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At least 1,189 records · Page 66Linked to original sources
PubMed2004

Affecting upper extremity strength by changing maxillo-mandibular vertical dimension in deep bite subjects.

The effect of vertical dimension of occlusion (VDO) on maximizing isometric deltoid strength (IDS) was measured in subjects with deep overbite. Sixteen female dental students with deep dental overbite and no history of temporomandibular joint disorder (TMD) were used as their own control and tested for isometric strength of the deltoid muscles, using a hand held strain gauge. Measurements were taken under four mandibular conditions: 1. habitual occlusion; 2. mandibular rest position; 3. biting on a bite elevating appliance set to the functional criterion of peak IDS; and 4. biting on a placebo appliance. Results showed that in deep bite subjects, isometric deltoid strength in habitual occlusion was significantly less than in the mandibular rest position. Isometric deltoid strength with the bite elevating appliance was significantly greater than isometric deltoid strength in habitual occlusion, as well as in the mandibular rest position. Isometric deltoid strength achieved in habitual occlusion and placebo did not differ. Results of this study support previous findings indicating that a change in the VDO will affect isometric strength of the upper extremities.

Adult↗
PubMed2002

Quantitative radionuclide lymphoscintigraphy predicts outcome of manual lymphatic therapy in breast cancer-related lymphedema of the upper extremity.

Secondary lymphedema is a localized, acquired lymphatic microcirculatory disturbance that affects large numbers of patients after breast cancer therapy. There is a paucity of objective methods to quantitate lymphatic function and to anticipate the response to therapeutic interventions. We applied radionuclide lymphoscintigraphy to evaluate lymphatic transport and axillary lymph node visualization in women following breast cancer therapy to determine the utility of these data in these patients. Lymphoscintigraphy was performed after subcutaneous injection of 0.25 mCi of Tc-filtered sulfur colloid. Subcutaneous accumulation of radiotracer ('dermal backflow') and the visualization of axillary lymph nodes were graded using our own scoring system. The ratio of radioactivity within the affected to normal axillae (ARR) was also quantified. Nineteen patients with lymphedema after breast cancer therapy were evaluated. The disease severity was documented by serial measurements of the limb volume using the truncated cone formula. Responses to therapy were quantified after completion of the therapy. There was a correlation between the ARR and the percentage reduction in edema volume. The lymphoscintigraphic score correlated with the initial arm volume excess and with the durationof lymphedema. It can be concluded that quantitative and semi-quantitative assessment by radionuclide lymphoscintigraphy represents a potentially useful tool for the clinical assessment of upper extremity lymphedema.

Aged↗
PubMed1995

Upper extremity thromboembolism caused by occlusion of axillofemoral grafts.

BACKGROUND: The axillofemoral bypass graft (AxFG) is increasingly accepted as treatment for lower extremity ischemia caused by aortoiliac occlusive disease in high-risk patients. The incidence of upper extremity (UE) thromboembolism caused by occlusion of an AxFG and the results of treatment form the basis for this report. METHODS: From 1984 to the present, all patients undergoing axillofemoral bypass grafting were followed up in a vascular registry. A standardized operative technique, using an externally supported 8-mm polytetrafluoroethylene graft, was used in performing 202 AxFGs in 182 patients. UE thromboembolism caused by occlusion of an AxFG was identified by retrospective patient record review. RESULTS: Occlusion of an AxFG occurred in 20 patients. Fifteen patients (75%) underwent immediate revision of the occluded graft. Two patients (10%) developed UE thromboembolism simultaneous with graft occlusion. One of these patients had immediate revision of the graft, and 1 had brachial embolectomy only. This patient and 4 others (25%) had the occluded AxFG left in place. Four of these 5 patients (80%) developed UE thromboembolism at 26 days, 2 years, 5 years, and 7 years, respectively, after occlusion. Overall, six UE thromboembolic complications occurred in 5 patients. CONCLUSIONS: UE thromboembolism represents a significant and specific complication of occluded AxFGs in our series (2.7% of patients, 25% of occluded grafts). It may be prudent to prophylactically detach the axillary portion of the graft and repair the axillary artery in patients who do not require immediate revision of an occluded AxFG.

Algorithms↗
PubMed1989

Treatment of frostbites of the upper extremities with prolonged blockade of axillary plexus.

Encouraged by the beneficial effect in the treatment of cold injury of the lower extremities, the authors applied permanent plexus anesthesia for treatment of the cold injury of the upper extremities too. Of the total of 10 in-patients treated with this method, amputation had to be made only in 2 cases due to the lack of compliance of the patients retarding the commencement of therapy. 7 patients with the same severity of cold injury admitted from other hospitals where they had been treated with traditional methods have undergone multiple phalangectomies. The method had beneficial effect only when applied within the first 8 h after trauma.

Anesthesia, Epidural↗
PubMed2007

Effect of aviation snip design and task height on upper extremity muscular activity and wrist posture.

Hand tools described as ergonomic in design are intended to reduce exposure to physical risk factors associated with work-related musculoskeletal disorders. Additionally, using the right tool for the job is believed to reduce exposure and, consequently, risk of disease. Sheet metal workers frequently use a cutting tool called aviation snips when fabricating and installing ductwork. The purpose of this laboratory simulation study was to determine the effect of (1) aviation snip design; and (2) work height on muscle activity, wrist posture, and user satisfaction among sheet metal workers. We hypothesized that specific aviation snips designs would be most appropriate for use at specific heights. Twenty-three sheet metal workers used three different designs of aviation snips to make curved cuts in sheet metal placed both at waist height and shoulder height. Conventional circular snips, straight snips, and an alternate design of offset snips were used. Upper extremity muscle activity was measured with surface electromyography, wrist posture was measured with electrogoniometry, and user satisfaction was rated by the participants on a survey. Statistically significant effects of snip design and task height on muscle activity, wrist posture, and user satisfaction were observed. However, no snip was preferable for all dependent variables. Work height had a greater effect on muscle activity and wrist posture than snip design. Field studies are indicated to determine the long-term effect of snip design on physical risk factors and risk of musculoskeletal disorders.

Adult↗
PubMed2006

Prenatal diagnosis and therapy of upper extremity vascular malformation causing high cardiac output and Kasabach-Merritt sequence: a report of two cases.

We present two cases of upper extremity vascular malformation causing a high output state in the prenatal period. One fetus responded well to transplacental digitalis treatment. Both newborns had a Kasabach-Meritt sequence including anemia and thrombocytopenia. Postpartum treatment included successful interventional occlusion of the main feeding arteries and subsequent surgical removal of the tumor.

Anemia↗
PubMed2006

Upper extremity vascular injury: a current in-theater wartime report from Operation Iraqi Freedom.

Past wartime experience and recent civilian reports indicate upper extremity (UE) vascular injury occurs less often and with less limb loss than lower extremity (LE) injury. Given advances in critical care, damage control techniques, and military armor technology, the objective of this evaluation was to define contemporary patterns of UE injury and effectiveness of vascular surgical management in UE vascular injury during Operation Iraqi Freedom (OIF). From 1 September 2004 through 31 August 2005, 2,473 combat-related injuries were treated at the central echelon III surgical facility in Iraq. Patients with UE vascular injuries upon arrival were reviewed. Vessels injured were delineated. Therapeutic interventions, early limb viability, and complication rates following vascular repair were recorded. Of casualties treated during the study period, 43 (1.7%) UE and 83 (3.3%) LE vascular injuries were identified. Of the UE injuries, 11 (26%) had been operated on at forward locations and six (14%) had temporary shunts in place upon arrival at our facility. Injury levels included 10 (23%) subclavian-axillary, 25 (58%) brachial, and 10 (23%) distal to the brachial bifurcation. Two patients had multilevel injury. Twenty-eight grafts were placed, and 10 vessel repairs and eight ligations were performed. Two (4.7%) brachial interposition grafts required removal due to infection. Four (9.3%) subacute brachial graft thromboses occurred. Four (9.3%) patients underwent early UE amputation. In this most recent U.S. military evaluation of wartime UE vascular injury, UE injury appears rare, with LE injury twice as frequent. Yet, UE limb loss appears more substantial than noted previously. These findings are likely related to significant tissue destruction occurring with the combined mechanisms of injury sustained in OIF.

Amputation, Surgical↗
PubMed2005

The use of Integra in an upper extremity avulsion injury.

We present the case of a 22-year-old man who suffered an avulsion injury of the left upper extremity including the elbow region in an industrial accident. After debridement of the skin flap, the defect was primarily closed with Integra. On day 22 split thickness skin graft was performed. Functional and aesthetic outcome and skin quality are excellent.

Accidents, Occupational↗
PubMed2006

Worker's compensation litigation of the upper extremity claim.

This article presents an overview of the issues presented to physicians and lawyers in evaluating, treating, litigating, and concluding an upper extremity workers' compensation claim. This analysis includes a review of the unique considerations involved in the workers' compensation patient/claimant, a general examination of workers' compensation law, and the interplay between litigation and the medical management of the patient.

Arm Injuries↗
PubMed1979

Free vascularized bone grafts in surgery of the upper extremity.

Free vascularized fibular grafts were employed in five patients with segmental bone defects following trauma or resection of tumors of the upper extremity with excellent results in three patients and satisfactory results in two. No donor site morbidity was experienced. A comparison with rib and iliac crest grafts indicates that the fibula is more suitable for reconstruction of long bone defects. The advantages of this technique are stability without sacrificing viability and a shorter immobilization period with more rapid incorporation and hypertrophy of the graft. The disadvantages are prolonged operating time, difficulty in assessing patency of anastamoses in the immediate postoperative period, and sacrifice of a major vessel in the lower extremity.

Adult↗
PubMed1983

The treatment of upper extremity reflex sympathetic dystrophy with prolonged continuous stellate ganglion blockade.

Twenty-nine consecutively treated patients over a 5-year period with upper extremity reflex sympathetic dystrophy were admitted to Massachusetts General Hospital for prolonged continuous stellate ganglion blockade. Diagnosis was based on the presence of pain, decreased joint motion, trophic changes, and vasomotor disturbances. Selection for blockade was made on the failure to improve with outpatient physical therapy, tranquilizers, and mild analgesics. Treatment consisted of indwelling-catheter injections of bupivacaine hydrochloride every eight hours to the stellate ganglion for an average of 7 days, supplemented with vigorous physical therapy. Improvement during treatment was documented in all but two patients with regard to pain and decreased joint motion and in two-thirds with regard to trophic and vasomotor changes. Long-term follow-up demonstrated a relapse rate of 25%, but marked improvement persisted in the rest and normal status was attained in four of 26 patients at an average of 3 years later.

Adult↗
PubMedDate not supplied

Computer simulation of the upper extremities.

The development of real-time, interactive, three-dimensional, computer graphic simulation of the musculoskeletal system with emphasis on the upper extremities is described. Developments in image analysis, scientific visualization, and interactive computer methods and the continuous improvement in knowledge of musculoskeletal function have combined to provide an exciting new tool for musculoskeletal research. Interactive simulation also has promising applications in medical education and clinical rehabilitation. Only those developments that fit the specific criteria of realism, real-time response, intuitive interaction, three-dimensional structures, and modeling flexibility are discussed. It is hoped that an improved understanding of this emerging tool and an appreciation for its potential applications will be gained.

Arm↗
PubMed1993

Computer-aided treatment design of a distal upper extremity soft tissue tumor with electron beam radiotherapy.

We present here a novel approach for the planning and treatment of a distal upper extremity soft tissue tumor. Utilizing computed tomography (CT) based electron dose calculations, a customized compensating wax bolus was designed in order to deliver sufficient dose coverage to the tumor volume while sparing the draining lymphatics of the patient's hand and digits. A clinical case is presented as well as the design and construction of the compensator. Outcome and clinical implications are discussed.

Adult↗
PubMed1999

Modulation of intracortical excitability for different muscles in the upper extremity: paired magnetic stimulation study with focal versus non-focal coils.

OBJECTIVE: Intracortical excitability was studied for 4 muscles in the upper extremity by paired transcranial magnetic stimulation on the motor cortex, using focal and non-focal coils. METHODS: Surface EMG responses of two hand and two forearm muscles were simultaneously recorded in 13 healthy subjects, after delivering paired stimuli at interstimulus intervals (ISIs) of 1-50 ms using circular and figure-of-8 (focal) coils. The intensities of conditioning and test stimuli were submotor and supramotor thresholds, respectively. RESULTS: Paired stimulation using a circular coil showed constant inhibition at 2 ms ISI for all muscles, but not at 5 ms ISI, and induced facilitation at 10 ms ISI. The results using a focal coil were similar to those with a circular coil at all ISIs except at 5 ms ISI, where the former showed inhibition. At 20 and 30 ms ISIs, there was interindividual variability for both coils, some subjects showing inhibition and others facilitation. CONCLUSIONS: The difference of the inhibition at 5 ms ISI between using circular and focal coils could be attributed to the cortical mechanism. The inhibitory effect at 2 ms ISI, consistently observed for the 4 muscles with both types of coil, could be easily applied to assess the inhibitory intracortical function in patients with neurological diseases.

Adult↗
PubMed2006

Effectiveness of an upper extremity exercise device integrated with computer gaming for aerobic training in adolescents with spinal cord dysfunction.

BACKGROUND/OBJECTIVE: To determine whether a new upper extremity exercise device integrated with a video game (GameCycle) requires sufficient metabolic demand and effort to induce an aerobic training effect and to explore the feasibility of using this system as an exercise modality in an exercise intervention. DESIGN: Pre-post intervention. SETTING: University-based research facility. SUBJECT POPULATION: A referred sample of 8 adolescent subjects with spina bifida (4 girls, 15.5 +/- 0.6 years; 4 boys, 17.5 +/- 0.9 years) was recruited to participate in the project. All subjects had some level of mobility impairment that did not allow them to participate in mainstream sports available to their nondisabled peers. Five subjects used a wheelchair full time, one used a wheelchair occasionally, but walked with forearm crutches, and 2 were fully ambulatory, but had impaired gait. MAIN OUTCOME MEASURES: Peak oxygen uptake, maximum work output, aerobic endurance, peak heart rate, rating of perceived exertion, and user satisfaction. RESULTS: Six of the 8 subjects were able to reach a Vo2 of at least 50% of their Vo2 reserve while using the GameCycle. Seven of the 8 subjects reached a heart rate of at least 50% of their heart rate reserve. One subject did not reach either 50% of Vo2 reserve or 50% of heart rate reserve. Seven of the 8 subjects increased their maximum work capability after training with the GameCycle at least 3 times per week for 16 weeks. CONCLUSIONS: The data suggest that the GameCycle seems to be adequate as an exercise device to improve oxygen uptake and maximum work capability in adolescents with lower extremity disability caused by spinal cord dysfunction. The subjects in this study reported that the video game component was enjoyable and provided a motivation to exercise.

Adolescent↗
PubMed2002

Surgical infections of the hand and upper extremity: a county hospital experience.

Between January 1992 and June 1995, 443 patients underwent surgical treatment for infections of the hand and upper extremity at Cook County Hospital. Most admissions were for human bites (51%). Other causes included cellulitis (17.0%), septic arthritis (11.8%), abscess formation (9.9%), gangrene (2.7%), flexor tenosynovitis (2.5%), osteomyelitis (1.8%), dog bites (1.4%), web space infections (0.9%), paronychia (0.45%), and cat bites (0.23%). Bacterial cultures were obtained in 395 cases; sensitivities were obtained in 247 of the cultures. Cultures grew a total of 719 organisms. By far, the most common organisms isolated were Gram-positive aerobes (61.9%), including streptococcal species (29.5%), Staphylococcus aureus (15.3%), and coagulase-negative Staphylococcus (11.5%). Most of the organisms isolated were common flora of the mouth or skin. Cultures reflected an increased incidence of Gram-negative enteric and anaerobic organisms compared with similar studies in the literature. Bacterial sensitivities reflected increased organism virulence compared with similar studies in the literature. Bacteria were resistant to the first-line antibiotic therapy of penicillin G (2-4 million units every 4-6 hours) and cefazolin (1 g every 8 hours) in 16.2% of cultures. The predominant resistant organism was Staphylococcus aureus, which grew resistant strains in 19.6% of cultures tested. Enterococcus grew resistant strains to the first-line regimen in 47%. The Enterobacteriaceae grew resistant strains to the first-line regimen in 66.6%. Acinetobacter grew resistant strains to the first-line regimen in 92%. Pseudomonas grew resistant strains to the first-line regimen in 100%. The addition of gentamicin (5 mg/kg every morning) in cases of suspected intravenous drug abuse did not significantly alter the results. Sensitivity results were also analyzed to determine the effectiveness of specific antibiotics against the prevalent resistant organisms. Vancomycin (1 g every 12 hours) proved most effective against the Gram-positive organisms. Ciprofloxacin (400 mg every 12 hours) proved most effective against the Gram-negative organisms, including Pseudomonas, and was also the most effective single agent overall.

Adolescent↗