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Upper extremity injection of household insecticide: a report of five cases.

Self-injection of household insecticide into the upper extremity in 5 patients is reported. All patients had mental problems, such as depression, substance abuse, or both. Four of the 5 cases were suicide attempts. Household insecticides can be divided into 3 categories based on the main chemical component. The hydrocarbon vehicle used in these insecticides, however, is poorly cleared by the local tissues and is responsible for fever, leukocytosis, and liquifaction necrosis. The focus for the hand surgeon is recognition and early and frequently repeated debridement. Psychiatric treatment and hand therapy are required.

Adult↗

[Pathology and histology of soft tissue sarcomas in the upper extremity: adults].

PURPOSE/BACKGROUND: Clinicopathologic characterization and demonstration of histologic findings in six common soft tissue sarcomas of the upper extremity in adult patients. RESULTS/CONCLUSION: Clinicopathologic findings and histologic features of the following malignant soft tissue tumours are compiled: epithelioid sarcoma, synovial sarcoma, clear cell sarcoma, liposarcoma, fibrosarcoma, and malignant fibrous histiocytoma (MFH). All these tumours show typical clinical presentations and characteristic histological findings.

Adolescent↗

Delayed brachial artery occlusion owing to a dog bite of the upper extremity.

We report a case of delayed presentation of vascular injury from a superficial dog bite of the upper extremity in a five-year-old male. This example of a significant arterial injury, in the setting of seemingly minor trauma, is the first known report of blunt arterial trauma owing to a dog bite in any age group. Blunt arterial trauma in children is rare unless associated with fractures, dislocations, or massive crush injuries. Additionally, persistent pulses following arterial occlusion are rare and can potentially lead to misdiagnosis of a serious arterial injury. A brief review of pediatric blunt vascular injuries is presented with implications for diagnosis and management of such cases.

Animals↗

Upper extremity radionuclide venography in the diagnosis and management of venous disease associated with intravenous catheters.

The utility of upper extremity radionuclide venography (RNV) in the assessment of suspected catheter-related central venous thrombosis (CRVT) was evaluated in 40 patients with subclavian venous catheters. Twenty normal patients (Group A) served as controls and their venographic patterns were analyzed by using four criteria: (1) delayed tracer transit time, (2) nonuniformity of flow and venous pooling, (3) jugular venous reflux, and (4) collateral venous filling. Control studies displayed no collaterals as a distinguishing characteristic but demonstrated the other three features to a variable degree. Of 106 extremities suspected of CRVT, 67 (Group B) were initially considered to have normal RNV findings (no collaterals). Contrast venography confirmed a normal pattern in 3 but identified CRVT with collaterals in 3 others. Retrospective review of the RNV studies confirmed faint collaterals in these latter 3. The 39 remaining extremities (Group C) showed abnormal RNV findings; contrast venography and postmortem studies confirmed the presence of venous disease in 5 patients. The authors believe that RNV is a reliable, noninvasive procedure for early diagnosis of venous occlusion associated with subclavian venous catheters.

Blood Flow Velocity↗

Chronic segmental spinal muscular atrophy of upper extremities in identical twins.

We present the 1st report of chronic segmental spinal muscular atrophy confined to the upper extremities in identical male twins. This occurrence in identical twins, together with reports of siblings and parent-child pairs of a disorder phenotypically similar to the more common sporadic form in the literature, suggests a genetic etiology in some cases.

Aged↗

[Analysis of subjective symptoms of upper extremities in dental technicians].

Our review of the literature showed no report on the subjective symptoms of the upper extremities in dental technicians. This study was therefore undertaken on 164 dental technicians in Gifu Prefecture to investigate the relationship between the subjective symptoms of the hands, arms and shoulders and work of dental technicians. The following results were obtained. 1) The prevalence of Raynaud's phenomenon and numbness of the fingers was 5.5 and 18.5 %, respectively. A significant positive correlation was observed between the prevalence and frequency of numbness and cold sensation in the fingers and the daily usage time (h) of high-speed type machines. In addition, pain in the fingers and around the wrists, and pain and numbness in the arms were significantly related to the daily usage time (h) of low-speed type machines. These results suggest that the usage of high- and low-speed type machines may be a cause of vibration syndrome among dental technicians. 2) A high prevalence of pain in the shoulders (30.8%), neck (30.1%), and back (36.3%) was observed in dental technicians. It is considered that these symptoms are related to the working posture and usage of machines.

Adult↗

[Value of intermittent pneumatic massage in the treatment of upper extremity lymphedema].

Technique and results of the conservative treatment of 116 female patients with secondary lymphedema of the upper extremity following total mastectomy are discussed. It was found, that intermittent pneumatic massage combined with exercises decreased mild edema by more that 50%, moderate edema by nearly 40%, and marked edema by more that 25%. Complete disappearance of edema was achieved in nearly 50% of patients with mild swelling. Improvement was seen in 20% of the treated patient independently of the extension of edema.

Arm↗

[Acupuncture as after care following injuries of the upper extremities].

Acupuncture is able to improve restriction of motion in general and in the smaller joints of the upper extremity, disturbances in circulation, posttraumatic swelling, reversible nerve lesions and ulcers following burns or pressure of a plaster. Localisation of the points for acupuncture in the different conditions and the possibilities of their combinations are described. Acupuncture is performed bilaterally at symmetrical points, unilaterally in pareses, contralaterally in amputees and in cases with dressings. During ear acupuncture the analgesic effect occurs more quickly, but has a shorter duration of action; in paralyses it was without success. The course of the treatment was controlled by clinical examination and measurement of the range of motion.

Acupuncture Therapy↗

[The procedure in the surgical treatment of compression neuropathies of the upper extremity].

The article deals with the treatment of 435 patients with compression of the nerve trunks of the upper extremities of 531 localizations. Operations were conducted on 351 patients for compression mononeuropathies, in 84 patients nerve trunks of the hand were compressed at several sites. A total of 160 operations were undertaken on these patients for decompression of the nerve trunks of different localizations and their combinations. The authors' experience allows them to recommend increasing the number of indications for this type of intervention, including multiple and irritative forms of compression neuropathies.

Arm↗

[Phlebography of the upper extremity--examination technic, indications and results].

Three radiological methods of examination can be used in phlebography of the upper extremity: screening (fluoroscopy) combined with on-target x-ray film examination; sheet film angiography; digital subtraction phlebography (DSP). Phlebography of the veins of the forearm performed preoperatively for selecting suitable veins for a dialysis shunt, should be done by screening with on-target x-ray film takes in several planes. DSP should be given preference if there is suspicion of thrombosis of the shoulder veins and the superior vena cava.

Arm↗

Reliability of percutaneous intramuscular electrodes for upper extremity functional neuromuscular stimulation in adolescents with C5 tetraplegia.

Chronically indwelling percutaneous intramuscular electrodes were implanted in the upper extremity muscles of five adolescents with C5 or C5-6 tetraplegia in an effort to provide lateral and palmar prehension using the neuroprosthetic system designed by Case Western Reserve University. The responses from 177 electrodes were evaluated at 3-month intervals and included measurements of electrical impedance and an assessment of recruitment properties. Electrode failures were categorized as breakage, an altered stimulated response or adverse sensation during stimulation. Survival probabilities were generated for all electrodes, each muscle group, the volar and dorsal exit sites, intrinsic and extrinsic muscles, and according to the subjects' time postinjury. The overall probability of an electrode surviving to 6 months was 0.75 and the 1 year survival probability was 0.56. Among muscle groups, the finger extensor and thumb adductor electrodes had the highest proportion of failures and the poorest survival likelihoods within the first year after implant. According to the Breslow test, significantly smaller survival chances were predicted for electrodes exiting dorsally and for the newly-injured adolescents (< 1 year postinjury). The cumulative survival likelihoods of this study are smaller than those reported in adult applications using the same electrode design. Factors that may account for the disparate results are discussed.

Adolescent↗

Reproducibility of dual-energy X-ray absorptiometry in the upper extremities in stroke patients.

Bone mineral loss after stroke in affected extremities can increase the prevalence of fractures that interrupt the rehabilitation programme and lower the level of activity. In stroke rehabilitation, precise bone mineral measurement is needed in order to assess the risk of fractures. We defined five regions-of-interest of the upper extremity (proximal humerus, distal forearm, distal radius, distal ulna and hand) consistently, so that the position was comfortable for hemiplegic patients to maintain during the measurement. The aim of this study was to determine whether our method using dual-energy X-ray absorptiometry is useful in hemiplegic patients. Ten normal subjects and 15 hemiplegic patients were studied. In normal subjects the reproducibility of our method was evaluated by repeated measurements of both the right and left sides. In hemiplegic patients the reproducibility was evaluated by repeated measurements of the affected side. The coefficient of variation (CV) values were obtained for BMD (0.7-1.7%) and BMC (0.7-2.3%) in normal subjects, and BMD (1.3-2.1%) and BMC (1.7-5.4%) in hemiplegic patients. The CV for the side-to-side BMD and BMC ratios in the normal subjects ranged from 1.1% to 2.2% and from 1.8% to 3.1%, respectively. Our study shows that the reproducibility of our method is sufficient for application to hemiplegic patients.

Absorptiometry, Photon↗

Diagnosis of aseptic deep venous thrombosis of the upper extremity in a cancer patient using fluorine-18 fluorodeoxyglucose positron emission tomography/computerized tomography (FDG PET/CT).

We describe a patient with a history of recurrent squamous cell carcinoma of the tongue and abnormal FDG uptake in the left arm during a re-staging FDG PET/CT. After revision of the patient's clinical history, tests and physical exam, the abnormal FDG uptake was found to correspond to an extensive aseptic deep venous thrombosis of the upper extremity.

Carcinoma, Squamous Cell↗

Effect of upper extremity exercise on secondary lymphedema in breast cancer patients: a pilot study.

PURPOSE: To examine the effect of a progressive upper-body exercise program on lymphedema secondary to breast cancer treatment. METHODS: Fourteen breast cancer survivors with unilateral upper extremity lymphedema were randomly assigned to an exercise (n = 7) or control group (n = 7). The exercise group followed a progressive, 8-week upper-body exercise program consisting of resistance training plus aerobic exercise using a Monark Rehab Trainer arm ergometer. Lymphedema was assessed by arm circumference and measurement of arm volume by water displacement. Patients were evaluated on five occasions over the experimental period. The Medical Outcomes Trust Short-Form 36 Survey was used to measure quality of life before and after the intervention. Significance was set at alpha < or = 0.01. RESULTS: No changes were found in arm circumference or arm volume as a result of the exercise program. Three of the quality-of-life domains showed trends toward increases in the exercise group: physical functioning (P =.050), general health (P =.048), and vitality (P =.023). Mental health increased, although not significantly, for all subjects (P =.019). Arm volume measured by water displacement was correlated with calculated arm volume (r =.973, P <.001), although the exercise and control group means were significantly different (P <.001). CONCLUSIONS: Participation in an upper-body exercise program caused no changes in arm circumference or arm volume in women with lymphedema after breast cancer, and they may have experienced an increase in quality of life. Additional studies should be done in this area to determine the optimum training program.

Aged↗

Activity performance and upper extremity function in cervical spinal cord injury patients according to the Klein-Bell ADL Scale.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: (1) To examine whether the Klein-Bell ADL Scale (K-B Scale) discriminates cervical spinal cord injury (SCI) patients in daily activities and to explore its applicability in this group of patients. (2) To examine the association between basic ADL and upper extremity function. (3) To investigate if grip ability can be discerned in the scale. SETTING: Spinal Cord Injury Unit, Sahlgrenska University Hospital, Göteborg, Sweden. METHODS: Fifty-five patients with cervical SCI with no prior reconstructive hand surgery were included in the study. Analyses of the patient's independence were made according to the K-B Scale. Three additional analyses were carried out, the first examined whether the use of assistive devices and house and car adaptations influenced independence. The last two used different approaches to investigate whether arm and grip function could be detected in the K-B scale. RESULTS: Raw score in the K-B Scale can discriminate for independence in daily activities but the scale's weight scheme does not function for cervical SCI patients. Assistive devices and car and house adaptations can compensate for dependence in daily activities. Lack of grip function decreases the patient's ability to become independent. Diagnosis-related activities cannot be assessed in all items. CONCLUSION: The K-B Scale's raw score was useful assessing daily activities in cervical SCI patients. Its reliability in conjunction with arm and grip function in patients with cervical SCI has yet to be proven.

Activities of Daily Living↗

The Effect of Game-Based Virtual Reality Rehabilitation and Its Impact on Upper Extremity Function After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial.

BACKGROUND: Arthroscopic rotator cuff repair (ARCR) often results in prolonged recovery and limited shoulder function. Conventional physical therapy rehabilitation programs require sustained patient engagement; however, adherence is frequently low. Game-based virtual reality (VR) offers an interactive and engaging environment that may enhance rehabilitation outcomes. OBJECTIVE: To evaluate the effect of a game-based VR program on the function of the upper limb in patients following ARCR. METHODS: A randomized controlled trial was conducted with patients who underwent ARCR. Participants were randomized into two groups: game-based VR or conventional rehabilitation. Outcomes were evaluated using the Disabilities of the Arm, Shoulder and Hand score, pain severity by the Numerical Pain Rating Scale, range of motion measures, and muscle strength testing. Assessments were performed at baseline and at 6 weeks and 12 weeks post surgery. RESULTS: Results have shown significant within-group improvements in pain, function, range of motion, and isometric muscle strength across all time points (P < 0.05). Between-group analysis revealed greater improvements in pain, function, flexion range, and abduction and external rotation strength in the experimental group at both time points (P < 0.05). Abduction range improved significantly only at 12 weeks (P = 0.02), whereas external rotation range showed no significant difference between groups at either time point (P > 0.05). CONCLUSION: The findings indicate that integrating game-based VR rehabilitation provides additional benefits over conventional therapy in improving pain and upper extremity function following ARCR. These findings support the use of VR as an effective alternative to the conventional rehabilitation for postoperative rehabilitation.

Humans↗

Pediatric upper extremity replantation.

The evolution of microsurgical technique has led to increasing success with pediatric replantation. The broader inclusion criteria for pediatric replantation, together with the greater technical demands of repair and the less favorable mechanism of pediatric amputations (crush-avulsion), yield a slightly lower overall survival rate than in adults. The superior nerve and soft tissue regenerative capacity of children appears to produce better functional outcomes. Nonetheless, the issue of cosmesis and developing self-image in a child may have ramifications beyond a simple calculus of range of motion and strength variables--hence the imperative that microsurgical salvage be attempted in pediatric upper-extremity amputations.

Amputation, Traumatic↗