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PubMed1982

Collateral circulation secondary to upper extremity venous thrombosis visualized during excretory urography.

Unsuspected upper extremity venous thrombosis was observed in three patients undergoing excretory urography. Thoraco-abdominal collateral vessels were readily visible following an intravenous bolus injection of contrast material into a vein in the affected extremity. The increased incidence of upper extremity venous thrombosis is probably due to the frequent use of subclavian vein catheterization for parenteral nutrition, central venous monitoring, and cardiac pacing. The collateral pathways are characteristic and can easily be recognized.

Adolescent↗

PubMedDate not supplied

[Stress phlebitis of the upper extremity. Medico-legal aspect].

Stress phlebitis of the upper extremity is in fact due to compression of the subclavian vein in the costo-clavicular space during certain movements, the effort being only a fortuitous component. Clinically, it evolves in two stages: at the stage of intermittent compression, the functional symptoms are related to certain positions of the upper extremity; the compression is identified clinically and with additional tests. Treatment includes physical therapy; however, persistence of the symptoms may result in having to consider the resection of the first rib. At the stage of organized phlebitis, the diagnosis is obvious although sometimes unrecognized, and the current consensus is to use anticoagulants: heparin followed by anti-vitamin K. From a medico-legal standpoint, stress phlebitis of the upper extremity is not considered a professional disease, but if it is possible to attribute it to a type of work requiring frequent upward positioning of the arms, there is an obligation for these patients to be rehabilitated professionally.

Arm↗

PubMedDate not supplied

[Pain in the upper extremity after a stroke].

Pain in the upper extremity presenting itself after prior stroke occurs in about 84% patients with hemiplegia. It may result from central/peripheral nervous system pathology or both. The arising and developing pain as well as its degree and pronouncement are thought to be influenced by additional factors such as aphasia, abnormalities in the affected extremity sensibility, depression. Treatment of post-stroke patients with the upper extremity pain syndrome is a difficult problem. Therefore it is essential to determine and, as far as possible, to adequately manage the source of pain since pain is an additional, and sometimes, a dominating factor in the patients' sufferings.

Arm↗

PubMedDate not supplied

Measuring disability of the upper extremity: a rationale supporting the use of a regional outcome measure.

OBJECTIVE: Many existing upper extremity outcome measures have been designed for a specific anatomic site (e.g., shoulder) or a specific disease entity (e.g., carpal tunnel syndrome). The purpose of this paper is to examine whether questionnaire items taken from very specific measures are considered relevant only to that specific region or are applicable to the whole extremity. METHODS: Fifteen practicing clinicians categorized a sample of 132 items from existing questionnaires according to whether the items reflected disability specific to an anatomic site or were relevant to the whole extremity. RESULTS: Seventy-two percent of the items were categorized as relevant to the extremity as a whole, while only 21% of the items were categorized as specific to an anatomic site. CONCLUSION: Items in existing specific upper extremity questionnaires are also relevant to other regions and conditions. This finding is in agreement with kinesiologic and biomechanical theories that the upper extremity acts as a single functional unit. Questionnaires designed for the whole extremity could provide a more practical and still valid measure of upper extremity disability.

Activities of Daily Living↗

PubMed1984

Nerve entrapment syndromes in the upper extremity contralateral to amputation.

Five cases are reported of upper extremity amputation with no metabolic disease. Patients experienced pain, paresthesia and weakness in the intact extremity associated with electrophysiologic evidence of entrapment neuropathies. All patients did heavy manual work, and all had carpal tunnel syndrome. One patient also had cubital tunnel syndrome and compression of the medial cord of the brachial plexus in the axilla, and another patient had cubital tunnel syndrome and axillary neuropathy. Surgery did not relieve symptoms of carpal tunnel and cubital tunnel syndromes for prosthesis users until the figure-8 harness was changed. Patients who did not use a prosthesis felt relief of symptoms following surgical release. Possible mechanisms which produce nerve entrapment syndromes in patients with upper extremity amputations are use of one limb for heavy manual work over prolonged periods, direct compression of neural structures from the axilla loop of a figure-8 harness, and compression of neural structures in the axilla resulting in entrapment at a distal site. Changing the figure-8 harness should be considered prior to surgical decompression for patients who have upper extremity amputations with entrapment syndromes.

Adult↗

PubMed1998

Ergonomic stressors and upper extremity disorders in vehicle manufacturing: cross sectional exposure-response trends.

OBJECTIVE: To evaluate the association between upper extremity soft tissue disorders and exposure to preventable ergonomic stressors in vehicle manufacturing operations. METHODS: A cross sectional study was conducted in one vehicle stamping plant and one engine assembly plant. A standardised physical examination of the upper extremities was performed on all subjects. An interviewer administered questionnaire obtained data on demographics, work history, musculoskeletal symptoms, non-occupational covariates, and psycho-physical (relative intensity) ratings of ergonomic stressors. The primary exposure score was computed by summing the responses to the psychophysical exposure items. Multivariate regression analysis was used to model the prevalence of disorders of the shoulders or upper arms, wrists or hands, and all upper extremity regions (each defined both by symptoms and by physical examination plus symptoms) as a function of exposure quartile. RESULTS: A total of 1315 workers (85% of the target population) was examined. The prevalence of symptom disorders was 22% for the wrists or hands and 15% for the shoulders or upper arms; cases defined on the basis of a physical examination were about 80% as frequent. Disorders of the upper extremities, shoulders, and wrists or hands all increased markedly with exposure score, after adjustment for plant, acute injury, sex, body mass index, systemic disease, and seniority. CONCLUSIONS: Musculoskeletal disorders of the upper extremities were strongly associated with exposure to combined ergonomic stressors. The exposure-response trend was very similar for symptom cases and for physical examination cases. It is important to evaluate all dimensions of ergonomic exposure in epidemiological studies, as exposures often occur in combination in actual workplaces.

Adult↗

PubMed2006

External tissue expansion using negative pressure in upper-extremity reconstruction.

Soft-tissue expansion in the upper extremities is a valuable technique with increasing indications, which means that using of tissue expansion in reconstruction of upper limb increases day after day. Tissue expansion with implantable balloons is a fairly standard method in reconstructive surgery. This article describes the use of external tissue expansion by using negative pressure in soft-tissue reconstruction of the upper extremities in 40 patients. Valved cups (external expanders) were applied to the skin on one or both sides of the lesion. With the subsequent application of a negative pressure source to the valves, gradual tissue expansion occurred inside the external expanders. When there was enough surface area of the expanded skin to cover the exposed area after lesion excision, the expansion process was stopped and surgery was performed. The upper limit of negative pressure must not exceed -200 mbar. The complications were mild and mainly involved skin blistering. External tissue expansion using a negative pressure technique is simple, safe, cost effective, and associated with good results in the reconstruction of soft-tissue injuries.

Blister↗

PubMed1999

Maximal grip force in chronic stroke subjects and its relationship to global upper extremity function.

OBJECTIVES: Previous studies have shown that recovery of recordable grip strength in acute stroke subjects is one of the most sensitive assessments of initial upper limb recovery and a good prognostic factor for latter recovery. The objectives of this study were to test the reliability of maximal voluntary grip force (MVGF) measures and evaluate the relationship between paretic grip strength deficit and paretic upper extremity function in chronic stroke subjects. DESIGN: Over a three-week period, bilateral MVGF was assessed three times with a modified strain gauge dynamometer in 15 chronic stroke subjects and 10 control subjects. The paretic MVGF deficit was expressed in relation to the MVGF of the nonaffected hand. OUTCOME MEASURES: Upper extremity function in stroke subjects was measured using the Fugl-Meyer, the upper extremity performance test for the elderly (TEMPA), Box and Block and finger-to-nose tests. RESULTS: MVGF measures in both groups of subjects demonstrated good reliability (intraclass correlation, ICC >0.86) and low standard error measurements (SEM). The paretic MVGF of the stroke subjects was greatly impaired in comparison to the control subjects. Results of linear and quadratic regressions analyses show that this impairment was significantly correlated (p <0.01) with the performance of the stroke subjects on the four upper extremity function tests. The percentages of variances explained by the MVGF deficit on all four upper extremity tests varied from 62% to 78% for the linear regressions and from 72% to 93% for the quadratic regressions. CONCLUSIONS: These results suggest that the paretic maximal grip strength, normalized with the maximal grip strength on the nonaffected side, appears to be a valuable outcome measure of upper extremity function in chronic stroke subjects.

Adult↗

PubMed2003

The effects of airbag deployment on severe upper extremity injuries in frontal automobile crashes.

The purpose of this study was to investigate severe upper extremity injuries resulting from frontal automobile crashes and to determine the effects of frontal airbags. The National Automotive Sampling System database files from 1993 to 2000 were examined in a study that included 25,464 individual cases that occurred in the United States. An analysis of the cases indicated that occupants exposed to an airbag deployment were statistically more likely to sustain a severe upper extremity injury (2.7%) than those occupants not exposed to an airbag deployment (1.6%) (P =.01). In particular, 0.7% of occupants exposed to an airbag deployment sustained a severe upper extremity injury specifically from the airbag. In addition, when in crashes with an airbag deployment, older occupants were at a higher risk for severe upper extremity injury, as well as occupants in crashes with higher changes in velocity.

Accidents, Traffic↗

PubMed1989

Relationship of cumulative trauma disorders of the upper extremity to degree of hand preference.

The degree of hand preference, ie, the extent to which the use of one upper extremity is obligate, has not been studied previously as a possible risk factor for the development of upper extremity cumulative trauma disorders (UECTDs). This case-control study was designed to test the hypothesis that strong hand preference, whether left or right, would be associated with UECTDs in a working population. Case subjects were drawn from workers who presented to one of two acute care clinics for treatment of work-related cumulative trauma disorders of the upper extremity. Control subjects were drawn from job applicants presenting for preplacement examinations at the same two clinics. The degree of hand preference was determined by the Edinburgh Handedness Inventory of Oldfield. The 48 case subjects evidenced a higher absolute value of the mean handedness score (indicative of a stronger degree of hand preference) than the 134 control subjects (P = .01). As a dichotomized variable, being "strong"-handed versus "weak"-handed was a significant risk factor for UECTD (P = .01, odds ratio = 2.48). Among the 48 case subjects, 83% had a UECTD ipsilateral to the side of hand preference. This study found that workers who develop cumulative trauma disorders of the upper extremity are more likely to exhibit a strong hand preference than a group of applicants entering the work force. These findings suggest that the endogenously determined obligate use of one extremity may be a significant risk factor for the development of upper extremity cumulative trauma disorders.

Adult↗

PubMed1982

Diagnosis of upper extremity deep venous thrombosis using noninvasive technique.

Forty-two patients suspected of having unilateral upper extremity deep venous thrombosis (DVT) were evaluated with Doppler ultrasonography and phleborheography (PRG). Venography was performed on 23 upper extremities (54%). Doppler ultrasonography and PRG produced similar accuracy (82%) in detecting upper extremity DVT when compared with venography. The accuracy improved to 91% when the results of both tests were considered together. It is concluded that Doppler ultrasonography and PRG, when used together, are useful, rapid, and accurate techniques for diagnosing upper extremity DVT.

Adult↗

PubMed2005

Upper-extremity phocomelia reexamined: a longitudinal dysplasia.

BACKGROUND: In contrast to longitudinal deficiencies, phocomelia is considered a transverse, intercalated segmental dysplasia. Most patients demonstrate severe, but not otherwise classifiable, upper-extremity deformities, which usually cannot be placed into one of three previously described phocomelia groups. Additionally, these phocomelic extremities do not demonstrate true segmental deficits; the limb is also abnormal proximal and distal to the segmental defect. The purpose of this investigation was to present evidence that upper-extremity abnormalities in patients previously diagnosed as having phocomelia in fact represent a proximal continuum of radial or ulnar longitudinal dysplasia. METHODS: The charts and radiographs of forty-one patients (sixty extremities) diagnosed as having upper-extremity phocomelia were reviewed retrospectively. On the basis of the findings on the radiographs, the disorders were categorized into three groups: (1) proximal radial longitudinal dysplasia, which was characterized by an absent proximal part of the humerus, a nearly normal distal part of the humerus, a completely absent radius, and a radial-sided hand dysplasia; (2) proximal ulnar longitudinal dysplasia, characterized by a short one-bone upper extremity that bifurcated distally and by severe hand abnormalities compatible with ulnar dysplasia; and (3) severe combined dysplasia, with type A characterized by an absence of the forearm segment (i.e., the radius and ulna) and type B characterized by absence of the arm and forearm (i.e., the hand attached to the thorax). RESULTS: Twenty-nine limbs in sixteen patients could be classified as having proximal radial longitudinal dysplasia. Systemic medical conditions such as thrombocytopenia-absent radius syndrome were common in those patients, but additional musculoskeletal conditions were rare. Twenty limbs in seventeen patients could be classified as having proximal ulnar longitudinal dysplasia. Associated musculoskeletal abnormalities, such as proximal femoral focal deficiency, were common in those patients. Eleven limbs in ten patients were identified as having severe combined dysplasia, which was type A in seven of them and type B in four. Four patients with severe combined dysplasia had congenital cardiac anomalies, and four had associated musculoskeletal abnormalities. Three of the four patients with the type-B disorder had a contralateral ulnar longitudinal dysplasia. CONCLUSIONS: We propose that cases previously classified as upper-extremity phocomelia represent a spectrum of severe longitudinal dysplasia, as none of the sixty extremities that we studied demonstrated a true intercalary deficiency. These findings have both developmental and genetic implications.

Child↗

PubMed2006

Comparison of the action research arm test and the Fugl-Meyer assessment as measures of upper-extremity motor weakness after stroke.

OBJECTIVE: To assess the relative responsiveness of 2 commonly used upper-extremity motor scales, the Action Research Arm Test (ARAT) and the Fugl-Meyer Assessment (FMA), in evaluating recovery of upper-extremity function after an acute stroke in patients undergoing inpatient rehabilitation. DESIGN: Prospective. SETTING: An acute stroke rehabilitation unit. PARTICIPANTS: One hundred four consecutive admissions (43 men, 61 women; mean age +/- standard deviation, 72+/-13y) to a rehabilitation unit 16+/-9 days after acute stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The following assessments were completed within 72 hours of admission and 24 hours before discharge: ARAT, upper-extremity motor domain of the FMA, National Institutes of Health Stroke Scale, FIM instrument total score, and FIM activities of daily living (FIM-ADL) subscore. RESULTS: The Spearman rank correlation statistic indicated that the 2 upper-limb motor scales (ARAT, FMA) correlated highly with one another, both on admission (rho = .77, P < .001) and on discharge (rho = .87, P < .001). The mean change in score from admission to discharge was 10+/-15 for the ARAT and 10+/-13 for the FMA motor score. The responsiveness to change as measured by the standard response mean was .68 for the ARAT and .74 for the FMA motor score. The Spearman rank correlation of each upper-limb motor scale with the FIM-ADL at the time of admission was as follows: ARAT, rho equal to .32 (P < .001) and FMA motor score, rho equal to .54 (P < .001). CONCLUSIONS: Both the FMA motor score and the ARAT were equally sensitive to change during inpatient acute rehabilitation and could be routinely used to measure recovery of upper-extremity motor function.

Aged↗

PubMed2005

Sonographic evaluation of upper extremity deep venous thrombosis.

OBJECTIVE: The purpose of this presentation is to review the techniques of performing an upper extremity Doppler examination, in addition to illustrating the sonographic appearances of acute and chronic upper extremity deep venous thrombosis (UEDVT). METHODS: The risk factors and complications of UEDVT are discussed, and the anatomy of the upper extremity deep venous system as well as examination techniques are described. Cases of acute and chronic deep venous thrombosis were also chosen to illustrate the spectrum of sonographic appearances. RESULTS: Color Doppler sonography is accurate in the diagnosis of UEDVT. However, in cases of equivocal Doppler findings, or when the sonographic findings are normal but clinical suspicion for central venous thrombosis is high, magnetic resonance or contrast venography is necessary for further evaluation. CONCLUSIONS: Color Doppler sonography is a rapid and noninvasive technique in the evaluation of venous disease in the upper extremity and is the modality of choice in screening for UEDVT.

Chronic Disease↗

PubMed2003

Changes in movement characteristics of the spastic upper extremity after botulinum toxin injection.

OBJECTIVE: To examine the longitudinal effects of botulinum toxin injection on movement characteristics of the spastic upper extremity in children by using motor control testing (MCT) techniques and standard clinical measures. DESIGN: Open-label clinical trial. SETTING: Motor control laboratory at an academic medical center. PARTICIPANTS: A convenience sample of 9 subjects (5 boys, 4 girls; age range, 7-16 y) with cerebral injury (stroke or cerebral palsy) and asymmetric upper-extremity function because of spasticity. Eight subjects had right-sided involvement. INTERVENTIONS: Botulinum toxin injection to the involved upper extremity, involving elbow, wrist, and finger flexors, depending on clinical presentation. MAIN OUTCOME MEASURES: Clinical measures included range of motion (ROM), the Ashworth Scale, FIM trade mark instrument, Pediatric Evaluation of Disability Inventory, portions of the Bruininks-Oseretsky Test of Motor Proficiency, and the Purdue pegboard. MCT consisted of visually guided reaching, bilateral finger-to-nose movements, hand tapping, and isometric pinch force tasks. Kinematic assessments were made before and at 2, 4, 6, 12, 18, and 24 weeks after botulinum toxin injection. RESULTS: All subjects had increased ROM and decreased Ashworth values throughout the testing period. In motor control tasks, improvement typically occurred earlier in the least complex movements, such as hand tapping, with 6 of 9 subjects showing a maximum, although transient, unilateral tapping speed by 6 weeks. A similar time course was observed for pinch force tasks. Improvement in more complex, forward-reaching tasks occurred much later (week 12 or later) or did not occur at all. As with the hand tasks, improved reach performance declined toward the end of the testing period. All subject showed minimal or no improvement in bilateral finger-to-nose movements. Neither maximum changes in ROM or Ashworth values correlated with improvements in functional elbow extension during sit and reach tasks, with 3 subjects with normal active ROM showing late onset or no change in reach. CONCLUSIONS: Although botulinum toxin reduced tone and increased ROM of the spastic upper extremity, the time course and degree of motor improvement appears to depend on the complexity of the task. Future research should focus on the value of adjunct therapy, such as task-specific training, in addition to botulinum toxin treatments to facilitate functional improvement of the spastic upper extremity.

Biomechanical Phenomena↗

PubMed2006

Upper extremity compartmental anatomy: clinical relevance to radiologists.

Malignant tumors of the upper extremity are uncommon, and their care should be referred to specialized facilities with experience treating these lesions. The Musculoskeletal Tumor Society (MSTS) staging system is used by the surgeon to determine appropriate surgical management, assess prognosis, and communicate with other healthcare providers. Magnetic resonance imaging (MRI) is employed pre-operatively to identify a lesion's compartment of origin, determine extent of spread, and plan biopsy and resection approaches. Involvement of neurovascular structures may result in devastating loss of upper extremity function, requiring amputation. Violation of high-resistance compartmental barriers necessitates more extensive surgical resection. Biopsy may be performed by the radiologist using imaging guidance. Knowledge of compartmental anatomy allows the radiologist or surgeon to use an easily excisable biopsy approach and prevent iatrogenic spread to unaffected compartments. Case examples are presented to illustrate the importance of compartmental anatomy in the management of benign and malignant upper extremity tumors.

Bone Neoplasms↗

PubMed2003

[Surgical treatment of acute embolism of the upper extremity].

OBJECTIVE: To study the methods of surgical treatment and the prognosis of acute embolism of the upper extremity. METHODS: Balloon catheter embolectomy through the brachial artery was performed in 18 patients with acute embolism of the upper extremity. RESULTS: Both the pulse of the radial and ulnar artery could be palpated in 8 patients, either the pulse of the radial or ulner artery could be palpated in 9 patients. The temperature of the upper extremity was increased in the patient whose embolectomy was performed in the 6th day after onset of the illness. Three patients died postoperatively. CONCLUSIONS: Embolectomy through the brachial artery is an effective method to treat acute embolism of the upper extremity. Elderly and heart and pulmonary diseases are the high risk factors for postoperative death.

Acute Disease↗

PubMed1981

Injuries to the upper extremity: patterns of occurrence.

Injuries to the upper extremity, as reported in home interviews, physician office records, and hospital records, are a problem of great magnitude. Upper extremity injuries not only are responsible for a great deal of disability and for a large number of visits for medical care, but also, because they often affect people of working age, have a great impact on society because of loss of productivity. However, regardless of the age at which they occur, these injuries can have an impact on the quality of life of the injured, both in the short term and in the long.

Adolescent↗