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PubMedDate not supplied

Factors influencing compliance with home exercise programs among patients with upper-extremity impairment.

OBJECTIVE: Patient cooperation and satisfaction with home exercise programs are important for successful outcomes of intervention. This study investigated factors from three models to predict increased compliance and satisfaction with home exercise programs: the Model of Human Occupation (MOHO), including the volition subsystem (interests), habituation subsystem (roles), and performance subsystem (reported physical capacity); the Health Belief Model (HBM), including perceived barriers, benefits, self-efficacy, and severity; and the Health Locus of Control (HLOC). METHOD: Sixty-two outpatients at an orthopedic upper-extremity rehabilitation facility completed a battery of questionnaires and self-report instruments, including a health belief survey to assess HBM factors, the Multidimensional Health Locus of Control Scale, the Modified Activity Profile to assess the performance subsystem of the MOHO, a demographic questionnaire (including roles), a report of home exercise, and a satisfaction scale of their therapist's treatment. Compliance was determined by comparing participants' report of exercises performed to exercises specified on their medical chart. RESULTS: Stepwise regression identified two predictors of compliance: perceived self-efficacy and internal HLOC, R2 = .16. CONCLUSION: Results supported the role of the MOHO's volition subsystem, but roles and physical capacity--representing the habituation and performance subsystems of the MOHO--did not contribute significantly to the prediction of compliance.

Adult↗
PubMed2000

Modern techniques for wound coverage of the thermally injured upper extremity.

The use of flaps; synthetic, dermal analogues; cultured skin substitutes; or a combination of these may one day help return severely burned arms to normal function and appearance. The complexity and expense of these alternatives limits their use in commonplace burns. As the techniques are refined with increased experience, so also will the roles for each of these options. Fortunately, an excellent result is still possible in most situations using simple autograft. The availability of these numerous choices to acutely cover the thermally injured upper extremity should not distract us from the gold standard of split-thickness skin graft (Fig. 7).

Burns↗
PubMed1989

[A case of juvenile-type distal and segmental muscular atrophy of upper extremities (Hirayama disease) with the isolated cervical fusion at the C3-C4 levels].

The case, 29-year-old male, had suffered from muscular weakness and atrophy of the bilateral forearms and hands with tremor of the bilateral fingers for about 13 years. A neurological examination showed normal muscle-stretch reflexes and no sensory disturbances. A cervical spinogram revealed a fusion at the C3-C4 levels and mild spondylotic changes. We clinically diagnosed him as juvenile-type distal and segmental muscular atrophy of upper extremities (Hirayama disease) with the isolated congenital cervical fusion. Magnetic resonance imaging demonstrated an enlargement of the anterior epidural space from the C4-C5 levels to the Th 1-Th 2 levels. This abnormal epidural space showed relatively high signal intensity partially with low signal intensity on the T2 weighted spin-echo image and decreased in signal on the T1 weighted spin-echo image. And the dural sac was shifted backward and narrowed. And the soft discs was slightly protruded at the level of C4-5, C5-6 and C6-7. These findings suggest the over swelling and the delayed blood flow of the internal vertebral venous plexus. In this case, the degeneration of the cervical spine and soft disc derived from the congenital cervical fusion seems to have caused the internal vertebral venous plexus congestion and then have damaged the anterior horn cells.

Adult↗
PubMed1997

Continuous brachial plexus infusion of butorphanol-mepivacaine mixtures for analgesia after upper extremity surgery.

We have recently reported that continuous administration of butorphanol into the brachial plexus neurovascular sheath provided superior analgesia compared with that obtained with continuous i.v. administration. Furthermore, we found that analgesia was most pronounced when a mixture of mepivacaine and butorphanol was given and that butorphanol alone ranked next. In this study, we increased the dose of butorphanol, compared with that used in our previous reports, and an initial bolus dose of butorphanol was administered into the brachial plexus neurovascular sheath just after surgery had ended. Thereafter, postoperative pain relief was estimated. In patients undergoing upper extremity surgery with continuous axillary brachial plexus block, group A received a bolus of 1 ml of physiological saline with 1.5% mepivacaine, 10 ml into the brachial plexus sheath followed by a continuous brachial plexus infusion of 0.5% mepivacaine with butorphanol 6 mg at a rate of 144 ml/ 72 h. Group B was given a bolus of butorphanol 1 mg (1 ml) with 1.5% mepivacaine, 10 ml into the brachial plexus sheath and a continuous brachial plexus infusion of 0.5% mepivacaine with butorphanol 6 mg at a rate of 144 ml/72 h. After operation, VAS scores did not differ between the two groups. The time to first use of supplementary analgesia did not differ significantly between the two groups and there were no significant differences in the number of patients who required supplementary analgesia. These results indicate that continuous butorphanol 2 mg day-1 with 0.5% mepivacaine provided sufficient postoperative analgesia after upper limb surgery.

Analgesia↗
PubMed1989

Upper extremity function after conservative interscapulo-thoracic tumor resection.

Six patients who had undergone an en bloc interscapulo-thoracic excision (for primary bone or soft tissue sarcoma in five, and metastatic disease in one) were subject to review, with special emphasis on the functional outcome of the operated arm. Active shoulder motion was poor in all patients, but this did not prevent passive positioning of the hand and elbow. Elbow and particularly hand function was either not, or only slightly, impaired so that two patients regained full use of their upper extremity. Three patients had satisfactory but impaired function and one with metastatic disease of the should had a poor functional outcome.

Adult↗
PubMed2000

Tissue Doppler echocardiography contribution to the diagnosis of upper extremities venous thrombosis.

We present the case of a 35-year-old man with a history of beta-thalassemia complicated with heart failure who was admitted to our department because of right arm painful swelling. A transthoracic echo-Doppler study revealed a mass within the right jugular vein (RJV) lumen and absence of flow within the right subclavian vein (RSV). Subsequently, color tissue Doppler echocardiography clearly demonstrated the intraluminal mass by means of its different color hues as compared with the surrounding vessel wall, further enforcing the suspicion of upper extremity vein thrombosis (UEVT). It is emphasized that tissue Doppler echocardiography, a safe and reproducible method, can contribute to the diagnosis of UEVT.

Adult↗
PubMed1979

Movements in the lumbar spine during exercises of the upper extremities. A roentgenologic study in para- and tetraplegic patients.

Strengthening exercises during treatment of patients with unstable lumbar fractures produce a kyphotic or lordotic sagittal movement in the lumbar spine. These movements have been measured roentgenologically. Forward flexion exercises in the shoulder joints to 45 degrees produced a kyphotic movement, while forward flexion to 110 degrees and abduction exercises to 90 degrees produced a lordotic movement. Flexion of hips and knees to 45 degrees produced a kyphotic movement adding to the movements caused by the shoulder exercises. Increasing the load on the upper extremities produced an increase of all movements.

Adult↗
PubMed1997

Clinical value of dynamic bone and vascular scintigraphy in diagnosing reflex sympathetic dystrophy of the upper extremity.

The role of planar dynamic scintigraphy in the diagnosis and staging of reflex sympathetic dystrophy (RSD) is presented. Bone and vascular tracers are used for this purpose. The bone scan assessment corresponded closely to the clinical diagnosis and appeared excellent to exclude RSD. Accurate staging is important for therapy decisions. Staging by the early phases of bone and vascular scans were concordant in about three quarters of patients, but vascular scintigraphy led to a restaging in the remaining quarter of patients. Both scintigraphic procedures (bone and vascular) are indicated in diagnosing and monitoring upper extremity RSD.

Adult↗
PubMed1992

Magnetic resonance imaging of tendon and ligament abnormalities: Part I. Spine and upper extremities.

Magnetic resonance imaging (MRI) has proven to be an ideal technique for evaluating tendons and ligaments, which, because of their fibrous structure, have a low signal intensity on all sequences. Trauma and a wide variety of other conditions cause aberrations in the normal appearance of these structures, ranging from minor alterations in shape, size, appearance, and continuity to various changes in signal intensity within the tendon, tendon sheath, and ligament on different sequences. The purpose of this paper is to review MRI findings in patients with abnormalities of tendons and ligaments in the spine and upper extremities.

Aged↗
PubMed1998

[The floating joint injury of the lower and upper extremity--epidemiology, therapy and results in 40 extremities].

GOAL: Floating Joint Injuries (FJI) are resulting from high energy traumas and are often combined with additional neuro/vascular damage. The high incidence of severe open or closed soft tissue injuries is complicating the initial management and requires a broad surgical know-how also in minimal-invasive fixation techniques. In a retrospective analysis of our cases treated between 1980 and 1995, we try to find out some important therapeutical feedback for the future. MATERIAL AND METHODS: Of the 37 patients, 33 had a FJI of the lower (2 bilateral) and 7 patients of the upper extremity. 90% were road traffic injuries, 75% showed an open fracture situation and 25% an associated neuro-vascular injury. All fractures were stabilised within the first hours, femur, humerus and forearm in one step, the tibia in 33% in two steps (initial external fixator ...). 80% of the FJI have been reexamined after 1-2 y. RESULTS: Local complication: Femur: 4/33 (1 infection, 2 refractures, 1 non-union). Tibia: 11/33 (5 infections, 4 delayed/non-unions, 2 malalignements). Humerus: 0/7. Forearm: 1/7 (1 malalignement). 1-2 y-results: Very good-good: Femur: 26/27 (96%). Tibia: 23/27 (85%). Humerus: 4/5. Forearm: 3/5. DISCUSSION: FJI should be stabilised as soon as possible in a way allowing for early functional aftercare of the affected joint. Most complications are observed in the proximal tibia fracture because of the thin and therefore often severely (open or closed) injured soft tissue cover. Despite a staged procedure, there exists a high complication rate, which probably can be reduced in the future by the single-step use of the hybrid external fixateur.

Adolescent↗
PubMed1997

Familial juvenile focal amyotrophy of the upper extremity (Hirayama disease). Superoxide dismutase 1 genotype and activity.

BACKGROUND: Juvenile focal amyotrophy of the arm is an unusual focal motor neuron disease that is rarely familial. Its pathogenesis is unknown. We recently described a family with amyotrophic lateral sclerosis associated with a mutation in the superoxide dismutase 1 (SOD1) gene substituting an aspartate for an alanine (D9OA). One of the carriers of this mutation had focal and nonprogressive amyotrophy of the arm, suggesting that focal amyotrophy might be associated with SOD1 mutations. OBJECTIVES: To describe the phenotype of 2 brothers with juvenile focal amyotrophy of the upper extremity and to characterize their SOD1 genotype and SOD activity. METHODS: Polymerase chain reaction and sequencing of the SOD1 gene and colorimetric measurement of the enzyme activity. RESULTS: We compared the phenotype of our patients to that of 375 patients described in the Western literature. The 5 exons of the SOD1 gene were normal, as was the SOD activity in red blood cells.

Adult↗
PubMed2002

Changes in upper extremity position cause migration of peripherally inserted central catheters in neonates.

OBJECTIVE: The migration of peripherally inserted central catheters (PICCs) from the superior or inferior vena cava into the right atrium can pose a significant risk of lethal pericardial effusion and tamponade secondary to myocardial perforation. Arm movement has been reported to cause displacement of the catheter tip toward the heart and lead to ventricular tachycardia in adults. The objective of this study was to investigate whether adduction or abduction at the shoulder and flexion or extension at the elbow affect the position of PICCs placed via upper limb veins. We also hypothesized that arm movements can be used to reposition malpositioned catheters. METHODS: A total of 280 radiographs of 60 neonates with PICCs inserted via upper limb veins from July 2000 through June 2001 were reviewed. Differences in catheter tip position as a result of abduction versus adduction at the shoulder, flexion versus extension at the elbow, and combination changes in arm posture were determined by measurements in paired radiographs. Correction of malpositioned catheters was attempted in 10 patients by using arm movements without any alterations at the site of insertion. RESULTS: Arm movements were associated with significant displacement of catheters. Catheters that were placed via the basilic or axillary vein migrated toward the heart with adduction of the arm, whereas those that were placed via the cephalic vein moved away from the heart with adduction. Flexion of the elbow displaced catheters that were placed in the basilic or cephalic vein below the elbow toward the heart but did not have any effect on catheters that were placed via the axillary vein. For catheters that were placed in the basilic vein, simultaneous shoulder adduction and elbow flexion caused the greatest movement toward the heart (15.11 +/- 1.22 mm). We were able to reposition correctly inappropriately placed catheters in 9 of 10 patients by using arm movements. CONCLUSIONS: Arm movements significantly affect the position of the tip of the PICCs. Prevention of catheter migration into the right atrium requires radiographic determination of vein of insertion and monitoring of catheter tip position with upper extremity in position of maximum inward movement of catheter for that vein. Arm movements can be used to correct the malpositioned catheters.

Arm↗
PubMed2001

Upper extremities deep venous thrombosis: comparison of light reflection rheography and colour duplex ultrasonography for diagnosis and follow-up.

BACKGROUND: Non-invasive diagnosis of axillary-subclavian vein thrombosis or documentation of the post-thrombotic syndrome performing methods currently in use is not definitive. The purpose of this prospective study was to compare two methods for the diagnosis and follow-up of patients with primary and secondary axillary-subclavian vein thrombosis: light reflection rheography (LLR) which is a reflection of venous pressure changes in the extremity as record from the subdermal capillary plexus, and colour duplex ultrasonography (CDUS). METHODS: In 36 patients with primary and secondary axillary-subclavian vein thrombosis were used a 4006 GE (Milwaukee, USA) colour duplex ultrasonography and an AV-1000 Hemodynamics instrument for the light reflection rheography for diagnosis and follow-up. The LLR methodology that applied was simple, involving testing of the venous outflow in the upper extremities in response to exercise, and with normally respiratory variations of an open venous system that was also assessed by the non-invasive modalities. In the LLR application of venous congesting pressure, and measurement of the rate of venous outflow when the congesting pressure is released was also performed. RESULTS: Both methods were able to diagnose the axillary-subclavian thrombosis in the initial acute state. There were no cases of false-positive results in either method. The CDUS presented a lower sensitivity in comparison to LLR in the follow-up period of the patients. A positive study was confirmed by phlebography in each instance. CONCLUSIONS: The tracing obtained by LLR is easy to interpret and provides objective evidence of proximal venous occlusion. The test is easy to apply and the instrumentation is relatively inexpensive. Both LLR and CDUS, could prove to be an exciting development among non invasive diagnostic techniques for axillary-subclavian vein thrombosis, with major sensitivity of LLR in the follow-up.

Adult↗
PubMed2002

Reconstruction of the upper extremity in the child with tetraplegia.

According to Howard H. Steel, the orthopedic surgeon who first recognized the need for special care for children with spinal cord injury (SCI), and who persuaded Shriners Hospitals to establish specialized programs for these children over 20 years ago, no field of the health sciences is the statement "a child is not a small adult" more apropos than in the arena of trauma to the spinal cord. Children and adolescents with tetraplegia differ in many ways from adults with the disease. The dissimilarities that influence the outcome of surgical reconstruction of the upper extremity are the focus of this article.

Arm↗
PubMed1989

[Pathomechanogenesis of contractures and deformities of the upper extremities in children with cerebral palsy].

The authors carried out dynamic observation of 180 children aged 3-14 with infantile cerebral paralysis (ICP) who were treated for pronation flexion contractures of the forearm and of the hand, studied up to 45 values connected with the age of the patients, terms of appearance of the symptoms of the disease, subsequently processed the results of their investigations employing methods of analysis of variance, non-linear correlation and regression analysis and constructed analytical models of development of the pathologic process, which allowed to draw the following conclusions. Pathomechanogenesis of disturbances of the upper extremity in ICP includes primary muscular disbalance, successive formation of faulty postures, pathologic locomotor stereotype, vegetotrophic disturbances, contractures of the joint and anatomical changes of the skeleton. These changes are closely correlated with the age of the patients and according to the degree of the disturbances may be regarded as stages of the disease.

Adolescent↗
PubMedDate not supplied

Hydrofitness devices for strengthening upper extremity muscles.

Our evaluation of hydrofitness devices for strengthening arm muscles has revealed several important determinants of their performance. Most importantly, the device's frontal projection should be in the shape of a paddle whose surface area can be varied to meet the individual exerciser's needs. Its weight should be light to minimize the inertial forces encountered in charging the velocity of paddle movement. Its handle should have a relatively large circumference without digital profiling. These optimal performance parameters have been recently incorporated into a new hydrofitness device that will be commercially available for aquatic exercise programs for strengthening upper extremity muscles.

Adult↗
PubMed1995

Rehabilitation and splinting of common upper extremity injuries in athletes.

Treatment of athletes and the injuries they sustain can be both challenging and rewarding. Each individual case requires a careful examination of the physical symptoms and the process leading up to the injury. From this, one attempts to determine the appropriate course of treatment aimed at minimizing lost time from sports and to develop preventive strategies to promote healing and prevent future injury. Open communication between the athlete and his or her physician, therapist, trainer, and coach facilitates the most innovative and effective treatment strategies, enabling the best possible result following an athletic injury to the upper extremity.

Athletic Injuries↗
PubMed2001

Neuroprostheses for the upper extremity.

Functional electrical stimulation (FES) neuroprostheses can be used to replace lost motor and sensory function in persons with neurological disorders. FES technology has subsequently been shown effective and safe in restoring hand function in adults with spinal cord injury. The freehand system consists of an implanted receiver-stimulator, an external shoulder position sensor, and an external control unit. Commands are originated by voluntary movement of the contralateral shoulder and are measured by the sensor. There are several types of electrodes: epimysial, intramuscular, nerve cuff, and intraneural. Neuroprostheses are recommended within the context of all available reconstructive options for the upper limbs. Voluntary tendon transfers are the first choice. The clinical outcomes as measured by improvement on scales of impairment, activities of daily living, and satisfaction are rewarding. The next step in improvement of the motor function of person with spinal cord injury will be the addition of a controllable second upper extremity and the elimination of additional external hardware.

Animals↗