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Results for “upper extremity”

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PubMed2005

The combined effects of controlled breathing techniques and ventilatory and upper extremity muscle exercise on cardiopulmonary responses in patients with spinal cord injury.

This study investigated the effects of controlled breathing techniques and ventilatory and upper extremity muscle exercise on cardiopulmonary and metabolic functions and exercise tolerance in patients with spinal cord injury (SCI). The design of the study was prospective and was a before-after trial. Twenty patients with SCI were included in the study. Resting pulmonary functions were assessed spirometrically. Cardiopulmonary and metabolic responses to maximum exercise were determined with an electronically braked arm crank ergometer. The expired gases during this exercise were collected and analysed using a computerized gas analysis system. Patients with SCI participated in a 6-week ventilatory and upper extremity muscle exercise program for 1 h, three times per week. At the end of the exercise program, we observed significant improvement in spirometric values, peak oxygen uptake, time to fatigue, peak power output and minute ventilation compared with pre-training values for the patients.

Adult↗

PubMed1995

Soft tissue infections of the upper extremities with special consideration of abscesses in parenteral drug abusers. A prospective study.

Despite surgical advances and new antibiotics, upper extremity infections continue to present a serious problem. Soft tissue infections of the upper extremities were prospectively examined to elucidate incidence, cause, bacterial pathogens involved, and treatment. Special attention was paid to infections associated with parenteral drug abuse. During an 18-month period all patients over 16 years of age presenting for treatment of an established infection were included in the study. Conservative treatment consisted of immobilization and antibiotics. Radical débridement with removal of all necrotic tissue was the guideline for operative care. In addition, for both regimens a penicillinase-resistant antibiotic was administered. A total of 415 patients (271 men and 144 women; mean age 36.7 +/- 14.5 years) were enrolled into the study, 55 of whom were parenteral drug abusers; 45 of these were HIV-reactive. Infections of fingers (excluding paronychia), paronychia and abscesses at injection sites were the most common diagnoses. Operative and conservative treatment were performed in 285 and 130 patients respectively. Staphylococcus and streptococcus species were the predominant organisms recovered from 212 specimens of pus. Anaerobic bacteria and yeasts were of minor importance. Therefore, a penicillinase-resistant antibiotic is a good initial choice.

Abscess↗

PubMed2000

The effectiveness of intervention strategies used to educate clients about prevention of upper extremity cumulative trauma disorders.

The increased prevalence of work-related cumulative trauma disorders (CTDs) of the upper extremity highlights the need for effective prevention programs. This paper examines the effectiveness of different intervention strategies used to educate workers about the prevention of upper extremity CTDs. The articles reviewed include primary prevention and reinjury prevention interventions in both clinical and workplace settings. The current research findings are inconclusive. Intervention strategies may include discussion, demonstration, or practice of proper posture and body mechanics. Practice of correct techniques may not be necessary to achieve improved hand-use patterns in assembly-line workers. However, practice with intensive feedback may be necessary to achieve the best performance of hand-wrist position, but not sitting posture, in computer operators. The effects of practice on correct hand use may depend on the type of job task. Further research is needed to clarify the role of practice and feedback in CTD prevention.

Journal Article↗

PubMed2006

Primary and secondary patency rates and complications of upper extremity arteriovenous fistulae created for hemodialysis.

The types of fistulae used and their complication rates are important for the hemodialysis patients. We aimed to compare retrospectively the primary and secondary patency rates and complications of upper extremity arteriovenous fistulae. Between 1984 and 2005, a total of 1,233 upper extremity arteriovenous fistulae were created in 920 patients. The mean age was 42 +/- 21 years. The fistulae were divided into the 3 groups; 588 radiocephalic, 205 brachiocephalic, and 127 were created by polytetrafluoroethylene graft. The fistulae types were evaluated with regard to their primary-secondary patency rates and complications. There was a significant difference with regard to development of thrombosis in radiocephalic group compared to other two groups, respectively, p = 0.0122, p = 0.0091. In brachiocephalic fistulae group, edema and steal phenomenon were statistically significant (p < 0.0001). The aneurysm formation was statistically significant in polytetrafluoroethylene fistulae graft group (p < 0.0001). During 6 months, 2 and 5 years period, while primary patency rate was higher in three fistulae types, in radiocephalic fistulae both primary and secondary fistulae patency rates were lower (p < 0.05). To create successful arteriovenous fistulae with long-term patency, appropriate veins of patients should be carefully preserved; thus initially a distal site should be preferred, and in case of failure the next fistulae should be created proximally. In case of failure of forearm fistulae, primary fistulae with autogenous veins should be tried at the upper arm first, and if this also fails, fistulae formation with synthetic grafts should be considered.

Adolescent↗

PubMed2005

Relation between stimulation characteristics and clinical outcome in studies using electrical stimulation to improve motor control of the upper extremity in stroke.

OBJECTIVE: Electrical stimulation can be applied in a variety of ways to the hemiparetic upper extremity following stroke. The aim of this review is to explore the relationship between characteristics of stimulation and the effect of electrical stimulation on the recovery of upper limb motor control following stroke. METHODS: A systematic literature search was performed to identify clinical trials evaluating the effect of electrical stimulation on motor control. The reported outcomes were examined to identify a possible relationship between the reported effect and the following characteristics: duration of stimulation, method of stimulation, setting of stimulation parameters, target muscles and stage after stroke. RESULTS: Nineteen clinical trials were included, and the results of 22 patient groups were evaluated. A positive effect of electrical stimulation was reported for 13 patient groups. Positive results were more common when electrical stimulation was triggered by voluntary movement rather than when non-triggered electrical stimulation was used. There was no relation between the effect of electrical stimulation and the other characteristics examined. CONCLUSION: Triggered electrical stimulation may be more effective than non-triggered electrical stimulation in facilitating upper extremity motor recovery following stroke. It appears that the specific stimulus parameters may not be crucial in determining the effect of electrical stimulation.

Arm↗

PubMed1995

Forearm arterial loop as an expedient source for inflow to upper extremity free flaps.

Challenging wounds of the upper extremity requiring free tissue transfers are relatively infrequent. As a direct consequence, methods to access recipient vessels or acceptable alternatives may not be as familiar as in the lower extremity. In rare circumstances, creation of an arterial loop by elevation of a portion of either major forearm artery provides an easily accessible, pristine source of inflow for a planned free flap matching vessels of comparable caliber. Such a maneuver may also be important to ensure preservation of optimal hand function by avoiding any dissection in the vicinity of essential musculotendinous and neurovascular structures that might reside within or adjacent to the zone of injury.

Adult↗

PubMed1989

Peripheral nerve mucoid degeneration of the upper extremity.

Peripheral nerve mucoid degeneration of the upper extremity is an extremely rare entity. Four new cases encountered in a 14-year period are added to the 10 cases reported in the world literature. Usually affecting males in their forties, it is heralded by an entrapement type syndrome. Pain, paresthesias, paralysis, and possible palpability, succinctly summarizes the order and frequency of the appearance of the differential diagnostic symptoms and signs. Soft part imaging may aid in the preoperative diagnosis. Therapeutically, conservative neurolysis, pertinent arcade sectioning, prudent neural dissection, partial pseudocyst wall excision, and content drainage all under optical enlargement is the treatment of choice. There are no recurrences with this treatment; however, the functional results depend on early diagnosis and surgical intervention before neural fiber destruction is complete.

Adult↗

PubMed1990

YAG laser resection of complicated hemangiomas of the hand and upper extremity.

Complicated hemangiomas of the hand or upper extremity have been resected in eight patients with use of the YAG laser with sapphire scalpels. This laser allows excellent hemostasis and precise surgery, thus allowing resection of complicated problems. Many of the patients have had preoperative arteriography with selective embolization, which has aided in hemostasis. Almost complete but subtotal resection of hemangioma was possible in four of the eight patients with well localized lesions. Three patients had only partial resections of hemangiomas and one lesion was considered unresectable.

Adolescent↗

PubMed2006

Occupational and physical therapy for work-related upper extremity disorders: how we can influence outcomes.

Upper extremity disorders in the workplace continue to be an economic strain on society. Physical and occupational therapy plays a crucial role in the management of the disorders. Medical providers should use therapists whose treatments demonstrate improvement in function and provide superior outcomes. Skilled therapy intervention requires that a therapist be able to identify and treat an injured worker in a holistic manner by looking at the whole individual, including issues that involve mechanical dysfunctions, psychosocial issues that include job satisfaction, and other age-related organic comorbidities. Therapists who work with injured employees must be highly skilled in identifying behavioral and organic disorders and must be confident in communicating these findings to various members of the health care team to help facilitate further medical testing.

Arm Injuries↗

PubMed1997

The relationship of phantom limb pain to other phantom limb phenomena in upper extremity amputees.

In thirty-two unilateral upper extremity amputees with and without phantom limb pain, various phantom limb phenomena were investigated. In general, the incidence of non-painful phantom limb sensations was higher in patients with phantom limb pain than in pain-free amputees. Kinesthetic and kinetic phantom limb sensations were reported more frequently than exteroceptive cutaneous sensations. There was a significant positive correlation between phantom limb pain and stump pain. Patients more frequently assigned sensory than affective pain qualities to their phantom limb pain, whereas no differences between pain qualities were observed for stump pain. No support was found for a relationship between the presence of telescoping (i.e., shrinkage of the phantom limb) and phantom limb pain. These findings point to central as well as to peripheral factors contributing to phantom limb pain.

Adult↗

PubMed2001

The relationship of perceptual phenomena and cortical reorganization in upper extremity amputees.

In this study 16 unilateral upper extremity amputees participated in a comprehensive psychophysiological examination that included the assessment of painful and non-painful phantom and stump sensations, thermal and electric perception as well as two-point discrimination thresholds, the detailed analysis of referred sensation and the measurement of reorganizational changes in primary somatosensory cortex using neuroelectric source imaging. Reorganization of the primary somatosensory cortex was associated with increased habitual phantom limb pain, telescoping, non-painful stump sensations and painful referred sensation induced by painful stimulation. It was unrelated to non-painful phantom sensations, non-painful referred sensation elicited by painful or non-painful stimulation, painful referred sensation elicited by non-painful stimulation, perception thresholds and stump pain. These data substantiate the hypothesis that painful and non-painful phantom phenomena are mediated by different neural substrates.

Adaptation, Physiological↗

PubMed1987

[Direct venous thrombolysis and venous angioplasty in the upper extremity].

Venous thromboses of stenoses in the upper extremity are often the result of a compression syndrome of the shoulder girdle, the Paget-von Schroetter syndrome, vascular surgery, space-occupying lesions in the mediastinum or the result of catheterisation. Direct venous thrombolysis and venous angioplasty were performed successfully in six patients.

Adult↗

PubMed1999

Tuberculosis of the upper extremity.

Twelve cases of tuberculosis of the upper extremity over a 5-year period are presented. The average time to diagnosis was 5 months. All patients were treated with a regimen of combination antituberculous chemotherapy for a minimum of 6 months, initial splinting, and intensive physiotherapy. The indications for surgery were limited, with biopsy being the most common procedure. Patients with tenosynovitis underwent tenosynovectomy, and nerve decompression was performed when indicated clinically. Large abscesses were drained. No patient had bony debridement or early arthrodesis to control the infection. The pre- and posttreatment range of motion was recorded, with a mean follow up of 25.4 months. Employing this regimen resulted in resolution of infection and an improved range of motion in 11 patients.

Adult↗

PubMed2003

Gunshots to the hand and upper extremity.

Gunshot injuries to the hand and upper extremity have been studied during military conflicts and in urban settings. Treatment concepts include identification of injured structures, aggressive surgical wound care, and reconstruction of important functional structures. There are various types of missile injuries. For simplicity, low-energy injuries imply limited damage, and require only conservative approaches. High-energy injuries are complicated by significant tissue destruction, rehabilitation dilemmas, and uncertain outcomes. The surgeon must recognize the anatomic complexity of the hand and proceed with caution. Most gunshot injuries to the hand involve a combination of tissue types. Bone injury is dramatic and is seen radiographically. However, injury to the soft tissue including skin, tendon, blood vessel, and nerve also must be appreciated. Individually, the tissues have varied function and properties of healing. Therefore, the challenge is to prioritize the injury, select an aggressive surgical approach, and integrate a suitable rehabilitation plan.

Bone and Bones↗

PubMed1983

Hay baler trauma to the upper extremity: a roller injury.

The mechanism of upper extremity trauma in three patients from a round hay baler is analyzed in relation to previously described experimental models of wringer or roller injury. One patient sustained an avulsive injury with typical tearing of the soft tissues. Thermal insult from roller friction heat and the duration of exposure were significant factors determining the extent of tissue injury in the other two patients.

Accidents, Occupational↗

PubMed2004

Forearm musculofasciocutaneous flap to cover glenohumeral arthrodesis hardware during reconstruction of the flail upper extremity.

SUMMARY: For selected patients with flail upper extremities after brachial plexus injury, glenohumeral arthrodesis, above-the-elbow amputation, and fitting of an above-the-elbow prosthesis are effective reconstructive options. In such situations, soft-tissue thinning at the shoulder, especially deltoid atrophy, presents the potential problem of shoulder fusion hardware causing pain or even eroding overlying soft tissue. The authors have used a pedicled forearm musculofasciocutaneous flap, elevated just before above-the-elbow amputation and subsequently transposed to the shoulder, to provide high-quality soft-tissue coverage of the arthrodesis hardware. Preliminary results with three patients suggest that this procedure may be useful for preventing tenderness and breakdown of tissue overlying glenohumeral arthrodesis hardware. In all three patients, the forearm flap remained well perfused, and all wounds healed fully with no subsequent problems with skin breakdown. All three patients had long-term benefit from prosthesis fitting.

Adult↗

PubMed2000

Upper extremity electrical injury.

Electrical injuries to the upper extremity are far ranging in extent and vary in magnitude. Proper management requires an appreciation for the pathophysiology, clinical manifestations, and therapeutic options. Persistent neurologic and psychiatric problems further impact the high incidence of disability in the electrical injury patient. Loss is significant for victims, their families, and employers, in part because of the relative youth of those injured.

Arm Injuries↗

PubMed1983

Functional comparison of upper extremity amputees using myoelectric and conventional prostheses.

Upper extremity amputees were tested on a standardized series of tasks using a myoelectric hand, a conventional prosthesis (cable-controlled hook), and their normal hand (unilateral amputees only). They answered also a questionnaire on activities of daily living (ADL) and provided other prosthetic information. Amputees who had been fitted only with a conventional prosthesis, and used their prosthesis regularly, tended to wear the prosthesis more hours per day (14 hours) than amputees fitted with a myoelectric hand (9.6 hours), some of whom continued to use a conventional prosthesis for some jobs. However, the amputees with myoelectric prostheses had a greater functional range of motion (ROM) than those with a conventional prosthesis, and many regular wearers of a myoelectric prosthesis had long since rejected a conventional prosthesis. Amputees took about 2.5 times as long to complete the tasks tested with a conventional prosthesis and about five times as long with a myoelectric prosthesis than with their normal hand. Despite the slower function, more than 60% of below-elbow (B-E) amputees accepted the myoelectric prosthesis in preference to a conventional prosthesis, which they had all been fitted with previously. Others preferred to continue using a conventional prosthesis to which they had become accustomed (13%) or no prosthesis (26%). The combination of function, ROM, and cosmetic appearance of a myoelectric prosthesis is preferred by most B-E amputees, despite its slower performance at the present time.

Activities of Daily Living↗