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PubMed2005

Severe upper extremity injuries in frontal automobile crashes: the effects of depowered airbags.

BACKGROUND: The purpose of this study was to determine the effects of depowered frontal airbags on the incidence of severe upper extremity injuries. METHODS: The National Automotive Sampling System database files from 1993 to 2000 were examined in a study that included 2,413,347 occupants who were exposed to an airbag deployment in the United States. RESULTS: Occupants exposed to a depowered airbag deployment were significantly more likely to sustain a severe upper extremity injury (3.9%) than those occupants exposed to a full-powered airbag deployment (2.5%) (P=.01). Full-powered systems resulted in an injury distribution of 89.2% fractures and 7.9% dislocations compared with depowered systems with 55.3% fractures and 44.3% dislocations. CONCLUSIONS: Although depowered airbags were designed to reduce the risk of injuries, they appear to have increased the overall incidence of severe upper extremity injuries through a shift from long bone fractures to joint dislocations.

Abbreviated Injury Scale↗

PubMed1978

Upper extremity deformities associated with the orofacial clefts.

A material of 89 cases of upper extremity deformities, among the 3225 cleft patients born during the period 1950-75, and treated in the Finnish Red Cross Cleft Centre is presented. About two-thirds of the patients had an isolated cleft palate--half of the male and nearly all of the female patients. The percentage of upper extremity deformities appearing with the different types of the orofacial clefts was, for clefts of the primary palate 2.0: specifically for cleft lip 0.8, cleft lip--palate 2.6, and cleft lip and palate 3.6; and for clefts of the secondary palate 3.5: specifically for cleft palate 3.7, submucous cleft palate 1.6; and for the branchial arch syndrome (lateral cleft) 5.2; the total average being 2.8 percent. About one-third of the patients were dwarfs, most of them diastrophic dwarfs. Syndactyly was somewhat more common among cleft patients, 0.3%, than in the average population. Polydactyly, 0.1% was about as common as the average. Ectrodactyly was more common among cleft patients, 0.4%, than either syndactyly or polydactyly that are considered the most common hand deformities among the general population. The syndactyly cases were more complicated than the average, among them 4 cases of Apert syndrome were noted. About three-fourths of the 89 patients had multiple deformities.

Abnormalities, Multiple↗

PubMed2001

Upper extremity peripheral nerve anatomy: current concepts and applications.

The nerve anatomy of the upper extremity is studied constantly through surgical findings, electrodiagnostic studies, and cadaveric dissections. Although it is recognized that the anatomy is not changing rapidly, knowledge of the anatomic relationships and their significance is increasing. The purpose of the current study is to provide a comprehensive analysis of the nerve anatomy of the upper extremity to include innervation patterns, critical landmarks, and clinical applications, with particular focus on recent contributions in the literature.

Arm↗

PubMed2006

Restricted upper extremity range of motion in mucopolysaccharidosis type I: no response to one year of enzyme replacement therapy.

BACKGROUND: Mucopolysaccharidosis type I (MPS I) results from deficiency of the lysosomal enzyme alpha-L: -iduronidase (IDUA). Glycosaminoglycans (GAGs) accumulate in multiple organs and the storage in connective tissues results in restricted mobility. Previous studies provided evidence of an improvement in range of motion (ROM), as measured by goniometry, after supplementation of recombinant enzyme (ERT). AIM: The aim of the study was to evaluate the efficacy of ERT in improving ROM in patients with MPS I, using a blinded three-dimensional (3D) video analysis of unrestricted movements of the upper extremities. METHODS: In 6 patients with the attenuated phenotype of MPS I, the longitudinal changes in the upper extremity ROM were analysed by 3D video analysis during one year of ERT. RESULTS: At baseline, all studied movements except for elbow flexion were restricted. No significant improvement of the restricted upper extremity ROM was observed after one year of ERT. CONCLUSION: Long-standing restrictions in ROM probably cannot be reversed by ERT. Early initiation of treatment might be essential to prevent irreversible functional defects.

Child↗

PubMed1992

Deep-venous thrombosis of the upper extremity after traumatic brain injury.

Deep-venous thrombosis (DVT) of the lower extremity occurs frequently in a variety of patients, including those with traumatic brain injury (TBI), during their rehabilitation. Thrombosis of the major veins of the upper extremity is believed to be relatively rare, although it has increased in recent years due to the routine use of indwelling percutaneous central venous catheters. Upper extremity pain and swelling in a TBI patient is commonly attributed to heterotopic ossification, reflex sympathetic dystrophy, or occult fracture. Clinicians may not consider DVT in the differential diagnosis. No longer regarded as a benign disorder, we report the successful outcome in a 27-year-old with TBI who developed an upper extremity DVT after subclavian catheterization. The diagnostic findings, as well as treatment recommendations are reviewed.

Adult↗

PubMed2003

Diagnosis of arterial occlusive disease of the upper extremities: comparison of color duplex sonography and angiography.

PURPOSE: The aim of this study was to assess the abilities of color duplex sonography (CDUS) to detect and characterize arterial occlusive disease of the upper extremities. METHODS: We prospectively compared the results of CDUS with those of intra-arterial digital subtraction angiography, which were considered definitive, in patients with symptomatic arterial occlusive disease of the upper extremities. In each extremity, we visualized 9 arterial segments, which were each evaluated for stenoses and occlusions. Each segment was categorized on each imaging modality as not significantly narrowed (narrowed by <50%), significantly narrowed (narrowed by > or =50% but <100%), or occluded (100%). RESULTS: We examined a total of 578 segments in 57 patients (34 men and 23 women) with a mean age of 50 years (range, 20-74 years). CDUS had a sensitivity, a specificity, a positive predictive value, a negative predictive value, and an accuracy of 98%, 99%, 97%, 99.5%, and 99%, respectively, for detecting occluded lesions and 79%, 100%, 100%, 99%, and 99%, respectively, for detecting hemodynamically significantly stenotic lesions. Notably, the sensitivity of CDUS for diagnosing significantly stenotic lesions (79%) was lower than that for diagnosing occlusive disease (98%). CONCLUSIONS: With high sensitivity and accuracy rates, CDUS is a reliable screening method for detecting arterial occlusive disease of the upper extremities. This modality efficiently provides anatomic and hemodynamic data that are useful in cases of such disease.

Adult↗

PubMed2006

Secondary prevention of work-related upper extremity disorders: recommendations from the Annapolis conference.

INTRODUCTION: Efforts to improve the secondary prevention of work-related upper extremity (WRUE) symptoms continue to present a challenge. As with many occupational musculoskeletal pain disorders no single, direct cause-effect relationship exists among specific exposures, pathologic processes, and symptoms. The field has yet to create truly effective and efficient interventions for these problems that are based on current epidemiological and clinical knowledge. METHODS: A working conference was held in Annapolis, Maryland on September 23rd and 24th, 2005 with leaders in research and application related to upper extremity disorders to address this challenge. The intent of the meeting was to review "state of the art" evidence in epidemiology and intervention research in order to develop suggestions regarding next steps in intervention research and application. On day 2 a number of stakeholders were present to discuss what they perceived as the missing pieces in both epidemiological research and applied intervention research in order to generate more effective workplace interventions. RESULTS: The papers in this series of the Journal of Occupational Rehabilitation indicate that scientifically sound progress has been made over the past decade in identifying ergonomic, workplace psychosocial, and individual factors in both the etiology and exacerbation of these symptoms/disorders. However, there is a gap between this knowledge and the development and practical implementation of comprehensive interventions for these problems. The conference also highlighted the paucity of economic analyses of the impact of these disorders as well as the economic study of the impact of intervention. Approaches for such evaluations were presented and are included in this special section of the journal. CONCLUSIONS: This series of papers and the summary of the invited group's discussions provided in this paper clearly emphasize the need for innovative ways to think about these problems and specific research topics that can help translate this knowledge into effective secondary prevention efforts.

Congresses as Topic↗

PubMed1996

Periostitis of the upper extremity: a report of 2 cases and literature review.

Periostitis in the athlete is a common overuse clinical entity often found in the lower extremity. An analogous overuse syndrome also may occur in the upper extremity. These 2 case reports describe the history, physical findings, radiographic changes, and treatment for periostitis of the upper extremity rarely seen in the athletic population.

Adult↗

PubMed2003

[Acute arterial occlusions of the upper extremities--clinical data].

The authors describe 30 cases of acute arterial occlusions of upper extremity during the last 10 years (1992-2001) in a group of 27 patients. In 27 cases the occlusions were caused by embolism and in 3 cases by acute thrombosis. In the group were 12 men and 18 women. The embolus was the most frequently located in brachial artery (cubital)--17 times (63%). In one case we were forced to perform amputation of left upper extremity for gangrene. Authors accentuate that early and adequate treatment lead to salvage of extremity in 80-100%.

Acute Disease↗

PubMed2005

[Clinical experience of flap appliance in soft tissue defects of upper extremity].

OBJECTIVE: To discuss the advantages and disadvantages of flaps in the repair of soft tissue defects in upper extremity. METHODS: Based on the 2609 cases of flaps in 2512 patients from 1995 to 2004, the advantages and disadvantages of different sort of flaps, outcomes of treatment and indications of different soft of flaps were analyzed retrospectively. In the series, 2 089 pieces of the traditional flaps of different sorts were applied in 1992 patients, 474 pieces of the axial flaps of different sorts were applied in 474 patients, different sorts of free flaps were used in 46 patients. RESULTS: Follow-ups were done for 1 month to 9 years (2.7 months in average). 2 531 flaps survived (97.01%); complete necrosis occurred in 10 flaps (0.38%); partial necrosis occurred in 68 flaps (2.61%). Of the 2089 traditional flaps, 46 had partial necrosis (2.2%); 687 needed flap revisions (32.9%). Of the 474 axial flaps, 28 had complete or partial necrosis (5.9%); 82 needed revisions (17.3%). Of the 46 free flaps, 4 had complete or partial necrosis (8.7%) and nearly all the anterolateral flaps of thighs needed revisions. CONCLUSION: Traditional flaps had the advantages of easy manipulation and the highest survival rate, however, also had the disadvantages of poor texture and many times of operations. The flap with a pedicle had the advantage of good texture, consistent artery, free-range arc, however, the venous congestion was its disadvantage, which impaired the survival of the reverse flap. Free flap had the advantage of good texture and abundant donor site, but complicate manipulation was its shortage. Axial Flap with a pedicle is the optional choice for repairing soft tissue defects in upper extremity.

Adolescent↗

PubMed1986

Upper-extremity venography using digital subtraction angiography.

Venography to evaluate the patency of upper-extremity veins was performed with digital subtraction angiography (DSA) and conventional angiography. Venous thrombosis was easily diagnosed, and the innominate veins and superior vena cava were more easily visualized using DSA. Iodine concentration for DSA was one-third that of conventional venography, and the examination time was reduced by 50% using DSA. Patient comfort and acceptance were greater with DSA. DSA is a superior technique for upper-extremity vein evaluation in cooperative patients.

Adult↗

PubMed1999

An application of upper-extremity constraint-induced movement therapy in a patient with subacute stroke.

BACKGROUND AND PURPOSE: The purpose of this case report is to demonstrate the application of constraint-induced movement therapy with an individual with upper-extremity hemiparesis within 4 months after sustaining a cerebrovascular accident (stroke). Such patients often fail to develop full potential use of their affected upper extremity, perhaps due to a "learned nonuse phenomenon." CASE DESCRIPTION: The patient was a 61-year-old woman with right-sided hemiparesis resulting from an ischemic lacunar infarct in the posterior limb of the left internal capsule. The patient's less-involved hand was constrained in a mitten so that she could not use the hand during waking hours, except for bathing and toileting. On each weekday of the 14-day intervention period, the patient spent 6 hours being supervised while performing tasks using the paretic upper extremity. Pretreatment, posttreatment, and 3-month follow-up outcome measures included the Wolf Motor Function Test and the Motor Activity Log (MAL). OUTCOMES: For the Wolf Motor Function Test, both the mean and median times to complete 16 tasks improved from pretreatment to posttreatment and from posttreatment to follow-up. Results of the MAL indicated an improved self-report of both "how well" and "how much" the patient used her affected limb in 30 specified daily tasks. These improvements persisted to the follow-up. DISCUSSION: Two weeks of constraining the unaffected limb, coupled with practice of functional movements of the impaired limb, may be an effective method for restoring motor function within a few months after cerebral insult. Encouraging improvements such as these strongly suggest the need for a group design that would explore this type of intervention in more detail.

Arm↗

PubMed2004

Ergonomic and physiotherapeutic interventions for treating upper extremity work related disorders in adults.

BACKGROUND: Conservative interventions such as physiotherapy and ergonomic adjustments play a major part in the treatment of most work-related musculoskeletal disorders (WRMD). OBJECTIVES: The objective of this systematic review is to determine whether conservative interventions have a significant impact on short and long-term outcomes for upper extremity WRMD in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register (January 2002) and Cochrane Rehabilitation and Related Therapies Field specialised register (January 2002), the Cochrane Controlled Trials Register (The Cochrane Library Issue 3, 2001), PubMed (1966 to November 2001), EMBASE (1988 to November 2001), and CINAHL (1982 to November 2001). We also searched the Physiotherapy Index (1988 to November 2001) and reference lists of articles. No language restrictions were applied. SELECTION CRITERIA: Only randomised controlled trials and concurrent controlled trials studying conservative interventions for adults suffering from upper extremity WRMD were included. Conservative interventions may include exercises, relaxation, physical applications, biofeedback, myofeedback and work place adjustments. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected the trials from the search yield and assessed the clinical relevance and methodological quality using the Delphi list. In the event of clinical heterogeneity or lack of data we used a rating system to assess levels of evidence. MAIN RESULTS: We included 15 trials involving 925 people. Twelve trials included people with chronic non-specific neck or shoulder complaints, or non-specific upper extremity disorders. Over 20 interventions were evaluated; seven main subgroups of interventions could be determined: exercises, manual therapy, massage, ergonomics, multidisciplinary treatment, energised splint and individual treatment versus group therapy. Overall, the quality of the studies appeared to be poor. In 10 studies a form of exercise was evaluated, and there is limited evidence about the effectiveness of exercises only when compared to no treatment. Concerning manual therapy (1 study), massage (4 studies), multidisciplinary treatment (1 study) and energised splint (1 study) no conclusions can be drawn. Limited evidence is found concerning the effectiveness of specific keyboards for patients with carpal tunnel syndrome. REVIEWER'S CONCLUSIONS: This review shows limited evidence for the effectiveness of keyboards with an alternative force-displacement of the keys or an alternative geometry, and limited evidence for the effectiveness of individual exercises. The benefit of expensive ergonomic interventions (such as new chairs, new desks etc) in the workplace is not clearly demonstrated.

Adult↗

PubMed2003

Evaluation of the validity of the prosthetic upper extremity functional index for children.

OBJECTIVE: To evaluate the validity of the Prosthetic Upper Extremity Functional Index (PUFI), a parent- and older child-report measure that evaluates the extent of Prosthetic limb use, ease of task performance with and without the prosthesis, and its usefulness. DESIGN: Evaluation of discriminant validity (the PUFI's ability to detect differences between children), construct validity (between the parent-report PUFI and University of New Brunswick Test of Prosthetic Function [UNB Test]), and criterion validity (comparison of parent-report PUFI responses with an assessor's scores of a child's performance of PUFI activities). SETTING: Four pediatric amputee clinics. PARTICIPANTS: Thirty-eight children, ages 3 to 18 years, with unilateral upper-extremity amputation and a prosthesis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The PUFI and the UNB Test. RESULTS: The PUFI differentiated between children in high and low UNB Test score categories, and between younger and older children's functional abilities. The extent of correlation between PUFI ratings and UNB skill of performance scores was moderate for "ease of performance" and "usefulness of prosthesis" categories (r>.47, P<.05). The level of agreement between parent report and observational assessment of PUFI skills was acceptable (weighted kappa range,.44-.65). CONCLUSIONS: The PUFI showed acceptable validity and showed promise in identifying prosthetic skill and use in children of different ages and abilities.

Activities of Daily Living↗

PubMed1999

Work-related upper-extremity disorders: prospective evaluation of clinical and functional outcomes.

The purpose of this study was to describe the demographic, vocational, medical, workplace, and psychosocial characteristics of patients treated for work-related upper-extremity disorders, to document treatment patterns in a community-practice setting, and to determine which of these factors predicts subsequent employment and functional status outcomes. A questionnaire was administered by mail or telephone to 112 patients seen at the University of Massachusetts Occupational Upper Extremities Disorders Clinic and included measures of disease-specific functional status, pain, reactions to pain, employer-employee relations, and number and type of interventions used to treat the disorder. Results were compared with baseline data obtained, on average, 16 months prior to follow-up. Of the original cohort (n = 124), 112 participated in the prospective study. Although most patients reported improvement in pain severity, fear of pain, life situation, and functional status, there was little change in employment status. Patients' self-reported intentions of return to work at baseline did not predict work status at follow-up. In general, those who were employed at baseline remained employed, had a greater reduction in symptom severity over time, and were significantly more likely to report improvement in their problem than those who were unemployed. The efficacy of various interventions was examined by type, mix, and intensity (number of different interventions undergone by the patient). No positive relationship was found between these measures and employment status, self-reported change in the problem, or self-reported improvement in functional status. Significant negative relationships were found between surgery, psychotherapeutic interventions, and outcomes. This was likely to have occurred because of a selection bias toward the more chronic and severely disabled patients for these treatments. However, the relative ineffectiveness of such intensive interventions as surgery in improving the work and health status of chronically symptomatic work-related upper-extremity patients cannot be overlooked. The findings suggest that more emphasis be placed on interventions aimed at resolving differences between employers and injured employees. More careful selection of patients for expensive and invasive procedures is recommended.

Adult↗

PubMed2006

Radiofrequency ablation of osteoid osteoma in the upper extremity.

PURPOSE: To examine the results of radiofrequency ablation (RFA) of osteoid osteoma in the upper extremity. METHODS: Twenty-nine patients with a clinical and radiographic diagnosis of an upper-extremity osteoid osteoma were referred for treatment between 1990 and 2003. All had computed tomography-guided percutaneous RFA performed by the senior investigator. Records were reviewed for patient age and gender, lesion size and location, prior treatment, and pathology results. Outcomes were determined by questionnaire via mail or telephone. Complete success was defined as complete resolution of pain without further treatment. Partial success was defined as occasional pain with activities that did not require another procedure. Failure was defined as recurrence, no change in symptoms, and/or the need for another procedure. RESULTS: Follow-up data were available for 25 patients at a minimum of 1 year. Lesion locations included 17 humerus, 5 scapula, 2 radius, 1 ulna. Results for 19 patients were rated completely successful, 4 were rated partially successful, and 2 were rated failures. Two patients whose results were not completely successful received decreased RFA temperature or duration because of the proximity of a neurovascular bundle. There were no complications. Outcomes did not correlate with any patient or tumor characteristics. CONCLUSIONS: Radiofrequency ablation is a safe and effective treatment for most osteoid osteomas in the shoulder, arm, and forearm. Lesions that do not allow a safe distance between the electrode and a major neurovascular structure may require surgical excision. This may be of particular importance in lesions of the hand and carpus. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Adolescent↗

PubMed1975

Uses of the electrical skin resistance method in the study of patients with neck and upper extremity pain.

Use of the electrical skin resistance method for the study of neck and upper extremity pain is reported. Skin resistance was mapped for 20 patients who had neck or upper extremity pain without clinical or radiographic evidence of spinal cord or nerve root irritation, but who did present evidence of an abnormality within a cervical intervertebral disc or involving a facet joint of the cervical spine. In general, areas of low skin resistance (sympathetic hyperactivity) corresponded well to areas of subjective pain. The skin resistance pattern has not led to localization of the level of abnormality within the cervical spine, but has been of value in confirming the clinical impression that a pain-producing mechanical or degenerative lesion is present. The test thus adds objective evidence in an area often fraught with subjectivity.

Adult↗

PubMed1994

Upper extremity weight-bearing effect on corticospinal excitability following stroke.

The effects of upper extremity weight-bearing on the excitability of corticospinal neurons projecting to the flexor carpi ulnaris (FCU) muscle of patients having had cerebrovascular accidents (strokes) were examined. Alternate transcranial magnetic and ulnar nerve stimulation were applied and peristimulus time histograms of single FCU motor unit discharge times were generated to provide information about the cortical and segmental postsynaptic potentials (PSPs), respectively. Recordings from 10 patients and 5 control subjects indicated the cortically evoked PSPs were initially abnormally small in the stroke group (p < .01). Following weight-bearing the cortical projection strength to FCU motoneurons increased in stroke patients (p < .05) only. The composite group Ia PSP was reduced in 2 patients, but data could not be obtained from the remaining subjects. It is concluded that upper extremity weight-bearing normalizes corticospinal facilitation of FCU motor units in stroke patients. A sustained increase in motor cortical excitability through augmented afferent input may be responsible.

Adult↗