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 577 records · Page 32Linked to original sources

PubMed1988

Massive upper extremity edema following vascular access surgery.

We recently treated three patients with chronic renal failure who required subclavian vein cannulation with Uldall catheters following thrombosis of their arteriovenous fistulae. New arteriovenous fistulae were created in each patient following removal of the Uldall catheters. The patients were seen subsequently with massive, painful edema in the ipsilateral upper extremities from one to 10 weeks following creation of the arteriovenous fistulae. Radiographic studies documented stenosis or occlusion of the ipsilateral proximal subclavian vein. The arteriovenous fistula was ultimately ligated in each patient, which promptly resolved the pain and edema. Because subclavian vein thrombosis following temporary hemodialysis through an indwelling catheter is frequently asymptomatic until an arteriovenous fistula is constructed, venography should be considered in patients requiring upper extremity vascular access procedures. Demonstration of subclavian vein stenosis or occlusion would either preclude use of the upper extremity for an arteriovenous fistula or would require a concomitant procedure to relieve the venous obstruction.

Adult↗

PubMed2006

Imaging of sports injuries of the upper extremity in children.

Competitive athletics in school-aged children has become the norm rather than the exception. The increased repetitive stresses placed on the upper extremity in a wide variety of sports result in a host of injuries unique to the skeletally immature athlete. This article focuses on a discussion of the more common upper extremity injuries encountered in the child athlete and the role of radiography and MRI in diagnosis and management.

Acute Disease↗

PubMed2003

Upper extremity bypass grafting for limb salvage in end-stage renal failure.

OBJECTIVE: Patients with end-stage renal failure and upper-extremity arterial occlusive disease sometimes have painful digital ulceration. We evaluated the efficacy of distal bypass grafting from the brachial artery for limb salvage in this setting. METHODS: All patients with end-stage renal disease with painful digital ulceration or gangrene of the hand seen from 1992 to 2002 were evaluated with clinical examination and noninvasive studies. Those with evidence of occlusive disease underwent conventional angiography. Individuals with forearm occlusive disease underwent bypass grafting, from the brachial artery to either the distal radial artery or ulnar artery at the level of the wrist or proximal hand. Follow-up was scheduled at regular intervals, and included duplex scanning. Limb salvage and bypass graft patency were determined with life table analysis. RESULTS: Over 10 years, 18 forearm bypass procedures were performed in 15 patients. The outflow artery was the radial artery in 15 procedures and the ulnar artery in 3 procedures. Bypass conduit was autogenous in all patients. No patient had a functioning arteriovenous fistula at bypass grafting; six limbs had previously occluded fistulas. Two bypass grafts (11%) occluded in the early postoperative period, with resultant progression of gangrene. In the remaining 16 grafts patency was maintained (mean follow-up, 18 months), with pain control and tissue healing. CONCLUSION: Treatment in patients with renal failure with upper extremity occlusive disease may be facilitated with brachiodistal bypass grafting. Pain control and reversal of progression of hand necrosis can be achieved.

Adult↗

PubMed2001

The molecular control of upper extremity development: implications for congenital hand anomalies.

As the molecular aspects of limb development are being unraveled, more of the congenital anomalies seen by hand surgeons in the clinical setting will have an identifiable molecular basis. The majority of the data available regarding the molecular development of the upper extremity have come from experimental animal studies, specifically the mouse and chicken. These findings are being discovered by either direct surgical and molecular manipulation of the developing limb or by production of mice deficient in specific genes. Relatively few specific human mutations that cause limb abnormalities have been identified. Hand surgeons should be aware of the basic molecular pathways controlling limb development because they are in a unique position to be able to identify patients with such deformities. In turn, detailed clinical descriptions of congenital anomalies affecting the upper extremity will advance the understanding of the cellular events controlled by the molecular pathways of limb development. This review describes the general molecular basis of limb development and correlates it with disease processes affecting the upper extremity.

Animals↗

PubMed1997

[Tolerance limit of human upper extremity with arm restraint plate on eject seat to simulated aerodynamic loads].

To obtain tolerance limit of human upper extremity with arm restraint plate on eject seat to windblast, impact was applied to the upper extremity of 13 human corpses and 7 living monkeys by a spring driven impact device. Relationship between impact load, moment of elbow joints and arm injuries with arm restraint plate were studied. Relationship between biomechanical characteristic curve of human elbow joint and clinical injuries was obtained. The results indicated that tolerance limit of human upper arm is higher than forearm. Safety limit of human anterior arm to simulated aerodynamic load is 1.26 kN.

Aerospace Medicine↗

PubMed1977

Upper extremity lymphangiography in the radiation therapy of lymphomas and carcinoma of the breast.

Seventeen bilateral upper extremity lymphangiograms were obtained in patients with lymphoma referred for radiation therapy. The projection of the opacified axillary nodes is analyzed when using the mantle technique in various positions. The position of the lymph nodes varies considerably in the supine and prone positions. Placing pads underneath the shoulders in the prone position allows for better protection of the pulmonary parenchyma while still including the opacified lymph nodes. Because these nodes vary in position, it is recommended that if the axillary nodes are clinically involved or if hilar adenopathy is present, upper extremity lymphangiograms should be obtained to ensure inclusion of all the axillary lymph nodes. In treating carcinoma of the intact breast, care should be taken to include the lower axillary nodes in the tangenital breast field and to include 2 cm of lung in the posterior axillary boost.

Arm↗

PubMed1999

Dynamic injury tolerances for long bones of the female upper extremity.

This paper presents the dynamic injury tolerances for the female humerus and forearm derived from dynamic 3-point bending tests using 22 female cadaver upper extremities. Twelve female humeri were tested at an average strain rate of 3.7+/-1.3%/s. The strain rates were chosen to be representative of those observed during upper extremity interaction with frontal and side airbags. The average moment to failure when mass scaled for the 5th centile female was 128+/-19 Nm. Using data from the in situ strain gauges during the drop tests and geometric properties obtained from pretest CT scans, an average dynamic elastic modulus for the female humerus was found to be 24.4+/-3.9 GPa. The injury tolerance for the forearm was determined from 10 female forearms tested at an average strain rate of 3.94+/-2.0%/s. Using 3 matched forearm pairs, it was determined that the forearm is 21% stronger in the supinated position (92+/-5 Nm) versus the pronated position (75+/-7 Nm). Two distinct fracture patterns were seen for the pronated and supinated groups. In the supinated position the average difference in fracture time between the radius and ulna was a negligible 0.4+/-0.3 ms. However, the pronated tests yielded an average difference in fracture time of 3.6+/-1.2 ms, with the ulna breaking before the radius in every test. This trend implies that in the pronated position, the ulna and radius are loaded independently, while in the supinated position the ulna and radius are loaded together as a combined structure. To produce a conservative injury criterion, a total of 7 female forearms were tested in the pronated position, which resulted in the forearm injury criterion of 58+/-12 Nm when scaled for the 5th centile female. It is anticipated that these data will provide injury reference values for the female forearm during driver air bag loading, and the female humerus during side air bag loading.

Air Bags↗

PubMed1995

Peripheral neuropathies in the upper extremities of paraplegic wheelchair marathon racers.

In order to know if peripheral neoropathies in the upper extremities of paraplegic individuals are induced by participating in wheelchair marathon races, we performed nerve conduction studies bilaterally on the median, ulnar, and radial nerves of 10 male wheelchair marathon racers, and on 10 male sedentary paraplegic individuals. In five of 10 paraplegic racers, and in nine of 10 sedentary paraplegics there was a decrease of motor nerve conduction velocities and/or prolongation of motor or sensory nerve distal latencies. Abnormal results in all of the nerve conduction studies were 3.2% and 13.6% in paraplegic racers and sedentary paraplegics, respectively. Although paraplegic racers had fewer peripheral neuropathies in the upper extremities than did sedentary paraplegics, ulnar lesions due to involvement of the deep motor branch and at the elbow were a characteristic feature of nerve injuries, presumably caused by wheelchair marathon racing. It is suggested that although a wheelchair marathon is generally a safe sport, wearing gloves and handling a wheelchair in the correct way during the race are necessary to prevent nerve injuries.

Adult↗

PubMed1992

Tire explosion injuries to the upper extremity.

Several articles have been published that bring attention to the destructive potential of tire explosions. Although the severity of tire explosion injuries to the head and neck region is well established, only one previous article has reported injuries to the upper extremity. Fourteen patients with upper extremity tire explosion injuries have been treated by us from 1980 to 1988. Each injury was caused by single-piece wheel assemblies, as opposed to multipiece wheel assemblies, which have traditionally been associated with the injury. Three representative patient reports are discussed. Prevention of this injury can be achieved by increased public awareness, formal industrial safety training, tire servicing with dedicated equipment including restraining devices or barriers, complete evaluation of wheel/tire serviceability before tire mounting, separation of servicing of single and multipiece wheels, and complete tire deflation before servicing.

Accidents, Occupational↗

PubMed2006

An upper extremity kinematic model for evaluation of hemiparetic stroke.

Quantification of rehabilitation progress is necessary for accurately assessing clinical treatments. A three-dimension (3D) upper extremity (UE) kinematic model was developed to obtain joint angles of the trunk, shoulder and elbow using a Vicon motion analysis system. Strict evaluation confirmed the system's accuracy and precision. As an example of application, the model was used to evaluate the upper extremity movement of eight hemiparetic stroke patients with spasticity, while completing a set of reaching tasks. Main outcome measures include kinematic variables of movement time, range of motion, peak angular velocity, and percentage of reach where peak velocity occurs. The model computed motion patterns in the affected and unaffected arms. The unaffected arm showed a larger range of motion and higher angular velocity than the affected arm. Frequency analysis (power spectrum) demonstrated lower frequency content for elbow angle and angular velocity in the affected limb when compared to the unaffected limb. The model can accurately quantify UE arm motion, which may aid in the assessment and planning of stroke rehabilitation, and help to shorten recovery time.

Adult↗

PubMed1980

H-reflex of the upper extremities in cervical myelopathy.

A study was made of the H-reflex in the upper extremities to express objectively the degree of spastic paralysis in cases of cervical myelopathy. This reflex cannot normally be elicited in healthy persons. The H-reflex was elicited in 63 out of 80 patients with advanced symptoms of cervical myelopathy and was most frequently recorded from the median nerve. The H/M amplitude ratio is used to express the degree of spastic paralysis, the higher the ratio the more severe the dysfunction. The longer the clinical history the greater the tendency for the H-type of reflex to change to the HF-type and the higher the H/M amplitude ratio. The decrease rate of the pre- and post-operative H-reflex was high amongst soft disc cases whilst that in spondylosis and ossification of the posterior longitudinal ligament was low compared to the improvement in symptoms. It is concluded that the H-reflex in the upper extremities is a good method of expressing the degree of spastic paralysis in cervical myelopathy.

Aged↗

PubMed1998

Work schedule and task factors in upper-extremity fatigue.

We tested the combined effects of work schedule and task factors on upper-extremity fatigue in the laboratory during 8-h and 12-h shift schedules. Participants performed a simulated manual assembly task at three repetition rates and three torque loads and self-adjusted their work cycle duration to maintain fatigue at moderate levels. Work cycle durations decreased with increases in both load level and repetition rate. Fatigue was observed more quickly with increasing time on shifts and during night shifts compared with day shifts. Work schedule effects were most apparent at lighter workloads, with minimal differences at higher workloads. The highest fatigue levels were observed during 12-h night shifts, with similar levels reached by the end of both the week of 8-h night shifts and the week of 12-h day shifts. Overall durations were 20%-30% shorter than in previous short-term studies, which was likely a result of the more realistic work schedules used in this study. Results from this study could be applied to the design of work-rest schedules for manual tasks involving the upper extremities.

Adult↗

PubMed1986

Upper extremity lymphedema secondary to mammary cancer treatment.

Upper extremity lymphedema resulting from the radiation or surgical therapy of breast cancer is quite common and can approximate 25% in some series. To treat patients with this condition, a special lymphedema clinic was started in 1979. To date, 150 patients have been enrolled. They have had their lymphedema for periods of 1 month to 14 years. Treatment was either by sequential pumping using a special device (Lymphapress) or by microsurgery. The surgery consisted of multiple lymphovenous anastomoses without sutures, carried out on the medial aspect of the affected upper arm. Thus far, 102 anastomoses have been performed in 15 patients. The results of both treatment methods have been very encouraging.

Adult↗

PubMed2006

Does functional capacity evaluation predict recovery in workers' compensation claimants with upper extremity disorders?

OBJECTIVES: Functional capacity evaluations (FCEs) are commonly used to determine return-to-work readiness and guide decision making following work related injury, yet little is known of their validity. The authors examined performance on the Isernhagen Work Systems' FCE as a predictor of timely and sustained recovery in workers' compensation claimants with upper extremity disorders. A secondary objective was to determine whether FCE is more predictive in claimants with specific injuries (that is, fracture) as compared to less specific, pain mediated disorders (that is, myofascial pain). METHODS: The authors performed a longitudinal study of 336 claimants with upper extremity disorders undergoing FCE. FCE indicators were maximum performance during handgrip and lift testing, and the number of tasks where performance was rated below required job demands. Outcomes investigated were days receiving time-loss benefits (a surrogate of return to work or work readiness) in the year following FCE, days until claim closure, and future recurrence defined as whether benefits restarted, the claim reopened, or a new upper extremity claim was filed. Cox and logistic regression were used to determine the prognostic effect of FCE crudely and after controlling for potential confounders. Analysis was performed separately on claimants with specific and pain mediated disorders. RESULTS: Most subjects (95%) experienced time-loss benefit suspension within one year following FCE. The one year recurrence rate was 39%. Higher lifting performance was associated with faster benefit suspension and claim closure, but explained little variation in these outcomes (r2 = 1.2-11%). No FCE indicators were associated with future recurrence after controlling for confounders. Results were similar between specific injury and less specific groups. CONCLUSIONS: Better FCE performance was a weak predictor of faster benefit suspension, and was unrelated to sustained recovery. FCE was no more predictive in claimants with specific pathology and injury than in those with more ambiguous, pain mediated conditions.

Accidents, Occupational↗

PubMed2000

The injury mechanisms of osteoporotic upper extremity fractures among older adults: a controlled study of 287 consecutive patients and their 108 controls.

The risk factors for falls in older adults are well known but knowledge on the direct injury mechanisms that result in various osteoporotic fractures has been very sparse. The purpose of this study was therefore to clarify the injury mechanisms of osteoporotic upper extremity fractures of older adults and to compare these mechanisms with those of the control fallers, and in this way to obtain reliable insight into the etiology and pathogenesis of upper extremity fractures and thus to enable fracture prevention. One hundred and twelve patients with a fresh fracture of the proximal humerus, 65 patients with an elbow fracture, 110 patients with a wrist fracture and 108 controls (no fracture, or a fracture other than the case fracture) were interviewed and examined between September 1995 and December 1997. The inclusion criteria of the subjects were that the patient was 50 years of age or older at the time of the accident, and that the fracture/injury had occurred as a result of low-energy trauma (typically a fall from standing height or less) within a week before the interview and examination. In 97% of patients with a proximal humerus or elbow fracture, and in all patients (100%) with a wrist fracture, the fracture was a result of a fall. In the control group this figure was 93%. In a polychotomous logistic regression analysis the intergroup differences in the fall directions (adjusted by gender, age and functional capacity) were statistically highly significant (chi 2 = 43.6, d.f. = 15, p < 0.001). Most of the patients with a proximal humerus fracture or elbow fracture reported that they had fallen 'obliquely forward' (43% and 38%) or 'to the side' (29% and 26%), whereas in the wrist fracture group the main fall direction was also 'obliquely forward' (34%) but the other fall directions (i.e., 'forward', 'to the side', 'obliquely backward' and 'backward') were quite equally represented (13-19%). The odds ratio (OR) for an obliquely forward fall resulting in a proximal humerus fracture was 3.5 [95% confidence interval (CI) 1.4-9.2), as compared with the fall directions of the controls and the 'obliquely backward' fall direction. In a logistic regression analysis the patients with a wrist fracture managed to break their fall (e.g., with an outstretched arm) more frequently than the patients in the other groups (OR 3.9; 95% CI 2.0-7.3). The patients with a proximal humerus fracture, in turn, managed to break their fall less frequently than the controls (OR 0.33; 95% CI 0.14-0.80). The same was true of the patients with an elbow fracture, although the difference was not significant (OR 0.49%; 95% CI 0.19-1.3). As objective evidence for a direct fall-induced impact on the fracture site, 68% of patients with a proximal humerus fracture revealed a fresh subcutaneous hematoma on the shoulder/upper arm, while such a hematoma was rare in the controls (2%) (p < 0.001). Correspondingly, 62% of patients with an elbow fracture showed a similar hematoma on the elbow area, while this was seen in none of the controls (p < 0.001). In patients with a wrist fracture a hand/wrist hematoma was seen in 58% of the victims, as compared with 18% of the controls (p < 0.001). The study shows that the most typical osteoporotic upper extremity fractures of older adults have their specific injury mechanisms. A great majority of these fractures occur as a result of a fall and a subsequent direct impact of the fractured site. Effective fracture prevention could be achieved by minimizing the obvious risk factors of falling and reducing the fall-induced impact force with injury site protection.

Accidental Falls↗

PubMed2004

Rates of claims for cumulative trauma disorder of the upper extremity in Ontario workers during 1997.

Surveillance of work-related cumulative trauma disorder of the upper extremity (CTDUE) requires valid and reliable claim extraction strategies and should examine for confounding and interaction. This research estimated crude and specific rates of CTDUE claims in Ontario workers during 1997 while acknowledging misclassification and testing for confounding and interaction. Lower and upper limit event estimates were obtained by means of an algorithm applied to the Ontario Workplace Safety and Insurance Board (OWSIB) database and were combined with "at-risk" estimates obtained from the Canadian Labour Force Survey (LFS). Poisson regression was used to evaluate confounding and interaction. The method used to identify CTDUE claims had a substantial impact on the magnitude of rates, female to male rate ratios, the most commonly affected part of the upper extremity and the highest risk occupational categories. Poisson regression identified sex interactions. It allowed rigorous evaluation of the data and indicated that rates should be examined separately for men and women. Researchers should clearly define extraction strategies and examine the impact of misclassification.

Adolescent↗

PubMed2000

Outcomes in work-related upper extremity and low back injuries: results of a retrospective study.

BACKGROUND: The outcomes of treatment for work-related injuries and illnesses are multidimensional and complex, but have rarely been explored in detail. This study was intended to provide information on a sample of workers representing a range of jobs and employers typical of the workers compensation system. METHODS: A mailed, self-report survey measuring multiple dimensions was conducted. Identified through the New Hampshire Division of Workers' Compensation First Report of Injury database, a sample of workers with injuries to their lower back (60%) or upper extremities (40%) a year prior to the study were surveyed. Response rate was 80% (N=169; upper extremity cases=70; low back cases=99). RESULTS: Most (82.8%) were working one year post-injury. Over half reported residual effects of the injury on work or activities of daily living. Many working subjects reported persistent injury-related anxiety and pain at the end of the work day, worse in those with low back pain compared to those with upper extremity injuries. Almost 40% of those who returned to work suffered a reinjury. Forty-four percent of respondents suffered significant injury-related financial problems, which were worse in those who had been out of work for longer periods. CONCLUSIONS: Occupational musculoskeletal injuries do result in significant, long-term adverse physical, economic, and psychological consequences, as demonstrated in self-reported surveys.

Absenteeism↗

PubMed1994

Distal arterial reconstruction using Esmarch's bandage technique to salvage upper extremity function in thoracic outlet syndrome caused by cervical ribs: a report of two cases.

We present herein the cases of two patients with thoracic outlet syndrome (TOS) who required arterial reconstruction due to gangrene of the fingers and/or hand. In both patients, the cervical ribs had produced intimal injury of the subclavian arteries, and the successive distal arterial embolism brought about severe ischemia of the affected upper extremity. To treat the TOS, the cervical ribs were resected through a supraclavicular incision. In the first patient, arterial reconstruction was performed from the subclavian artery to the radial collateral artery, a branch of the deep brachial artery, which resulted in minimizing amputation of the gangrenous hand. In the second patient, resection and direct anastomosis of the injured subclavian artery were performed, and bypass surgery from a brachial artery to an interosseous artery was carried out, preserving finger function. Reversed saphenous vein grafts were utilized and Esmarch's bandage technique was applied as a substitute for a vascular clamp in both patients. Following these case reports, we discuss the technique of performing distal bypass in the upper extremities and comment on the usefulness of Esmarch's bandage technique for preserving upper extremity function.

Adult↗