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At least 1,531 records · Page 85Linked to original sources
PubMed1999

Reproducibility of a self-report questionnaire for upper extremity musculoskeletal disorder risk factors.

A self-report questionnaire was developed to evaluate the potential for assessment of possible risk factors for musculoskeletal disorders. Visual-analog and categorical scales were designed to represent responses relating to primary work as well as a second job and hobbies or non-work activities. 71 tree nursery workers completed the scales twice in consecutive weeks. Agreement between means of the two questionnaire administrations was 0.80 or higher for all scales. Intraclass correlation coefficients ranged between 0.59 and 0.69 for the primary job hand/wrist responses and between 0.49 and 0.82 for non-work/hobby neck and upper arm scales. These results show potential for future application of similar scales in industry or temporary and seasonal work to evaluate exposure to upper extremity risk factors.

Adult↗
PubMed1997

Motor cortical mapping of proximal upper extremity muscles following spinal cord injury.

Focal transcranial magnetic stimulation was used to map the motor cortical representations of the relaxed and gently contracted biceps brachii, deltoid and triceps muscles in 22 subjects comprised of 12 controls, five subjects with complete and five with incomplete cervical spinal cord lesions (SCI). Motor evoked potentials (MEPs) were rarely observed during the resting condition (3/30 muscles tested; SCI group) which precluded detailed analysis of these data. With background facilitation, the mean number of scalp stimulation sites producing MEPs varied according to muscle (P < 0.001); biceps yielded the largest maps and triceps the smallest. The cortical representations of proximal upper extremity muscles were largest for the control group and smallest for the incomplete SCI group although differences were not significant (P > 0.09). The optimal site of stimulation (that which produced the largest MEP) was always surrounded by an area producing submaximal MEPs, but was variable across subjects and groups. There was extensive overlap in the motor cortical representation areas corresponding to the three muscles of interest. Following maximal intensity stimulation at the optimal site, the mean MEP amplitudes (normalized) were largest for the biceps muscle and smallest or absent in triceps (P < 0.02). No differences were detected between groups (P > 0.50). The threshold stimulus intensity was highest for those with incomplete SCI and lowest amongst control subjects (P < 0.05), with biceps then deltoid muscles generally having lower thresholds than triceps (P < 0.001). The findings suggest that cortical map areas and MEP characteristics are not significantly altered in gently contracting muscles innervated by nerve roots rostral to the lesion. Only activation thresholds are higher following SCI, particularly incomplete lesions, although there is no apparent association with sensorimotor function. The inability to elicit MEPs in the relaxed muscles of patients with SCI fail to support previous reports of expanded motor cortical representations associated with muscles innervated by roots rostral to the lesion.

Adult↗
PubMed1995

Ranking of static non-neutral postures around the joints of the upper extremity and the spine.

Constrained body postures are usually cited as the major cause of musculoskeletal static loading. Thus, the main goal of the present study was to develop a ranking system for the stressfulness of the non-neutral static postures around the wrist, elbow, shoulder, neck and lower back. This was based on the ratings of perceived discomfort. Sixteen men participated in the study. The results indicated that static postural stresses yielded varying effects on the discomforting rating levels. On the basis of these preliminary findings, a ranking system was developed for the stressfulness of non-neutral postures around the joints of the upper extremity and the spine.

Adult↗
PubMed1991

Brachial plexus anesthesia for outpatient surgical procedures on an upper extremity.

We retrospectively reviewed 543 brachial plexus blocks performed on 526 outpatients. Most (98%) of the blocks were performed by means of the axillary approach. Various techniques were used, including paresthesia, transarterial fixation, nerve stimulation, or a combination of techniques; a high success rate was achieved with each of them. Only 7% of the blocks were incomplete and thus necessitated either general anesthesia or block supplementation with thiopental sodium and nitrous oxide. No persistent neurologic deficit was ascribed to the anesthetic technique. This review indicates that brachial plexus block, especially with use of the axillary approach, is a safe and effective option for outpatient surgical procedures on an upper extremity.

Adolescent↗
PubMed1996

Function of the upper extremities in hereditary multiple exostoses.

The radiographic anatomy, functional status, and impairment ratings of twenty-eight patients (fifty-six extremities) who had hereditary multiple exostoses were evaluated. The patient (or the parent) also subjectively graded the function of each extremity with use of a standard rating-assessment tool. Degenerative joint disease was evident in three (5 per cent) of the fifty-six extremities at the time of follow-up, when the patients were an average of twenty-one years old. With use of the hand test of Jebsen et al., the average score was in the forty-seventh percentile for the dominant extremity and in the twenty-eighth percentile for the non-dominant extremity. Loss of pronation and supination increased with increasing age. Dislocation of the radial head was significantly associated with negative ulnar variance (p=0.008) and with the impairment rating (p=0.001), but not with the subjective score or with the performance on the hand test of Jebsen et al. So-called whole-person impairment ratings ranged from 0 to 17 per cent (average, 5 per cent). It has been our experience that deformities of the upper extremity in patients who have hereditary multiple exostoses are well tolerated and lead to little loss of function as measured both subjectively and objectively.

Adolescent↗
PubMedDate not supplied

Medical screening of office workers for upper extremity cumulative trauma disorders.

An apparent "outbreak" of cumulative trauma disorders (CTDs) was noted in a subset of white-collar workers employed in medical illustration and medical graphic arts. Among graphic artists (n = 7), there were three cases of carpal tunnel syndrome (CTS), based on patient reports of personal physician diagnoses; no such reports occurred among other workers in the department (n = 39, p = .0023, Fisher's exact test). Jobs were studied to identify possible risk factors for CTDs, and workers underwent a standardized medical screening protocol. Specific work elements were found to be performed more frequently by graphic artists and appeared to be related to increased reporting of distal upper extremity symptoms and electrodiagnostic changes at the wrist. Nevertheless, using a strict case definition of CTS that required electrophysiologic evidence of median mononeuropathy at the wrist and appropriate symptoms or signs, only two persons--one graphic artist and one comparison subject--had evidence of mild CTS. The approach employed in this study of an outbreak of CTDs is an example of a multidisciplinary investigation of CTDs in an office setting.

Adult↗
PubMedDate not supplied

Use of the pedicled latissimus muscle flap for upper-extremity reconstruction.

Tissue with a blood supply derived from a single constant vascular pedicle may be raised as a flap and rotated within the reach of its blood supply to cover and reconstruct a variety of complex wounds. The latissimus dorsi muscle makes an ideal pedicled flap because of its long neurovascular pedicle, large size, ease of mobilization, and expendability. It can be rotated, with or without overlying skin, to cover soft-tissue defects involving the shoulder, arm, and elbow, or it can be transferred as an innervated muscle to improve shoulder abduction as well as elbow flexion and extension. The major clinical applications of the pedicled latissimus dorsi muscle flap for upper-extremity reconstruction include use as a bipolar transfer to improve elbow flexion after trauma or brachial plexus injury and as a nonfunctioning myocutaneous transfer for coverage of nerves, bones, and joints after soft-tissue loss due to trauma, tumors, infection, or irradiation.

Adolescent↗
PubMed2000

Macroangiopathy of the upper extremities in progressive systemic sclerosis.

BACKGROUND: Raynaud's phenomenon is a hallmark of progressive systemic sclerosis (SSc). While nailfold capillary changes are well known, morphological changes in larger arteries have less been focused on. OBJECTIVE AND METHODS: In the study presented we examined how often in digital subtraction angiography organic changes of the arteries of the fingers, hands and forearms were observed, whether they showed a typical picture like the changes in nailfold capillaries and whether they correlated with cutaneous sclerosis, Raynaud's phenomenon and serological findings. 29 patients were examined, 14 with acroscleroderma and 15 with proximal ascending sclerosis. RESULTS: In 27 of those 29 patients a stenosis of the arteries of the upper extremity was found. The frequency of arterial occlusions decreased from the fingers (26 patients) to the forearms (9 patients with occlusion of the ulnar artery, none with occlusion of the radial artery). The arteries of 47% of patients with proximal ascending sclerosis showed no reactivity towards the alpha-sympatholyticum tolazoline hydrochloride due to severe organic changes while in patients with acroscleroderma only 14% of patients did not respond to tolazoline hydrochloride. The severity of Raynaud's phenomenon did not correlate with the severity of the angiographic findings. In patients with stenoses refractory to tolazoline hydrochloride and in those with occlusions Scl-70 autoantibodies were more frequently positive than in other patients with SSc (44% compared to 23%). CONCLUSION: As in SSc the severity of the organic arterial changes is in close correlation with the extent of the cutaneous sclerosis and with the serological findings the arterial system should gain much more importance in the diagnosis and therapy of SSc.

Aged↗
PubMed2006

Salvage of amputated upper extremities with temporary ectopic implantation followed by replantation at a second stage.

Salvage of the complex amputation of extremities, such as combined with devastating segmental injuries, extensive soft tissue defect, and multiple important organ injuries, continues to be a challenge for plastic surgeons. Temporary ectopic implantation of the amputated part to a healthy recipient site allows the patient to recover from critical combined injuries, radical debridements, and soft tissue repair. In this article, the authors report two cases of temporary ectopic implantation of complexly amputated forearms, followed by successful replantation to their anatomic positions at a second stage. The contralateral upper extremity is an acceptable recipient site for temporary ectopic implantation. In secondary replantation, a cross-arm flap can be designed to carry the vascular pedicle from the ectopic implantation recipient to improve blood supply to the replanted part when the second blood supply is established. The authors validated that temporary ectopic implantation of amputated parts provides an alternative procedure for the salvage of amputated extremities under special circumstances.

Adult↗
PubMed1987

Proposed screening tool for the detection of cumulative trauma disorders of the upper extremity.

The incidence of cumulative trauma disorder (CTD) has become noteworthy in plants that rely on automated production. This rise was evident in an Ohio poultry company. The purpose of this study was to develop a screening tool to detect employees who might be at risk of sustaining a CTD injury and to identify trends of CTD at specific workstations. Thirty-five employees at three workstations completed a questionnaire and underwent a physical examination. Results identified 24 employees with a potential for CTD, and these employees were recommended for remediation. Job modifications and supportive devices were placed in the workplace. A newly designed industrial wrist splint was developed for this study. The personnel department has noted that employee complaints of upper extremity discomfort have decreased.

Accidents, Occupational↗
PubMed1985

Optokinetic nystagmus and upper extremity dressing independence after stroke.

Right hemisphere brain-damaged stroke patients demonstrate a variety of neurologic deficits which seem to impair their ability to regain self-care independence. Visual perceptual and visual search disorders have been implicated with persistent functional deficits. The objective of this study was to measure the extent to which defects of optokinetic nystagmus (OKN), an ocular movement reflex, may be associated with inability to regain independent function. Eighteen right hemisphere brain-damaged stroke patients suffering similar sensory-motor deficits were followed up from admission as they underwent self-care training in a comprehensive stroke rehabilitation center. Ten subjects demonstrated unilateral absence of OKN and eight subjects demonstrated bilaterally intact responses upon admission. Upper extremity (UE) dressing independence was used as an indicator of functional skill level at admission, during treatment, and at discharge. Subjects with unilateral loss of OKN were significantly less independent at admission and at discharge when compared to subjects with intact OKN. Although both groups of patients made statistically significant gains in UE dressing, those with defective OKN had a 40% greater inpatient length of stay and were more likely to be discharged to a nursing home or needed care by a significant other after rehabilitation.

Activities of Daily Living↗
PubMed1998

Impairment level sumscore in reflex sympathetic dystrophy of one upper extremity.

OBJECTIVES: To construct a set of instruments to measure the level of impairment in reflex sympathetic dystrophy (RSD), to convert the scores for each instrument into one score and to derive a compounded impairment level sumscore (ISS), and to evaluate reliability, validity, and responsiveness of the ISS. DATA SOURCES AND EXTRACTION: Literature search in Medline (1985 to 1995), non-Medline journals, and references from these reports for measurement parameters and suitable, reliable, responsive, and validated instruments. DATA SYNTHESIS: Four measurement parameters (pain, active range of motion, temperature, and volume) and five measurement instruments were chosen to construct the ISS. All outcomes were converted into one score, resulting in an addable score. RESULTS: Forty-five patients with RSD of one upper extremity were evaluated. As expected for this heterogeneous index, the internal consistency of the ISS was poor to moderate. The ISS seemed to have content and concurrent validity. The responsiveness of the ISS was adequate. CONCLUSIONS: A multicomponent test was constructed to map alterations in the level of impairment in RSD patients. Each of the parameter scores could be translated into a uniform score. Adding the scores yielded the ISS.

Arm↗
PubMed1996

The effects of the saddle seat on seated postural control and upper-extremity movement in children with cerebral palsy.

A repeated-measures experimental cross-over study was conducted with school-aged children with spastic cerebral palsy (spastic CP) to compare the effects of flat-bench versus saddle-bench seating on postural control and reaching motions. The saddle bench allowed significantly better postural control as measured by the clinical rating scale Sitting Assessment for Children with Neuromotor Dysfunction and by a study-defined variable, Spinal Extension. No statistically significant differences were found for any other variables using aggregate data-analysis techniques. However, the group results and those of single-subject data analysis suggest that the saddle seat may help such children to develop and maintain seated postural control and upper-extremity movement patterns.

Arm↗
PubMed1990

Venous haemodynamics of the upper extremity after subclavian vein thrombosis.

Late post-thrombotic complaints after subclavian vein thrombosis are reported with highly varying frequencies (8-80% severe disability). The therapeutic approach depends partly on this frequency. With the aim to evaluate late sequelae a questionnaire was answered by 26 patients with arm-shoulder symptoms leading to arm phlebography, but where the examination did not reveal any thrombi. 65% had remaining symptoms 2-9 years after the examination. 3 had to change profession. 36 patients with phlebographically shown subclavian vein thrombosis answered the same questionnaire. Only 9 (25%) had remaining symptoms and in 4 it was classified as mild, in 4 as moderate and only in 1 patient as severe leading to change of profession. Venous haemodynamics in the upper extremity were also studied in 3 groups of patients; I) healthy volunteers (n = 16 arms), II) patients with arm-shoulder disabilities with negative arm phlebography (n = 7 disabled arms, n = 7 non-disabled arms), III) patients with phlebographically verified subclavian vein thrombi (n = 10 arms with DVT, n = 8 arms without DVT). Strain gauge plethysmography was used measuring venous capacity and maximal venous outflow. Venous pressure measurements were made both with the arms in a resting position and in a military position with and without work-load. Repeat phlebography of arms with symptoms were made. Maximal venous outflow was significantly lower in arms with previous subclavian vein thrombi (p less than 0.05) and venous pressure measurements with the arm in military position was significantly higher in those arms. However, no correlation between these measurements and the degree of arm disability was noted.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2002

Evaluation of upper extremity motor function tests in tetraplegics.

OBJECTIVE: To provide an overview of arm-hand function tests useful in tetraplegic subjects. Considerations for selection of an appropriate test are also provided. DATA SOURCES: A Medline literature search was conducted covering the period from 1967 to March 2001. Relevant references cited in the selected papers were also considered, regardless of the year of publication. STUDY SELECTION: This review was restricted to strength tests, functional and ADL tests. Only general tests and tests designed specifically to test tetraplegic persons written in English, or in Dutch were included in the review. RESULTS: Information is provided on four types of strength tests, 10 general and five specific functional tests and eight ADL tests. CONCLUSION: Many tests are available to measure upper extremity motor function in tetraplegics. Selection of a test is at first determined by the outcome value in which the investigator is interested. When the type of outcome value has been determined, the most suitable test has to be selected from the range of available tests. When two tests appear to be equally suitable, the availability of information on psychometric properties of the test when used in tetraplegic patients is a decisive factor. When information on the reliability, validity and sensitivity of a test is missing, it should be gathered before using the test.

Activities of Daily Living↗
PubMedDate not supplied

Normal values of F wave in upper extremities of 50 healthy individuals in Iran.

F wave latency has been shown to be a valuable method in evaluation of a variety of neurologic disorders. We measured F wave values in 50 healthy individuals in Shiraz. Maximum normal F wave latency for median nerve was 25.7 ms for women and 28.5 ms for men with stimulation at the wrist. It was 23 ms for women and 25 ms for men with stimulation at the elbow. Maximum normal F wave latency for ulnar nerve was 26.45 ms for women and 28.9 ms for men with stimulation at the wrist. It was 23.1 ms for women and 25.3 ms for men with stimulation at the elbow. Maximum normal difference in F wave latency between right and left upper extremities with stimulation at the wrist for total group was 2.2 ms for median nerve and 2.4 ms for ulnar nerve. Maximum normal difference in F wave latency between median and ulnar nerve in an extremity with stimulation at the wrist for total group was 2.7 ms. There was statistically significant difference in F wave latency between women and men.

Adolescent↗
PubMed2004

Anterolateral thigh flap technique in hand and upper extremity reconstruction.

The anterolateral thigh flap is an extremely versatile flap first described in 1984. The flap is based on either a septocutaneous or musculocutaneous perforator of the descending branch of the lateral circumflex femoral system. It can be designed as a skin and subcutaneous flap, fasciocutaneous, or musculocutaneous flap. Furthermore, it can be harvested as a sensate flap by taking the lateral cutaneous nerve of the thigh. Technique for harvesting the flap is described in detail. Complications include flap failure and donor site morbidity. Due to its versatility, the anterolateral thigh flap is particularly useful for upper extremity reconstruction.

Journal Article↗
PubMed1994

Aggressive fibrous tissue lesions in the upper extremity: treatment and results.

The oncologic and functional results of treatment of aggressive fibromatosis were reviewed in 16 patients. Five had undergone previous resections. Complete surgical excision, the recommended primary treatment modality for aggressive fibromatosis tissue lesions, could only be performed in five patients. Radiation was administered in 13 patients and mainly used when the resection margins were positive. One patient required reoperation for recurrence. Complete detailed follow-up data were available in 15 patients. Functional analysis revealed 11 good-excellent, 2 fair, and 2 poor results using the Enneking classification. Local control was achieved with a combination of surgery and radiation, maintaining good-excellent function in most patients. The local nature of this tumor can be controlled with surgery and radiation while preserving function in the upper extremity.

Adult↗