Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Upper Extremity”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,207 records · Page 67Linked to original sources
PubMed1995

Effects of continuous intrathecal baclofen infusion and selective posterior rhizotomy on upper extremity spasticity.

This study was performed to compare the effects of continuous intrathecal baclofen infusion (CIBI) and selective posterior rhizotomy (SPR) on upper extremity (UE) spasticity and range of motion in children with cerebral palsy. Spasticity was assessed with the Ashworth scale of muscle tone and range of motion was evaluated. Thirty-eight patients who had been treated with CIBI for at least 6 months were paired, according to pretreatment UE muscle tone and functional status, with 38 patients who had undergone SPR. The CIBI dosage had been titrated to reduce over lower extremity spasticity and improve lower extremity function, rather than to improve UE tone. The pretreatment muscle tone in the two groups was virtually identical. The UE tone of children treated with CIBI decreased from 2.07 prior to treatment to 1.66 after 1 year (p < 0.01). The tone of children treated with SPR decreased from 2.03 to 1.70 after 1 year (p = 0.005). In that group, the likelihood of a clinically significant reduction in muscle tone (one point or greater) was greater in children with a higher pretreatment UE muscle tone. There was no correlation between the percentage of posterior lumbar roots divided in SPR and the subsequent reduction in UE tone. There were no significant changes in the range of motion in any UE joint, at either 6 or 12 months, after either CIBI or SPR. We conclude that both CIBI and SPR significantly reduce UE spasticity, in addition to the previously documented reduction in lower extremity spasticity.

Arm↗
PubMed1993

[The skin microflora of the upper extremities as the source of suppurative diseases of the hand and fingers].

The parallel bacteriologic studies of microflora of skin of the upper extremities and pus in purulent diseases of the hands and digits in workers of the combine plant was carried out. It was established that besides Staphylococcus aureus, the haemolytic forms of coagulase-negative species, in particular S. hyicus, S. epidermidis, S. haemolyticus, S. warneri, were the agents of purulent-inflammatory processes both in monocultures and in associations. Incidence of isolation of staphylococci and density of bacterial populations depend on the use of oils and emulsions in the manufacturing process.

Adolescent↗
PubMed1990

Skin substitutes in upper extremity burns.

Four techniques for permanent skin replacement with skin substitutes are described. A claim of superiority to conventional skin grafting on upper extremity and hand burns is not made, but some clinical observations and histologic evidence of different healing characteristics are shown. The composite grafts described appear to effectively replace the bilayered structure of skin and seem to have good subjective resistance to shear forces. If the skin replacement is durable and heals with less scarring than conventional skin grafts, the inexorable course to stiffness and contracture may be altered. Further basic science and clinical investigation may provide us with a better way of managing these difficult problems.

Bandages↗
PubMed1981

Reflex sympathetic dystrophy syndrome of the upper extremity: analysis of total outcome of management of 125 cases.

Case histories of 125 patients with reflex sympathetic dystrophy syndrome of the upper extremity seen from July 1973 to March 1976 were reviewed. There was a 2.9:1 female preponderance. Twenty-four patients had documented litigation pending; however, it did not alter the final outcome significantly. On medical records, progress was noted for 86 patients with 16% having excellent results, 35% good, 26% satisfactory, 6% fair and 17% poor (all subjective evaluations by treating physicians). Median duration of follow-up prior to this study was approximately 2.5 months. Median duration between last clinic visit and follow-up study was 14.5 months. Follow-up letters sent to 123 patients who were believed to be alive showed that 4 patients had died; 77 (63%) replied. The majority of patients (53/77) reported that they still had pain in the shoulder/or hand, but 68% were taking no medications and only 15.3% (12) were taking narcotics. Twenty-eight patients (36%) claimed they were continuing physical therapy at home. Twenty-four (31%) retired or did not go back to the same work. Thirty-five percent were officially disabled, 30% were back at their same jobs and 29/59 female patients (49%) were able to do all the housework. Eighteen patients (23%) were able to return to 100% daily activity, 23 patients (30%) to 75% activity. Eleven patients (14%) had modified their activities considerably and were not able to do well.

Adolescent↗
PubMed1994

[Brachial plexus blockade via the interscalene port--for regional anesthesia/analgesia of upper extremities; use, application and risks].

The interscalene technique for brachial plexus anaesthesia is described. The method is suitable for anaesthesia of the upper extremity, especially when anaesthesia of the proximal part of the arm and the shoulder region is desired. The technique is also useful in paediatric cases. Side effects are few, but the risk of paralysing of the diaphragm makes this method inappropriate for patients with severe respiratory disease.

Aged↗
PubMed1997

Upper-extremity deep vein thrombosis. Risk factors, diagnosis, and complications.

BACKGROUND: Little is known about the clinical, diagnostic, and prognostic aspects of upper-extremity deep vein thrombosis (UEDVT). OBJECTIVES: To identify the clinical and laboratory parameters associated with this disease, to assess the diagnostic accuracy of ultrasonographic methods for its detection, and to establish the frequency of both early and late complications. PATIENTS AND METHODS: After a careful history was taken, 58 consecutive patients with signs and symptoms that were clinically suggestive of UEDVT underwent the determination of antithrombin III and protein C and S levels and resistance to activated protein C and lupuslike anticoagulants. Compression ultrasonography, color flow Doppler imaging, and Doppler ultrasonography were performed prior to venography. Patients with confirmed UEDVT underwent objective tests to detect a pulmonary embolism and were followed up prospectively to record recurrent thromboembolic events and postthrombotic sequelae. RESULTS: Findings from venography confirmed UEDVT in 27 patients (47%). Central venous catheters, thrombophilic states, and a previous leg vein thrombosis were statistically significantly associated with UEDVT. Sensitivity and specificity of compression ultrasonography (96% and 93.5%, respectively) and color flow Doppler imaging (100% and 93%, respectively) were comparable and better than those of Doppler ultrasonography (81% and 77%, respectively). Objective findings suggestive of a pulmonary embolism were recorded in 36% of the patients with UEDVT. After a mean follow-up of 2 years, 2 patients with UEDVT experienced recurrent thromboembolic events, and 4 had postthrombotic sequelae. CONCLUSIONS: Symptomatic UEDVT is associated with central venous catheters, thrombophilic states, and a previous leg vein thrombosis. Both compression ultrasonography and color flow Doppler imaging are accurate methods for its detection. A pulmonary embolism is a common complication of the disease. Finally, this disorder may recur and may be followed by postthrombotic sequelae.

Adult↗
PubMed2004

Laser Doppler flowmetry assessment of microcirculation in upper extremities before and in long-term period after harvesting of radial artery.

Radial artery (RA) is rather commonly used as a graft for autoarterial myocardial revascularization. Consequences of RA harvesting for the development of ischemic disturbances in distal hand segments are poorly understood. The paper presents assessment of hand microcirculation (HMC) before and in late postoperative period after RA harvesting with modern precise diagnostic method - laser Doppler flowmetry (LDF). LDF assessment of HMC was carried out in 80 patients with ischemic heart disease (160 hands) to evaluate the possibility of RA harvesting for coronary artery bypass surgery. HMC classification was developed on the base of these measurements: type 1 -normocirculatory HMC: 6.7-17 ml/min/100 g (58%); type 2 - vasospastic HMC: < or = 6.7 ml/min/100 g (20%); type 3 - hyperemic HMC: > or = 17 ml/min/100 g (22%). In 34% of cases preoperative examination revealed microcirculatory asymmetry between right and left hands. Based on preoperative examination results in 22.9% of cases the decision was made to refuse from RA excision because of positive collateral circulation test developed in our Institute (positive decision about Patent award according to appeal No2000122582/14 (023905) from 28.08.2000). In 14 patients (14 upper extremities) HMC was measured before and 1-1.5 years after RA harvesting. After RA excision baseline HMC in operated hand reduced significantly while maximal HMC reserve remained at the level close to preoperative one. Postoperative HNMC alterations evidence of adequate preoperative assessment of hand collateral circulation potential. In case of blood flow asymmetry RA must be taken from the hand with higher blood supply and adequate collateral microcirculation.

Arteriovenous Shunt, Surgical↗
PubMed2003

Regeneration and functional recovery in the upper extremity of rats after various types of nerve injuries.

The aim was to establish an accurate, reproducible, and simple method to evaluate functional recovery after different types of nerve injuries to the brachial plexus of rats. To that end, pawprints, measured as distance between the first and fourth and second and third digits, were used for evaluation of injuries including crush injury, transection/repair, or graft repair of the median, ulnar, and radial nerves. Immunocytochemistry of the C-terminal flanking peptide of neuropeptide Y (CPON) and neurofilaments was used to investigate the cell body response and axonal outgrowth, respectively. Functional recovery was dependent on the severity as well as on the level of the lesion. Neither a single injury to the median nerve nor an injury to the ulnar nerve affected the pawprint, while an injury to both these nerves or a single injury to the radial nerve caused impairment of pawprints. There was a rapid recovery after crush injury to these nerves compared to previous reports of a similar injury to the sciatic nerve. The pattern of axonal outgrowth was related to the severity of the lesion. A conditioning lesion, i.e., an initial lesion of the same nerve preceding a test injury by a few days, of both motor/sensory fibers led to a quicker functional recovery. Surprisingly, conditioning of only sensory fibers had nearly the same effect. The cell body response was dependent on the level of the nerve lesion. The upper extremity of rats might be useful to evaluate the effects of new repair methods after nerve injuries using functional evaluation with pawprints as a simple and accurate method.

Analysis of Variance↗
PubMed2003

Superficial venous anastomosis in the human upper extremity--a post-mortem study.

The frequent use of veins in surgery, especially in the replacement of clogged arteries in the lower extremities, persuaded the authors to conduct research concerning the morphology of superficial veins in the human upper extremity. In a post-mortem study a group of 40 male subjects of 22-92 years of age was examined. The preparation of the region of the elbow fossa was performed in order to establish the architecture of superficial veins in the extremity. Many detailed anthropometrical measurements were also carried out, enabling a typological evaluation to be made of the deceased under study. Two characteristic pictures of venous anastomosis were tested, one with symmetrical tributaries to the vena basilica et cephalica and the second characterised by a rich set of tributaries to the vena basilica. The characteristics, calibre and structure of both these suggest a fruitful application of them in vessel surgery. The vena cephalica in particular, taken with efficient valves, may successfully play the role of vessel implant.

Adult↗
PubMed2000

Hypercoagulable states in primary upper-extremity deep vein thrombosis.

BACKGROUND: There are very few data on the prevalence of coagulation abnormalities in primary deep vein thrombosis of the upper limbs. OBJECTIVE: To determine if coagulation abnormalities play a role in effort-related and/or idiopathic (non-effort-related) upper-extremity deep vein thrombosis (UEDVT). METHODS: Fifty-one consecutive patients (21 men and 30 women) who had effort-related (n = 20) or idiopathic (n = 31) UEDVT over an 18-year period (median age at diagnosis, 32 years; age range, 15-86 years) were routinely reexamined. Plasma was screened for antithrombin, protein C, and protein S deficiencies and for antiphospholipid antibodies (lupus anticoagulant and anticardiolipin antibodies). The DNA was screened for factor V Leiden and for prothrombin gene G20210A mutations. RESULTS: The median age (35 vs. 28 years), the proportion of women (81% [25/31] vs. 25% [5/201), the proportion of patients with a personal and/or family history of thromboembolism (42% [13/31] vs. 15% [3/20]), and the proportion of patients with at least 1 coagulation abnormality (42% [13/31] vs. 15% [3/20]) were higher in the idiopathic UEDVT group than in the effort-related UEDVT group. The odds ratio of having a coagulation abnormality was 4.09 (95% confidence interval, 0.99-16.78; P = .06) in the idiopathic UEDVT group compared with the effort-related UEDVT group. CONCLUSION: Hypercoagulable states appear to play a significant role in idiopathic but not in effort-related UEDVT.

Adolescent↗
PubMed1993

Grasp synthesis for upper-extremity FNS. Part 1. Automated method for synthesising the stimulus map.

Functional neuromuscular stimulation (FNS) has been used in open-loop upper-extremity neuroprostheses to provide grasp and release for quadriplegic individuals. A principal issue in implementation of the open-loop neuroprosthesis is the synthesis of the grasp stimulus map, which is the relationship between the input control signal and the output stimulus applied to each electrode. The goal of this project was to develop a method of stimulus map synthesis which compensates for the influence of the electrode-position-dependent recruitment properties on the grasp output, and which can be performed using automated procedures. A method called the external moment grasp synthesis procedure (GSP) has been developed which meets these criteria. The GSP uses an external moment of model of the hand which describes the interaction between the active moments produced by electrical stimulation, the passive joint moments and the total joint moment and angle. The GSP was used to develop the stimulus map for three paralysed subjects, and in all cases the GSP-generated grasp patterns had lower errors than grasp patterns developed using the previously implemented rule-based method of stimulus map synthesis. The GSP was successfully implemented by computer and was able to compensate for the effects of the electrode recruitment properties on the grasp pinch force.

Electric Stimulation Therapy↗
PubMedDate not supplied

rt-PA thrombolysis in acute thromboembolic upper-extremity arterial occlusion.

PURPOSE: Retrospective analysis of the results of rt-PA thrombolysis in the treatment of acute thromboembolic occlusion of the upper limb. METHODS: Of 55 patients with demonstrated acute embolic arterial occlusion, rt-PA thrombolysis was performed on 40 occlusions in 38 patients (23 women with a mean age of 62 years, range 32-85 years; 15 men with a mean age of 65 years, range 32-92 years) according to the following design: 6 mg rt-PA/hr for 30 min, 3 mg rt-PA/hr for the next 30 min, 1 mg rt-PA/hr for 7 hr, and 0.4 mg rt-PA/hr until the end of lysis. Onset of symptoms varied from 1 to 14 days. Included were three isolated upper-arm occlusions, nine combined brachial and forearm occlusions, and 28 forearm and hand artery occlusions. RESULTS: The overall success rate was 55%. The lysis results for isolated upper arm, combined brachial and forearm occlusions, and forearm and hand artery occlusions were 100%, 66%, and 46%, respectively. In eight patients surgical embolectomy had to be performed after failed thrombolysis. No amputation was required in the follow-up period. No lethal complications occurred. CONCLUSIONS: Interventional rt-PA treatment of proximal upper-extremity arterial occlusions may be performed with comparable success rates to surgical embolectomy and without severe complications. For distal occlusions the results are inferior to the success rates obtained with surgery.

Acute Disease↗
PubMed2005

Disabilities of the arm, shoulder and hand (DASH) questionnaire: Determining functional activity profiles in patients with upper extremity disorders.

The Disability of Arm, Shoulder and Hand (DASH) questionnaire is a standardized measure which captures the patients' own perspective of their upper extremity health status. Based on the scores of the DASH modules: symptoms, function and sport, this follow-up study of 590 hand-injured subjects from 11 diagnostic groups evaluated impairments and disabilities perceived 2 to 5 years postoperatively. Secondly, we explored the relationships between the diagnostic groups at the individual DASH item level. Exploratory testing of statistical significance showed that the DASH modules differentiated well among the groups (ANOVA P-value 0.001) and further differences existed at the item level, so that functional activity problem profiles could be developed for each diagnostic group. Our findings confirm that the DASH is a useful instrument for outcome evaluation. Moreover, in view of the continuing challenge to provide comprehensive care which meets patients' needs in the shortest space of time, we consider that DASH has potential in the development of patient-centred treatment programmes which are tailored to the individual patients' requirements and have relevance to their daily activities.

Adult↗
PubMed1999

Musculoskeletal rehabilitation and sports medicine. 2. Shoulder and upper extremity injuries.

This self-directed learning module discusses classic concepts and highlights new advances in the diagnosis and management of shoulder and upper extremity injuries commonly occurring from athletic competition. It is part of the chapter on musculoskeletal rehabilitation and sports medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation.

Adult↗
PubMed1997

Age-associated loss of power and strength in the upper extremities in women and men.

Cross-sectional and longitudinal age-associated reductions in power and isometric strength are described for the upper extremities. Over a 25-year period, repeated measures were taken approximately every 2 years from men and women in the Baltimore Longitudinal Study of Aging (BLSA). The longitudinal measures covered an average 9.6 years, range 1-25 years for men and an average 4.6 years, range 1-8 years for women. Strength and power declined beginning by age 40 in both women and men. Thereafter, power declined about 10% more than strength in men, while no significant differences were found in women. Age had a statistically independent influence on strength and power measures after adjusting for gender, height, weight, caloric expenditure, and muscle mass. Twenty-five-year longitudinal analyses in men confirmed the declines observed cross-sectionally, while no changes were observed in women over the 4-5 years of longitudinal data available. Further longitudinal studies are needed to understand the relationships between strength and power losses with age in women. The differences between power and strength changes with age in men argue for the importance of factors other than strength affecting power.

Adult↗
PubMed1992

Interscalene blocks for chronic upper extremity pain.

A study of 25 patients was carried out to determine the efficacy of interscalene block (ISB) for the treatment of chronic upper extremity pain. An RSD score was used to categorize these patients. Seventeen of the 25 patients had less pain after ISB, and 14 also had increased range of motion of the affected limb. Patients with reflex sympathetic dystrophy (RSD)/causalgia, as well as other chronic pain conditions, improved. ISB was compared with stellate ganglion block (SGB) in patients undergoing both treatments. ISB seemed to be at least as effective as SGB for treatment of RSD/causalgia and may have some advantages over SGB. The role of somatic and sympathetic blockade is discussed.

Adult↗
PubMed1995

Isolated muscle atrophy of the distal upper extremity in cervical spinal cord compressive disorders.

The purpose of this article is to clarify one mechanism of muscular atrophy of the distal upper extremity that we attribute to cervical compression (Hirayama-type amyotrophy) by medical imaging and anatomical studies of the cervical spine. Five young male patients (mean age: 22.6 years) with this disorder showed characteristic findings to include an abnormal anterior displacement of the posterior dura wall in flexion that resulted in an anteroposterior compression of the spinal cord segment from C7 to C8. To identify an anatomical relationship to this disorder, the lower cervical spine was studied using 11 embalmed adult human cadavers. Abundant posterior epidural ligaments were observed between the posterior dura mater and the ligamentum flavum. Posterior epidural ligaments in the cervical spine have not been reported previously. The anterior displacement of the dura mater may be attributed to a lack of and/or insufficiency of the posterior epidural ligaments.

Adolescent↗
PubMedDate not supplied

Pulse oximetry for vascular monitoring in burned upper extremities.

The reliability and accuracy of pulse oximetry as a monitoring device in deep superficial and full-thickness circumferential burns of the upper extremity were evaluated clinically. Pulse oximetry was correlated with the laser Doppler flowmeter experimentally in healthy volunteers. By continuously monitoring oxygen saturation levels, the pulse oximeter detected extremity hypoxia before it resulted in an adverse outcome. Extremities exhibiting oxygen saturation above 95% were treated with early excision and skin grafting without escharotomy. Extremities with O2 saturations of less than 95% underwent immediate escharotomy with return to normal saturation levels. The pulse oximeter is easy to use by nursing personnel; is noninvasive and accurate; and displays the oxygen saturation level within seconds.

Arm↗