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PubMed1985

Effects of a wrapping technique on passive range of motion in a spastic upper extremity.

Limited range of motion (ROM) and subsequent soft tissue contractures resulting from spasticity are common developments in patients with acquired hemiplegia from cerebrovascular accidents. The purpose of this study was to examine the effects of a wrapping technique on ROM in patients with a spastic upper extremity. Four adult patients, postcerebrovascular accident of less than one year, received wrapping of the upper extremity for three hours, three times a week on alternating days for a total of two to four weeks. Baseline passive range-of-motion (PROM) measurements were established for shoulder flexion, shoulder abduction, shoulder external rotation, and wrist extension; these movements were commonly limited in all patients. The PROM was recorded after each wrapping session. The results showed a significant change in PROM for all motions in all patients (p = less than .01). In addition, all patients reported a decrease in pain in the upper extremity. Comparisons of videotapes of two patients at baseline and after 12 wrappings revealed an increase in ROM and a decrease in spasticity in the upper extremity during ambulation. These findings should encourage clinicians to experiment further with the wrapping technique and to report their findings.

Adolescent↗

PubMed1979

Upper extremity edema control: rationale of the techniques.

Edema of the upper extremity is a condition frequently encountered by those interested in hand rehabilitation. It frequently accompanies other problems associated with functional restrictions of the upper extremities. Its control and prevention are a part of the total rehabilitation of these extremities. Persistent edema becomes painful, disfiguring, and disabling. Fibrosis develops in the edematous tissue leading to contractures. The susceptibility for infection increases and the functional ability of the limb decreases. Treatment is based upon an understanding of the pathophysiology of edema. Edema occurs when there is an imbalance of effective pressures across the capillary membrane or when there is an obstruction to venous and lymphatic flow. The conservative treatment program consists of elevation, massage, use of external compression devices, exercises, and instructions to avoid contributing factors. This paper will discuss the physiologic rationale for the effectiveness of these treatment methods.

Arm↗

PubMed1991

Callotasis lengthening in the upper extremity: indications, techniques, and pitfalls.

Bone lengthening through callotasis has been performed in 12 bones of the upper extremity in eight patients. Diagnoses included congenital amputations, phocomelia, radial agenesis, traumatic amputations, and infected fracture with bone loss. Nine of the 12 procedures resulted in complete consolidation of the transport gap with new bone without need for bone graft. One patient died of unrelated illness before completion of treatment but demonstrated early consolidation of the gap. In two cases bone graft was required. Complications included one superficial pin tract infection and one case of premature cessation of lengthening because of hand deviation. Early experience with this technique indicates that it is effective in the management of bone defects in the upper extremity. It appears that in most cases a half-frame lengthening device, rather than a more complex circular frame, can be used in the non-weight-bearing upper extremity. Adequate control of the distal segment, appropriate choice of location for corticotomy, and gentle handling of the bone and periosteum can improve results and minimize complications.

Adult↗

PubMed2002

Rare cause of acute ischemia of the right upper extremity: thrombosis of a retroesophageal subclavian artery.

Thrombosis of a subclavian artery is an uncommon cause of acute upper extremity ischemia in the elderly. Malformations of the aortic arch system are also rare. The purpose of this report is to describe an unusual case involving acute ischemia of the right upper extremity due to extensive thrombosis of a retroesophageal right subclavian artery (RSA) in a 79-year-old woman. Despite delayed diagnosis of the underlying etiology, the patient was successfully treated by extensive thrombectomy of the arteries in the upper extremity and right subclavian-to-carotid artery transposition.

Acute Disease↗

PubMedDate not supplied

The immediate and short-term effects of a wrist extension orthosis on upper-extremity kinematics and range of shoulder motion.

OBJECTIVE: The purpose of this study was to investigate upper-extremity kinematics and range of shoulder motion while wearing a wrist extension orthosis compared to the free hand at initial testing and after a week's wear. METHOD: A convenience sample of healthy women, ages 20-50 years, performed a stacking task and a pouring task, freehanded and splinted, at two times, 1 week apart in this counterbalanced, repeated measures design. A Motion Analysis 3-D system measured quality of movement and range of motion variables. A 2 by 2 analysis of variance (splinted vs. freehanded by time of testing) was used to analyze each variable. RESULTS: In both tasks, participants tended to move more slowly (p = 0.005) with less direct movements (p < .001) when wearing the orthosis. In stacking, splinted movements were also less smooth than when free-handed (p < .0001). When splinted both tasks required more shoulder abduction (p < .0001) and pouring required more shoulder flexion (p < .0001). Participants demonstrated several improvements in quality of movement and amount of shoulder motion used after a weeks' orthotic wear, indicating some adaptation to the orthosis with use. CONCLUSION: In this study, a wrist extension orthosis interfered with the quality of upper-extremity movement and required more range of shoulder movement compared to the free hand. Future research is needed to determine whether persons with upper-extremity conditions (i.e., arthritis, carpal tunnel syndrome) respond similarly to wrist orthoses. Therapists should consider discussing with patients how their wrist splint could affect their hand performance and help patients learn techniques to reduce stress on their proximal joints.

Adult↗

PubMed1995

Upper-extremity motor co-ordination of healthy elderly people.

Motor co-ordination is an important prerequisite to adequate upper-extremity performance. With the ageing of the population, more and more elderly people are at risk of acquiring upper-extremity motor inco-ordination following sensorimotor deficit. The main objective of the study was to develop normative data on upper-extremity motor co-ordination for elderly people. Three hundred and sixty subjects aged 60 and over were randomly selected and evaluated with the Finger-Nose Test. The results revealed a linear decline in the performance of this test with age. Younger, more active and subjectively healthier subjects presented better motor co-ordination. Some differences were found between sexes and sides. The normative data will help clinicians to identify pathological reduction in motor co-ordination in an elderly population.

Aged↗

PubMed2004

[Method of the tissue expanding in surgical treatment of the upper extremity deformity].

Results of surgical treatment of 14 patients suffering the segments deformity and the joints contracture of the upper extremity, using the tissue expanding method, were analyzed. The latex expanders as well as those, made according to own model were applied for the dermotension commitment. The peculiarities and modes of operation of the upper extremity tissues expanding were determined. Application of the tissues balloon expanding method during elimination of the upper extremities deformity and the joints contracture had permitted to achieve in immediate period the positive functional and cosmetic results in 83% of observations. In the late period good results were noted in 75% of patients and satisfactory--in 25%.

Adolescent↗

PubMedDate not supplied

Upper extremity restraint during hip spica cast application.

Control of the upper extremities of a sedated or anesthetized patient can be a cumbersome and difficult problem during hip spica cast application. To overcome this, we developed a simple technique to control the upper extremities without placing the neurovascular structures under tension while allowing easy venous access for the anesthesia personnel. Use of a simple armboard made of supplies commonly available in the cast room has made this possible. The construction and clinical use of this armboard is described. It has been used successfully for > 12 months at the authors' institution with no untoward effects.

Anesthesia, General↗

PubMed1998

Reconstruction of upper-extremity peripheral-nerve injuries with ePTFE conduits.

This reported investigation was designed to determine the role of a new synthetic conduit-expanded polytetrafluoroethylene (ePTFE) tube--in clinical repair of median and ulnar nerves in the upper extremities. The main goals of this study were: to determine the effectiveness of the ePTFE conduit in clinical nerve reconstruction; to evaluate the potential of this technique in reconstruction of various nerve gaps (1.5 to 6 cm); and to analyze the results of repair with the ePTFE tube regarding different mechanisms of injury. Forty-three patients were evaluated. They had upper-extremity peripheral-nerve injuries (21 injuries to the median nerve, and 22 ulnar nerve injuries) located at the various levels of the upper extremities. All surgical procedures described in the study were secondary reconstructions, and the average delay from injury to repair was 4.2 months. With regard to the nerve-gap lengths, patients were categorized in two groups. Group 1 (gaps from 1.5 to 4 cm) included 28 patients (17 median nerve injuries and 11 ulnar nerve injuries), and Group 2 (gaps from 4.1 to 6 cm) comprised 15 patients (4 median nerve injuries and 11 ulnar nerve injuries). Results showed that 78.6 percent of patients from Group 1 demonstrated functional motor and sensory recovery, while reconstruction of only 13.3 percent of peripheral nerves from Group 2 resulted in useful reinnervation. According to published results, ePTFE conduit is a reliable and successful surgical procedure for nerve repair in reconstruction of nerve gaps up to 4 cm between the ends of median and ulnar nerves in various levels of the upper extremity. Because of its properties, ePTFE conduit has the advantages of promoting better nerve regeneration, compared to other synthetic tubes, especially in reconstruction of proximal nerve injuries, larger nerve gaps, and in cases with unfavorable mechanisms of nerve injury.

Adult↗

PubMed1999

Multiple Entrapment Neuropathy in the Upper Extremity.

Multiple entrapment neuropathy is compression of more than two nerves in the same extremity. In this case series, 169 patients (208 upper extremities) with this condition were identified, and 124 patients (138 upper extremities) had surgical decompression after an ineffective course of conservative treatment. There were 31 men and 93 women. Average age was 41 years (range 20-87 years). Follow-up averaged 23 months (range 12 to 60 months). Our rating system included patients' self-assessment of overall symptom improvement and return to activity and a physician assessment of strength (grip and pinch) and sensibility (recovery of two-point discrimination). A total of 92 patients (67%) achieved good to excellent results. The clinical features of multiple entrapment neuropathy in our series were presented with a variety of nerve compression syndromes and with a high incidence of regional musculotendinous syndromes. In our surgical treatment, we emphasise simultaneous release of all possible compression sites with a minimally invasive endoscopic approach to achieve better results.

Journal Article↗

PubMed2005

Does the presence of an upper extremity injury affect outcomes after major trauma?

BACKGROUND: There is a paucity of information about the impact of upper extremity (UE) injuries on patient outcomes, particularly after major trauma. METHODS: Data were obtained from a statewide trauma registry. Cases were defined as major trauma cases (Injury Severity Score > 15) with (UE group) and without (no-UE group) an associated upper extremity injury. Multivariate analysis was performed to identify independent predictors of outcome. RESULTS: Major trauma patients with UE injury were 1.5 times (p = 0.011) more likely than the no-UE group to have a length of stay greater than 7 days. After adjusting for age, mechanism of injury, and Injury Severity Score, UE injury was not an independent predictor of discharge destination. CONCLUSION: In major trauma patients, the presence of an upper extremity injury is a significant predictor of length of stay, indicating a greater complexity and cost of care associated with this group of major trauma patients.

Accidental Falls↗

PubMedDate not supplied

Upper extremity injuries in skiing.

In a six-year study, 1,711 ski injuries and 998 controls at Sugarbush North Ski Area were studied. Upper extremity injuries, which constituted 25% of all ski injuries, did not increase in frequency. Men and women were at equal risk of injury. When edging conditions were poor, upper extremity injuries were more common than lower extremity injuries. Forty percent of all upper extremity injuries involved the thumb (85% included injuries to the ulnar collateral ligament of the metacarpophalangeal joint). Twenty-five percent of 405 skiers interviewed had, at one time, injured their thumbs while skiing but only one-quarter of these reported their injury. Our study suggests that injury to the ulnar collateral ligament of the metacarpophalangeal joint may be the most frequent in skiing and that gripping the ski pole outside the strap may prevent these injuries.

Arm Injuries↗

PubMed2004

Upper extremity pain and computer use among engineering graduate students.

BACKGROUND: The objective of this study was to investigate risk factors associated with persistent or recurrent upper extremity and neck pain among engineering graduate students. METHODS: A random sample of 206 Electrical Engineering and Computer Science (EECS) graduate students at a large public university completed an online questionnaire. RESULTS: Approximately 60% of respondents reported upper extremity or neck pain attributed to computer use and reported a mean pain severity score of 4.5 (+/-2.2; scale 0-10). In a final logistic regression model, female gender, years of computer use, and hours of computer use per week were significantly associated with pain. CONCLUSIONS: The high prevalence of upper extremity pain reported by graduate students suggests a public health need to identify interventions that will reduce symptom severity and prevent impairment.

Adult↗

PubMed1994

Occupational cumulative trauma disorders of the upper extremity.

The umbrella term cumulative trauma disorders (CTDs) (also known as repetitive strain injuries, overuse syndromes, and repetitive motion disorders) covers a number of similar conditions arising from overuse of the joints or soft tissues of the upper extremity. Occupational CTDs have become a common problem in the workplace. These disorders are costly to the employer, the worker, and society in terms of time lost from work and resulting disability. Within the past decade, occupational therapists and physical therapists specializing in rehabilitation of work-related musculoskeletal injuries have seen an increase in the incidence of CTDs of the upper extremity in the workplace. Therapists are called upon not just to treat these injured workers, but also to help them regain a functional level for work reentry and to educate them to prevent reinjury. This article reviews the literature on the epidemiology, etiology, pathophysiology, and management of upper-extremity occupational CTDs. Because the ultimate goal of the workplace is to maintain the health and safety of the employee, an educational approach to hand, wrist, elbow, and shoulder use is essential to prevent, decrease, or eliminate the risk of occupational CTDs of the upper extremity.

Arm Injuries↗

PubMed1999

Long-term follow-up of upper extremity implanted venous access devices in oncology patients.

PURPOSE: To evaluate function and assess incidence of complications relating to upper extremity implanted venous access devices placed in oncology patients primarily for chemotherapy. MATERIALS AND METHODS: The authors retrospectively evaluated the clinical course of 205 upper extremity implanted venous access devices placed with fluoroscopic and sonographic guidance in 204 patients during a 2-year period. All patients had a diagnosis of malignancy for which chemotherapy was planned. Follow-up data were collected by patient examination, direct evaluation of device function, as well as chart review and review of relevant imaging procedures. A modified technique for device placement is described. RESULTS: The devices were placed successfully on the initial attempt in all cases. Clinical follow-up was obtained for 195 devices (95.1%) for a total device service period of 33,619 days (mean service interval = 169 days). Seventy-eight devices (40%) had service intervals greater than 180 days. Thirty-seven devices (19% of total devices) led to 39 complications (0.116 event/100 days). No immediate procedural complications were incurred. Eight complications occurred after 180 days of port service. Nineteen devices (9.7% of total devices followed) required removal as a result of complication. Common complications included port malfunction requiring urokinase to clear (n = 10; 0.030 event/100 days), ipsilateral upper extremity deep venous thrombosis (n = 9; 0.027), and local infection (n = 7, 0.021). A comparison of these results relative to other published series of similar devices placed for mixed indications is presented. CONCLUSIONS: Implanted venous access devices are an effective means of long-term venous access in oncology patients. Complication rates in this large series compared favorably to other published radiologic and surgical series. Analysis of complications in a subgroup of extended use implanted venous access devices (greater than 180 days follow-up) showed no statistically significant (P < .05) difference from the larger group of devices.

Adult↗

PubMed1998

Pitfalls in the radiologic evaluation of extremity trauma: Part I. The upper extremity.

Family physicians often are required to evaluate patients who present with acute skeletal trauma. The first of this two-part series discusses the features and evaluation of some commonly missed fractures and dislocations of the upper limb, excluding the hand. Dislocations of the sternoclavicular joint are infrequent and often missed. Clavicular fractures in adults usually are not hard to diagnose. Acromioclavicular joint dislocations represent about 10 percent of all dislocation injuries to the shoulder girdle. Forty percent of all dislocations occur at the glenohumeral joint. Scapular fractures are often a result of significant force. Multiple views should be obtained in adults with a suspected fracture of the elbow. Complications in fractures of the wrist are strongly related to the location of the fracture.

Acromioclavicular Joint↗

PubMed2002

[The use of fillet flaps in upper extremity and shoulder reconstruction].

Extensive soft tissue defects of the upper extremities were reconstructed with major fillet flaps in nine patients over a 5-year period at two institutions. Etiologies included trauma and tumor resection. Defect locations were the shoulder ( n=3), combined defects of the shoulder plus neck, arm or chest wall ( n=4) as well as one upper arm and one forearm defect. Seven of nine flaps required microsurgical free tissue transfer. Fillet flaps harvested from amputated parts represent the "spare part" concept, providing coverage of defects without additional donor site morbidity. Unlike the classic "spare part" fillet flap concept, the partial or complete conversion of an anatomically intact arm was performed for the coverage of large defects, especially for tumor reconstruction, in this series. Fillets flaps facilitate reconstruction in difficult and complex cases. Major fillet flaps represent a valuable option for reconstruction in the upper extremities with either pedicled or free tissue transfers involving extensive tissue defects.

Adult↗

PubMed1998

Occupational upper-extremity-related disability: demographic, physical, and psychosocial factors.

Occupational upper-extremity disorders have been associated with prolonged pain and work disability. Using the U.S. Army Physical Disability Agency database, the present case-control studies (n = 434 and n = 342) investigated the contribution of demographic, physical, occupational psychosocial, and individual psychosocial factors to work disability in soldiers with upper-extremity disorders. Age (odds ratio [OR] = 1.11), rank (private E-2: OR = 3.79; private first class: OR = 4.39; specialist or corporal: OR = 2.17), ethnic group (white: OR = 1.54), and occupational stress ("often": OR = 2.46) were found to predict disability. The results highlight the importance of occupational stress as a predictor of disability and the potential utility of addressing this factor in the development of empirically based disability prevention strategies. This investigation also emphasizes the need for research that delineates the biobehavioral mechanisms linking occupational stress to prolonged symptoms and subsequent work disability.

Adult↗