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At least 469 records · Page 26Linked to original sources

PubMed2006

An identification technique for evaluating body segment parameters in the upper extremity from manipulator-hand contact forces and arm kinematics.

OBJECTIVE: To show that it is possible to determine segment masses and segment centers of mass by measuring manipulator-hand contact forces and joint angles during upper extremity movement. BACKGROUND: The method serves as a quick subject specific body segment parameter evaluation technique. Clinically we see this method as an alternative upper extremity body segment parameter evaluation study especially useful in rehabilitation treatment activities. METHODS: The experiment is based on coupling the human arm with a robotic manipulator which is then used for imposing a specified sagittal plane trajectory. Joint angles and forces in the contact point serve as input to the identification procedure. For verification purposes the proposed identification procedure was first performed on a mechanical arm. Afterwards a low velocity trajectory was imposed into all joints of the human upper extremity, with very small angular deviations. Within this small angular region the arm was assumed to be represented as a linear system. FINDINGS: The outcome of the identification procedure is an estimate of masses and center of mass coordinates for the lower arm and palm segments, their products for the upper arm and the passive moments around the measured angle of all joints in the sagittal plane. The results obtained for three particular human arms are eventually compared to the average population based literature. CONCLUSION: From the clinical point of view the study can become useful for biomechanical evaluation and for evaluating biomechanical properties of lower extremities or other body segments. This method may also provide a foundation to measuring body segment moments of inertia and joint viscoelastic parameters.

Adult↗

PubMed1998

Noninvasive diagnosis of upper extremity vascular disease.

The relative rarity of vascular disorders of the arm accounts for unfamiliarity with upper extremity diagnostic testing on the part of even experienced vascular clinicians. Understanding the wide variety of noninvasive tests is imperative if one is to appropriately diagnose and treat these disorders. The diagnosis and localization of arterial occlusive disease is dependent on the use of Doppler-derived arterial pressures, which may be measured serially from the upper arm to the digits. Plethysmographic digital waveforms can be used as an aid in the diagnosis of vasospastic disorders as well as in the assessment of therapy. Similarly, provocative testing with cold stimulation can assist in the diagnosis of Raynaud's and other vasospastic disorders. The use of duplex ultrasonography for venous occlusion, although not as accurate as when used for lower extremity problems, can be a useful aid in the diagnosis of upper extremity venous thrombosis. Symptoms associated with the thoracic outlet syndrome can be evaluated and confirmed noninvasively, measuring Doppler pressures and gauging venous outflow obstruction while the patient performs a variety of positional maneuvers. A thorough knowledge of upper extremity noninvasive tests will provide the clinician with confidence in the objective assessment of upper extremity vascular disease.

Arm↗

PubMed2001

Upper extremity microsurgery.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Understand the indications for free flap coverage of the upper extremity. 2. Know the advantages and disadvantages of the flaps discussed. 3. Have a basic understanding of the anatomy of the flaps discussed. 4. Have a variety of options for free tissue transfer.The application of microsurgical tissue transfer to reconstruction of the upper extremity allows repair of significant bone and soft-tissue defects. Through the years the approach has changed from one of simply getting the wound covered to primary reconstruction to preserve or regain function. A wide variety of free flaps offers the potential to reconstruct nearly any defect of the arm and hand. Vascularized bone transfer can be utilized to repair large bony defects, while innervated free muscle transfer can replace missing muscle function. The total array of flaps and their indications is beyond the scope of a single discussion, but this article focuses on a few flaps that have found application for coverage and functional restoration in the hand and upper extremity.

Arm Injuries↗

PubMedDate not supplied

Breast implantation and the incidence of upper extremity somatic complaints.

Attention has been drawn to elevated laboratory tests of inflammation as indicators of a possible reaction to silicone breast implants. These patients have complaints of joint pain, pain, and myalgia that were possibly caused by a reaction to silicone. This study is a retrospective review of 100 consecutive patients (79 female, 21 male) who were evaluated because of a purported industrial injury to the upper extremity. Patients were examined by a single examiner and all had laboratory screening for indicators of inflammation (sedimentation rate, anti-nuclear antibody levels, C-reactive protein, anti-streptolysin, rheumatic factor), endocrine abnormalities (thyroid panel), and serum glucose. None of the patients had any history of breast augmentation with any implant. Of the 79 female patients, 50 had an identifiable clinical diagnosis and 18 of them had elevation of at least one of the indicators of inflammation. The remaining 29 did not have an identifiable diagnosis and 21 of them had elevation of at least one indicator of inflammation (P < 0.01). There were 74 out of 79 females with subjective complaints of upper extremity pain, joint pain, and aching. Forty-five of these patients had an identifiable diagnosis and 17 of them had elevation of at least one inflammatory indicator. Of the 74 female patients, 29 had no identifiable diagnosis and 21 of them had elevation of at least one inflammatory indicator (P < 0.01). In summary, there were a high number of female patients with complaints of upper extremity symptoms with no prior exposure to silicone from breast implantation. There was a statistically significant correlation in these patients who had no identifiable diagnosis and elevated indicators in inflammation. This study suggests these markers of inflammation should not be used as indicators of a reaction to silicone from breast implantation in patients with upper extremity subjective complaints.

Adult↗

PubMed2005

Cervical radiculopathy or Parsonage-Turner syndrome: differential diagnosis of a patient with neck and upper extremity symptoms.

STUDY DESIGN: Resident's case problem. BACKGROUND: The signs and symptoms of cervical radiculopathy (CR) warrant the consideration of several other conditions in CR's differential diagnosis. One condition that may mimic CR, which is not well known amongst physical therapists, is Parsonage-Turner syndrome (PTS). PTS is characterized by an onset of intense pain that typically subsides within days to weeks. However, as pain subsides, weakness and/or paralysis may develop in upper extremity muscles. The purpose of this resident's case problem is to describe a patient who presented to our clinic with a diagnosis of CR, but had findings consistent with PTS. DIAGNOSIS: The patient was a 43-year-old male referred to physical therapy with a diagnosis of CR. He had a previous episode of CR 1 year ago that was treated successfully. He had positive magnetic resonance imaging findings of structural abnormalities suggestive of causative factors for CR. The patient was treated for CR with thoracic and cervical spine manipulations and intermittent cervical traction. The initial acute severe pain subsided, but weakness in the upper extremity worsened. Diagnosis of PTS was made upon exclusion of other potential confounding diagnoses and the findings of fibrillation potentials and positive waves in electrodiagnostic studies. DISCUSSION: CR and PTS are characterized by pain in the cervical spine, shoulder, and upper extremity. CR generally has an insidious onset, while PTS has a rapid onset of intense pain. Symptoms of CR are exacerbated with neck movements, while symptoms related to PTS should not be exacerbated with neck movements. In patients that do not respond to conventional therapy and have a progression of upper extremity muscle weakness, regardless of decreased pain, the diagnosis of PTS should be considered.

Adult↗

PubMed1996

Rehabilitation intervention for patients with upper extremity dysfunction: challenges of outcome evaluation.

Upper extremity (UE) dysfunction attributed to overuse is an increasingly prevalent problem managed with interdisciplinary rehabilitation. Outcome evaluation of these programs is limited by a number of factors. First, patients with UE dysfunction include a wide variety of pathophysiologic processes and diagnoses that are associated with multiple secondary impairments, disabilities, and handicaps that limit personal performance. Second, the particular experience of disablement and expectations each person brings to the rehabilitation process necessitates an individualized program with unique goals. Successful outcome measurement of the rehabilitation process must take into account the achievement of individual goals as well as objective scalar quantification of impairments, disabilities, and handicaps that are comparable between groups. Understanding of the relationships between UE impairments and given functional outcomes will come from controlled, dosed treatment studies in "pure" diagnostic patient groups. Outcomes research applied to UE rehabilitation as it is currently practiced should include individually devised patient assessments of accomplishment and satisfaction in addition to long-term quantitative reassessment of the person under all domains of disablement and work performance.

Arm Injuries↗

PubMed1998

Cutaneous withdrawal reflexes of the upper extremity.

We characterized reflexes of the upper limb elicited by electrical stimulation of the fingers. Surface electromyogram (EMG) was recorded from several upper extremity muscles, and a finger was stimulated through paired ring electrodes. A train of 4-10 shocks at a frequency of 300 Hz and an intensity 4-6 times the perceptual threshold was the most effective stimulus for evoking EMG activity in relaxed arm muscles. Habituation was prominent. Latencies of EMG activity were <100 ms for most proximal and forearm muscles, and at least 40 ms prior to voluntary withdrawal movements. The timing of EMG activity in arm muscles was similar to that of the E2 component of the cutaneomuscular reflex evoked in these same muscles during contraction, and coincided with a silent period in active hand muscles. We conclude that cutaneous stimuli to the fingers activate a complex motor pattern that tends to withdraw the hand at the same time the grasp is released.

Adult↗

PubMed1997

Forequarter amputation with fasciocutaneous deltoid flap reconstruction for malignant tumors of the upper extremity.

BACKGROUND: Malignant tumors of the upper extremity involving a considerable portion of the medial axillary wall may require forequarter amputation to achieve gross resection of tumor. These resections frequently leave a large defect, often requiring a split thickness skin graft or free flap to close the wound. To address this problem of wound closure, we have modified our technique and devised a reconstructive component as part of our forequarter amputation procedure. METHODS: The medical records of seven patients who underwent forequarter amputation and fasciocutaneous deltoid flap reconstruction between 1982 and 1994 were reviewed. RESULTS: All the amputation sites were completely closed with a fasciocutaneous deltoid flap without the use of additional skin grafts or free flaps. After a median follow-up of 12 months, there were no local recurrences. Three patients (43%) are alive and disease free 5, 12, and 19 months after their forequarter amputation. One patient is alive with disease after 14 months. The remaining three patients died of their disease. CONCLUSION: The fasciocutaneous deltoid flap is technically easy to perform, provides wound coverage without the use of skin grafts, and is especially useful for tumors involving the media axillary wall and in patients with previous axillary radiation.

Adult↗

PubMed1993

Rule based artificial intelligence expert system for determination of upper extremity impairment rating.

Quantitative evaluation of upper extremity impairment, a percentage rating most often determined using a rule based procedure, has been implemented on a personal computer using an artificial intelligence, rule-based expert system (AI system). In this study, the rules given in Chapter 3 of the AMA Guides to the Evaluation of Permanent Impairment (Third Edition) were used to develop such an AI system for the Apple Macintosh. The program applies the rules from the Guides in a consistent and systematic fashion. It is faster and less error-prone than the manual method, and the results have a higher degree of precision, since intermediate values are not truncated.

Arm Injuries↗

PubMed1995

Emergency free tissue transfer for severe upper extremity injuries.

29 patients with severe upper extremity injury were treated with 27 emergency free flap and three emergency toe-to-hand transfers, after radical débridement and primary reconstruction of all injured structures. There was no flap failure, and no infections or wound-healing complication were seen. Follow-up ranged from 3 months to 6.6 years with a mean of 3.2 years. 19 patients returned to work (14 to their original jobs), three were retired and another seven had no employment before injury. Operation time ranged from 2 hours 45 minutes to 18 hours 20 minutes with an average of 7 hours 45 minutes, depending upon the size of the defect and mechanism of injury. Long-term follow-up revealed successful functional and aesthetic results, decreased morbidity and invalidity, and reduced rates of free flap failure, post-operative infection, secondary operative procedures, hospital stay and medical expense.

Adolescent↗

PubMedDate not supplied

Myofascial pain syndromes in the upper extremity.

Myofascial pain syndromes of the upper extremity are common causes of pain that may follow trauma and are associated with acute or chronic musculoskeletal stress. The syndromes are characterized by the presence of the myofascial trigger point, a physical finding that is reliably identified by palpation. Local and referred pain are hallmarks of the syndrome, and the referred pain patterns may mimic such conditions as radiculopathy and nerve entrapment syndromes. Treatment is directed toward inactivating the myofascial trigger point, correcting underlying perpetuating factors, and restoring the normal relationships between the muscles of the affected functional motor units.

Arm↗

PubMed1984

Combined subclavian artery and brachial plexus injuries from blunt upper-extremity trauma.

Four cases of blunt upper extremity trauma producing subclavian artery and brachial plexus injuries are presented. In each case the patient was hemodynamically stable and arteriography demonstrated the subclavian lesion. Arterial reconstruction was successfully accomplished in three cases, but no use of the injured limb was regained by any patient. Early arterial repair may still be indicated to allow later above-elbow amputation for the purpose of functional rehabilitation.

Adult↗

PubMed1990

Arterial trauma of the upper extremity in children.

Thirty children with upper extremity arterial trauma were retrospectively reviewed. Trauma was penetrating in 87% of cases and in 53% injury was caused by broken plate glass. The injured artery was repaired in all but four cases. Nerves were injured in 53% and tendons in 23%. All severed nerves and tendons were repaired primarily. Postoperatively three children with proximal injuries had no palpable pulse in the affected extremity. One patient died of underlying disease and another required amputation during initial surgery due to extensive soft-tissue injury. Followup revealed no dysfunction directly related to vascular insufficiency. Neurologic deficit was found in 33% of the children followed, but only in one was the limb totally nonfunctional. We conclude that the long-term outcome is largely dependent upon neurologic injury. Glass doors and large glass windows should be avoided in the vicinity of children's play areas.

Adolescent↗

PubMed1993

Soft tissue coverage for the upper extremity.

Soft tissue coverage of the upper extremity continues to be a challenging and evolving field. The expeditious and reliable methods of soft tissue coverage currently in use are discussed with reference to their shortcomings and advantages. For soft tissue coverage of fingertip injuries, open treatment or local flaps from the hand remain the mainstay of treatment. For dorsal and volar hand defects, distal axial flaps, such as the groin flap or microvascular tissue transfer, are utilized most commonly. For large defects proximal to the wrist, trunk axial pattern flaps, microvascular transfer, or the radial forearm flap have the greatest utility. Finally, technical points necessary for the success of some of the flaps are discussed.

Arm↗

PubMed1976

Electrical injuries of the upper extremity.

Although electrical burns of the upper extremity comprise a small percentage of all thermal injuries, they present formidable clinical problems. The physician must not be lulled into a false sense of security because the visible cutaneous burn is not great. Sound surgical principles, such as the control of bacterial proliferation with topical chemotherapy, débridement of dead tissue, and timely wound closure, in conjunction with the expertise necessary in caring for thermally injured patients, are necessary for a maximally rehabilitated patient.

Adolescent↗

PubMed1992

Upper extremity venous duplex imaging.

Over 500 upper extremities have been imaged with the Duplex Scanner at the John J. Cranley Vascular laboratory. Venous anatomy and imaging techniques are presented. Reference points and zones for localizing abnormal findings are demonstrated. Abnormal venous pathology including case presentations of acute radial, basilic, cephalic, and axillary vein thrombosis are presented. Complications of subclavian and internal jugular vein catheterization are demonstrated. Soft tissue pathology including edema, lymphadenopathy, hematomas, cysts, and abscesses are visualized and differentiated. Duplex use for evaluation of aneurysm, pseudo aneurysm and graft surveillance has been increasing in frequency. Examples are demonstrated.

Arm↗

PubMed2005

Upper extremity dog bite wounds and infections.

Upper extremity dog bite wounds comprise a large percentage of all mammalian bite wounds. The purpose of the study was to assess the bacteriology of patients presenting with such injuries to the emergency room that required consultation by a hand surgeon. The study also analyzed the effect of delayed intervention on growth of invasive pathogens, on the incidence of multiple pathogens, on treatment interventions, and on length of hospital stay. Objective data and subjective descriptions of the wound were collected on 32 patients who presented to Chicago area hospitals. The authors retrospectively analyzed the data and grouped the patients into two categories based on time of intervention: early or those treated within 48 hours, and delayed to include those treated after 48 hours. Incidence of bacterial growth and Pasteurella species growth in cultures was similar to that reported in the literature. Delayed patients had a significantly higher incidence of positive bacterial growth from wound cultures (100%) compared with nondelayed patients (54%). Delayed patients also had a higher incidence of treatment intervention (delayed group 86% surgical irrigation and debridement compared with 48% for the early group). There was a trend toward increased length of hospital stay (delayed group 4.6 days compared with 2.6 days), although this was not significant. The growth of multiple pathogens between the two groups was similar and not significant (delayed group 43% compared with 54% early group).

Adolescent↗

PubMedDate not supplied

Clinical and diagnostic features of upper extremity work-related musculoskeletal disorders.

Upper extremity work-related musculoskeletal disorders, (UE-WMSDs) are one of the major causes of work-related disability in industrialized countries. Diagnostic criteria for many UE-WMSDs are still under debate, and several different national and international studies have attempted to reach a consensus agreement on the minimum criteria for case definition of UE-WMSDs. This paper describes clinical and diagnostic features of UE-WMSDs, focussing on carpal tunnel syndrome and rotary cuff tendinopathy.

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