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PubMed2005

Extensive upper-extremity venous thrombosis after fluorescein angiography.

PURPOSE: To report a case of extensive cephalic and basilic venous thrombosis after fluorescein angiography. DESIGN: Interventional case report. METHODS: A 38-year-old Chinese male presented with blurring of vision in his left eye. Clinical examination revealed central serous retinopathy, and a routine fluorescein angiography was performed. RESULTS: He developed inflammation over the right arm over 4 days. Duplex scan disclosed extensive superficial venous thrombosis of the right upper limb with occlusion of the basilic vein and cephalic vein in the proximal right upper arm to the level of the midarm. He was treated medically but was subsequently lost to follow-up. CONCLUSIONS: Extensive upper-extremity venous thrombosis is infrequent after single-shot intravenous cannulation. Venous thrombosis occurring after fluorescein angiography has not been reported up to this time. It is possible that proper arm positioning during the procedure may reduce this risk, and ophthalmologists should be vigilant of this potentially unusual complication.

Adult↗
PubMed2000

The Radboud skills questionnaire: construction and reliability in patients with reflex sympathetic dystrophy of one upper extremity.

PURPOSE: To construct a questionnaire to measure skills in which notably both hands are active, which is suitable for patients with a disease of one or both hands and to research its response stability and possible improvements. METHOD: Using the Dutch elaboration of the ICIDH and then experts in a Delphi round, the questionnaire was constructed. Thereafter, test-retest and inter-observer reliability was examined. Fifty-four patients with RSD in one upper extremity and a normal contralateral extremity participated in the study, the first twenty to evaluate the construction of the questionnaire and the others to test reliability. RESULTS: The constructed Radboud skills questionnaire was reliable in terms of response stability (median coefficients of variation 2.2% to 6.6%). Correlation's between categories of items were fair to good. CONCLUSIONS: A useful questionnaire was constructed to map alterations in the level of disability in patients with a disease of one hand or both hands.

Adult↗
PubMed2002

[Entrapment syndromes of the peripheral nerves of the upper extremities].

BACKGROUND: The author presents the results of surgery of entrapment syndromes of the peripheral nerves implemented at his department in the course of 10 years (1990-2000). MATERIAL AND METHODS: In 72 patients 90 operations were performed in the course of which 85 entrapment syndromes were treated. The carpal tunnel syndrome was recorded in 40 patients (55.6%), the cubital canal syndrome in 24 patients (33.3%). The other entrapment syndromes of the peripheral nerves of the upper extremities-8(11.1%) were classified as rare. In 13 patients the entrapment syndrome was bilateral, the carpal tunnel syndrome in 12 and the cubital canal syndrome in one patient. In 17 patients there were re-operations, incl. 12 re-operations after primary treatment in another department. The clinical picture of compressive syndrome was divided according to the intensity according to Dellon's classification into 3 grades. Grade I compression was found in 2 cases (2.8%) (2/2). Grade II compression was found in 8 patients (11.1%) (9/10). Grade III Patients with grade III compression-62 (86.1%) predominated (68/80). The values are expressed as the number of patients/number of entrapment syndromes. The effectiveness of the surgical operation was analyzed with regard to the degree of compression, length of compression and duration of symptoms. RESULTS: Excellent and satisfactory results were recorded in all cases with grade I and II compression and duration of symptoms up to 12 months. The position was worse in patients with grade III compression where excellent and satisfactory results were recorded in 62 cases (77.5%) and when the complaints persisted for more than 12 months, i.e. in 30 of 48 cases (62.5%). CONCLUSION: The decisive factor which influences the result of the operation is the grade of nerve compression and its duration. Decisive factors improving the results of surgery are age under 30 years and period of complaints shorter than one year, when the symptoms are not yet irreversible.

Adult↗
PubMed1999

The value of electrodiagnostic consultation for patients with upper extremity nerve complaints: a prospective comparison with the history and physical examination.

OBJECTIVES: To determine whether electrodiagnostic testing changes diagnostic certainty compared with a detailed history and physical examination, and whether interactions between medical information, the extent of testing, and diagnostic certainty imply a need for advanced medical knowledge on the part of the tester. DESIGN: Prospective observation. SETTING: University orthopedic department and small community hospital electrodiagnostic laboratories. PATIENTS: Two hundred fifty-five consecutive referrals for upper extremity nerve complaints. OUTCOME MEASURES: Diagnosis, diagnostic confidence, and severity of neurologic lesion were coded after standardized history and physical and after electrodiagnostic testing. RESULTS: Electrodiagnostic testing substantially altered 42% of diagnoses, confirmed 37%, and did not clarify 21%. The extent of testing correlated with the size of the differential diagnosis, the number of previous hospitalizations, and the number of other medical problems. Confidence in final diagnoses correlated positively with severity of the lesion, but negatively with the size of the differential diagnosis and the number of painful body areas. Hospitalizations and medical problems also tended towards negative correlations. CONCLUSIONS: This study, in which all electrodiagnostics, histories, and physical examinations were performed by a single physician, suggests that electrodiagnosis substantially alters clinical impressions in a large percentage of patients. The complex relationship between clinical information, the extent of testing, and final diagnostic certainty suggests that specialized medical knowledge is required for accurate electrodiagnosis.

Adult↗
PubMed1990

Infiltrating lipomas of the upper extremities.

The typical lipoma is an encapsulated subdermal tumor, usually easily removed if necessary. We recently encountered two lipomas that infiltrated muscles of the forearm. Excision of infiltrating lipomas may be complicated by their deep location and potential involvement of vascular and neural structures. This paper should increase dermatologists' awareness of this uncommon variant and facilitate appropriate referral for definitive treatment. We believe that this is the first report in the dermatologic literature of infiltrating lipoma of the upper extremity.

Female↗
PubMed1982

Brachial plexus injury management through upper extremity amputation with immediate postoperative prostheses.

Management of patients with brachial plexus injuries requires a team approach so that all aspects of their care are addressed simultaneously. This report examines elective amputation and prosthetic rehabilitation in a patient with brachial plexus avulsion of the left arm. The best possibility for good prosthetic rehabilitation is the early application of prosthetic devices with intensive occupational therapy. Using this type of approach, we have achieved significant improvement in amputation rehabilitation of upper extremity amputees treated with immediate postoperative conventional electric and myoelectric prostheses.

Adult↗
PubMed2005

[Upper extremity gangrene in an infant of a diabetic mother, presenting at birth].

In utero gangrene of an extremity because of an arterial thrombosis is rare. More than 20% of the reported cases concern infants of diabetic mothers (IDM) with poor control of diabetes. Changes in coagulation related to deviation of clotting factors and low plasminogen activity may be the cause. We report a case of an IDM who presented at birth with upper extremity gangrene. The Dopplersonography has shown missing pulsations and thrombosis of a. brachialis sin, which was confirmed after amputation of the arm on the 5th day. The postoperative period was complicated by septicaemia, necrotising enterocolitis and disseminated intravasal coagulation resulting in the baby's death 10 days after birth.

Adult↗
PubMed2005

[Upper extremity gangrene in an infant of a diabetic mother, presenting at birth].

In utero gangrene of an extremity because of an arterial thrombosis is rare. More than 20% of the reported cases concern infants of diabetic mothers (IDM) with poor control of diabetes. Changes in coagulation related to deviation of clotting factors and low plasminogen activity may be the cause. We report a case of an IDM who presented at birth with upper extremity gangrene. The Dopplersonography has shown missing pulsations and thrombosis of a.brachialis sin, which was confirmed after amputation of the arm on the 5th day. The postoperative period was complicated by septicaemia, necrotising enterocolitis and disseminated intravasal coagulation resulting in the baby's death 10 days after birth.

Adult↗
PubMed2006

Upper extremity arteriovenous fistulas induce modest hemodynamic effect on the in situ internal thoracic artery.

BACKGROUND: The left internal thoracic artery is the ideal conduit for coronary artery revascularization due to superior patency compared with venous grafts. The hemodynamic effects of an arterio-venous fistula on the native in situ internal thoracic artery and the potential for coronary flow steal after revascularization with the internal thoracic artery, are not well-characterized. METHODS: Fifteen chronic hemodialysis patients with functioning left upper extremity arterio-venous fistulas were evaluated with the use of transthoracic color Doppler analysis. Flow characteristics of the left and right internal thoracic arteries at baseline, with arterio-venous fistula occluded, and during hemodialysis were recorded. Peak systolic and diastolic velocities for the right and left internal thoracic arteries were calculated for each fistula state (occluded, open, and on-dialysis). One-way analysis of variance was used to compare the different means. RESULTS: Mean flow velocity calculations failed to identify any statistically significant differences between the ipsilateral and contralateral internal thoracic artery in any fistula state. In addition, mean internal thoracic flow velocities were similar between the different fistula states. CONCLUSIONS: Changes in arteriovenous fistula flow state did not significantly alter Doppler flow hemodynamics of either the ipsilateral or contralateral in-situ internal thoracic artery. Further studies of the possible effects on internal thoracic arteries used as pedicled coronary grafts may be required.

Arm↗
PubMed2004

Nerve conduction studies of upper extremities in tennis players.

OBJECTIVES: The influence of regular and intense practice of an asymmetric sport such as tennis on nerves in the elbow region was examined. METHODS: The study included 21 male elite tennis players with a mean (SD) age of 27.5 (1.7) years and 21 male non-active controls aged 26.4 (1.9) years. Anthropometric measurements (height, weight, limb length, and perimeters of arm and forearm) were determined for each subject, and range of motion assessment and radiographic examination carried out. Standard nerve conduction techniques using constant measured distances were applied to evaluate the median, ulnar, and radial nerves in the dominant and non-dominant limb of each individual. RESULTS: The sensory and motor conduction velocities of the radial nerve and the sensory conduction velocity of the ulnar nerve were significantly delayed in the dominant arms of tennis players compared with their non-dominant arms and normal subjects. There were no statistical differences in the latencies, conduction velocities, or amplitudes of the median motor and sensory nerves between controls and tennis players in either the dominant or non-dominant arms. However, the range of motion of the upper extremity was significantly increased in tennis players when compared with control subjects. Tennis players were taller and heavier than control subjects and their dominant upper limb lengths were longer, and arm and forearm circumferences greater, than those of the control subjects. CONCLUSIONS: Many of the asymptomatic tennis players with abnormal nerve conduction tests in the present study may have presymptomatic or asymptomatic neuropathy similar to subclinical entrapment nerve neuropathy.

Adult↗
PubMed1994

Functional electrical stimulation (FES) to the biceps brachii for controlling forearm supination in the paralyzed upper extremity.

Control of forearm supination using the functional electrical stimulation (FES) to the biceps brachii was studied in a C4 quadriplegic patient. As a result of FES to the biceps brachii, and the other elbow flexors and extensors, supination was induced in maintenance of the elbow in the maximum flexion and extension, respectively. Although a range of the movements was still small and limited, these findings indicated a possibility of FES to the biceps brachii for controlling supination in paralyzed upper extremities.

Adult↗
PubMedDate not supplied

Groin flap for coverage of upper extremity defects in Enugu, Nigeria.

BACKGROUND: Extensive tissue loss of the hand has remained a big challenge to the Plastic and Reconstructive Surgeon. The objective of this study is to review the use of pedicle groin flap for coverage of distal forearm and hand defects in our centre, and to find out problems of using the flap and make suggestions for improvement. METHOD: This is a retrospective study done using case records of patients treated with pedicle groin flaps for upper extremity defects at the National Orthopaedic Hospital Enugu from January 1999 to December 2004 (six year period). Information on biodata, clinical presentation, treatment, complications and outcome was extracted and analyzed using descriptive statistics. RESULTS: Thirteen (13) patient's case files met the inclusion criteria and were analyzed. There were seven (7) males and six (6) females with mean age ranges between 9 years and 42 years. Four (4) had distal forearm and nine (9) hand wound coverage's. Flap survival was very good to excellent in all cases and the outcome quite satisfactory. CONCLUSION: Use of pedicle groin flap for coverage of defects of the hand and distal forearm remains a very valuable treatment option in our environment.

Adolescent↗
PubMed1991

Upper extremity contractures in a patient with eosinophilia-myalgia syndrome.

L-tryptophan is an essential amino acid taken as an over-the-counter nutritional supplement for a variety of conditions including chronic pain, insomnia, and depression. In October 1989 several patients were reported having eosinophilia-myalgia syndrome (EMS) who had taken L-tryptophan in large doses. Little is known about the long-term outcomes of EMS. A patient with EMS who developed contractures of the upper extremities because of severe myalgias is discussed. Early aggressive rehabilitative intervention may prevent contractures in patients with EMS.

Arm↗
PubMed1992

Mixed sclerosing bone dystrophy presenting with upper extremity deformities. A case report and review of the literature.

We present a detailed study of a 59-year-old white woman with mixed sclerosing bone dystrophy: the rare occurrence of two or more sclerosing bone dysplasias in a single subject. She exhibited features of osteopoikilosis, osteopathia striata and melorheostosis. The symptoms were primarily the result of the melorheostosis lesions which were distributed within the C6 sclerotome. This is an unusual case of mixed sclerosing bone dystrophy in that the upper extremity was the main site of involvement, instead of the usual symmetrical involvement of all limbs. The patient developed a recalcitrant lateral epicondylitis in the un-involved contralateral elbow that required surgical treatment.

Female↗
PubMed1997

Acute upper extremity ischemia during concomitant use of ergotamine tartrate and ampicillin.

Individual hypersensitivity to the vasoconstrictor effects of ergotamine tartrate has been observed even at doses within recommended limits. Hypersensitivity can be induced by concomitant use with other drugs. The best-documented example of drug-induced hypersensitivity to ergotamine tartrate involves antibiotics of the macrolides class. The mechanism underlying this interaction appears to be interference with metabolism of ergotamine tartrate by the liver. In the present report we describe a case of upper extremity ischemia during concomitant use of ergotamine tartrate and ampicillin. The fact that the effect was not dose-dependent, disappeared when administration of ampicillin was discontinued, and reappeared when administration of ampicillin was resumed suggests that the underlying mechanism in our patient was immunologic. Since immunologic hypersensitivity to the vasoconstrictor effects of ergotamine tartrate is unpredictable, great caution and close surveillance is advisable when ergotamine tartrate is used in association with other drugs.

Ampicillin↗
PubMed1991

Growth plate activity in the upper extremity.

Roentgenograms of 200 males and females were examined to determine the contribution of each growth center to the total length of the humerus, radius, and ulna. Subjects were healthy, middle-class Americans, mostly of northwest European descent. The nutrient foramen in the cortex provides the site of entry for the nutrient vessel and is a fixed point in the long bone. Growth occurring at each growth plate was measured in relation to the nutrient foramen. The proportion of growth from each upper extremity growth plate is not equal. Also, growth plate activity is not constant or average throughout the growth period. Growth occurs one or two years earlier in females than in males. Overall, approximately 80% of growth in the humerus occurs at the proximal growth plate. Before the age of two years, less than 75% of growth occurs at the proximal growth plate, increasing to 85% at the age of eight and remaining constant at 90% after the age of 11. For the ulna, approximately 85% of overall growth occurs at the distal growth plate, but by the age of five years, 90% of growth occurs distally. After the age of eight years, 95% of growth occurs at the distal growth plate. For the radius, approximately 80% of overall growth occurs distally. At the age of five years, the distal growth plate contributes 85% of total growth, increasing to 90% by the age of eight.

Adolescent↗
PubMed1983

Replantation of the upper extremity.

In recent years, the functional results after replantation surgery have improved with increased experience. Stiffness remains as the single greatest postoperative problem. Improvements in this area are now possible with aggressive and closely supervised postoperative hand therapy and splinting. The efficiency of the replantation effort itself has increased dramatically in the hands of a number of surgeons experienced in replantation working together as a team. Once vascular flow to an amputated part has been reestablished, the injury is converted to a complex upper extremity injury that would be treated aggressively by many surgeons trained in this discipline. The stigma associated with the amputated part as being one to which function may never be restored has largely been eliminated. One thing is certain ... missing digits never function.

Adult↗
PubMed1990

Nuchal cystic hygroma associated with massive lymphangiomatosis of the upper extremity and myocardium in a stillborn fetus: a case report.

Nuchal cystic hygromas may be encountered in stillborn fetuses as part of a spectrum of a more generalized abnormality of the lymphatic system. These lymphatic system abnormalities may be accompanied by various visceral anomalies, especially in Ullrich-Turner Syndrome (UTS) (45,X0) but also in non-45,XO fetuses. We present unique autopsy findings in the case of a stillborn female fetus with a nuchal cystic hygroma associated with massive lymphangiomatosis of the upper extremity as well as myocardium. While previous descriptions of abnormal cardiac lymphatics associated with nuchal cystic hygroma have focused on dilated lymphatics surrounding the root of the aorta and pulmonary artery, the present case extends the spectrum of possible findings to include subtotal replacement of the ventricular myocardium by dilated lymphatics.

Cardiomegaly↗