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PubMed2006

Rheumatic diseases that can be confused with work-related upper extremity disorders.

Rheumatic illnesses are a common cause for musculoskeletal complaints in the general population. All ages can be affected, including people in the prime of their working years. Secondary problems, such as entrapment neuropathies, enthesopathies, and Raynaud's syndrome, can be associated with various inflammatory arthritides. A detailed history and physical are the most important tools in screening for potential inflammatory disease in workers with upper extremity complaints.

Adult↗

PubMed1991

The injured upper extremity and the JAMAR five-handle position grip test.

Niebuhr and Marion (Am J Phys Med Rehab 1990;69:96-101) recently presented a study that utilized healthy subjects who were able to control the amount of force exerted during submaximal grip strength efforts. Stokes (J Occup Med 1983;25:683-684) proposed that a true weakness of grip can be distinguished in the injured upper extremity from a feigned effort that yields a flat horizontal type of curve. The purpose of this study was to evaluate the five-handle position JAMAR grip test in an injured population and compare the curves produced with a group of healthy subjects. We found that the patients with well-documented pathology produced a curve that was similar in shape to the healthy group; however, the curve on the injured extremity was reduced in force output.

Adult↗

PubMed1995

Glomus tumors of the upper extremity: experience with twelve cases.

BACKGROUND: The glomus tumor is an uncommon tumor of the hand, which presents with much pain. It is a benign neoplasm composed of a glomus body, which is located in the dermis. Glomus tumors present a classic clinical picture of pain, sensitivity to cold and local tenderness over the lesion. METHODS: Twelve patients underwent surgical removal for glomus tumors of the upper extremity from 1983 to 1992. There were three males and nine females; their average age was 37 years (25 to 60 years). The clinical manifestations were pain and local tenderness in 12 patients, and cold intolerance in 6 patients. RESULTS: There was a difference in gender in the anatomical site of the tumor. In three male patients, only one tumor was found in the digit. In female patients, all nine tumors were located in the digits. The average tumor size was 0.6 cm in diameter. After follow-up of 4.5 years (average), no recurrence, no residual pain or cold intolerance was noted. CONCLUSIONS: The treatment of glomus tumor consisted of local excision or curettage, with or without reconstruction of the nail bed. Recurrence is not a problem after complete removal of the tumor tissue. Permanent nail deformity is still a problem. Efforts to prevent this sequelae are worth trying.

Adult↗

PubMed1996

Botulinum toxin type A in the treatment of upper extremity spasticity: a randomized, double-blind, placebo-controlled trial.

Spasticity is a disorder of excess muscle tone associated with CNS disease. We hypothesized that botulinum toxin, a neuromuscular blocking agent, would reduce tone in spastic muscles after stroke. This randomized, double-blind, placebo-controlled, multicenter clinical trial evaluated the safety and efficacy of botulinum toxin type A (BTXA) in the treatment of chronic upper limb spasticity after stroke. Thirty-nine patients received IM injections of a total dose of either 75, 150, or 300 units of BTXA or placebo into the biceps, flexor carpi radialis, and flexor carpi ulnaris muscles. At baseline, patients demonstrated a mean wrist flexor tone of 2.9 and elbow flexor tone of 2.6 on the Ashworth Scale (0 to 4). Treatment with the 300-unit BTXA dose resulted in a statistically and clinically significant mean decrease in wrist flexor tone of 1.2 (p = 0.028), 1.1 (p = 0.044), and 1.2 (p = 0.026) points and elbow flexor tone of 1.2 (p = 0.024), 1.2 (p = 0.028), and 1.1 (p = 0.199) at weeks 2, 4, and 6 postinjection. In the placebo group, tone reduction at the wrist was 0.3, 0.2, and 0.0 and at the elbow was 0.3, 0.3, and 0.6 at weeks 2, 4, and 6 postinjection. BTXA groups reported significant improvement on the physician and patient Global Assessment of Response to Treatment at weeks 4 and 6 postinjection. There were no serious adverse effects. In this 3-month study, BTXA safely reduced upper extremity muscle tone in patients with chronic spasticity after stroke.

Adult↗

PubMed2006

Sporotrichoid presentation of Mycobacterium marinum infection of the upper extremity. A case report.

BACKGROUND: Mycobacterium marinum is a human opportunistic pathogen that is known to inhabit swimming pools, home aquariums, and natural bodies of salt and fresh water. Epidemic cases involving swimming pools are easily recognized, but sporadic cases are frequently misdiagnosed. OBJECTIVE: A 42-year-old male presented with a 2-month history of the appearance of livid, verrucous, painless nodules on his right upper extremity. He had cleaned an aquarium with tropical fish for the past 2 years. METHODS: A histopathological examination suggested a granulomatous inflammation. After incubation on Löwenstein-Jensen medium, Mycobacterium marinum was identified using biochemical methods and the PCR technique. RESULTS: Systemic therapy with rifampicin, ethambutol, and clarithromycin over a period of 6 months led to complete resolution of the skin lesions with some residual scars. CONCLUSION: Knowledge of this condition is very important to avoid unnecessary diagnostic procedures and improper treatment.

Adult↗

PubMed1986

Electrical stimulation applied to bone and nerve injuries in the upper extremity.

In conclusion, electrical stimulation of bone has advanced from the laboratory to clinical reality. Despite the lack of good double-blind clinical studies, it is impossible to ignore the excellent results reported from numerous multicenter trials. Doubts and controversies will and should continue. Electrical stimulation has a definite place in the treatment of scaphoid nonunion as well as other failures of osteogenic biology in the upper extremity. The future may realize the enormous potential of electrical stimulation in areas of nerve repair, wound healings, or osteoporosis. The hand surgeon may soon be operating in the age of biophysics where he or she can charge by the kilowatt hour. Yet one should not become a mere technician, but understand the basic science of what one is doing and, above all, maintain a balanced and critical approach.

Arm Injuries↗

PubMed1977

Electrical injuries, with special reference to the upper extremities. A review of 182 cases.

A twenty year experience in the management of 182 patients with electrical injuries has been reviewed. Males predominate. The average age is thirty-six years. Bodily contact with high tension wires by linemen constituted the most common accidents. High voltage injuries were sustained by 67% of patients. Burns were sustained by 74% of our cases and of these, 71% involved the upper extremities. Complications developed in three fourths of patients, and one third of patients suffered some degree of permanent disability. Mortality (2.1%) was largely due to septicemia, pneumonia, and renal failure. The wide variety of injuries necessitates individualization in treatment. Prevention offers greatest hope in management.

Accidents, Occupational↗

PubMed1983

Congenital hypoplastic thumb in the Silver syndrome--a case report and review of upper extremity anomalies in the world literature.

A case of classical Silver syndrome presented with a congenital hypoplastic thumb, absent thenar musculature, and partial index ankylosis. No previous association of congenital hypoplastic thumb and the Silver syndrome has been noted by Dr. Silver or described in the world literature. Restoration of thumb function was achieved in this particular case by the abductor digiti minimi transfer described by Huber. The upper extremity anomalies thus far reported with Silver syndrome in the world literature are summarized.

Child↗

PubMedDate not supplied

[Macroreplantation of the upper extremity. Report of experiences based on 4 cases].

Amputation of an extremity frequently represents a life-threatening injury and is accompanied by volume deficiency shock through loss of blood. The loss of an arm leads to diability and thus impairs the physical and psychic integrity of the person concerned. This contribution presents 4 cases with macroamputation at the upper extremity, 3 of them involving successfully performed reimplantations. After a historic survey, these cases are used as a basis for discussing the establishment of the indication, the procedure, the complications and the results of the reimplantation.

Adult↗

PubMed1982

[Ischemia syndrome of the upper extremities not due to cardiac causes. Proximal arterial stenosis with embolization into the periphery].

Five cases are reported with the pathological entity of proximal arterial stenosis and embolization into the peripheral vascular bed. Therapeutic management, e.g. diagnostic work-up, eradication of the embolic source and embolectomy of the peripheral arterial tree - if technically feasible - seems beyond any doubt. Sometimes the diagnosis is difficult to obtain, since in the upper extremity microembolic seeds occur, posing a differential diagnosis problem. Once a partial sternotomy and in situ removal of the lesion was employed, in the remaining cases extrathoracic repair was done. In the left subclavian artery using a carotid-subclavian-anastomosis, we obtained satisfactory results, in the right subclavian and end-to-end-anastomosis was performed after resection of the diseased arterial segment.

Adult↗

PubMed1993

Upper-extremity deep-vein thrombosis: thrombolytic therapy with anistrepalase.

A patient with primary axillary vein thrombosis was treated successfully in the emergency department with a single IV bolus of anistrepalase followed by continuous IV heparin. The patient's symptoms resolved quickly, and a repeat venogram 16 hours later showed near-complete resolution of the venous obstruction. We discuss briefly the role of thrombolytic therapy in the treatment of upper-extremity deep-vein thrombosis and the potential advantages of using anistrepalase.

Adult↗

PubMed2002

Sequential muscle activity and its functional role in the upper extremity and trunk during overarm throwing.

The proximal-to-distal segmental sequence has been identified in many sports activities, including baseball pitching and ball kicking. However, proximal-to-distal sequential muscle activity has not been identified. The aims of this study were to establish whether sequential muscle activity does occur and, if it does, to determine its functional role. We recorded surface electromyograms (EMGs) for 17 muscles from the upper extremity and abdomen during overarm throwing and detected the onset and peak times as indices of muscle activity. The following electromyographic properties were commonly identified in the participants. First, sequential muscle activity was observed from the scapular protractors to the shoulder horizontal flexors and from the shoulder horizontal flexors to the elbow extensor, but not from the elbow extensor to the wrist flexor or forearm pronator. Secondly, the external oblique contralateral to the throwing arm became activated before the ipsilateral external oblique. This sequence is considered to be very effective for the generation of high force and energy in the trunk. Thirdly, the ipsilateral external oblique began its activity almost at foot strike. Finally, the main activity of the rectus abdominis appeared just before the point of release.

Abdominal Muscles↗

PubMed2006

Task selection and enriched environments: a functional upper extremity training program for stroke survivors.

Functional tasks using real-life objects in an enriched environment provide a multidimensional approach to treatment. Functional tasks are therapeutic for stroke survivors, because they require the simultaneous use of motor control, cognition, visual perception, sensation, and motor planning. Therapists utilizing functional tasks as treatment modalities must also be multidimensional in their implementation. This article provides a systematic approach to guide therapists in developing a functional upper extremity training program for stroke survivors.

Activities of Daily Living↗

PubMed2001

Treadmill injuries to the upper extremity in pediatric patients.

Injury is the leading cause of preventable death and disability in childhood and early adulthood. Approximately 25,000 children are injured on exercise equipment each year. Although hand injuries sustained on stationary bicycles in the home have been well documented, little has been reported on home treadmill injuries. Between September 1996 and March 2000, the authors treated 12 children at The Children's Hospital of Philadelphia for injuries to the upper extremity sustained on a treadmill. The age at the time of injury ranged from 14 months to 7 years, with a median age of 2.4 years. Average length of follow-up was 11.4 months. Ten of the 12 children sustained partial- or full-thickness burns to the volar aspect of the hand and digits. Overall, 6 patients required surgical repair. A total of 25% of the volar flexion creases involved required surgery. All patients had good functional results. The authors discuss the mechanism of injury, management, and measures to prevent treadmill injuries to children. To their knowledge, this is the first report of such injuries resulting from the use of a treadmill.

Accidents, Home↗

PubMed1993

A methodology to assess the upper extremity strength in a chair egress posture.

In this paper a method is presented which can be used to analyse the force distribution resulting from the application of force on the left and right armrest of a chair during the action of sitting down or standing up. The peak data for both hands can be combined to obtain the maximum for a trial on a specific chair configuration. This method is useful to assess the upper extremity limitations of an elderly or disabled population when rising from a seated position. The method involved the instrumentation, with strain gauges, of armrests of a prototype lounge chair obtained from a manufacturer of seating for the elderly. Provision for hand placement was included and the system was appropriately calibrated. The methodology presented may have a variety of applications, such as the assessment of seating requirements for the elderly or disabled, and the relative evaluation of a range of seats for nursing homes, clinics, hospitals and rehabilitation or recreational lounges.

Journal Article↗

PubMed2006

Incidence and prevalence of upper-extremity musculoskeletal disorders. A systematic appraisal of the literature.

BACKGROUND: A systematic appraisal of the worldwide incidence and prevalence rates of UEDs available in scientific literature was executed to gauge the range of these estimates in various countries and to determine whether the rates are increasing in time. METHODS: Studies that recruited at least 500 people, collected data by using questionnaires, interviews and/or physical examinations, and reported incidence or prevalence rates of the whole upper-extremity including neck, were included. RESULTS: No studies were found with regard to the incidence of UEDs and 13 studies that reported prevalence rates of UEDs were included. The point prevalence ranged from 1.6-53%; the 12-months prevalence ranged from 2.3-41%. One study reported on the lifetime prevalence (29%). We did not find evidence of a clear increasing or decreasing pattern over time. The case definitions for UEDs used in the studies, differed enormously. Therefore, it was not possible to pool the data. CONCLUSION: There are substantial differences in reported prevalence rates on UEDs. Main reason for this is the absence of a universally accepted way of labelling or defining UEDs. If we want to make progress in this field, the first requirement is to agree on unambiguous terminology and classification of EUDs.

Arm↗

PubMed2004

Upper extremity work-related musculoskeletal disorders: a treatment perspective.

Numerous terms, including repetitive-stress injuries and cumulative-trauma disorders, have been used to describe what is now commonly termed work-related musculoskeletal disorders. The etiology of work-related musculoskeletal disorders is multifactorial and includes physical, individual, and psychosocial factors that contribute to the presenting symptoms. Prolonged positioning away from the ideal posture will affect neural and other soft tissues in the upper extremity. Abnormal postures and positions may result in chronic nerve compression or may shorten muscles and, if the muscle crosses over a nerve, compression may occur. These postures may also contribute to muscle imbalance. A thorough clinical evaluation is necessary to identify all sites of nerve compression, muscle imbalance, and factors affecting patient symptoms so that appropriate intervention can be instituted. Management must include patient education, postural correction, and a specific physical therapy program to address the multiple levels of nerve compression and cervicoscapular muscle imbalance. In addition to physical therapy intervention, behavioral modification at home and at work may be necessary for successful management.

Cumulative Trauma Disorders↗

PubMed1998

[Prosthesis of the upper extremity].

In functional impairment of a joint due to pain and (or) limited mobility in which conservative measures are inadequate, an operation may be considered. The principal possibilities are arthrodesis and implantation of an artificial joint. Reasons to opt for a prosthesis are involvement of adjacent articulations (in rheumatoid arthritis) and preservation of mobility which, together with stability, is necessary for good articular function. The principal indications for implantation of an artificial joint in the upper extremity are rheumatoid arthritis and (to a lesser degree) osteoarthritis and posttraumatic impairments. The functional results of prostheses in the shoulder, elbow and wrist are good, but the proportion of complications is relatively large (compared with that in hip and knee prostheses) and follow-up so far has only been short.

Arthritis, Rheumatoid↗