SEARCH · PubMed Health

Results for “upper extremity”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 559 records · Page 31Linked to original sources

PubMedDate not supplied

Surgical management of arthrogryposis in the upper extremity.

Arthrogryposis multiplex congenita is a rare congenital disorder in which the extremities are affected with severe resistant musculoskeletal contractures. In the upper extremity, these deformities typically consist of internal rotational contractures of the shoulder, extension deformity of the elbow, flexion and ulnar deviation of the wrist, thumb-in-palm deformity, and digital interphalangeal joint flexion contractures occurring singularly or in combination. At the Houston Unit of the Shriners Hospital for Crippled Children, during the interval from 1962 to 1982, 25 patients underwent 56 operative procedures to correct upper-extremity deformities due to arthrogryposis multiplex congenita. Functional improvement was observed clinically and reported subjectively by the patients or their parents in 75% of the cases.

Arthrogryposis↗

PubMed1990

[Objective display on phenomena of propagated sensation along channels (PSC)--changes on the infrared thermal image channels pathway of upper extremity].

This paper reported the observed results on changes of the infrared thermal image of upper extremity induced by needle "Hega" (LI 4), "Daling" (P 7) and "Neiguan" (P6) points. The results indicated that 10 out of 23 cases whose higher and middle temperature bands of upper extremity distributed along the "Dachang" (Large Intestine) channels, when they felt phenomena of propagated sensation along the "Dachang" channels induced by needle "Hegu" points. Those effects did not appear in the objects who did not feel PSC along the "Dachang" channels induced by needled points. Above results provide an objective basis for the phenomena of channels and suggest that the phenomenon of PSC is an objective fact in human body.

Acupuncture Points↗

PubMed2003

Kinetics of the upper extremity in the open and square stance tennis forehand.

Seven right-handed teaching professionals and eight intermediate tennis players were filmed using two high-speed cameras (100 Hz) as they performed open and square stance forehand drives. Three-dimensional coordinates (3D) were reconstructed using the DLT method. A three-segment rigid body model of the racket and upper extremity was used to calculate the kinetics of the wrist, elbow, and shoulder joints up to impact. The open stance created lower resultant velocities of the racket at impact (21.2 and 15.8 m/s) than the square stance (22.3 and 16.4 m/s) for professional and intermediate subjects, respectively. The largest components of the resultant joint torques were generated by the shoulder horizontal adductors, followed by elbow varus torques, and shoulder internal rotation torques. Torques were similar across stance and skill level except for significantly (p < 0.05) greater peak shoulder internal rotation torques in the square compared to the open stance, greater peak wrist flexion torques in the intermediate compared to the professionals, and greater peak wrist flexion torques in the square stance compared to the open stance. The data did not support the hypothesis that the open stance technique creates greater loading throughout the upper extremity than the square stance technique. Peak upper extremity torques were similar to peak torques reported for baseball pitching and represent loads that could contribute to strength imbalances and overuse injuries.

Biomechanical Phenomena↗

PubMed2006

Combined functional task practice and dynamic high intensity resistance training promotes recovery of upper-extremity motor function in post-stroke hemiparesis: a case study.

BACKGROUND AND PURPOSE: Weakness is a significant impairment in persons with post-stroke hemiparesis, yet traditional clinical perspectives caution against strengthening in neurological populations. Significant correlations between weakness and functional movement have been demonstrated, however, a clear relationship between increased strength and functional improvement has been elusive. This case study describes a combined program of dynamic, high-intensity resistance training and functional task practice for the upper-extremity in adult hemiparesis. CASE DESCRIPTION: The patient was a 65-year-old, right hand dominant woman who presented to the Neural Control of Movement Laboratory at the Palo Alto VA Rehabilitation Research and Development Center 16 weeks following clipping of an unruptured aneurysm with consequent dense right hemiparesis. She received 7 weeks of acute rehabilitation according to CARF guidelines (ie, at least 3 hours of two or more disciplines, 6 days per week). Her baseline research evaluation revealed significant upperextremity deficits at the ICF body structure/function level including: weakness, shoulder pain, mild resistance to passive movement, and need for moderate to maximal assistance in many activities of daily living including bathing and dressing. The Stroke Impact Scale score reporting her perspective indicated she had recovered from her stroke only 50%. The hybrid resistance training-functional task practice intervention, detailed in this report, was delivered 3 times per week for 6 weeks with each session lasting 75:00. OUTCOMES: The subject revealed marked improvements in isometric and dynamic force production in 5 key upper-extremity actions: elbow flexion, elbow extension, shoulder flexion, shoulder abduction, and shoulder external rotation. Strength gains were accompanied by increased EMG activation immediately postintervention and by a combination of increased activation and apparent hypertrophic effects at 6 month follow up. Marked improvements were noted in all clinical and functional measures and in an elbow trajectorytracking task which served as a surrogate measure of motor control. DISCUSSION: Improvements in strength and positive outcome effects at the physiological, clinical, and functional levels were observed in this subject following the experimental hybrid upper-extremity rehabilitation intervention described. Importantly, no deleterious effects were observed including exacerbation of spasticity or musculoskeletal compromise. Observations of improved EMG activation in this case study suggest that improvements in motor activation underlie these strength gains and can likely be attributed to working at a high intensity level.

Activities of Daily Living↗

PubMed1988

Upper extremity fractures in the acute spinal cord injured patient.

Fifty-three long bone upper extremity fractures in 46 patients with recent spinal cord injuries were reviewed with reference to the outcome of operative versus nonoperative treatment. Twenty-four fractures had surgery and 29 fractures were treated nonoperatively. Criteria used in assessing outcome included range of motion, time to union, total rehabilitation time, and orthopedic and medical complications. Humeral fractures had similar outcomes with either operative or nonoperative treatment. Radial nerve injury occurring with humeral fractures prolonged the rehabilitation time. All three combined radial and ulnar fracture treated surgically developed synostosis whereas two of the three nonoperatively treated fractures had other orthopedic complications. Nondisplaced radial fractures responded appropriately to closed treatment. Displaced radial fractures treated nonoperatively had a high incidence of malunion. All ulnar fractures were treated operatively, and all achieved acceptable range of motion and fracture healing at the time of discharge. Medical complications such as deep venous thromboses and decubitus ulcers occurred more frequently in the nonoperatively treated group (28%) than in the operatively treated group (4%). Standard guidelines for upper extremity fracture care apply to the patient with a spinal cord injury. However, operative stabilization may be associated with a decreased risk of medical complications in these patients.

Adolescent↗

PubMed1990

Upper extremity assistive devices: assessment of use by spinal cord-injured patients with quadriplegia.

Upper extremity assistive devices prescribed during the rehabilitation of the patient with quadriplegia often are discarded once the patient leaves the hospital. Therefore, we conducted this study to investigate patterns of the prescription and use of such devices and satisfaction with them. An oral questionnaire was administered to 56 spinal cord-injured quadriplegic patients 1 and 2 years after their first rehabilitation experience. Although the patients had discarded 46% of the devices within the 1st year, most of these devices were inexpensive, commercially available devices or devices made by occupational therapists. The respondents' most frequently cited reasons for discarding a device were "improved physical function" and "alternative solutions found." The devices retained in use most often were the more costly orthotics such as reciprocal orthoses and ball-bearing feeders. Sixty-four percent of the devices used within the 1st year were still being used at the end of the 2nd year. Thirty-five percent of all devices prescribed during rehabilitation were still in use at the end of 2 years. The results of this study have heightened therapists' awareness of the efficacy and use of upper extremity assistive devices and have enabled them to eliminate some devices, to modify methods of instructing patients in the use of devices, and to develop alternative products.

Activities of Daily Living↗

PubMed1990

Multifocal neurilemomas in different nerves of the same upper extremity.

We report a case of multifocal neurilemomas originating from different nerves in the same upper extremity. In the excision of all seven tumors care was taken not to damage the nerves involved. The common features of multifocal neurilemomas that originated from different nerves of the same upper extremity are outlined and the consequent risk of potential nerve damage during the operation is discussed. We recommend intracapsular excisions of multifocal neurilemomas.

Humans↗

PubMed1994

Mangled extremity severity score: an accurate guide to treatment of the severely injured upper extremity.

The mangled extremity severity score (MESS) is a scoring system that can be applied to mangled extremities and help one determine which mangled limbs will eventually come to amputation. The MESS is a graduated grading system based on skeletal and soft tissue injury, shock, ischemia, and age. The records of 37 patients having sustained 43 open fractures or mangled upper extremity injuries, seen and treated at the University of New Mexico's Regional Trauma Center between April 1987 and September 1990, have been reviewed. All nine extremity injuries with a MESS of greater than or equal to seven were amputated, and 34 of 34 with a MESS of less than seven were salvaged. Nine Grade IIIC and six mangled extremities were identified in our study. Five of these Grade IIIC and four of the mangled extremities with a MESS of greater than or equal to seven were amputated. All Grade IIIC or mangled extremities with a MESS of less than seven were salvaged. In conclusion, the MESS is an early and accurate predictor for identifying the extremities that may be best treated by amputation.

Adult↗

PubMed2006

Low field MRI: a review of the literature and our experience in upper extremity imaging.

Since its introduction to medical imaging in the early 1980s, MRI has become essential in diagnosis and treatment of musculoskeletal conditions. Most imaging in the United States is performed on high-field whole-body scanners (>1.0 T). Imaging on low (<0.5 T) and medium (0.5-1.0 T) field strengths using small, low-cost, easily installed scanners in physicians' offices or imaging centers has gained popularity. These scanners can be useful in imaging the upper extremity from the shoulder to the fingers. This article provides an overview of the different extremity scanners available and their advantages and disadvantages, a brief review of the literature regarding their use, and a discussion of our experience in using the low-field extremity scanners in evaluating the upper extremity.

Humans↗

PubMedDate not supplied

Local anesthetic infusion through nerve sheath catheters for analgesia following upper extremity amputation. Clinical report.

BACKGROUND AND OBJECTIVES: Reports about the efficacy of local anesthetic perfusion of nerve stumps following lower extremity amputation are conflicting. We report our experience with this technique following amputation of the upper extremity. METHODS: Six consecutive patients undergoing proximal upper extremity amputations (four forequarter amputations and two shoulder disarticulations) for malignancy were prospectively observed. In all patients, catheters were placed within the amputated nerve sheaths at the conclusion of the procedure. Bupivacaine. 0.25%, was administered through each catheter as a bolus and then as a continuous infusion for at least 72 hours after surgery. Narcotic usage, level of pain as reported verbally, and presence of phantom limb pain during the infusion were recorded. For at least 1 year after operation, data were gathered on the presence of phantom limb pain and its intensity during each follow-up visit. RESULTS: Complete analgesia was achieved in all patients by postoperative day 2. Narcotic usage was low. Three of the six patients reported phantom limb pain during follow-up evaluation. CONCLUSIONS: Continuous local anesthetic perfusion of amputated nerves via a catheter placed under direct vision provided excellent postoperative analgesia. The incidence of phantom limb pain for cancer patients did not differ from that previously reported but was easily managed pharmacologically. The technique may also be efficacious for traumatic amputations.

Adult↗

PubMed1998

Occupational upper extremity disorders in the federal workforce. Prevalence, health care expenditures, and patterns of work disability.

Upper extremity disorders (UEDs) account for a significant number of work-related illnesses in the US workforce. Little information exists on the distribution of UEDs, their associated health care and indemnity costs, or patterns of work disability. The study presented is an analysis of upper extremity claims within the federal workforce. In this study, the universe consisted of all claims accepted by the US Department of Labor, Office of Workers' Compensation Programs (OWCP), from October 1, 1993, through September 30, 1994. A total of 185,927 claims of notices of injury were processed during the study period, and of these, 8,147 or 4.4% had an UED diagnosis coded according to the International Classification of Diseases, Clinical Modification (ICD-9-CM). 5,844 claims involved a single UED diagnosis and were the only claims field by these employees between October 1, 1990, and September 30, 1994. These single claims with single diagnoses comprised the sample for further analysis. Mononeuritis and enthesopathies of the upper limb were the most common diagnoses, accounting for 43% and 31% of the claims, respectively. Women had a higher proportion of carpal tunnel syndrome, "unspecified" mononeuritis, and "unspecified" enthesopathies. The majority of claimants for both the mononeuritis- and enthesopathy-related diagnoses were between 31 and 50 years of age, received only health care benefits, and did not incur wage loss. Health care costs for mononeuritis and enthesopathy claims were $12,228,755 (M = $2,849). Carpal tunnel syndrome (CTS) and enthesopathy of the elbow were the most costly diagnoses, accounting for 57% and 16% of the total, respectively. Surgical services represented the highest expenditures in CTS claims. Physical therapy accounted for the majority of health care costs for enthesopathy cases. The mean number of workdays lost for CTS and enthesopathy claims were 84 and 79, and the average indemnity costs were $4,941 and $4,477, respectively. These findings indicate that while UEDs represent a relatively small percentage of all workers' compensation cases, the health care and indemnity costs are considerable. Also mean duration and pattern of work disability revealed that these disorders can result in chronic work disability similar to that observed in low back pain. The results highlight the need to determine whether interventions that account for the majority of costs significantly impact long-term outcomes. There is also a need to identify risk factors for prolonged disability in those who experience problems with delayed recovery.

Adolescent↗

PubMed2002

Soft tissue sarcoma of the upper extremity: a 5-year experience at two institutions emphasizing the role of soft tissue flap reconstruction.

BACKGROUND: The objective of this study was to define the impact of soft tissue flap reconstruction on multimodality therapy for patients with soft tissue sarcomas of the upper extremity. Treatment standards continue to evolve for these patients, and, with multimodality therapy, most of them are candidates for limb-preserving surgery. Consequently, the role of soft tissue flap reconstruction is expanding. METHODS: A review was conducted of 100 consecutive patients with soft tissue sarcomas of the upper extremity who underwent surgery at several institutions between 1992 and 1997. RESULTS: Seventy-one patients underwent direct closure of defects after tumor resection, and 29 patients required soft tissue reconstruction with flaps. These groups were similar in most respects, except that 52% of the patients who required soft tissue reconstruction presented with recurrent disease (P = 0.0004), and 79% of them had tumors measuring > 5 cm in greatest dimension (P = 0.0003). The patients who required flap reconstruction had larger skin deficits after undergoing tumor resection (140 cm2) compared with the patients who had wounds that were managed by direct closure (40 cm2; P < 0.00001). Margins around the resected tumors were larger (1.62 cm) when flaps were employed compared with margins when defects were closed directly (0.87 cm; P = 0.0005). However, the number of patients with intralesional, marginal, wide, and radical resections was the same regardless of wound management. Major complications occurred in 14% of patients, but none led to death or amputation. The median follow-up was 31 months, and 66% of patients had no evidence of disease at that time. Rates of local recurrence and survival were similar for patients who underwent flap reconstruction compared with patients who underwent direct closure. CONCLUSIONS: Soft tissue flap reconstruction facilitates therapy for patients with soft tissue sarcomas of the upper extremity, so that patients with larger tumors can undergo resection, limiting complications and limb sacrifice.

Adolescent↗

PubMed1998

Disorders of the upper extremity in children.

This article presents a brief overview of the indications of MR imaging in a variety of disorders of the upper extremity of the pediatric patient. This covers congenital anomalies: Sprengel shoulder, Poland sequence, arthrogryposis; posttraumatic lesions of cartilage, bone, tendon, muscle and nerve including the brachial plexus injury; inflammatory arthritis and synovitis; bone and joint infection; osteochondritis dissecans, bone necrosis and infarcts in sickle cell anemia and juvenile Gaucher disease, as well as tumors. In this last category, the authors briefly describe the appearances of cysts and tumors of bones and soft tissues of the upper extremity. Indications for the intravenous administration of Gadolinium are given throughout the article with emphasis on the synovial enhancement seen in active arthritis and synovitis.

Adolescent↗

PubMedDate not supplied

Dupuytren's contracture after burns of the upper extremity.

A case of Dupuytren's contracture in a patient with previous history of burns of the upper extremity is reported. Because this patient has no predisposition to the disease, burns of the upper extremity should be considered as a trigger to the onset of the disease.

Arm Injuries↗

PubMed2002

Restoration of upper extremity function after peripheral nerve injuries.

These days injuries to the peripheral nerves of the upper extremity that necessitate total or partial lesion are very common in the household and working environment. With regard to the majority of these injuries, not only plastic surgeons or neurosurgeons must have knowledge of their correct treatment, but general surgeons as well. The principles of reconstruction of the peripheral nerves of the upper extremity are described. The authors refer to immediate and delayed nerve repair, free nerve grafting, free vascularised nerve grafting, tendon transfer for a paralyzed hand, pedicled muscle transfer, functioning free muscle transplantation and neurotization.

Arm↗

PubMed1996

Upper extremity musculoskeletal disorders at a pulp and paper mill.

A small cross-sectional study of upper extremity disorders was conducted in two departments of a pulp and paper mill. The objective of the study was to determine the prevalence of upper extremity disorders and identify any associated work place risk factors in long cycle jobs with multiple tasks of varying duration. Physical exams and health status interviews were conducted on 23 employees (77%) in the paper machine department and on 17 employees (59%) of the power and recovery department. All participants completed questionnaires on physical and psychosocial job characteristics. There was a statistically significant difference in hand and wrist disorders between the two departments at the p < 0.05 level (34.8% in the power and recovery department, and 5.9% in the paper machine area). Multiple logistic regression models showed a significant relationship between the use of a steel lance and shoulder disorders. Elbow arthritis was also associated with lance usage. There was evidence that the job analysis was not able to fully describe the risk factors present in the paper machine department. Biomechanical exposures existing prior to the time of the study may not have been adequately characterized. An important aspect of this study is that the jobs studied were not typical repetitive jobs that are commonly studied.

Journal Article↗

PubMed2002

Strain in the median and ulnar nerves during upper-extremity positioning.

The purpose of this study was to quantify the strain of the median nerve and the ulnar nerve throughout upper-extremity positioning sequences used by clinicians to evaluate nerve dysfunction. A microstrain gauge was used to quantify strain and digital calipers were used to assess nerve excursion in 4, fresh, intact cadavers. Data analysis of noncontinuous motion trials showed that the median nerve tension test caused a maximum summative strain in the median nerve at the carpal tunnel of 7.6%, with the largest increase in strain during elbow extension (3.5%). Components of the median nerve tension test decreased strain in the ulnar nerve at the cubital tunnel. The ulnar-nerve tension test caused a maximum summative strain in the ulnar nerve of 2.1%, with the largest increase in strain during shoulder abduction (0.9%). Some components of the ulnar-nerve tension test decreased strain in the median nerve. These cadaver findings lend support to the use of upper-extremity positioning sequences in the clinic to induce nerve strain during evaluation of nerve dysfunction.

Adult↗

PubMed1990

Validity of function tests on the upper extremities in establishing a prognosis in vibration syndrome.

The validity of function tests on the upper extremities as prognostic tools in vibration syndrome was evaluated over a sequence of observation periods. The subjects examined were 672 forest workers using chain saws who had had some complaints and who had shown abnormal findings in the function tests. The function tests consisted of peripheral circulatory and sensory tests, including cold provocation and motor tests of functional capacity in the upper extremities. From the results of testing, 23 variables were selected and examined by multivariate analysis. The four principal components were extracted by principal component analysis, and the factor score of the peripheral circulatory disturbances component was found to be highly correlated with the severity of VWF (Vibration-induced White Finger). The course of VWF and the nail compression test had high standard regression coefficients with the severity of vibration syndrome. The course of finger numbness, pinching power, pain threshold, skin temperature and X-ray findings in the elbow joints had high discriminant function values for the evaluation of the severity of vibration syndrome.

Discriminant Analysis↗