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At least 1,243 records · Page 69Linked to original sources
PubMed1998

Results of the treatment of posttraumatic reflex sympathetic dystrophy of the upper extremity with regional intravenous blocks of methylprednisolone and lidocaine.

The results of the treatment of 36 patients with posttraumatic reflex sympathetic dystrophy of the upper extremity with regional intravenous blocks of methylprednisolone and lidocaine are presented. The extremity is exsanguinated and a tourniquet is applied. A solution of methylprednisolone, lidocaine and heparin is injected. The duration of the block is 20-25 minutes. After the limb is anesthetized the affected joints can be manipulated in a progressive, controlled fashion. With a 1-year follow-up the response to treatment in 25 patients (69%) was considered as good (relief of spontaneous pain, no limitation in finger movement), in 8 as moderate (22%) and in 3 as poor (9%--the symptoms were unaltered or worse). Physiotherapy was applied in all patients (program of finger exercises, whirlpool therapy). Complications in 2 cases were transient superficial thrombophlebitis of the forearm; in 2 other patients the block was interrupted because of severe pain in the limb. We found this method simple, easy to perform, safe and inexpensive; the results are comparable to other established methods of the treatment i.e. sympathetic blocks or calcitonin.

Adult↗
PubMed1992

Reconstruction of the bones and joints of the upper extremity by vascularized free fibular graft: report of 46 cases.

The vascularized free fibular graft was applied in reconstructing bone and joint structures of the upper extremity in 46 cases between August, 1977 and December, 1989. Among these, 30 were grafts of the fibular shaft and 16 were grafts of the fibular head. There were 19 bony defects after trauma or osteomyelitis, 18 bony or articular defects after resection of tumors, five congenital deformities or defects, and four replacements for fibrous dysplasia. The longest grafted fibula was 22 cm and the shortest, 5 cm. Thirty-one cases were followed for more than two years, and these were evaluated for functional ability in daily living, roentgenologic appearance, and 99mTc scan during follow-up. The results revealed quite sufficient functional restoration, solid bone healing, and adequate blood supply, in most cases. The vascularized free fibular head graft appears to be an ideal procedure for the reconstruction of defects of the lower end of the radius or the upper humerus, including the humeral head. The stability of the reconstructed wrist or shoulder joint was maintained by suturing the lateral collateral ligament, the palmar collateral ligament around the wrist, or by passing the long head of the biceps brachii through the grafted fibula at the shoulder. Methods for fixation of the fibular shaft to the recipient bone and the selection of vessels for anastomoses, both in the graft and at the recipient site, are discussed. The importance of postoperative functional exercise is emphasized.

Adult↗
PubMed1994

The free-fillet flap for reconstruction of the upper extremity.

The pedicled fillet flap concept has been successfully applied in both the upper and lower extremities for the treatment of difficult wounds. However, in cases of complete extremity amputation, the transfer of pedicled flaps from the amputated part is not possible. In such instances, we have designed free-fillet flaps from the amputated limb to provide wound coverage when replantation of the amputated part was contraindicated. This technique allows immediate wound coverage and preservation of functional amputation stump length, without the morbidity of an additional donor site. We present three cases that demonstrate the utility of this technique as an additional reconstructive option in patients with unreplantable upper-extremity amputations.

Adult↗
PubMed1984

Upper extremity gangrene of the newborn infant.

Ischemia of a limb occurring in the first week of life is uncommon. Gangrene presenting at birth in the upper extremity is fortunately rare. The result in this case and a review of the literature of the last 40 years shows that prompt recognition, early arteriography, and aggressive surgical treatment are necessary.

Amputation, Surgical↗
PubMed1997

Late results after microvascular reconstruction of severe crush and avulsion injuries of the upper extremity.

From 1978 to 1985, a total of 64 patients underwent successful hand and digit replantation/revascularisation for salvage after crush and avulsion trauma to their upper extremities. Forty-seven of them (39 males and 8 females) were followed between 10 and 17 years (mean: 12.6 years). The average age was 33.2 years. In 39 patients, replantations were performed: 37 digits (including seven thumbs), two hands, and three midhands. Eight patients underwent revascularizations in cases of subtotal amputations: two in the midhand, three at the wrist, and three at the lower arm. Concomitant injury to the hand or forearm was a feature of all cases. In 45 percent of the study population, secondary reconstructions were necessary. Outcomes were evaluated using Chen's classification (1981) and showed that 19 percent of the patients were classified grade 1, 49 percent grade II, 28 percent grade III, and 4 percent grade IV. Results demonstrated a greater patient age in the grade III group, and relatively more secondary operations in the grade IV patients.

Adolescent↗
PubMed2000

Shoulder rotational strength, movement, pain and joint tenderness as indicators of upper-extremity activity limitation in moderate rheumatoid arthritis.

In this study 32 women were investigated in order to elucidate how shoulder rotational muscular strength and upper-extremity impairments are associated with activity limitation in moderate rheumatoid arthritis. A regression analysis was carried out to determine whether these variables could indicate the outcomes of a shoulder-arm disability questionnaire (SDQ) comprising three parts, plus parts of the Health Assessment Questionnaire, the Functional Status Questionnaire and the Sickness Impact Profile. Shoulder-arm and wrist movements were moderate-to-good (r = 0.53, p < 0.01 and r = 0.58, p < 0.01, respectively) in relation to isometric internal rotational strength. The relationship between isokinetic concentric and eccentric internal rotational strength was moderate-to-good (r = 0.59, p < 0.01). Isokinetic eccentric internal rotation strength, shoulder-arm movement, joint tenderness and pain variables together indicated 25-61% (adjusted R2) of the variation in SDQ. Eccentric strength had the highest adjusted R2 (41%) in relation to SDQ 1, covering mainly personal hygiene. Shoulder rotational strength did not indicate the more general instruments. Thus, hand and elbow impairments also are probably important in explaining activity limitations.

Activities of Daily Living↗
PubMed1987

Assessment of strength deficits in eight paretic upper extremity muscle groups of stroke patients with hemiplegia.

This retrospective investigation was undertaken to describe and compare the initial and discharge strength deficits of eight upper extremity muscle groups of 42 patients who were hemiparetic secondary to cerebrovascular accidents (CVAs). Static strengths of the eight muscle groups were measured using a hand-held dynamometer, and strength deficits were calculated against the side ipsilateral to the side affected by the CVA. A two-way analysis of variance for repeated measures revealed significant differences (p less than .001) in the strength deficits of the eight muscle groups and between initial and discharge strength deficits. The strength deficits of the shoulder medial rotator and abductor muscle groups were significantly less than those of any other muscle group. No difference was found in the proportion of muscle groups improving in strength in patients tested within six weeks after the onset of hemiplegia versus patients tested six weeks later. Our results do not confirm the common expectation of relatively lesser involvement of the elbow flexor muscles after a CVA. The results do suggest that patients improve in muscle strength concurrent with a rehabilitation program.

Adult↗
PubMed1999

An ergonomics program designed to reduce the incidence of upper extremity work related musculoskeletal disorders.

In 1992, the Johns Hopkins Hospital and University initiated a program aimed at the early diagnosis and treatment of potential upper extremity work related musculoskeletal disorders (UEWMSDs), ergonomic assessment and abatement of work areas where individuals with UEWMSDs are employed, as well as the identification and correction of areas throughout the hospital and university where UEWMSDs could possibly occur. The program resulted in an initial increase in the number and cost for the treatment of UEWMSDs. Subsequently, there was a significant decrease in the number of UEWMSDs reported and virtual elimination of the need to use surgical procedures to correct these conditions. This article suggests that a coordinated program of medical care, ergonomic assessment, and intervention can be efficacious in the primary, secondary, and tertiary prevention of UEWMSD.

Continuity of Patient Care↗
PubMed2004

Radioisotope technique to evaluate the motor functional status of donor nerve for upper extremity reconstruction.

A rapid and precise method of nerve fascicle identification based on measurement of choline acetyltransferase activity using radioisotope technique was used intraoperatively during upper extremity reconstruction. This technique can be used to evaluate the motor function of donor fascicles directly and quantitatively. This technique is useful to evaluate the motor functional status of donor fascicles during functioning free muscle transfer, to distinguish between preganglionic and postganglionic injuries in brachial plexus injury, and to differentiate between motor and sensory fascicles during nerve grafting procedures.

Journal Article↗
PubMed2004

Congenital and acquired thrombotic risk factors in lymphoma patients bearing upper extremities deep venous thrombosis: a preliminary report.

BACKGROUND: Congenital thrombotic risk factors, oncological diseases and its therapies have been related to an increased occurrence of upper extremities deep venous thrombosis (UEDVT). PATIENTS AND METHODS: We studied seven patients bearing lymphoma (one Hodgkin's and six non-Hodgkin's) who developed UEDVT, one at diagnosis and six during chemotherapy (two of these six cases had implantation of a central venous catheter and four received Growth Colony Stimulating Factors in addition to chemotherapy). Patients were screened for: factor V G1691A (Leiden), prothrombin G20210A, methylene tetrahydrofolate reductase (MTHFR) C677T mutations and antithrombin III, proteins C and S plasma activity. RESULTS: All patients were wild-type homozygotes for G20210A. One was heterozygote for factor V G1691A, the other 6 were wild-type homozygotes. Three of the 7 patients were homozygotes and 2 heterozygotes for the MTHFR mutation; the remaining 2 were wild-type homozygotes. Clotting inhibitor levels were normal in all patients. CONCLUSIONS: UEDVT in patients bearing haematological malignancies can occur irrespective of congenital thrombophilic alterations. However, in a subgroup of patients UEDVT could also depend on congenital thrombophilic alterations. A screening for inherited thrombophilia can identify high risk patients that could be specifically treated to prevent thrombotic complications.

Journal Article↗
PubMed1975

Electrophysiological orthosis for the upper extremity in hemiplegia: feasibility study.

A versatile two channel stimulator with cutaneous electrodes was designed and built to test the feasibility of multi-channel upper extremity functional electrical stimulation in hemiplegic patients. Preliminary experiments led to the choice of stimulation for hand opening (extensor carpi radialis and ulnaris, extensor digitorum communis) and elbow extension (triceps). Three channel stimulation including the deltoideus muscle was attempted successfully in one patient. Five of eight patients showed substantial improvement with the orthosis and three of these five showed some therapeutic effect over a period of two months. The stimulation was proportionally controlled by the patient by means of movement of the nonaffected shoulder. Functional tasks such as the shifting of an object between two specified areas on a desk were used for evaluation of performance. Tasks that were impossible without stimulation were easily performed with stimulation and after minimal training. The results obtained were significant for the functional rehabilitation of hemiplegic subjects. It is concluded that a more extensive clinical evaluation program including regular long term training of the subjects is justified.

Arm↗
PubMedDate not supplied

Arterial embolectomies in the upper extremity after acute occlusion. Report on 79 cases.

Between 1970 and 1981 a total of 79 surgical interventions were performed for acute ischemia of the upper extremities. The cause of occlusion in 70 patients was an arterial embolism, mainly affecting the brachial or radial artery. Embolectomy was successful in restoring the patency of the occluded vessel, regardless of its location or the duration of the occlusion. In 8 patients the cause of occlusion was an arterial thrombosis. The results after surgery varied, in 4 patients an amputation was necessary whilst 2 patients underwent successful bypass operations. One patient had angiospasm after osteosynthesis of a humerus fracture. The mean age was 67 years, the hospital mortality amounted to 12%. After embolectomy, the function and pulse condition of the treated extremity was excellent in the 51 patients still alive.

Adolescent↗
PubMed1997

Orthopedic problems of the upper extremities. Assessment and diagnosis.

1. Cumulative trauma or repetitive motion disorders are among the most commonly reported occupational illness, and mainly affect the neck and upper extremities. 2. The etiology of cumulative trauma disorders includes nerve compression secondary to inflammation and tendinitis secondary to microtearing at tendon insertions and/or friction irritation of the tendons. 3. Work postures, such as forward flexed position of head, neck, and shoulders; static loading of muscles; as well as repetitive motions can cause cumulative trauma disorders or aggravate pre-existing problems. 4. The occupational health nurse is in a unique position to encourage early reporting of these problems so that conservative treatment can be initiated, identify ergonomic issues at the worksite and institute change, and work closely with the orthopedist to manage clients effectively with clear communication and collaboration.

Arm↗
PubMed2004

Vascularized nerve grafts for the treatment of large nerve gap after severe trauma to an upper extremity.

We reviewed the clinical outcomes of vascularized nerve grafts for the repair of large nerve gaps (longer than 20 cm) after severe trauma to an upper extremity. Six patients who underwent vascularized sural nerve grafting (five to the median nerve and one to the ulnar nerve) with a monitoring skin flap were evaluated. The length of the vascularized sural nerve grafts ranged from 20 to 30 cm, with a mean length of 23.3 cm. All but one of the monitoring skin flap grafts was successful. In those patients for whom the monitoring skin flap graft was successful, the mean static-2PD at the corresponding fingertip was 14.2 mm (range 10-20 mm). Evaluation of these patients with the Semmes-Weinstein test produced the following results: filament 6, two patients; filament 10, three patients. The results of this study show that vascularized sural nerve grafting should be considered as a clinical alternative for nerve reconstruction in patients with nerve defects longer than 20 cm.

Adult↗
PubMed2002

Oral creatine supplementation enhances upper extremity work capacity in persons with cervical-level spinal cord injury.

OBJECTIVE: To examine the effects of short-term creatine monohydrate supplementation on the upper extremity work capacity of persons with cervical-level spinal cord injury (SCI). DESIGN: Randomized, double-blind, placebo-controlled, crossover design study. Consists of 2 treatment phases lasting for 7 days, separated by a 21-day washout period. SETTING: University research laboratory trial. PARTICIPANTS: Sixteen men with complete cervical-level SCI (C5-7). INTERVENTION: Subjects were randomly assigned to 1 of 2 groups and received either 20g/d of creatine monohydrate supplement powder or placebo maltodextrin powder for the first treatment phase; the treatment was reversed in the second phase. Incremental peak arm ergometry tests, using 2-minute work stages and 1-minute recovery periods, were performed immediately before and after each treatment phase (total of 4 assessments). The initial stage was performed unloaded, with power output progressively increased 10 watts/stage until subjects had achieved volitional exhaustion. MAIN OUTCOME MEASURES: Peak power output, time to fatigue, heart rate, and metabolic measurements, including oxygen uptake (VO2), minute ventilation, tidal volume (VT), and respiration frequency. RESULTS: Significantly greater values of VO2, VCO2, and VT at peak effort after creatine supplementation (P <.001). CONCLUSIONS: Creatine supplementation enhances the exercise capacity in persons with complete cervical-level SCI and may promote greater exercise training benefits.

Administration, Oral↗
PubMed1989

Reconstruction of the upper extremity with multiple microvascular transplants: analysis of method, cost, and complications.

During an 8-year period, 131 multiple microvascular transplants were performed on 62 patients for upper extremity reconstruction of complex wounds. Patients were classified into two groups: In group I 35 patients received paired simultaneous transplantation of 70 flaps performed in 35 operations. Group II consisted of 27 patients who underwent reconstruction with 61 sequentially transferred flaps; each procedure consisted of a single transplant. No statistical differences in flap failure or complications were seen between groups, except that group I required emergency reexploration more frequently. Patients receiving sequential reconstruction required rehospitalization, leading to significantly elevated costs. In our experience, simultaneous multiple microvascular transplants, particularly in patients admitted with acute injuries, result in reduction of costs, total number of procedures, and duration of hospitalization without increased complications.

Adolescent↗