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PubMed1998

MR angiography of the aortic arch vessels and upper extremities.

MR angiography of the aortic arch vessels and upper extremities is a noninvasive alternative to conventional catheter angiography without the risks of stroke or the potential toxicity of iodinated contrast. The use of optimized, breath hold gadolinium-enhanced three-dimensional MR angiography provides excellent image quality with the capability of display options not available with conventional angiography. This article demonstrates the utility of this new technique in the diagnosis of congenital and acquired conditions of the supraaortic vascular system.

Aneurysm↗

PubMedDate not supplied

Upper extremity deep vein thrombosis: clinical and treatment characteristics.

We aimed to evaluate patients with upper extremity deep vein thrombosis (UEDVT) in terms of the risk factors, symptoms, clinical course, diagnostic approaches and treatment outcome. Thirty-six patients with a diagnosis of UEDVT, comprising 19 males (52.7%) and 17 females (47.3%), were included in the study; the mean (+/- SD) age was 54 +/- 12.3 years. The most common risk factor was central venous catheter use. The treatment protocol consisted of low molecular weight heparin for up to 7 days, followed by oral anticoagulants for up to 6 months. All patients were followed up for 1 year. More than 90% of the patients responded well to treatment. Nine patients (25%) died due to underlying diseases; no patients died secondary to UEDVT. None of the patients developed pulmonary embolus or recurrent deep venous thrombosis, and post-thrombotic syndrome was not observed. The mortality rate was related to the underlying diseases.

Adult↗

PubMed2002

Occupational upper extremity conditions: a detailed analysis of work-related outcomes.

While work-related upper extremity conditions (WRUECs) cause almost 25% of lost time cases in the US, little is known about their long-term occupational consequences. A self-report survey was mailed to New Hampshire workers reporting a WRUEC one year prior to the study. Of the 72 (52%) valid respondents, 60% had lost > or = 1 week of work and 90% had returned to work. Almost 70% reported acute injury onset, and 26% had experienced a recurrence of their WRUEC. Both gradual-onset injuries and recurrences had worse outcomes. Recurrence was related to shorter job tenure, lower job satisfaction, and less satisfaction with medical care and insurer responses. Results imply that a single measure is insufficient to assess occupational outcomes subsequent to a WRUEC. The importance of secondary prevention was highlighted. There is a need for focus on gradual-onset injuries, as well as those acute-onset injuries with risk for recurrence.

Absenteeism↗

PubMed2000

Reflex sympathetic dystrophy: misdiagnosis in patients with dysfunctional postures of the upper extremity.

The purpose of this case-control study was to assess the frequency of the inappropriate diagnosis of reflex sympathetic dystrophy (RSD) in patients who presented with dysfunctional postures of the upper extremity (n = 43). This group of patients with a dysfunctional posture was compared with a randomly selected control group of patients who presented with pain but no dysfunctional posture (n = 88). The patients underwent radiographic evaluation after review of previous medical records and history and physical examination. Patients with dysfunctional postures had a significantly higher frequency (63%) of a previous inappropriate diagnosis of RSD compared with the control group (6%). None of the patients in either group had objective findings consistent with a diagnosis of RSD. Patients presenting with dysfunctional postures of the upper extremity may be misdiagnosed as having RSD and rarely meet the criteria for this diagnosis.

Adolescent↗

PubMed2004

Th2 shift in juvenile muscular atrophy of distal upper extremity: a combined allergological and flow cytometric analysis.

Juvenile muscular atrophy of the distal upper extremity (JMADUE) is considered to be a type of flexion myelopathy; however, we recently reported cases of JMADUE associated with airway allergy successfully treated by plasma exchange. To further characterize the allergo-immunological features of JMADUE, 11 consecutive JMADUE patients in the neurology clinic at Kyushu University Hospital were studied. Past and present together with family histories of common allergic disorders were investigated. Total serum IgE was measured by an enzyme linked immunosorbent assay (ELISA) and allergen-specific IgE by a liquid phase enzyme immunoassay. Intracellular interferon (IFN) gamma-, interleukin (IL)-4-, IL-5- and IL-13-producing T cells in peripheral blood were analyzed by flow cytometry. Data from 42 healthy subjects were used as controls for allergological studies. Flow cytometric data from 21 healthy subjects were also used for comparison. The patients exhibited significantly higher frequencies of coexisting airway allergies such as allergic rhinitis (p=0.0057) and pollinosis (p=0.0064), family histories of allergic disorders (p=0.0075), and mite antigen specific IgE (p=0.0361) compared with the healthy subjects. Patients with JMADUE had a significantly higher percentage of IFNgamma-IL-4+CD4+T cells (p=0.0017), but not IL-5- or IL-13-producing CD4+T cells, and a reduced intracellular IFNgamma/IL-4 ratio in CD4+T cells (p=0.002) compared to the controls. These findings suggest that JMADUE has a significant T helper 2 (Th2) shift, which may in part contribute to the development of spinal cord damage.

Adolescent↗

PubMed1986

Spinal curvature, hand dominance and prolonged upper-extremity use of wheelchair-dependent DMD patients.

A study of 26 wheelchair-dependent patients with Duchenne muscular dystrophy aged between 11 and 23 years (average 16.5 years) showed no correlation between handedness or prolonged use of one upper extremity and convexity of the spinal curve. Severe, untreated scoliosis results in loss of function. A straight, stable spine allows patients to use their upper extremities functionally rather than for supporting the trunk.

Adolescent↗

PubMed1990

Noninvasive evaluation of the upper extremity.

Vascular problems of the arm and hand can be assessed by a number of noninvasive modalities that are chosen on the basis of the history and physical examination. For suspected upper-extremity ischemia, we begin with SLPs and velocity-waveform analysis. The former test will define the extent and approximate location of the disease process, and subjective assessment of the waveform will further determine the degree and location of occlusive disease. When digital ischemia is suspected, the Doppler examination combined with intermittent compression of the radial and ulnar arteries is valuable for defining the variable arterial anatomy of the hand and the patency of the common and proper digital arteries. The extent of distal ischemia can be assessed by digital pressures. Duplex scanning has been found to be of value in determining the source of upper-extremity micro-emboli, in imaging suspected aneurysmal changes, and for evaluating arteriovenous fistulae and bypass grafts. Cold testing is used to confirm the diagnosis of Raynaud's disease after excluding proximal occlusive disease. When symptoms suggest intermittent arterial obstruction, arterial compression at the thoracic outlet is assessed by monitoring the arterial waveform during a series of maneuvers that change the anatomy of the outlet. Although a combination of IPG and venous Doppler examination accurately identifies venous occlusion, we routinely use duplex scanning in this setting. In addition to providing both anatomic and hemodynamic information about the subclavian vein, the jugular vein and the junction of the innominate vein can also be studied. Because of its ability to image in a coronal plane, MRI scanning is another nonivasive study that we have found useful for evaluation of venous anatomy and patency of the subclavian, jugular, and innominate veins. Venous thrombosis, often the first manifestation of subclavian vein compression at the thoracic inlet, is best evaluated using duplex scanning.

Arm↗

PubMed1997

[The development and introduction of diagnostic and treatment methods for neurovascular diseases of the upper extremity].

The diagnosis complex, permitting to reveal the disease cause and the character of the affect faulty and quickly, was elaborated, based on the experience of treatment analysis of more than 600 patients with the upper extremities neurovascular diseases--thoracic inlet syndrome, Raynaud disease and syndrome. Methods of conservative therapy are introduced, indications for operative treatment are substantiated. Application of new methods of restoration-reconstructive interventions permitted to raise the treatment quality, particularly in seriously ill patients with complicated forms of upper extremities neurovascular diseases.

Arm↗

PubMed2004

Quantitative three-phase bone scintigraphy in the evaluation of intravenous regional blockade treatment in patients with stage-I reflex sympathetic dystrophy of upper extremity.

OBJECTIVE: To investigate the role of quantitative three phase bone scintigraphy (QTPBS) in the evaluation of efficacy of intravenous regional blockade treatment in patients having reflex sympathetic dystrophy (RSD) of the upper extremity. MATERIAL AND METHODS: Twenty-six patients with stage-I RSD were focused on in this study. Patients were treated with physical therapy and intravenous (I.V.) regional blockade therapy consisting of dexamethasone and lidocaine. All patients were clinically evaluated before and 1 month after the completion of the therapy protocol. QTPBS was applied to patients before therapy and 1 month after the therapy. As a control group, 11 healthy subjects also underwent QTPBS. Perfusion, hyperemic and fixation indices were calculated from three-phase bone scintigraphy. RESULTS: All patients showed statistically significant clinical improvement after the therapy (p < 0.01). Pre-treatment, perfusion (1.67 +/- 0.63), hyperemic (1.44 +/- 0.48) and fixation (1.69 +/- 0.48) indices of patients were higher than those of healthy subjects (PI: 0.95 +/- 0.05, HI: 0.94 +/- 0.06, FI: 1.01 +/- 0.2) (p < 0.01) and all indices significantly decreased after the treatment (PI: 1.33 +/- 0.46, HI: 1.18 +/- 0.23, FI: 1.42 +/- 0.26) (p < 0.01). CONCLUSION: I.V. regional blockade therapy combined with corticosteroids is a simple, safe and effective method for the treatment of patients with stage-I RSD in the upper extremity. QTPBS is a valuable and objective method to evaluate the response to therapy and may be useful for staging of patients and predicting the response to therapy.

Adult↗

PubMed1998

Reflex sympathetic dystrophy of the upper extremity--a 5.5-year follow-up. Part I. Impairments and perceived disability.

The aim of this retrospective and long-term follow-up study was to identify impairments resulting from reflex sympathetic dystrophy (RSD) of the upper extremity and to analyze the relationship between impairment and disability in RSD patients. The study group consisted of a referred sample of 65 RSD patients, with clinical signs in the upper extremity. RSD developed after fractures of the wrist or hand in 29 patients or after a carpal tunnel release in 9 patients. The mean interval between the RSD diagnosis and our evaluation was 5.5 (3-9) years (SD = 0.8). The main outcome measurements were the impairments assessed by standard physical examination. ADL and pain were quantified with a visual analogue scale (VAS). Pain was evaluated immediately before and after the physical examination and the perceived pain was determined in the week before the examination. Significant differences in impairments were found between the affected and the unaffected sides (p < 0.05). According to the AMA-guides, the impairments did not lead to disabilities. Significant correlations were found between VAS-ADL and VAS-pain in the last week prior to evaluation and full fist grip-strength. Pain seems to be the most disabling effect.

Activities of Daily Living↗

PubMed1998

Vascularised bone graft applications in upper extremity problems.

Between 1990 and 1996, 16 cases of bone defects were treated by vascularised bone grafting by the authors. Free vascularised fibula was used in 10 cases and one free iliac crest graft was used for upper extremity bone defects. Four vascular pedicled first metacarpal bone and one radial styloid bone were used for scaphoid nonunion. Average follow-up was 26 months (6-78 months) and success rate was 94%. We recommend vascularised bone grafts in the upper extremity when there is risk of infection; the defect is greater than five centimeters when the forearm rotation is unlimited. The avascularity of the scaphoid pseudarthrosis must be verified radiologically or through magnetic resonance imaging. This technique should only be used when other reconstructive techniques are unlikely to succeed.

Adolescent↗

PubMed2001

Magnetic resonance imaging of the upper extremity: advances in technique and application.

Vast advances in technology have taken place in the field of radiology led by the introduction of magnetic resonance imaging. The added advantages of exquisite soft tissue contrast and multiplanar imaging capabilities have revolutionized the understanding of complex anatomic relationships and diagnoses. The current authors will focus on the introduction of new advances in magnetic resonance imaging of the upper extremity that may prove helpful in the diagnosis and treatment of upper extremity abnormalities.

Arm↗

PubMed2000

Thoracic spine dysfunction in upper extremity complex regional pain syndrome type I.

STUDY DESIGN: Case study. OBJECTIVE: To demonstrate the importance of assessment and treatment of the thoracic spine in the management of a patient with signs and symptoms of upper extremity Complex Regional Pain Syndrome Type I (CRPS-I). BACKGROUND: The patient was a 38-year-old woman who suffered a traumatic injury to her left hand. Five months after injury, she presented with severe pain, immobility of the left arm, and associated dystrophic changes. She was unable to work and needed help in some activities of daily living. METHODS AND MEASURES: The patient was treated for 3 months in 36 visits. Initial treatment consisted of cutaneous desensitization, edema management, and gentle therapeutic exercises. However, further examination indicated hypomobility and hypersensitivity of the upper thoracic spine. Joint manipulation of the T3 and T4 segments was implemented. The patient's status was monitored and range of motion, strength, temperature, and skin moisture were measured. RESULTS: Immediately after the vertebral manipulation, there was a significant increase in the left hand's skin temperature and a decrease in hyperhydrosis as measured by palpation. Shoulder range of motion increased from 135-175 degrees and the patient reported reduced pain from 6/10 to 3/10 on a scale from 0 to 10, where 0 represents no pain. The decrease in the patient's dystrophic and allodynic symptoms permitted further progress in functional re-education. The patient was discharged with full return to independence and initiation of a vocational retraining program. CONCLUSION: Assessment and treatment of the thoracic spine should be considered in patients with upper extremity CRPS-I.

Adult↗

PubMed2004

Upper extremity limb salvage with microvascular reconstruction in patients with advanced sarcoma.

Limb salvage is a viable alternative to amputation in many cases of advanced sarcoma. The authors examined their experience with microvascular reconstruction of upper extremity defects after sarcoma resection, focusing on oncologic and functional outcomes. A retrospective analysis yielded 17 patients who underwent 18 free flap procedures and met the inclusion criteria. Most patients (71 percent, n = 12) had recurrent sarcoma at presentation to the authors' institution. Malignant fibrous histiocytoma was the most common pathologic subtype (n = 6). High-grade tumors were present in 94 percent of patients (n = 16). The free flap survival rate was 100 percent. The rectus abdominis flap was the most common free flap used (39 percent; n = 7). Local recurrence occurred in nine flaps (50 percent), and five patients ultimately required amputations. Six patients (35 percent) had distant recurrence. The mean Enneking score for limb function was 73 percent of the maximum (21.9 of 30). The 5-year disease-specific survival rate was 61.3 percent. In select patients with advanced upper extremity sarcoma undergoing limb salvage, microvascular flap reconstruction can provide reliable, safe coverage with reasonable preservation of function.

Adult↗

PubMed2006

Epidemiology of work-related upper extremity disorders: understanding prevalence and outcomes to impact provider performances using a practice management reporting tool.

In 2001, the number of repeated trauma cases accounted for 4% of total workplace injuries and 65% of all occupational illnesses, with work-related upper extremity disorders accounting for most cases. Because chronic disability leads to the highest cost, systematic evaluation of this growing occupational condition is needed. This article sheds light on work-related upper extremity disorders by understanding the prevalence and pattern for these diagnoses, their impact on outcomes influenced by age, gender and geography on metrics such as utilization, duration, disability status, and costs. To assess these types of outcomes measurements, a good reporting and management system must be in place to allow for ongoing evaluation and analysis of data and in the construction of intervention programs to improve provider performances and, ultimately, patient outcomes.

Adult↗

PubMed1985

[Lymphatic vessels of the upper extremity and their relation to nodes in the axillary area in healthy subjects and lymph flow blockade].

Large and small lymphatic vessels have been studied roentgenologically on the medial, lateral, posterior and anterior surfaces of the upper extremity in 113 patients at the age of 19-63 years at blockade of the lymphatic stream. On the medial and lateral surfaces the lymphatic vessels are filled with the contrast substance via anatomical approaches from the palmar and dorsal sides of the forearm. With isolated contrasting of various large lymphatic vessels, zones in the skin and in the subcutaneous fatty layers drained by them are revealed, as well as distribution of small vessels in the forearm and shoulder in each region. Variants of large lymphatic vessels and their tributaries are defined; an essential variability of their inflow into the axillary lymph nodes from various anatomical areas of the upper extremity is found. Into every 1-4 groups of the lymph nodes of the axillary area, 1-3 large vessels inflow, through them the contrast substance switches from the same anatomical zone repeatedly.

Adult↗

PubMed1995

Efficacy of immediate postirrigation culture in the treatment of upper-extremity abscesses.

A retrospective chart review of 192 patients of the musculoskeletal infection ward at the authors' facility was performed to assess the value of immediate postirrigation cultures in the treatment of acute soft tissue infections of the upper extremity. Twenty-two patients (11.5%) had postirrigation cultures with an organism that was not present in the preirrigation cultures. All of those organisms not previously found were gram-positive organisms, and no changes were necessary in the initial antibiotic regimes. Immediate postirrigation cultures did not prove to be effective in the information they provided related to treatment of acute soft tissue infections of the upper extremity.

Abscess↗

PubMed1993

Improvement in upper extremity function and trunk control after selective posterior rhizotomy.

Selective posterior rhizotomy is being increasingly used in the treatment of spasticity associated with cerebral palsy. Anecdotal reports in the literature note that this procedure results in improved upper extremity function and trunk control. We present a systematic analysis of the results of selective posterior rhizotomy performed on patients with cerebral palsy at Santa Rosa Children's Hospital. Patients were video-taped before surgery and one year postoperatively. These videos were reviewed blind by an occupational therapist who graded patients' performance on three tasks: assumption of side sitting, maintenance of side sitting, and block building. Statistically significant improvements were noted in all three categories with p values of .0003, .0001, and .0044 respectively. These results support the anecdotal reports of improvement in upper extremity function and trunk control with selective posterior rhizotomy.

Adolescent↗