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PubMed2005

Reliability and validity of the upper-extremity Motor Activity Log-14 for measuring real-world arm use.

BACKGROUND AND PURPOSE: In research on Constraint-Induced Movement (CI) therapy, a structured interview, the Motor Activity Log (MAL), is used to assess how stroke survivors use their more-impaired arm outside the laboratory. This article examines the psychometrics of the 14-item version of this instrument in 2 chronic stroke samples with mild-to-moderate upper-extremity hemiparesis. METHODS: Participants (n=41) in the first study completed MALs before and after CI therapy or a placebo control procedure. In addition, caregivers independently completed a MAL on the participants. Participants (n=27) in the second study completed MALs and wore accelerometers that monitored their arm movements for 3 days outside the laboratory before and after an automated form of CI therapy. RESULTS: Validity of the participant MAL Quality of Movement (QOM) scale was supported. Correlations between pretreatment-to-posttreatment change scores on the participant QOM scale and caregiver MAL QOM scale, caregiver MAL amount of use (AOU) scale, and accelerometer recordings were 0.70, 0.73, and 0.91 (P<0.01), respectively. Internal consistency (alpha>0.81), test-retest reliability (r>0.91), stability, and responsiveness (ratio>3) of the participant QOM scale were also supported. The participant AOU and caregiver QOM and AOU scales were internally consistent, stable, and sensitive, but were not reliable. CONCLUSIONS: The participant MAL QOM scale can be used exclusively to reliably and validly measure real-world, upper-extremity rehabilitation outcome and functional status in chronic stroke patients with mild-to-moderate hemiparesis.

Activities of Daily Living↗
PubMed2003

Identifying barriers to recovery from work related upper extremity disorders: use of a collaborative problem solving technique.

Improving health and work outcomes for individuals with work related upper extremity disorders (WRUEDs) may require a broad assessment of potential return to work barriers by engaging workers in collaborative problem solving. In this study, half of all nurse case managers from a large workers' compensation system were randomly selected and invited to participate in a randomized, controlled trial of an integrated case management (ICM) approach for WRUEDs. The focus of ICM was problem solving skills training and workplace accommodation. Volunteer nurses attended a 2 day ICM training workshop including instruction in a 6 step process to engage clients in problem solving to overcome barriers to recovery. A chart review of WRUED case management reports (n = 70) during the following 2 years was conducted to extract case managers' reports of barriers to recovery and return to work. Case managers documented from 0 to 21 barriers per case (M = 6.24, SD = 4.02) within 5 domains: signs and symptoms (36%), work environment (27%), medical care (13%), functional limitations (12%), and coping (12%). Compared with case managers who did not receive the training (n = 67), workshop participants identified more barriers related to signs and symptoms, work environment, functional limitations, and coping (p < .05), but not to medical care. Problem solving skills training may help focus case management services on the most salient recovery factors affecting return to work.

Cooperative Behavior↗
PubMed2003

Upper extremity peripheral venous pressure measurements accurately reflect pulmonary artery pressures in patients with cavopulmonary or Fontan connections.

After the bidirectional cavopulmonary or Fontan operation, the physiologic consequence is passive flow of the systemic venous return to the pulmonary arteries. Knowledge of pulmonary artery pressure (PA) is valuable in the management of these patients, and obtaining this information without the need for a central line or cardiac catheterization would be advantageous. The aim of this study was to evaluate the correlation between upper extremity peripheral venous (PV) pressures and PA or superior vena cava (SVC) pressures in patients who have undergone cavopulmonary or Fontan connections. During cardiac catheterization, 19 patients with complex cyanotic heart disease who had undergone a cavopulmonary shunt or Fontan procedure were studied. Simultaneous pressure measurements were obtained from the peripheral intravenous line placed prior to the procedure and the SVC or PA. The mean pressures were compared. The mean PV pressure was 17.5 +/- 5.6 mmHg. The mean SVC or PA pressure was 16.1 +/- 5.4 mmHg. The mean difference was 1.5 +/- 1.5 mmHg ( p < 0.001). The correlation coefficient PV to SVC or PA pressure was 0.97 ( p < 0.001). PV pressure measurements taken from an upper extremity accurately reflect PA pressures in patients who have undergone a cavopulmonary shunt or Fontan procedure.

Adolescent↗
PubMedDate not supplied

Workplace risk factors and occupational musculoskeletal disorders, Part 2: A review of biomechanical and psychophysical research on risk factors associated with upper extremity disorders.

Injuries and disorders caused by overexertion and repetitive motion are the leading causes of compensable lost-time cases in the United States. Epidemiological and laboratory-based research methods have been used to evaluate the significance of various risk factors associated with overuse injuries and disorders. The National Institute for Occupational Safety and Health performed a comprehensive review of over 600 epidemiological studies in 1997 and concluded that there was evidence of a causal relationship between workplace exposures to forceful exertions, repetition, awkward posture, and vibration and disorders of the neck, shoulder, and upper extremities. Although epidemiological studies provide important insights to understanding the causes of work-related overuse disorders, they are sometimes criticized for their inability to measure precisely how people respond to specific risk factors found in the workplace. This article presents a review of recent laboratory studies and biomechanical models of work factors believed to be associated with increased risk of upper extremity injuries and disorders. Biomechanical models and laboratory studies do not replace epidemiological studies. However, these approaches provide important complementary information that is needed to understand the complex process of how exposures to physical risk factors result in strain that may ultimately lead to injury or disease. These studies also provide important insights as to how people react and respond to specific physical risk factors found in the workplace. Combined with epidemiological research, laboratory studies are an essential element in understanding the causes and prevention of work-related overexertion injuries.

Arm↗
PubMed1992

Replantation of the upper extremity severed at the level of the ulnar joint.

Two cases of upper extremity replantation at the level of the ulnar joint are presented. In both cases, the ulnar joint and adjacent anatomic functional structures were destroyed in accidents and excised during surgery. Some functional rehabilitation of the replanted extremities was obtained. In one case, the grasp function of the hand was recovered through primary use of the muscular apparatus of the upper arm. In another patient, the function of the lost ulnar joint was restored through microsurgical autotransplantation of the vascularized first metatarsophalangeal joint of the foot.

Accidents, Occupational↗
PubMed1983

Epitrochlear node involvement in melanoma of the upper extremity.

Between 1955 and 1979, 240 patients with melanoma of the upper extremity were admitted to the National Institutes of Health (NIH). Thirty nine of these patients (16%) had primary lesions of the forearm, hand, or digit. Twenty-two patients underwent axillary dissection during their treatment. Ten patients were subjected to both axillary and epitrochlear lymph node dissection. Nine of these ten patients had lymph node metastases; two in the axillary nodes only, two in the epitrochlear nodes only, and five in both nodal groups. Epitrochlear node involvement occurred in 18% of patients with forearm or hand lesions, and only when the primary melanoma was within 5 cm of the elbow or in the ulnar distribution, the classically described drainage area of the epitrochlear nodes. The prognosis of the patients in this study was related to the depth of their primary lesions and the presence or absence of axillary node involvement. However, since approximately 18% of patients with melanomas of the hand, forearm and elbow area have a high probability of recurrence in the epitrochlear nodes, close attention to this area and early dissection of clinically suspicious nodes can favorably affect locoregional control in this group of melanoma patients.

Adult↗
PubMed1981

Malignant melanoma of the upper extremities.

There were 487 patients treated for malignant melanoma of the upper extremities at the Pack Medical Group in New York City between 1939 and 1967 inclusive, fourth in frequency (14.7%) of total malignant melanomas treated here, being exceeded by malignant melanoma of the trunk (34%), head and neck (23%), and the lower extremities (20%). A 10-year survival rate of 342 determinate patients was 63%. Fourteen percent of the patients who died of melanoma died between the fifth and tenth years, indicating the need to report survival at the 10-year span. Survival was equal for the sexes (61% male and 64% female). The majority of the patients had infiltrating melanomas (Clark's Level 4 and 5) with a survival rate of 62%. Ten patients with superficial spreading melanomas (Clark's Level 2 and 3) and juvenile melanomas enjoyed a 100% 10-year survival. The worst prognosis was for six patients with amelanotic melanoma in that only two of ten survived ten years or longer. The question of elective axillary dissection remains elusive. In 106 patients classified as clinical Stage I, elective axillary dissection was performed in 55 instances, and 26 patients had microscopic evidence of metastases. Their 10-year survival rate was 65%, slightly higher than 16 patients in whom no elective axillary dissection was performed, among whom six later developed evidence of metastases, underwent therapeutic node dissections, and had a 10-year survival of 56%. Radical amputation is occasionally indicated with great palliation and often prolongation of life.

Adolescent↗
PubMed1983

Management of acute ischemia of the upper extremity.

Records of 76 patients who presented with ischemia of the upper extremity from 1966 to 1981 were reviewed. Patients were divided into three groups according to cause: Group 1, emboli from the artery; Group 2, ischemia after catheter injury; and Group 3, ischemia due to lesions of the axillary and subclavian arteries. Management varied among the three groups. Long-term anticoagulation therapy was helpful in Group 1 patients in preventing reembolization. Forty percent of patients with catheter-related trauma required angioplasty of some sort in addition to embolectomy. Management of Group 3 patients was most difficult and the results least acceptable (three patients required amputation). Management of this type of ischemia must be individualized; it should vary according to the underlying disorder.

Acute Disease↗
PubMed1986

Ischemia of the upper extremity: significance of proximal arterial disease.

Thirty-four patients had upper extremity ischemia due to proximal arterial disease, including subclavian compression at the thoracic outlet, innominate or subclavian atherosclerosis, and other causes. Nineteen lesions caused distal embolization. Although successful arterial reconstructions were performed in all but one patient, there were five major amputations. Four were associated with a delay in diagnosis, which allowed the formation of repeated distal emboli. Since overlooked proximal brachiocephalic arterial lesions can produce devastating consequences, we believe these vessels should be examined in all cases of hand and arm ischemia.

Adolescent↗
PubMed1988

Emergency free flaps to the upper extremity.

Thirty-one emergency free flaps were applied to the upper extremities of patients who ranged in age from 16 to 57 years. The size of the skin defects ranged from 13 to 540 square centimeters, with an average of 145 square centimeters. A variety of flaps were used, including 14 lateral arm, seven groin, five latissimus, three first web space of the foot, one scapular and one medial arm. In patients with small defects, the operative time ranged from 3 to 9 hours, with an average of 4 hours and 54 minutes. The hospital stay was never longer than 4 days. In patients with medium size defects, the operating time ranged from 3 to 18 hours, with an average of 7 hours and 45 minutes. The hospital stay averaged 7.4 days. In large defects in which extensive reconstruction was undertaken before flap application, the operative time ranged from 3 to 20 hours, with an average of 11 hours and 54 minutes. The average hospital stay was 11.8 days. Twenty-nine of the 31 flaps survived in their entirety (93.5%). In one of the successful flaps (3.2%), exploration was required after the patient left the operating room. Severe infection occurred in only one case, that being one of the two flap failures. Twenty-seven of the 31 patients returned to work, 18 of them to their original employment.

Adolescent↗
PubMed1980

Upper extremity gangrene: a complication of subclavian artery division.

Gangrene of the upper extremity is a rare complication following subclavian artery ligation. Two case reports from the 23-year experience at the Hospital for Sick Children are presented. If gangrene is to be eliminated in such cases, early recognition of inadequate limb perfusion is mandatory. A suspicion of inadequate perfusion justifies heparin therapy, and prompt revascularization and fasciotomy must be considered.

Aortic Coarctation↗
PubMed1999

Lymphatic mapping for melanomas of the upper extremity.

Over a period of 4 years, 127 consecutive patients with upper extremity melanomas were identified from a prospectively accrued database. A protocol consisting of preoperative lymphoscintigraphy and intraoperative lymphatic mapping and with a vital blue dye and radiocolloid was used; the protocol had a 98% success rate of identifying the sentinel lymph node (SLN). Preoperative lymphoscintigraphy identified unpredictable cutaneous lymphatic flow in 15 (12%) of the patients. These discordant areas would not have been included in classic regional node dissection and possible sites of metastatic disease would not have been identified. Metastatic disease was identified within the SLNs in 12 (9%) of the patients. Of the 12 patients with a positive SLN, 2 (17%) were found on complete node dissection to have metastatic disease in higher nodes in the regional basin. The SLN was the only site of disease in 10 of these 12 patients with documented metastases in the regional basin. Patients with a negative SLN biopsy can be spared the morbidity and expense of a complete lymph node dissection.

Arm↗
PubMed1993

Dissociated motor loss in the upper extremities. Clinical features and pathophysiology.

Dissociated motor loss occurring in the upper extremities with and without lower extremity myelopathy was evaluated in patients with cervical spondylosis. The presence of dissociated motor loss without attendant myelopathy was correlated with selected compression of the anterior nerve root in the lateral spinal canal, close to the intervertebral foramen. The clinical and radiologic feature differentiating these two dissociative syndromes were reviewed.

Arm↗
PubMed1999

Outcomes comparison of treatment for chronic disabling work-related upper-extremity disorders and spinal disorders.

Since 1986, the percentage of upper-extremity musculoskeletal disorders (UEMSDs) has increased from 1% to 4% of all occupational injury claims, while the average total medical and compensation cost is 80% higher than the average of all other claims. Because chronic disability leads to the highest cost, systematic evaluation of this growing occupational condition is needed. We performed a prospective case-series cohort study of patients (n = 163) with UEMSDs, compared with a matched group of spinal disorder (SD) patients (n = 163) treated with the same protocol. UEMSD patients were subclassified as those with one or more neuropathic diagnoses or those with non-neuropathic diagnoses. The neuropathic UEMSD subgroup had the poorest outcomes, with significantly higher surgery rates, higher health care utilization rates, and lower work retention when compared with the SD group. Rehabilitation outcomes for UEMSDs are similar to those for SDs. However, neuropathic-diagnosis patients are at risk for high-cost injuries and/or poorer prognoses.

Adult↗
PubMed2002

[Symptomatological and electrophysiological study on cold paresis in juvenile muscular atrophy of distal upper extremity (Hirayama's disease)].

Patients with juvenile muscular atrophy of distal upper extremity (Hirayama's disease) often show marked weakness of the fingers occurring with exposure to cold. We term this phenomenon cold paresis. We conducted an original test to induce cold paresis (Cold Paresis Inducement Test) in 11 patients of this disease and 10 normal controls. Cold paresis was induced in 9 of 11 patients, but was not induced in the 2 patients who had the disease longer than 20 years and in all normal controls. We examined the electromyogram of abductor digiti minimi during 5 Hz and 20 Hz rate of ulnar nerve stimulation at cooling. The patients in whom cold paresis was induced exhibited a waning of amplitude of compound muscle action potential (M wave) during 20 Hz stimulation. This waning was aggravated by intravenous administration of anticholinesterase (edrohponium). We found a remarkable conduction delay of M waveform at the waning by means of waveform analysis. These results suggest that cold paresis may be caused by a conduction block of the muscle fiber membrane in re-innervating muscles after active denervation.

Adolescent↗
PubMedDate not supplied

Soft tissue disorders of the upper extremities.

The incidence of occupationally induced cumulative trauma disorders of the upper extremities appears to be in the rise in the United States. Such disorders account for a significant amount of human suffering, loss of productivity and economic burden. The author defines the problem and its etiology, reviews appropriate screening procedures and the diagnosis, summarizes treatment approaches, and concludes with a discussion of preventative measures that should be considered.

Arm Injuries↗
PubMed1988

Surgical reconstruction of the upper extremity in cerebral palsy.

This article discusses surgical treatment of the upper extremity in cerebral palsy. Such treatment should provide a balanced grasp and release, a reasonable range of pronation and supination of the forearm, and should maintain sufficient strength for hand function.

Arm↗