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PubMed1984

Normal thermographic standards for the cervical spine and upper extremities.

Although thermography has been used for a variety of abnormal conditions, extensive data on large, relatively asymptomatic populations has heretofore not been available. More specifically, no data deal with the upper extremities and, more particularly, no analyses are based on simultaneous thermograms of the posterior neck and shoulders. The current study undertook this task. The results confirm the existence of thermal symmetry in the overwhelming majority of 100 normal relatively asymptomatic, actively employed factory workers. Conversely, if persistent, statistically significant thermal asymmetry exists, as outlined and correlates with patient symptomatology, an organic basis for it should be sought.

Adolescent↗
PubMed1996

Closure of wounds in the upper extremity using a skin stretching device.

A skin stretching device (SSD) harnessing the viscoelastic properties of skin using incremental traction has been used in 20 patients with skin deficits in the upper extremity. Complications were few considering the extensive damage to the skin and included slight partial dehiscence, necrosis of skin edges, local infection and hypertrophic scars. All wounds healed without the need for further surgical procedures. Application of the SSD is simple and it can even be used at the bedside under local anaesthesia. It reduces the need for more complicated surgical procedures like grafts or flaps.

Adult↗
PubMed1978

The S-H-A-F-T syndrome in the upper extremity.

The S-H-A-F-T syndrome is a passive form of Munchausen's syndrome in which a patient submits to multiple surgical procedures to a part of the upper extremity. Apart from the obvious connotation, the title emphasizes that the patients are sad, hostile, anxious, frustrating, and tenacious, with psychological problems similar to those of patients with Munchausen's disease--problems which are aimed at secondary gain from a psychological and/or financial nature. Three representative patients are described who had a total of 25 operations as well as multiple injections of cortisone performed by 11 doctors in five different states. Early recognition to avoid progressively mutilating operations is urged.

Adult↗
PubMed1975

Follow-up study on upper extremity bracing of children with severe athetosis.

This paper describes the results of a follow-up evaluation of a bracing program for severely athetoid, mentally retarded children. Bracing to improve upper extremity control was started in 1968 and was described in a 1971 AJOT article. The follow-up study was done in order to provide criteria for selecting patients in future bracing programs, to identify the type of motion problems that could be successfully braced, and to determine the bracing configurations most effecive in aiding arm control.

Activities of Daily Living↗
PubMed1997

Work organization is significantly associated with upper extremities musculoskeletal disorders among employees engaged in interactive computer-telephone tasks of an international bank subsidiary in São Paulo, Brazil.

This study was designed to verify the risk factors for developing upper extremities musculoskeletal disorders (UEMD) among workers engaged in customer service tasks performed by telephone at a private banking corporation in São Paulo, Brazil. The monthly incidence of UEMD in hands and/or wrists in this group was studied retrospectively from January 1993 to June 1995. The statistical analysis was done by using multiple linear regression with the monthly incidence of UEMD considered as dependent variable in models controlled for age, seniority, mean daily regular worktime and overtime per operator, time pressure at work, rest/work schedule, management status, personnel training on postural and muscle stretching, and ergonomic hazards. The variables associated with UEMD were the following: time pressure at work (coefficient = 0.049; p = 0.008) and rest/work schedule (coefficient = -0.047; p = 0.02). The results indicate that working conditions are significantly associated with UEMD, and changes in the working schedule may decrease the incidence of this problem in workers assigned to tasks related to the interactive use of computer-accessible databases during telephone contacts.

Adult↗
PubMed1985

[Circulatory values of the upper extremity--results using venous occlusion plethysmography in normotensive persons with healthy vessels and hypertensive patients].

In 386 test persons with healthy vessels of different age indices of the blood supply of the upper extremities were established by means of the plethysmography of plebembraxis. While with regard to sex, side of the examination and behaviour of the blood pressure no essential differences are existing, there is a distinct age-dependence of the results which must be taken into consideration when the norm-value is established.

Adolescent↗
PubMed1977

[Functional rehabilitation of the upper extremity in children with sequelae of birth injuries to the brachial plexus using the method of adaptive bioregulation].

The authors report of their experience in the rehabilitation of active functions in the upper extremities of 22 children with sequelae of birth injuries of the shoulder plexi of the Erb type. In order to accelerate the reconstruction of the function of the transplanted trapezius muscle a method of adaptive bioregulations is suggested which permitted to quantify the doses of developed muscular tension and control the movements. The obtained results give ground to positively evaluate this method, based on the principle of external reverse connection in the rehabilitative period following an operation of myolavsanoplastics in children with spquelae of birth injuries of the shoulder joint of the Erb's type.

Biofeedback, Psychology↗
PubMed2006

Hemodynamic and morphologic evaluation of sequelae of primary upper extremity deep venous thromboses treated with anticoagulation.

OBJECTIVES: This study was performed to describe venous function, residual morphologic abnormalities, and the occurrence of post-thrombotic syndrome in patients with conservatively treated primary upper-extremity deep venous thromboses (UEDVT). METHOD: This was a retrospective follow-up study of 31 patients with previous primary UEDVT treated with anticoagulation only, identified by a search of medical records. The mean follow-up time was 5 years. The patients were evaluated by interview, clinical examination, computerized strain-gauge plethysmography, and color duplex ultrasound imaging. The grade of post-thrombotic syndrome was rated according to the Villalta score (0 to 3 on each of four subjective and five clinically assessed features). RESULTS: The rate of venous emptying was significantly lower in the arms with DVTs than in the contralateral arms (P < .001). Eleven of the patients (35%) had a remaining outflow obstruction in the affected arm (venous emptying <68 mL/100 mL per min). Eighteen (58%) had a residual thrombus according to color duplex ultrasound scans, with four remaining occluded subclavian veins. None of the patients had deep or superficial venous reflux. There was no statistically significant relationship between plethysmographic and duplex findings. Most (77%) of the patients reported remaining symptoms in the affected arm, and there was a significant side difference in upper arm circumference (P < .001). Approximately one third had developed a moderate grade of post-thrombotic syndrome according to the Villalta score (total, 5 to 9). No significant relation was evident between the post-thrombotic syndrome score and duplex findings. Patients with post-thrombotic syndrome had a lower venous emptying value than those without (69 vs 84 mL/100 mL per min), but this difference was not statistically significant. CONCLUSIONS: Patients with conservatively treated previous primary UEDVT had significantly reduced venous outflow capacity and a residual thrombus was common. Swelling of the arm was the most common symptom, and one third had a moderate grade of post-thrombotic syndrome. However, there was no clear relation between hemodynamic and morphologic factors and the development of post-thrombotic syndrome in these 31 patients, examined at a mean of 5 years after an acute DVT episode.

Adult↗
PubMed1987

Effect of exercise speed on heart rate, systolic blood pressure, and rate-pressure product during upper extremity ergometry.

The purpose of this study was to investigate the effects of arm cranking speed on heart rate (HR), systolic blood pressure (SBP), and rate-pressure product (RPP) using an isokinetic upper extremity ergometer. Fifteen healthy men exercised for one minute at a work load of 300 kg X m/min and for five minutes at a work load of 600 kg X m/min on three different occasions at speeds of 30, 60, and 90 rpm. An analysis of variance and a Duncan's multiple range test were performed on all immediate postexercise (IPE) values. Significant differences were found in IPE HR and RPP across the exercise speeds. No significant differences were found in IPE SBP. The 60-rpm speed elicited significantly lower HR and RPP responses than the 30- or 90-rpm speeds. The 90-rpm speed elicited significantly lower HR responses than the 30-rpm speed. These results indicated that the 60-rpm speed caused the least cardiovascular stress at a submaximal work load of 600 kg X m/min.

Adult↗
PubMed1991

Atypical neutrophilic dermatosis on the upper extremity affected by postmastectomy lymphedema: report of 2 cases.

We describe 2 female patients, both with a history of radical mastectomy for breast cancer, in whom several indurated erythematous plaques developed on the upper extremity affected by postmastectomy lymphedema. There were no general symptoms or leukocytosis. Histopathological examination showed a dense neutrophilic infiltrate without a feature of vasculitis in the dermis and subcutis. Dramatic therapeutic response was observed to treatment with potassium iodide. These findings resemble Sweet's syndrome, but such cases have not been previously reported. Possible pathogenic mechanisms for these unique cutaneous eruptions are discussed.

Adult↗
PubMed1990

Severe frostbite of the upper extremities--a psychosocial problem mostly associated with alcohol abuse.

In the catchment area of Helsinki University Central Hospital (in total 16 surgical hospitals) amputation was performed on 9 patients with frostbite in the upper extremities during 1984-1985. The population during the study period in this area was 1.165,000 inhabitants, corresponding to 24% of the whole population in Finland. All 9 patients were male and the mean age was 49 years (range 31-75). All amputations performed were of the fingers, the third, fourth and fifth fingers most frequently affected. Alcohol was a marked etiologic or contributing factor in most of the frostbites. Two patients were chronic schizophrenics showing no signs of alcohol abuse, but the remaining 7 were either acutely or chronically alcohol intoxicated: 5 patients were chronic alcoholics, one was an alcohol abuser without a definite diagnosis of alcoholism, and one patient with no previous history of alcohol abuse was alcohol intoxicated. Based on the present study it is clear that, in addition to the cold winters in Finland, other factors contribute to severe frostbite. These include many psychosocial factors such as alcoholism or mental disease, unbalanced marital status, occupation handicap and lack of regular residence.

Adult↗
PubMed1994

[Pathomechanism of juvenile muscular atrophy of unilateral upper extremity (Hirayama's disease)--extensibility and asymmetry of the cervical posterior dural wall].

We performed myelography in chin-up position during neck flexion in 20 patients with juvenile muscular atrophy of unilateral upper extremity, and we also performed CT-myelography in rotational position during neck flexion in 15 of them. In this disease, in which posterior lower cervical dural wall shifts anteriorly and compresses the spinal cord during neck flexion, we found that the anterior dural shift and cord compression became lessened by making chin-up without changing the position of neck flexion. By measuring the posterior dural length from foramen magnum to C6 vertebra on the profile of myelogram in neutral and neck flexion posture, we found that the posterior lower cervical dural wall of this disease was less extensible during neck flexion than that of control cases. On CT-myelogram the spinal cord compression of muscularly atrophic side increased by the neck rotation to the non-atrophic side during neck flexion, which is the position of maximum extension of posterior dural wall. The spinal cord compression decreased by the rotation to the atrophic side. We think that the low extensibility and asymmetry of posterior lower cervical dural wall may be the cause of this disease and its laterality may be relevant to unilaterality of this disease. These findings could also explain the efficacy of cervical immobilization by using cervical coller.

Adolescent↗
PubMed1993

Upper extremity disorders in performing artists.

Studies in the past decade have shown that a significant proportion of instrumentalists report musculoskeletal problems severely affecting their musical performance. Musicians endure daily intensive use of their upper extremities, frequently placing them in bizarre positions. Their training schedules are rigorous and long term Predisposing factors to, and treatment for, overuse syndromes, tendinitis, and tendon trauma commonly encountered by musical performers are discussed at length. Nerve entrapment has also surfaced as a major problem in musicians, and the means of evaluation and treatment and the role of surgery are put forth. Techniques for studying and analyzing the difficulties faced by instrumentalists are summarized.

Arm↗
PubMed1996

The dynamics of changes of upper extremities caused by vibrations and unilateral excessive load after discontinued risk exposure.

The main aim of our research was evaluation of changes affecting vessels and peripheral nerves of patients with disorder of the upper extremities caused by vibrations and also peripheral nerves due to excessive loads. We evaluated both groups of these patients after two and five years' discontinued exposure. During both examinations 90% of these subjects reported persistence or deterioration of their complaints. We found by objective examination of persons with disorders caused by an excessive load in 80% cases significant improvement of the neuropathy already after two years. But five years after absence from risk exposure we found only a slight further regression of disorders. In the group of patients with disorders caused by vibrations we found normalization of neurological changes after two years in 33%, but in 21% of these patients we proved progress to a more serious affections, however after five years there were almost no further changes. The vasospastic changes on vessels persist after two years in 83% and after five years in 51% of the examined patients. In both examined groups significant improvement of neural and vascular changes during the two years after absence from exposure was found. After five years only slight regression occurred.

Adult↗
PubMed1984

[Development of the joints of the upper extremities in children after intra- and periarticular fractures].

The authors studied long-term (from 2 to 9 years) results of treatment of 178 children with intra- and periarticular localization of fractures of the upper extremities. The age of the children was from 4 to 15. It has been established that the further development of the injured joint is dependent on the character of the primary displacement, exact arrangement of fragments and correct terms of immobilization being of certain significance for the consolidation and further restoration of the anatomical integrity of the bone and for the joint functioning.

Adolescent↗
PubMed1995

Limb salvage surgery with microsurgical reconstruction for the treatment of musculoskeletal tumours involving the upper extremity.

Microsurgical reconstructive techniques have been applied in the management of 14 patients with malignant bone and soft tissue tumours as well as for 30 patients with benign but aggressive bone lesions affecting the upper extremity. Vascularised bone grafts were used in 6 patients with malignant bone tumours and 30 patients with aggressive bone lesions. Reconstruction with soft tissue free flap transfer was required in 6 patients with soft tissue defects, primarily following excision of soft tissue tumours in 2 and after excision of recurrent tumours in 4 patients. Microneural dissection and vascular reconstruction were performed in 2 patients with tumours around the major neurovascular bundles. The patients were followed up for varying periods, ranging from 1 to 12 years and assessment of the limb function was performed using Enneking's system of evaluation. There were no local recurrences. In the malignant tumour group, 3 patients died of systemic disease, 7 were alive but with disease and 4 were disease free. Extremity function was excellent in 3 patients, good in 6 patients, fair in 4 patients and poor in 1 patient. In the benign bone tumour group, extremity function was graded as excellent in 12 patients, good in 14 patients, fair in 3 patients and poor in 1 patient. The vascular bone grafts united in all but 3 patients at 4 months following surgery. Minimal donor site complications had been recorded and there had been no failures. Useful limb salvage may thus be achieved with the application of microsurgical techniques for a variety of indications in limb salvage surgery after tumour excision.

Adolescent↗
PubMed2006

Upper-extremity venography: CO2 versus iodinated contrast material.

PURPOSE: To determine prospectively the diagnostic performance of CO(2) venography, by using conventional venography with iodinated contrast material as the reference standard, for the preoperative evaluation of upper-limb and central veins before creation of fistulas for hemodialysis access. MATERIALS AND METHODS: The study was approved by the institutional review board, and informed consent was obtained from all patients. Twenty-two patients underwent comparative CO(2) and conventional venography of upper-extremity and central veins. Two independent observers evaluated the opacification of the veins and grade of stenosis, if present. Interobserver agreements were estimated with the Cohen kappa coefficient. Calculations of sensitivity, specificity, and accuracy were used for intertechnique observations. RESULTS: For CO(2) venography, global interobserver agreement was good, with a kappa value of 0.90 (range, 0.71-1.00; 95% confidence interval: 0.84, 0.95). A kappa value of 0.96 (range, 0.86-1.00; 95% confidence interval: 0.93, 0.99) was calculated for global interobserver agreement for conventional venography. The sensitivity, specificity, and accuracy of CO(2) venography for all vein segments were 97%, 85%, and 95%, respectively. CONCLUSION: CO(2) venography had a sensitivity of 97% and a specificity of 85% in the assessment of upper-limb and central vein patency and stenosis, with conventional venography used as the reference standard.

Aged↗