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PubMed1988

[Deep venous thrombosis of the upper extremities].

Deep vein thrombosis of the upper extremity is rare. While its pathogenesis is not always evident, it often occurs in connection with tumors, thoracic outlet syndrome or intravenous catheter therapy. Acute thrombosis of the subclavian vein usually is a clinical diagnosis, but in doubtful cases diagnostic tests such as Doppler ultrasound and/or plethysmography may be useful. If necessary, verification of subclavian vein thrombosis can be done by phlebography. Considering the incidence of thromboembolic complications such as pulmonary embolism, anticoagulation is indicated in all cases of acute thrombosis. Under standard conservative treatment residual symptoms following the venous occlusion are few and the prognosis is favorable. Therefore, invasive treatment such as thrombectomy or thrombolysis should be considered only in special cases.

Arm↗

PubMed1979

Total joint arthroplasty. Introduction to the upper extremity.

Total joint replacement in the upper extremity has developed in step with that of the lower extremity. The indications for treatment, the place of total joint arthroplasty in contrast to other forms of arthroplasty, and the criteria for patient selection have recently been classified. A number of problem areas are under biomechanical and clinical study, and most investigators are proceeding cautiously. In properly selected patients, however, prosthetic replacement offers great improvement in both relief of pain and joint function, and improvement should continue. The patient and physician should recognize the limitations that are inherent in any "artificial joint" replacement. Realistic expectations would be for improvement that approaches, but rarely achieves, normal function.

Arthritis↗

PubMed1983

Current diagnosis and management of upper extremity ischemia.

Although the causes of upper extremity ischemia are diverse, their management follows well established surgical principles in most instances. Evaluation that emphasizes precise physical examination and exploits simple noninvasive determinations aids in reducing cost and complexity. Subclavian occlusive lesions are optimally managed by bypass procedures that avoid thoracotomy. Occlusions in the arm may usually be treated with bypass grafts of reversed autogenous saphenous vein. Brachial artery occlusion after cardiac catheterization should be approached with early exploration, using local reconstruction of the artery if necessary. Vasospastic symptoms should be evaluated thoroughly in an attempt to identify their cause. Most often they may be treated with medications, singly or in combination. Sympathectomy is of benefit only in unusual instances, when no specific cause of the vasospastic symptoms can be found after prolonged evaluations.

Arm↗

PubMed1980

Occupational therapy for the limb-deficient child: a developmental approach to treatment planning and selection of prostheses for infants and young children with unilateral upper extremity limb deficiencies.

Habilitation of the upper extremity limb-deficient child is enhanced when the treatment program is based on normal growth and development guidelines. Specific developmental tasks have been identified as key indicators of a child's readiness to benefit from prosthetic fitting, activation of major components, use training, and changes in prosthetic design such as modular prostheses and electric components. Use of developmental guidelines also enhances family support because their role in the program can be realistically defined and supported.

Arm↗

PubMed1997

Electrical stimulation and the treatment of complex regional pain syndromes of the upper extremity.

Clinical, intractable pain in the upper extremity often results from neuroma, direct injury to a peripheral nerve, or repetitive operative insults to a peripheral nerve that has compressive neuropathy. Electrical stimulation applied directly to a single peripheral nerve can provide sufficient relief of pain, improve patient outlook, improve lasting sleep, release the individual from addictive narcotic pain medication, and restore a psychological sense of well-being.

Arm↗

PubMedDate not supplied

Upper extremity DVT. Correlation of MR and nuclear medicine flow imaging.

The purpose of this study is to determine correlation between MR and nuclear medicine flow studies in the evaluation of upper extremity deep venous thrombosis. We retrospectively reviewed MR and radionuclide venography images obtained in 10 patients with suspected upper extremity venous thrombosis. In nine cases there was complete agreement in the identification of thrombus. In one case, MR images failed to identify a thrombus in the axillary vein adjacent to a port-a-cath. Good correlation between MR and radionuclide venography images in evaluation of upper extremity DVT is present in the majority of cases.

Axillary Vein↗

PubMed2005

Venovenostomy for outflow venous obstruction in patients with upper extremity autogenous hemodialysis arteriovenous access.

Outflow venous obstruction is a common problem in patients with autogenous upper extremity hemodialysis access. Surgical revision to divert blood flow into the patent vein is sometimes possible to restore unobstructed flow. The result of this type of procedure is not yet well known. The purpose of this report is to describe our experience with outflow venovenostomy (VV) to salvage dysfunctional autogenous upper extremity arterial venous access (AVF) threatened by venous outflow obstruction in hemodialysis-dependent patients. All patients who underwent VV procedures between September 1999 and October 2004 were reviewed. Data regarding patient demographics, comorbidities, procedure indications, perioperative complications, as well as postoperative AVF function and patency were gathered from patient charts and dialysis records. A total of 11 patients underwent VV in the study period. The median age of the AVF prior to VV was 14 months, with a range of 4-45 months. Two patients had radial cephalic AVF, and they had VV done in the antecubital fossa. Nine patients had brachial cephalic AVF. Seven of them underwent cephalic vein transposition VV, while two patients had basilic vein transposition. Functional AVF was achieved after 1 month in 10 out of 11 patients. Five patients had no further access interventions, four patients required angioplasty at the VV site to maintain access function, and one patient had access infection requiring surgical revision during follow-up. One patient never achieved access function. Postintervention assisted functional patency was 90% +/- 9.5% at 39 months. Median follow-up after VV was 16 months. Outflow VV is a viable surgical option for selected patients with failing AVF due to venous outflow obstruction.

Aged↗

PubMed2006

A community-based upper-extremity group exercise program improves motor function and performance of functional activities in chronic stroke: a randomized controlled trial.

OBJECTIVE: To assess the effects of a community-based exercise program on motor recovery and functional abilities of the paretic upper extremity in persons with chronic stroke. DESIGN: Randomized controlled trial. SETTING: Rehabilitation research laboratory and a community hall. PARTICIPANTS: A sample of 63 people (> or =50y) with chronic deficits resulting from stroke (onset > or =1y). INTERVENTIONS: The arm group underwent an exercise program designed to improve upper-extremity function (1h/session, 3 sessions/wk for 19wk). The leg group underwent a lower-extremity exercise program. MAIN OUTCOME MEASURES: The Wolf Motor Function Test (WMFT), Fugl-Meyer Assessment (FMA), hand-held dynamometry (grip strength), and the Motor Activity Log. RESULTS: Multivariate analysis showed a significant group by time interaction (Wilks lambda=.726, P=.017), indicating that overall, the arm group had significantly more improvement than the leg group. Post hoc analysis demonstrated that gains in WMFT (functional ability) (P=.001) and FMA (P=.001) scores were significantly higher in the arm group. The amount of improvement was comparable to other novel treatment approaches such as constraint-induced movement therapy or robot-aided exercise training previously reported in chronic stroke. Participants with moderate arm impairment benefited more from the program. CONCLUSIONS: The pilot study showed that a community-based exercise program can improve upper-extremity function in persons with chronic stroke. This outcome justifies a larger clinical trial to further assess efficacy and cost effectiveness.

Age Factors↗

PubMed2006

Work characteristics and upper extremity disorders in female dental health workers.

Many dental health workers suffer from musculoskeletal disorders in the upper extremities. In addition to ergonomic factors, psychosocial work characteristics have been linked to musculoskeletal disorders. The present cross-sectional study aimed at investigating how musculoskeletal disorders in the upper extremities (UED) and occupational position are related to work characteristics and general health problems in female dental health workers. Questionnaire data from dentists, dental hygienists and dental nurses (N=945) showed that 81% reported UED. Multivariate analysis of variance showed that dentists reported the highest levels of physical load and fatigue whereas dental nurses reported the lowest levels of influence at work. Irrespective of position, those with UED considered their physical and psychosocial work environment and their own health to be significantly poorer than did those without UED. A hierarchical multiple regression showed that the physical load of dentistry was most strongly related to UED. Despite improvements to the ergonomics and physical work environment of dentistry, it is concluded that female dental health workers are still at high risk of developing UED.

Adult↗

PubMed2006

A placebo-controlled trial of constraint-induced movement therapy for upper extremity after stroke.

BACKGROUND AND PURPOSE: Constraint-Induced Movement therapy (CI therapy) is a neurorehabilitation technique developed to improve use of the more affected upper extremity after stroke. A number of studies have reported positive effects for this intervention, but an experiment with a credible placebo control group has not yet been published. METHODS: We conducted a placebo-controlled trial of CI therapy in patients with mild to moderate chronic (mean=4.5 years after stroke) motor deficit after stroke. The CI therapy group received intensive training (shaping) of the more affected upper extremity for 6 hours per day on 10 consecutive weekdays, restraint of the less affected extremity for a target of 90% of waking hours during the 2-week treatment period, and application of a number of other techniques designed to produce transfer to the life situation. The placebo group received a program of physical fitness, cognitive, and relaxation exercises for the same length of time and with the same amount of therapist interaction as the experimental group. RESULTS: After CI therapy, patients showed large (Wolf Motor Function Test) to very large improvements in the functional use of their more affected arm in their daily lives (Motor Activity Log; P<0.0001). The changes persisted over the 2 years tested. Placebo subjects showed no significant changes. CONCLUSIONS: The results support the efficacy of CI therapy for rehabilitating upper extremity motor function in patients with chronic stroke.

Adult↗

PubMedDate not supplied

Hand-grip dynamometry provides a valid indication of upper extremity strength impairment in home care patients.

This retrospective study investigated the validity of hand-grip dynamometry with respect to its use in predicting generalized upper extremity strength. The records of 37 patients (mean average age, 77.7 years) receiving home care were used. Discriminant construct validity was examined by comparing their dynamometry measurements with measurements of age- and gender-matched healthy individuals reported in the literature. Convergent construct validity was described by the correlations of their dynamometry measurements and manual muscle test scores of the upper extremities. The patients' dynamometer-measured grip forces were significantly less than reported normative values. The patients' dynamometer measured grip forces were correlated significantly with their manual muscle test scores. These findings support the construct validity of hand-grip dynamometry for characterizing upper extremity strength impairment among adults treated in a home care setting.

Aged↗

PubMed1993

Stress testing in the evaluation of upper-extremity perfusion.

Stress testing is an important element in the evaluation of upper extremity vascular perfusion. Advances in noninvasive testing provide mechanisms to evaluate the static structural characteristics of the arterial system, to define patient and nonpatient vessels to identify areas of thrombosis or occlusion, to evaluate arterial wall motility and elasticity, and to observe the nutritional capillary bed. To understand upper-extremity vascular function, however, some form of stress testing is crucial. The techniques discussed previously continue to evolve and serve only as examples of the potential of noninvasive tests evaluated before, during, and after stress. Stress testing provides techniques that allow us to understand the functional components of vascular perfusion and to monitor our attempts at interventions.

Adult↗

PubMedDate not supplied

Leiomyosarcoma of the upper extremity.

A case of rapidly fatal, high-grade leiomyosarcoma of the upper extremity is described. The pleomorphic appearance of this sarcoma on light microscopy required the use of immunohistochemistry and electron microscopy to establish the morphologic diagnosis and to exclude a diagnosis of other high-grade sarcoma, such as malignant fibrous histiocytoma or pleomorphic rhabdomyosarcoma. The observed clinical behavior of this leiomyosarcoma of the upper extremity seemed unusually aggressive compared with the biologic behavior predicted by the independent prognostic indicators of location, tumor size, and depth of invasion. The observed clinical behavior did not seem unusual compared with the clinical behavior predicted by the use of a staging scheme for soft tissue sarcomas.

Arm↗

PubMed1999

Neuromuscular electrical stimulation and dynamic bracing as a treatment for upper-extremity spasticity in children with cerebral palsy.

We have investigated a therapeutic regimen using neuromuscular electrical stimulation (NMES) and dynamic bracing to assess their effectiveness in reducing upper-extremity spasticity in children with cerebral palsy. Nineteen patients between 4 and 21 years of age with documented diagnoses of spastic cerebral palsy were treated. The patients included in the study followed a regimen of two 30-minute sessions of NMES of the antagonist extensors combined with dynamic orthotic traction during the day. A static brace was used at night. Spasticity of the wrist and fingers was assessed periodically using the Zancolli classification. Treatment ranged from 3 to 43 months. After treatment with electrical stimulation and dynamic bracing, all the patients moved up 1 to 3 levels in the Zancolli classification and showed a marked improvement in upper-extremity function. These results show that combining NMES and dynamic orthotic traction dramatically decreases spasticity of the upper extremity in young patients with cerebral palsy.

Adolescent↗

PubMed2003

Clinical and workplace factors associated with a return to modified duty in work-related upper extremity disorders.

Return to work following treatment for a work-related upper extremity disorder (WRUED) is affected by a variety of medical, workplace, and personal factors, and returning to modified duty may ease the transition to normal work activities. This study surveyed 165 federal government employees (127 females, 38 males) who were unable to resume their normal work after filing a workers' compensation claim for a WRUED (<90 days from claim filing) and who volunteered for a randomized study of alternative case management strategies. Before randomization, participants completed a baseline survey of upper extremity (UE) symptoms, functional limitations, and workplace factors. At baseline, 58 participants (35%) were working modified duty and 107 participants (65%) were not working. Compared with participants working modified duty, those who were not working were more likely to report: (a). a diagnosis of mononeuropathy, odds ratio (OR)=3.16 (95% confidence interval (CI)=1.37-7.14) versus enthesopathy, (b). higher pain ratings, OR=1.43 (95% CI=1.01-2.01), (c). greater functional limitations, OR=1.63 (95% CI=1.11-2.38), and (d). higher level of ergonomic stressors, OR=1.62 (95% CI=1.09-2.43) in a multivariable logistic regression. Measures of high risk work styles (fast pace and working despite pain) were associated with greater perceptions of ergonomic exposure, but not with work status. The model had 87.9% sensitivity and 43.1% specificity to correctly classify those not working (overall classification 72.1% correct). The results suggest that modified duty for workers with persistent WRUEDs may be enhanced by assessing perceived functional limitation and ergonomic exposure as well as the type and severity of symptoms.

Arm Injuries↗

PubMed2000

Internal jugular and upper extremity central venous access in interventional radiology: is a postprocedure chest radiograph necessary?

OBJECTIVE: The necessity of obtaining a postprocedure chest radiograph after central venous access using the upper extremity or internal jugular veins and interventional radiologic techniques was evaluated. SUBJECTS AND METHODS: A prospective study of 937 consecutive central venous access procedures in interventional radiology using the internal jugular veins or upper extremities was performed from June 1995 through September 1997. Established interventional radiologic techniques were used to place various ports (n = 34) and tunneled (n = 670) and nontunneled (n = 233) catheters. All catheters were positioned using fluoroscopy and readjusted if necessary before termination of the procedure. Afterward, a chest radiograph was obtained with the patient upright to evaluate catheter position and possible procedural complications. Procedural complications and manipulations or interventions that resulted from the radiographic findings were noted. In addition, nursing time for acquisition of the chest radiograph was recorded. RESULTS: We found seven procedural complications (four air emboli, two pneumothoraces, one innominate vein laceration) significant enough to alter the patient's treatment. These complications were apparent during the examination. Postprocedure chest radiography failed to reveal any unknown complications and revealed only one catheter sufficiently malpositioned to require manipulation. The amount of nursing time to acquire postprocedure chest radiographs ranged from 8 to 40 min (mean, 23 min) per patient. CONCLUSION: When imaging guidance and interventional radiologic techniques are used for upper extremity and internal jugular central venous access, performing postprocedure chest radiography yields little benefit.

Adolescent↗

PubMed1983

Functional studies in 79-year-olds. II. Upper extremity function.

As part of the Gerontological and Geriatric Population Study of 79-year-old people in Göteborg, a representative subsample comprising 112 women and 93 men took part in a study of upper extremity function. Thirty-eight per cent of the women and 37% of the men had disorders in the upper extremities. The investigation included tests of co-ordination, static strength in the key-grip and the transversal volar grip, power capacity in opening jars and a bottle, basal movements in the upper extremities in personal hygiene and dressing activities, function in the kitchen e.g. reaching shelves, manual tasks including tests of pronation and supination of the forearm. In the key-grip as well as in the transversal volar grip men showed a generally larger decrease in strength with age than women compared to 70-year-olds in a previous population study. Significant correlations were found between strength in the key-grip and the performance time in the test of co-ordination. Women produced about 66% of the muscular force of the men when opening jars. Significant correlations were found between strength in the transversal volar grip and the maximal torque for opening the jars. Female and male subjects who were not capable of handling the electric plug in the manual ability test had significantly weaker strength in the key-grip. The importance of designing products and adapting the environment so as to correspond to the functional capacity of the elderly, is emphasized.

Activities of Daily Living↗

PubMed2001

Results of surgical treatment of peripheral nerve injuries in upper extremities.

OUTLINE: This study presents the results of surgical treatment of nerves in upper extremities performed in our clinic over 15 years, from 1985 to 1999. Basic lines of surgical treatment of various injuries of nerves in upper extremities are presented and evaluated in the study. SYNOPSIS AND METHODS: 140 nerves in 123 patients were treated within this period. 95 reconstruction operations were performed by a microtechnique in 95 patients. All reconstruction surgeries were performed in cases characterized by complete and persisting neurological deficit and by the absence of action potentials in relevant nerves. In 42 patients, 45 nerves were reconstructed by an autotransplant. In 53 patients, reconstruction surgery was performed by suture of peripheral nerve that included treatment of 65 nerves. In this group, 10 patients were treated by suturation of 2 nerves and 3 nerves were suturated in one patient. In 28 patients, external neurolysis was the final surgical therapeutic treatment. In this group, neurolysis of 2 nerves was performed in 2 patients. The presence of action potential was always an important criterion in the determination of the type of surgical intervention. The analysis of the effectiveness of surgical intervention was performed with respect to: the period elapsed between injury and operation, age of the patient, character of injury, location of injury, category of injured nerve, type of surgical intervention. RESULTS: The best results were observed for external neurolysis and for n. medianus. Evaluation of the effectiveness of neural suture did not reveal any significant differences between neural grafts and classical suture. Similar results were obtained for surgical treatment of isolated nerve injuries and for cases involving the reconstruction of more than one nerve. Good or excellent results were typical for early treatment, for distal injuries and for clean incised wounds, especially in young patients. CONCLUSION: Early surgical revision combined with neurolysis and reconstruction surgery (if necessary) are crucial factors determining the outcome of operation in indicated cases. With respect to reconstruction operations we did not observe any significant difference between classical suture and suture using nerve graft.

Adult↗