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PubMed2002

Coronary steal from a left internal mammary artery coronary bypass graft by a left upper extremity arteriovenous hemodialysis fistula.

In patients with end-stage renal disease undergoing hemodialysis, the upper extremity arteriovenous (AV) fistula is the dialysis access recommended by the DOQI guidelines for patients with appropriate vasculature. Upper extremity AV fistulae have long periods of usefulness, high flow rates, and low associated complication rates. Placement of AV access may result in increased cardiac output and increased cardiac oxygen demand in these patients. In general, cardiovascular complications from AV access have been limited. We report a novel cardiovascular complication of AV access in an end-stage renal disease patient with a coronary artery bypass graft employing the left internal mammary artery who experienced angina while undergoing hemodialysis. The angina was mediated at least in part by cardiac catheterization laboratory-documented steal of blood flow from the internal mammary artery graft. This phenomenon suggests the need to consider the impact of upper extremity access placement on blood flow to the left internal mammary artery in patients who previously have undergone placement of a coronary artery bypass graft.

Aged↗

PubMed2000

Upper extremity replantation: three-year experience.

Microsurgery in Mexico was initiated in 1967, when the first report of the subspecialty was published. At our hospital, we have had a well-organized microsurgery department since 1995. This has improved our management of patients with amputations of the upper extremity. This article presents our experience with upper extremity replantation, including hand and fingers. During the first 3 years, we managed 55 patients, 42 male and 13 female, aged 2-52 years, who had suffered amputations of some part of their upper extremity or even of the complete limb. These patients underwent surgical exploration for replantation. We analyzed 103 amputations in the 55 patients operated. The amputated parts are summarized as follows: 11 thumbs, 25 index, 24 middle, 22 ring, and 12 little fingers; 5 hands, 5 forearms, and 2 arms. The average hospital stay was 10 days. The follow-up was 6-24 months. Replantation success was 82%, with 18% failure for survival of the replanted part. Functional recovery was satisfactory in the 50% of cases, and sensitive recovery was satisfactory in 75% of cases. We conclude that although our experience on upper extremity replantation is not so large, our results are similar to those from other series. We discussed our results.

Adolescent↗

PubMed2000

Recovery of upper-extremity strength in complete and incomplete tetraplegia: a multicenter study.

OBJECTIVE: To examine upper-extremity motor recovery of subjects with tetraplegia with both complete and incomplete injuries, to predict which patients and at what time they would recover a motor level. DESIGN: Prospective, multicenter clinical study of upper-extremity motor recovery in subjects with acute traumatic spinal cord injury. SETTING: Three regional spinal cord injury centers. SUBJECTS: One hundred sixty-seven individuals with acute traumatic tetraplegia (144 males [86%], and 23 females [14%]) between the ages of 15 and 75 years (mean age, 35.5 yrs). METHODS: Subjects were examined and classified using sequential manual muscle tests performed on admission, 72 hours, 1, 2, and 3 weeks, and 1, 2, 3, 6, 12, 18, and 24 months postinjury. C5 biceps, C6 extensor carpi radialis, C7 triceps, and C8 flexor digitorum profundus were evaluated using a 0-5 scale. Analyses of the right motor levels used a series of logistic regression models, and for multiple measurements on each subject, models were estimated using generalized estimating equations. RESULTS: The analysis for recovery of the biceps for the C4 group showed 70% of complete compared with 90% of incomplete injuries recovered (p < .001); of the extensor carpi radialis in the C5 group, 75% complete and 90% incomplete recovered (p < .002); and of the triceps in the C6 group, 85% of complete and 90% of incomplete injuries recovered (p < .16). CONCLUSION: Predicting future potential for upper-extremity motor recovery and for independence in self-care in groups of patients at a specific motor level is possible within the first week of injury.

Adolescent↗

PubMed2002

Upper-extremity deep vein thrombosis associated with peripherally inserted central catheters in acute spinal cord injury: a report of 2 cases.

Catheter-associated upper-extremity deep vein thrombosis (DVT) carries a 12% to 36% risk of pulmonary embolism (PE). Acute spinal cord injury (SCI) is a thrombophilic state resulting from altered fibrinolytic and platelet function and abnormal concentrations of clotting factors. Patients with SCI are frequently burdened with the classic risk factors of Virchow's triad including stasis, hypercoagulability, and intimal trauma. We present 2 patients with acute cervical SCI, both with venous thrombosis of the upper extremity associated with peripherally inserted central catheters. Both thrombotic events were insidious, and 1 patient developed a large PE. A high index of suspicion is necessary to make the diagnosis, and prompt aggressive anticoagulation is warranted absent contraindications. Little is known about the prevalence of and the morbidity associated with upper-extremity DVT in the SCI population. Our experience suggests that catheter-related, upper-extremity venous thromboembolism in SCI deserves further study.

Acute Disease↗

PubMedDate not supplied

Upper extremity ischemia from developmental failure of brachial artery-a case report.

Advances in medicine and technology have increased brachial artery utilization for diagnostic and interventional radiology. Hence, detection and assessment of variations in upper extremity vasculature are important regardless of the low surgical intervention rate in the upper extremity. Anomalies of the upper extremity artery are infrequently reported, and anomalies of the brachial artery are even less common. Presented here is a case of developmental failure of the brachial artery. A segment about 2.1 cm from its origin was treated with bypass surgery. This is presented as an uncommon variation of the brachial artery.

Blood Vessel Prosthesis Implantation↗

PubMed2006

Motor assessment of upper extremity function and its relation with fatigue, cognitive function and quality of life in multiple sclerosis patients.

OBJECTIVES: The aim of this study was to assess the motor function of upper extremity and its relation with fatigue, cognitive function and quality of life in Multiple Sclerosis (MS) patients. DESIGN: Cross-sectional and controlled study. SETTING: Outpatient clinic in a university hospital. SUBJECTS: Thirty-one patients with MS (25 women, 6 men; mean age 39.74 +/- 10.10 years; mean EDSS, 2.56 +/- 1.91) and 30 healthy subjects (20 women, 10 men; mean age 33.56 +/- 8.85 years) were enrolled into the study. MAIN MEASURES: Nine-hole peg test (9-HPT) and Valpar Component Work Sample Test (VCWS-4), Upper Extremity Index (UEI), Paced Auditory Serial Addition Test (PASAT), Fatigue Severity Scale (FSS), and the Multiple Sclerosis Quality of Life-54 (MSQOL-54). RESULTS: MS patients showed significant impairment in upper extremity motor functions, cognitive function and excessive fatigue compared to controls (p < 0.05). 9-HPT in MS group correlated with EDSS, UEI and MSQOL-54 physical health and cognitive function, whereas VCWS-4 scores (assembly right, assembly left and disassembly) correlated only with EDSS and UEI. No correlation was found between the VCWS-4 and cognitive function and fatigue in both of the groups. Compared to control group, a strong correlation existed between the 9-HPT and VCWS-4 in MS patients (p < 0.05). CONCLUSION: The results indicate that disability level (EDSS), UEI and cognitive function in MS patients are related with impairment in upper extremity motor function. This again contributes to an impairment in physical domain of quality of life. A strong correlation of the 9-HPT with VCWS-4 supports the use of the 9-HPT as a measure of manual dexterity and gross motor functions.

Adult↗

PubMed1998

Long-term complications of snake bites to the upper extremity.

The purpose of this study was to determine long-term complications of upper-extremity snake envenomations. The records of 73 patients, who were seen for snake bites were obtained; 46 of these patients had bites to the upper extremity, and 27 had bites to the lower extremity. These patients were graded according to the severity of the bite. The snakes involved were eastern diamondback rattlesnake, coral snake, pigmy rattlesnake, water moccasin, and unknown. Fourteen of the 46 patients receiving upper extremity bites were examined by a hand surgeon and an occupational hand therapist 1 to 3.2 years after their bite. Subjective pain data, range-of-motion, intrinsic, extrinsic, finger-flexion tightness, grip strength, pinch strength and objective sensory data were collected. Four patients had continued pain and tissue atrophy at the bite site. There were no long-term sequelae from a missed compartment syndrome.

Adult↗

PubMed1996

Assessment of upper-extremity function in children with spastic diplegia before and after selective dorsal rhizotomy.

The upper-extremity function of 26 children (mean age 6.0 years) with spastic diplegia was assessed prior to and one year following selective dorsal rhizotomy (SDR). No significant change was found in upper extremity range of motion, muscle tone, or strength (MMT). A significant increase was noted in grasp strength bilaterally which could not be explained simply on the basis of maturation. Manipulation patterns were noted to improve significantly one year after SDR; however, this was proposed to be a maturation rather than intervention effect. Standardized test results revealed no significant improvement in functional hand use when the scores of children with spastic diplegia were compared with age-matched norms, to control for the effect of maturation. The significant improvement found in ability to toilet, dress and undress independently was most likely due to the effect of SDR on lower-extremity muscle tone. Further investigation with a matched control group would provide a conclusive result regarding the effect of SDR on upper extremity function and assist in understanding the maturation of hand function in children with spastic diplegia.

Activities of Daily Living↗

PubMed2002

Upper extremity infections following common carp fish (cyprinus carpio) handling.

Upper extremity infection caused by aquatic pathogens on fish is a well recognized clinical entity. We report five consecutive cases of upper extremity infections, ranging from a simple localized reaction to a life-threatening systemic illness, which developed after handling common carp fish (Cyprinus carpio). In four cases, infection occurred following a penetrating injury by either the bones or the fin spines of the fish. Vibrio vulnificus was isolated from wound aspirates in four cases. Early broad-spectrum antibiotic therapy is mandatory. Deterioration in the clinical condition or a poor response to conservative treatment requires a meticulous surgical drainage and excision of both infected and necrotic tissues.

Aged↗

PubMed1987

Rehabilitation in dual disability of hemiplegia and upper extremity amputation: two case reports.

Dual disability involving amputation and hemiplegia is relatively rare. The vast majority of these cases involve lower extremity amputations. In this report two patients sustained a right-sided hemiplegia complicating an old left upper extremity amputation. Through the comprehensive rehabilitation program these two patients were able to make gains, especially in some activities of daily living and in lower extremity functions. Since some of the upper extremity activities, such as dressing or bathing, could not be accomplished, it appears that patients with upper extremity amputation who have a contralateral hemiplegia have a poorer prognosis for achieving functional independence than patients with lower extremity amputation and similar neurologic loss.

Amputation, Surgical↗

PubMed1999

Contraction-induced upper extremity H reflexes: normative values.

OBJECTIVES: To determine the reliability of contraction-induced upper extremity H reflexes; to calculate normal values for latency, amplitude, and side-to-side variation; and to correlate latency to arm length. DESIGN: Case series. SETTING: Electrophysiology laboratory of a tertiary care center. PARTICIPANTS: Twenty-three healthy volunteers (4 men, 19 women), aged 19 to 42. INTERVENTION: Volunteers were tested bilaterally for H reflexes in four to six upper extremity muscles during an isometric contraction. MAIN OUTCOME MEASURES: H reflex onset latency, onset to negative peak amplitude, side-to-side variation, normal ranges, and latency versus arm-length correlation. RESULTS: H reflexes were found at all 264 sites tested. Mean latencies varied from 9.5 to 27 msec. Maximum normal side-to-side variation was 1.5 to 2.7 msec. Maximum normal amplitude ratios (larger to smaller) ranged from 2.06 to 4.80. Abductor pollicis brevis (APB) and abductor digiti minimi (ADM) H reflex latencies were strongly correlated to arm length. Correlation for APB = .64 (p<.0001) and for ADM = .70 (p<.0001). CONCLUSIONS: Contraction-induced upper extremity H reflexes occur consistently in healthy adults, with latencies, amplitudes, and side-to-side variation occurring in predictable ranges.

Adult↗

PubMed1975

[Surgical treatment of elephantiasis of the upper extremities].

According to the author' data elephantiasis of the upper extremities was observed in 13 (6.2%) among 215 patients, operated upon for elephantiasis of the extremities. There were 3 males and 10 females. The patients' age ranged from 3 to 56 years. Five patients suffered elephantiasis of the upper extremity since their birth, 8 patients showed acquired elephantiasis, in particular after mastectomy and operative procedures in the axillary region. Late results of surgical treatment proved to be quite satisfactory.

Adolescent↗

PubMed2004

Long-term outcome following thrombembolectomy in the upper extremity.

OBJECTIVES: To evaluate short- and long-term mortality and morbidity in patients that were treated for acute upper extremity ischemia. DESIGN: Single center retrospective study. PATIENTS: A consecutive series of 148 patients who were admitted with a diagnosis of acute ischemia of the upper extremity during an 11-year period. METHODS: All charts were reviewed retrospectively and 96% of all survivors participated in clinical follow-up. RESULTS: The median age was 78 years and 64% of patients were females. The 30-day mortality was 8% and the overall 5-year survival 37%. The observed mortality during the follow-up period was significantly higher than expected. Survival was not significantly different in patients who received anticoagulant drugs following discharge from the hospital. The duration of ischemia did not significantly influence long-term arm-function. CONCLUSIONS: Acute embolic episodes in the upper extremity primarily occur in elderly and the peri-operative mortality is high. Mortality following discharge from the hospital remains significantly higher than that of the background population.

Acute Disease↗

PubMed1991

Bite wounds to the upper extremity.

The complications secondary to mismanaged or neglected bite wounds to the upper extremity can be devastating to upper extremity functioning. An organized approach to treatment can prevent infection and permanent disability.

Animals↗

PubMed2002

Biomechanical models for the pathogenesis of specific distal upper extremity disorders.

BACKGROUND: Knowledge of the pathogenesis of most disorders that occur in the distal upper extremity is generally lacking. The individual roles of postulated etiologic factors, such as biomechanical or psychosocial exposures, are poorly understood and their potential interactions even less so. This article proposes biomechanical or physiological models of pathogenesis for specific distal upper extremity disorders. METHODS: Tendon entrapment of the dorsal wrist compartments (tenosynovitis), peritendinitis, lateral epicondylitis, and carpal tunnel syndrome are common specific neuromusculoskeletal disorders of the upper extremities observed among workers. The normal anatomy and function of the targeted structures is considered the initial state; their pathology is considered the final state. Using biomechanical or physiological principles combined with clinical observations and experimental studies, pathways leading from the initial state to the final state are proposed. Each model defined a critical biomechanical or physiological attribute that was considered to best characterize 'dose.' Two temporal patterns of exposure (duration vs. repetition) were used to characterize 'dosage.' The roles of long-term exposure vs. unaccustomed work were mentioned, but not incorporated into the models. RESULTS: Compressive force transmitted to the extensor retinaculum was considered the critical factor in the model for tendon entrapment at the dorsal wrist compartments. Two models were proposed for lateral epicondylitis. One emphasized the role of eccentric exertions; the other emphasized contact pressure from the radial head. The model for peritendinitis relied on localized muscle fatigue. Seven plausible models were presented for carpal tunnel syndrome. CONCLUSIONS: It is possible to propose biologically plausible models of pathogenesis that are both coherent with current knowledge of tissue responses and consistent with clinical observations; however, more than one model was plausible for some conditions. Additional research is needed to determine which, if any, of the proposed models might be correct. Such models may be useful to health care providers and ergonomists in the context of primary, secondary, or tertiary prevention.

Biomechanical Phenomena↗

PubMed1994

Upper extremity arterial injuries: experience at the Royal Adelaide Hospital, 1969 to 1991.

PURPOSE: A review of upper extremity arterial injuries managed at the Royal Adelaide Hospital between 1969 and 1991 was undertaken because the optimal management of complex upper extremity trauma, particularly in proximal injuries, remains unclear. METHODS: Patients were identified from the computer registry of patients treated by the vascular unit at the Royal Adelaide Hospital. They were studied in three groups: (1) subclavian and axillary artery, (2) brachial artery, and (3) radial and ulnar artery injuries. The mechanism of injury, associated injuries, treatment and outcome were reviewed. RESULTS: There were 114 patients with upper extremity arterial injuries: 28 with subclavian and axillary, 62 with brachial, and 24 with radial and ulnar artery injuries. Good upper limb function was obtained in 32% of subclavian and axillary artery injuries, 79% of brachial artery injuries, and all radial and ulnar artery injuries. Amputation was performed in 14% of the proximal injuries and 8% of the brachial artery injuries. Three deaths occurred in this study group. CONCLUSION: Blunt proximal injuries were usually associated with neurologic, soft tissue, and bony damage, which was responsible for the poor functional outcome. Critical limb ischemia or severe hemorrhage rarely occurred. Complete brachial plexus lesions resulted in uniformly poor outcomes. More distal injuries were associated with fewer nerve and soft tissue injuries, resulting in a more satisfactory outcome.

Adolescent↗

PubMed1992

Upper extremity occlusive arterial disease after radiotherapy for breast cancer.

Upper extremity arterial occlusive disease is a rare complication of radiation therapy for breast cancer. We present the case of a 74 year old woman who developed upper extremity ischemia 32 years after mastectomy and radiation therapy. Arteriography identified a stenotic proximal brachial artery lesion within the previous radiation field. Balloon angioplasty was unsuccessful. An axillo-brachial bypass relieved the ischemia and is still patent after 24 months. The previous literature shows that arterial bypass procedures have been uniformly successful in this circumstance. Little experience has been reported with balloon angioplasty for these lesions.

Aged↗

PubMed1997

Major vascular malformations of the upper extremity: long-term observation.

Vascular malformations of the upper extremity continue to be a therapeutic challenge to the hand surgeon. In the past 22 years, the authors treated 17 patients with major vascular malformations of the upper extremity. The lesions were evaluated with the aid of plain radiographs, angiography, and histology. Thirteen of the patients were female and 4 were male. The average age at treatment was 18 years, ranging from birth to 64 years. The average follow-up period was 12 years, ranging from 4 months to 36 years. The main indications for surgery were pain, progressive enlargement, neurologic compromise, diminished function, or a combination of these. The progression of these lesions under observation led to surgical management in all cases. A total of 36 excisions, 3 embolizations, and 4 amputations were done. Postoperative angiograms were obtained in selected individuals. Diffuse lesions defied total surgical removal. Recurrence and persistence was evident in 12 of the 17 patients. A knowledge of the progressive nature of these lesions and the need for long-term observation are the keystones to the successful management of these challenging yet unresolved problems.

Adolescent↗