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 91 records · Page 5Linked to original sources

PubMed2005

Prevalence of upper extremity symptoms and disorders among dental and dental hygiene students.

CONTEXT: Upper extremity musculoskeletal disorders are common among dental professionals. The natural history of these disorders is not well-understood. These disorders are more common in older workers, but the prevalence among younger workers has not been well-studied. OBJECTIVE: The objective of this study was to determine if dental/dental hygiene students had a similar prevalence of upper extremity musculoskeletal disorders compared to age-matched clerical workers. We hypothesize students will have a lower prevalence of upper extremity musculoskeletal disorders compared to clerical workers. DESIGN: This was a cross-sectional design. SETTING: Dental and dental hygiene students from three schools were compared to clerical workers from three locations (an insurance company and two data processing plants). SUBJECTS: There were 343 dental and dental hygiene students and 164 age-matched clerical workers. MAIN OUTCOME MEASURES: Regional discomfort was the primary outcome. The secondary health outcomes were diagnoses of carpal tunnel syndrome and upper extremity tendinitis. RESULTS: Clerical workers had a higher prevalence of hand symptoms (62 percent vs. 20 percent), elbow symptoms (34 percent vs. 6 percent) and shoulder/neck symptoms (48 percent vs. 16 percent) and a higher prevalence of carpal tunnel syndrome (2.5 percent vs. .6 percent) and upper extremity tendinitis (12 percent vs. 5 percent). The clerical workers were more obese, smoked more, exercised less frequently, and had lower educational levels and less control of their work environment. CONCLUSIONS: Dental and dental hygiene students have a very low prevalence of upper extremity musculoskeletal disorders. A longitudinal study is necessary to evaluate ergonomic and personal risk factors.

Adult↗

PubMed2002

Upper extremity injuries in snowboarding and skiing: a comparative study.

OBJECTIVES: To determine the types and causes of upper extremity injuries sustained while snowboarding. DESIGN: A prospective survey of snowboarders with upper extremity injuries, especially fractures and dislocations. PARTICIPANTS: Between 1995 and 2000, we analyzed and interviewed 6,837 injured snowboarders and 2,175 injured skiers, and a total of 2,742 snowboarders and 361 skiers with fractures or dislocations of the upper extremities were studied. RESULTS: The ratio of upper extremity injuries to all injury types was significantly higher in snowboarders (40%, p < 0.001). Shoulder dislocations accounted for 5.5% of all injuries in skiers but 71% of all dislocations. In comparison, 6.5% of snowboarders' injuries were shoulder dislocations, representing 50% of all dislocations. It was noted that dislocation of the elbow joint was a more characteristic injury of snowboarders (30%) than of skiers (3%). The most frequently fractured site in skiers was the clavicle (32% of all fractures), and in snowboarders, it was the wrist (62% of all fractures). The most frequently affected side of the snowboarders' upper extremity was the left, with the exception of wrist fractures. With the exception of wrist fractures, the edge side that caused the accident was the opposite of the side that was injured. Most snowboarders did not have initial instruction from professional instructors (93%) and did not use protective equipment (87%). CONCLUSIONS: The results of this study indicate that the upper extremity injuries are much more common in snowboarders than skiers. In particular, upper extremity fractures in snowboarders are three times more common than in skiers. Furthermore, in snowboarding, wrist fractures have a different underlying cause compared with other upper extremity injuries.

Adolescent↗

PubMed1998

Upper extremity arterial disease: etiologic considerations and differential diagnosis.

Upper extremity ischemia is an unusual clinical entity. Using a careful history and physical examination, detailed vascular laboratory testing, serological tests, and occasionally arteriography, it is possible to determine the cause in most patients. Most patients presenting with upper extremity ischemia have small vessel disease that is not amenable to surgical treatment. The primary treatment of upper extremity ischemia remains cold avoidance, with pharmacological treatment added in a limited number of patients. A patient's long-term prognosis can be determined based on initial serological studies and the presence or absence of arterial obstruction. Patients with no serological or arterial abnormalities usually continue to have upper extremity ischemic symptoms, but these remain only a nuisance. Patients with either serological abnormalities or arterial obstruction have a mild to moderate risk of progressive symptoms. Those patients with combined serological abnormalities and arterial obstruction at presentation are most likely to have continued difficulties. A significant number of these patients, approximately 50%, are most symptomatic at the time of initial presentation and improve under follow-up.

Angiography↗

PubMed2006

What is known about temperature and complaints in the upper extremity? A systematic review in the VDU work environment.

UNLABELLED: Upper extremity musculoskeletal complaints and disorders are frequently reported among visual display units (VDU) workers. These complaints include cold forearms, hands or fingers. OBJECTIVE: The aim of this systematic review was to gain an insight into the relationship between objective and subjective temperature decrease and musculoskeletal disorders (MSDs) in the upper extremity in a VDU work environment by (internal or external) cooling of the arm and hand. Two questions were formulated: (1) Is a VDU work environment (temperature between 15 and 25 degrees C) associated with temperature decrease of the arm, hand or fingers in healthy subjects? (2) Is there a difference in arm, hand and finger temperature between patients with upper extremity MSDs and healthy subjects in a VDU work environment? METHODS: Through a systematic literature search in six databases between 1989 and October 2005, 327 articles were retrieved and 17 included. RESULTS: Forearm, hand and finger temperature significantly decreases when the ambient temperature (between 15 and 25 degrees C) decreases. The skin temperature in the hand that uses a computer mouse is lower than the other hand in the same ambient temperature. At baseline, no objective temperature differences are found between patient groups and controls, whereas in patients with cold hand complaints, lower skin temperatures are found compared to controls. The association between temperature (changes) in the forearm, hand or fingers during VDU work, and MSDs in the upper extremity is not clear. CONCLUSION: There is no consistent evidence available for the association between upper extremity MSDs and temperature changes in forearm, hand or fingers in an office work environment.

Computer Terminals↗

PubMed2000

Mycobacterial infection of the upper extremities.

BACKGROUND AND PURPOSE: Mycobacterial infection of the upper extremities is extremely rare. To make an early accurate diagnosis is often difficult, and the treatment is, therefore, frequently delayed in clinical practice. This paper describes the diagnosis and treatment of mycoabacterial infection of the upper extremities in a series of patients treated at National Taiwan University Hospital. METHODS: The medical records of 15 patients with mycobacterial infection of the upper extremities treated between 1985 and 1998 were retrospectively analyzed. The diagnosis of mycobacterial infection was established by positive culture results, the presence of acid-fast bacilli, or characteristic histopathologic findings. RESULTS: Mycobacterial infection was suspected on initial examination in only two patients. The duration between the onset of symptoms and correct diagnosis averaged 37.5 months (range, 3 wk to 209 mo). The involved sites of mycobacterial infection included the wrist in nine patients, the elbow in two, the hand in two, the humerus in two, the forearm in one, and the shoulder in one. Three patients suffered from multifocal musculoskeletal mycobacterial infection. Microbiologic studies identified Mycobacterium tuberculosis in four patients and nontuberculous mycobacteria (NTM) in four. Characteristic histopathologic findings of mycobacterial infection including caseation, granulomatous inflammation, eosinophilic epithelioid cells, Langhan's giant cells, and lymphocytic aggregates were noted in all 15 patients. All patients received chemotherapy and 14 patients underwent surgical treatment. The mean duration of follow-up was 46 months (range, 15-97 months). Treatment failed in two of the patients with multifocal NTM infection and in one patient whose mycobacterial infection was identified by histopathology. CONCLUSIONS: Mycobacterial infection should be included in the differential diagnosis of infection of the upper extremities. Treatment failures are more frequent in patients with multifocal NTM infection.

Adolescent↗

PubMed2004

Physical demands and injuries to the upper extremity associated with the space program.

Hand and upper-extremity overuse and repetitive injuries in astronauts have been and continue to be a common problem in the space program. The demands on upper-extremity use in the astronaut training program, the zero-gravity environment, the extreme temperature conditions of space, the effects of space travel on human physiology/anatomy, and the constraints and pressures of space suits and gloves all can negatively impact upper-extremity function in ways that can result in overuse/repetitive injuries. Future plans for space exploration include endeavors that will continue and even increase the demands on the hand and upper extremity.

Astronauts↗

PubMed1996

Rehabilitation of the painful upper extremity.

Therapy for the painful upper extremity is a challenge. This article focuses on various assessment tools and techniques that are reflective of the painful status. The author reviews several research articles that discuss validating treatment options and outlines rehabilitation for the painful upper extremity as it relates to peripheral nerve irritation and compression.

Arm↗

PubMed2005

Erysipelas of the upper extremity following locoregional therapy for breast cancer.

Cellulitis is a well-known complication of lymphedema of the lower extremities. Erysipelas of the upper extremity complicating breast cancer therapy has never been reported in the English-language literature. We describe seven breast cancer patients with erysipelas of the upper extremity. Five had a predisposing injury to the extremity. All patients responded very well to intravenous antibiotics without any sequelae. They had rapid resolution with typical desquamation. No long-term sequelae were seen except for mild increase of lymphedema. Erysipelas should be listed as a rare complication after locoregional therapy for breast cancer. Intravenous penicillin should be used as the initial therapy. Prevention of arm lymphedema and avoidance of any trauma to the arm are important prophylactic measures. Sentinel lymph node biopsy reduces the rate of axillary lymph node dissection and thus should reduce the incidence of lymphedema and erysipelas.

Adult↗

PubMed1997

Risk factors for deep venous thrombosis of the upper extremities.

BACKGROUND: Hypercoagulable states and triggering factors (surgery, trauma, immobilization, pregnancy, and use of oral contraceptives) are associated with an increased risk for deep venous thrombosis of the lower extremities. In contrast, risk factors for deep venous thrombosis of the upper extremities have not been identified. OBJECTIVE: To evaluate the prevalence of hypercoagulable states and triggering factors in patients with primary deep venous thrombosis of the upper extremities. DESIGN: Frequency-matched case-control study. SETTING: Hemophilia and thrombosis center at a university hospital. PATIENTS: 36 patients who had primary deep venous thrombosis of the upper extremities, 121 patients who had primary deep venous thrombosis of the lower extremities, and 108 healthy controls. Patients who had deep venous thrombosis of the lower extremities and study controls were frequency-matched by age, sex, geographic origin, and social status with patients who had deep venous thrombosis of the upper extremities. MEASUREMENTS: Resistance to activated protein C was evaluated by a clotting method based on the activated partial thromboplastin time. If test results were abnormal or borderline, DNA analysis for substitution in coagulation factor V gene was done. Antithrombin, protein C, protein S, antiphospholipid antibodies, and total plasma homocysteine levels were also measured. RESULTS: Prevalences of abnormalities of the natural anticoagulant system (9%) and hyperhomocysteinemia (6%) in patients who had deep venous thrombosis of the upper extremities were similar to prevalences of both factors in controls (6% and 7%, respectively) but lower than in patients who had deep venous thrombosis of the lower extremities (31% and 14%, respectively). Antiphospholipid antibodies were found only in patients who had venous thrombosis of the lower extremities (7%). The overall prevalence of hypercoagulable states in patients who had thrombosis of the upper extremities (15%) was similar to that in controls (12%) but was significantly lower than that in patients who had thrombosis of the lower extremities (56%). A recent history of strenuous exercise of muscles in the affected extremity was the most frequent triggering factor for patients who had deep venous thrombosis in the upper extremities (33%). CONCLUSIONS: This preliminary study indicates that the prevalence of hypercoagulable states is low in patients who have primary deep venous thrombosis of the upper extremities.

Adult↗

PubMed2001

Primary and secondary microvascular reconstruction of the upper extremity.

Tissue defects of the upper extremity may result from trauma, tumor resection, infection, and congenital malformation. Restoration of anatomy and functional integrity may require microsurgical free flap transfer for coverage of bones, nerves, blood vessels, or tendons. Microsurgical tissue transfer also may be required prior to secondary reconstruction, such as tendon transfers or nerve or bone grafts. This article addresses indications for upper extremity reconstruction using microsurgical tissue transfer flap selection and strategies including primary and secondary reconstruction.

Amputation, Traumatic↗

PubMed1987

Aneurysms of the upper extremity.

Thirty aneurysms in the upper extremity in 28 patients over the last 10 years are reviewed. Analysis showed that false aneurysms develop from penetrating trauma, while true aneurysms tend to arise in parts of the arterial tree exposed to blunt trauma. Penetrating injury to vessels should be thoroughly explored and repaired. Arterial aneurysm should be included in the differential diagnosis of masses in the upper extremity, especially after trauma. Three-phase radionuclide scanning is a useful tool for evaluating lesions of the distal arterial tree. When an aneurysm is suspected, early treatment is advised. Treatment options of resection and ligation versus reconstitution of vessel flow should be based on preoperative and intraoperative evaluation of circulatory status.

Aneurysm↗

PubMed1996

A complicated variation of the upper extremity vascularisation.

In the right upper extremity of a cadaver, the radial artery originated from the medial side of the brachial artery at a higher level than usual, which was 16.7 cm below the coracoid process. Then, this artery crossed over the brachial artery, passed to its lateral side and ran to the forearm in front of the aponeurosis of the biceps brachii muscle. The brachial artery ended 1 cm distal to the elbow joint by dividing into the ulnar, anterior interosseous and posterior interosseous arteries. The common interosseous artery was absent. As the radial and ulnar arteries may be used as microvascular donor or recipient vessels, a good knowledge of the arterial vascularisation of the upper extremity is essential in planning surgical and reconstructive procedures in this area. Secondly, the course of the radial artery in our cadaver may be mistaken for a vein and an intravenous injection in such an artery can result in the loss of the hand or forearm.

Arm↗

PubMed1993

Outcome following blunt vascular trauma of the upper extremity.

Blunt trauma to the upper extremity may cause extensive vascular damage in addition to severe musculoskeletal injury. Over a 5.5-year period, 17 patients with a total of 23 arterial injuries were treated. Diagnosis was made in 16 patients before surgery by physical and Doppler ultrasonographic examination. Angiography performed in ten patients assessed the extent of injury. Associated orthopedic injuries were present in 11 patients and neurologic injury in 16. At surgery, 21 of 23 arterial repairs required autologous vein. The initial limb salvage rate was 76%. Four patients underwent above-elbow amputation because of progressive sepsis and myonecrosis. A fifth underwent delayed amputation at 7 months due to loss of limb function. Neurologic impairment was the major long-term morbidity. The data show that outcome following blunt vascular trauma of the upper extremity is governed by the associated injuries.

Adolescent↗

PubMed1976

Upper and lower motor neuron lesions in the upper extremity muscles of tetraplegics.

Paralysed upper extremity muscles of 24 tetraplegic patients were examined to determine whether their lower motor neuron was intact. Primary emphasis was placed on the forearm finger flexor muscles (Flexor Digitorum Superficialis and Flexor Digitorum Profundus) and finger extensor muscles (Extensor Digitorum Communis and Extensor Indicis). It was found that the vast majority of these muscles in C4, C5 and C6 subjects retained some or all of their lower motor neurons intact. In C5 subjects, examination was performed on additional muscles that were potentially most useful in an orthosis utilising functional stimulation. Similar to the results of the finger flexor and extensor muscles, the muscles of the wrist and thumb generally had the lower motor neuron at least partially intact. A muscle that often was an exception was M. Flexor Carpi Radialis. These studies indicate that most of the forearm muscles of the upper extremity in high level spinal cord injury patients which are paralysed have the lower motor neuron totally or partially intact. With electrically induced exercise, such muscles are strengthened to functional levels of contraction. Subsequent electrical activation enables the quadriplegic patients to use the muscle functionally.

Adolescent↗

PubMed2001

Muscle learning therapy--efficacy of a biofeedback based protocol in treating work-related upper extremity disorders.

Work-related upper extremity disorders (WRUEDs) continue to present significant treatment and financial challenges to providers, employers, and insurers. This retrospective study reviews outcomes for 309 subjects who, between 1995 and 1999, were referred through the workers' compensation system for treatment of computer keyboard- and mouse-related WRUED injuries. The mean length of time from the recorded date of injury to the date of intake was 12.9 months. Subjects were offered a 12-visit course in muscle learning therapy (MLT). MLT is an operant conditioning program which uses surface electromyography (sEMG) to train injured workers to control their muscles during work activities. Patient response to therapy was obtained by a therapist-administered questionnaire during Visit 8 of 12. A group of 309 subjects, who had failed to respond to a previous course of therapy (typically physical therapy), reported significant improvements of pain in the neck, thorax, and upper extremities. Ninety six percent reported that they felt "more in control," 86% reported feeling "better overall," and 81% reported either "working the same and feeling better" or "working and accomplishing more." This study provides preliminary support for this approach and provides justification for controlled clinical trials in the future.

Adult↗

PubMedDate not supplied

Monitoring peripheral nerve function during external fixation of upper extremities.

Limb lengthening of the upper extremity using external fixation devices is associated with a high risk of neurovascular impairment. To aid early detection of nerve injury, intraoperative monitoring of neural function was performed in five patients undergoing Ilizarov-type circular external-fixator application. The apparatus was applied to the humerus in two cases and to the forearm in the other three cases. The function of ulnar, median, and radial nerves was assessed continuously throughout the surgery by using sensory-evoked potential (SEP) monitoring technique. The responses were elicited by stimulation of these nerves in the distal forearm with recording at Erb's point and over the anterior cervical spine. During apparatus application, radial-response attenuation was identified in two instances. No corrective actions were performed in one case, and the patient had symptoms of radial nerve deficit postoperatively. In the other case, prompt removal of the offending half-pin after the detection of electrophysiologic abnormalities resulted in subsequent response restoration and the avoidance of postoperative nerve dysfunction. Sensory-evoked potential monitoring proved to be a reliable indicator of nerve compromise during external fixation of upper extremities and may be considered a valuable surgical adjunct.

Adolescent↗

PubMed1999

Videotapes in evaluating work-related upper extremity symptoms.

Thirteen patients with upper extremity symptoms that were claimed to have occurred in the course of employment were evaluated to determine the role of videotapes in their evaluation and management. Videotapes were of two types: work demonstration by patient or coworker (8 tapes) and surveillance tapes obtained by a private investigator (5 tapes). Four of eight work station videotapes demonstrated significant repetitive motion that could have contributed to their symptoms. Four of eight work station videotapes demonstrated that the tasks were neither forceful nor repetitive in nature. Return to work recommendations were made based on both clinical grounds and job site information provided on tape. After viewing five surveillance videotapes, two fraudulent claims were settled soon after medical opinions were rendered. Two patients were declared able to return to work; one returned to work and the other was dismissed. The videotape of patient No. 13 was not crucial for the decision and he was authorized to have surgery. The opinions formed concerning the causality of alleged claims of injury were often altered by viewing the content of the videotapes. Videotapes are a valuable tool and useful adjunct in the overall management of the workers with upper extremity symptoms.

Adult↗

PubMed2004

A review of upper extremity fasciotomies in a level I trauma center.

The purpose of this study was to review recent experience with upper extremity fasciotomy. This study is a retrospective review of injured patients undergoing fasciotomy in the upper extremity at an urban trauma center. Mechanisms of injury, indications for and timing of fasciotomy, role of compartment pressures, techniques of closure, amputation rate, and patient outcomes were collected. Over a 3-year period, 201 fasciotomies were performed in the extremities of 157 injured patients, including 37 in the upper extremities of 27 patients. The mechanisms of injury were penetrating trauma in 13 patients (10 GSW, three SW), blunt or crush in 9, and burns (4 electric, 1 flame) in 5. Vascular injuries and fractures were present in 15 (56%) and 9 (33%) patients, respectively. The decision to perform a fasciotomy was a clinical one in 21 patients (75%), and only 6 patients had compartment pressures measured (range, 40-87 mm Hg; mean, 52). Upper extremity fasciotomy was performed at a first operation in 24 patients, whereas only 3 patients had a delayed fasciotomy from 6 to 48 hours after injury. Two patients died on the first hospital day, and 5 others had an amputation of an upper extremity at a mean of 8 days (range 2 to 26) after injury; however, no amputation was due to the failure to perform a timely fasciotomy. In the remaining 20 patients, closure of the fasciotomy site was performed at a mean of 9 days (range, 2 to 22) after injury, most commonly by split thickness skin grafting. Hospital stay was a mean of 20 days (range, 7-35). We conclude that 1) upper extremity fasciotomy accounts for less than 20 per cent of all fasciotomies performed; 2) a clinical decision is the most common reason for performing upper extremity fasciotomy, and only 11 per cent of patients underwent a delayed fasciotomy in this review; 3) the need for upper extremity fasciotomy is associated with a length of stay longer than expected for overall injury severity.

Adult↗