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PubMed2026

The Impact of Upper Extremity Rehabilitation on Fatigue in Individuals With Multiple Sclerosis: A Systematic Review.

BACKGROUND: Although numerous interventions have been investigated to alleviate fatigue in people with multiple sclerosis (PwMS), evidence regarding the effects of upper extremity rehabilitation on fatigue remains limited. OBJECTIVE: The objective of this review was to evaluate and synthesize the available evidence on the effects of upper extremity rehabilitation interventions on fatigue in PwMS. METHODS: This review was conducted in accordance with the PRISMA guidelines and was prospectively registered in the PROSPERO database. A systematic search of PubMed, Web of Science, and Scopus was performed up to August 2026. Studies were eligible if they investigated the effects of upper extremity rehabilitation interventions on fatigue in PwMS. The risk of bias of randomized controlled trials was assessed using the Risk of Bias 2 (RoB 2), and the certainty of the evidence was appraised using the GRADE methodology. RESULTS: Nine studies including 250 participants (136 intervention, 114 control) met the inclusion criteria. The included studies evaluated a range of technology-assisted, exercise-based, home-based, and task-oriented upper extremity rehabilitation approaches, with some interventions incorporating more than one therapeutic or technological component. Fatigue outcomes were measured using the Fatigue Severity Scale (FSS) and the Modified Fatigue Impact Scale (MFIS). Risk of bias was low in three randomized controlled trials, with some concerns in two and high in two; among the two crossover studies, one was rated as low risk and one as high risk. GRADE assessment showed low certainty of evidence for studies using the FSS and very low certainty for those using the MFIS, indicating an overall low certainty of the available evidence. CONCLUSIONS: The available evidence is insufficient to draw definitive conclusions regarding the effects of upper extremity rehabilitation on fatigue in PwMS. Further high-quality randomized controlled trials are required.

Humans↗

PubMed1992

Evaluation and management of upper extremity neuropathies in Charcot-Marie-Tooth disease.

The evaluation and treatment of five patients with upper extremity neuropathies secondary to Charcot-Marie-Tooth disease were reviewed with emphasis on age at onset of Charcot-Marie-Tooth disease and upper extremity deformities, clinical findings, signs of associated nerve compression, and outcome of surgical treatment. The onset of the disease generally occurred in the first or second decade of life. The onset of upper extremity symptoms lagged behind by an average of 8 years. All patients had intrinsic minus hands with decreased sensibility. Three of five patients had clinical or electrophysiologic evidence of associated nerve compression syndromes. Treatment with standard tendon transfers, nerve compression releases, soft tissue releases, and joint fusions resulted in subjectively improved function in three of four patients undergoing reconstruction. Release of six compression neuropathies in one patient provided excellent pain relief, but the underlying neuropathy progressed. Pessimism regarding reconstructive surgery in the patient with upper extremity neuropathies secondary to Charcot-Marie-Tooth disease is unwarranted.

Adult↗

PubMed1998

The Capabilities of Upper Extremity instrument: reliability and validity of a measure of functional limitation in tetraplegia.

OBJECTIVE: To evaluate the reliability and validity of the Capabilities of Upper Extremity (CUE) instrument, designed to measure upper extremity functional limitations in individuals with tetraplegia. Functional limitations are actions such as reaching or grasping and are a link between the domains of impairment and disability. DESIGN: Survey of people with chronic spinal cord injury. SETTING: Regional spinal cord injury center. SUBJECTS: One hundred fifty-four individuals (140 male) with tetraplegia at least 1 year after injury and followed by the center. Mean age was 36.7 years (SD=11.1). Sixty-eight percent were motor complete. METHODS: The 32-item CUE was administered by telephone interview twice about 2 weeks apart. The motor portion of the Functional Independence Measure (FIM) was collected during the first interview. Upper extremity motor scores and motor levels were obtained from the most recent assessment in the outpatient chart. The instrument was evaluated for internal consistency, reliability, and validity. Exploratory factor analysis was performed to examine scale structure. RESULTS: Homogeneity of the scale was excellent. Cronbach's alpha was .96, and item-total correlations ranged from .49 to .78. Test-retest reliability was high (ICC=.94). All but three items had desired levels of agreement (K > .60). Analysis of variance indicated that the CUE distinguished between motor levels of tetraplegia more than one level apart. The CUE was correlated highly with both motor scores and FIM. Regression analysis indicated that the CUE was better than upper extremity motor scores for predicting FIM scores. The model containing the CUE explained 73% of the variance in FIM and was not enhanced by the addition of motor scores. Factor analysis suggested four potential subscales: arm function (bilateral), right hand function, left hand function, and reaching down. CONCLUSION: The CUE exhibits good homogeneity, reliability, and validity; further work is needed to determine its sensitivity to change in function.

Activities of Daily Living↗

PubMed1998

Management of upper extremity central venous obstruction using interventional radiology.

Upper extremity central vein stenosis/occlusion is responsible for significant morbidity. The objective of this report is to review our management using interventional radiological techniques and to determine the long-term clinical results. All radiological interventions for central vein stenosis/occlusion (n = 59) between July 1991 and July 1996 at our institution were reviewed. The interventions consisted of thrombolytic therapy alone in 10 cases, PTA in 40 cases (combined with initial thrombolytic therapy in 6 cases), and deployment of a venous stent in 9 cases. At follow-up, the cumulative success (patency and relief of symptoms) was determined (Kaplan-Meier method). The involved vein was the subclavian, axillary, or innominate (SUB-AX-INN) in 45 cases and the superior vena cava (SVC) in 14 cases. The etiology was secondary to an indwelling foreign body (catheter, pacemaker lead) in 53 cases (90%), and spontaneous in only 6 cases (10%). The average follow-up after intervention was 17.2 months, with a cumulative success of 70 +/- 7.5% at 2 years, with rapid decline thereafter. Analysis of the failure quantiles revealed that 25% failed by 17 months, 50% failed by 26.6 months, and 75% failed by 33.8 months. There were no subgroup differences (log-rank test) for stenosis versus occlusion (p = 0.526), SUB-AX-INN versus SVC (p = 0.744), or if the intervention was begun < 5 days versus > or =5 days after symptom onset (p = 0.240), or whether or not a stent was deployed (p = 0.893). Interventional radiological techniques should be considered when symptoms from upper extremity central vein stenosis/occlusion are severe and disabling, or when veno-access or maintenance of patency of an ipsilateral arteriovenous (A-V) access is necessary. These results suggest an acceptable short-to medium-term solution.

Adult↗

PubMed1984

The need for replantation surgery after traumatic amputations of the upper extremity--an estimate based upon the epidemiology of Sweden.

Reports in the literature give different views of the frequency of serious amputation injuries of the upper extremity. In Sweden the vast majority of work injuries are registered by the Swedish Labour Market Insurance. All registered serious amputation injuries of the upper extremity in Sweden (8 million inhabitants) during 1979 were investigated in this study. For comparison the frequency of all amputation injuries (work and leisure) of the upper extremity in a county of Sweden (0.4 million inhabitants) during five years (1976-1980) were studied. The overall (work and leisure) incidence in Sweden is fourteen serious amputation injuries of the upper extremity per million inhabitants annually, i.e. a total number in the country of 110 cases per year. The frequency is lower in the areas of the largest cities and substantially higher in regions with sawmills, mechanical industry and/or agriculture. Thus, estimation of the total incidence based upon single counties or smaller regions may be misleading. Replantation would have been technically possible in more than 70% of the cases, but attempts at replantation were only carried out in less than 10% of the serious cases. This study emphasizes the importance of a referral of all patients with a suitable injury of the upper extremity to microsurgically trained handsurgeons.

Accidents, Occupational↗

PubMed2002

A review of functional status measures for workers with upper extremity disorders.

In order to identify functional status measures for epidemiological studies among workers with mild to moderate disorders of the neck and upper extremity, a literature search was conducted for the years 1966 to 2001. Inclusion criteria were: (1) relevance to neck and upper extremity; (2) assessment among workers; and (3) relevance to mild to moderate disorders. Of 13 instruments reviewed, six measures were tested among workers. The three best measures, depending on the purpose of research, included the standardised Nordic Musculoskeletal Questionnaire, the Upper Extremity Questionnaire, and the Neck and Upper Limb Instrument. Development of a functional protocol is regarded as a realistic enhancement for research of neck and upper extremity disorders in the workplace. For research and clinical practice, measures of functional status, sensitive enough to measure the subtle conditions in mild to moderate disorders, may provide prognostic information about the risk of developing musculoskeletal disorders in apparently healthy patients. Appropriate use of functional status questionnaires is imperative for a meaningful portrayal of health.

Disability Evaluation↗

PubMed1997

New method and device for assessment of functional capacity of upper extremity with chronic ischemia.

BACKGROUND: The aim of this study is to establish an objective diagnostic method, through which the functional capacity of the upper extremity with chronic ischemia could be best assessed. METHODS: For a 9-year period (1986-1994) 74 patients suffering Arterial Occlusive Disease (AOD) of the upper extremity with chronic ischemia were treated. Fifty five of them (74.3%) were males (an average age of 52.4 years) and 19 females (25.6%), (an average age of 42.5 years). Forty nine of them (66.2%) were in second stage according to the adapted Fontain's classification. An original method and device have been established for the investigation of the abilities of the upper extremity to make repeated movements till they get an intermittent claudication. The apparatus consists of tree modules: a mechanical device, an interface adapter and a microcomputer. RESULTS: During the flexion of the fingers the patient overcomes the resistance of springs which is 1.82 Nm. An Ischemic Fatigue Index (IFI) is calculated--it gives the quantitative value of the functional capacity of the limb. IFI in patients in second stage of Chronic Arterial Ischemia (CAI) is from 0.14 to 0.76 during the diagnostic test and from 0.18 to 1.0 after the operative or drug treatment or Percutaneous Transluminal Angioplasty (PTA). A retrospective analysis shows that in patients who were operated on, the preoperative IFI was less than 0.50. The measurement of Arm-Arm Blood Pressure Index (AABPI) before treatment and after it in some cases shows normal values in spite of the presence of subclavian artery stenoses. The angiographies that were done could not help for the evaluation of the functional capacity of the upper extremities. The presence of pulse in 9 patients (18.4%) does not exclude a presence of occlusion. CONCLUSIONS: IFI is a quantitative indicator for the upper extremity capacity. It shows whether the symptoms are severe enough to justify the surgery. The periodical measurement of IFI is a monitoring of the development of AOD.

Adolescent↗

PubMed1996

Upper extremity thromboembolism after axillary-axillary bypass grafting.

Two patients experienced upper extremity thromboembolism after axillary-axillary bypass grafting (AxAG) for symptomatic subclavian artery stenosis. The first patient, a 67-year-old male, presented with left upper extremity thromboembolism 3 years after AxAG with 8 mm externally support PTFE. An arteriogram revealed a patent AxAG, thrombus in the proximal left subclavian arterial stump just distal to its occlusion, and multiple digital artery emboli. The patient was treated with warfarin for 8 months, with resolution of symptoms. The second patient, a 57-year-old male, occluded his AxAG (8 mm knitted Dacron) with minimal return of symptoms. Non-operative treatment was elected and 4 years later the patient presented with right upper extremity (donor side) thromboembolism. Arteriography revealed occlusion of the AxAG, radial artery, and digital arteries of the index, long and ring fingers. Thrombolytic therapy of the right arm was undertaken with minimal improvement. Subsequent detachment of the AxAG and placement of an interposition reversed saphenous vein graft was performed. Both patients continue to be asymptomatic during follow-up of 4.7 and 2.0 years, respectively.

Aged↗

PubMed1995

Phased array coils for upper extremity MRA.

A phased array coil was constructed for imaging the upper extremity vasculature for patients undergoing dialysis treatment. The phased array coil exhibits improved signal-to-noise ratio (SNR) over the body coil and allows imaging of the entire upper extremity. SNR as a function of depth was measured on a homogeneous phantom with the arm coil and compared with the body coil. Near the coil there is an improvement of a factor of 7 and at a depth of approximately 6-7 cm, there is an improvement of factor 2. In vivo SNR measurements resulted in similar improvements. Images of the upper extremity vasculature of healthy volunteers were generated using 2D-time-of-flight (2DTOF) angiography. Blood flow velocity was assessed in a CINE-phase contrast study.

Arm↗

PubMed2007

Are clinical characteristics associated with upper-extremity hypertonia in severe ischaemic supratentorial stroke?

OBJECTIVE: The primary goal of this study was to identify clinical risk factors, in addition to muscle weakness, for upper-extremity hypertonia in patients with severe ischaemic supratentorial stroke. The secondary goal was to investigate the time course of upper-extremity hypertonia in these patients during the first 26 weeks post-stroke. DESIGN: Inception cohort. PATIENTS: Forty-three consecutive patients with an acute ischaemic supratentorial stroke and an initial upper-extremity paralysis admitted to an academic hospital. MAIN OUTCOME MEASURES PRIMARY OUTCOME: hypertonia assessed by the Ashworth scale at week 26 post-stroke. Potential risks factors: motor functions assessed by the upper-extremity subscore of the Fugl-Meyer motor assessment, Barthel Index at week 1, consciousness, sensory disturbances, apraxia, neglect, and hyper-reflexia. Secondary outcome: time course of upper-extremity hypertonia by assessing its prevalence at 6 consecutive moments post-stroke during a follow-up period of 26 weeks. RESULTS: Twenty-five patients (63%) developed hypertonia during the follow-up period of 26 weeks. During this period, the prevalence of hypertonia followed a rather dynamic course, with cases of early, transient and late hypertonia. Univariate analyses yielded none of the selected clinical characteristics as significantly associated with hypertonia. CONCLUSION: Despite the high incidence of hypertonia (63%) observed, none of the selected clinical characteristics could be identified as a risk factor for hypertonia.

Aged↗

PubMed2004

Endovascular stent placement in the treatment of upper extremity central venous obstruction in hemodialysis patients.

OBJECTIVE: To evaluate the efficacy of stent placement for treating upper extremity central venous obstruction in chronic hemodialysis patients. METHODS AND MATERIAL: Between January 1999 and October 2001, we inserted metallic stents into the upper extremity central veins of 14 patients with shunt dysfunction and/or arm swelling. The indications for stent placement were stenosis or occlusion of the central vein in the upper extremity used for dialysis. Six of the individuals were diagnosed with subclavian vein stenosis, and 5 with brachiocephalic vein stenosis. Of the remaining 3 patients, 2 had subclavian vein occlusion, and 1 had left brachiocephalic vein occlusion. RESULTS: All the stent placement procedures were technically successful, and there were no major complications. Follow-up ranged from 2 weeks to 29 months. The 1-, 3-, 6- and 12-month primary stent patency rates were 92.8, 85.7, 50 and 14.3%, respectively. Repeat interventions, including percutaneous transluminal angioplasty and additional stent placement, were required in 9 patients. The 3-, 6-, 12-month, and 2-year assisted primary stent patency rates were 100, 88.8, 55.5 and 33.3%, respectively. CONCLUSION: Endovascular stent placement is an effective alternative to surgery in patients with shunt dysfunction due to obstruction of an upper extremity central vein. Repeated interventions are usually required to prolong stent patency.

Adolescent↗

PubMed2002

Responsiveness of two upper extremity function instruments for stroke inpatients receiving rehabilitation.

OBJECTIVE: To compare the responsiveness of the Action Research Arm test (ARAT) and the upper extremity section of the Motor Assessment Scale (UE-MAS) in assessing the recovery of upper extremity function in stroke inpatients receiving rehabilitation. SUBJECTS: Forty-eight stroke inpatients. SETTING: The physical medicine and rehabilitation department of a medical centre. DESIGN: The patients were tested at admission and at discharge from the department. METHODS: Various indices, including effect size d, Wilcoxon test and Spearman's rho, were used to assess responsiveness. The change in score of the upper extremity subscale of the Fugl-Meyer scale was used as the external criterion. RESULTS: The responsiveness indices of both total scores of the ARAT and UE-MAS are generally moderate and similar (d = 0.52, Wilcoxon Z = 5.03, p < 0.001 and rho = 0.66 for the ARAT; d = 0.45, Z = 4.54, p < 0.001 and rho = 0.7 for the UE-MAS). Responsiveness indices are small to moderate and similar in each of the subscales of both instruments. CONCLUSION: The results of this study support the value of the ARAT and UE-MAS for measuring recovery of upper extremity function in stroke patients.

Aged↗

PubMed1997

[Delayed exacerbation of cervical myelopathy in a case of juvenile muscular atrophy of unilateral distal upper extremity].

We reported a case in which cervical myelopathy exacerbated 20 years after the stabilization of juvenile muscular atrophy of unilateral distal upper extremity. The patient presented progressive weakness in the right proximal upper extremity and spastic paraparesis in addition to the long-lasting muscular atrophy of right distal upper extremity. Plain x-ray showed severe cervical spondylosis with kyphosis of the cervical spine. Dynamic study on MRI disclosed cervical spinal cord atrophy and compression enhanced in both flexion and extension position of the neck. Malalignment (kyphosis) and severe spondylotic change of the cervical spine seemed to affect the spinal cord with little functional reservoir, manifesting the delayed exacerbation of myelopathy. We conclude that malalignment and subsequent spondylotic change of the cervical spine would be significant factors to determine the long term prognosis of patients with juvenile muscular atrophy of unilateral distal upper extremity.

Arm↗

PubMed2004

Upper extremity interaction with a helicopter side airbag: injury criteria for dynamic hyperextension of the female elbow joint.

This paper describes a three part analysis to characterize the interaction between the female upper extremity and a helicopter cockpit side airbag system and to develop dynamic hyperextension injury criteria for the female elbow joint. Part I involved a series of 10 experiments with an original Army Black Hawk helicopter side airbag. A 5(th) percentile female Hybrid III instrumented upper extremity was used to demonstrate side airbag upper extremity loading. Two out of the 10 tests resulted in high elbow bending moments of 128 Nm and 144 Nm. Part II included dynamic hyperextension tests on 24 female cadaver elbow joints. The energy source was a drop tower utilizing a three-point bending configuration to apply elbow bending moments matching the previously conducted side airbag tests. Post-test necropsy showed that 16 of the 24 elbow joint tests resulted in injuries. Injury severity ranged from minor cartilage damage to more moderate joint dislocations and severe transverse fractures of the distal humerus. Peak elbow bending moments ranged from 42.4 Nm to 146.3 Nm. Peak bending moment proved to be a significant indicator of any elbow injury (p = 0.02) as well as elbow joint dislocation (p = 0.01). Logistic regression analyses were used to develop single and multiple variate injury risk functions. Using peak moment data for the entire test population, a 50% risk of obtaining any elbow injury was found at 56 Nm while a 50% risk of sustaining an elbow joint dislocation was found at 93 Nm for the female population. These results indicate that the peak elbow bending moments achieved in Part I are associated with a greater than 90% risk for elbow injury. Subsequently, the airbag was re-designed in an effort to mitigate this as well as the other upper extremity injury risks. Part III assessed the redesigned side airbag module to ensure injury risks had been reduced prior to implementing the new system. To facilitate this, 12 redesigned side airbag deployments were conducted using the same procedures as Part I. Results indicate that the re-designed side airbag has effectively mitigated elbow injury risks induced by the original side airbag design. It is anticipated that this study will provide researchers with additional injury criteria for assessing upper extremity injury risk caused by both military and automotive side airbag deployments.

Journal Article↗

PubMed2002

Clinical experience with upper extremity venous sonography in a high-risk cancer population.

OBJECTIVE: To determine the frequency of sonographically evident upper extremity venous thrombosis in symptomatic cancer patients with and without central venous catheters. METHODS: Retrospective review of 573 consecutive upper extremity venous sonographic reports from a 26-month period was performed. Findings including distribution of venous thrombosis, the presence of a central line, cancer type, and miscellaneous findings were recorded. RESULTS: Overall, 514 studies (90%) had satisfactory visualization of all upper extremity vessels; 53 (9%) had limited visualization of 1 or more vessels; and 6 (1%) were inconclusive. Venous thrombosis was present in 227 (40%) of 573 studies. Of the studies with positive findings, there were 186 acute, 13 chronic, 19 fibrin sheath versus nonocclusive, and 9 superficial thromboses. Central venous catheters were present in 325 (57%) of 573 studies. Sonographically evident thrombosis was present in 157 (48%) of 325 studies with central catheters versus 70 (28%) of 248 studies without central venous catheters (P = .001) CONCLUSIONS: Upper extremity venous thrombosis is common (40%) in symptomatic cancer patients and is nearly twice as frequent in cancer patients with indwelling central venous catheters.

Arm↗

PubMed2004

Therapeutic orthosis and electrical stimulation for upper extremity hemiplegia after stroke: a review of effectiveness based on evidence.

Upper extremity hemiplegia after stroke is common and disabling. Apart from conventional physical and occupational therapy, a number of additional approaches that use devices such as orthoses, prostheses, electrical stimulation, and robots have been introduced. The purpose of this review was to assess the clinical efficacy of such devices used for the affected upper extremities of acute, subacute, and chronic stroke patients. Assessments of their effectiveness and recommendations were based on the weight of published scientific evidence. The amount of evidence with respect to hand splints and shoulder slings is limited. Further study with a well-designed randomized controlled trial (RCT) is required to investigate accurately their short- and long-term efficacy. A number of studies suggested that the use of electrical stimulation for reducing shoulder subluxation or improving the function of wrist and finger extensors is effective during or shortly after the daily treatment period. The robotic approach to hemiplegic upper extremities appears to be a novel therapeutic strategy that may help improve hand and arm function. However, the longer term effectiveness after discontinuation as well as the motor recovery mechanism of electrical stimulation or robotic devices remains unclear. More research is needed to determine the evidence-based effectiveness of electrical stimulation or other devices for stroke survivors.

Arm↗

PubMed2004

Autosomal recessive spastic ataxia of Charlevoix-Saguenay: upper extremity aptitudes, functional independence and social participation.

Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is an early-onset ataxia with pyramidal, cerebellar and distal neuropathic involvement. A cross-sectional study with 24 subjects was carried out to examine upper extremity aptitudes in ARSACS by comparing scores between two age groups (<40 and > or =40) and with reference values. Upper extremity aptitude measures included coordination, gross and fine dexterity, upper extremity strength, muscle tone, kinaesthetic sensitivity and global upper extremity performance. Functional aptitudes were evaluated with part of the Functional Independence Measure (FIM) and social participation was measured with the Assessment of Life Habits. Data showed significant differences between younger and older participants for coordination, gross and fine finger dexterity, pinch strength and global performance. Even the younger group had lower scores when compared with reference values. Functional aptitudes and social participation also showed differences between the two groups but the younger group had near normal performance as compared with reference values. This study demonstrated that upper extremity aptitudes related to coordination are affected early in the course of the disease. Functional independence and social participation showed a decrease performance later on and a high level of variability.

Adult↗

PubMed2005

Palmar arch revascularization for arterial occlusion of the distal upper extremity.

During a period of nine years, 10 patients, ages 42 to 66 years (55 +/- 7, mean +/- SD) underwent upper extremity bypass for ischemic changes to the hand not responsive to conservative management. Patients were referred from the vascular department at the authors' institution. Preoperative angiograms were performed and attempts at angioplasty or intravenous attempts to dissolve clots were carried out (with tissue plasminogen activator-tPA) when appropriate. Patients with persistent upper extremity ischemia and an obvious occlusion with reconstitution in the hand were candidates for upper extremity bypass to the palmar arch. All patients had upper extremity bypasses performed with reverse saphenous vein grafts. The proximal anastomoses (end-to-side) were performed by either the vascular or plastic surgery team, while all distal anastomoses (end-to-side) were performed by plastic surgery team microscopic magnification to the deep or superficial palmar arch. Postoperative follow-up ranged from 3 months to 3 years. The bypass graft to the hand resulted in improved pain and resolution of tissue ischemia in all cases. Patients with preoperative ulcers were completely healed by 3 months. The results are in accordance with previous studies demonstrating that improved blood flow afforded by the procedure can improve the healing of recalcitrant ulcers and mitigate the symptoms of ischemic changes. In addition, end-to-side anastomosis to the palmar arch offers significant advantages, in that the continuity of the arch is maintained with all possible outflow vessels, and the problems associated with size discrepancy in the anastomosed vessels are eliminated.

Adult↗