[Symptomatologic studies on the hand; certain neurologic sign of the upper extremity].
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Hand↗
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Results for “Upper Extremity”
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[Surgery of the hand; surgical treatment of the sequels of poliomyelitis of the upper extremities].
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Hand↗
[Nocturnal acroparesthesia of the upper extremities].
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Humans↗
[Arteriosclerosis of the upper extremity].
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Arteriosclerosis↗
[Localized pains of the upper extremity].
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Arm↗
Nerve conduction studies in upper extremities: skin temperature corrections.
The relationship of skin to near nerve (NN) temperature and to nerve conduction velocity (NCV) and distal latency (DL) was studied in 34 normal adult subjects before and after cooling both upper extremities. Median and ulnar motor and sensory NCV, DL, and NN temperature were determined at ambient temperature (mean X skin temp = 33 C) and after cooling, at approximately 26, 28, and 30 C of forearm skin temperature. Skin temperatures on the volar side of the forearm, wrist, palm, and fingers and NN temperature at the forearm, midpalm, and thenar or hypothenar eminence were compared with respective NCV and DL. Results showed a significant linear correlation between skin temperature and NN temperature at corresponding sites (r2 range, 0.4-0.84; p less than 0.005). Furthermore, both skin and NN temperatures correlated significantly with respective NCV and DL. Midline wrist skin temperature showed the best correlation to NCV and DL. Median motor and sensory NCV were altered 1.5 and 1.4m/sec/C degree and their DL 0.2 msec/C degree of wrist skin temperature change, respectively. Ulnar motor and sensory NCV were changed 2.1 and 1.6m/sec/C degree respectively, and 0.2 msec/C degree wrist temperature for motor and sensory DL. Average ambient skin temperature at the wrist (33 C) was used as a standard skin temperature in the temperature correction formula: NCV or DL(temp corrected) = CF(Tst degree - Tm degree) + obtained NCV or DL, where Tst = 33 C for wrist, Tm = the measured skin temperature, and CF = correction factor of tested nerve. Use of temperature correction formula for NCV and DL is suggested in patients with changed wrist skin temperature outside 29.6-36.4C temperature range.
Adult↗
Upper extremity pain of 10 years duration caused by a glomus tumor.
BACKGROUND AND OBJECTIVES: Long-standing limb pain typically has a multifactorial etiology not amenable to causal therapy. We present a case of chronic progressing upper extremity pain caused by a glomus tumor; the excision was curative. METHODS: A 39-year-old woman presented with 10-year history of constant deep internal throbbing, aching pain localized to the radial aspect of the left index finger and additional intermittent shooting pains radiating up the arm toward the shoulder. Pain was increased after minor local trauma, following cold exposure, and for unknown reasons. A blotchy, bluish skin discoloration could appear on the radial aspect of the index finger during severe pain. Nonsteroidal antinflammatory drugs, narcotics, amitriptyline, local heat, bracing, and a sympathetic nerve block had all been ineffective. The physical examination was characterized by exquisite pressure tenderness over the radial aspect of the left index finger, most pronounced just distal to the distal interphalengeal joint. RESULTS: Inflation of a left arm blood pressure cuff to above systolic pressures abolished pain. A glomus tumor was suspected and confirmed by histologic examination. CONCLUSIONS: Glomus tumors are rare, benign neoplasms (1 to 5% of all hand tumors), developing from neuromyoarterial glomus bodies. They usually present with pain and may mimic other painful conditions, delaying the average time until diagnosis for up to 10 years. The classic diagnostic triad consists of local pain, pressure tenderness, and cold hypersensitivity. Abolition of pain following inflation of a blood pressure cuff to above systolic levels (ischemia test) is highly diagnostic. We suggest routine use of this test in cases of upper limb pain of unclear etiology.
Adult↗
Case report: upper extremity soft-tissue reconstruction by alloplastic implant: long-term result and follow-up.
Prosthetic implants for reconstruction have found a variety of applications. Soft-tissue defects of the extremities are but one example in which alloplastic reconstruction is useful. As shown in the following case, gratifying cosmetic results can be obtained in posttraumatic upper extremity defects by reconstruction with a silastic implant. Although it is not a novel use for the device, it is one that has not been widely reported. The patient has been followed for 7 years postoperatively and he remains pleased with the cosmetic result. Furthermore, his function has not been compromised by placement of the prosthesis.
Adult↗
Advances in implant arthroplasty in the upper extremity, circa 1988.
Artificial joint replacement has paralleled that in the lower extremity during the past 15 years. The ability to replace the shoulder, elbow, and the wrist joint has relieved pain and restored function to the upper extremities of patients with rheumatoid arthritis. Engineering developments have led to improved design, sufficient enough that the implant durability appears to exceed that of the patients' themselves. The kinematics and design of these implants has been under intensive and continuing study since the inception of these procedures. The exact anatomical restoration of the centers of motion and alignment for movement are essential for the success of these arthroplasties. We report here our long-term experience with shoulder replacement arthroplasties in which the success rate in terms of good and excellent results has been 90%. Similar results have been achieved with elbow replacement arthroplasties during a 14 year follow-up. Wrist replacement arthroplasties have also shown high good to excellent results during a nine-year follow-up period. Experience has demonstrated that if infection and wound complications are minimized, the long-term results are excellent in terms of pain relief, movement, and restoration of function.
Elbow Joint↗
Musculoskeletal disorders of the upper extremities: the use of epidemiologic approaches in industrial settings.
This article illustrates the use of a simple questionnaire in identifying those sections of a work force at risk for musculoskeletal disorders and chronic discomfort of the upper extremities. Two research studies are described. The first, conducted in a chicken-processing factory, illustrates the use of self-administered questionnaires in the assessment of the musculoskeletal health of the work force and in the identification of groups of workers who may be at increased risk and for whom ergonomic reappraisal of the tasks performed may be beneficial. A second study of retail trade staff suggests that chronic musculoskeletal discomfort is widespread. The article further considers the importance of such data for those persons concerned with the allocation of health care. The need to consider the broader spectrum of musculoskeletal health from discomfort to clinical disorder is stressed.
Arm↗
Abnormalities of the fibrinolytic system as a cause of upper extremity ischemia: a preliminary report.
Abnormalities of the fibrinolytic system can result in unusual or unexplained clotting that occurs spontaneously or after minor trauma. We identified five patients with limb-threatening arterial thrombosis of the upper extremity associated with either a low level of plasminogen or an abnormal immunoreactive plasminogen. All patients had extensive thrombosis of the brachial, radial, and ulnar arteries. Two patients had concomitant thrombus of the subclavian artery, which in one patient was associated with distal embolization to the hand. There was no evidence of atherosclerosis in any patient. Detection of an abnormal plasminogen level was done by immunoelectrophoresis of the patient's serum with antiplasminogen sera. In these patients a separate immunoreactive band located near the anode and distinct from the normal single plasminogen band was detected. Because of extensive thrombosis of the arterial system, exploration of the brachial artery, as well as the origin of all the forearm vessels, was necessary for complete balloon catheter thrombectomy. Prompt diagnosis and treatment are necessary to prevent the catastrophic complication of arm or hand amputation. Patients with an abnormal plasminogen level should receive perioperative heparin therapy and long-term warfarin to prevent recurrent thrombotic episodes.
Adult↗
Early adipofascial flap coverage of deep electrical burn wounds of upper extremities.
The adipofascial flap is a useful method for treating deep electrical burn wounds requiring early definitive wound closure to preserve vital structures and function. In the past 2 years, 14 deep electrical burns of the upper extremities involving exposure of tendon, nerve, bone, or blood vessels requiring immediate vessel reconstruction were covered with an adipofascial flap. The latter was a local random turnover flap of the fascia and its overlying subcutaneous fat. All flaps were successfully elevated and applied to severe wounds in order to preserve underlying structures. There were no serious complications. Tendon gliding under the flap was found to be excellent during second reconstructive surgical procedures. The reconstructed limbs had satisfactory preservation of function.
Adipose Tissue↗
[Cervical flexion-induced changes of motor evoked potentials by transcranial magnetic stimulation in a patient with Hirayama disease--juvenile muscular atrophy of unilateral upper extremity].
A 16-year-old girl noticed weakness in the left hand in 1990, which gradually progressed over the next 2 years but then stabilized. Her neurologic and electrophysiological signs were compatible with juvenile muscular atrophy of unilateral upper extremity (Hirayama disease). Cine MRIs demonstrated a mild cervical cord atrophy at the C6 spine level together with an engorged epidural vein at the C4-C6 extradural spaces during neck flexion. Transcranial magnetic stimulation over the motor cortex was carried out with a pickup placed on the contralateral abductor brevis muscle. While neck flexion was maintained, the amplitude of the evoked potentials steadily attenuated and the central motor conduction time lengthened as time passed. After 8 minutes, she began to feel some dullness in the left upper limb. These phenomena were reversible and were observed only on the affected limb. The above facts not only supported the presence of a reversible cortico-efferent dysfunction in Hirayama disease, but also appeared to justify the use of neck collars to treat those afflicted with this entity.
Adolescent↗
Thrombosis in the upper extremity: use of Doppler ultrasound for diagnosis.
A case of subclavian vein thrombosis which was not detected clinically is described. Doppler ultrasound was used to ascertain the diagnosis. The technique of examination with the Doppler method for upper limb thrombi is described. It is expected that this technique will be as valuable for detection of thrombosis in the upper extremities as it has been shown to be in lower extremities. This is important because the incidence of deep vein thrombosis has increased with the frequent use of indwelling central venous catheters and because of increased awareness of the possibility and dangerous sequelae of the thrombosis, Early detection of thrombus by this non-invasive method, with removal of the catheters and prompt heparin therapy can preserve the integrity of the venous conduits and avert emboli. This is particularly relevant for anaesthetists in critical units.
Aged↗
Neuromuscular electrical stimulation and dynamic bracing for the management of upper-extremity spasticity in children with cerebral palsy.
A prospective study was designed to determine whether the combined use of neuromuscular electrical stimulation (NMES) and dynamic bracing was more effective than use of either alone in reducing upper-extremity spasticity in children with spastic hemiplegic cerebral palsy. Twenty-four patients (12 males, 12 females; mean age 8y 7mo [SD 4y 2mo]; age range 3-18y) diagnosed with spastic hemiplegic CP were randomly allocated to three groups: group 1 had two 30-minute sessions of NMES a day applied on the antagonist extensors without bracing; group 2 had two 30-minute sessions of dynamic bracing per day; and group 3 had two 30-minute sessions of NMES and dynamic bracing every day. Treatment was continued for 6 months in all groups and applied only to the affected extremity. Patients were evaluated before therapy, at monthly intervals during the therapy, and 3 months after completion of the therapy. Three measures of outcome were taken: the Melbourne Assessment, grip strength, and posture evaluation with Zancolli's classification. The therapist performing the outcome assessments was blinded as to groups. Statistically significant differences were found in all three measures for only those treated with combined NMES and dynamic bracing. However, this significant effect lasted for only 2 months after discontinuation of the treatment. We conclude that the combined use of NMES and bracing is more effective than either alone but requires continuous application.
Adolescent↗
Efficacy of electromyographic biofeedback compared with conventional physical therapy for upper-extremity function in patients following stroke: a research overview and meta-analysis.
BACKGROUND AND PURPOSE: The purpose of this study was to examine the efficacy of electromyographic biofeedback compared with conventional physical therapy for improving upper-extremity function in patients following a stroke. SUBJECTS AND METHODS: A literature search was done for the years 1976 to 1992. The selection criteria included single-blinded randomized control trials. Study quality was assessed for nine criteria. For functional (disability index or stage of recovery) and impairment outcomes, meta-analyses were performed on odds ratios for improvement versus no improvement. Mann-Whitney U-Test probability values were combined across studies. RESULTS: Six studies were selected, and outcome data were obtained for five studies. The common odds ratio was 2.2 for function and 1.1 for impairments in favor of biofeedback. The estimate of the number needed to treat to prevent a nonresponder was 11 for function and 22 for impairments. None of the meta-analyses were statistically significant. CONCLUSIONS AND DISCUSSION: The results do not conclusively indicate superiority of either form of therapy. Although there is a chance of Type II error, the estimated size of the effect is small. Given this estimate of little or no difference, therapists need to consider cost, ease of application, and patient preference when selecting these therapies.
Activities of Daily Living↗
Case management services for work related upper extremity disorders. Integrating workplace accommodation and problem solving.
A case manager's ability to obtain worksite accommodations and engage workers in active problem solving may improve health and return to work outcomes for clients with work related upper extremity disorders (WRUEDs). This study examines the feasibility of a 2 day training seminar to help nurse case managers identify ergonomic risk factors, provide accommodation, and conduct problem solving skills training with workers' compensation claimants recovering from WRUEDs. Eight procedural steps to this case management approach were identified, translated into a training workshop format, and conveyed to 65 randomly selected case managers. Results indicate moderate to high self ratings of confidence to perform ergonomic assessments (mean = 7.5 of 10) and to provide problem solving skills training (mean = 7.2 of 10) after the seminar. This training format was suitable to experienced case managers and generated a moderate to high level of confidence to use this case management approach.
Arm↗
An unusual case of intermittent venous obstruction of the upper extremity.
The axillary vein can be subject to intermittent obstruction from numerous anatomic structures such as the pectoralis minor and the scalenus anterior muscles. The diagnosis can be readily made on history and physical examination of the upper extremity, but it can be difficult to confirm by routine venogram done with the arm in the standard position at the side with full extension at the antecubital fossa. Positional venography with the arm fully abducted and flexion of that antecubital fossa allows for better definition of this extrinsic compression. In the case presented, a fascial band arising from the medial head of the biceps was compressing the axillary vein and was suspected on history and physical examination; it was confirmed with positional venography as noted. As in this case, it is important to make the diagnosis early, before thrombosis of the vein occurs, to minimize the associated morbidity. Transaxillary exploration was performed with excision of the band and complete resolution of the symptoms. Subsequent noninvasive studies were performed that showed complete resolution of the extrinsic axillary vein compression. Having a high suspicion of intermittent venous obstruction with early diagnosis and surgical correction of any extrinsic compression are the keys to a successful outcome in these patients.
Adult↗