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At least 307 records · Page 17Linked to original sources

PubMed2000

The impact of seating and positioning on the development of repetitive strain injuries of the upper extremity in wheelchair athletes.

The population of people who use wheelchairs has been increasing due to technological advances. With this increase, there has also been an increase in participation in wheelchair sports. The incidence of upper extremity injury in wheelchair users has been reported to be between 31 and 73% [2,13,23,26,29]. Wheelchair athletes may be at an increased risk for upper extremity injury due to increased upper extremity use with sport. The purpose of this paper is to ascertain whether proper seating and positioning have an impact on the prevention of repetitive strain injuries (RSI) of the soft tissues, including peripheral nerve entrapments and muscle injury, of the upper extremity in wheelchair athletes. A review of current research on wheelchair propulsion and RSI revealed several hazards for wheelchair athletes to develop RSI's. These include duration of impairment, muscle imbalance, awkward positioning, inadequate rest breaks, repetition of muscle use in daily activities and in sport participation, the degree of force needed for propulsion, and fatigue. Current research does not provide conclusive information on optimal seating. Suggestions of preventative measures are given including suggestions with regard to positioning in the wheelchair.

Journal Article↗

PubMed2006

The effect of positioning for children with cerebral palsy on upper-extremity function: a review of the evidence.

CONTEXT: Controversy exists about the most appropriate seating position for children with cerebral palsy (CP) to promote energy conservation and maximize upper-extremity function. EVIDENCE ACQUISITION: Sixteen journal articles published after 1980 were identified by searching allied health, medical, and occupational and physical therapy data bases and evidence-based medicine reviews using specific key terms (positioning, wheelchair, postural control, posture, adaptive seating devices, patient positioning, cerebral palsy, movement disorders, upper extremity, reaching, grasping, and occupational therapy) and reviewing bibliographies of retrieved articles. EVIDENCE SYNTHESIS: The majority of the evidence supports the positive effects of a neutral to slightly forward orientation (whole chair tilted) on upper-extremity function. Only one study did not demonstrate such effects. Of the supporting studies, one suggested the addition of an abduction orthrosis (AO), one recommended the entire functional sitting position (FSP) package (this orientation plus a hip-belt, footrests, AO, and cutout tray), and one established the long-term effects of the FSP. One less rigorous study opposed the addition of an AO. With the exception of one study, most of the evidence states that seat angle does not affect functional abilities. However, some of these studies contain faulty methodology and/or their results demonstrate clinical significance. CONCLUSION: Evidence supports that children with CP should be fitted for wheelchairs that place them in a FSP, which includes; orientation in space of 0 degrees -15 degrees, a hip-belt, an AO, footrests, and a cutout tray, with the addition of a sloped forward seat of 0 degrees -15 degrees, to improve upper-extremity function. The exact seat angle and orientation in space within the 0 degrees -15 degrees range should be determined on an individual basis.

Activities of Daily Living↗

PubMed2006

The role of imaging of work-related upper extremity disorders.

Work-related upper extremity disorders can pose a diagnostic and management challenge because the nontraumatic disorders that are often believed to be caused by repetitive work activities can and do occur without any apparent provoking activity and can be caused or associated with many systemic medical conditions. One mainstay in the assessment of hand and arm disorders remains imaging. Imaging capabilities have made incredible advances with the advent of MRI, CT, ultrasound, bone scan, and numerous technologies that enable clinicians to view fine details of anatomy and pathology. This article reviews the potential imaging choices and clinical indications for work-related injuries of the elbow, hand, and wrist.

Arm Injuries↗

PubMed2003

Upper-extremity deep vein thrombosis.

Upper-extremity deep vein thrombosis (UEDVT) was an understudied disease until recently. Previously thought of as benign, UEDVT has been shown in recent studies to pose a significant risk for pulmonary embolus and death. This article reviews the epidemiology, risk factors, clinical features, diagnostic tests, treatment options, complications, and prevention strategies for patients with UEDVT.

Anticoagulants↗

PubMed2000

Vascular injuries of the upper extremity.

Vascular injuries of the upper extremity represent approximately 30% to 50% of all peripheral vascular injuries. The majority of injuries are to the brachial artery, and 90% of injuries are due to penetrating trauma. Return of function is often related to concomitant injury to peripheral nerves. However, timely restoration of blood flow is essential to optimize outcome. The diagnosis is made by physical examination and limited Doppler ultrasonography. Arteriography may be helpful if there are multiple sites of injury. Anticoagulation with heparin should be given if not otherwise contraindicated. Revascularization should be completed within the critical ischemic time: 4 hours for proximate injuries and 12 hours for distal injuries. Revascularization methods include resection and primary repair or resection with an interposition graft. The sequence of repair of multiple injuries to the extremity begins with arterial revascularization followed by skeletal stabilization and nerve and tendon repair.

Adult↗

PubMed1991

Upper extremity aneurysms.

Five cases of upper extremity aneurysms are reported in 4 male and 1 female patients. Four were of traumatic and one of arteriosclerotic origin. Diagnosis and treatment are discussed.

Adult↗

PubMed1990

Evolving concerns relating to occupational disorders of the upper extremity.

Occupational disorders of the upper extremity have become a problem of increasing concern around the world. The management of these problems must be understood in light of current social trends that influence patient management. Workers' compensation is one of these continually developing trends. This article describes the historical aspects of compensation and bodily injury or loss occurring in the work place. Changes in workers' attitudes during the development of workers' compensation have been observed since the turn of the century. The influence of the legal system in this regard is also noteworthy. The modern surgeon is faced with these confounding influences when treating a patient with a work-related injury or cumulative trauma disorder.

Arm Injuries↗

PubMedDate not supplied

Cardiogenic embolism of the upper extremity.

Arterial embolism of the upper extremity is not as rare and especially not as benign in all instances as was considered in the past. Postembolic ischemic changes or frank gangrene of fingers or hand may occur in a substantial percentage of patients. This paper will attempt to update the current concepts of this problem. The clinical data and the methods for evaluation of the degree of viability of the hand or forearm will be reviewed. Arteriography is recommended more liberally than in the past. Arterial embolectomy usually performed under local anesthesia is widely applicable in view of the simplicity, safety and effectiveness of the balloon catheter technique. The overall results based on a compilation from six reports indicate that complete circulatory restoration occurred in 55% and salvage without a return of wrist pulses in 24%. Gangrene occurred in 9.3% and mortality in 11.8%. In general, mortality following embolectomy is primarily related to the gravity of the cardiopathy and least to the surgical procedure.

Aged↗

PubMed1995

Benign and malignant vascular tumors of the upper extremity.

Vascular tumors of the upper extremity comprise a wide and varied group of pathologies. A variety of benign and malignant tumors exist. Proper diagnosis is imperative for the proper management of these lesions. On occasion, diagnosis can be made by a careful history and physical examination. However, the differentiation of benign from malignant tumors often requires permanent histologic section analysis by an experienced tumor specialist. The malignant vascular lesions, although rare, are aggressive in their behavior and require prompt diagnosis and treatment for patient survival.

Aneurysm↗

PubMed1995

Malignant bony tumors of the upper extremity.

Management of malignant upper-extremity tumors is a complex process that should be carried out using all the resources at the disposal of the patient and the surgeon. This article focuses on diagnosis, evaluation, pathology, and treatment.

Arm↗

PubMed1993

[The facilitation and inhibition of monosynaptic reflexes in the upper extremity of nursing infants].

The upper extremity H-reflex was investigated in healthy children, aged from 3 to 15 months. The electromyographic reflex responses of m. abduct or digiti min. and m. flexor carpi uln. were registered after electric stimulation of n. ulnaris. We constructed the curve of restoration of H-reflex after application of a couple of stimuli with equal duration and intensity, but over increasing intervals. We established changes in the excitation of H-reflex, obtained from m. flexor carpi uln., by increasing of the interval between the conditional and test stimuli. In the interval of 5 ms maximal facilitation was registered, while in the interval of 20 and 30 ms-maximal inhibition. In children aged from 3 to 9 months with persisting H-reflex in m. abductor digit min. we established possibility for its complete inhibition after application of a couple of stimuli with interval of 20 ms. In children aged from 9 to 15 months with vanished H-reflex in m. abductor digiti min. possibility for its obtaining was established after application of a couple of stimuli with interval of 5 ms. Quotation is made of evidences in favour of the hypothesis for the functional character of the disappearance of H-reflex in the small muscles of the arm in the first year of life of the children.

Arm↗

PubMed1998

Spastic hemiplegia of the upper extremity in children.

Care of upper extremity problems in hemiplegic children requires careful evaluation and planning. This article focuses on the evaluation and treatment of spastic hemiplegia attributable to cerebral palsy. All treatments must take into consideration the level of static and dynamic motor deformity; levels of discriminatory sensibility, intelligence, and motivation; and overall level of function. The treatments discussed are designed to improve the child's musculoskeletal condition but do not cure the underlying disease.

Arm↗

PubMed1999

What do we know about the reliability and validity of physical examination tests used to examine the upper extremity?

The literature regarding the reliability and validity of commonly used clinical tests for disorders of the upper extremity was reviewed. Formal literature search, standard texts, and experts in the field of upper extremity were consulted to locate relevant articles. Range of motion and strength testing of the upper limb have been shown to be reliable, while various tests used for the diagnosis of conditions in the upper limb, such as carpal tunnel syndrome and rotator cuff tendinopathy, have been shown to have varying degrees of validity. Overall, however, we determined that there is little evidence regarding the reliability and validity of physical examination for the upper extremity and specifically less information available regarding the reliability of diagnostic physical examination tests and the validity of impairment measures used for the upper limb. Further studies in this area are warranted in view of the impact of these findings on the treatment of patients.

Arm↗

PubMed2000

[A case of antiphospholipid antibody syndrome with cerebral infarction showing slowly progressive pure motor monoparesis in unilateral upper extremity].

We reported a 68-year-old man with anti-phospholipid antibody syndrome who presented slowly progressive pure motor monoparesis(PMM) in left upper extremity as a sign of cerebral infarction. He had history of hypertension and hyperlipidemia. He first noticed clumsiness in left fingers, then weakness of left fingers with drop hand developing gradually in 2 to 6 weeks. He began to feel difficulty in raising left upper arm in 8 weeks and was admitted to our hospital. On admission, he exhibited severe weakness in distal portion and moderate weakness in proximal portion of left upper extremity. Deep tendon reflexes were slightly hyperactive in left side. Muscle strength of right upper extremity and bilateral lower extremities were normal. There was no sensory and autonomic abnormality. Laboratory examination revealed high titer of anti-cardiolipin IgM antibody. Brain MRI demonstrated a small cortical infarction in the right precentral gyrus. Cerebral angiography revealed severe stenosis in right common carotid artery. Other examinations including EMG were unremarkable. PMM in left upper extremity was considered to be caused by the ischemic lesion in the precentral motor cortex. Slowly progressive course might be explained by the hypovolemic factor due to the marked stenosis in right common carotid artery, poor collateral circulation, and abnormal coagulation caused by anti-phospholipid antibody syndrome.

Aged↗

PubMed1996

Sonographic diagnosis of fetal upper extremity dysmorphology: significance and outcome.

The aim of this study was to determine the etiology, associated anomalies and outcome of fetuses with postural deformities and contractures of the upper extremities detected sonographically. Fifty-four fetuses with sonographically detected postural anomalies of the upper extremities were identified from our database. Sonographic findings and associated anomalies were tabulated on the basis of the original sonogram. Perinatal follow-up and/or karyotype were available in 52 cases from a review of the maternal and newborn medical records and pathology reports. Of the 52 fetuses with sonographically detected anomalies of the upper extremities, 44 (85%) were non-survivors and eight (15%) were survivors. Forty-three fetuses had associated sonographic abnormalities. Karyotyping performed in 44 cases revealed 26 cases (59%) of aneuploidy, with trisomy 18 accounting for 23/26 (88%). In the setting of a normal karyotype, a variety of genetic disorders were found, including syndromes involving the fetal dyskinesia/akinesia sequence. Disturbances in amniotic fluid occurred in 48% of the cases (24 fetuses with polyhydramnios and one with oligohydramnios). In conclusion, the sonographic detection of postural abnormalities of the upper extremities carries a guarded prognosis, with survival in 15% of fetuses and a high incidence of chromosomal defects.

Chromosome Aberrations↗

PubMed2000

Reliability of physical examination of the upper extremity among keyboard operators.

BACKGROUND: Physical examination is a traditional outcome measure in epidemiological research. Its value as a reliable measure depends, in part, on the prevalence of positive findings. The purpose of this paper is to determine the empirical reliability of physical examination and anthropometry in a field study of upper extremity disorders among keyboard operators. METHODS: Two experienced examiners independently performed common provocative tests and procedures in physical examinations of the neck and upper extremity among 160 keyboard operators. Two additional examiners conducted anthropometric surveys among 137 workers. Inter-examiner reliability was assessed with observed agreement, kappa statistics, and intra-class correlations (ICC). RESULTS: Observed agreement was between 96% and 100% for neck and upper extremity signs, muscle stretch reflexes, and muscle strength, however, with the exception of provocative tests, reliability statistics were unstable. Among the provocative tests, Phalen and Tinel tests had modest agreement after adjusting for chance (kappa range: 0.20-0.43). The carpal compression test had the best reliability (kappa=0.60 and kappa=0.67, left and right side, respectively). The ICCs for anthropometry ranged from 0.36-0.91. CONCLUSIONS: Results from the study showed that statistically, except for the carpal compression test, physical examination contributed minimal reliable information. This was attributed mainly to the low prevalence of positive findings, and generally mild nature of upper extremity disorders in this population. The results are the best estimate of what would be found in a field study with experienced examiners. While it may reduce bias, separating physical examination from medical history may contribute to the poor reliability of findings. With a shift toward reliable measures, resources can be allocated to more effective tools, like questionnaires, in epidemiological research of upper extremity disorders among keyboard operators.

Adult↗

PubMed1989

Upper extremity tourniquet effects in carpal tunnel release.

We studied the presence and extent of upper extremity denervation in limb muscles after surgical release of the carpal tunnel. Sixty consecutive patients were randomly assigned to have the procedure performed with (31 patients) or without (29 patients) tourniquet application. Cervical paraspinal and upper extremity muscles were examined electromyographically 3 weeks before and 3 weeks after carpal tunnel release. Three weeks after the operation 77% of the patients in the tourniquet group had denervation in other than thenar muscles. Only one patient in the control (no tourniquet) group had similar electromyographic abnormalities after surgery. Tourniquet time and pressure did not vary significantly between those patients with or without postoperative forearm denervation. Mean operative time for the tourniquet and control groups was nearly identical. These findings indicate that upper extremity tourniquet application results in subclinical, temporary changes in the muscles of the forearm, probably on the basis of nerve changes and denervation.

Arm↗

PubMed2005

Golf injuries of the upper extremity.

Golf has demonstrated increasing popularity and with this heightened enthusiasm has come an increased awareness of the significant number of injuries associated with playing golf. While back injuries represent the most commonly injured specific body part, upper extremity injuries are most frequent overall and the most likely to result in loss of play. Patterns of injury differ based on level of play and time spent playing or practicing golf. Among golf professionals, the hand/wrist is the most commonly injured upper extremity structure. Among amateurs, the elbow is most commonly injured. The vast majority of upper extremity injuries are due to overuse. Age, ability, equipment, and swing mechanics also play contributing roles. Most upper extremity golf injuries can be successfully treated with appropriate cessation or modification of play, anti-inflammatory modalities, and rehabilitation. Surgical treatment is rarely required, but if needed can prove successful in a high percentage of patients.

Carpal Bones↗