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At least 1,171 records · Page 65Linked to original sources
PubMed2003

Repetitive, negligible force reaching in rats induces pathological overloading of upper extremity bones.

UNLABELLED: Work-related repetitive motion disorders are costly. Immunohistochemical changes in bones resulting from repetitive reaching and grasping in 17 rats were examined. After 3-6 weeks, numbers of ED1+ macrophages and osteoclasts increased at periosteal surfaces of sites of muscle and interosseous membrane attachment and metaphyses of reach and nonreach forelimbs. These findings indicate pathological overloading leading to inflammation and subsequent bone resorption. INTRODUCTION: Sixty-five percent of all occupational illnesses in U.S. private industry are attributed to musculoskeletal disorders arising from the performance of repeated motion, yet the precise mechanisms of tissue pathophysiology have yet to be determined for work-related musculoskeletal disorders. This study investigates changes in upper extremity bone tissues resulting from performance of a voluntary highly repetitive, negligible force reaching and grasping task in rats. MATERIALS AND METHODS: Seventeen rats reached an average of 8.3 times/minute for 45-mg food pellets for 2 h/day, 3 days/week for up to 12 weeks. Seven rats served as normal or trained controls. Radius, ulna, humerus, and scapula were collected bilaterally as follows: radius and ulna at 0, 3, 4, 5, 6, and 12 weeks and humerus and scapula at 0, 4, and 6 weeks. Bones were examined for ED1-immunoreactive mononuclear cells and osteoclasts. Double-labeling immunohistochemistry was performed for ED1 (monocyte/macrophage lineage cell marker) and TRACP (osteoclast marker) to confirm that ED1+ multinucleated cells were osteoclasts. Differences in the number of ED1+ cells over time were analyzed by ANOVA. RESULTS: Between 3 and 6 weeks of task performance, the number of ED1+ mononuclear cells and osteoclasts increased significantly at the periosteal surfaces of the distal radius and ulna of the reach and nonreach limbs compared with control rats. These cells also increased at periosteal surfaces of humerus and scapula of both forelimbs by 4-6 weeks. These cellular increases were greatest at muscle attachments and metaphyseal regions, but they were also present at some interosseous membrane attachments. The number of ED1+ cells decreased to control levels in radius and ulna by 12 weeks. CONCLUSIONS: Increases in ED1+ mononuclear cells and osteoclasts indicate that highly repetitive, negligible force reaching causes pathological overloading of bone leading to inflammation and osteolysis of periosteal bone tissues.

Animals↗
PubMed2002

Psychophysiology of work: stress, gender, endocrine response, and work-related upper extremity disorders.

BACKGROUND: Mental stress may induce muscle tension and has been proposed to contribute to the development of work related upper extremity disorders (WRUEDs) by driving low threshold motor units into degenerative processes by overload. METHODS AND RESULTS: Measurements of perceived stress, catecholamines, blood pressure, and heart rate are associated with stress induced elevation of trapezius electromyographic activity. In repetitive tasks, where WRUEDs are common, psychophysiological arousal is generally high both during and after work. A possible explanation of the high prevalence of WRUEDs among women could be that women often are performing repetitive tasks and are exposed to additional stress from unpaid work. CONCLUSIONS: It is concluded that both physical and psychosocial work conditions may contribute to WRUEDs by inducing physiological stress and muscle tension.

Adult↗
PubMed2002

Stress and work-related upper extremity disorders: implications for prevention and management.

BACKGROUND: A causal link between stress and work-related musculoskeletal disorders of the upper extremities (WRUEDs) has been established, but there is less evidence for a beneficial effect of stress reduction interventions on WRUED symptoms and incidence. METHODS: Searches of Medline, Ergonomics Abstracts, and Psychlit from 1990 to 2001 identified studies that either targeted stress and measured WRUED outcomes, or described other interventions with both stress and WRUED outcomes. RESULTS: Workplace interventions, including discrete improvements in technology, work organization and ergonomics, and more comprehensive approaches can reduce levels of stress. In a few studies, these interventions have been associated with decreases in WRUED symptoms. Similar effects are noted in stress-related interventions targeting individuals before WRUEDs have appeared, and at several stages of these conditions. CONCLUSIONS: Health care providers can recognize stress-WRUED interactions through careful, directed inquiry. Both individual as well as workplace-targeted interventions, delivered in the primary care setting or workplace, may be helpful. Future research priorities include prospective studies of well-defined interventions, with ample measures of subject, intervention and workplace characteristics that can impact outcomes, and adequate follow-up to determine sustained effects.

Arm Injuries↗
PubMed2000

Arterial injury in uncomplicated upper extremity dislocations.

The purpose of this study is to analyze causes and consequences of arterial injury complicating simple dislocations of the upper extremity. This is a multicenter, 5-year, retrospective analysis of vascular injury in patients sustaining shoulder or elbow dislocations without associated fractures. Foci of the study were mechanisms of injury, preoperative imaging, incidence of closed reductions, types of arterial injury, methods of surgical repair, and ultimate outcome. Arterial injury in this patient cohort occurred in 0.74% of patients. Axillary artery injury occurred in 0. 97% and brachial in 0.47%. Both elbow and shoulder dislocations may cause severe arterial damage and strenuously test surgical expertise to achieve successful repair.

Axillary Artery↗
PubMedDate not supplied

Medical and pharmacologic management of upper extremity neuropathic pain syndromes.

Written from a neurologic and therapeutically conservative perspective, this review advocates fundamentally medical and pharmacologic management of upper extremity neuropathic pain syndromes, including chronic regional pain syndromes, formerly classified reflex sympathetic dystrophy (RSD) and causalgia. Mandatory steps include, first, a prompt serious attempt to localize the nerve lesion whenever possible using complete, sophisticated neurologic examinations, then thoughtfully selected conventional neurophysiologic and radiologic tests. Strongly discouraged are promiscuous use of "RSD" to describe all neuropathic pains, and diagnostic reliance upon thermography and uncontrolled sympathetic blocks. Conservative multidisciplinary diagnostic and treatment teams should often possess a nucleus of neurologist and hand therapist, plus additional consultants including psychiatric. Every physician and therapist managing neuropathic pain must consider psychologic and wellness issues within their responsibilities. Prompt referral to an experienced surgeon is crucial for decompression or repair of relevant, significant, objectively proven (ideally neurophysiologically) nerve and root lesions. Ambiguous professional colloquialisms, "central pain" and "central sensitization," unfortunately provide value-laden pretexts for premature invasive treatments, and animate the truly dreadful concept "central RSD". Various classes of conventional oral non-narcotic adjuvant analgesics are reviewed, and the inevitability of their empiric, non-formulaic administration. No patient-specific, rationally-identifiable molecular receptor/switch can be deduced clinically or tripped mechanistically to terminate chronic pain. Two promising new non-narcotic centrally-active medications, gabapentin and tramadol, are highlighted as harbingers of future progress. The neglected subtle art of prescription writing is stressed, particularly for medication-sensitive patients. Medical cost containment should promote critical, long overdue outcomes studies comparing conservative and invasive pain treatments.

Analgesics↗
PubMed1988

Treatment of upper extremity reflex sympathetic dystrophy with joint stiffness using sympatholytic Bier blocks and manipulation.

Twenty patients with reflex sympathetic dystrophy involving the upper extremity with associated joint stiffness were treated by manipulation under Bier blocks composed of lidocaine, methylprednisolone, and reserpine or guanethidine. Depending on the patients' response, repeat blocks were performed at 48- to 72-hour intervals. Range of motion in the affected joints (primarily the hand and wrist) improved from a pre-block mean of 46% to 81% of normal following the blocks. Patients also reported an 80% mean improvement in their pain. The treatment of advanced reflex sympathetic dystrophy using joint manipulation under sympatholytic Bier blocks appears to be a safe and effective method of treatment.

Arm↗
PubMed2001

[Importance of adequate immobilization of the upper extremity in using the vascularized fibular graft].

The most complications in patients after the reconstruction of the bone defect of the upper extremities are the fractures of the bone graft and pseudoarthrosis on one of the graft suture with defects of humerus. These complications influence on the primary efficiency of the reconstruction and prolong the recovery period. We registered five fractures, four pseudoarthrosis and two graft angulations in the prospective study on 25 patients where the defect of humerus, radius and ulna was compensated by the vascularized fibular graft. The analysis showed four fractures on the distal part of the reconstructed humerus graft and three pseudoarthrosis on the proximal part of reconstructed ulna. All osteogenic complications, apart from angulations which did not require additional interventions were solved by spongyoplasty according to Phemisters and more efficient postoperative immobilization.

Female↗
PubMed2003

Prothrombin G20210A mutation and oral contraceptive use increase upper-extremity deep vein thrombotic risk.

The role played by a hypercoagulable state, either inherited or acquired, in the pathogenesis of upper-extremity deep vein thrombosis (UEDVT) remains a question of debate. We performed a case-control study including 79 patients with a first objectively confirmed episode of UEDVT, 31 secondary and 48 primary, and 165 healthy controls. Nine patients (11.4%) with UEDVT were carriers of the prothrombin G20210A mutation vs. six (3.7%) in controls; P = 0.025, OR: 3.39 (95% CI 1.16 to 9.88). No statistical difference was observed between cases and controls for the factor V Leiden mutation, AT, protein C or protein S deficiency and anticardiolipin antibodies (ACAs). Thirteen (35.1%) UEDVT patients were oral contraceptive (OC) users vs. 12 (16%) controls; P = 0.020, OR: 2.89 (95% CI 1.16-7.21). When secondary UEDVT patients were compared with controls, no differences were observed in any of the risk factors analysed. On the other hand, when primary UEDVT was considered, six (12.5%) patients were carriers of the prothrombin G20210A mutation vs. six (3.7%) controls; P = 0.031, OR: 3.76 (95% CI 1.15-12.26). Regarding ACAs, a borderline statistical significance was observed when primary UEDVT was compared with controls, P = 0.048; OR: 4.88 (95% CI 1.05-22.61). In primary UEDVT, 52% of the fertile women were OC users vs. 16% of controls; P = 0.001, OR: 5.78 (95% CI 2.13-15.67). When the interaction of both factors, i.e. prothrombin G20210A mutation and OC intake, were considered, the risk increased markedly, indicating a synergistic effect as observed with other thrombotic locations. In patients with primary UEDVT screening for antithrombin, protein C and protein S deficiency and APC resistance would not be justified, although it might be reasonable to determine the carrier status of the prothrombin G20210A mutation only in OC users.

Adolescent↗
PubMed1990

Cerebral palsy. Management of the upper extremity.

Although only a small number of children with cerebral palsy have indications for surgical treatment of dynamic or structural upper-extremity deformities, orthopedic surgery does improve function and appearance of the involved hand, particularly in spastic hemiplegia. For further assessment of the patient after careful physical examination, myoneural nerve blocks and dynamic electromyography are useful. Physical and occupational therapists have an important role as crucial links among parents, patients, and physicians. Surgeons can try to prevent deformity with splints; however, their use in prevention of deformities of the hand has not been validated by scientific studies. Shoulder deformities can be managed with myotomies, tendon transfers, and (if fixed) osteotomies; rarely is arthrodesis used. Elbow flexion and dynamic or fixed deformities greater than 60 degrees are treated by lengthening of the muscles and tendons. Pronation deformities of the forearm are managed by myotomies, lengthenings, and tendon transfers. Wrist flexion deformities can be corrected with tendon lengthenings and transfers. The best results have been obtained with transfer of the flexor carpi ulnaris to the extensor digitorum communis. Finger flexion deformities can be managed satisfactorily with Z-lengthenings of the flexor digitorum superficialis in the forearm; rarely is it necessary to lengthen the flexor digitorum profundus. For adduction deformity of the thumb, division of the proximal or distal insertions of the adductor pollicis and release of the first dorsal interosseus muscle from the first and second metacarpals are preferred.

Arm↗
PubMed1987

Axillary artery aneurysm as an occult source of emboli to the upper extremity.

Reported here is a case of axillary artery aneurysm secondary to crutch trauma as a source of emboli to the upper extremity. This patient along with several reported in the literature was initially diagnosed and treated for brachial artery embolism. It is believed that awareness of this entity as a cause of forearm and hand ischemia is important in planning the appropriate surgical therapy.

Aneurysm↗
PubMed1987

Upper extremity strength deficits in hemiplegic stroke patients: relationship between admission and discharge assessment and time since onset.

This study describes objective upper extremity strength deficits in hemiplegic stroke patients on initial and discharge assessment, and the relationship between these deficits and the time since onset. The static strength of ten different muscle groups had been measured bilaterally in patients (n = 24 to 58, depending on the muscle group), using a hand-held dynamometer. Strength deficits were calculated in relation to the nonparetic side of the body. Zero order correlations were calculated for strength deficit and time variables. Only the relationships between the strength deficits of the initial and discharge assessments were significant (p less than 0.01). These results suggest that the strength deficits of an initial assessment are the best predictors of strength deficits at discharge. This finding has implications for clinicians in clinical decision-making and in addressing patient expectations.

Aged↗
PubMed1983

Vertical impact evaluation of the F/FB-111 crew restraint configuration, headrest position, and upper extremity bracing technique.

An experiment to assess the influence of changes in restraint harness configuration, fore-aft headrest position, and upper extremity bracing technique on human response to impact was conducted using the AFAMRL Vertical Deceleration Tower. A total of 201 tests was performed with volunteer subjects in 11 test conditions to evaluate 3 restraint harnesses, 3 arm bracing conditions, and 4 seat adjustment configurations. The test fixture, restraint harness, and subject were instrumented to obtain pertinent objective data during each experiment. Measured parameters included acceleration of the impact carriage and test seat, velocity of the carriage, loads reacted at the seat, loads measured at the restraint harness attachment points, triaxial translational accelerations at the head and chest of the subject, and body segment displacements. The mean peak carriage acceleration for the 161 experimental level tests was 10.5 G (S.D. = 0.18) and the mean carriage velocity change was 7.89 m/s (S.D. = 0.05). Resultant head and chest accelerations were increased in a proposed, modified F/FB-111 restraint system compared to the operational F/FB-111 restraint system. These findings contributed to the decision not to implement the proposed modification. Also, the arms crossed bracing position for F/FB-111 ejectees preparing for landing impact of the crew module was associated with higher seat loads than the arms extended position. With the arms extended and braced on the anterior thighs or knees, loads are transmitted through the extremities to the footrest thereby reducing loading of the vertebral column. Operational use of the arms extended position prior to anticipated vertical impact accelerations may be helpful in reducing the vertebral fracture rate associated with these mechanical force environments.

Adult↗
PubMed1983

[Phlebography of the upper extremity: assessment of various x-ray signs].

The article reports on the findings obtained in 56 serial phlebographies of the upper extremity. Using 17 phlebographies without pathological findings as basis, the physiological phenomena of venous contrasting in the region of the shoulder and arm are examined. The remaining phlebograms with pathological findings are assessed according to different criteria, such as localisation and extent of venous vascular occlusion, visualisation of vascular clot and formation of collaterals resulting in collateral circulation.

Arm↗
PubMed1993

Upper-extremity deep venous thrombosis: analysis of 52 cases.

In a review of 52 cases of deep venous thrombosis (DVT) of the upper extremity, the predisposing factors, clinical manifestations, topography of thrombosis, treatment employed, presence of complications, and evolution of the disease were investigated. In all patients, clinical manifestations were confirmed by bilateral phlebography and superior cavography. Thirty-five (67%) of the patients were male; the mean age was 45.4 years. Clinical manifestations were edema in 51 patients (98%), dilated collateral circulation in 37 (71%), and pain in 33 (63%). One patient presented with pulmonary embolism and another with phlegmasia cerulea dolens-like signs in an extremity. The right axillosubclavian segment was involved in 23 patients (44%), the left in 17 (33%), and both left and right segments associated with DVT of the superior vena cava in 11 (21%). One patient had left and right axillosubclavian thrombosis without superior vena cava involvement. The main predisposing factors identified were central venous catheterization in 15 patients (29%) and extrinsic compression, caused mainly by cancer, in 15 (29%). There were three cases of DVT related to effort and three to thoracic outlet syndrome. The majority of patients were treated with systemic heparin therapy followed by oral anticoagulation. During a follow-up of 6 months, nine patients died, one from pulmonary embolism; 21 patients (40%) were symptom-free, 11 (21%) had minimal edema, and seven (13%) had symptomless edema. Four patients (8%) were lost to follow-up. The overall incidence of pulmonary embolism was 4%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Control strategies in FNS systems for the upper extremities.

The condition of the paralyzed patient is described, regarding both the primary paralysis and the secondary physiological changes in the upper limb resulting in abilities and disabilities in upper limb function. Although the review relates mainly to spinal cord injuries at the C4, C5, and C6 levels, other conditions are noted such as hemiplegia. Activation of muscle by functional neuromuscular stimulation (FNS) is discussed. The biomechanics of the FNS-activated paralyzed upper limb is analyzed for activation by both implanted and by surface electrodes, and a review is presented of open-loop strategies for systems in clinical use. Closed-loop strategies applied to the upper extremity are reviewed for analog and digital systems, and regimes developed for specific functional activities are outlined. Finally, adaptive control strategies are surveyed.

Arm↗
PubMed2005

Gender difference in prevalence of upper extremity musculoskeletal symptoms among Swedish pig farmers.

There have been very few epidemiological studies dealing with pig farmers' musculoskeletal health. The aim of this study was to carry out a cross-section postal questionnaire survey dealing with musculoskeletal symptoms among female and male pig farmers in large-scale production. The participation rate overall was 70% (288/410). Over 10% of the questionnaires had missing gender data. Three different questionnaires were used: the general standardized Nordic questionnaire for the analysis of musculoskeletal symptoms; a questionnaire dealing with occurrence of numbness, reduced muscle strength, etc., in the wrists and hands; and occupational factors were screened by a special questionnaire. The results showed that musculoskeletal morbidity is high among pig farmers. The women had significantly more problems than the men with respect to the upper extremities. Symptoms in the wrists and hands such as numbness, reduced muscle strength, aching fingers and wrists, and tendency to drop things were significantly more common among the women than the men. Occupational factors dealing with, for example, the size of the pig farm, were not related to the occurrence of symptoms. Occupational factors of importance for the development of disorders, particularly among women pig farmers, should be given priority in ergonomic interventions.

Adult↗
PubMed2006

Changes in upper extremity biomechanics across different mouse positions in a computer workstation.

In order to determine differences in biomechanical risk factors across different mouse positions within computer workstations a repeated measures laboratory study was completed with 30 adults (15 females 15 males). The subjects performed mouse-intensive tasks during two experiments. One experiment examined three mouse positions: a standard mouse (SM) position with the mouse directly to the right of the keyboard; a central mouse (CM) position with the mouse between the keyboard and the body, positioned in the body's mid-sagittal plane; a high mouse (HM) position, which simulated using a keyboard drawer with the mouse on the primary work surface. The second experiment compared two mouse positions: the SM position and a more central position using a keyboard without a number keypad (NM). Electrogoniometers and inclinometers measured wrist and upper arm postures and surface electromyography measured muscle activity of four forearm muscles and three shoulder muscles. The CM mouse position was found to produce the most neutral upper extremity posture across all measures. The HM position produced the least neutral posture and resulted in the highest level of muscle activity. Compared to the SM position, the NM position reduced wrist extension slightly and promoted a more neutral shoulder posture. Little difference in muscle activity was observed between the SM and NM positions. In conclusion, of these alternative mouse positions, the HM position was the least desirable, whereas the CM position reduced overall awkward postures associated with mouse-intensive computer tasks.

Adult↗
PubMed2005

New perspectives on improving upper extremity function after spinal cord injury.

Injury to the cervical spinal cord adversely affects arm and hand function to varying degrees depending on the level and severity of injury. These impairments typically result in reduced independence in the performance of activities of daily living and limit participation in recreational activities. There is evidence to suggest individuals with incomplete spinal cord injury may benefit from intensive rehabilitation interventions aimed at improving hand and arm function. Massed practice (repetitive activity-based training) and somatosensory stimulation (prolonged peripheral nerve electrical stimulation at submotor threshold intensity) are 2 interventions that have been shown to improve strength and function in individuals with stroke, presumably by changing cortical excitability. These techniques, however, had not previously been investigated in individuals with spinal cord injury (SCI). In this article the stroke and SCI literature supporting the use of massed practice and somatosensory stimulation as a potential rehabilitative tool to promote recovery of function in individuals with incomplete cervical spinal cord injury (SCI) is reviewed. Recently published research using these novel techniques in which a combination of massed practice and somatosensory stimulation resulted in increased pinch grip strength and upper extremity function in individuals with incomplete cervical SCI when compared to subjects participating in massed practice alone is presented.

Activities of Daily Living↗