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PubMed2002

Missed upper extremity fractures in athletes.

The majority of missed fractures in athletes are not overlooked because of difficulties recognizing them on radiographs. Rather, these fractures occur less commonly and often exist without accompanying disabilities, which makes their diagnosis more of a challenge. To complicate matters, evaluation of an injured athlete is often completed in the setting of the playing field, where distractions can be abundant. The physician treating sports-related injuries must not only follow the general principles of fracture evaluation and management, but must also be aware of the commonly understated fractures associated with the athlete's upper extremities. This manuscript reviews several such subtle fractures based on presentation, evaluation, and treatment.

Athletic Injuries↗
PubMed2004

Upper extremity deep vein thrombosis and pulmonary embolism after coronary bypass surgery: a case report and preliminary results from a prospective study evaluating patients during cardiac rehabilitation.

A 78-year-old woman with unstable angina underwent coronary bypass surgery with complete cardiac revascularization and no immediate postoperative complications. Six days after surgery, during hospitalization for cardiac rehabilitation, the patient developed severe respiratory distress and pulmonary embolism was diagnosed. Color duplex ultrasound revealed the presence of concomitant upper extremity deep vein thrombosis (UEDVT), ipsilateral to the site of placement of a central venous line, in the absence of lower extremity deep vein thrombosis. We describe this case and provide preliminary data from a prospective observational study evaluating the prevalence of catheter-related UEDVT and symptomatic pulmonary embolism (55 and 1.4% respectively) in a series of 71 consecutive coronary bypass surgery patients admitted to a cardiac rehabilitation facility. Catheter-related UEDVT and pulmonary embolism may complicate coronary bypass surgery and should be taken into consideration when managing patients after surgery.

Aged↗
PubMed2004

Upper extremity deep venous thrombosis in patients with 5-fluorouracil-containing adjuvant chemotherapy--three case reports and a review.

Catheter-related deep venous thrombosis is a complication that can occur in patients receiving chemotherapy. Three such cases are described and a review of the literature is made, focusing on recent results regarding possible thrombogenic mechanisms and the high prevalence of non-symptomatic thrombosis as well as the high morbidity and mortality associated with upper extremity deep venous thrombosis. Special emphasis is given to the cytotoxic effects of 5-fluorouracil on vascular endothelium and the likely link to thrombotic complications. The possible differences between two different methods of administering chemotherapy, continuous infusion and bolus dose administration, in this regard are briefly discussed. It is concluded that the first steps towards an understanding of the mechanisms behind the vascular effects of 5-fluorouracil have been taken. Much remains to be done before active interaction with the pathogenic processes leading to vascular and cardiac complications can be realized, yet various forms of anticoagulant therapy could well be an efficient form of prophylaxis.

Adult↗
PubMed2000

The impact of occupational injury on injured worker and family: outcomes of upper extremity cumulative trauma disorders in Maryland workers.

BACKGROUND: Surveys have identified a dramatically rising incidence of work-related upper extremity cumulative trauma disorders (UECTDs). Outcome studies have addressed time lost from work and cost of compensation; omitting other significant consequences. We assess health, functional and family outcomes. METHODS: We identified 537 Workers' Compensation UECTD claimants. A computer-assisted telephone questionnaire was used to elicit symptom prevalence, functional impairment, depressive symptoms (CES-D scale), employment status. RESULTS: One to 4 years post-claim, respondents reported persistent symptoms severe enough to interfere with work (53%), home/recreation activities (64%) and sleep (44%). Only 64% of responses to the activities of daily living scale items indicated "normal" function. Job loss was reported by 38% of respondents, and depressive symptoms by 31%. CONCLUSIONS: Work-related UECTDs result in persisting symptoms and difficulty in performing simple activities of daily living, impacting home life even more than work. Job loss, symptoms of depression, and family disruption were common.

Activities of Daily Living↗
PubMed1991

Severe complex injuries to the upper extremity: revascularization and replantation.

Twenty-nine patients with an incomplete (26) or a complete (3) amputation of the upper extremity proximal to the wrist with revascularization or replantation were reviewed. Limb survival rates were very high (93%) despite the severity of the injuries. All patients regained some useful hand function, with 76% attaining a group I or group II (Chen criteria) functional result. Bone shortening osteotomies are a helpful way to reduce the soft tissue defect size. In contrast to earlier studies, clear correlations between the level of injury, degree of nerve lesion, bone pathology, and the number of major nerves involved, and the functional outcome achieved were not found. There was a weak correlation between the type of wound and the functional recovery ultimately obtained.

Activities of Daily Living↗
PubMed1980

Cutaneous larva migrans in the upper extremity.

Parasitic infestation may resemble bacterial inflammation leading to inappropriate therapy. Three cases of cutaneous larva migrans of the upper extremity are presented in order to emphasize diagnostic and treatment modalities.

Adult↗
PubMed1984

Isolated cold stress testing in the assessment of symptoms in the upper extremity: preliminary communication.

Isolated cold stress testing is introduced as a method for quantification of thermoregulatory capacity of the upper extremities. Ninety-six patients with pain, numbness, or cold intolerance were studied. All diagnoses were confirmed by operation, arteriography, or dynamic radionuclide imaging. Patients were prospectively evaluated, and the observed response patterns were correlated with pathologic processes. Three characteristic temperature-response curves were identified. Isolated cold stress testing is a safe and effective technique that provides useful information about vasomotor tone and areas of arterial compromise and competency that is unavailable with static-state testing.

Adolescent↗
PubMed1996

Recent trends in work-related cumulative trauma disorders of the upper extremities in the United States: an evaluation of possible reasons.

The increasing trends of cumulative trauma disorders of the upper extremities (CTDUEs) in US industry is well established; however, systematic examination of potential reasons for these trends has been lacking. Data from the United States Bureau of Labor Statistics and from Liberty Mutual Group workers' compensation claims were used to count CTDUEs. The proportions of all Bureau of Labor Statistics' cases and Liberty Mutual Group workers' compensation claims that resulted from CTDUEs were estimated for the years 1986 to 1993. The proportions by occupation (job classification code), gender, potential video display unit use, and in the meat-packing industry are described. Both data systems show a steady increase in cases and claims from less than 1% in 1986 to about 4% in 1993. Women and specific occupational categories are over-represented with respect to CTDUEs. A shift to service industry work and video display unit use do not appear to be strongly related to the increased reporting of CTDUEs, whereas increased productivity, an increased number of women in the work force and general awareness of CTDUEs in the media and health care system may be related. Coding and definition problems still limit these conclusions, however.

Arm Injuries↗
PubMed2002

Evaluation of command algorithms for control of upper-extremity neural prostheses.

Five new command control algorithms were created to enable increased control over grasp force in upper-extremity neural prostheses. Most of these algorithms took advantage of the ability to lock or assign a steady command value to the hand neural prosthesis. Five able-bodied subjects tested the algorithms by using a shoulder controller that controlled a video-simulated hand to repeatedly complete a consistent evaluation task. A generalized estimating equations-based linear model was used to analyze the data. The algorithms were ranked via contrast analyses between the coefficient values from the linear model of the proportional control with lock algorithm, which is the algorithm presently used in neural prostheses, and each of the other algorithms. The algorithms that allowed adjustment of the command value after the hand was locked as well as algorithms that allowed a decrease in controller gain after the hand was locked performed better than the proportional control with lock algorithm. Algorithms that changed command as a function of time performed worse than the proportional control with lock algorithm. Further, the computer-based video simulator proved to be useful as a first-pass evaluation tool for neural prosthesis control.

Adult↗
PubMed1981

Spatial kinematic analysis of the upper extremity using a biplanar videotaping method.

A biplanar videotaping system is used to generate spatial kinematic data of an upper extremity motion. The technique is based upon the characterization of each segment by four points in three-dimensional space using biplanar videotaping and subsequent analysis by computer-aided descriptive geometry. The tests were conducted to determine the system's accuracy and repeatability. The results of the joint kinematics of the test subjects performing a diagonal reaching activity with and without an orthosis (or an assistive device) are presented.

Biomechanical Phenomena↗
PubMed2001

Physical workload on upper extremities in various operations during machine milking.

The aim of the study was to quantify the workload on the upper extremity for fundamental work tasks during machine milking. Eleven milkers working in a loose-housing system with a milking parlour participated in the study. Muscle activity for the biceps and the forearm flexors, as well as positions and movements of the wrists were simultaneously measured by electromyography and electrogoniometry while video-recording the work. The milking work was broken up in three main tasks "Drying (the cow's udder)", "Pre-milking (the first milk)" and "Attaching (the milking unit to the udder)" and three supplementary tasks. All three main tasks show high muscle load values and almost no time for rest. The highest load values for the biceps and flexor muscles were found during the tasks "Attaching, holding the milking unit" and "Drying", respectively. For 10% of the recording time, the milkers held active hands in 42 degrees dorsal flexion during the milking tasks "Pre-milking" and "Attaching" and in deviated positions exceeding 50% of their maximum values during "Attaching" and "Drying". The high muscle loads in combination with extreme positions and movements of the hand and forearm might contribute to the development of injuries among milkers. The result from the study aims to form a basis for technical improvements of the milking equipment to decrease the risk for arm wrist and hand disorders.

Adult↗
PubMedDate not supplied

MR Imaging of the cervical cord in juvenile amyotrophy of distal upper extremity.

We report the MR studies of the cervical cord in seven patients presenting juvenile muscular atrophy of distal upper extremity. This illness, also known as monomelic amyotrophy or benign focal amyotrophy, is distinct from the other motor neuron diseases. Seen in young males, it is characterized by muscular atrophy of the hand, and usually of the forearm, most often unilateral. The underlying process, of unknown origin, affects the anterior horn cells in the lower cervical cord. The gradual onset of purely motor disturbances may mimic early amyotrophic lateral sclerosis. This latter diagnosis may be excluded because of clinical stabilization and lack of pyramidal tract involvement. In our series, five MR studies were positive. In three cases we were able to demonstrate focal and unilateral atrophy in the lower cervical cord limited to the anterior horn region. Morphologic MR findings correlated with clinical and electromyographic features. In two other cases the MR-clinical correlation was more complex. No pathologic MR signal was detected on either T1- or T2-weighted images. Although the diagnosis of monomelic muscular atrophy is based on neurologic and neurophysiologic data, MR provides confirmatory evidence as well as useful information contributing to an understanding of this disease.

Adolescent↗
PubMed1977

The development of the myo-tendinous junction in the upper extremity of mouse embryos (days 15 p.c.--1 p.p.).

The development of the myo-tendinous junction in the upper extremity of mouse embryos of days 15 p.c. to 1 p.p. was studied electron microscopically. In the region of the myo-tendinous junction two cell types can be differentiated (muscle cells, fibroblasts) which undergo characteristic changes during the course of their development: The muscle cells show an increase in contractile material, the fibroblasts show a massive collagen production. The myo-tendinous junction is characterised by the appearance of four structures: 1. Irregular pattern of the plasma membrane resulting from intracellular membrane vesiculations in defined areas under the cell membrane on the longitudinal side as well as the end of the muscle fibre. These membrane vesiculations can break through to the cell membrane, thus leading to cell invaginations appearing in large amounts up to day 1 p.p. 2. Densifications of the plasma membrane towards the cell centre. 3. Insertion of the myofilaments of the muscle fibre at the desinfications of the plasma membrane (hemidesmosomes). 4. Insertion of collagen filaments in the extracellular space into the basement membrane which then also appears densified. The mechanical stress transmission seems therefore to be dependent upon the adhesion between myofibrils, plasma membrane, basement membrane and collagenous filaments.

Animals↗
PubMed1976

[Primary and secondary microsurgical suturing of nerve injuries of the upper extremities. Results of treatment (author's transl)].

In the course of two years, 53 traumatic nerve severances of the upper extremity were sutured microsurgically at the Freiburg University Surgical Hospital. Continuity was restored by primary suture in 29 cases, by secondary suture in 4 cases and by transplantation in 20 cases. The first reinnervation potentials showing in the EMG served as evidence of the motor regeneration. With primary sutures, incipient voluntary innervation was observed after 2 1/2 months, but only after 9 months with nerve transplantation. Favourable conditions given, the authors therefore prefer the microsurgical primary suture to transplantation.

Arm↗
PubMedDate not supplied

[Cervical epidural anesthesia for upper extremity surgery using three different formulations of local anesthetics].

OBJECTIVE: To evaluate the efficiency and safety of the cervical epidural blockade (CEB) in upper extremity surgery, using lidocaine 2%, bupivacaine 5% and a mixture of both local analgesics. MATERIAL AND METHODS: Eighty five patients were submitted to upper limb surgery under CEB. They were assigned into one of three groups: group I received 100 mg of 2% lidocaine; group II received 30 mg of 0.5% bupivacaine, and group III received a mixture of 60 mg of 2% lidocaine and 15 mg of 0.5% bupivacaine. We evaluated their effects on vital signs, blockade quality, adverse effects, and patient comfort. RESULTS: Anesthesiologist and surgeon evaluated the technique as "good" in 80% of the patients. Significant differences were found for motor blockade. Group II developed complete motor block (100%). Observed adverse effects were vomiting in groups II and III and dural puncture was present in 6.7% of the cases in group II. CONCLUSIONS: This study confirms the safety of cervical epidural anesthesia for upper limb surgery using three different formulations of local anesthetics.

Adult↗
PubMed2006

Upper extremity arterial combat injury management.

Traumatic hemorrhage and vascular injury management have been concerns for both civilian and military physicians. During the 20th century, advances in technique allowed surgeons to focus on vascular repair, restoration of perfusion, limb salvage, and life preservation. Military surgeons such as Makins, DeBakey, Hughes, Rich, and others made significant contributions to the field of surgery in general and vascular surgery in particular. Casualties from combat in Afghanistan and Iraq confront physicians and surgeons with devastating injuries. The current generation of providers is challenged with applying contemporary care while expanding upon the lessons taught by our predecessors. The objective of this report is to review the historical experience with managing military upper extremity arterial injuries and compare that experience with current management.

Arteries↗
PubMed1997

Acute central cervical cord injury presenting with only upper extremity involvement.

Twenty-four patients with acute central cervical cord injury with motor and sensory impairment involving only the upper extremities are described; none had any abnormality in the lower extremities. They were all treated conservatively with one exception in whom an anterior decompression was performed. Seventeen had complete recovery of motor function; the remaining 7 had some weakness of the palmar interosseous muscles. The time to recovery was from 2 weeks to 4 months. Sensory recovery took from 4 to 6 months after injury. This type of injury is caused by damage to the anterior and posterior horn cells in the cervical cord.

Accidental Falls↗
PubMed1986

Hysterical paralysis in the upper extremity of chronic pain patients.

The patient with chronic pain who develops the conversion symptom of hysterical paralysis in the upper extremity can be treated successfully by rehabilitation medicine services, using a shaping behavioral program. Four case reports illustrate the management of this condition and the basic ingredients for such a program are outlined. The approach is based upon learning principles and experience with conversion reactions affecting gait. Treatment outcome often is related directly to the care and skill with which psychological assessment is performed and to the coordinated effort of the various team members.

Adult↗