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PubMed2001

[The most common overuse injury syndromes of the upper extremity associated with work activity].

Repetitive use of upper extremities, non-physiological body posture, especially of cervical spine, shoulders, lower arms, and fists are still present in modern technological processes. Innate deformities, weakness of connective tissue, accompanying morbidity (radicular symptoms, neuropathies, superior thoracic aperture syndrome, vasopathies and neuroses) are significant pathogenic overuse syndromes. Other causes of overuse syndromes are non-ergonomic tools, musical instruments, furniture, or keyboards. Lack of training for jobs involving repetitive movements, as well as job dissatisfaction are additional aggravating factors of the overuse syndrome. Polypragmasy with drug and physical therapy, insufficient rehabilitation, and questionable medical prognosis of working capacity are challenges to public health of even in richer societies. This paper describes the most common overuse syndromes of upper extremities. The aetiology of reflex dystrophy syndrome, carpal tunnel, and myofascial painful syndrome are still insufficiently explained. The paper also presents data collected in a group of 40 metal workers exposed to significant shoulder strain. They more often reported pain in the cervical spine than the control group of workers under moderate strain (45% v. 7.5%; P < 0.01), as well as pain in the shoulders (12.5% v. 5.0%) and stiffened hand (22.5%:7.5%). Symptoms were significantly more frequent in the dominant hand. A common diagnosis in a sample of 110 musicians was a change in the shoulder joint, which was more distinct in the right shoulder (10%) than in the left (7%) and comparable in the elbows (8%). The paper proceeds with cases of advanced overuse syndrome in a textile worker and cases of dissimulation in a physician and a guitarist. The paper stresses the importance of quantification of morphological and functional changes in overuse syndromes and discusses the necessity of prevention, education, early diagnosis, pharmacological and physical therapy, and rehabilitation of overuse syndromes.

Adult↗

PubMed2004

Infections of the upper extremity in hospitalized diabetic patients: A prospective study.

OBJECTIVES: To study the clinical characteristics of a group of patients with diabetes and established upper extremity infections and to determine the causative factors of hand infections. METHODS: Prospective study of diabetic patients referred in to our service with infections of the upper extremity from January 1992 to December 2001. RESULTS: Twenty-six diabetic patients with an infection of the upper extremity were studied (17 F, 9 M). The admission rate equalled 0.7%. Twenty-one patients (80.8%) presented a Type 2 diabetes and 5 a Type 1 diabetes (19.2%). The diagnosis age of diabetes was 44.6 +/- 13.8 Years (range: 16-62). The average age at the occurrence of the lesion was 52.5 +/- 15.1 Years (range: 21-73). The average duration of diabetes was 8.3 +/- 5.9 Years (range: 0-22). Diabetes was, in all the cases, poorly controlled because of an inadequate hypoglycaemic treatment and/or bad compliance. The patients had a high prevalence of peripheral neuropathy (n=17; 65.4%). The delays in presentation to the doctor and those related to hospitalization were respectively 9.1 +/- 10.0 days (n=23) and 16.8 +/- 12.1 days. The hospitalization length reached 33.6 +/- 22.6 days (range: 7-93). The final results, 6 Months after hospitalization, were as follows: the death rate reached 19.2% (n=5); 23.1% of the patients (n=6) had a minor amputation; for 53.8% of the patients (n=14), the lesions healed without any amputation. One patient left hospital against medical advice. Eleven out of 20 patients (55%), amputated or not, were left with deformities and a subjective dysfunction of the affected limb. CONCLUSION: Infections of the upper extremity in diabetic patients constitute an uncommon but serious complication. They seem to be more frequent in housewives. They result in a high morbIdity. Prevention of these infections should be based on patients' education (compliance with diabetes treatment, hand care, prompt visit to the doctor) and General Practitioners' training for an adequate treatment and/or a rapId patient referral to hospital.

Algeria↗

PubMed2002

Thoracoscopic sympathectomy for symptomatic arterial obstruction of the upper extremities.

BACKGROUND: Severely symptomatic arterial insufficiency of the hand and upper extremities requires adequate treatment. Medical therapy and local care are usually unsuccessful, and thoracic sympathectomy can represent an effective procedure to control pain, to help ulcer healing, and to prevent or delay amputation. METHODS: We performed 20 thoracoscopic sympathectomies in 15 patients (13 men and 2 women) with upper extremity ischemia. Mean age was 47 years (range 21 to 72 years). All patients were thought to have organic blockage of digital arteries. The condition was unilateral in 10 patients and bilateral in 5. Primary diagnosis was digital arteriosclerosis in 8 patients, Buerger's disease in 4 patients and the remaining 3 were drug abusers with severe ischemia due to accidental intraarterial injection of drugs. Eleven patients (73%) presented with terminal digital necrosis, gangrene, or ulceration of the fingers associated with severe pain. Four patients complained of coldness, pain, and some degree of soft tissue infection without permanent loss of tissue. RESULTS: We performed 10 unilateral and five bilateral staged (mean interval was 3 months) thoracoscopic sympathectomies. We had two minor complications and no mortality. Mean duration of postoperative chest drainage was 2.5 +/- 0.4 days and mean postoperative hospital stay was 5.3 +/- 0.5 days. Follow-up ranged from 3 to 71 months, with a mean of 33 months. All patients demonstrated clinical benefit after operation. CONCLUSIONS: Thoracoscopic sympathectomy in patients with severe ischemia of upper limb extremities permits optimal symptomatic control and maximum tissue salvage. Because the procedure is minimally invasive, safe, and associated with a low rate of complications, it should be considered earlier the natural course of this disease.

Adult↗

PubMed1998

Trends in the incidence of upper extremity soft tissue malignancies: a 40-year review of the Connecticut State Tumor Registry.

BACKGROUND: Although soft tissue malignancies of the upper extremity are rare, the management of these lesions has been controversial and the etiologic factors associated with the occurrence of these tumors are not well understood. The purpose of this study was to identify possible epidemiologic factors related to a recently noted rise in the occurrence of these tumors in the state of Connecticut. METHODS: The occurrence of upper extremity soft tissue tumors over the past 40 years was reviewed in the Connecticut State Tumor Registry. Demographic data collected included occupational history, residence, and presence of concomitant malignancies. Tumor histology, the extent of resection, and the incidence of recurrences were also noted. Factors associated with recurrence were identified using linear regression analysis. RESULTS: During the 40-year study period, 359 patients having upper extremity soft tissue tumors were entered into the Connecticut State Tumor Registry. An increasing trend in the number of upper extremity soft tissue tumors was evident. Many patients were involved in heavy industry or related fields. Fibrosarcoma and liposarcoma were the most common tumor types, occurring in 111 (30.3%) and 48 patients (13.2%), respectively. Sixty-seven patients presented with a synchronous second primary malignancy of the breast (49 patients), lung (seven patients), or gastrointestinal tract (five patients). Most patients (69.9%) underwent local excision of the soft tissue tumors, with fewer undergoing wide excision (20.3%) or radical excision (9.7%). Recurrence, which occurred in 144 patients, was found to be associated with extent of resection, occupational history, and concomitant malignancy. Delineation of such risk factors may be helpful in identifying patients in whom aggressive management may decrease recurrence and improve survival.

Adolescent↗

PubMed1982

Upper extremity prone position exercise as aerobic capacity indicator.

Peak oxygen uptake of prone upper extremity exercise (VO2peak arm) compared with maximal oxygen uptake of upright lower extremity cycling (VO2max leg) was examined in an unselected young healthy male population (n = 21). The large standard deviation of the mean value of VO2peak arm expressed as a percentage of VO2max leg (60.48% +/- 11.84%) discourages use of a maximal upper extremity exercise test to predict total body aerobic capacity (r = 0.595 p = 0.002). However, the relationship between VO2peak arm and VO2max leg was influenced by the individual's cardiorespiratory fitness and capacity to perform either arm or leg work. When the population was divided into subgroups according to cardiorespiratory fitness or when subjects previously trained for either arm or leg work were excluded from analysis, the predictive power of VO2peak arm improved. (r = 0.946 p less than 0.001). Study results suggest that with careful analysis of subjects' fitness prior to upper extremity exercise testing, such exercise in a prone position can indicate aerobic capacity and may be used for fitness training when lower limb disabilities exist.

Adult↗

PubMed2005

Old and new risk factors for upper extremity deep venous thrombosis.

BACKGROUND: Well known risk factors for upper extremity deep venous thrombosis are the presence of a central venous catheter (CVC) and malignancy, but other potential risk factors, such as surgery, injury and hormone replacement therapy (HRT), have not yet been explored. METHODS: We performed a population-based case-control study including 179 consecutive patients, aged 18-70 years with upper extremity deep venous thrombosis and 2399 control subjects. Participants reported on acquired risk factors in a questionnaire and factor V Leiden and prothrombin 20210A mutation were ascertained. Information on CVC was obtained from discharge letters. RESULTS: Forty-two patients (23%) and one control subject (0.04%) had a CVC (ORadj: 1136, 95% CI: 153-8448, adjusted for age and sex). Cancer patients without a CVC had an eightfold increased risk of venous thrombosis of the arm (ORcrude: 7.7, 95% CI: 4.6-13.0). Other evident risk factors were prothrombotic mutations, surgery, immobilization of the arm (plaster cast), oral contraceptive use and family history, with odds ratios varying from 2.0 up to 13.1. The risk in the presence of injury and during puerperium was twofold or more increased, although not significantly. In contrast HRT, unusual exercise, travel and obesity did not increase the risk. Hormone users had an increased risk in the presence of prothrombotic mutations or surgery. Obese persons (BMI > 30 kg m(-2)) undergoing surgery had a 23-fold increased risk of arm thrombosis compared with non-obese persons not undergoing surgery. CONCLUSION: A CVC is a very strong risk factor for arm thrombosis. Most risk factors for thrombosis in the leg are also risk factors for arm thrombosis.

Adolescent↗

PubMed1995

Upper extremity injuries related to airbag deployments.

OBJECTIVE: Details on airbag injuries to the upper extremity are relatively unknown to clinicians. The injuries presented here should provide a clear understanding of the mechanisms of forearm, hand, and wrist injuries that may be seen by emergency room physicians. MATERIALS AND METHODS: From our crash investigations of 325 airbag-equipped passenger cars, a subset of upper extremity injuries are presented that are related to airbag deployments. MAIN RESULTS: Minor hand, wrist, or forearm injuries--contusions, abrasions, and sprains--are not uncommonly reported. Infrequently, hand fractures have been sustained and, in isolated cases, fractures of the forearm bones or of the thumb, wrist, and fingers. The close proximity of the forearm to the airbag module door is related to most of the fractures identified. Steering wheel airbag deployments can fling the hand-forearm into the instrument panel, rearview mirror, or windshield, as indicated by contact scuffs, tissue debris, or the star burst (spider web) pattern of windshield breakage in fron of the steering wheel. CONCLUSION: Minor injuries of the upper extremity can occur when contacted by the deploying airbag either directly or by flinging the hand-forearm into interior car structures. Fractures of the forearm are rare and usually are due to direct impact by the forceful opening of the airbag module door.

Accidents, Traffic↗

PubMed2006

Nationwide survey of juvenile muscular atrophy of distal upper extremity (Hirayama disease) in Japan.

Juvenile muscular atrophy of the distal upper extremity (JMADUE, Hirayama disease) was first reported in 1959 as 'juvenile muscular atrophy of unilateral upper extremity'. Since then, similar patients in their teens or 20s have been described, under a variety of names, not only in Japan, but also in other Asian countries, as well as Europe and North America. Biomechanical abnormalities associated with JMADUE have recently been reported through various imaging examinations, proposing its disease mechanism. Since JMADUE differs from motor neuron disease, or spinal muscular atrophy, this disease entity should be more widely recognized, and early detection and effective treatments should be considered. We report an epidemiological study in Japan. Two nationwide questionnaire-based surveys, conducted in Japan from 1996 to 1998, identified 333 cases. The numbers of patients per year, distribution of ages at onset, mode of onset, time lapse between onset and quiescence, neurological signs and symptoms, imaging findings, and the effects of conservative treatments were analyzed. The peak age was 15 to 17 years, with a marked male preponderance, usually a slow onset and progression, and quiescence six or fewer years after onset. There was a predominantly unilateral hand and forearm involvement with 'cold paresis'. The imaging findings are described.

Adolescent↗

PubMed1999

Anatomic and physiologic evaluation of upper extremity ischemia.

This study assessed the accuracy of arteriography and laser Doppler perfusion imaging (LDPI) as predictors of digital ischemia and correlated upper extremity symptoms, function, and nutritional flow with arteriographic and laser Doppler assessments. Multiple-level occlusive disease was documented in 25 hands (23 patients) by arteriography. LDPI demonstrated one or more hypoperfused digits in 17 hands. Patient questionnaires were used to assess upper extremity symptoms, pain, cold sensitivity, and function. Spearman correlation coefficients indicated that arteriography is a poor indicator of nutritional perfusion as measured by LDPI. Neither arteriography or laser Doppler perfusion imaging served as an indicator of the severity of cold intolerance. However, upper extremity symptoms and functional status correlated with both laser Doppler measurements and the level of cold sensitivity. Laser Doppler perfusion imaging and arteriographic analysis provide complimentary data in the evaluation of upper extremity ischemia.

Adolescent↗

PubMed1993

Upper extremity bypass grafting. A 15-year experience.

OBJECTIVE: To analyze the perioperative morbidity and mortality, long-term patient survival, and patency characteristics of arterial bypass related to upper extremity ischemia. DESIGN: This is a retrospective review of sequential patients undergoing upper extremity arterial bypass during a 15-year period at a single tertiary-care teaching hospital. Data are expressed in a 5-year life-table format and interpreted using log-rank analysis. PATIENTS: Seventy-four patients with upper extremity ischemia undergoing arterial bypass, which included 95 separate operations. MAIN OUTCOME MEASURES: Operative morbidity and mortality, life-table survival, life-table bypass graft patency, and limb salvage are reported. RESULTS: There was no operative mortality, and there was a single major amputation. Survival rate was 86% at 5 years, and overall patency rate was 61.2% at 5 years, with autogenous conduits superior at all sites compared with prosthesis (70.9% vs 37.7%). Secondary operation was inferior to primary bypass (66% vs 48%) and associated with higher morbidity (22% vs 5%). All far distal forearm prosthetic bypass grafts failed within 1 year. CONCLUSIONS: Primary upper extremity bypass with venous conduit is a safe, durable procedure, after which prolonged patient survival can be expected.

Adolescent↗

PubMed2001

[Range of motion in the joints of the upper extremity at different stages of sympathetic reflex dystrophy (SRD)].

Sympathetic reflex dystrophy of the upper extremity is among the most serious complications of trauma injuries. The aim of this paper was to assess the effectiveness of mobilization treatment, augmented by cryogenic temperatures of post trauma SRD of the upper extremity. The material comprised 113 patients treated at the Orthopedic Outpatient Clinic of the J. Babiński Hospital in Breslau during the years 1987-1995. All patients underwent conservative treatment because of post trauma SRD. The effectiveness of cryo-therapy was based on pre- and post-therapy ROM examination. These results were compared to the ROM of the healthy extremity and the degree of ROM limitation was hence calculated. Limitation of ROM was found in all joints of the upper extremity regardless to the stage of the disease. The greatest limitations were found in the joints directly adjacent to the area were the disease was most pronounced. The applied therapy in these cases was found to increase ROM in all patients, with the greatest increase of ROM during stage I and II of the disease.

Arm Injuries↗

PubMed1995

Upper extremity replantation at a regional medical center: a six-year review.

Trauma to the upper extremity can be a cause of significant morbidity and disability to otherwise productive people. Traumatic amputation can be particularly devastating, but many of these extremities can be saved by replanatation of the amputated parts. We reviewed the upper extremity replantations performed at the Medical Center of Central Georgia in the 6-year period from September 1987 to August 1993. A total of 48 replantations in 39 patients (33 male, six female) were studied: 36 fingers, seven thumbs, two transmetacarpals, one wrist, one forearm, and one brachium. Average patient age was 32.7 years, with a range of 4 to 69 years. All seven thumbs, two transmetacarpals, and three proximal replants survived. Viability of replanted fingers was 56 per cent; however, sharp injuries fared better than crush injuries (62% vs 50%). The success rate improved with experience of the surgeon (85% after 1990). Leeches were used effectively for venous congestion in nine of 13 cases (70%). Results were comparable with those of large academic medical institutions. Replantation of traumatic amputations can be performed with reasonable success at a regional medical center if a qualified surgeon and appropriate ancillary care are available. Results improve with experience of the surgeon and careful patient selection. Successful replantation significantly reduces the morbidity of upper extremity amputations and will continue to be important in the management of the trauma patient.

Adolescent↗

PubMed2004

Free scapular flap for reconstruction of upper extremity defects.

OBJECTIVE: To determine the functional outcome of free scapular flaps performed for reconstruction of complex upper extremity defects. DESIGN: Case series. PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, from 1998 to 2001. SUBJECTS AND METHODS: All those patients in whom free scapular flap was done for reconstruction of upper extremity defects, were included. The important variables included demographic data, etiology of soft tissue defects, site and size of defect, complications, percentage of wound coverage by flap. Patient satisfaction, objective assessment of flap and range of motion of involved joints was determined. RESULTS: There were 9 males and 2 female patients with mean age of 31.54 +/- SD11.86 years. The causes of tissue defects were road traffic accident in eight cases, bomb blast injury in 2 and industrial injury in one case. Eight scapular flaps were performed to reconstruct the defects over the hand, wrist and forearm; two flaps for defects of arm and shoulder and one for elbow coverage. Average defect size was 18 cm long and 11 cm wide. Donor site was closed primarily in all cases. Based on cosmetic appearance, coverage of required defect, performance of activities of daily living and functional range of motion of involved joints, 7 cases were graded excellent and 4 cases were good. CONCLUSION: Scapular flap provided good robust coverage, which helped to do an early reconstruction and rehabilitation in our cases. Scapular flap can be considered workhorse for reconstruction of upper extremity defects.

Adult↗

PubMed2005

Predictors of upper extremity discomfort: a longitudinal study of industrial and clerical workers.

Upper extremity discomfort associated with work activity is common with a prevalence of over 50% in many settings. This study followed a cohort of 501 active workers for an average of 5.4 years. Cases were defined as workers who were asymptomatic or had a low discomfort score of 1 or 2 at baseline testing and went on to report a discomfort score of 4 or above on a 10-point visual analog scale. This change is considered clinically significant. Controls had a low baseline discomfort score and continued to have a low discomfort rating throughout the study. The risk factors found to have the highest predictive value for identifying a person who is likely to develop a significant upper extremity discomfort rating included age over 40, a BMI over 28, a complaint of baseline discomfort, the severity of the baseline discomfort rating and a job that had a high hand activity level (based upon hand repetition and force). The risk profile identified both ergonomic and personal health factors as risks and both factors may be amenable to prevention strategies.

Adult↗

PubMedDate not supplied

Arteriographic study of variant arterial anatomy of the upper extremities.

Anatomic variations in the major arteries of the upper extremities have been reported in 11-24.4% of individuals. In a review of 100 upper extremity arteriograms, we found an overall incidence of 9%. High origin of the radial artery from the brachial artery was the most frequently encountered anomaly occurring in 7% of individuals and accounting for 78% of all anatomic variations. Origin of the radial and ulnar arteries from the axillary artery was an infrequent finding occurring in only 2% of extremities.

Adult↗

PubMed2006

Peripherally inserted central catheters and upper extremity deep vein thrombosis.

The purpose of the study was to determine the incidence and risk factors for venous thrombosis in patients with a peripherally inserted central catheter (PICC). A retrospective study of all upper extremity venous duplex scans was carried out in the Vascular Medicine department from year 2000 to 2002 inclusive. A chart review of positive scans was undertaken to identify possible thrombotic risk factors. Of 317 upper extremity venous duplex scans carried out, 115, or 32%, were positive for upper extremity deep vein thrombosis. Three main risk factors were identified - presence of a central line, malignancy and administration of chemotherapy. PICC were the most common central line present. Symptomatic thrombosis occurred in 7% of PICC inserted for chemotherapy compared with 1% of PICC inserted for other reasons. Ten per cent of the patients receiving chemotherapy through a PICC developed a thrombosis. The post-thrombotic syndrome was infrequent following upper extremity deep vein thrombosis. Patients receiving chemotherapy through a PICC are at increased risk of thrombosis. There may be a role for prophylactic low-dose anticoagulation in these high-risk patients.

Adolescent↗

PubMed1997

An electromyographic study of strength and upper extremity muscle activity in simulated meat cutting tasks.

Meat cutting has long been associated with a high incidence rate of upper extremity musculoskeletal disorders. This study examined upper extremity muscle activities and force exertion capabilities to identify postures which have potential for causing overexertion injuries. Fifteen subjects exerted force against a handle in postures similar to those observed in the meatpacking industry. Exertion level, direction of exertion, handle height, reach distance and grip type were varied. Activity in the posterior deltoid, biceps brachii, triceps brachii, extensor digitorum and flexor digitorum superficialis was monitored via surface electromyography (EMG). The ratio of normalized EMG activity to force produced during the exertion was computed for each muscle under each condition. The results showed that handle position had a significant effect on force exertion capability and the EMG/force ratio in all muscles. Force exertion capability was maximized, and the EMG/force ratio was generally minimized when participants pulled downward on a handle positioned at full arm's reach above the shoulder. For vertical cuts, force decreased and muscle activity generally increased as the handle height was lowered. For horizontal cuts, the full reach distance tended to allow greater force exertion with lower EMG/force ratios. The stab grip also tended to be associated with higher forces and lower EMG/force ratios than the slice grip. This study supports the premise that musculoskeletal stresses in meatpacking tasks can be altered through tool and workstation redesign. The data provided herein may be useful in selecting design modifications that reduce biomechanical stress on the upper extremities.

Adult↗

PubMedDate not supplied

Spectrum of upper-extremity deep venous thrombosis in a community teaching hospital.

OBJECTIVE: The goal of this study was to characterize the spectrum of upper-extremity deep venous thrombosis in a community teaching hospital. DESIGN AND SETTING: A retrospective analysis was used at a large urban teaching hospital. MATERIAL AND METHODS: We reviewed the records of 90 patients with ultrasound-documented thrombosis of the internal jugular, subclavian, axillary, or brachial veins to determine clinical characteristics, risk factors, and outcome. RESULTS: The most common underlying conditions associated with upper-extremity deep venous thrombosis were the presence of a central venous catheter in 65 patients (72%), infection in 25 (28%), extrathoracic malignancy in 20 (22%), thoracic malignancy in 19 (21%), renal failure in 19 (21%), and a prior lower-extremity deep venous thrombosis in 16 (18%). Pain was noted in 31 (34%) patients, and 76 patients (84%) had edema of the involved extremity. The left subclavian vein was involved in 44 patients (49%), and 35 patients (39%) had a central venous catheter in the left subclavian vein. When a central venous catheter was present, the deep venous thrombosis was usually ipsilateral (P <.001). Heparin and warfarin were administered to 65 (72%) and 53 (59%) of the patients, respectively. Eleven patients (12%) died. Of these patients, 8 (73%) had an underlying infection, whereas only 22% of survivors had an infection (P =.0012). CONCLUSION: Upper-extremity deep venous thrombosis typically occurs in patients with a systemic illness in the presence of a central venous catheter. The left subclavian vein is frequently involved because this is a common site for placement of a central venous catheter. Pain is uncommon, but edema of the involved extremity is noted in the majority of patients. The mortality rate of patients in this study with an upper-extremity deep venous thrombosis was 12%; most patients who died had a central venous catheter and an underlying infection.

Aged↗