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PubMedDate not supplied

Lengthening of the humerus for upper extremity limb length discrepancy.

We present a case of humeral lengthening for a limb length discrepancy of 7.7 cm due to proximal humeral growth arrest in a 12-year-old boy. Lengthening of 69 mm was achieved using the Wagner technique. Bone grafting was not required. Humeral lengthening may be performed for upper extremity limb length discrepancy with good results. Objectives of treatment must include protection of the radial nerve from traction injury and from entrapment in the osteotomy site. Elbow extension may be lost during lengthening, but in the adolescent age group, full return of elbow motion can be expected.

Bone Diseases↗
PubMed1976

Early removal of the eschar in upper extremity burns.

The rationale behind early removal of the burn is sound, but the techniques presently available to accomplish this are limited. In patients with large area burns, massive excision should be considered only in burn centers prepared to provide the enormous amount of supportive care required. Carefully selected, localized burns of the upper extremity may benefit from timely surgical excision. Final function, particularly in the hand, depends more on the depth of initial injury and involvement of deep structures than on the choice between excision and topical chemotherapy. Enzymatic débridement, though an attractive concept, is presently in the development stage and should be viewed with caution. The success of any procedure for early removal of the eschar depends on prompt and complete wound coverage with skin grafts.

Arm Injuries↗
PubMed2006

Complex regional pain syndrome type I in the upper extremity.

Complex regional pain syndrome (CRPS) remains a challenging condition for physicians to treat since the earliest descriptions dating back to the Civil War. It has been most commonly reported after traumatic injury or fracture; however, many other causes have been documented. This article focuses on CRPS type 1 as it pertains to the upper extremity. In general, patients who have complex regional pain syndrome suffer from pain, sensory changes, edema, sweating, and temperature disturbance in the afflicted extremity. Chronic changes can involve the skin, nails, and bone. The pathophysiology of this condition remains unclear and is probably multifactorial, involving persistent inflammation, the sympathetic nervous system, the central nervous system and external stimuli. Treatment should be based on a multidisciplinary experienced team approach that is focused on functional restoration. Future research will provide insight into pathophysiology and optimal treatment regimens.

Analgesics↗
PubMed1978

Deep venous thrombosis of the upper extremity associated with use of the Swan-Ganz catheter.

Two patients who developed unilateral neck vein distention following insertion of a Swan-Ganz catheter are described. One patient developed unilateral swelling of the arm used for catheter insertion. Following removal of the Swan-Ganz catheter in this patient, venograms of both upper extremities revealed internal jugular vein thrombosis and subclavian vein thrombosis of the involved extremity. The other patient had thrombosis of the internal jugular veins and subclavian veins bilaterally, as well as superior vena cava thrombosis.

Catheterization↗
PubMed1986

Normal growth and growth predictions in the upper extremity.

The study consisted of 102 children, 50 boys and 52 girls, who were randomly selected. Measurements of their extremities were obtained from orthoroentgenograms with the method described by Anderson and Green. On the basis of this information, growth prediction charts were developed for the individual bones (humerus, ulna, and radius), as well as for the entire upper extremeity. These charts can be a valuable tool in the correction of growth inequality, particularly in the treatment of differential bone growth of the distal forearm.

Adolescent↗
PubMed1996

Giant cell arteritis presenting as pulseless disease of the upper extremities.

The most frequently recognized clinical features of giant cell arteritis (GCA) derive from the involvement of the cranial arteries. In 10% of patients, however, the aorta and its major branches, are also affected. We report a case of a 53-year-old woman presenting with a fainting episode and diminished pulses in the upper extremities. Histologic examination of the temporal artery revealed features of giant cell arteritis.

Angiography↗
PubMed1997

Nonspecific work-related upper extremity disorders.

The incidence of work-related repetitive motion disorders has increased rapidly during the past 20 years. While it appears that psychosocial factors have contributed largely to the increasing incidence of these disorders, ergonomic factors and other medical conditions also play a role. The most common single diagnostic category of work-related upper extremity disorders is likely to be nonspecific. The presentation and physical findings in patients with these regional myofascial pain syndromes are often characteristic. In most cases, no measurable tissue damage or inflammatory response is found. A traditional medical approach that reduces risk factors, provides symptomatic treatment and utilizes rehabilitative techniques is usually effective in maintaining productivity in patients with nonspecific repetitive motion disorders and, thus, minimizes the personal and economic impact of these disorders.

Arm Injuries↗
PubMed2005

Robot-aided neurorehabilitation of the upper extremities.

Task-oriented repetitive movements can improve muscle strength and movement co-ordination in patients with impairments due to neurological lesions. The application of robotics and automation technology can serve to assist, enhance, evaluate and document the rehabilitation of movements. The paper provides an overview of existing devices that can support movement therapy of the upper extremities in subjects with neurological pathologies. The devices are critically compared with respect to technical function, clinical applicability, and, if they exist, clinical outcomes.

Arm↗
PubMed1989

Factors affecting the sensitivity and specificity of the three-phase technetium bone scan in the diagnosis of reflex sympathetic dystrophy syndrome in the upper extremity.

The three-phase technetium bone scan has been recommended for use in the diagnosis of the reflex sympathetic dystrophy syndrome with a sensitivity and specificity of greater than 90%. A retrospective chart review was conducted of 63 patients who had three-phase technetium bone scan as part of a work-up for unexplained upper extremity pain, to determine the predictive value of the three-phase technetium bone scan in reflex sympathetic dystrophy syndrome, and what factors might affect it. The prevalence of definite or probable reflex sympathetic dystrophy syndrome, as assessed by Kozin's criteria, was 26% in this sample. The 3-hour delayed image demonstrated a sensitivity = 50%; specificity = 92%; positive predictive value = 67%, and negative predictive value = 84%. This was not improved using the data from the blood flow or pool phase. The sensitivity of 50% is lower than previous reports. The predictive value of the three-phase technetium bone scan was affected by the duration of symptoms and the age of the patient. Duration of symptoms less than 6 months, or ages more than 50 years substantially increased the sensitivity and positive predictive value of the three-phase technetium bone scan.

Adult↗
PubMed1989

Drug injection injuries of the upper extremity.

The increasing incidence of illicit intravenous drug abuse has reached epidemic proportions in western society. Although the accompanying infectious complications such as hepatitis and acquired immunodeficiency syndrome receive the most notoriety, injection injuries are causing an increasing number of problems. A retrospective review of patients requiring admission for acute or chronic drug injection injuries of the upper extremities was made at the Detroit Receiving Hospital from 1980 through 1985. The demographical, historical, physical, microbiological, and follow-up data were analyzed. The majority of the injuries involved subcutaneous injections into the hand with accompanying inflammatory or infectious complications. The bacteriological data revealed unique characteristics and did not reflect patterns expected from inoculation of normal skin flora. A treatment regimen based on the data is proposed.

Adult↗
PubMed1990

The radial forearm flap for reconstruction of the upper extremity.

The radial forearm flap, owing to its good-caliber arteries of long length and equally well distributed venous system, has proved very reliable. It has not only earned its place and recognition in reconstructive hand surgery, but also has emerged as a workhorse for the microvascular surgeon. We have used 14 radial forearm flaps for upper extremity reconstruction, and we present herein our experience. The technique of extracorporeal tissue transfer, which has been published elsewhere, was used in two patients and is detailed. Four representative patients are presented.

Adolescent↗
PubMed1998

Benign fetal rhabdomyoma of the upper extremity. A case report.

Benign fetal rhabdomyoma is a tumor of striated muscle origin that rarely is seen in the extremities. Because of the similarities of fetal rhabdomyoma to its malignant counterpart, rhabdomyosarcoma, an important distinction is to be made to avoid errors in treatment. The clinical presentation, radiographic, and pathologic features of the first known case of an isolated upper extremity rhabdomyoma are described. The authors discuss, the distinction between this and rhabdomyosarcoma and also describe a unique histologic feature in rhabdomyoma, the presence of psammoma bodies.

Arm↗
PubMed1995

Computer mouse use and cumulative trauma disorders of the upper extremities.

The computer mouse is now present in virtually every office environment because of the recent adoption of the graphical user interface. However, Karlqvist et al. (1994) pointed out that there still remains a paucity of work on the musculoskeletal problems associated specifically with computer mouse use. Likewise, there have been no published data on the magnitude of upper extremity musculoskeletal disorders associated with computer mouse use. In order to ascertain this magnitude, claims data from the Liberty Mutual Group were reviewed for the years 1986 to 1993, inclusive. Count, total cost and average cost per claim for all claims associated with computer use and computer mouse use were determined for the years in question. It was concluded that although there are few claims related to computer mouse use, it appears to be a growing problem, and therefore, perhaps, deserves more research and intervention attention. However, the present magnitude is less than for other musculoskeletal disorders.

Arm↗
PubMed1992

Vascularized bone grafts to the upper extremity. Indications and technique.

Massive autogenous bone grafts with an intact vascular pedicle decrease the time to bony union and immobilization required for treatment of segmental bony defects. These techniques have been shown to be effective in treatment of segmental defects of more than 6 cm after trauma or tumor resection in relatively avascular beds. Additionally, in the upper extremity, the free vascularized bone graft is in the developmental phase for employment in the reconstruction of epiphyseal arrest and congenital radial club hand. There are disadvantages to free vascularized bone transfers compared with conventional techniques. For example, a free vascularized fibular transfer requires a team skilled in microvascular technique, a long operative time (6 to 10 hours), and the sacrifice of a major vessel to the lower extremity. If the anastomosis fails, however, the free vascularized fibula will act as a conventional bone graft, thereby minimizing adverse effects. We think that by proper patient selection, appropriate evaluation and preparation of the bony defect, meticulous microvascular anastomosis, and correct fixation and immobilization of the graft a good outcome can be achieved in those patients with large bony defects that defy the use of conventional methods.

Adolescent↗
PubMed2002

[Persistent neurological deficit of the upper extremity after a shoulder operation under general anesthesia combined with a preoperatively placed interscalene catheter].

For correction of a shoulder instability (Bankart's operation) in a 33-year-old woman, a combined regional and general anaesthesia was chosen. An interscalene catheter to block the brachial plexus was placed preoperatively without complication. The following day this resulted in an upper extremity almost without motor function and with complete hypoesthesia of the dermatomes C5-C7. Surgical exploration of the plexus was performed 41/2 months later. Stimulation of the three truncs of the brachial plexus was possible and showed electrophysiological signs of recovery of distal parts of the plexus. After 2 years no clinical corresponding recovery could be observed. Despite all investigations (electroneuromyography, evoked potentials, etc.) no clear etiology could be established to explain this adverse outcome.

Adult↗
PubMed1992

Perineural pressures under the pneumatic tourniquet in the upper extremity.

The literature indicates that tourniquet-induced neurological injuries are relatively common and frequently occur at a subclinical level. In order to evaluate the pressure transmitted to the major peripheral nerves of the arm by an externally applied pneumatic tourniquet, a fully implantable biomedical pressure transducer was placed adjacent the radial, median and ulnar nerves in six cadaver upper extremities of average dimensions. This sensor allowed accurate, reproducible measurements of perineural pressures without requiring significant disruption of the normal anatomical structures of the test limb for its installation. At levels of tourniquet cuff inflation which are commonly used in clinical practice, there was little or no decrease in the pressure detected in the perineural regions over that applied to the surface of the limb. In addition, there was a steep gradient of perineural pressure between locations beneath the edge of the cuff and those under its midpoint. This was most marked at the highest levels of tourniquet inflation. At presently accepted levels of inflation, pneumatic tourniquet cuffs transmit high pressures to the peripheral nerves without any significant attenuation by the intervening soft tissues. The distribution of these forces is one which may subject the underlying nerves to deleterious shear forces, especially at higher levels of inflation.

Arm↗
PubMed2002

A novel technique of upper extremity revascularization: the retrohumeral approach.

Although the standard approach for inflow to the brachial artery is directly from the subclavian or the carotid artery, unusual scenarios exist when this direct route is not accessible. We present a case of a patient after right radical mastectomy and radiation therapy for breast cancer with severe ischemic symptoms of the dominant right upper extremity. Angiography revealed an occluded right subclavian artery with a paucity of distal collaterals across the right shoulder. A reversed vein graft was constructed from the right common carotid artery to the right brachial artery and was tunneled with a retrohumeral approach to avoid the previously operated and irradiated field. The patient has remained asymptomatic with a patent graft at 2 years.

Aged↗
PubMed1995

Automotive airbag-related upper extremity injuries: a report of three cases.

Automotive airbag technology has reduced the number of injuries and fatalities resulting from motor vehicle crashes. With the increasingly frequent application of this safety feature in automobiles, recent reports of airbag-associated injuries have emerged, including ocular and non-lethal cardiac trauma. We report three cases of airbag-related upper extremity injuries seen at a level-I trauma center over a 6-month period. A heightened awareness of this type of injury in patients injured in motor vehicle crashes with airbag deployment is recommended. The awareness, identification, and management of these high energy injuries will take on added meaning as the airbag technology becomes universally applied.

Accidents, Traffic↗