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At least 343 records · Page 19Linked to original sources

PubMed2006

Upper-extremity disability in essential tremor.

OBJECTIVE: To determine the extent of disability in subjects with essential tremor (ET) using time-based, standardized measures of upper-extremity function. DESIGN: Descriptive case series. SETTING: Motor performance research laboratory. PARTICIPANTS: Thirty subjects with ET (mean age, 58.3+/-13.7 y) and 28 healthy controls (mean age, 58.4+/-12.4 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We assessed upper-extremity function using the Box and Block Test, Purdue Pegboard Test (PPT), and Test Evaluant la performance des Membres supérieurs des Personnes Agées (TEMPA). We measured tremor severity with laser displacement sensors. RESULTS: Subjects with ET-type tremor in 1 or both hands performed significantly worse than controls on all unilateral and bilateral tasks (P range, .038-.001) except on the PPT for the dominant side. ET subjects without ET-type tremor in the dominant hand also performed significantly worse than controls on the TEMPA unilateral tasks (P=.043). Performance on the 3 functional measures correlated moderately with tremor severity for the nondominant hand. CONCLUSIONS: Subjects with ET show measurable disability on time-based measures of upper-extremity function. However, our findings are consistent with other reports that tremor severity does not correlate well with disability, especially with regard to the dominant upper extremity.

Adult↗

PubMed2004

Impact of musculoskeletal co-morbidity of neck and upper extremities on healthcare utilisation and sickness absence for low back pain.

AIMS: To describe the presence of musculoskeletal co-morbidity of the neck and upper extremities among industrial workers with low back pain, and to examine whether it has an impact on healthcare utilisation and sickness absence for low back pain. METHODS: A self administered questionnaire was used to collect data from 505 industrial workers (response 86%). RESULTS: The 12 month prevalence of low back pain was 50%. Among subjects with low back pain the 12 month prevalence of musculoskeletal co-morbidity of the neck and upper extremities was 68%. Among workers with low back pain, subjects with high pain intensity or disabling low back pain were more likely to have musculoskeletal co-morbidity. In comparison to the subjects who report back pain only, subjects with co-morbidity showed worse general health and health related quality of life. No impact of upper extremity co-morbidity was found on healthcare utilisation, and sickness absence due to low back pain. CONCLUSIONS: This study provides no evidence that musculoskeletal co-morbidity of the neck and upper extremities influences the choice to seek care or take sick leave due to low back pain among industrial manual workers. For occupational health practitioners the finding of a high co-morbidity is important to consider when implementing workplace interventions aimed at the reduction of specific musculoskeletal complaints, since the controls for one musculoskeletal complaint may impact adversely on another musculoskeletal complaint. Researchers who perform low back pain intervention studies using generic health measures, should take into account the impact of musculoskeletal co-morbidity on these measures.

Absenteeism↗

PubMed2005

Workstyle: development of a measure of response to work in those with upper extremity pain.

Workstyle or the behavioral, cognitive, and physiological response that can occur in some individuals to increases in work demands has been proposed to help explain the link between ergonomic and psychosocial factors in the exacerbation of work-related upper extremity symptoms. Currently, there is no measure of this construct, hindering research on its potential link to work related upper extremity problems in the workplace. The present study describes the development and psychometric properties of a measure of workstyle. Questionnaire items reflecting dimensions of workstyle as per the original conceptualization were generated primarily through focus groups with office workers and separate groups held with occupational physicians, physical therapists, occupational health psychologists, and experts in ergonomics, behavioral science, and human factors. Items created through this process were then administered to 282 symptomatic and asymptomatic office workers. Measures of job stress, ergonomic risk, upper extremity symptoms, and functional limitations were also obtained. The workstyle questionnaire was divided into two broad dimensions: Characteristic responses to work and Response to increased work demands. The scale development process as indicated by factor analysis yielded subscales that are theoretically consistent with the workstyle construct. These subscales include: working through pain, social reactivity at work, limited workplace support, deadlines/pressure, self imposed work pace/workload, breaks, mood, pain/tension, autonomic response, and numbness tingling. The internal consistency of these subscales varied from 0.61 to 0.91, n = 282 while the test-retest (3 weeks) reliability for the various subscales ranged from r = 0.68 to 0.89, n = 143. A total workstyle score was computed that excluded the pain/tension and numbness/tingling subscales to avoid circular reasoning in terms of the measure's relationship to outcomes of pain and functional limitations. The total score was stable over time and provided unique variance in relation to traditional measures of job stress. Total workstyle score was significantly associated with higher levels of pain, and greater functional limitations. Dimensions of the workstyle construct were identified. The workstyle measure possesses acceptable psychometric properties in office workers who work with computers. This measure can be used in future studies on the interaction of psychosocial and ergonomic factors in the exacerbation of upper extremity pain and functional limitation.

Adult↗

PubMed2005

The effect of wrist guard use on upper-extremity injuries in snowboarders.

The objective of this investigation was to determine the effect of wrist guard use on all upper-extremity injuries in snowboarders. This matched case-control study was conducted at 19 ski areas in Quebec, Canada. Cases were 1,066 injured snowboarders who reported upper-extremity injuries to the ski patrol during the 2001-2002 season. Controls were 970 snowboarders with non-upper-extremity injuries who were matched to cases on ski area and the nearest date, age, and sex, in that order. The response rate was 71.8% (73.5% for cases and 70.1% for controls). Cases were compared with controls with regard to wrist guard use. The prevalence of wrist guard use among snowboarders with hand, wrist, or forearm injuries was 1.6%; for those with elbow, upper arm, or shoulder injuries, it was 6.3%; and for controls, it was 3.9%. Thus, wrist guard use reduced the risk of hand, wrist, or forearm injury by 85% (adjusted odds ratio = 0.15, 95% confidence interval: 0.05, 0.45). However, the adjusted odds ratio for elbow, upper arm, or shoulder injury was 2.35 (95% confidence interval: 0.70, 7.81). These results provide evidence that use of wrist guards reduces the risk of hand, wrist, and forearm injuries but may increase the risk of elbow, upper arm, and shoulder injuries.

Adolescent↗

PubMed1996

Is immediate decompression of high voltage electrical injuries to the upper extremity always necessary?

OBJECTIVE: To determine if immediate decompression is required for all high voltage injuries to the upper extremity. DESIGN: Retrospective review. MATERIALS AND METHODS: Charts reviewed of 62 patients who had upper extremity contact with >1,000 volts of electricity over a 10-year period. MAIN RESULTS: One hundred upper extremities were treated. Twenty-two percent were decompressed within 24 hours because of progressive nerve dysfunction, clinical compartment syndrome, or failure of resuscitation. This group required a mean of 4.2 operations with an amputation rate of 45%, similar to other series. Thirty-five percent of burned extremities had their first operative procedure delayed until resuscitation was complete. This group required a mean of 2.1 operations with no amputations. Forty-three percent of extremities did not require operations to achieve healing. Overall results show a 10.0% amputation rate and mean hospital stay of 27 days. CONCLUSIONS: We conclude that the need for amputation and multiple operations is determined by the injury itself and that immediate decompression is only required for the usual clinical signs of compartment syndrome. Selective decompression may actually preserve tissue and decrease the need for eventual amputation because fasciotomy can lead to soft tissue dessication by exposing viable tissue.

Adolescent↗

PubMed2005

A methodological study of computerized venous strain-gauge plethysmography of the upper extremities.

This study was performed to assess the efficiency of computerized strain-gauge plethysmography for evaluation of venous volume (VV) and outflow capacity of the upper extremities and to receive reference values. For this purpose, we investigated 34 healthy controls; 16 males and 18 females with a mean age of 45 years (range 31-58 years). These results were compared with those obtained in 32 patients with earlier spontaneous deep venous thrombosis (DVT) in the upper extremities. In the control group, there was no difference between right and left arm and none of the variables were influenced by age and gender. Venous volume and rate of venous emptying (VE) were significantly lower in arms with earlier DVT than in those without (VV: DVT arms 3.7+/-0.96 ml 100ml-1 and controls 4.6+/-0.81 ml 100 ml-1; VE: DVT arms 79+/-24 ml 100 ml-1 min-1 and controls 110+/-21 ml 100 ml-1 min-1). Repeated measurements had a coefficient of variation of approximately 10% in both groups. We found the device easy to handle and the results demonstrates that this is a useful method to study venous function in upper extremities. This implicates that computerized strain-gauge plethysmography is an efficient method both for clinical diagnostic routine and research studies of circulatory changes in acute and chronic DVT in the upper extremity.

Adult↗

PubMed2005

Upper extremity kinetics during Lofstrand crutch-assisted gait.

A three-dimensional (3D) biomechanical model was developed to determine upper extremity kinematics and kinetics of persons walking with forearm crutches. Six-component load cells and strain gauges were installed in the crutches to determine crutch forces. A six-camera VICON motion system was used to acquire coordinate data from 24 reflective markers attached to the upper extremities and crutches. Joint axes for the wrist, elbow, and glenohumeral joints were defined and joint forces and moments were determined using inverse dynamics. Accuracy of the crutch instrumentation was established by simultaneously collecting force data from a Kistler forceplate and each crutch during crutch-assisted gait with the respective crutch tip contacting the forceplate. In order to demonstrate the application of this biomechanical model, upper extremity weight bearing forces, joint motion, and stride characteristics were recorded from a subject with T-12 incomplete spinal cord injury (SCI), using a crutch-assisted reciprocal four-point gait pattern. The peak net joint forces and moments were greater for the right arm opposite the weaker left lower extremity. The largest joint forces were directed superiorly (Fz) and the asymmetrical pattern of crutch use was consistent with lower extremity strength differences. During left leg weight acceptance, increased right wrist extension motion and moment were recorded, which may contribute to wrist pathology.

Aged↗

PubMed1984

Functional test for the hemiparetic upper extremity.

A test, called the Functional Test, that evaluates the integrated function of the total upper extremity of an adult hemiparetic patient has been developed. It was used with 82 patients admitted to Rancho Los Amigos Hospital for stroke rehabilitation, together with a battery of six objective test measures. Sequential testing by two examiners demonstrated that the test had interrater reliability. The Functional Test score accounted for 87 percent of the variation in the scores achieved by the patients on the six separate objective measures. This tool integrates the information from these objective assessments and appears to be a valid measure of functional use of the hemiparetic upper extremity. The test can be administered in approximately 30 minutes, can be used in different treatment settings, and provides an accurate and immediate assessment of upper extremity capabilities.

Adult↗

PubMed2001

Upper extremity venous gangrene following coronary artery bypass. A case report and review of the literature.

Acute symptomatic upper extremity deep vein thrombosis (DVT) are estimated to account for only 2-4% of all deep vein thrombosis. Upper extremity DVT leading to phlegmasia cerulea dolens (PCD) occurs in an estimated 2-5% of these cases. Progression of PCD to venous gangrene is extremely rare with only 16 previously reported cases in the literature. Only 7 of the cited cases document significant tissue loss. This report describes a 61-year-old male who developed upper extremity DVT complicated by PCD which led to venous gangrene and limb loss.

Amputation, Surgical↗

PubMed1976

Dislocations of the upper extremity in children.

Traumatic dislocations and subluxations of the upper extremity in children have been surveyed. The elbow joint is most commonly dislocated and is dislocated more frequently in children than in adults. Severe neurovascular injury may be associated with dislocation of this joint. The most common subluxation is that of the radial head, secondary to a "pulled elbow." Otherwise dislocations and subluxations of the upper extremity are uncommon in children, apparently because of the relative weakness of the epiphyseal plate. Most of these injuries are the result of predictable indirect forces. Principles of reduction and immobilization are based on the unique anatomic structure of the joint involved and the known anatomic disruption resulting from the trauma.

Acromioclavicular Joint↗

PubMed1992

In situ and composite in situ vein bypass for upper extremity ischaemia.

The in situ saphenous vein bypass for lower limb revascularisation is well established. For upper extremity ischaemia necessitating bypass this special technique offers the same advantages. From 1987 to 1991 five patients underwent cephalic and basilic vein in situ bypass for critical ischaemia of the upper extremity. Underlying disease was a thoracic outlet syndrome (two cases), radiation injury (one case) and a chronic atherosclerotic lesion (two cases). One graft failed because of a critical outflow situation. The most important advantage of the in situ technique for revascularisation of the upper extremity seems to be minimal endothelial damage and the better compliance of the in situ vein to the extensive movements of the joints.

Aged↗

PubMed2006

Determining causation of work-related upper extremity disorders.

To determine causation in work-related upper extremity disorders, one must appreciate the philosophical constructs used in establishing causation and have clear definitions of the disorder in question. The preponderance of evidence does not support repetition as a major risk factor for physical injury. Terms such as "repetitive stress," "repetitive strain," and "cumulative trauma" should be abandoned, and we should educate our patients as to the multiple risk factors for upper extremity pain.

Arm Injuries↗

PubMed1996

[Study on the inflation pressure of air tourniquets in surgery of the upper extremities].

52 patients were studied under two different inflation pressure so as to find out the proper inflation pressure in the upper extremity operation. Analyzing the hemostasis effect and EMG of the upper extremity under different inflation pressre, it suggested that when the air tourniquet is used in the upper extremity operation the traditionally used pressure (33.3-40.0 kPa) of the air tourniquet should be changed according to the patient's condition. Usually good hemotasis effect could be obtained under the pressure of 4.0-6.6 kPa, which is more than the systolic pressure of the brachial artery.

Air Pressure↗

PubMedDate not supplied

Updating upper extremity temporary prosthesis: thermoplastics.

Since 1989 amputees with upper-extremity burns have been fitted with a temporary prosthesis fabricated from low-temperature thermoplastic. Before 1989 conventional temporary prostheses were fabricated with plaster. The use of the thermoplastic material has produced a lightweight, cost-effective, modular system. No patients exhibited skin breakdown with the thermoplastic material. It appears that thermoplastics may be the next major breakthrough in terms of a design for a temporary upper-extremity prosthesis.

Amputation, Surgical↗

PubMed1987

Localized operable soft tissue sarcoma of the upper extremity. Presentation, management, and factors affecting local recurrence in 108 patients.

Radical ablative surgery for upper extremity sarcoma often results in significant loss of function. With the recent emphasis on limb preservation, function-sparing excision has been combined with adjuvant radiation and chemotherapy in an increasing number of patients. To assess the effect of changing management on local recurrence rates and identify factors governing local failure, the records of 108 patients with operable, nonmetastatic soft tissue sarcoma of the upper extremity, treated at the Memorial Sloan-Kettering Cancer Center between 1968 and 1978, were reviewed. Median follow-up care was 8.2 years. One third of the patients presented with locally recurrent tumors after initial treatment elsewhere. Over half of the lesions were above the elbow and 62% were high grade. Seventy-three patients (68%) had limb-sparing surgery (LSS), but margins were considered adequate in less than half. Local recurrence was directly related to the adequacy of the surgical margins and was significantly higher in the LSS patients (p = 0.008). Other factors associated with an increased risk of local failure included: presentation with local recurrence, superficial location, and invasion of vital structures (LSS only). Local failure varied significantly with histologic type and was highest in patients with embryonal rhabdomyosarcoma and angiosarcoma. When the data were subjected to multivariate analysis, the following variables emerged as independent predictors of local failure: presentation with local recurrence, surgery by LSS, inadequate margins, angiosarcoma, and invasion of vital structures. These risk factors should be carefully weighed when selecting local treatment for patients with upper extremity soft tissue sarcomas.

Adolescent↗

PubMed1988

Upper extremity function in multiple sclerosis: improving assessment sensitivity with box-and-block and nine-hole peg tests.

The need for standardized operational definitions, as well as a more sensitive, easily applied, and reproducible upper extremity functional assessment for following patients in multiple sclerosis clinical trials is evident. Experience with the use of two upper extremity functional assessment instruments--the nine-hole peg test (9HPT) and the box-and-block test (BBT)--is described. The patients, who were followed for six months, experienced subjective change in functional status but failed to show significant change on the pyramidal, cerebellar, or visual functional scores of the Kurtzke Expanded Disability Status Scale (EDSS). The prevalence of upper extremity dysfunction in multiple sclerosis, as measured by the 9HPT and the BBT, is higher than previously appreciated. The 9HPT and BBT are more sensitive in detecting upper extremity functional status change than the EDSS and should prove helpful in following patients in clinical trials.

Adult↗

PubMed1976

[Recovery of voluntary motion in the upper extremity following hemiplegia in patients with cerebrovascular accident. Prognostic evaluation].

The study aims the registration and anlaysis of the main facts which occur during recovery of the voluntary movements in the upper extremity, in patients with hemiplegia following cerebrovascular accident, and it also intends to evaluate the prognosis. Of particular interest was the comparative recognition of the spontaneous recovery of voluntary motricity in different segments of the upper extremity in 88 patients, not previously selected, with hemiplegia after cerebrovascular accident, admitted to the hospital at the acute stage. Of the 88 hemiplegic patients studied whose further evolution has been fairly followed 56 cases (group 1) experienced clinical improvement, either with partial or total remission of neurological manifestations and complete recovery of all voluntary movements in the different upper extremity joints, while 32 patients (group 2) with persistent neurological symptoms, particularly spasticity, showed a slighter clinical improvement, as well as only partial recovery of upper extremity movements. The clinical quantification of neurological signs applied in this study, has made possible to report the main significant changes developed during the 88 patients recovery. This criteria has allowed to emphasize the degree of the spontaneous remission of symptoms and the determination of the critical level of stabilization "plateau". The analysis of the data supplied by the two groups led to the following conclusions: a) the critical level of remission of symptoms and the spontaneous recovery of voluntary movements ocurred around the 70th day after the installation of hemiplegia; b) the 256 average score acquired 70 days after the onset of the hemiplegia represents the critical level stabilization (plateau); c) although the presence of early initial movements, immediately after the installation of hemiplegia, is a valuable data for the prognosis, the characterization of early movement patterns is of most important meaning; d) patients with hemiplegia after cerebrovascular acident who present the thumb flexion-extension and opposition movements showed a better prognosis than those whose initial movements were represented by the elbow flexion and/or arm flexion-adduction.

Adolescent↗

PubMed2004

Role of vascularised tissue transfer after oncological resection in the upper extremity.

We reviewed 12 patients who had had vascularised tissue transfer after oncological resection in the upper extremity. All patients had immediate reconstruction, and one had a double tissue transfer. Tissues used were skin flaps, free muscles, and vascularised fibulas, for resurfacing the wound, motor recovery, and reconstruction of large bony defects, respectively. All the patients returned early to their daily activities. Although local recurrences were encountered in two patients, they were again rendered disease-free by salvage operations. Two patients had secondary reconstructions using pedicle latissimus dorsi flaps for late problems, including one of the two patients who developed a local recurrence. The mean functional score using the system devised by the Musculoskeletal Tumor Society was 84%. All the upper extremities were successfully rescued with satisfactory function. Vascularised tissue transfer was invaluable for achieving both curative resection of the tumour and a useful upper extremity.

Adolescent↗