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PubMedDate not supplied

[Peripheral nerve damage in upper extremities in glass cutters].

A group of glass cutters working with flint-glass was analysed in view of their susceptibility to ulnar nerve crush injury. The group comprised 429 cutters from Eastern Bohemia working in the Bohemia manufacture. The type of work done by cutters is described with particular reference to the way in which they rest their upper extremities during work and to the duration of work. Subjective symptoms were present in 44.7% of workers. The following neurological abnormalities were found during examination: hypaesthesia in 36.8%, motor activity impairment in 21.9%, muscular atrophy in 8.1%. Autonomic abnormalities involved hands in 29.1% of workers. Slight electromyographic abnormalities were demonstrated not only in the innervation area of the ulnar nerve but also in that of the median nerve. The authors discuss their views on the aetiology of the disease and criteria used in medical evaluation of ability to work in these workers.

Electromyography↗
PubMed1989

Upper extremity joint movement: comparison of two measurement devices.

The Ortho Ranger is a new device available for measurement of joint motion. The purposes of this study were (1) to determine the clinical reliability of the Ortho Ranger compared to the reliability of the standard goniometer and (2) to investigate the correlation between the Ortho Ranger and the goniometer for upper extremity joint movements in healthy adults. Three measurements with each instrument were taken during three different sessions for active shoulder, elbow, and wrist movements. The within-session reliability was higher for the goniometer. The Pearson correlation coefficients suggest a strong relationship between the Ortho Ranger and the goniometer for shoulder internal and external rotation, and a poor relationship for elbow movements. The Ortho Ranger does not provide remarkable advantages in measurement compared to the goniometer.

Adult↗
PubMed1997

Functioning free-muscle transplantation for the upper extremity.

Functioning free-muscle transplantation (FFMT) is an advanced microneurovascular technique indicated in patients who have an injury with major functional muscle or muscle group loss or denervation and no locally available or ideal musculotendinous donor units. Over the 9-year period, from 1986 to 1994, 47 FFMTs were applied in patients who had severe hand and upper-extremity injuries (not including brachial plexus injury). Thirteen patients had 15 FFMTs to reconstruct muscle loss caused by severe Volkmann's ischemia. Seventeen patients had 21 FFMTs for reconstruction after severe crushing and traction injuries of the forearm or arm, with major muscle loss or major nerve injury. Nine patients, with 11 FFMTs, sustained major limb avulsion amputation for which replantation without nerve repair was done initially. FFMT was the only technique available to resolve the motor deficit and consequent deformity. Most patients achieved significant functional improvement.

Arm Injuries↗
PubMedDate not supplied

Presumed pulmonary embolism following power-pulse spray thrombectomy of upper extremity venous thrombosis.

To achieve more effective thrombolysis in a shorter treatment time, percutaneous mechanical thrombectomy has been increasingly used in the treatment of deep venous thrombosis (DVT). The power-pulse spray is a new technique to combine chemical and rheolytic effects on clots. We present a case of presumed pulmonary embolism following power-pulse spray treatment for upper extremity DVT which necessitated resuscitation and intubation. The power-pulse spray technique should be used with caution when treating DVT.

Adult↗
PubMed2005

The activation of the cortical hand area by toe tapping in two bilateral upper-extremities amputees with extraordinary foot movement skill.

Functional reorganization of the human brain after an arm amputation has been documented in several investigations, but as far as we know, there has been no report on amputees with skilled foot movement ability. To further assess the power of functional reorganization of the brain after an amputation, we investigated two bilateral upper-extremities amputees who were professional sculptors and painters with their feet. Performance tests showed that they possessed high foot movement ability. Functional MRI data indicated that toe tapping of the amputees not only activated the classical foot primary motor cortex, but also activated the hand area. In the T1-weighted MRI, the central sulci of both amputees kept their characteristic shape. Our study suggests that there is a remarkable power of neural plasticity in the motor cortex, and the maturation of the cortex develops in response to daily practice. The possible mechanisms of the reorganization are tentatively discussed.

Adult↗
PubMed1995

Evaluating and treating common upper extremity nerve compression and tendonitis syndromes ... without becoming cumulatively traumatized.

Cumulative trauma disorder, repetitive motion injury, and overuse syndrome are all umbrella descriptions of many specific injuries that require careful evaluation, diagnosis, and treatment to restore function, decrease pain, and minimize time spent in a patient role. This article describes anatomic sites of common nerve compressions and tendonitis in the upper extremity (UE). Evaluation techniques are described with emphasis on clinical, environmental, and psychological mitigating factors essential in identifying microtrauma of nerves and tendons to achieve the correct differential diagnosis. Conservative treatment recommendations, including splinting, ergonomics, corticosteroid injection, and hand surgery, are outlined to assist the practitioner in discerning the most appropriate course of action. Surgical intervention and postoperative care and follow-up for median, ulnar, radial, and thoracic outlet nerve compression syndromes are briefly described.

Arm↗
PubMed2000

[Microcirculation in the skin of the upper extremities in type 1 diabetics using the laser doppler method].

BACKGROUND: Diabetic microangiopathy is a very frequent complication of both types of diabetes mellitus. Detection of early microcirculation impairment may identify patients at high risk of severe complications and may have a great value for prevention of these complications. The aim of the study was to evaluate the skin microcirculation in upper extremities in Type 1 diabetic patients and in healthy volunteers with laser Doppler technique. Parameters of microcirculation were compared between these two groups and with diabetes control expressed by glycated hemoglobin, fructosamin and fasting glycaemia. Relationship between perfusion parameters, the age of patients and the duration of diabetes was analysed as well. METHODS AND RESULTS: Thirty-eight Type 1 diabetic patients (18 men, 20 women) and twenty-six healthy persons (16 men, 10 women) were evaluated in this study. Differences of high statistical significance in many parameters of perfusion were found between these groups. A significant negative relationship was found between the percentage perfusion increase during postocclusive hyperaemia in forearm and HbA1c and fructosamine (r = -0.52, p < 0.001 and r = -0.47, p < 0.01, respectively), between percentage perfusion increase during local hypertermia and HbA1c (r = -0.47, p < 0.001). Negative correlation was also found between maximal perfusion during postocclusive hyperaemia in finger and fructosamine (r = -0.4, p < 0.01) and between the same parameter in forearm and fasting glycaemia (r = -0.62, p < 0.001). Skin perfusion was independent on age and duration of diabetes. CONCLUSIONS: Significant differences between diabetic patients and healthy controls and a relationship between perfusion parameters and compensated diabetes status were described in the current study. Laser Doppler fluxmetry is a non-invasive method comfortable for patients and it can be used for detection of microangiopathy in diabetology.

Adult↗
PubMed2002

[Individual perforator flaps of the upper extremity].

Perforator flaps allow an individual flap design on the basis of a preoperative ultrasound examination. Aim of the present study is a preliminary evaluation of results and technical pitfalls of this new technique in the use for flap coverage on the dorsum of the hand and the elbow region. Since 1999, seven individually designed pedicled perforator flaps were prepared on the upper extremity. In four cases, defects on the dorsum of the hand and in a further three defects in the elbow region were treated. In the latter cases the flaps were harvested in a mainly epifascial plane, without dissecting the perforating vessels down to their origin. Five flaps were based on perforating vessels of the interosseous arteries, a further two from the lateral collateral humeral artery. Three out of four pedicled perforator flaps used on the dorsum of the hand healed completely. One flap was lost because of venous insufficiency due to the lack of wrist immobilisation. In the elbow region, two out of three defects were successfully covered with an individual perforator flap. One flap was lost due to venous insufficiency, a further needed an additional split-skin graft with a partial flap loss. The main advantage of the presented technique remains the possibility of individual flap design. However, the donor-site defect is almost negligible since in most cases a primary closure of the donor site was possible. The main arteries remained untouched leaving the blood supply to the hand unchanged. Nevertheless, the mainly epifascial harvest of the perforating vessels in the elbow region has the disadvantage of a short pedicle together with a high degree of torsion which leads to an increased risk of flap loss due to venous insufficiency.

Adult↗
PubMed1997

Input-increase and input-decrease types of cortical reorganization after upper extremity amputation in humans.

A plastic remodeling of regions in somatosensory cortex has previously been observed to occur in separate experimental paradigms in response to loss of somatosensory input and to increase in input. In this study, both types of cortical reorganization have been observed to occur concurrently in the same adult human nervous system as a result of a single intervention. Following upper extremity amputation, magnetic source imaging revealed that tactile stimulation of the lip evoked responses not only in the area of the somatosensory cortex corresponding to the face, but also within the cortical region that would normally correspond to the now absent hand. This "invasion" of the cortical amputation zone was accompanied by a significant increase in the size of the representation of the digits of the intact hand, presumably as a result of an increased importance of sensory stimulation consequent to increased dependence on that hand imposed by the loss of the contralateral extremity.

Adolescent↗
PubMed1979

Free groin flap transfer to the upper extremity.

Seven patients underwent free groin flap transfer to the first web space, palm, wrist or elbow. Six of the seven were successful. The seventh developed acute venous occlusion and superficial necrosis of part of the flap, receiving split thickness skin grafts to salvage the dermal portion. Transfer is offered as an alternative to more conventional flaps for coverage of defects of the upper extremity.

Adolescent↗
PubMed2004

[Secondary nerve reconstruction in the upper extremity in children--results with respect to number of motor units].

After nerve injury, the therapy of choice is primary suture. If this, however, is not possible or inadequate, a secondary reconstruction must be carried out within a suitable period of time. This study shows results after nerve transplantation within a timeframe of six weeks. Seventeen children with peripheral nerve injuries of the upper extremity were treated. Secondary nerve reconstruction was accomplished by sural nerve transplantation. Eight children, aged from 5 to 13 years, were examined. The median nerve was affected in three and the ulnar nerve in five cases. The examination included clinical and electrophysiological assessments. The length of grafts was correlated with the clinical result. Besides the calculation of sensitive and motor nerve conduction velocity the number of motor units from the flexor pollicis brevis muscle or abductor digiti minimi muscle were determined by motor-unit-estimation (MUE) on both sides. The observation time period was on an average 2.9 years. Results were good to excellent. A persisting Hoffmann-Tinel's sign was found only once in median nerve lesion. Loss of sensitivity following harvesting of sural nerve was not noted as a problem by any of these children. Length of grafts did not affect the results. Standard values were reached in every case in the electrophysiological examination. The number of motor units of the abductor pollicis brevis muscle and abductor digiti minimi muscle decreased to approximately 50% compared to the healthy side. Sural nerve grafting resulted in good motor and sensory function. We recommend grafting within six weeks, as Wallerian degeneration is completed and regeneration from the proximal nerve stump is optimal. Although children have a very good regeneration potential, the examined cases did not achieve a complete restoration of all motor units of the muscles.

Action Potentials↗
PubMedDate not supplied

Kinematic assessment of the upper extremity in brachial plexus birth palsy.

Children with brachial plexus birth palsy (BPBP) may have shoulder external rotation and abduction weakness that can restrict activities of daily living (ADLs). Static range of motion measurements may not measure ADL restrictions. Motion analysis has been used to quantify gait limitations and measure changes associated with treatment. The purpose of this study was to determine whether upper extremity motion analysis (UEMA) can measure the differences in shoulder motion during ADLs between children with BPBP and normal children. Following a previously described UEMA protocol, 55 children with BPBP and 51 normal children (control group) were studied. Kinematic data of selected ADLs were collected before surgery. UEMA was used to measure statistically significant differences between children with BPBP and control subjects for all planes of shoulder motion in all activities tested. The authors conclude that UEMA can discriminate between children with BPBP and control subjects during selected ADLs, and suggest that UEMA can also be used to measure the effects of surgical interventions in children with BPBP.

Activities of Daily Living↗
PubMedDate not supplied

Validity of generic risk factors and the strain index for predicting nontraumatic distal upper extremity morbidity.

Nine individual generic risk factors, eight combinations of generic risk factors, the presence of any generic risk factor, and the Strain Index were evaluated for 56 jobs by 2 evaluators blinded to morbidity measures. Jobs then were assigned to dichotomous hazard classifications (problem versus safe) according to recommendations from the literature. OSHA 200 logs were used to ascertain historical evidence of distal upper extremity (DUE) morbidity, and jobs were assigned to a dichotomous morbidity classification (positive versus negative) using none versus one or more recorded cases as the criterion. Evidence of association and measures of predictive validity were evaluated by comparing hazard and morbidity classifications using 2 x 2 contingency tables. Five individual generic risk factors, three generic risk factor combinations, and the presence of any generic risk factor were not associated with morbidity classification. The odds ratio estimates among the four individual generic risk factors and the five combinations of generic risk factors associated with DUE morbidity varied from 3.3-36.0. The Strain Index had the largest estimated odds ratio of any exposure factor at 108.3. The exposure methods were grouped according to patterns of predictive validity. With one exception, the individual generic risk factors and their combinations had high sensitivity with low specificity (many false-positives), low sensitivity with high specificity (many false-negatives), or low sensitivity with low specificity. The only generic risk factor that demonstrated reasonable predictive validity was the use of gloves--its sensitivity, specificity, positive predictive value, and negative predictive value were equal to 0.75. The Strain Index performed better than any of the individual or combinations of generic risk factors. Its sensitivity, specificity, positive predictive value, and negative predictive value were all approximately 0.90.

Arm↗
PubMed1988

Beneficial effects of intra-arterial reserpine after upper-extremity embolectomy: a prospective randomised trial.

Persistent ischaemia occasionally follows technically-successful arterial embolectomy, and has generally been ascribed to small-vessel thrombosis in the distal vascular bed. Because of the possibility that distal vasospasm might be a contributory cause, we conducted a prospective randomised trial of vasodilator therapy in this setting. In 50 consecutive patients presenting with their first episode of upper-extremity arterial embolism, we compared the results of the intra-arterial instillation of 0.5 mg reserpine with those of saline alone following embolectomy. Among 29 patients receiving saline only, 13 (44.8%) suffered persistent or recurrent limb ischaemia requiring reoperation, while three (14.3%) of 21 patients receiving reserpine had continuing ischaemia (P = 0.02). Three patients in each group required a second re-operation; all three in the reserpine group were ultimately found to have a proximal axillo-subclavian artery stenosis as the cause for their persistent or recurrent limb ischaemia. Although its underlying pathophysiology remains obscure, peripheral vasospasm appears to accompany acute embolic arterial occlusion. Manoeuvres to prevent or reverse such distal vasoconstriction may be useful in avoiding persistent or recurrent ischaemia following arterial embolectomy.

Aged↗
PubMed2004

Soft-tissue sarcomas of the upper extremity: surgical treatment and outcome.

The objective of this retrospective follow-up study was to evaluate the outcome of patients with soft-tissue sarcoma treated by the authors' protocol, which consists of a selective combination of conservative surgery and radiotherapy. Patients who relapsed were especially evaluated to improve treatment results. The authors examined 80 patients with local soft-tissue sarcoma in the upper extremity referred to their multidisciplinary group. Fifteen patients were referred for first or subsequent local recurrence, and 65 patients were treated for primary tumor. The goal of treatment was local control and preservation of a functional limb. Wide excision was attempted. If the margin was less than 2.5 cm, postoperative radiotherapy was administered. Eighty-five percent of the patients were treated by limb salvage. Thirty patients needed reconstructive procedures such as pedicled (20 patients) or free flaps (10 patients). No free flaps were lost. The 5-year disease-specific overall survival rate was 75 percent, the local recurrence-free survival rate was 79 percent, and the metastasis-free survival rate was 68 percent. In univariate analysis, prognostic factors for local recurrence were extracompartmental site; for development of metastases, large size and extracompartmental site; and for decreased disease-specific overall survival, large size and extracompartmental site. Intramuscular, cutaneous, and subcutaneous tumors had a 5-year local control rate of 100 percent, and extracompartmental tumors had a local control rate of 69 percent. Extracompartmental tumors clearly have the worst prognosis and should be the main target for improving treatment strategies. After exclusion of patients with inadequate treatment according to the authors' protocol, the local control rate at 5 years was 90 percent. Strict adherence to treatment protocol should be practiced.

Adult↗
PubMedDate not supplied

Upper extremity weight-training modifications for the injured athlete. A clinical perspective.

The ability of the health care professional to make correct decisions about the progression of weight-training is critical to the rehabilitation process. The purpose of this article is to describe our approach to modification of weight-lifting techniques using the injured shoulder as a model. Additionally, the impact of various upper extremity weight-training techniques on healthy athletes is discussed. The effects of grip, hand spacing, bar trajectory, and start and finishing positions on microtraumatic injury and return to weight-training activities after injury are considered. Several weight-training functional progressions for common multijoint exercises (such as bench press, shoulder press, power clean) are presented. Adaptations for periodization are also presented for implementation in the rehabilitation sequence. The weight-training modifications described in this paper will assist the health professional to safely return athletes to the weight room after shoulder injury.

Adaptation, Physiological↗
PubMed2001

Ergonomics in a hospital and a university setting: The effect of worksite analysis on upper extremity work-related musculoskeletal disorders.

OBJECTIVES: The purpose of this study was to determine whether individuals with work-related injuries receiving worksite analysis would have less lost workdays than individuals not receiving worksite analysis. Therapeutic management of work-related injuries in a hospital and a university setting were also compared. STUDY DESIGN: Over a one-year period, employees who sustained an upper extremity work-related injury were issued questionnaires regarding their injury, treatment, functional status and pain level. Participants were divided into three groups: group 1 consisted of hospital employees (N=14) who underwent worksite analysis, group 2 included university employees (N=15) who underwent worksite analysis whereas group~3 included university employees (N=14) who underwent no analysis. RESULTS: All groups were similar in demographics, functional status, and pain level. Satisfaction with the worksite analysis was similar for groups one and two. CONCLUSION: A pattern of less absenteeism but greater modified duty days was associated with those individuals undergoing worksite analysis.

Journal Article↗
PubMed1998

Reflex sympathetic dystrophy of the upper extremity--a 5.5-year follow-up. Part II. Social life events, general health and changes in occupation.

The aim of this retrospective long-term follow-up study was to describe the psychosocial aspects, such as social life events (SLE), around the causative event of reflex sympathetic dystrophy (RSD) and the psychological history of 65 patients, 3-9 years after RSD of the upper extremity. General health and long-term changes in occupation were assessed by means of a general health questionnaire (RAND-36) and a structured interview, respectively. SLE, with a life-change unit rate more than 35, was present in 32 patients. A psychological (or psychiatric) history was found in 22 patients. In total, 60% of the patients had a SLE and/or a psychological history. The pain scores of the RAND-36 among RSD patients differed significantly from those of the control group. 17 patients changed occupation after RSD. Nearly 30% of the patients had to stop work for more than one year. The results show a high coincidence between RSD and associated psychosocial disorders and this may play a role in intensifying and prolonging the symptomatology of RSD.

Adolescent↗