SEARCH · PubMed Health

Results for “Lower 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 757 records · Page 42Linked to original sources

PubMed2001

Simple lower extremity two-joint synergy.

The purpose of this study was to describe the existence of a simple synergy in the lower extremity. Subjects performed discrete knee flexion or extension movements or ankle plantar or dorsiflexion movements in a sagittal plane, moving one of the joints "as fast as possible." Joint angles and electromyographic (EMG) signals from the biceps femoris, rectus femoris, soleus, and tibialis anterior were recorded. Typically, EMG patterns in both muscle pairs acting at the joints demonstrated the "triphasic" pattern. The knee flexor (biceps femoris) and ankle plantar flexor (soleus) tended to show simultaneous EMG bursts, while the knee extensor (rectus femoris) and ankle dorsiflexor (tibialis anterior) had similar patterns of activation. A two-joint simple synergy previously established for upper extremities seems pertinent for lower extremities as well. Such a synergy is used by the central nervous system to simplify control of the postural component of a motor task.

Adult↗

PubMed1999

Lower-extremity amputation in diabetes. The independent effects of peripheral vascular disease, sensory neuropathy, and foot ulcers.

OBJECTIVE: To identify risk factors for lower-extremity amputation (LEA) in individuals with diabetes and to estimate the incidence of LEA. RESEARCH DESIGN AND METHODS: This is a prospective study of 776 U.S. veterans in a general medicine clinic in Seattle, Washington. The outcome was first LEA during follow-up. Potential risk factors evaluated in proportional hazards models included, among others, peripheral vascular disease (PVD), sensory neuropathy, former LEA, foot deformities and ulcers, diabetes duration and treatment, and hyperglycemia. RESULTS: Associated with an increased risk for LEA were PVD defined as transcutaneous oxygen < or = 50 mmHg (relative risk [RR] = 3.0, 95% CI 1.3-7.1), insensitivity to monofilament testing (RR = 2.9, odds ratio = 1.1-7.8), lower-extremity ulcers (RR = 2.5, CI 1.1-5.4), former LEA, and treatment with insulin when controlling for duration of diabetes and other factors in the model. PVD defined as absent or diminished lower-extremity pulses or an ankle arm index < or = 0.8 was also associated with a significantly higher risk of LEA in separate models. Foot ulcers were associated with an increased ipsilateral risk of amputation. The age-adjusted incidence among men only for LEA standardized to the 1991 U.S. male diabetic population was 11.3/1,000 patient-years. CONCLUSIONS: This prospective study shows that peripheral sensory neuropathy, PVD, foot ulcers (particularly if they appear on the same side as the eventual LEA), former amputation, and treatment with insulin are independent risk factors for LEA in patients with diabetes.

Adult↗

PubMed1992

Magnetic resonance imaging of tendon and ligament abnormalities: Part II. Pelvis and lower extremities.

Magnetic resonance imaging (MRI) has provided an ideal means, unmatched by other preexisting modalities, of examining musculoskeletal abnormalities, particularly those involving tendons and ligaments in the lower extremities. Lack of motion artifact, convenience of application of surface coil, and absence of overlying structures have made the lower extremities ideally suited to MRI. In addition, the abundance of adjacent adipose tissue provides a superb contrast background. Although evaluation of trauma remains the most common reason for MRI examination, many other conditions may also affect tendons and ligaments. As in other soft-tissue, chondral, and osteochondral lesions, MRI provides exquisite details of abnormalities in these structures. Part II of this review systematically reviews the abnormalities of tendons and ligaments in the pelvis and lower extremities.

Adolescent↗

PubMed1996

[Local fibrinolytic therapy of arterial occlusions of the lower extremity: initial success and clinical outcome].

INDICATIONS: The efficiency of local fibrinolysis therapy in patients with chronic and acute peripheral arterial occlusions of the lower extremities has been investigated. PATIENTS AND METHODS: A total of 33 patients were examined following a local fibrinolysis therapy (in 14 cases with supplementary percutaneous transluminal angioplasty) for chronic or acute peripheral arterial occlusion of the lower extremities. The success of the intervention was first evaluated by angiography and then by subsequent controls by means of treadmill ergometry. RESULTS: A primary intervention success was achieved in 75.8% (25 of 33 patients) of the cases. In 18.2% (6 of 33 patients) a vascular surgical operation was required within 30 days of the intervention (5 therapy failures, 1 complication of the intervention). In two further patients, vascular surgery was necessary after five or six months. In 22 of the 25 successfully treated patients (92%), the Fontaine stage was reduced by at least one step after an average of 7.6 (range: 1 to 30) months. CONCLUSIONS: Local lysis with or without PTA represents an effective alternative therapy to vascular surgery for the treatment of peripheral arterial occlusions in not immediately endangered lower extremities. On the basis of our results and a survey of the literature, an aid for selecting therapeutic measures for patients with arterial occlusion of the extremities is presented.

Adult↗

PubMed2001

Combined computed tomographic pulmonary angiography and venography for evaluation of pulmonary embolism and lower extremity deep venous thrombosis: report of two cases.

Pulmonary embolism (PE) and deep venous thrombosis (DVT) are major causes of morbidity and mortality, which can be reduced with accurate diagnosis and proper treatment. More than 90% of PEs originate in lower-extremity DVT. Currently, evaluation of PEs and lower-extremity DVT requires 2 separate tests (ventilation-perfusion scan, computed tomographic pulmonary angiography (CTPA), or pulmonary angiography for PE and sonography, computed tomographic venography (CTV), conventional venography, or magnetic resonance venography for DVT). Combined computed tomographic pulmonary angiography and venography (CTPAV) is a new diagnostic technique that combines CTPA and CTV into a single study for the screening of PE and subdiaphragmatic DVT. CTPAV is a modified CTPA study that evaluates the subdiaphragmatic deep vein system at the time of CTPA, without additional venipuncture or contrast medium. It is easy to perform, fairly easy to interpret, readily available, and requires no invasive procedure. We present 2 cases of multiple PE and lower-extremity DVT in which CTPAV was used.

Aged↗

PubMed2006

[Microsurgical treatment of arterial occlusion in lower extremity].

OBJECTIVE: To investigate the procedure and clinical effect of revascularization for arterial occlusion in lower extremity. METHODS: From July 1998 to March 2005, 29 cases of arterial occlusion were treated by microsurgery. Of 29 cases, there 22 males and 7 females, aging 22-86 years, including 9 cases of thromboangiitis obliterans (TAO), 17 cases of arterial sclerosis obstruction (ASO) and 3 cases of diabetic foot (DF). The location was the left in 17 cases, the right in 11 cases and both sides in 1 case. All cases were inspected by color-Doppler ultrasonic scanning before operation. The cases of ASO and DF were checked with MRA. The results of examinations showed that the locations of arteriostenosis and obstruction were: in 9 cases of TAO, the distal superficial femoral artery in 3 cases, popliteal artery in 5 cases, bilateral dorsal metatarsal artery in 1 case; in 17 cases of ASO, common iliac artery in 2 cases, external iliac artery in 4 cases, femoral artery in 10 cases and popliteal artery in 1 case; and were all superficial femoral artery in 3 cases of DF. DSA examination confirmed that there was appropriate outflow in 15 cases. Basing on the location and extent of the arterial occlusion, 11 cases were treated by the primary deep vein arterializing, 16 cases by arterial bypass distribution and 2 cases of extensive common iliac arterial occlusion were amputated in the level of 1/3 distal thigh. RESULTS: The postoperative duration of follow-up for all cases was 3 months to 7 years. In 9 cases of TAO, 2 healed by first intention after deterioration, 4 healed after changing dressing and 3 had fresh soft tissue growth after debrided superficial secondary necrosis. In 17 cases of ASO, 13 healed by first intention, 2 healed after changing dressing and 2 were amputated. In 3 cases of DF, 2 healed after changed dressing and debrided, 1 was aggravated with the second toe necrosis. CONCLUSION: Performing primary deep vein-arterialization and arterial bypass distribution is effective for treatment of arterial occlusion of lower extremity. The arterial reconstructive patency rate can be improved by microsurgical treatment.

Adult↗

PubMedDate not supplied

Underassessment of lower extremity deep venous thrombosis using color flow Doppler compared to compression sonography.

The aim of this paper is to compare the accuracy of color Doppler to compression sonography in the diagnosis of lower extremity deep vein thrombosis. Longitudinal color flow imaging was performed in 60 lower extremities in patients with clinically suspected deep venous thrombosis (DVT). The study was then repeated by a blinded examiner using transverse compression sonography. The results were then correlated. Thirty-five examinations were negative by both color flow and compression methods. Twenty thrombi were diagnosed on compression sonography, while only 13 were diagnosed by the color flow method. Thirty-five percent of thrombi were missed using color flow imaging alone. We conclude that compression sonography should remain an integral part of the assessment of lower extremity DVT, as a significant number of thrombi might be overlooked using longitudinal color flow imaging alone. This is especially true in non-occlusive thrombi that are adherent to the vessel wall.

False Negative Reactions↗

PubMed2002

Test-retest reliability of isokinetic muscle strength of the lower extremities in patients with stroke.

OBJECTIVE: To i the test-retest reliability of isokinetic strength measurements of 3 muscle groups of the lower extremities in stroke patients. DESIGN: Isokineth tests of bilateral hip flexors, knee extensors, and ankle plantarflexors at 2 angular velocities, performed during 2 sessions scheduled 1 week apart for each subject. SETTING: Outpatilitation clinic of a local hospital in Taiwan. PARTICIPANTS: Nts with mild spastic hemiparesis secondary to stroke and with poststroke onset time of at least 6 months. All subjects could communicate and voluntarily move the affected lower extremity. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The maximal peak torque, total work, and average power of the 3 muscle groups on the affected side examined during each test were quantified by using the normalization and the deficit methods. The normalization method divides the measured strength value by the patient's body weight, whereas the deficit method divides the difference between the strengths of the unaffected and affected extremities by the strength of the unaffected extremity. RESULTS: The normalized strength measures for muscles on the affected side showed good to excellent test-retest reliability (intraclass correlation coefficient [ICC] range,.62-.94; P<.05), whereas the deficit strength measures did not always show good reliability (ICC range,.13-.91). The knee extensors and ankle plantarflexors, but not the hip flexors, on the affected side showed better test-retest reliability of isokinetic strength generated at faster velocity (ICC range,.73-.94) than that generated at slower velocity (ICC range,.62-.88). The normalized peak torque (ICC range,.76-.94) and total work (ICC range,.83-.91) were more reliable than the normalized average power (ICC range,.62-.90) for all 3 muscle groups on the affected side. CONCLUSIONS: Quantitative assessment of muscle strength of the affected lower extremity in patients with mild spastic hemiparesis secondary to stroke is feasible using isokinetic testing. However, the test-retest reliability of isokinetic strength measures is affected by the quantifying method, testing velocity, and strength measures.

Adult↗

PubMed1976

Melanomas of the lower extremity among native Puerto Ricans.

The clinical features of 57 melanomas of the lower extremity occurring in native Puerto Ricans were studied. Whereas most melanomas of the lower extremity among Caucasians occur above the ankle, the group studied showed a predilection for the foot, particularly in the minimally pigmented zones (sole, heel, and nail bed), a distribution similar to that reported in black patients. The possibility that pigment-deficient areas may represent the target organ for sunligh-induced melanomas in Negroes and dark-skinned subjects is discussed.

Black People↗

PubMed1987

[Diagnostic value of thermography in diseases of the vessels of the lower extremities].

The thermographic examinations of 430 patients with different diseases of the lower extremity vessels have confirmed the diagnostic value of thermography. The method was shown to give the objective assessment of alterations in blood circulation of the lower extremity resulting from a pathological process. It may be widely used for diagnosis and control of treatment of vascular diseases.

Aorta, Abdominal↗

PubMed2005

Complex regional pain syndrome involving the lower extremity: a report of 2 cases of sphenopalatine block as a treatment option.

We report 2 cases of complex regional pain syndrome (CRPS) involving the lower extremity; in both, a sphenopalatine ganglion (SPG) block was performed as part of a pain management program. In the first case, a woman in her late twenties presented with CRPS in the left lower extremity that was inadequately controlled with typical oral medications. Sympathetic block of the extremity did not provide significant pain relief. However, a noninvasive sphenopalatine block with 4% tetracaine resulted in a 50% reduction in pain level. The patient was shown how to self-administer the sphenopalatine block and was provided with exercises and therapy to help improve her functional status. The second case involved a woman in her mid forties with CRPS in the right lower extremity that was partially controlled with oral medications. The patient experienced a 50% reduction in pain level when SPG block with 4% tetracaine was given. Further study is needed to determine the effects of SPG blocks on symptoms related to chronic regional pain syndrome.

Adult↗

PubMed2002

Diagnosing deep vein thrombosis in the lower extremity: correlation of clinical and duplex scan findings.

OBJECTIVE: To identify factors that predict a positive duplex scan examination result in patients with suspected deep vein thrombosis of the lower extremity. DESIGN: Retrospective study. SETTING: Vascular laboratory in a university teaching hospital. PATIENTS AND METHODS: The results of 345 lower extremity duplex venous scans performed between August 1994 and November 1998 were reviewed. All patients were in-patients referred from different specialties due to clinical suspicion of lower extremity deep vein thrombosis. Positive duplex scans were correlated with patients' demographic data (sex, age), medical history (history of malignancy, deep vein thrombosis, and pulmonary embolism) and clinical features (leg swelling, venous insufficiency, calf pain, and leg ulcer). Univariate analysis was performed using the Chi squared test. RESULTS: A total of 345 scans were performed for 313 patients. The mean age was 55 years (range, 19-92 years). Sixty-three patients (49 male, 14 female) had a positive scan, giving a yield of 18.3%. Four factors had a significant association with a positive scan: male sex (P=0.0102), history of malignancy (P=0.0040), history of deep vein thrombosis (P=0.0001), and history of pulmonary embolism (P=0.0265). CONCLUSIONS: Common presenting clinical features do not predict the result of ultrasonographic investigation for deep vein thrombosis. The chance of having a positive scan is significantly higher in male patients and those with a history of malignancy, deep vein thrombosis, or pulmonary embolism.

Adult↗

PubMed2004

Role of alendronate in therapy for posttraumatic complex regional pain syndrome type I of the lower extremity.

OBJECTIVE: To evaluate the effects of the antiresorptive agent alendronate at a daily oral dose of 40 mg in patients with posttraumatic complex regional pain syndrome type I (CRPS I) of the lower extremity. METHODS: Forty patients were enrolled in this 8-week randomized, double-blind, placebo-controlled study of alendronate therapy for CRPS I, a condition associated with regional osteoclastic overactivity. An optional 8-week open extension of alendronate therapy (weeks 12-20) was available after a 4-week period without therapy. Clinical assessments included joint mobility, edema of the lower extremity, tolerance to pressure in the lower extremity, and levels of spontaneous pain. Urinary levels of type I collagen N-telopeptide (NTX) were assessed by enzyme-linked immunosorbent assay. Patients were examined at weeks 4, 8, 12, 16, 20, and 24. Statistical analysis included two-way factorial analysis of variance. RESULTS: In contrast to placebo-treated patients (n = 20), all of the alendronate-treated patients (n = 19) exhibited a marked and sustained improvement in levels of spontaneous pain, pressure tolerance, and joint mobility, as well as a significant reduction in urinary levels of NTX at weeks 4 and 8. The improvement was maintained at week 12. Twelve patients from each treatment group volunteered for the 8-week open trial, and all of them had a positive response to alendronate. CONCLUSION: Our findings support the use of oral alendronate in posttraumatic CRPS I. By reducing local acceleration of bone remodeling, alendronate might relieve pain by effects on nociceptive primary afferents in bone, pain-associated changes in the spinal cord, and possibly also through a central mechanism.

Administration, Oral↗

PubMed2006

The use of botulinum toxin therapy for lower-extremity spasticity in children with cerebral palsy.

Hypertonicity is a leading cause of disability for children with cerebral palsy (CP). Botulinum toxin A (BTA) chemically denervates muscle tissue and is commonly used in the management of lower-extremity hypertonicity in children with CP because of its focal effects and wide safety margin. Randomized controlled trials have demonstrated that BTA injections in the ankle flexors, hamstrings, and adductors reduce spasticity and result in improved passive and active range of motion. In other studies, improvements in gait and measurements of functional outcome were found in appropriately selected children who had been injected with BTA. A multidisciplinary treatment approach that includes physical therapists, occupational therapists, orthotists, neurologists, physicians with expertise in performing botulinum toxin injections, orthopedic surgeons, and neurosurgeons is critical to optimize care in children with lower-extremity tone due to CP. In this paper, the authors propose treatment algorithms based on clinical presentation, detailed dosing, and technical information to optimize the treatment of these children. With a multidisciplinary approach, children with lower-extremity hypertonicity due to CP can experience improvements in muscle tone and function.

Algorithms↗

PubMed2001

[Experience of application of lymphotropic methods in the treatment of lower extremity veins].

Experience of treatment of 368 patients with disease of veins of lower extremities was summarized. In patients with an acute thrombophlebitis and chronic venous insufficiency of lower extremities significant disorders of microhemo- and lymphatic circulation, manifesting as venous or lymphatic stasis, were noted. Conduction of lymphotropic therapy have promoted microcirculation improvement, elimination of interstitial oedema and signs of inflammation, permitting to shorten the stationary treatment period.

Adolescent↗

PubMed2000

Influence of Q-angle on lower-extremity running kinematics.

STUDY DESIGN: Two-group posttest-only comparison. OBJECTIVE: To assess the influence of the Q-angle on the 3-dimensional lower-extremity kinematics during running. BACKGROUND: An excessive Q-angle has been implicated in the development of knee injuries by altering the lower-extremity locomotion kinematics. Previous investigations using 2-dimensional analyses during walking did not support this hypothesis. METHODS AND MEASURES: We hypothesized that individuals with Q-angles more than 15 degrees would display an increase in rearfoot eversion and tibial internal rotation during running. Thirty-two nonimpaired subjects (men: n = 16, mean age = 22 +/- 3 years; women: n = 16, mean age = 23 +/- 3 years) ran over ground, and 3-dimensional kinematic data were collected from the right lower extremity. Subjects with a Q-angle of 15 degrees or less comprised the low-Q-angle group, whereas those with Q-angles of more than 15 degrees comprised the high-Q-angle group. Segment and joint maximum angles and the times when the maxima occurred during stance were measured. RESULTS: The Q-angle magnitude did not increase the maximum segment or joint angles during running. The groups displayed similar maximum angles for rearfoot eversion (low Q-angle, -15.5 +/- 5.0 degrees; high Q-angle, -15.6 +/- 6.6 degrees) and tibial internal rotation (low Q-angle, -8.8 +/- 4.8 degrees; high Q-angle, -6.8 +/- 5.1 degrees). The high-Q-angle group (39.5 +/- 16.3%) achieved maximum tibial internal rotation later in the stance phase than the low-Q-angle group (28.8 +/- 10.7%). CONCLUSIONS: In support of the previous investigations involving Q-angle influences on kinematics, our study did not reveal any differences between groups in maximum joint or segment angles. The kinematic information did reveal that the high-Q-angle group displayed an increase in time to maximum tibial internal rotation. The impact of this single factor on producing knee injury is unknown.

Adult↗

PubMed2003

Lower extremity spasticity as an early marker of ambulatory recovery following traumatic brain injury.

METHODS: A consecutive series of 107 children and young persons with traumatic brain injury (TBI) admitted to a hospital-based inpatient rehabilitation program was assessed to determine whether lower extremity spasticity could be utilized as an early clinical marker for recovery of ambulation. Presence of spasticity was determined by clinical examination at admission, and the ability to ambulate safely indoors (15.24 m) was evaluated at discharge. Sensitivity, specificity and positive and negative predictive values for spasticity were calculated. RESULTS: Lower extremity spasticity is a sensitive (71.4%) and specific (81.5%) predictor of the inability to ambulate at discharge. The absence of lower extremity spasticity, however, was a better predictor of ambulation recovery than the presence of spasticity was a predictor of nonambulatory status at hospital discharge. DISCUSSION: Implications for spasticity assessment and prognosis in terms of ambulation and recovery are discussed.

Adolescent↗

PubMed1975

[Some peculiarities of the treatment of burns of the lower extremities].

The results of treatment in 323 patients with burns of the lower extremities according to the materials of the CITO Burn Department for a 10-year period are reported. The authors described the method of treatment of circular burns of the lower extremities, based on suspension of the latter by needles stretched between arches, in Ilizarov apparatuses and by gauze bands supporting plaster dressings. The method is simple, convenient and facilitates the management of patients and obviates burn wound compression, prevents fusion of transplanted grafts due to compression and would permit to obtain favourable results of the treatment in the shortest time.

Adolescent↗