used to isolate the effects of regional trauma care systems on medical costs while controlling for personal and injury characteristics and other factors likely to influence medical costs. Percentage reductions in costs are translated into dollar cost savings with corrections for excluded costs and losses from premature death. SETTING: Injuries to workers filing workers' compensation lost workday claims. PARTICIPANTS: Randomly sampled workers' compensation claims from 17 states filed between 1979 and 1988 (N = 217,000). MAIN OUTCOME MEASURE: Medical payments per episode of four injury groups: lower-extremity fractures and dislocations, upper-extremity fractures and dislocations, other upper-extremity injuries, and back strains and sprains. We distinguish hospitalized from nonhospitalized claims. RESULTS: Statistical analyses reveal that states with trauma care systems have 15.5% lower costs per hospitalized injury episode. Savings average $1025 per case in 1988 dollars. Costs per episode for disabling nonhospitalized injury are 10% lower in states with trauma care systems, with savings averaging $75 per case. The largest savings are for back injuries. CONCLUSIONS: Extending trauma care systems nationwide could lower annual medical care payments by $3.2 billion. Including productivity losses due to premature death, the savings could total $10.3 billion, 5.9% of national injury costs.

Arm Injuries↗