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At least 1,135 records · Page 63Linked to original sources
PubMed2003

Seasonal variation in the incidence of wrist and forearm fractures, and its consequences.

We have used the All Wales Injury Surveillance System (AWISS) in a population-based study of wrist and forearm fractures. We examined seasonal variation in the incidence of these injuries, and looked at resulting pressures on outpatient and inpatient trauma services. AWISS collected data from eight Accident and Emergency (A&E) departments which between them serve a total of 1.2 million people in South Wales. During a single year, we identified all 5013 people who presented with a wrist or forearm fracture. Seasonal variation in wrist/forearm fracture incidence was apparent, but showed a different pattern in different age groups. Overall incidence figures were dominated by an increase in children's fractures in spring and summer. Children under the age of 15 suffered a total of 360 wrist and forearm fractures during the three winter months; an incidence of 5.9/1000 per year that was only about half that observed during the remainder of the year (10.7/1000 per year). In contrast, older people showed a higher incidence in the winter. During the winter months people aged over 75 sustained a total of 160 wrist/forearm fractures; an incidence of 8.2/1000 per year, significantly higher than the incidence observed in other months (5.8/1000 per year). Seasonality of incidence was not apparent in other age groups. Children presenting during the spring and summer months were significantly more likely to need admission to hospital; 22.8% were admitted compared with just 10.3% of those presenting during the winter months (P<0.001, chi(2)-test). Other age groups showed no significant seasonal variation in the likelihood of hospital admission.

Adolescent↗
PubMed2003

Combined effect of coenzyme Q10 and fenofibrate on forearm microcirculatory function in type 2 diabetes.

Arteriopathy is the principal complication of type 2 diabetes mellitus. It develops from endothelial dysfunction, which we have hypothesised occurs in diabetes primarily as a consequence of dyslipidaemia and oxidative stress. Fenofibrate and CoQ may improve endothelial function by regulating dyslipidaemia and oxidative stress, respectively. We therefore aimed to assess the independent and combined effects of fenofibrate and coenzyme Q(10) (CoQ) on endothelium-dependent and endothelium-independent vasodilator function of the forearm microcirculation in type 2 diabetes. Eighty dyslipidaemic type 2 diabetics were randomized to receive fenofibrate (200 mg/daily), CoQ (200 mg/daily), fenofibrate plus CoQ (200+200 mg daily), or placebo for 12 weeks. Forearm microcirculatory function was assessed with venous occlusion plethysmography during the infusion of acetylcholine (ACh), bradykinin (BK), sodium nitroprusside (SNP) and N(G)-monomethyl-L-arginine (L-NMMA) into the brachial artery. Blood flow responses were calculated as area under the curve (AUC). Fenofibrate significantly lowered plasma cholesterol, triglyceride and fibrinogen (P<0.001), and elevated HDL-cholesterol and homocysteine (P<0.001). CoQ did not change plasma isoprostanes, but significantly lowered systolic blood pressure and HbA(1c) (P<0.05). Fenofibrate plus CoQ significantly improved (P<0.05) the AUC for ACh, BK and SNP without significantly altering basal responses to L-NMMA. Fenofibrate or CoQ alone did not significantly alter blood flow responses. Improvements in blood flow were independent of changes in plasma lipids, blood pressure, homocysteine and isoprostanes, but were correlated (P=0.013) with HbA(1c). In conclusion, in this factorial trial we found that only the combination of fenofibrate and CoQ markedly improved endothelial and non-endothelial forearm vasodilator function in dyslipidemic type 2 diabetic patients. The favourable vascular effect of this therapeutic combination could be due to increase in the bioactivity of and/or responses to endothelium-derived relaxing factors, including nitric oxide, and this may entail synergistic stimulation of peroxisome proliferator-activated receptors.

Acetylcholine↗
PubMed2000

A rigid body model of the forearm.

In this article the forearm, with its complex, continuous motion of masses during pronation/supination, was approximated by a rigid body model consisting of a radial segment rotating around an ulnar segment. The method used to obtain the model parameters is based on three-dimensional voxel data that include velocity information. We propose a criterion that allows the voxels to be attributed to either of the two segments. It is based on the notion that the rotational kinetic energy determined from the voxel data equals the kinetic energy of the rigid body model. To obtain a three-dimensional smoothing we further propose a parameterization of the shape of both segments. These shapes can then be used to determine the dynamic integrals of the segments, i.e. mass, center of mass, and inertia. Using this approach we determined all model parameters for a human forearm from three series of MRI scans in a supinated, a pronated, and an intermediate position. In the appendix, a procedure is described that allows the dynamic quantities to be scaled homogeneously without recalculation of the integrals. Thus, this article provides all essential parameters required for three-dimensional dynamic simulations of general movements of the forearm.

Adult↗
PubMed2000

Simulation of elbow and forearm motion in vitro using a load controlled testing apparatus.

The purpose of this study was to compare passive to active testing on the kinematics of the elbow and forearm using a load-controlled testing apparatus that simulates muscle loading. Ten fresh-frozen upper extremities were tested. Active control was achieved by employing computer-controlled pneumatic actuators attached to the tendons of the brachialis, biceps, triceps, brachioradialis and pronator teres. Motion of the radius and ulna relative to the humerus was measured with an electromagnetic tracking system. Active elbow flexion produced more repeatable motion of the radius and ulna than when tested passively (p<0.05). The decrease in variability, as determined from the standard deviation of five successive trials in each specimen, was 76.5 and 58.0% for the varus-valgus and internal-external motions respectively (of the ulna relative to the humerus). The variability in flexion during simulated active forearm supination was 30.6% less than during passive testing. Thus under passive control, in the absence of stability provided by muscular loading across the joint, these uncontrolled motions produce increased variability amongst trials. The smooth and repeatable motions resulting from active control, that probably model more closely the physiologic state, appear to be beneficial in the evaluation of unconstrained kinematics of the intact elbow and forearm.

Aged↗
PubMed1999

Effect of local sympathetic blockade on forearm blood flow and glucose uptake during hypoglycemia.

During hypoglycemia, hepatic glucose production increases and peripheral glucose utilization decreases. Systemic beta-adrenergic blockade during hypoglycemia increases peripheral glucose utilization. To explore the local effects of increased alpha- and beta-adrenergic activity on skeletal muscle glucose utilization, we measured arterial and venous plasma glucose concentrations, forearm blood flow (FBF), and forearm glucose uptake (FGU) during a hyperinsulinemic (40 mU/m2/min) stepped-hypoglycemic clamp with intrabrachial artery infusion of saline, phentolamine, propranolol, or combined phentolamine and propranolol. A control study was also performed with a euglycemic clamp and intraarterial saline. During hypoglycemia with saline and phentolamine, there were significant increases in FBF (130% +/- 38% and 180% +/- 35%, respectively) and FGU (120% +/- 51% and 230% +/- 150%, respectively). During hypoglycemia with propranolol and phentolamine + propranolol, FBF remained constant. FGU during hypoglycemia with propranolol was not different versus hypoglycemia with saline. No differences were found in these studies for forearm lactate output (FLO) or venous free fatty acid concentrations. These results demonstrate that local, as opposed to systemic, blockade during hypoglycemia does not alter peripheral glucose utilization.

Adrenergic alpha-Antagonists↗
PubMed2006

[Life experience of adults with unilateral agenesia of the forearm: effect of prosthesis on self image and social relations].

PURPOSE OF THE STUDY: This study was devoted to better understanding how adults with agenesia of the forearm live their condition. The malformation studied was identical to that of a previous study in children. The present study was designed to provide professionals and parents with a reference system for making therapeutic decisions. MATERIAL AND METHODS: An intensive survey using semi-directive interviews was conducted among adults aged 19 to 37 years, 12 women and 8 men, with unilateral agenesia of the forearm. The majority of the participants had an occupation and an active social and familial life. RESULTS: The survey revealed factors of limitation or progress, expectations and renouncements, marking the life experience of these persons. The prosthesis had a significant impact on their lives. DISCUSSION: Four types of life experience could be identified from the survey data. All four could be understood as a search for equilibrium between internal reality (desired self image) and external reality (image produced by the physical and human environment via the regards of others and obstacles encountered). Several modalities for using a prosthesis, several ways of coping with the absence of a hand, with or without a prosthesis, and several ways of constructing a self-representation were distinguished. Rather than a functional disability, agenesia was found to be perceived as a persistent problem in daily life, generating handicap- or discrimination-producing situations. CONCLUSION: Forearm agenesia creates a situation different from normal and as such makes the question of self-identity and social relations more complex than for others. The comments provided by these young adults who cope with the paradoxical condition of an amputated but functional body demonstrated the central role of the body.

Activities of Daily Living↗
PubMed2001

Implementation of a forearm support to reduce the amount of irradiated lung and heart in radiation therapy of the breast.

We compared simulator images of medial tangential fields taken in two positions: (1) with the ipsilateral arm abducted, holding a 'L-bar' armrest and (2) with both arms extended above the head in a forearm support. The average maximum heart distance as well as the central lung distance decreased significantly by 3.4 (SE 0.9) and 4.7 (SE 1.1) mm, respectively, when the new forearm support was used. The estimated normal tissue complication probability for excess cardiac mortality decreased by on average 3.1% (SE 1.3%). For some patients, a greater amount of the axilla was included in the field. We recommend the use of the forearm support during breast cancer treatment with tangential fields to decrease the amount of heart and lung inside the fields.

Breast Neoplasms↗
PubMed2003

Activation patterns in forearm muscles during archery shooting.

A contraction and relaxation strategy with regard to forearm muscles during the release of the bowstring has often been observed during archery, but has not well been described. The purpose of this study was to analyze this strategy in archers with different levels of expertise; elite, beginner and non-archers. Electromyography (EMG) activity of the M. flexor digitorum superficialis and the M. extensor digitorum were recorded at a sampling frequency of 500 Hz, together with a pulse synchronized with the clicker snap, for twelve shots by each subject. Raw EMG records, 1-s before and after the clicker pulse, were rectified, integrated and normalized. The data was then averaged for successive shots of each subject and later for each group. All subjects including non-archers developed an active contraction of the M. extensor digitorum and a gradual relaxation of the M. flexor digitorum superficialis with the fall of the clicker. In elite archers release started about 100 ms after the fall of the clicker, whereas in beginners and non-archers release started after about 200 and 300 ms, respectively. Non-archers displayed a preparation phase involving extensive extensor activity before the release of the bowstring, which was not observed in elite and beginner archers. In conclusion, archers released the bowstring by active contraction of the forearm extensors, whereas a clear relaxation of the forearm flexors affecting the release movement was not observed.

Adolescent↗
PubMed1999

Hepatic amino- to urea-N clearance and forearm amino-N exchange during hypoglycemic and euglycemic hyperinsulinemia in normal man.

BACKGROUND/AIMS: Hypoglycemia has well-described effects on glucose metabolism, whereas the possible effects on hepatic amino nitrogen conversion in relation to muscle amino nitrogen flux are more uncertain. METHODS: We studied six healthy young male subjects three times, i.e. for 6 h in the basal state, during a 6-h euglycemic hyperinsulinemic (1.5 mU/kg/min) clamp and during a 6-h hypoglycemic (plasma glucose below 2.8 mmol/l) clamp. Alanine (2 mmol/kg body weight/h) was infused for 3 h to describe the relationship between blood amino nitrogen concentrations and hepatic ureagenesis estimated from urea urine excretion and accumulation in body water. The slope of this relationship is denoted functional hepatic nitrogen clearance (FHNC) and quantifies substrate-independent alterations in hepatic amino nitrogen degradation. In parallel, amino nitrogen balances across muscles were estimated by the forearm flux method. RESULTS: Euglycemia decreased circulating glucagon values (100+/-25 ng/l vs. 160+/-30 ng/l), whereas hypoglycemia doubled glucagon (350+/-45 ng/l, p<0.05). Hepatic nitrogen clearance (FHNC) decreased during hyperinsulinemic euglycemia (19.5+/-3.4 l/h vs. 30.6+/-5.7 l/h, p<0.01), whereas forearm net uptake of amino nitrogen increased (130+/-40 nmol/100 ml x min vs. control: -10+/-4 nmol/100 ml x min). During hypoglycemia there was a 3-fold increase in hepatic nitrogen clearance up to 83.0+/-16.8 l/h (p<0.01) and increased release of amino nitrogen from the forearm (-100+/-30 nmol/100 ml x min, p<0.01). CONCLUSION: Hypoglycemia in man induces a marked increase in hepatic amino- to urea-N clearance. This catabolic response to hypoglycemia in the liver may be of primary importance for muscle amino acid release. Our data are compatible with the notion that liver and muscle together are responsible for catabolism during hypoglycemia, and that glucagon may be the primary mediator via its effect on liver metabolism.

Adult↗
PubMedDate not supplied

Single versus dual venous drainage of the radial forearm free flap.

PURPOSE: To compare single versus dual venous drainage of radial forearm free flaps (RFFF) and its impact on flap survival. DESIGN: A retrospective case series of 43 consecutive patients undergoing radial forearm free flap reconstruction for head and neck cancer defects, combined with a meta-analysis of 218 reported cases. SETTING: Two academic, tertiary referral medical centers. INTERVENTION: All 43 RFFF's were harvested and inset in a similar fashion. In 16 patients (group 1), two venous anastomoses were performed. In 27 patients (group 2) one anastomosis was created. The arterial anastomosis was similar in both groups. OUTCOME MEASURES: Clinically noted viability of the radial forearm free flap over the first 6 postoperative weeks. RESULTS: All 43 RFFFs maintained complete viability. No flap loss, complete or partial, was identified. Two patients in group 1 and one patient in group 2 developed postoperative pharyngocutaneous fistulae, but complete healing occurred with local wound care. One patient in group 2 developed a postoperative neck hematoma, which was evacuated with no insult to the free flap. Single venous anastomosis shortened operative time by 21 to 36 minutes. CONCLUSION: Though two venous anastomoses may provide a more fail-safe mechanism for adequate venous drainage, a single venous anastomosis employing a subcutaneous vein provides adequate drainage with reduced operative time and no additional morbidity. Meta-analysis statistically confirmed the equivalency of single and dual venous anastimoses (correction of amastimoses) with respect to flap survival.

Adult↗
PubMed1997

Preoperative vascular assessment: an aid to radial forearm surgery.

Twenty-three patients undergoing oral reconstructive surgery with radial forearm free flaps had a vascular assessment of the forearm preoperatively. Segmental upper limb pressures were measured and colour flow duplex visualization of forearm vessels and blood flow done. In 18 the blood pressure and flow were within normal limits, but five (22%) showed either unilateral or bilateral arteriopathy or aberrant vascular anatomy. Identification of pre-existing vascular disease helps to rationalize the selection of donor vessels, reduces the risk of ischaemic damage to the hand after disruption of the radial artery and may be of benefit in reducing the incidence of failure of free flaps.

Adult↗
PubMed1996

Lengthening of the forearm by callus distraction.

Ten patients aged 3 to 13 years (mean, 9 years and 7 months) underwent forearm lengthening by callotasis. The indications for lengthening were shortening and/or deformity of the forearm due to exostosis of the distal ulna in five cases, enchondroma of the distal ulna in one, growth disturbance after fracture of the distal radius in one, radial club hand in one, congenital amputation of the forearm in one and congenital dislocation of the radial head in one. Four had lengthening of the ulna, one of the radius and five of both the radius and the ulna. The average lengthening achieved was 30 mm. Complications encountered were pin track discharge in three cases, callus fracture in five, delayed consolidation of the callus in one and no callus formation in one. Review after 1 to 7 years follow-up (with a mean of 4 years and 9 months) showed satisfactory improvement in appearance and function especially in patients who had tumorous conditions or traumatic epiphyseal arrest.

Adolescent↗
PubMed2000

Morphologic changes in forearm flaps of the oral cavity.

PURPOSE: This study was undertaken to investigate the morphologic changes in the forearm flap in the oral environment. PATIENTS AND METHODS: Histologic evaluation of biopsy specimens from 20 forearm flaps was done 1 to 75 months after intraoral reconstruction after treatment of cancer. Hematoxylin and eosin and Azan were used to stain the deparaffinized sections. RESULTS: The clinical features of the grafted flap seemed to depend on the time since the operation. The cornified layer of the epidermis of the flaps showed thinning histologically. CONCLUSION: After 11 months of exposure to an intraoral environment, "mucosalization" of the forearm flap is evident.

Adult↗
PubMed2002

[Nerve entrapment syndrome of the elbow and forearm].

In this study we will discuss entrapment of the median, ulnair, radial and lateral antebrachial nerves of the elbow and the forearm. Compression of the nerves may occur when they traverse a tunnel and an incompatibility exists between the diameter of the tunnel and its contents (e.g. nerves, tendons,...). However, at the elbow and the forearm the nerves are also exposed to particularly dynamic compressions. This is due to anatomical relationships changing between the nerve and its surrounding muscles, tendons and aponevroses during the motion of flexion-extension of the elbow and the prono-supination of the forearm. The possibility of this dynamic factor should be thoroughly explored during the examination through appropriate dynamic tests as described in this study.

Biomechanical Phenomena↗
PubMed2001

Coriolis-induced cutaneous blood flow increase in the forearm and calf.

Using venous occlusion plethysmography, Sunahara et al. reported that Coriolis-induced nausea was accompanied by an increase in forearm blood flow, suggesting a decrease in sympathetic activity to this vascular bed. No significant blood pressure and heart rate changes were observed. Vasodilation of the limbs theoretically impairs orthostatic tolerance, particularly if blood flow is shown to increase simultaneously in the lower limbs. This study examined the latter possibility. Seventeen subjects were exposed to the Coriolis cross-coupling effects induced by 20 RPM yaw rotation, and a simultaneous 45 degrees pitch forward head movement in the sagittal plane every 12 s. Forearm and calf skin blood flow were monitored in real-time using laser Doppler flowmetry (PeriFlux 4001). Our results indicated a significant (p < 0.001) simultaneous forearm and calf skin blood flow increase as a result of Coriolis cross-coupling across all 15 susceptible subjects. No significant changes in blood pressure and heart rate were observed. Coriolis-induced cardiovascular changes may confound previous reports on reduced G tolerance using ground-based centrifuges that invariably evoke cross-coupling effects.

Adult↗
PubMed1995

The retrograde radial fascial forearm flap: surgical rationale, technique, and clinical application.

The retrograde radial fascial forearm flap may be used to provide appropriate tissue coverage for nerve, tendon, or soft tissue defects in the forearm and hand. The procedure is differentiated from the standard radial forearm flap in that the radial artery remains intact when the retrograde radial fascial flap is designed. The rationale, technique, and clinical application of the flap are presented in order to allow surgeons to maintain the radial arterial trunk in continuity while obtaining the advantage of appropriate soft tissue cover in this critical area.

Adult↗
PubMed1985

Surgical significance of the motor fascicular group of the ulnar nerve in the forearm.

The topography of the fascicular group of the ulnar nerve at the wrist and forearm was studied focusing on the motor (muscle) fascicular group. In 109 of 111 specimens studied (98%), the motor fascicular group of the ulnar nerve is located at the ulnar dorsal or straight dorsal position at the wrist and the distal forearm. This motor fascicular group may be identified as a distinct entity up to 90 mm proximal from the level of the radial styloid. The relatively constant location of the motor fascicular group is significant since most lacerations of the major peripheral nerves of the upper extremity are at the distal forearm or the wrist. In the surgical treatment of acute lacerations of the ulnar nerve at these levels, one should direct special attention to the correct identification, matching, and alignment of the motor fascicular group to enhance reinnervation of the intrinsic muscles of the hand.

Forearm↗
PubMed1986

Radial sensory nerve entrapment in the forearm.

A group of 51 patients with complaints related to entrapment of the superficial sensory branch of the radial nerve is described. Symptoms included altered sensibility over the dorsoradial aspect of the hand and dorsoradial cutaneous pain with ulnar flexion of the wrist or with gripping and pinching. Pertinent history included compressive or crushing forearm injuries, work activities requiring frequent pronation and wrist hyperextension, and associated illnesses, such as diabetes. Physical examination included abnormal touch perception, abnormal moving two-point discrimination over the dorsoradial area of the hand, a positive Tinel sign in the forearm, and aggravation of the patient's symptoms with forced forearm pronation and wrist ulnar flexion. Seven (37%) of 19 patients treated with nonoperative modalities after a mean of 28 months from the onset of symptoms or their injury were improved. Of the 32 patients treated with surgery with a mean follow-up of 10 months (range of 6 to 29 months), there has been excellent subjective improvement in 37%, good subjective improvement in 49%, and fair subjective improvement in 6%, and 8% were not improved. Of this group of surgically treated patients, 43% have returned to their regular jobs, and 22% are in either vocational rehabilitation or working at a different job.

Adult↗