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PubMed1975

[A clinico-physiologic assessment of the state of the neuromuscular apparatus in children with ischemic lesions of the upper extremities].

A study of the potentials of action in the muscles of the brachium and carpus during voluntary movements and the assessment of the velocity of conduction along the motor filaments of the ulnar and median nerve in children with ischemic lesions of the upper extremities have shown that the pathological picture is characterized by a drop in the muscular electrogenesis and the velocity of excitational conduction. The authors come to the conclusion that there is a direct correlation between the decrease in the velocity of excitational conduction and a drop in the electrical muscle activity during voluntary movements.

Adolescent↗
PubMed1996

Electrodiagnosis in compression neuropathies of the upper extremities.

Compression neuropathies may occur at several points along the course of a nerve. Electrodiagnostic studies are helpful in the evaluation of nerve compression. Nerve conduction studies are the most useful of these techniques in determining the site of compression. Compression neuropathies of the upper extremities are common, and a well planned study is important to localize the site of involvement and the severity of the nerve damage.

Arm↗
PubMed2005

End-to-side nerve repair in the upper extremity of rat.

The end-to-side nerve-repair technique, i.e., when the distal end of an injured nerve is attached end-to-side to an intact nerve trunk in an attempt to attract nerve fibers by collateral sprouting, has been used clinically. The technique has, however, been questioned. The aim of the present study was to investigate end-to-side repair in the upper extremity of rats with emphasis on functional recovery, source, type, and extent of regenerating fibers. End-to-side repair was used in the upper limb, and the radial or both median/ulnar nerves were attached end-to-side to the musculocutaneous nerve. Pawprints and tetanic muscle force were used to evaluate functional recovery during a 6-month recovery period, and double retrograde labeling was used to detect the source of the regenerated nerve fibers. The pawprints showed that, in end-to-side repair of either one or two recipient nerves, there was a recovery of toe spreading to 60-72% of the preoperative value (lowest value around 47%). Electrical stimulation of the end-to-side attached radial or median/ulnar nerves 6 months after repair resulted in contraction of muscles in the forearm innervated by these nerves (median tetanic muscle force up to 70% of the contralateral side). Retrograde labeling showed that both myelinated (morphometry) sensory and motor axons were recruited to the end-to-side attached nerve and that these axons emerged from the motor and sensory neuronal pool of the brachial plexus. Double retrograde labeling indicated that collateral sprouting was one mechanism by which regeneration occurred. We also found that two recipient nerves could be supported from a single donor nerve. Our results suggest that end-to-side repair may be one alternative to reconstruct a brachial plexus injury when no proximal nerve end is available.

Anastomosis, Surgical↗
PubMed1998

Major replantation versus revision amputation and prosthetic fitting in the upper extremity: a late functional outcomes study.

The functional outcomes of amputated arms that were either replanted or had a prosthesis were compared. In addition, factors that influenced the functional outcome of replants were evaluated. The Carroll test was used to evaluate functional capacity of 22 successful upper extremity replantations at or proximal to the wrist as well as 22 amputees (at similar levels) fitted with a variety of prosthetic devices. The outcome was excellent or good in 8 (36%) replanted limbs. This proportion was statistically higher than those grades in the prosthetic group. When the groups were more closely matched (adults with below elbow injuries), the replantation group had 6 (50%) good or excellent outcomes and the prosthetic group had none. An analysis of covariance of the replantations demonstrated a statistical association between a better outcome in younger patients with more distal injuries. This study indicates that replantation produces superior functional results compared with amputation and a prosthesis.

Adolescent↗
PubMed1988

Bilateral upper extremity ischemia after administration of dihydroergotamine-heparin for prophylaxis of deep venous thrombosis.

Prolonged arterial spasm as a complication of ergot-containing medications has been reported since antiquity. This article describes our experience with a patient who had severe bilateral arterial spasm in the upper extremities 6 days after the initiation of a regimen of dihydroergotamine and heparin for prophylaxis against deep venous thrombosis. The spasm was refractory to oral calcium channel blocking agents and direct intraarterial infusion of tolazoline (Priscoline). However, intraarterial nitroglycerin produced a prompt and dramatic improvement in symptoms and in physical and arteriographic findings. This experience suggests that intraarterial nitroglycerin may be an appropriate first choice for ergot-induced arterial spasm.

Arm↗
PubMed1994

Development of a multidisciplinary research clinic for patients with work-related upper extremity disorders.

The health care reform debate has focused attention on the need for outcomes research performed in ambulatory care settings. In this article, the authors describe the development of a research clinic focusing on symptomatic, functional, and vocational outcomes of patients with work-related upper extremity disorders. The authors describe the programmatic and research challenges associated with performing such research and emphasize the need for balancing the research and clinical agendas. Research efforts in this setting require careful consideration of the patient selection process and allocation of sufficient time for the clinical staff to collect and record essential research data.

Academic Medical Centers↗
PubMed2000

Preventing upper extremity overuse injuries in child and adolescent athletes.

Physicians who treat young athletes must not only correctly diagnose specific musculoskeletal injuries but also pay attention to factors that predispose the patient to the injury. This article reviews the intrinsic and extrinsic factors that can lead to upper extremity overuse injury in child and adolescent athletes and describes the physician's role in preventing injury in this population.

Adolescent↗
PubMedDate not supplied

Focal fibrocartilaginous dysplasia in the upper extremity.

Focal fibrocartilaginous dysplasia is a benign lesion known to cause tibia vara in young children. To date, this lesion has been recognized in only the proximal medial tibia. This study reports two additional cases of focal fibrocartilaginous dysplasia occurring in the long bones of the upper extremity. The clinical presentation, radiographic appearance, histopathology, and natural history of focal fibrocartilaginous dysplasia in the humerus and ulna are analogous to published descriptions involving the tibia. Spontaneous resolution of the lesion and the resultant angular deformity is possible but not entirely predictable. Limb-length discrepancy should be anticipated.

Arm↗
PubMed2004

Left-handed versus right-handed computer mouse use: effect on upper-extremity posture.

Alternatives to reduce postural constraints have to be sought in order to reduce musculoskeletal complaints related to computer work. This study aimed at documenting the impact of using the mouse on the left side of a standard keyboard (with a right numeric keypad) on upper-extremity posture. A simulated computer task was performed by 27 subjects in a laboratory before and 1 month after ergonomics training. Shoulder flexion and abduction, as well as wrist extension were reduced with left-handed mouse use. Sixteen of the 27 subjects truly converted to using the mouse with the left hand. After a month of using the mouse with the left hand, the time required to perform the same task reduced, the perceived difficulty and discomfort improved, though the time to perform the task was still longer than when using the mouse with the right hand. For work involving both keyboard and mouse use, and without the need of the numeric keypad, it would probably be preferable to use a keyboard without the numeric keypad if the mouse is to be used on the right-hand side. If such keyboards are unavailable, an interesting alternative would be to use the mouse on the left side provided sufficient time is allowed to get accustomed to it.

Adult↗
PubMed1984

Rehabilitative operation for motor neuron disease: tendon transfer for segmental muscular atrophy of the upper extremities.

Segmental spinal muscular atrophy of adolescence is a clinical syndrome that can be distinguished from the more common forms of motor neuron disease. A patient with this syndrome who was no longer able to care for herself is described. After selective tendon transfers in her right upper extremity, she has been able to perform many of the activities of daily living. This improved function has been maintained for more than 2 years. We suggest that transfer of tendons and muscles may be indicated in selected patients with slowly progressive muscular atrophy.

Activities of Daily Living↗
PubMed2002

Latissimus dorsi pedicled flap for upper extremity soft-tissue reconstruction.

The latissimus dorsi often is used as a functional muscle transfer to restore elbow and shoulder motion. Although less common, its use as a pedicled muscle flap with a split-thickness skin graft provides excellent soft-tissue coverage of large upper extremity wounds. Seven male patients ranging in age from 6-71 years were treated with a pedicled latissimus dorsi muscle flap and split-thickness skin graft for coverage of open wounds of the shoulder, arm, or elbow with exposed vital structures (mean wound size: 15x10 cm). The flap also was used as a functional muscle transfer in one patient to replace destroyed anterior and middle portions of the deltoid. Wounds resulted from trauma in three patients, infection following trauma in two, and sarcoma excision in two. All flaps healed well, and donor site morbidity was minimal. At mean 16-month follow-up (range: 3-41 months), all muscle flaps had contoured well, producing satisfactory cosmesis. Functional results were good, and all patients were satisfied with their outcome. The tendinous insertion is left intact to guard against excessive traction on the pedicle when the flap is used for soft-tissue coverage only.

Adult↗
PubMed1996

High median nerve entrapments. An obscure cause of upper-extremity pain.

Compression of the median nerve at the wrist is the most common nerve entrapment syndrome but may be over- or misdiagnosed. With high (proximal) median nerve entrapment being uncommon and having an elusive diagnosis, proximal compression may be overlooked as a cause of the painful upper extremity. Recognition and diagnosis of this problem will help ensure timely and effective management of the more common pain syndromes.

Arm↗
PubMedDate not supplied

Kinematic analysis of human upper extremity movements in boxing.

Using two synchronized cameras, four experienced boxers were filmed while they threw a series of punches at a practice bag. Three-dimensional (3D) coordinates of each boxer's shoulder, elbow, wrist, and glove were used to estimate linear and angular kinematics of the upper extremity. Average velocities at contact ranged from 5.9 to 8.2 m/s with peak velocities of 6.6 to 12.5 m/s reached 8 to 21 ms prior to hand/grove contact with the bag. Significant differences in shoulder and wrist velocitie, elbow angle excursions, and elbow angular velocities were seen when comparing hooks and jabs. Few differences were evident when comparing the kinematics of gloved versus bare-handed punches. Results are significant in providing kinematic data characteristic of experienced performers, which may be used in a kinetic model of punch impact and its relationship to potential injury mechanisms.

Adult↗
PubMed1978

Automated upper extremity progressive resistive exercise system.

This paper describes a semiautomated, motorized skateboard and skate system for use in progressive resistive arm exercises. This experimental system has been evaluated in an occupational therapy clinic for the past two years and found to be valuable in the treatment of impaired upper extremity function. It is superior in function and design to the previously used apparatus and provides the following features: adjustable load (force), adjustable range of motion limits, an automatic method of counting the correct repetitions of the prescribed exercise, the visual feedback to patients regarding their performance. Based on therapists' evaluations, the system's three main advantages are: a decrease in the amount of therapist/attendant time needed for the exercise program, improved performances by the patients, and a better, quantitative measure of the patients' progress.

Adult↗
PubMed1993

Disappearing bone disease of the upper extremity.

Disappearing bone disease (Gorham's disease) is a rare clinical problem. The extensive bone loss seen with this entity makes it a difficult therapeutic problem, especially if contiguous bones are involved, which is a highly unusual occurrence. We report a case of disappearing bone disease involving the upper extremity and review the relevant literature.

Female↗
PubMed2004

Nerve tumors of the hand and upper extremity.

Tumors of peripheral nerve origin are usually slow growing and minimally symptomatic, making differentiation from other soft tissue neoplasms difficult. Yet failure to recognize a nerve tumor may result in irreversible loss of neurologic function. This article provides current information on the history, pathologic identification, and treatment of upper extremity nerve tumors. Other neoplastic and tumor-like lesions that occur within the peripheral nerve are also considered.

Arm↗
PubMed2005

[Microsurgical reconstruction of the burned upper extremity].

BACKGROUND: Free tissue transplantation is a rarely indicated procedure in burn reconstruction. As the versatility and variability of free flaps have significantly increased during recent years, so too have the indications for these procedures expanded. MATERIAL AND METHODS: We retrospectively report the results of 42 free flaps for upper extremity reconstruction in 35 severely burned patients using 13 different free flaps. This experience has enabled us to establish reconstructive principles pertinent to the type of injury (burn versus high voltage injuries) and the timing of reconstruction procedures. RESULTS: In high voltage injuries (n = 17) early free flap coverage (< 21 days after trauma) with muscular flaps was the most frequently used type of reconstruction. Reconstruction site was predominately the forearm. In burn injuries (flame, contact, fluid), free flap coverage was performed during a later stage of the treatment course (3 to 6 weeks after trauma), or as a secondary procedure. Reconstruction with cutaneous or fascial flaps was the preferred method. The elbow and the dorsum of the hand underwent defect coverage in most circumstances. For the reconstruction of complex or large defects (n = 6) combined "chimeric" flaps, preexpansion of free flaps, or the combination of a free and local flap were used. Overall, the flap failure rate was 12 % (n = 5). Interestingly, there was a relationship between flap failure rate and timing of the procedure. Four out of five flap failures occurred within 5 to 21 days after trauma, all five flap failures occurred between five days and six weeks. No flap failure was seen during secondary reconstruction. CONCLUSION: Our data demonstrate that burn and high voltage injuries are distinct entities, each requiring custom-tailored reconstructive solutions for limb salvage. Even if our flap failures all occurred during the first six weeks it should not be forgotten that this type of coverage is the only alternative to amputation in selective cases.

Adolescent↗
PubMedDate not supplied

Thromboangiitis obliterans affecting the upper extremity in a woman. Case report.

A rare case of thromboangiitis obliterans is reported, with involvement of the left brachial and axillary artery and signs of median-nerve denervation in a 42-year-old woman following long affection of the right popliteal artery. Arterial reconstruction of the upper extremity was beneficial when the patient stopped smoking. The histologic changes distinguished the condition from atherosclerosis.

Adult↗