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PubMedDate not supplied

Feasibility of distractive auditory stimuli on upper extremity training in persons with chronic obstructive pulmonary disease.

OBJECTIVE: To determine the feasibility of distractive auditory stimuli (DAS) used during an upper extremity training (UET) program on perceived dyspnea, functional performance, and health-related quality of life. In addition, to determine the appropriate music tempo used during the UET. DESIGN: Experimental, randomized, 3-group design with testing at baseline and 4 weeks. SETTING: Outpatient. PATIENTS: Thirty patients (13 male and 17 female) with moderate to severe chronic obstructive pulmonary disease (FEV1 41.27% +/- 18% predicted). INTERVENTION: Moderate DAS group (n = 10) and slow DAS group (n = 10) subjects were instructed to perform UET for up to 15 minutes 3 to 5 times a week using DAS (walkman, audiocassettes). The control group (n = 10) received the same instructions, but no DAS. MEASURES AND RESULTS: Primary outcome measures were perceived dyspnea, functional performance using the 6-minute peg and ring board (6MRPB) count and health-related quality of life. In addition, all subjects recorded the time of UET performance using self-report (daily logs). A significant increase was seen in 6MRPB count (P = .002) between groups. Moderate DAS subjects increased 6MPRB count 46 +/- 21 rings and slow DAS subjects increased 46 +/- 20 rings from baseline to 4 weeks whereas control subjects increased only 5 +/- 4 rings. No significant differences were noted for the remaining variables. CONCLUSION: Subjects who used DAS (music) while performing UET improved functional performance whereas controls failed to continue improvement. The DAS is a feasible adjunct to UET that may have the potential to augment the effectiveness of pulmonary rehabilitation training.

Acoustic Stimulation↗
PubMed2005

Imaging findings of Kimura's disease in the soft tissue of the upper extremity.

OBJECTIVE: The objective of our study was to describe the imaging findings of Kimura's disease in the soft tissue of the upper extremity. CONCLUSION: Kimura's disease should be considered as a possible diagnosis when a partially or poorly defined subcutaneous mass of high signal intensity on T1- and T2-weighted images with homogeneous enhancement, surrounding subcutaneous edema, and internal flow voids is seen in the medial epitrochlear region in an Asian person, especially if accompanied by peripheral eosinophilia.

Adolescent↗
PubMed1996

Common upper-extremity injuries.

In the daily practice of family medicine, injuries to the upper extremity are frequently encountered. Most of these injuries can by easily treated by the primary care physician who has an understanding of the joint anatomy and treatment principles. Some injuries, however, may appear relatively minor, yet require prompt referral for surgical care. We reviewed the pathoanatomy, historical and physical examination findings, and treatment of the more common injuries to the hand, wrist, elbow, and shoulder.

Arm Injuries↗
PubMed1998

Psychosocial aspects of upper extremity lymphedema in women treated for breast carcinoma.

BACKGROUND: Lymphedema of the upper extremity following breast carcinoma is highly distressing and disabling. METHODS: A review is presented of the literature on psychosocial aspects of lymphedema. RESULTS: Studies have shown that women who develop lymphedema exhibit higher levels of psychological, social, sexual, and functional morbidity than women with breast carcinoma who do not develop this complication. Women who have poor social support, pain, lymphedema in the dominant hand, and/or a passive and avoidant coping style report the highest levels of disability. CONCLUSIONS: Due to the morbidity of lymphedema once it develops, prevention and information given early are extremely important. However, the recommendations made to women sometimes involve considerable changes in lifestyle but are not based on solid, prospective evidence. In addition, how to best impart and time information about lymphedema pre- and postoperatively require investigation. In this paper, the authors discuss the psychological and functional impact of lymphedema and strategies for intervention and research to help women prevent the condition or enhance coping with it once it develops.

Adaptation, Psychological↗
PubMed1989

Results of primary nerve repair in the upper extremity.

The results of primary repair of peripheral nerve injury in the upper extremity are reported for 143 nerves in 120 patients, with a mean follow-up of 24 months. Normal values for static and moving two-point discrimination were established and related to the person's age. Sensory reeducation was employed routinely in the postoperative rehabilitation program. Moving two-point discrimination recovered to a better level in 61%, the same level in 38%, and a worse level in 1% than static two-point discrimination after nerve repair. Results for digital, median, ulnar, and radial nerve repairs are reported.

Adolescent↗
PubMed2005

Atypical Mycobacterium infections of the upper extremity.

BACKGROUND: We encountered five patients with atypical Mycobacterium infections in the upper extremity, and examined their outcomes. PATIENTS AND METHODS: Two patients were male and three were female. The average patient age was 67 (range, 63-75) years. A wide synovectomy was performed to diagnose all cases followed by a therapeutic regimen of Rifampicin, Isoniazid, and Ethambutol. RESULTS: The causative atypical organism was Mycobacterium marinum in three cases and Mycobacterium intracellulare in two cases. In one patient, inflammation recurred or did not disappear, and, therefore, three debridements were necessary. The average duration of antimicrobial therapy was 12 (range, 5-24) months. The average follow-up period was 26 (range, 5-66) months, and resolution had been achieved in all cases at the time of follow-up evaluation. CONCLUSION: Surgical debridement and appropriate mycobacterial culture or PCR method are critical to enable diagnosis and appropriate management.

Aged↗
PubMed1994

Compensation in recovery of upper extremity function after stroke: the Copenhagen Stroke Study.

Compensation by the unaffected upper extremity (UE) was studied in stroke patients who were unable to use the affected UE. The main aim was to evaluate the need of teaching compensatory techniques to stroke patients during rehabilitation of UE function. The study was prospective and community based and included 636 consecutive acute stroke patients. UE function and UE paresis were assessed weekly using the Barthel Index subscores for feeding and grooming and the Scandinavian Stroke Scale (SSS) subscores for arm and hand. Rehabilitation was performed according to the Bobath technique. Initially, 214 had severe UE paresis according to SSS; the arm could not move against gravity and the fingertips could not reach palm. In 64 of the 115 patients discharged alive, the affected UE definitely remained useless despite intensive and longstanding rehabilitation. Improvement of UE function was seen in 25 of these patients (39%) and was possible only through compensation by the unaffected UE. Patients who gained UE function by compensation were younger (p < 0.01), had less severe stroke (p < 0.01), smaller (p < 0.01), and subcortically located (p = 0.02) lesions and less affection of higher cortical function (p = 0.01). Recovery of UE function in more than half of the stroke patients with initial severe UE paresis can be achieved only by compensation by the unaffected UE.

Activities of Daily Living↗
PubMed1992

Clinical characteristics of vascular leiomyoma of the upper extremity: report of 11 cases.

Clinical features of vascular leiomyoma of the upper extremity which have not been described or have been described incorrectly are documented with a report of 11 consecutive cases seen within the past 11 years. All patients were followed without recurrence or surgical morbidity. Vascular leiomyoma has been described as a painful nodule found more frequently on the extensor surfaces, but in our experience spontaneous or paroxysmal pain is exceptional and the tumour tends to be located on the volar surface when it is in the hand. In the digit, they tend to be found at the base away from the midline, and not seen distal to the DIP joint.

Adolescent↗
PubMed1993

Osteoid osteoma of the upper extremity.

Forty-six patients with histologically confirmed osteoid osteoma of the upper extremity seen from 1947 to 1990 were retrospectively reviewed. The patients' age at presentation averaged 20 years. Twenty-four of the lesions were located in the wrist and hand and 22 in the arm and forearm. The average duration of symptoms before diagnosis was 15 months. Pain was the presenting symptom in 44 of 46 patients. Of the 28 patients who took aspirin for pain, 24 obtained at least partial relief. A mass or swelling was more commonly noted in lesions of the hand and wrist as compared to the arm and forearm. The diagnosis of osteoid osteoma was made by plain x-ray films alone in 35 cases. Bone scans were performed on 13 patients; all were positive at the site of the lesion. Tomography was performed in 13 cases to identify the intraosseous location of the lesion. All lesions were treated by excision and curettage. Thirty-four of the 46 patients were followed at our institution for more than 6 months, with an average follow-up period of 27 months. Six of the patients had persistent lesions. Of the six persistent osteoid osteomas, five occurred in the wrist or hand (p = .0012). A total of 15 procedures were required to excise these lesions.

Adolescent↗
PubMed2002

Upper extremity injuries in youth sports.

This article provides an overview of common upper extremity injuries in youth sports, including injuries to the shoulder, elbow, and wrist. Pain in the shoulder and elbow is common among youngsters who participate in throwing sports, raquet sports, and swimming, while wrist pain is common among young gymnasts. Acute trauma to the shoulder and elbow can occur in almost any sporting activity. This article provides descriptions of common injuries and guidelines for treatment.

Adolescent↗
PubMed1987

Upper extremity injuries due to medications.

One hundred eleven patients were treated for upper extremity complications due to therapeutic agents. Forty-nine injuries were associated with chemotherapy and 62 with so-called "non-toxic" solutions. Twenty-five required debridement and skin coverage operations, and six required emergency fasciotomies. The most effective regimen included immediately stopping the intravenous line, elevation, avoidance of antidotes, late debridement and coverage, and early rehabilitation.

Adolescent↗
PubMed2001

Ulnar nerve excursion and strain at the elbow and wrist associated with upper extremity motion.

Significant excursion of the ulnar nerve is required for unimpeded upper extremity motion. This study evaluated the excursion necessary to accommodate common motions of daily living and associated strain on the ulnar nerve. The 2 most common sites of nerve entrapment, the cubital tunnel and the entrance of Guyon's canal, were studied. Five fresh-frozen, thawed transthoracic cadaver specimens (10 arms) were dissected and the nerve was exposed at the elbow and wrist only enough to be marked with a microsuture. Excursion was measured with a laser mounted on a Vernier caliper fixed to the bone and aligned in the direction of nerve motion. A Microstrain (Burlington, VT) DVRT strain device was applied to the nerve at both the elbow and wrist. Nerve excursion associated with motion of the shoulder, elbow, wrist, and fingers (measured by goniometer) was measured at the wrist and elbow. An average of 4.9 mm ulnar nerve excursion was required at the elbow to accommodate shoulder motion from 30 degrees to 110 degrees of abduction, and 5.1 mm was needed for elbow motion from 10 degrees to 90 degrees. When the wrist was moved from 60 degrees of extension to 65 degrees of flexion, 13.6 mm excursion of the ulnar nerve was required at the wrist. When all the motions of the wrist, fingers, elbow, and shoulder were combined, 21.9 mm of ulnar nerve excursion was required at the elbow and 23.2 mm at the wrist. Ulnar nerve strain of 15% or greater was experienced at the elbow with elbow flexion and at the wrist with wrist extension and radial deviation. Any factor that limits excursion at these sites could result in repetitive traction of the nerve and possibly play a role in the pathophysiology of cubital tunnel syndrome or ulnar neuropathy at Guyon's canal.

Cubital Tunnel Syndrome↗
PubMed2001

Clinical tools to facilitate workplace accommodation after treatment for an upper extremity disorder.

Failure to implement work site accommodations for work-related upper extremity disorders (WRUEDs) may be a factor contributing to delayed functional recovery and relapse. The present study describes the use of the 38-item Job Requirements and Physical Demands (JRPD) scale, a self-report measure of ergonomic exposure, and other case management tools to improve accommodation efforts for 101 workers (75 women, 26 men) returning to work after lost time related to a WRUED. Items were categorized into five subscales based on item content: administrative, computer-related, workstation design, environmental, and equipment. Administrative risk factors were elevated among office clerks, whereas postal clerks and letter carriers reported more workstation design risk factors, and letter carriers and electrical/mechanical workers cited more equipment-related risk factors (p < 0.05). All occupational categories rated computer-related risk factors highest. The Integrated Case Management (ICM) approach, which relies on the JRPD scale to guide recommendations, was used with a subgroup of these workers (n = 53), resulting in 1.4 times more workplace accommodations per worker than with a non-ICM approach. Clinical use of the self-reported exposure measure within the overall workplace accommodation process may have been a factor contributing to more frequent accommodation in the ICM group. This study of a subgroup of workers' compensation cases highlights the need for additional investigation of tools to integrate ergonomic approaches within the workplace accommodation process.

Arm Injuries↗
PubMed2004

Upper-extremity deep vein thrombosis: a prospective registry of 592 patients.

BACKGROUND: Upper-extremity deep vein thrombosis (UEDVT) occurs spontaneously or sometimes develops as a complication of pacemaker use, long-term use of a central venous catheter (CVC), or cancer. METHODS AND RESULTS: To improve our understanding of UEDVT, we compared the demographics, symptoms, risk factors, prophylaxis, and initial management of 324 (6%) patients with central venous catheter (CVC)-associated UEDVT, 268 (5%) patients with non-CVC-associated UEDVT, and 4796 (89%) patients with lower-extremity DVT from a prospective US multicenter DVT registry. The non-CVC-associated UEDVT patients were younger (59.2+/-18.2 versus 64.2+/-16.9 years old; P<0.0001), less often white (65% versus 73%; P<0.01), leaner (body mass index [BMI] 26.8+/-7.1 versus 28.5+/-7.3 kg/m2; P<0.001), and more likely to smoke (19% versus 13%; P=0.02) than the lower-extremity DVT patients. By way of propensity analysis and multivariable logistic regression analysis, we determined that an indwelling CVC was the strongest independent predictor of UEDVT (odds ratio [OR], 7.3; 95% confidence interval [CI], 5.8 to 9.2). An age of <67 years, a BMI of <25 kg/m2, and hospitalization were the independent predictors of non-CVC-associated UEDVT. Most (68%) UEDVT patients were evaluated while they were inpatients. Only 20% of the 378 UEDVT patients who did not have an obvious contraindication to anticoagulation received prophylaxis at the time of diagnosis. CONCLUSIONS: UEDVT risk factors differ from the conventional risk factors for lower-extremity DVT. Our findings identify deficiencies in our current understanding and the prophylaxis of UEDVT and generate hypotheses for future research efforts.

Adolescent↗
PubMed1998

[The importance of excision of the first thoracic rib and accessory cervical rib in the treatment of deep venous thrombosis of the upper extremities].

This paper presents 15 cases of deep venous thrombosis of the upper extremity as a complication of previously asymptomatic thoracic outlet syndrome. The diagnosis was based on clinical examination and phlebography. To achieve prompt recanalisation of the vein streptokinase was used. Fibrinolytic treatment was followed by surgical treatment carried out 6 to 8 weeks after resolution of acute symptoms. The surgery consisted of excision of first rib and accessory cervical rib when present through the axillary approach. In 73% of cases complete lysis of the thrombus was achieved which was confirmed by phlebography and resolution of symptoms of venous hypertension.

Acute Disease↗
PubMed1992

Upper extremity strength and function in children with spinal muscular atrophy type II.

Upper extremity strength and function in a sample of ten children with spinal atrophy type II was determined using manual muscle testing, a sphygmomanometer, and a pinchometer. Functional abilities were recorded on self-report forms. Overall strength in this sample was determined to be 35% to 40% of normal. Repeated-measures analysis of covariance revealed no change with time in proximal or distal strength. Six children were capable of at least 1/2 pound of force in pinch or gross grasp vs four children with zero force in one of these measures. Ability to produce a measurable force in pinch or gross grasp was found to be associated with independence in mobility, hand function, and ADL by Fisher exact test (p = .02). These data document the weak, but stable, muscle force present in these children and relate the strength of function.

Activities of Daily Living↗
PubMed1989

[Disorders of the cervical spine and the upper extremities and occupations].

A chronological review of damage to the spine and upper extremities associated with work was carried out in a sample of 120 retired disabled workers. Examination of risk factors for cervicobrachial syndrome (CBS) showed that the forced, bent position of the body at work contributed significantly to the frequency of the disease, particularly in women (70.0% against 38% in controls P less than 0.01). The lifting of heavy loads was also frequently observed in women with CBS (12% compared to 6% in the control group (P less than 0.05). Repeated movements during work were claimed by 52.9% of the males and 80% of the females with CBS and by only 41.4% of the males and 50% of the females without it (P less than 0.01). The heaviest load lifted by subjects with CBS at work exceeded significantly that of control subjects. It is considered that there is a causal link between excessive burden and the occurrence of CBS in women. For early diagnosis of CBS, tiredness, pain in the cervical spine, reduced strength in the hands and poor ability to endure manual work are signs to be looked for. Early recognition of disease, improved working conditions and recreation can help prevent the disease or slow down its progress.

Brachial Plexus Neuritis↗