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PubMed2006

Diagnosis of a rare source of upper extremity symptoms in a healthy woman after weight lifting.

STUDY DESIGN: Resident's case problem. BACKGROUND: The popularity of weight training has increased dramatically during the past 20 years. With the increase in popularity of weight training, the rate of injury has also increased dramatically. The types of injuries range from benign to life threatening. DIAGNOSIS: The patient was a 21-year-old woman originally referred for pelvic pain who presented with new complaints of right upper extremity swelling, discomfort, and cyanosis after recently beginning a comprehensive weight-lifting program. Additional signs, including paresthesias decreased pulses, and venous distension, warranted a timely referral by the physical therapist bavk to the referring physician. DISCUSSION: The primary injury in this case report was hypothesized to have been induced by the recent start of a weight-lifting program, with no other significant contributing risk factors. A comprehensive examination by the physical therapist revealed clinical signs of an upper extremity deep vein thrombosis, leading to a same-day referral back to the referring physician. Further research, resulting in a clinical decision rule for upper extremity deep vein thrombosis or estimates of diagnostic accuracy of clinical signs and symptoms, would improve the diagnostic process.

Adult↗

PubMed2004

[The upper extremity in cerebral palsy. OP indications and surgical techniques].

In cerebral palsy patients, surgical treatment procedures of the upper extremity have an important place in the concept of multidisciplinary care. Nevertheless, operative indications remain selective and the number of operative interventions is limited in comparison to the lower extremity. For an appropriate surgical outcome, soft tissue techniques, applied in a multilevel strategy with clear consideration of functional aspects, are often sufficient. Osseous operative corrections, i.e. osteotomies or joint fusions, are restricted to selected cases. The retrospective evaluation of 209 patients who underwent surgical treatment of the upper extremity between 1975 and 2000 revealed a general satisfaction with the functional outcome in 68.4% of cases and cosmetic improvement in 97.6% of cases. The surgical treatment of upper limb deformities in cerebral palsy requires a particular focus on the correct indication and selection of an adequate surgical technique requiring outstanding experience.

Adolescent↗

PubMedDate not supplied

Arterial insufficiency of the upper extremity with special reference to Takayasu's arteritis and Buerger's disease.

The occlusive arterial lesions of the upper extremity in Takayasu's arteritis is estimated in 72.3% in the left and in 45.6% in the right subclavian arteries, respectively. Buerger's disease also involves the arteries distal to the elbow and the digital arteries in about 22% of total cases. In Takayasu's arteritis, the surgical treatment for the upper extremity ischemia is rarely indicated, except for the cases with aneurysm, because the occlusive lesion involves exclusively the aorta and its branches, and severe ischemia of the upper digital arteries in Buerger's disease frequently causes severe ischemic symptoms of hand and fingers, such as rest pain, trophic changes and tissue loss. Therefore, the surgical treatment, including upper thoracic sympathectomy and amputation, is mandatory in some cases.

Adult↗

PubMed1992

[Cervical root avulsion presenting proximal segmental muscular atrophy of unilateral upper extremity].

A 56-year-old woman noticed non-progressive weakness in the proximal part of the right upper extremity from her childhood. At the age of 37 years, she was diagnosed as "spinal muscular atrophy" by an orthopedic surgeon. At the age of 56, neurological examinations revealed muscular atrophy and weakness confined to the right deltoid, biceps brachii and brachioradialis together with minor sensory disturbance in the lateral side of the right shoulder and forearm without pyramidal sign in the lower extremities. The neurological features of this case differed from those of juvenile type of distal and segmental muscular atrophy of upper extremities in distribution of muscular atrophy, and simulated those of cervical spondylotic amyotrophy. Myelography demonstrated root avulsion of the right C5 and C6 roots. CT myelography revealed traumatic meningocele. Therefore a clinical diagnosis of cervical root avulsion resulting from unrecognized birth injury was made. The reason of motor dominant pictures of this case may be vulnerability of the anterior nerve roots to traction injury.

Arm↗

PubMed2001

[Surgical treatment of patients with consequences of combined trauma of upper extremity complicated by purulent infection].

Result of treatment of 256 patients with consequences of combined trauma of upper extremity was analyzed. In 83 (32.4%) patients the purulent-necrotic complications occurred, caused by mistakes committed on the treatment process phase, especially during rendering the primary aid. It had promoted occurrence of the joint's contracture and ancilosis, osteomyelitis, ischemic contracture and the skin defects as well. Approach to the treatment conduction was in accordance with general principles of the patients orthopedic rehabilitation with consequences of combined trauma of upper extremity. Sanation of purulent focus was performed in 19 patients and microvascular transplantation of tissues--in 13 before restorational procedure was done.

Adult↗

PubMed1999

Strength training for 1h in humans: effect on the motor performance of normal upper extremities.

It has been found that one session of intense muscle strength training decreases muscle strength temporarily and causes neuromuscular fatigue in the trained muscles, but little attention has been given to the effects of neuromuscular fatigue on the other components of motor performance. The purpose of this study was to examine in normal healthy volunteers the effects of a 1-h strength training session on the motor performance of the upper extremity, including reaction time, speed of movement, tapping speed and coordination. Group of 30 healthy female volunteers, aged 29-47 years, were randomly divided into sub-groups, (A and B, n = 15 per group). Both groups first completed a set of motor performance tests on 3 consecutive days. On the 4th day, group A carried out a 1-h muscle strength training session of the upper extremities. Isometric muscle strengths and electromyogram (EMG) data were recorded before the training session. Immediately after the training session the same recordings were repeated, and additional motor performance tests were also performed. Group B carried out only the motor performance tests. The groups exchanged programmes the following week. The 1-h strength training session decreased the isometric muscle strength of wrist flexion by 18% (P < 0.001) and extension by 18% (P < 0.001) in group A, while in group B flexion strength decreased by 19% (P < 0.001) and extension strength by 17% (P < 0.001). All the measured EMG activations also decreased in both groups. There were no statistically significant differences in the results of the motor performance tests between the mean values of the three baseline measurements and the values recorded after the training session. The result was surprising, but straightforward; neuromuscular fatigue induced by a 1-h strength training session of the upper extremities had no effect on the motor performance functions of the hand, as indicated by reaction times, speed of movement, tapping speed and coordination, in these normal healthy female volunteers.

Adult↗

PubMed2006

Free vascularized fibular grafting for reconstruction after tumor resection in the upper extremity.

BACKGROUND: Limb salvage is viable in the majority of patients with malignant bone tumors, but especially in case of extensive tumors and bad soft tissue conditions, it is challenging in upper extremity. OBJECTIVES/METHOD: The clinical and radiological results of 21 patients, who had free vascularized fibular grafts (VFG), for diaphyseal (14), and epipyseal (7) defect reconstruction of the upper extremity, are presented. The indications for VFG were resection after osteosarcoma (9 cases), Ewings sarcoma (9 cases), chondrosarcoma (1 case), rhabdomyosarcoma (1 case), and 1 case of fibrous dysplasia. The 20 malignant tumors were staged as follows: 2a (1), 2b (18), 3 (1). The mean follow-up was 43.6 months (min 6.0-max 131.9). Functional results were described and graded quantitatively according to the MSTS-score. RESULTS: Results were satisfactory with regard to pain, emotional acceptance, manual dexterity, and function. Lifting ability was decreased in two patients. Hypertrophy index was 31% (min 13%-max 71%). Main complications were fracture (5), pseudoarthrosis (4), prolonged wound healing (4), temporary nerve irritation (2), and deep infection (1). Re-operation was required in eight patients (12 operations). CONCLUSION: VFG offers a good possibility for biological reconstruction of large skeletal defects, with an acceptable complication and re-operation rate. When conservative treatment of complications was not successful, further surgery led to recovery in the majority of cases.

Adolescent↗

PubMed1988

[The role of hereditary and environmental factors in the variability of the components comprising the mass of the human upper extremity at various stages of postnatal ontogeny].

The investigation has been performed in mono- and dizygotic twins of the Ukrainian ethnic and territorial groups. As a whole 196 pairs of twins, among them 80 pairs of mono- and 116 pairs of dizygotes of both sex at the age of 12-60 years have been undergone the examination. The twins selected are divided into two age groups--period of sex maturation (12-17 years of age) and that of maturity (30-60 years of age). Quantitative parameters on composition of the components of the upper extremity mass (fatty, muscular and osseous) are studied in all the twins. Coefficients of intrapaired correlation and indices of Holzinger's heritability are calculated according to an original program, using the microcomputer "Electronika B3-34". The degree of hereditary and environmental influences for development and formation of the main components of the upper extremity mass at certain stages of individual development are characterized with ontogenic changeability. With age the degree of hereditary dependence of the development and formation of the upper extremity mass components decreases, and sex dimorphism according to the degree of the hereditary dependence of the components studied is displayed as a greater hereditary determination in male persons.

Adolescent↗

PubMed1992

[Arterial injuries of the upper extremities].

At the Department of Surgery in Pilsen in 1982-1991 a total of 26 patients with upper extremity vascular injuries was treated. Brachial artery was injured most commonly (50%). The direct trauma was responsible for 88.5% injuries, indirect injury was recorded in 11.5% cases only. The incidence of concomitant injuries of the vein, nerve or bone was 73.1%. Approximately one third of arterial injuries was caused by criminal offences. The vascular reconstruction was performed in all 26 patients. The overall patency rate was 84.6%, the amputation rate was 3.8%. One patient with polytrauma died of sepsis (3.8%). The authors give a comprehensive review of the causes, diagnosis and treatment of vascular injuries of the upper extremities.

Adolescent↗

PubMed1993

A quantitative assessment of limited joint mobility in patients with diabetes. Goniometric analysis of upper extremity passive range of motion.

OBJECTIVE: The syndrome of limited joint mobility is a common but not widely recognized musculoskeletal complication of diabetes. The purpose of this study was to further characterize this syndrome using quantitative goniometric measures. METHODS: Cross-sectional analysis of a sample population was performed to establish the prevalence, location, and severity of limited joint mobility and to determine its relationship to extraarticular manifestations and complications of diabetes. Passive range of motion of both upper extremities was measured by goniometry in 70 adult patients with insulin-dependent diabetes mellitus and 70 nondiabetic controls who were group-matched for age, sex, and general activity level. Joint mobility was assessed by both individual joint motions and a composite scoring technique. RESULTS: Analysis of individual joints and composite scores revealed significant differences between dominant and nondominant extremities in both the control and the diabetic groups. Diabetic patients were generally less flexible than nondiabetic subjects throughout the arm, especially in shoulder and finger joints. In the full study population, multivariate analysis revealed that advanced age, male sex, and the presence of diabetes were associated with decreased passive range of motion for a majority of joints (P < 0.05). In the diabetes group, passive range of motion was significantly correlated (P < 0.05) with age, sex, duration of diabetes, and to a variable extent, glucose control, but was not correlated with the presence of clinically significant neuropathy, retinopathy, nephropathy, or peripheral vascular disease, with activity level, or with hand dominance. Stepwise regression analysis failed to identify single key joint motion(s) to serve as possible screening tests in predicting generalized limited joint mobility of the upper extremity. Finally, the effect of limb usage on range of motion in flexion may differ in diabetic and nondiabetic subjects. CONCLUSION: Limited joint mobility is a generalized phenomenon occurring throughout the upper extremities of many diabetic patients. It is significantly related to age, sex, and to a variable extent duration of diabetes and glucose control. It is not related to the standard complications of diabetes as defined in this study.

Adult↗

PubMed1998

A 10-week strength training program: effect on the motor performance of an unimpaired upper extremity.

OBJECTIVE: Muscle strength training is one of the most common therapy methods in physical therapy programs, and the usual goal of this treatment is to improve muscle strength. Little attention has been paid, however, to the effects of strength training on the other components of motor performance. This study examined the effects of a 10-week strength training program on the motor performance of the hand, including reaction time, speed of movement, tapping speed, and coordination in normal healthy volunteers. DESIGN: Before-after trial. SUBJECTS AND SETTING: Sixteen healthy women volunteers aged 25 to 45 years participated. INTERVENTION: Subjects accomplished a 10-week muscle strength training program of the upper extremities. MAIN OUTCOME MEASURES: Reaction time, speed of movement, tapping speed, and coordination were measured three times on consecutive days, and muscle strength and electromyographic values of the right upper extremity were recorded once before the training period. After the training period, the same measurements were made as before the training. RESULTS: The 10-week strength training decreased choice reaction time by 6% (p < .01) and increased tapping speed by 3% (p < .01) and coordination by 5% (p < .05). Speed of movement increased, but this change was not statistically significant. All the measured isometric muscle strengths and electromyographic activations upon maximum isometric contraction increased. CONCLUSIONS: A 10-week strength training of the upper extremities increased muscle strength and some motor performance functions of the hand, including choice reaction time, tapping speed, and coordination.

Adult↗

PubMed1985

Regional anesthesia in the upper extremity.

We have attempted to formulate a guide for surgeons who operate frequently on the hand and upper extremity and who wish to learn how to provide their own local anesthesia. The methods that we have presented are those that work well in our hands and are in frequent use in our practices. We recognize very clearly that there are other methods and that these work well for other surgeons. The method itself is not of great importance (given that it is safe and effective), but the philosophy of learning is. By observation and by practice, the surgeon will gain further mastery of his specialty; we feel strongly that local anesthesia is as much or more a part of surgery than it is of any other specialty. Reading and observation are important. Dissection, whether in the operating room as part of a surgical procedure or in the anatomy laboratory or morgue, is of great benefit in learning the whereabouts and relationships of the nerves that are to be blocked. In the end, however, the surgeon simply must try the various blocks himself on his own patients. Failure is not a calamity; we have tried to emphasize that there are ways to recover with a reasonable degree of grace. The worst calamity is not to learn, not become facile with techniques that are so ideally suited to surgery in the upper extremity.

Anesthesia, Conduction↗

PubMed2005

Exercise-induced changes of the upper extremity in chronic stroke survivors.

Problems with daily activities due to decreased aerobic capacity and decreased strength are common in people who survive a stroke. Implementation of exercise for the upper extremity is challenging because of weakness and other impairments that limit performance of exercise activities. Although maximal exercise testing protocols are difficult to administer, submaximal testing may be a safe and effective means for prescribing exercise. Research studies have demonstrated that people with stroke can improve aerobic capacity and upper extremity muscle strength with exercise intervention, although the number of randomized controlled trials is limited and this area requires further investigation.

Adult↗

PubMed1997

[Pedicled thoraco-abdominal skin flap applied in early repair of deep ulcer of upper extremity resulting from snake-bite injury].

The ulcer resulting from snake-bite injury was characterized by deep and wide tissue necrosis and secondary infection. The patient was at high risk of loss of function of his extremity. From 1989 to 1996, 16 cases with deep ulcer of the upper extremity resulting from snake-bite injury were treated with different types of axial thoraco-abdominal skin flaps, depending on the location of the ulcer. Thoraco-umbilical skin flap was used in 2 cases, lateral thoracoabdominal skin flap in 1 case, iliolumbar skin flaps in 5 cases, lower abdominal skin flaps in 6 cases, lower abdominal divided foliated skin flap in 1 case and Y-shaped hypogastric skin flap in 1 case. Reparative operation was carried out within 3 weeks after injury and primary repair were undertaken in 6 of them. The pedicles were divided in 17 to 24 days after operation. Twelve flaps survived. Three of the 6 flaps had mild signs of inflammation which disappeared after administration of antibiotics. One had necrosis of the distal part of the flap, and was healed with split skin graft. This type of skin flap was an ideal method for the treatment of snake-bite injury of the upper extremity.

Adolescent↗

PubMed1999

[Compressive ischemic neuropathies of the upper extremities and work].

The objective of the presented study was to motile that cumulative trauma disorders of the upper extremities in recent years leads to arising morbidity and applications for compensation for occupational diseases. This rise is probably not associated with an increase of this disorder but a different awareness of workers and doctors as regards the possible adverse effect of forceful and frequently repeated movements of the upper extremities on their function, extended diagnostics and notification. It is important to master the diagnosis of these diseases and interpretation of auxiliary examinations to prevent inadequate payment of damages to the affected subjects and on the other hand to prevent breakdown or in adequate function of the financial provisions in this area. A number of syndromes of the mentioned conditions has very few objective symptoms and abnormal results of auxiliary examinations. The diagnosis of stenotic syndromes has a compared with other disorders great support in electrophysiological techniques, their high sensitivity and specificity (1, 15). The authors discuss therefore their problems and suggest electrophysiological criteria of medium grade affections in the carpal tunnel syndrome which is the condition for compensation for occupational disease and which so far was defined only roughly in this country.

Cumulative Trauma Disorders↗

PubMed2006

Efficacy of constraint-induced movement therapy on involved upper-extremity use in children with hemiplegic cerebral palsy is not age-dependent.

OBJECTIVES: Constraint-induced (CI) movement therapy has been shown recently to be promising for improving upper-limb function in children with cerebral palsy (CP). Because little is known about patient characteristics predicting treatment efficacy, not all children may benefit from this intervention. Here we examine the relationship between efficacy of a child-friendly form of CI therapy and age on involved upper-extremity function. DESIGN: Twenty children with hemiplegic CP age 4 to 13 years received CI therapy and completed evaluations. Based on established functional and neuromaturational changes in hand skill development, the children were divided into a "younger group" (age 4-8 years, n = 12) and "older group" (age 9-13 years, n = 8). Children wore a sling on their noninvolved upper extremity for 6 hours per day for 10 of 12 consecutive days, during which time they were engaged in play and functional activities. Each child was evaluated by trained evaluators who were blinded to the fact that the children received treatment. The evaluations took place once before the intervention and at 1 week, 1 month, and 6 months after the intervention. Efficacy was examined at the movement efficiency (Jebsen-Taylor Test of Hand Function, subtest 8 of the Bruininks-Oseretsky Test of Motor Proficiency), environmental (caregiver frequency and quality of involved upper-limb use), and impairment (strength, tactile sensitivity, and muscle tone) levels. RESULTS: Children in both age groups had significant improvements in involved hand-movement efficiency and environmental functional limitations, which were retained through the 6-month posttest. However, there were no differences in efficacy between younger and older children. Both hand severity and the children's behavior during testing (number of redirections), with the latter serving as a reasonable correlate for attention during the intervention, were related to changes in performance in the younger group but not in the older group. CONCLUSIONS: The results suggest that the intensive practice associated with CI therapy can improve movement efficiency and environmental functional limitations among a carefully selected subgroup of children with hemiplegic CP of varying ages and that this efficacy is not age-dependent.

Adolescent↗

PubMed2001

Measurement of upper extremity volume in women after axillary dissection for breast cancer.

OBJECTIVE: To determine if 2 methods of calculating upper extremity volume (using arm circumferences) can substitute for water displacement volumetry. DESIGN: Interrater and test-retest reliability and limits of agreement for volume measures. SETTING: University. PARTICIPANTS: Twenty-five women at risk for lymphedema who had undergone axillary lymph node dissection surgery for breast cancer. INTERVENTIONS: Circumference and volume measurements of both upper extremities were taken by 2 physical therapists at an initial visit and by 1 of the therapists 1 week later. MAIN OUTCOME MEASURES: Intraclass correlation coefficients (ICCs) were calculated to analyze measurement reliability. Pearson's product-moment correlation coefficient (r) was used to evaluate the relationship between volumetry and calculated truncated cone volumes. Limits of agreement were calculated to determine the level of agreement between the 2 measurement methods. RESULTS: Interrater and test-retest reliability ICCs for circumferential and volumetric data were .99 and .99, respectively. Pearson's r values were .93 and .97 for the single truncated cone and the summed truncated cone volume calculations, respectively. Limits of agreement (mean +/- 2 standard deviations) were -52 +/- 334mL and -40 +/- 234mL, respectively, between volumetry and the single truncated cone and summed truncated cone calculations. CONCLUSIONS: Calculated and volumetric measurements in this population are both reliable and closely related, but do not agree with each another, and thus should not be used interchangeably.

Adult↗

PubMed2004

Bone-forming tumors of the upper extremity and Ewing's sarcoma.

This article presents an overview of bone-forming tumors that occur in the upper extremity. Osteoid osteoma, osteoblastoma, osteosarcoma, and Ewing's sarcoma are covered. Each tumor type is described, and suggestions are made for diagnostic workup and differential diagnosis. Locations in the upper extremity where each tumor typically occurs are given. Preferred treatment regimens and incidence of recurrence are also presented.

Arm↗