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 793 records · Page 44Linked to original sources

PubMedDate not supplied

Intravenous regional anesthesia: a safe and cost-effective outpatient anesthetic for upper extremity fracture treatment in children.

We reviewed our most recent 100 consecutive cases with respect to efficacy and safety of anesthesia in which Bier block anesthesia was used to reduce upper extremity fractures. Records were reviewed to document diagnosis, number of reduction attempts, efficacy of anesthesia, and incidence of complications and untoward effects. No adverse effects were noted from lidocaine injection or tourniquet release. The cost of Bier block anesthesia administered in the emergency room (ER) was significantly less than that of a general anesthetic in the operating room. We have found the Bier block to be a safe, reliable, and cost-effective anesthetic in treatment of children's upper extremity fractures in the ER.

Adolescent↗

PubMed1993

Color duplex imaging. Applications to upper-extremity and microvascular surgery.

Color duplex scanning is a relatively new noninvasive vascular test combining ultrasound, Doppler recording, and color. It has numerous documented applications to various other subspecialties but only recently has been used in upper-extremity and microvascular surgery. It is quite useful in evaluating masses, perfusion abnormalities, trauma, and aberrant or repaired vasculature in the upper extremity. Applications to rotational and free tissue transfers include preoperative evaluation of both the donor and recipient vessels as well as postoperative monitoring.

Arm↗

PubMed1997

Adhesion receptors and cytokine profiles in controlled tourniquet ischaemia in the upper extremity.

Adhesion mechanisms mediated by cytokines have been recognized to play a crucial role in ischaemia-reperfusion mechanisms. Although this phenomenon has been well investigated in organ transplantation, little data is available from upper extremity surgery. Profiles of adhesion molecules (CD11/CD18), key cytokines (TNF-alpha and IL-1), CD4+ and CD8+ lymphocytes, and polymorphonuclear neutrophils were investigated following controlled tourniquet ischaemia of the upper extremity for elective hand surgery. Data suggest that relatively short periods of ischaemia activate a mediator cascade and cell-cell interactions that may be associated with adverse pathopyhsiological effects on peripheral tissues after prolonged ischaemia.

Antigens, CD↗

PubMed1997

Thermal asymmetry of the upper extremity in scalenus anticus syndrome, leg-length inequality and response to chiropractic adjustment.

OBJECTIVE: To describe a case of a vasomotor, vascular form of thoracic outlet syndrome that causes upper extremity thermal asymmetry, and to discuss a single subject case study (N-of-1) comparing the correlation of a subjective test for putative atlas vertebral subluxation complex (supine leg-length inequality) with a single blinded objective measurement [temperature differential (delta degree T)] on the dorsum of the hands. CLINICAL FEATURES: A 71-yr-old woman with a cold, painful right hand and chronic neck pain sought chiropractic evaluation. There was a left head tilt and muscular hypertonicity with fibrous bands in the opposite scalenes and sternocleidomastoid. Thermographic examination revealed a large temperature differential (12 degrees F) between the dorsum of the right and left hands, with the superficial veins on the dorsum of the cold hand collapsed. Thoracic outlet provocation tests were negative. A left-side leg-length inequality potentially indicative of putative upper cervical subluxation was also noted. A diagnosis of presumptive thoracic outlet syndrome with vasomotor vascular complications subsequent to altered cervical biomechanics was made. INTERVENTION AND OUTCOME: Treatment was limited to chiropractic, upper cervical, vectored, linear adjustment of the atlas vertebra. Temperature differential between the hands improved significantly after individual atlas adjustment(s) and in the long term. CONCLUSION: Scalenus anticus syndrome and upper extremity thermal asymmetry may result from altered cervical biomechanics caused by atlas vertebral subluxation complex. Furthermore, the supine leg check may be of value in determining the necessity of atlas adjustment.

Aged↗

PubMed1997

Industrial rehabilitation medicine. 3. Case studies in upper extremity cumulative trauma disorders.

This self-directed learning module highlights new advances in this topic area. It is part of the chapter on industrial rehabilitation medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This section contains three case studies discussing nerve, joint, and soft tissue pathology and work disability due to upper extremity pain. New areas of interest covered in this section include the controversy regarding the work causality of upper extremity disorders, a detailed review of the impact of upper quadrant postural dysfunction on symptom perpetuation, and the assessment and nonsurgical management of thoracic outlet syndrome.

Adult↗

PubMed1986

Effects of thiopental, fentanyl, and etomidate on upper extremity somatosensory evoked potentials in humans.

The effects of three anesthetic induction agents on somatosensory evoked potentials (SEP) were assessed in unpremedicated patients who were without neurologic abnormality of the upper extremities. SEP was assessed by stimulation of the nondominant median nerve and responses were recorded over Erbs point (N10), second cervical vertebra (N14), and the contralateral cortex (P15, N20, P23 latencies, and P15-N20 and N20-P23 amplitudes). Nine patients received thipental (4 mg/kg, iv bolus), nine patients received fentanyl (25 micrograms/kg, iv bolus), and nine patients received etomidate (0.4 mg/kg, iv bolus). SEP was assessed before and after drug administration at motor threshold stimulus intensity. Thiopental increased the latency of N10, N14, and N20. The amplitudes of N10-, N14-, and scalp-recorded waves were not altered by thiopental. Fentanyl increased N20 and P23 latency and decreased the amplitude of P15-N20. Etomidate increased latency of N20 and P23 without alteration of latencies of N10 or N14 and increased the amplitude of P15-N20 and N20-P23, while the amplitude of N10 was unchanged and the amplitude of N14 was decreased. It is concluded that thiopental or fentanyl causes only modest alterations in early waves of upper extremity SEP, whereas etomidate increases the amplitude of scalp-recorded waves. The effect of etomidate on SEP may make diagnosis of neurologic injury more difficult because of the changing waveform.

Adult↗

PubMed1983

Upper-extremity free skin flap transfer: results and utility as compared with conventional distant pedicle skin flaps.

A group of patients who underwent free skin or muscle flap transfer to the upper extremity are compared with a similar group who were treated by a conventional distant pedicle skin flap. The most frequent indications for using a free flap technique were the presence of an exoskeletal fixation apparatus at the recipient site which precluded a more conventional procedure, or the desire to obtain an innervated flap for sensibility. The free flap group generally had more massive defects. In this group, the mean initial surgical time was 5.37 hours and total cost was $7,692. An average of 1.58 general anesthetics was required, and the mean postoperative hospitalization was 13.08 days. In the conventional distant pedicle flap group, mean initial surgical time was 2.76 hours and total cost was $6,849. An average of 2.54 general anesthetics was required and mean postoperative hospitalization was 19.15 days. All cases had a successful outcome, although the complication rate was slightly higher in the free flap group. Overall, the economic advantage was slightly weighted toward the conventional pedicle flap group, although hospitalization time was longer. Therefore, for the management of soft tissue defects in the upper extremity requiring pedicle flap coverage, a free flap should probably be chosen only for specific indications and special circumstances.

Back↗

PubMed1990

Prevalence of tendinitis and related disorders of the upper extremity in a manufacturing workforce.

A cross sectional survey of a randomly selected population of 2,261 textile workers form an overall population of 8,539 eligible workers was performed to evaluate the prevalence of tendinitis in related upper extremity disorders. Of the sample, 2,047 respondents (91.3%) participated in a nurse screening history and examination: 1,091 (53%) had no upper extremity symptoms or abnormalities on examination; 959 (47%) with positive findings were examined by trained physicians. Of these, 347 (36.5%) were found to have no abnormality, whereas, 548 (57.3%) workers were assigned a diagnosis. Of these 227 were considered to fall into the categories of tendinitis (n = 69) or related disorders (n = 158). The projected prevalence of tendinitis and related disorders for the overall group was 11.6% (carpal tunnel syndrome 1.1%, epicondylitis 2.0%, tendinitis 3.5%, shoulder condition 2.3%, ganglion 2.3%, neck conditions 4.0%). Tendinitis was less frequent in the older age group and those employed for a longer time. The prevalence of tendinitis was found to be statistically higher in physically demanding job categories. Ninety-four percent of ailments were of mild or moderate severity. Although our study provides prevalence data for these conditions in a large manufacturing workforce across several job categories.

Adult↗

PubMed1994

Nerve grafting in peripheral nerve microsurgery of the upper extremity.

The use of microsurgical techniques is essential in peripheral nerve surgery, in which dissection at the fascicular level is required. Magnification with an operating microscope allows for an accurate evaluation of the severity of the trauma to the nerve tissue and permits atraumatic interfascicular dissection. Fascicular or interfascicular dissection and repair with the use of nerve grafts was carried out in 220 peripheral nerve lesions of the upper extremity. Our results of nerve-grafting in the upper extremity (median, ulnar, and radial-nerves) indicate an inverse association between the age of the patient and the delay between injury and grafting. In addition, we found that nerve grafting without tension produces superior results over simple neurorrhaphy under tension and permits better axonal growth and nerve recovery.

Adolescent↗

PubMed2002

Effect of submaximal and incremental upper extremity exercise on platelet function and the role of blood shear stress.

INTRODUCTION: Platelets are involved in the pathogenesis of atherosclerosis. Although physical exercise is recommended to prevent atherosclerosis, the effect of exercise on platelet function and the underlying mechanisms of these effects are not completely understood. Accordingly, we aimed to examine the effect of different intensities acute arm exercises on platelet function. In addition, we evaluated the effect of lipid peroxidation and fluid shear rate on platelet response. MATERIALS AND METHODS: Twenty four healthy sedentary male volunteers aged 18-24 years performed submaximal and incremental exercises by upper extremity ergometer. The shear rate in the right artery was measured by Power Doppler Ultrasound (US) at rest and immediately after exercise. Pre and postexercise maximum intensities of ADP and collagen-induced platelet aggregation were measured using the impedance technique. Bioluminescent detection of thrombin-induced platelet ATP release and measurement of thromboxane B(2) (TxB(2)) levels (as a marker of thromboxane A(2) (TxA(2)) formation) by enzyme-linked immunoassay were performed before and after exercise. RESULTS AND CONCLUSION: Shear rate increased after both submaximal and incremental exercise. Collagen-induced platelet aggregation increased after submaximal exercise, while ADP-induced aggregation and thromboxane B(2) levels did not alter with this protocol. Incremental exercise caused increased collagen and ADP-induced platelet aggregation and thromboxane B(2) levels. Neither of the protocols altered platelet ATP release. It was shown that acute upper extremity exercise increased platelet aggregation, without an increase in platelet release. Collagen-induced signalling pathways were more sensitive than those induced by ADP. The increase in thromboxane B(2) after incremental exercise implied increase in thromboxane A(2) formation and lipid peroxidation. Despite a significant correlation between platelet aggregation and thromboxane B(2) levels at rest, we found no clear-cut relationship between thromboxane A(2) formation, blood shear rate and platelet response to exercise.

Adenosine Diphosphate↗

PubMed1991

Upper-extremity deep venous thrombosis and pulmonary embolism. A prospective study.

We prospectively evaluated the prevalence of pulmonary embolism (PE) in 30 consecutive patients with proved deep venous thrombosis (DVT) of the upper extremity. Ten patients (seven male and three female; mean age, 43 years) had primary DVT, and 20 patients (14 male and six female; mean age, 52 years) had catheter-related DVT. Ventilation-perfusion lung scans were routinely performed at the time of hospital admission to all but one patient (one patient was critically ill, and he died four days after DVT diagnosis because of massive PE). Lung scan findings were normal in nine of ten patients with primary DVT, and they were indetermine in the remaining patient. By contrast, perfusion defects were considered highly suggestive of PE in four patients with catheter-related DVT; two patients had indeterminate lung scans, and 13 patients had normal scans. We conclude that PE is not a rare complication in upper extremity DVT, and that patients with catheter-related DVT seem to be at a higher risk.

Adult↗

PubMed2005

Risk factors for mortality in patients with upper extremity and internal jugular deep venous thrombosis.

OBJECTIVE: To elucidate the natural history of upper extremity deep venous thrombosis (UEDVT), we examined factors that may contribute to the high mortality associated with UEDVT. METHODS: Five hundred forty-six patients were diagnosed with acute internal jugular/subclavian/axillary deep venous thrombosis from January 1992 to June 2003 by duplex scanning at our institution. There were 329 women (60%). The mean age +/- SD was 68 +/- 17 years (range, 1-101 years). Risk factors for UEDVT were the presence of a central venous catheter or pacemaker in 327 patients (60%) and a history of malignancy in 119 patients (22%). Risk factors for mortality within 2 months of the diagnosis of UEDVT that were analyzed included age, sex, presence of a central venous catheter or pacemaker, history of malignancy, location of UEDVT, concomitant lower extremity deep venous thrombosis, systemic anticoagulation, placement of a superior vena caval filter, and pulmonary embolism. RESULTS: The overall mortality rate at 2 months was 29.6%. The number of patients diagnosed with pulmonary embolism by positive ventilation/perfusion scan or computed tomographic scan was 26 (5%). The presence of a central venous catheter or pacemaker ( P < .001), concomitant lower extremity deep venous thrombosis ( P = .04), not undergoing systemic anticoagulation ( P = .002), and the placement of a superior vena caval filter ( P = .02) were associated with mortality within 2 months of the diagnosis of UEDVT by univariate analysis. Pulmonary embolism ( P = .42), sex ( P = .65), and a history of malignancy ( P = .96) were not. CONCLUSIONS: These data suggest that the high associated mortality of UEDVT may be due to the underlying characteristics of the patients' disease process and may not be a direct consequence of the UEDVT itself.

Adolescent↗

PubMed2001

Hypercoagulability states in upper-extremity deep venous thrombosis.

Deep venous thrombosis of the upper extremity (DVTUE) is a rare thrombotic disorder that may occur spontaneously but is most often related to predisposing factors, such as an indwelling central venous catheter, malignancy, or exercise. The role of coagulation disorders, i.e., a hypercoagulable state in the pathogenesis of DVTUE is not well known. We have evaluated both genetic and acquired thrombophilia parameters in consecutive patients with DVTUE. A hypercoagulable state was found in 32% of the patients. The most frequent coagulation abnormality was the presence of lupus anticoagulant or anticardiolipin antibodies (27%). Factor V Leiden mutation was detected in two patients, antithrombin deficiency in one, and none of the patients had the prothrombin G20210A gene variant or protein C or S deficiency. The prevalence of coagulation abnormalities was not significantly different in a subgroup of patients with spontaneous DVTUE as compared to those with an obvious predisposing factor, such as an indwelling central venous catheter. We conclude that antiphospholipid antibodies are frequently found in patients with DVTUE. Factor V Leiden mutation, prothrombin 20210A gene variant, protein C deficiency, and protein S deficiency do not seem to play a major pathogenetic role in DVTUE.

Adolescent↗

PubMed1975

Analytical model for the temperature dependence of the circulation pattern in upper extremities.

An analytical model for the circulation in the upper extremities of man is studied under the condition that the hand is immersed in water at different temperatures. The arterial and venous system is represented by one artery and two veins. One of the veins lies close to the deep lying artery; the other one is a cutaneous vein. The model permits a qualitative description of the dependence on temperature of the rate of heat loss of the hand as a function of the rate of blood flow and the water temperature, by means of parameters which determine the behaviour of the considered system. One parameter accounts for the relative amount of the rate of blood flow along deep and cutaneous veins. Comparison with experiment leeds to the following results. At water temperatures 0Hw higher than 25 degrees C about 10% of the blood is returning through the deep vein; for water temperatures lower than 13 degrees C this percentage becomes about 80%. In between the circulation pattern changes gradually. The influence of the counter-current effect, between the artery and the deep vein, on the heat loss of the hand is studied. The arterial blood temperature at the entrance in the hand is compared with the available experimental results.

Adolescent↗

PubMed1978

Upper extremity complications of axillofemoral grafts.

Four patients sustained five upper extremity complications after axillobifemoral grafting including brachial plexus injuries, axillary artery thrombosis, and arterial steal. To avoid these problems, the following precautions are recommended: (1) proper positioning of the patient to prevent hyperabduction of the shoulder; (2) adequate exposure of the axillary artery during dissection and gentle handling of the nerve trunks; (3) meticulous technic during construction of the proximal anastomosis and avoidance of undue tension on the graft; and (4) careful preoperative assessment of the axillary-subclavian artery as a potential donor vessel.

Aged↗

PubMed1982

Microvascular free-flap coverage of mechanical injuries to the upper extremity.

Extensive soft-tissue avulsion injuries of the upper extremities with or without bony involvement are difficult reconstructive problems. They usually cannot be adequately managed by traditional methods using skin grafts or local flaps. Microvascular free-tissue transplantation may offer the best chance for success with these severe injuries. Free-tissue transfer is indicated in this type of injury (1) when no simpler method of obtaining a closed wound is available, or (2) when the quality of soft-tissue coverage by simpler methods would not be adequate from a functional standpoint. For example, if a skin graft is placed over bone and tendons, there may be impairment of function, and certainly this is a poor environment for tendon transfers, nerve repairs, and so forth. The much more adequate tissue of a free-flap coverage provides a better environment for reconstruction. Three cases demonstrating these principles have been presented.

Adolescent↗

PubMed1989

Aeromonas hydrophila upper extremity infection.

A severe soft tissue infection of the upper extremity caused by Aeromonas hydrophila followed a water skiing injury in which a tow rope caused degloving of a portion of the skin and severe contusion to underlying muscle. Infection was established within 36 hours of the injury, accompanied by fever, leukocytosis, and a foul odor. Rapid clinical improvement occurred following radical debridement of all nonviable tissue and antibiotic therapy. In cases involving water contamination, Aeromonas hydrophila infection should be suspected with the onset of a rapidly developing infection with a febrile response. Rapid surgical intervention and treatment with an aminoglycoside or a third-generation cephalosporin antibiotic is the treatment of choice.

Adult↗

PubMed1992

Perineural hemangiomas of the upper extremity: report of four cases.

Perineural hemangiomas in the upper extremity have been the subject of few reports. We found only eight such cases reported in the literature. We report four additional cases in which there were neurologic symptoms. The specific diagnosis of cavernous hemangioma was not made preoperatively in any of the patients. The greater the extent of intrafascicular involvement, the more difficult is total eradication of the hemangioma.

Adolescent↗