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PubMed2006

Self-reported upper extremity health status correlates with depression.

BACKGROUND: The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is the most widely used upper extremity-specific health-status measure. The DASH score often demonstrates greater variability than would be expected on the basis of objective pathology. This variability may be related to psychosocial factors. The purpose of the present study was to investigate the correlation between the DASH score and psychological factors for specific diagnoses with relatively limited variation in objective pathology. METHODS: Two hundred and thirty-five patients with a single, common, discrete hand problem known to have limited variations in objective pathology completed the DASH questionnaire, the Eysenck Personality Questionnaire-Revised (EPQ-R) to assess neuroticism, the Center for Epidemiologic Studies-Depression (CES-D) scale to quantify depressive symptoms, and the Pain Anxiety Symptoms Scale (PASS). Forty-five patients had carpal tunnel syndrome, forty-four had de Quervain tenosynovitis, forty-eight had lateral elbow pain, and seventy-one had a single trigger finger. In addition, twenty-seven patients were evaluated six weeks after a nonoperatively treated fracture of the distal part of the radius. Relationships between psychosocial factors and the DASH score were determined. RESULTS: A significant positive correlation between the DASH score and depression was noted for all diagnoses (r = 0.38 to 0.52; p < 0.01 for all). The DASH score also correlated with pain anxiety for four of the five diagnoses (carpal tunnel syndrome, r = 0.40; de Quervain tendinitis, r = 0.46; lateral elbow pain, r = 0.42; and trigger finger, r = 0.24) (p < 0.05 for all). The DASH score was not correlated with neuroticism for any diagnosis. There was a highly significant effect of depression (as measured with the CES-D score) on the DASH score for all diagnoses. Both the CES-D score (F = 62.68, p < 0.0001) and gender (F = 11.36, p < 0.001) were independent predictors of the DASH score. CONCLUSIONS: Self-reported upper extremity-specific health status as measured with the DASH score correlates with depression and pain anxiety but not neuroticism. These data support the contention that psychosocial factors have a strong influence on health-status measures.

Adult↗
PubMedDate not supplied

Effect of clonidine on upper extremity tourniquet pain in healthy volunteers.

BACKGROUND AND OBJECTIVES: Tourniquet pain is often a limiting factor during intravenous regional anesthesia (IVRA). The purpose of this study was to evaluate the efficacy of 1 microg/kg of clonidine added to IVRA-lidocaine in decreasing the onset of severe tourniquet pain. METHODS: Upper extremity IVRA was performed in 15 volunteers with a double-cuffed tourniquet on 2 separate occasions at least 1 week apart. IVRA was established with either 40 mL 0.5% lidocaine (IVRA-L) or 40 mL 0.5% lidocaine with 1 microg/kg clonidine (IVRA-Cl). Verbal pain scores (VPS) from 0 to 10 were recorded every 5 minutes. When the VPS reached 6, the distal cuff was inflated, and the proximal cuff was deflated. This was defined as the first tourniquet time (T1). The study was terminated at a VPS of 10, or at 60 minutes, whichever occurred first. The time from distal cuff inflation to deflation was defined as the second tourniquet time (T2). Total tourniquet time (TT) was the sum of T1 and T2. RESULTS: T1 for IVRA-L (21.6 +/- 3.9) and IVRA-Cl (22.7 +/- 2.7) were not significantly different. T2 and TT were significantly longer (P < .0001; P < .0007, respectively) for IVRA-Cl (33.0 +/- 6.2; 55.6 +/- 6.6) than for IVRA-L (25.5 +/- 4.4; 47.1 +/- 5.2). CONCLUSION: This study shows that the addition of 1 microg/kg of clonidine to 40 mL of 0.5% IVRA-L delays the onset time of tourniquet pain in healthy, unsedated volunteers.

Anesthesia, Intravenous↗
PubMed1990

A schema for local flap selection in the upper extremity: a hypothesis.

Whereas any contemplation suggesting routinization in a plastic surgery endeavor may engender abhorrence or bespeak heresy, some generalizations are essential at least as a foundation from which a logical divergence may proceed. Such an approach for the selection of preferable local flaps in wound coverage within the upper extremity can be developed based on available options as will be presented in schematic form to confirm this hypothesis.

Arm↗
PubMed1989

A transverse facial cleft accompanied by a accessory ear and hypoplasia of the upper extremity--a case report.

Malformations of the extremities frequently accompany cleft lip and palate. An association of malformation of the extremities with transverse facial cleft, however, has never been reported. We have recently discovered a 5-month-old Japanese female with a transverse facial cleft accompanied by an accessory ear and hypoplasia of the upper extremity. The case is reported and a discussion is included.

Abnormalities, Multiple↗
PubMedDate not supplied

Epidural venous system (meningorachidian venous plexus) in juvenile amyotrophy of distal upper extremity: assessment with GD-DTPA enhanced volumetric MR study.

The epidural venous system (meningorachidian venous plexus) was analyzed utilizing gadolinium-diethylenetriamine pentaacetic acid (DTPA) (Gd-DTPA) enhanced volumetric magnetic resonance (MR) images in 11 patients with focal cervical spinal cord atrophy, clinically consistent with juvenile amyotrophy of distal upper extremity. In our series, all of the patients showed unusual posterior epidural venous enhancement at the C5-6 level, suggesting posterior epidural venous dilatation. Three patients also showed prominent dilatation of cervico-thoracic epidural veins surrounding the thecal sac. These MR findings were also demonstrated by spinal phlebography. Gd-DTPA enhanced MR images, especially high resolutional volumetric MR images, were efficient for evaluating these vessels. The observation of meningorachidian venous plexus along the disease course should be necessary for searching the pathogenesis of this disease.

Adolescent↗
PubMed2003

A study on the prevalence of upper extremity repetitive strain injuries among the handloom weavers of West Bengal.

Handloom is one of the oldest cottage industries in India, particularly in West Bengal, where a considerable number of rural people are engaged in weaving. Purposes of the present investigation were to clarify the prevalence of repetitive strain injuries in upper extremities among the handloom weavers and to identify the risk factors leading to its development. Fifty male handloom weavers were randomly selected from the population. A questionnaire (Kourinka et al., 1987) method including Borg scale assessment of pain, checklist analyses of the work, and time-motion studies for analyzing the repetitiveness/non-repetitiveness of the job were implemented. The time-motion analyses demonstrated that weaving occupied over 50% of the work cycle time for majority of subjects, and thus could be regarded as a repetitive activity. Statistical analyses revealed a highly significant correlation between the intensity of pain feeling and the repetitiveness on one hand, and the year of experience as a weaver on the other. By contrast, no significant relationship was observed between chronological ages of weavers and the pain intensity. These results suggested that highly repetitive works engaged for a long time could increase the intensity of the pain felt and would lead to repetitive strain injuries.

Adult↗
PubMedDate not supplied

Deep venous thrombosis of the upper extremity: case reports and review of the literature.

The development of a thrombosis of the axillary-subclavian vein has long been an uncommon clinical entity. The more routinely use of central venous lines in modern patient management, however, has increased its incidence. Three cases of deep venous thrombosis of the upper extremity are reported. The different possible etiologic factors, the diagnostic tools, complications and different treatments--both conservative and non-conservative--are reviewed and discussed.

Adult↗
PubMed1996

A clinical pilot study to assess functional return following continuous muscle stimulation after nerve injury and repair in the upper extremity using a completely implantable electrical system.

This clinical pilot study evolved from a 10-year experience in the experimental laboratory using continuous muscle stimulation in a series of animal studies following nerve injury and microsurgical repair. A completely implantable system was developed (Medtronic) to provide electrical stimulation to the denervated muscles until nerve regeneration had occurred. Both peripheral nerve injuries in the extremities and facial nerve severances were studied, and a definite improvement in functional capacity was obtained as well as improved morphology compared with nonstimulated controls. In this study, 13 patients with peripheral nerve injuries in the upper extremity are included. All patients had muscle stimulation for extended periods until nerve regeneration was evident; a careful analysis of their functional capacity was then completed. There were five patients with median nerve injuries, four with ulnar nerve or combined median-ulnar nerve injuries, and four with severed radial nerves. All patients showed satisfactory nerve regeneration on clinical examination and electromyographic studies. Motor recovery was usually better than sensory return. Functional muscle analysis varied somewhat from patient to patient, but every patient had a satisfactory to excellent recovery. Patients with low nerve lesions had better results, but muscle recovery even in patients with mid-forearm or higher nerve injuries was most encouraging. Functional recovery in radial nerve injuries was close to normal in all cases. The results from this pilot study have clearly shown the benefits of continuous muscle stimulation using an implantable system following nerve injury and repair.

Adolescent↗
PubMed1993

Management of major penetrating glass injuries to the upper extremities in children and adolescents.

Penetrating glass injuries are a common cause of severe neurovascular damage, both in adults and in children. Frequently, an innocent skin wound disguises the extensive nature of the injuries beneath. Nineteen children and adolescents (ages 3-16 years) with a mean age of 9 years who sustained upper extremity penetrating glass wounds were evaluated retrospectively in order (1) to determine the incidence of unappreciated significant neurologic, musculotendonous, or vascular injury; (2) to provide indications for intraoperative evaluation under anesthesia; and (3) to further define the role of microneurorrhaphy in this population. Twelve patients sustained injuries above the elbow and seven patients injuries distal to the elbow. Above the elbow, the structures injured in order of frequency were the median nerve (75%), the brachial artery (58%), the ulnar nerve (50%), the musculocutaneous nerve (33%), sensory nerves of the arm and forearm and venae commitantes (42% each), the radial nerve (25%), and the chords of the brachial plexus (8%). Distal to the elbow, the ulnar nerve was the most frequently involved (71%), followed by the ulnar artery (57%), the flexor carpi ulnaris (57%), the superficialis and profundus flexor tendons (43%), the median nerve (43%), and the palmaris longus and flexor carpi radialis (14% each). Early exploration is critical to successful management. Vascular repairs and or microneurorrhaphy were necessary in all cases. A detailed follow-up evaluation to assess the results of these repairs was carried out from 4 to 9 years postsurgery. There were no clinical problems related to the vascular reconstructions. The results of the nerve repairs in this small series of children and adolescents were remarkably good.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Home↗
PubMed1992

Soft tissue contractures from melorheostosis involving the upper extremity.

Melorheostosis is a rare disorder characterized by a linear hyperostosis of cortical bone, joint pain, stiffness, deformity, and limited motion. In the hand, the disease is often disabling because of progressive contractures of the joints and soft tissues involved. Two cases of melorheostosis involving the radial side of the hand and upper extremity are reported. Splinting or surgical release did not result in permanent correction of the soft tissue contractures. Retraining patients to use their unaffected hand should be considered early in the course of the disease.

Adult↗
PubMed1978

Upper extremity total joint replacement.

Current techniques of total joint replacement surgically correct badly destroyed joints by the insertion of plastic and metal components, which are secured to the skeleton by methylmethacrylate cement. This approach began in England in 1962 and in the United States in 1967. Recent development in the field of upper extremity joint replacement allow implementation of refined total shoulder, elbow, and wrist prostheses. Although less experience has been gained with these prostheses than with total hip and knee replacements, preliminary results are encouraging.

Arm↗
PubMed1981

A study of various function tests on the upper extremities for vibration syndrome.

For early diagnosis of vibration syndrome, it is necessary to detect the insidious functional disorders which appear without organic changes in it's early stage. In Japan, peripheral circulation and sensory tests, including tests after cold water immersion, and functional capacity motor tests are performed widely on the upper extremities. We have examined workers exposed to three kinds of vibration, and control workers, using these function tests, and analyzed the data with the use of principal component analysis. As a result, these function tests were considered to be of diagnostic significance as a screening test for vibration syndrome. It is also suspected that peripheral circulation disturbance, sensory disturbance and motor disturbance found in vibration syndrome advance independently of each other. Disparities in the findings of vibration syndrome were recognized and were attributed to differences of work conditions.

Adult↗
PubMed2006

Hormonal and reproductive factors are associated with chronic low back pain and chronic upper extremity pain in women--the MORGEN study.

STUDY DESIGN: Cross-sectional study of 11,428 women aged 20-59 years who were included in a postal questionnaire survey in the Dutch general population. OBJECTIVE: To examine how hormonal and reproductive factors are associated with chronic low back pain (LBP) and chronic upper extremity pain (UEP) in women. SUMMARY OF BACKGROUND DATA: Although LBP is suggested to be linked to hormonal and reproductive factors in women, results from previous studies are inconclusive. In addition, the association with chronic UEP is unknown. METHODS: Multivariate logistic regression models were used to examine associations between hormonal and reproductive factors (independent variables) and, respectively, chronic LBP, chronic UEP and combined chronic LBP/UEP. Associations were adjusted for age, level of education, working status, smoking, and overweight. RESULTS: Past pregnancy, young maternal age at first birth, duration of oral contraceptive use, and use of estrogens during menopause were associated with chronic LBP, while young age at menarche was associated with chronic UEP. Irregular or prolonged menstruation and hysterectomy were associated both with chronic LBP and chronic UEP. No positive associations were found for current pregnancy and number of children. CONCLUSIONS: In adult women, hormonal and reproductive factors are associated with chronic musculoskeletal pain in general. Factors related to increased estrogen levels may specifically increase the risk of chronic LBP.

Adult↗
PubMed1996

Upper extremity deep venous thrombosis in cancer patients with venous access devices--prophylaxis with a low molecular weight heparin (Fragmin).

Central venous access devices are often essential for the administration of chemotherapy to patients with malignancy, but its use has been associated with a number of complications, mainly thrombosis. The true incidence of upper extremity deep vein thrombosis (DVT) in this setting is difficult to estimate since there are very few studies in which DVT diagnosis was based on objective tests, but its sequelae include septic thrombophlebitis, loss of central venous access and pulmonary embolism. We performed an open, prospective study in which all cancer patients who underwent placement of a long-term Port-a-Cath (Pharmacia Deltec Inc) subclavian venous catheter were randomized to receive or not 2500 IU sc of Fragmin once daily 90 days. Venography was routinely performed 90 days after catheter insertion, or sooner if DVT symptoms had appeared. Our aims were: 1) to investigate the effectiveness of low doses of Fragmin in preventing catheter-related DVT; and 2) to try to confirm if patients with high platelet counts are at a higher risk to develop subclavian DVT, as previously suggested. On the recommendation of the Ethics Committee, patient recruitment was terminated earlier than planned: DVT developed in 1/16 patients (6%) taking Fragmin and 8/13 patients (62%) without prophylaxis (Relative Risk 6.75; 95% CI: 1.05-43.58; p = 0.002, Fisher exact test). No bleeding complications had developed. As for prediction of DVT, there was a tendency towards a higher platelet count in those patients who subsequently developed DVT, but differences failed to reach any statistical significance (286 +/- 145 vs 207 +/- 81 x 10(9)/1; p = 0.067). According to our experience, Fragmin at the dosage used proved to be both effective and safe in these patients.

Adult↗
PubMed1998

Bowling related injuries of the hand and upper extremity; a review.

Bowling is one of the oldest and most popular indoor sports. The earliest evidence of bowling dates back to ancient Egypt. Archaeologists discovered equipment for a game resembling bowling. Modern forms of bowling appeared in England as early as the 1100s. Bowling can cause a variety of hand and upper extremity injuries either due to acute or reparative forces. Greater number of such injuries is being encountered as the popularity of the game has increased. The goal of this article is to present an overview of bowling related injuries, their mechanisms along with preventive and treatment measures.

Arm Injuries↗
PubMed2000

Resurfacing deep wound of upper extremities with pedicled groin flaps.

A total of 29 axial pedicled groin skin flaps were applied clinically with satisfactory result excepting for one flap which tailed on transplantation. These cases included severe scar contracture of the dorsum of hands in 20 patients, deeply burned wounds with infection and exposure of deep structure in upper extremities in nine patients, such as electrical burns and hot-crushing injuries. The flap is supplied by two groups of nutrient vessels with abundant vascularization and located in a hidden area. Therefore, the pedicled groin skin flap is still valuable due to its advantages as safe, easy operation and strong antiinfective ability although the free groin flap is more widely used today.

Adult↗
PubMed1994

Multiple recurrent benign schwannomas of deep and superficial nerves of the upper extremity: a new variant of segmental neurofibromatosis.

Benign schwannomas of the brachial plexus are uncommon tumors, first described in the late 19th century. These lesions, which are histologically benign, can generally be excised without sacrifice of neural elements. We present the first known case of multiple concurrent and recurrent benign schwannomas of the upper extremity in an individual who demonstrated no other evidence of neurofibromatosis, and we suggest that this case may represent a new subtype of type V neurofibromatosis.

Adult↗