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PubMed1998

Causes of upper extremity compartment syndrome.

Multiple causes, including various types of trauma, prolonged compression, muscle avulsions, burn, snake bites, high-pressure injection injuries, exercise, infection, bleeding, and intravenous drug infiltration, have been reported to lead to the development of a compartment syndrome in the upper extremity. Awareness of the different causes and risks of compartment syndrome should facilitate early diagnosis and prompt treatment to help avoid the development of serious sequelae such as Volkmann's ischemic contracture. A review of the various reports of upper extremity compartment syndromes and classification systems is presented to assist in the understanding of this condition's development.

Arm↗

PubMed1990

Upper extremity venous thrombosis diagnosed by duplex scanning.

The incidence of axillary-subclavian venous thrombosis continues to rise, while reports of noninvasive methods to diagnose this condition have been sparse. A review of the records of 693 consecutive upper extremity duplex scans was performed, and a diagnosis of acute venous thrombosis was made in 123 of these patients. Of these, 85 involved the axillary or subclavian vein. Use of a central venous catheter was the most common risk factor for axillary-subclavian venous thrombosis. Within this group, 8% had a pulmonary embolism, of which 25% were fatal. Follow-up of patients with axillary-subclavian venous thrombosis at a mean of 2 years revealed that 49% of these patients had died. Of the remaining patients, more than one third had evidence of the post-thrombotic syndrome. Duplex scanning of the venous system provides a safe, reliable, and repeatable method of evaluating and following patients with suspected venous thrombosis of the upper extremity.

Acute Disease↗

PubMedDate not supplied

Mini-dose Bier block intravenous regional anesthesia in the emergency department treatment of pediatric upper-extremity injuries.

The safety and effectiveness of the "mini-dose" Bier block, a technique of i.v. regional anesthesia using low-dose lidocaine (1.5 mg/kg) without routine premedication, was evaluated in the emergency department treatment of pediatric upper-extremity fractures and dislocations. We prospectively studied 69 patients, aged from 2 to 16 years, treated at a pediatric primary care/referral-based emergency department. Good to excellent anesthesia was achieved during closed reduction in 90% of the cases. All patients achieved an acceptable reduction, as demonstrated by follow-up radiographs. None required further treatment of the injury under general anesthesia. No significant complications were noted. We conclude that the mini-dose Bier block provides safe, reliable, and cost-effective anesthesia for the outpatient reduction of pediatric upper-extremity injuries.

Adolescent↗

PubMed1990

From the archives of the AFIP. Giant cell tumor of the upper extremity.

Giant cell tumor (GCT) is a relatively common primary bone tumor that typically develops in young adults between the ages of 20 and 40 years. Our archives contain 1,183 cases of histologically proved and radiographically correlated GCTs, collected in consultation over 40 years. From this large series, we identified 243 lesions (21% of GCTs) arising in the upper extremity distal to the scapula. This report demonstrates the spectrum of radiologic findings of GCT of the upper extremity, augmented where appropriate by accompanying pathologic material.

Adolescent↗

PubMed1983

Phleborheography of the upper extremity.

Phleborheography is a well-established technique for the noninvasive diagnosis of deep venous thrombosis of the lower extremity. For ten years we have used phleborheography in the diagnosis of axillary and subclavian venous thrombosis. We developed modifications in technique and interpretation that are necessary for accurate application of phleborheography to the upper extremity. When compared with venography, the sensitivity and specificity of this technique approached 90%. Therefore, phleborheography appears to be a useful screening examination for deep venous thrombosis of the upper extremity.

Axillary Vein↗

PubMed2004

Surgery on the affected upper extremity of patients with a history of complex regional pain syndrome: the use of intravenous regional anesthesia with clonidine.

STUDY OBJECTIVES: To evaluate the efficacy of intravenous regional anesthesia (IVRA) with clonidine in patients with a previous history of complex regional pain syndrome (CRPS) who are undergoing upper extremity hand surgery. DESIGN: Prospective, randomized, double-blind study. SETTING: Operating suites and Pain Management Center of a large university-affiliated medical center. PATIENTS: 84 patients with a previous history of upper extremity CRPS undergoing surgery on the affected extremity. All signs and symptoms of CRPS had resolved prior to the time of surgery. INTERVENTIONS: Patients were randomized to receive IVRA with 0.5 % lidocaine with either 1 mL normal saline (n=42) or clonidine 1 microg/kg (n=42) added to the lidocaine solution. MEASUREMENTS: Recurrence of CRPS symptoms at 1 year following surgery were recorded. MAIN RESULTS: The recurrence rate of CRPS was significantly lower (p <0.001) in those patients receiving IVRA with lidocaine and clonidine (10%, n=4) compared with those patients receiving IVRA lidocaine only (74%, n=31). CONCLUSIONS: Intraoperative IVRA with lidocaine and clonidine on patients with a history of CRPS can significantly reduce the recurrence rate of this disease process.

Anesthesia, Conduction↗

PubMedDate not supplied

[Sensory nerve conduction of upper extremity nerves in degenerative cervical vertebral disease].

Sensory conduction was measured in the median, ulnar and radial nerves in patients with clinical and radiological evidence of degenerative disease of cervical spine. A significant reduction of conduction velocity and decreased amplitude of action potentials in nerves were demonstrated. In the group of 50 patients in only one case no changes in sensory conduction in upper extremity nerves were found. In the remaining 49 cases reduction of conduction velocity in sensory nerves or decreased amplitude of nerve action potentials were found in at least one of these nerves. Since evident disturbances in sensory conduction were observed even in the extremities without any subjective or objective abnormalities it may be supposed that determination of sensory nerve conduction in upper extremities may be an adjunct method in early diagnosis of degenerative cervical vertebral disease.

Action Potentials↗

PubMed1981

Contralateral effects of upper extremity proprioceptive neuromuscular facilitation patterns.

Electromyography was used to determine the presence of electrical activity in the nonexercised latissimus dorsi, infraspinatus, and pectoralis major muscles while the contralateral limb underwent the proprioceptive neuromuscular facilitation pattern of flexion, abduction, external rotation with elbow straight and extension, adduction, internal rotation with elbow straight. Activity was present in all of these muscles during both components of the pattern. There was no significant difference in activity for the pectoralis major muscle during the flexor as compared to extensor component. The infraspinatus was more active during the flexor component, while the latissimus dorsi was more active during the extensor component. These results could be used in planning a treatment program for patients who are unable to exercise one of their upper extremities and who could benefit from the contralateral effects of upper extremity proprioceptive neuromuscular facilitation patterns.

Adult↗

PubMedDate not supplied

Lateral cervical epidural catheter placement for continuous unilateral upper extremity analgesia and sympathetic block.

BACKGROUND AND OBJECTIVES: The use of the laterally directed cervical epidural catheter for the treatment of acute and chronic pain has not been previously described. We have used this technique in a series of 30 patients to produce unilateral upper extremity analgesia and sympathetic block. We present a case report of a patient treated with this technique and a description of the technique and results from the series. METHODS: We placed an epidural catheter at the C6-7 vertebral interspace and directed the needle bevel and catheter to the affected side in a woman with a history of complex regional pain syndrome of the right upper extremity. RESULTS: We were able to show a unilateral block with this technique by anatomic parameters (unilateral contrast dye spread), physiologic parameters (unilateral Horner's syndrome), and symptomatic parameters (unilateral, subjective neural block). Although 1 patient treated with this technique had bilateral effects, no patient has had a predominant block on the contralateral side and there have been no complications. CONCLUSIONS: This case report shows results typical of this series of 30 patients. In this series, the laterally directed cervical epidural catheter was an effective technique to produce continuous unilateral analgesia and sympathetic block. Key Words: Analgesia (epidural), Autonomic nerve block, Reflex sympathetic dystrophy, Postoperative pain.

Anesthesia, Epidural↗

PubMed1995

State of health in dental technicians with regard to vibration exposure and overload of upper extremities.

The authors examined 120 dental technicians, 111 women, 9 men, of mean age 44.8 years, mean duration of exposure 24.9 years. Cold water test, plethysmographic investigation, and EMG (in indicated persons), X-ray, neurological and orthopedic examinations were performed. Combination of exposure to vibration above the limit value, with overload of upper extremities, was proved by hygienic measurement. The most frequent subjective complaints included vertebral complaints (52.5%), paresthesiae in the hand fingers (47.4%) and pain in the joints of upper extremities (elbow 26.6%, shoulder 10.8%, wrist 6.6% and small joints of hand 6.6%). Four workers reported history of white fingers, but the cold water test did not prove it. Deteriorated plethysmographic curve was in 11 cases only. Pathological motor conduction in nervus medianus was found (by EMG investigation) in 13 persons. Carpal tunnel syndrome was acknowledged in 4 individuals as an occupational disease. The results of these investigations show the hazard of dental technicians work and the necessity of improvement of their work conditions.

Adult↗

PubMed1996

The treatment of hand ischemia by arterial ligation and upper extremity bypass after angioaccess surgery.

BACKGROUND: Hand ischemia remains an uncommon but potentially devastating complication of angioaccess operations. In the past, fistula ligation, arterial banding, and graft lengthening have been recommended as treatment with varying degrees of success. The procedure of arterial ligation and upper extremity bypass has recently been proposed as a more physiologic alternative method of treating this problem. STUDY DESIGN: The records of six patients with hand ischemia after hemodialysis access surgery who were treated with arterial ligation and revascularization were reviewed. Indications for operation, patient demographics, and risk factors were noted. The clinical results of surgery as well as fistula and bypass graft patency were recorded. RESULTS: All six patients demonstrated marked improvement in the perfusion of the affected hand. Five of six patients had complete resolution of their symptoms, while one continues to have a mild residual numbness of the hand. All fistulas and arterial bypass grafts remain patent at a follow-up period of two to 18 months (mean, 7.4 months). There were no perioperative complications or deaths. CONCLUSIONS: The technique of arterial ligation and upper extremity bypass provides a consistent and reliable method of correcting hand ischemia after angioaccess surgery. We believe it is the procedure that is most likely to alleviate the clinical symptoms of hand ischemia without jeopardizing the long-term function of the hemodialysis fistula.

Aged↗

PubMedDate not supplied

An integrative review of outcomes in patients with acute primary upper extremity deep venous thrombosis following no treatment or treatment with anticoagulation, thrombolysis, or surgical algorithms.

Primary upper extremity deep venous thrombosis (UEDVT) is a rare condition that typically affects young patients and can cause considerable long-term morbidity. Proposed treatments have included rest, heat, elevation of the affected limb, anticoagulation, thrombolysis, surgical decompression, percutaneous transluminal angioplasty (PTA), and stenting. However, the optimal management of primary UEDVT remains controversial. This study was an integrative review of the English-language literature since 1965 on primary UEDVT, with comparison of long-term symptoms, rethrombosis, and pulmonary embolism in 4 treatment algorithms: rest, heat, and elevation alone; anticoagulation alone; surgical decompression without thrombolysis; and algorithms including thrombolysis. Forty-one studies describing 559 patients met the criteria for inclusion. Statistically significant differences were found among the 4 treatment algorithms in the incidence of residual symptoms (p < 0.000), the incidence of pulmonary embolism (p < 0.000), and the incidence of rethrombosis (p < 0.027). Residual symptoms and the severity of residual symptoms were greatest in the rest, heat, and elevation algorithm (74%), followed by the surgical (60%), anticoagulation (44%), and thrombolysis (22%) algorithms. Pulmonary embolism was also greatest in the rest, heat, and elevation algorithm (12%), followed by the anticoagulation (7%), thrombolysis (1%), and surgical algorithms (0%), while rethrombosis was greatest in the thrombolytic algorithm (7%) followed by the surgical (3%), anticoagulation (2%), and rest, heat, and elevation (0%) algorithms. These results support the current clinical practice of a staged, multidisciplinary approach to treatment of primary UEDVT that includes thrombolytic therapy and possible surgical decompression. Further studies are needed to evaluate the natural history of patients treated with thrombolysis alone, to assess the optimal timing of surgical decompression, and to determine the best use of PTA and stenting in the multidisciplinary approach.

Acute Disease↗

PubMed1992

Upper extremity functional changes following selective posterior rhizotomy in children with cerebral palsy.

Spasticity in children with cerebral palsy may inhibit function and reduce progress in therapy. Selective posterior rhizotomy, a neurosurgical procedure, has been found to effectively reduce spasticity in selected cases. The literature suggests that positive changes in upper extremity function results from this surgery. At the Alberta Children's Hospital in Calgary, Alberta, Canada, all candidates for this surgery are screened by the neuromotor clinic team, which includes an occupational therapist, a speech therapist, and a physical therapist. This paper outlines the specific changes seen in the upper extremity functions of 7 children over a 12-month period following their surgeries. The data collected suggest the children had improved function in activities of daily living, play skills, balance, and endurance. This paper focuses on the changes in activities of daily living and recommends future direction for research in this area.

Adolescent↗

PubMedDate not supplied

Forced use of the upper extremity in cerebral palsy: a single-case design.

OBJECTIVE: Muscle imbalance and poor control of movement can have an impact on the daily occupational functioning of children with cerebral palsy. When one side of the body functions better than the other, children will often prefer to use the less-involved upper extremity for completion of play and self-care activities because they have learned that the other hand does not function as effectively. This study examined a method purported to overcome this learned nonuse of the affected upper extremity by directing the child's attention to this extremity and increasing his or her motivation to use it. The research hypothesis was that restriction of the less-involved hand with a resting splint would result in increased use of the more-involved hand in a child with spastic cerebral palsy. METHOD: Initially, two children with cerebral palsy participated in this single-subject, ABA design study, but only one subject complied with the splint-wearing schedule and completed the study. This subject was a 2-year-old girl with greater involvement of the right side than the left. During the experimental phase, she wore a resting splint on her less-involved hand for most of the waking hours of the day to restrict its use. Data were collected over a 7-week period (2 weeks presplinting, 3 weeks splinting, 2 weeks postsplinting) and at a 6-month follow-up. Use of the more-involved extremity was measured through analysis of her performance during 15-min videotaped sessions of free play, administration of items from the Peabody Developmental Fine Motor Scales, and completion of a daily finger-feeding task. RESULTS: An improvement in quality, quantity, and variety of use of the more-involved extremity after splinting, with some continuing improvement evident at follow-up, was found. The subject had increased voluntary control of her more-involved arm and hand and used them more spontaneously for completion of daily occupations. CONCLUSIONS: Although the results of this single-case design are encouraging, further research with a randomized, controlled design is necessary to determine the effectiveness of the forced-use technique with a larger population.

Cerebral Palsy↗

PubMed1984

Myositis ossificans of the upper extremity: a long-term follow-up.

The long-term results of nonoperative treatment of myositis ossificans traumatica have been infrequently reported. We reviewed 83 cases of myositis ossificans seen at the Mayo Clinic from 1950 to 1979 in patients up to 21 years of age. The upper extremity was involved in 31 patients. Follow-up averaged 13 years for 23 of the (74%) patients studied. Football injuries had occurred in 20 of these patients, and the diagnosis was made an average of 3.3 weeks from the time of the initial injury. Observation was the only treatment in 18 of the 31 cases. At follow-up two-thirds of the patients with upper extremity involvement had no problems associated with the disorder, and one-third described some difficulties. Nonoperative treatment remains an accepted management approach for this problem.

Adolescent↗

PubMed1984

Large-vessel arterial occlusive disease in symptomatic upper extremity.

Subclavian and axillary artery occlusive disease resulted in sufficient upper extremity symptoms to necessitate 30 vascular reconstructions in 28 patients over the past ten years. Female patients predominated, with a ratio of 2.5:1. The average age of the patients was 61 years. The incidence of diabetes mellitus was low (7%). Sixteen of 18 proximal subclavian lesions were on the left side, while more distal lesions were equally distributed on the left and right. Extrathoracic bypasses were used in all cases. Dacron grafts were used in 16 of 17 carotid-subclavian bypasses. Autogenous vein grafts were used in 11 of 13 bypasses to the axillary or brachial artery. Concomitant cervicodorsal sympathectomy was done in only four patients. The in-hospital graft patency rate was 93% and the long-term graft patency rate at one year and beyond was 88%.

Adult↗

PubMed2001

A case of ochronosis: upper extremity involvement.

We present an ochronotic patient with spondylosis and upper extremity involvement. We also evaluated radiologic findings of joints that were involved and MRI features of the lumbar spine.

Follow-Up Studies↗

PubMed2002

[Using prostaglandin E1 in microvascular reconstruction of the upper extremity after acute trauma].

The operative treatment of hand and upper extremity trauma with injury of main vessels becomes a daily standard work in trauma and microsurgical replantation centers. The techniques of vessel and soft tissue reconstruction are well known. The outcome of the replantation depends on various factors. Main influences are the intraoperative status of the vessel wall and the unobstructed flow in the vessel after the operation. Another factor for successful replantation is the homeostasis of the patient. It can be influenced by many drugs which are applied according to a replantation schema. Aim of this therapy is the correction of the rheologic properties of a patient. In a patient group of 25 treated with Prostaglandin E1 (Prostavasin) we observed better wound healing with a 80% rate of successful replantation and microvascular vessel reconstruction.

Adolescent↗