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PubMed2003

Investigation of sentinel lymph nodes of the axillary and cubital regions in upper-extremity malignant skin tumors: a series of 15 patients.

BACKGROUND: Few articles have reported the location of sentinel lymph nodes (SLNs) in relation to skin-tumor location. We examined the location of SLNs in relation to skin-tumor location in the axillary and cubital regions. METHODS: We attempted to detect SLNs of the axillary and cubital regions using 1% sulfan blue dye in 15 patients with melanoma and other skin cancers. RESULTS: SLNs were detected in 12 patients: in 10 patients, one SLN was detected; in 2 patients, two SLNs were detected. In 4 patients, tumor metastasis in SLNs was positive. In 69 samples, 16 metastatic lymph nodes were detected: tumor metastasis was recognized in 4 SLNs and in 12 other lymph nodes. In 8 patients, the SLNs were negative for tumor metastasis. Ten SLNs were found in 45 other samples; all lymph nodes were negative for tumor metastasis (false-negative rate, 0%). The SLNs were located in the following regions: central axillary nodes, 6 cases; lateral axillary nodes, 4 cases; subscapular nodes, 1 case; cubital node, 2 cases. CONCLUSIONS: Because the lateral and central lymph nodes drain the lymph channels of the upper extremity, the SLNs were mainly located in the central and lateral lymph nodes in the axillary region. However, the ulnar dorsal hand tumors and the dorsal little-finger skin tumors were connected to the cubital lymph node. It is necessary to check both the cubital and axillary regions when dyed lymph vessels are going toward the cubital region.

Aged↗
PubMed2000

The effect of arm and wrist supports on the load of the upper extremity during VDU work.

OBJECTIVE: To evaluate the effectiveness of arm and wrist supports in reducing the workload during computer work. DESIGN: Female subjects (n=10) performed computer work in conditions with arm or wrist supports and in a condition without supports. BACKGROUND: Sustained muscle tension in the trapezius muscle is a risk factor for trapezius myalgia. Arm and wrist supports are used at the workplace with the intention to reduce the muscle tension. The effectiveness of these aids in reducing the load is not clear. METHODS: A typing task and mouse task were performed, each with four types of supports and without support. Electromyography and subjective ratings were used to quantify the workload. RESULTS: Lower levels of trapezius muscle activation were recorded with the use of arm supports. Wrist supports did not reduce activation. The rated perceived workload did not discriminate. CONCLUSIONS: Reduction of muscle activation in the neck-shoulder region during standard visual display unit work can be achieved with arm supports. Wrist supports do not reduce the strain on the neck-shoulder region. Subjective ratings seem not of use in selecting ergonomic aids in low intensity tasks. RelevanceVisual display unit workers are at risk of developing complaints of the neck and upper extremity. Arm and wrist supports are introduced at the workplace to reduce the workload. If arm and wrist supports are effective in reducing the workload they might be of use as preventive measures to reduce the risk of neck-shoulder complaints.

Adult↗
PubMed1976

[The fibrolipomatous hypertrophy of the main nerves of the upper extremity].

10 cases of lipofibromatous hypertrophy of the main nerves in the upper limb in 7 female and 3 male patients are described. In 1 case at the level of the middle third of the upper arm and in 6 cases at the level of the wrist and neighboring areas. In 2 patients these pathological changes were found in the ulnar nerve, in 1 case the hypertrophy was limited to the upper arm, in the other it extended all along the extremity from below the axilla to the wrist. Finally, in 1 case a 20 cm long hypertrophy was found at the level of the deep branch of the radial nerve (posterior interosseus nerve) in the lower arm below the elbow. The fibrous and lipomatous tissue snugly surrounds the fascicles and cannot be separated from them without damaging them, even if the finest microsurgical techniques are used. As the disease has been diagnosed in children as young as five years a congenital etiology has to be considered. The condition is distinct though from the disease of DEJERINE-SOTTAS or from that of von RECKLINGHAUSEN. The hypertrophic nerve is progressively submitted to a chronic compression in the naturally narrow passages (carpal tunnel, ulnar grove at the elbow, arcade of FROHSE) or it becomes painful and paretic after even minor trauma which leads probably to local oedema, intraneural bleeding and epineural compression. An external and internal decompression has to be carried out. Resection or defatting of the hypertrophic fascicles, however, should be avoided. In 2 of our cases the disease was anamnestically present for 45-50 years and clinically followed in another case for 18 years. The disease does not seem progressive. These cases show, that this disorder, which first appeared in the medical literature in 1964 and have been described by several authors in the median nerve, exists as well in the two other main nerves of the upper extremity.

Adult↗
PubMed1991

Compressive mononeuropathies of the upper extremity in chronic paraplegia.

Controversy exists with regard to the actual prevalence of compressive mononeuropathies at the wrist which may occur following chronic paraplegia. Thirty one chronic paraplegics, with a mean age of 37.9 years (range 20-68 years), and mean time since injury of 9.7 years (range 1-28 years), were studied with a comprehensive neurologic and electrodiagnostic (EDX) assessment. No patient had any clinical or EDX evidence of a peripheral polyneuropathy. The diagnosis of a median mononeuropathy at the wrist was determined by the following criteria: (a) prolonged median sensory distal latency greater than ipsilateral ulnar sensory distal latency greater than or equal to 0.5 msec; (b) a median mid-palmar sensory latency greater than ipsilateral ulnar mid-palmar sensory latency of greater than or equal to 0.3 msec; or (c) a median motor distal latency greater than or equal to 1.7 milliseconds as compared to the ipsilateral ulnar motor distal latency. Ulnar mononeuropathy at the wrist or across the elbow was also characterised. The EDX criteria for a median mononeuropathy at the wrist was met in 55% of subjects (24% of these with bilateral presentations). The location of ulnar mononeuropathies included: two at the superficial sensory branch at the wrist, one at the deep motor branch at the wrist, and three patients with a conduction block across the elbow. Overall, 67% of all patients tested had evidence of at least one mononeuropathy of the upper extremity. There was no association between prevalence of compressive mononeuropathies and age of the patient or time since onset of injury.

Adult↗
PubMed2000

Objective measurement of functional upper-extremity movement using accelerometer recordings transformed with a threshold filter.

BACKGROUND AND PURPOSE: The consensus is that the most important outcome for rehabilitation is functional activity in the life situation. Constraint-Induced Movement Therapy, a new treatment that transfers in-clinic gains to the life situation, demands objective measurement of real-world movement. However, direct, objective, and accurate measures of arm use in the real world are not available. Previous attempts to use accelerometry to measure extremity movement have failed because of unacceptable variability. This problem has been addressed here by use of a threshold filter. METHODS: Nine stroke patients and 1 healthy individual wearing accelerometers were videotaped while they carried out their usual activities at home or in the clinic; the duration of their arm, torso, and ambulatory movements was judged by 2 observation teams. In addition, 11 college students performed 5 standardized activities of daily living for varying durations in the laboratory. The accelerometer data were transformed; the raw value recorded for a given epoch was set to a constant if it exceeded a low threshold. RESULTS: The threshold-filtered recordings measured the duration of movement accurately and with very little variability. Correlations between the threshold-filtered recordings and the observer ratings of the duration of arm, torso, and ambulatory movements were 0.93, 0.93 and 0.99, respectively; the corresponding correlations for the raw values were -0.17, 0.34, and 0.85. CONCLUSIONS: These results present initial evidence for the validity of threshold-filtered accelerometer recordings for objectively measuring the amount of real-world upper-extremity movement as an index of treatment outcome for rehabilitation patients.

Adult↗
PubMed2000

Frostbite of the upper extremity.

Human capacity for physiologic adaptation to cold is minimal; we survive by insulating ourselves with protective clothing. In addition to the irreversible direct injury caused by ice crystallization, the authors have outlined four possible mechanisms by which indirect injury may damage tissue. Other than rapid rewarming, there is no uniformly accepted protocol for the treatment of frostbite injury. Attempting to sort out the world's literature on frostbite in an effort to present a comprehensive treatment protocol is a daunting task. In addition to the probably irreversible direct injury caused by ice crystallization, the authors have outlined at least four possible mechanisms by which indirect injury may damage tissue. The literature is full of various treatment protocols that allegedly are beneficial despite addressing different mechanisms. Mills described 10 different categories of medications, each addressing one of four possible mechanisms, used in the clinical treatment of frostbite injury over a 30-year period. Analyzing this information is even more confusing when one realizes that there is little uniformity in animal models employed to generate these data. This is further complicated by the lack of clinical correlation with the most common experimental model--liquid nitrogen rapid freezing. The risk of frostbite is highest when psychiatric disturbance, intoxication, or unplanned circumstances lead to cold exposure without adequate protective clothing. As tissue freezes, both direct and indirect factors cause injury. Most therapies have been aimed at limiting indirect injury, in an attempt to limit progressive tissue loss. Rapid rewarming is universally accepted, but the benefits of other modalities are still controversial. Traditionally, observation and delayed amputation have been employed to manage frostbite. More recently, triple-phase bone scans have been used to distinguish between tissue that is irreversibly destined for necrosis and tissue that is at-risk for necrosis, but potentially salvageable. Early operation can be used to provide at-risk tissue with a new blood supply and preserve both function and length in the upper extremity.

Amputation, Surgical↗
PubMedDate not supplied

Regional anesthesia: preferred technique for venodilatation in the creation of upper extremity arteriovenous fistulae.

Owing to the overall poor medical health of patients with end-stage renal disease, we have sought alternatives to the use of general anesthesia for access procedures. Furthermore, since local anesthesia (1) does not offer the motor block that is sometimes desired and (2) can be difficult to maintain when a large amount of vein needs to be transposed, we examined whether regional blocks can be useful for the creation of new arteriovenous fistulae (AVF). From August 2002 to January 2005, 41 patients scheduled for AVF placement underwent a regional block with the use of a lidocaine and ropivacaine mixture using a nerve stimulator. Either axillary, interscalene, or infraclavicular blocks or a combination was used. Intraoperative duplex ultrasonography was used to assess the degree of venodilatation of the basilic and cephalic veins before and after the block. The site of each measurement was marked on the skin and selected by a clearly identifiable branch point. Each measurement was recorded three times and was made in the (1) native state, (2) after application of a tourniquet with opening and closing of the hand for 15 seconds, and (3) after placement of the block. The average age of the patients was 65 +/- 14 years (SD), with ages ranging from 33 to 91 years, and the prevalence of diabetes mellitus was 50%. Complete brachial plexus block was achieved in 34 patients (83%). Sensory block was accomplished within 10 to 15 minutes and usually lasted 4 to 6 hours. Motor block was accomplished in 10 to 25 minutes. Venodilatation was not noted in patients whose blocks did not work (n = 7) or whose vein was found to be phlebitic on exploration (n = 3). The degree of venodilatation noted as a percentage increase after application of the tourniquet compared with the native state for these 34 patients (in whom the block worked) was 37% for the distal cephalic, 31% for the midcephalic, and 32% for the midbasilic vein. The degree of venodilatation noted as a percentage increase after placement of the block compared with after tourniquet application for these 34 patients was 42% for the distal cephalic, 19% for the midcephalic, and 26% for the midbasilic vein. No instances of systemic toxicity, hematomas, or nerve injury from the block were noted. Accesses placed included 20 radiocephalic AVF, 8 brachiobasilic AVF, 8 brachiocephalic AVF, 2 arteriovenous grafts, 2 radiobasilic AVF, and 1 brachial vein AVF.Regional block is a safe and, in our opinion, preferred technique for providing anesthesia for upper extremity vascular surgery. The venodilatation observed is augmented compared with that using a tourniquet and may allow more options for access placements.

Adult↗