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PubMed1978

Juvenile type of distal and segmental muscular atrophy of upper extremities.

Seventy-one cases of distal and segmental muscular atrophy of the upper extremities with juvenile onset were studied. The clinical features consisted of: juvenile onset, male preponderance, unique distribution of the muscular atrophy in the hand and forearm, tendon reflexes hypoactive in most cases but hyperactive in some, no definite sensory disturbances, no involvement of the cranial nerves, and autonomic nerve disorders in the affected region. There was rapid progression during the 2 to 3 years after onset with a slowly progressive course thereafter. There were no abnormal laboratory findings except for electrophysiological and morphological findings of the affected muscles. The site of lesion was surmised to be from the C5 to T1 spinal segments with intramedullary involvement. The cause is unknown.

Adolescent↗

PubMed1994

Microvascular reconstruction of the upper extremity with the rectus abdominis muscle.

Large soft-tissue defects of the upper extremity are difficult to reconstruct. Defects in 21 patients (15-75 years old) were treated by free tissue transfer of the rectus abdominis muscle. The defects were the result of trauma or resection of tumor and measured more than 15 x 15 cm. The muscle was transferred on the inferior epigastric pedicle and covered with a skin graft within 48 hours. All transfers were successful, and early soft-tissue healing occurred. This procedure offers the advantages of easy positioning, large donor vessels, and a highly vascular soft tissue reconstruction. The long-term functional and cosmetic results have been excellent.

Adolescent↗

PubMed1990

Maintenance of stump length of both upper extremities after severe electrical burn injury.

A patient with electrical injury to both upper extremities which necessitated amputation above the elbow on both sides is presented. Further débridement on the stumps resulted in extensive exposure of bone with little coverage by skin and granulation tissue. Adequate coverage and maintenance of the length of both stumps was possible with bilateral myocutaneous latissimus dorsi flaps. This enabled the patient to carry out various activities and to wear a prosthesis.

Adult↗

PubMed1995

Prosthetic usage in major upper extremity amputations.

Patterns of use of contemporary prostheses by 135 patients with major upper extremity amputations were evaluated by questionnaire. Eighty-four percent of the patients were male and 16% were female. Amputation levels represented were below elbow, 44%; above elbow, 40%; and shoulder disarticulations or forequarter amputations, 16%. The follow-up interval averaged 12 years (range, 1-67 years). One hundred and thirteen patients were fitted with either a myoelectric or body-powered prosthesis. The overall rejection rate was 38%. Thirty-nine of 42 in the below-elbow amputation group used the prosthesis and appeared to benefit the most. Eight of 141 in the wrist disarticulation group used the prosthesis: as did 9 of 21 in the above-elbow amputation group. In contrast, all bilateral amputees used their prostheses. Stiff shoulders and brachial plexus injury were both predictors for poor prosthetic usage.

Amputees↗

PubMed2001

Treatment of recurrent compressive neuropathy of peripheral nerves in the upper extremity with an autologous vein insulator.

The treatment of entrapment neuropathy in the upper extremity with surgical decompression has generally provided good results. Recurrence of symptoms, however, is not uncommon and its management is both challenging and difficult. Nineteen patients with recurrent carpal tunnel and cubital tunnel syndrome were treated with the vein wrapping technique using the autogenous saphenous vein. The average number of surgeries before vein wrapping was 3.3. The mean patient age was 53 years (range, 28-75 years) and the mean follow-up period was 43 months (range, 24-78 months). All patients reported reduction in pain and the sensory disturbances secondary to the compression of the median or ulnar nerve. Two-point discrimination and electrodiagnostic findings also improved.

Adult↗

PubMed1999

4.5 year follow-up after surgical correction of upper extremity deformities in spastic cerebral palsy.

Reconstructive surgery was carried out on 27 upper extremities in 24 children with deformities due to spastic cerebral palsy. Functional evaluation of the affected extremities was made preoperatively, at 6 months and at a mean of 4.5 years postoperatively using a score added to the assessment system described by the Committee on Spastic Hand Evaluation. According to the score, dysfunction of the arm was significantly reduced 6 months after the reconstructive surgery and the improvements remained essentially unchanged at the later follow-up. The addition of a score to the original assessment system facilitated the overall assessment of postoperative results.

Adolescent↗

PubMed1999

Revascularization of the upper extremity in a preterm infant: a case report and review of the literature.

Upper extremity arterial injuries in preterm infants are usually of iatrogenic origin. Current microsurgical techniques permit extremity revascularization in these patients. The authors report the microsurgical repair of a 0.7-mm brachial artery in a 940-g preterm infant. The preterm infant warrants special consideration due to physiological immaturity. Rapid fluid shifts, a relative polycythemia, and the potential for low cardiac output states increase the risk for vascular thrombosis. Systemic heparinization is contraindicated in this population due to the risk of intraventricular hemorrhage. Optimization of various physiological variables should reduce the risk of thrombosis.

Anticoagulants↗

PubMed1978

Congenital arteriovenous malformations of the upper extremity.

The embryology and the clinical management of congenital AV fistulas of the upper extremity are discussed. Early excisional surgery of asymptomatic lesions should be confined to ones of a very limited extent. Excisional surgery on extensive lesions should be limited to those which are symptomatic and have decreasing hand function. Possibly of limited effectiveness in some lesions may be the selective occlusion of vascular feeders by injecting cyanoacrylate glue through a catheter.

Adolescent↗

PubMed2003

Applications of the vascularized fibula for upper extremity reconstruction.

There are limited reconstructive options for segmental bone defects of the upper extremity larger than 6 cm in length, especially when associated with soft-tissue loss. Among the limited treatment options the osteoseptocutaneous fibular transplant is well established. The anatomy is reliable, the blood supply is constant, and the operative technique can be standardized. The advantage of including skin with the vascularized fibular transplant is twofold. First, the skin paddle can be used to augment the soft-tissue envelope. Second, the skin paddle serves as a monitor, providing an immediate, ongoing, and reliable method to monitor the blood flow to the graft. The osteoseptocutaneous fibular transplant proved to be an effective treatment of combined segmental bony and soft-tissue defects of the forearm and humerus.

Journal Article↗

PubMed1982

Angiography of upper extremity access fistulas for dialysis.

One-hundred twenty-five cases of upper extremity internal arteriovenous and graft fistulas were reviewed. Clinical problems requiring study were poor fistula flow during dialysis, difficulty in cannulation, diminished graft pulsations, extremity edema or varicosities, the appearance of pulsatile or nonpulsatile masses in the graft or fistula, and distal ischemia. Angiography demonstrated venous occlusion (13 cases), venous stenosis at or near the anastomotic site (32 cases), thrombi within shunts (9 cases), venous aneurysms or pseudoaneurysms related to either proximal obstruction or traumatic dialysis (23 cases), distal venous overdistention due to proximal obstruction or overcirculation (15 cases), and radial artery steal of blood from the distal extremity (15 cases). The causes and predisposing factors leading to the complications are presented along with a discussion of the angiographic techniques that were used.

Aneurysm↗

PubMedDate not supplied

Venous aneurysms of the upper extremity--a case report.

Venous aneurysms are a rare clinical entity, especially in upper extremities. A 35-year-old Japanese woman was diagnosed as having venous aneurysms in her left arm. The lesions were excised, and microscopic examination revealed a lack of smooth muscle, media, and elastic fibers in the aneurysmal wall, with partial hyperplasia of smooth muscle.

Adult↗

PubMed1991

Left-side dominance of upper extremity fracture in children.

In 148 children who had sustained trauma to the upper extremities from falls, fractures were twice as common on the left as on the right side. This seemed to be due to the childrens' preferential use of the left hand to parry the fall even when both hands were free and because the left arm seemed to be more easily broken than the right arm during trauma.

Adolescent↗

PubMedDate not supplied

[Cervical collar therapy for juvenile muscular atrophy of distal upper extremity (Hirayama disease): results from 38 cases].

BACKGROUND: Juvenile muscular atrophy of distal upper extremity is a peculiar type of cervical myelopathy affecting young people characterized by localized amyotrophy in the forearm and hand that is initially progressive, and then stabilized in a few years. The anterior horn cell damage may be induced by forward displacement of the lower cervical dural sac and spinal cord on neck flexion. We proposed that the forward displacement was one of pathogenic factors, and reported that therapeutic intervention using a cervical collar in order to minimize neck flexion halted the progressive weakness in some patients. OBJECTIVE: To examine effectiveness of cervical collar treatment for this disease and to investigate clinical and radiological profiles that predict a favorable outcome before treatment. METHODS: Thirty-eight patients who had progressive illness within 5 years after onset underwent cervical collar therapy (treatment group). Forty-five patients in a previous case series without any therapeutic intervention made up a control group. The duration of progressive phase of illness was compared between the two groups. In the treatment group, the time interval from onset and the measurements of cervical cord atrophy and its flattening on neck flexion at the introduction of treatment by CT-myelography or MRI were analyzed with respect to prognosis. RESULTS: All the patients in the treatment group showed no further progression after introduction of treatment. The duration of the progressive period was shorter in the treatment group (mean 1.8 +/- 1.2 years) than in the control group (mean 3.2 +/- 2.3 years) (p < 0.005). In the treatment group, 15 of 31 patients within 2.5 years after the onset showed not only stabilization but also improvement of muscular weakness or cold paresis. Five of 7 patients who had no or mild cord atrophy at the introduction showed improvement after treatment. CONCLUSION: Cervical collar therapy induces a premature arrest of this disease. Improvement is expected in patients who have shorter duration of illness and have mild cord atrophy in a neutral neck position. Early diagnosis and therapeutic intervention may minimize the functional disability of young patients.

Adolescent↗

PubMed1991

[Acute ischemia in the upper extremity caused by cervical rib].

Young patients presenting with acute ischemia of the upper extremity and no cardiac source of embolism are uncommon. Two cases of cervical ribs are reported. Early recognition of this anatomical abnormality is the key to appropriate management.

Aortography↗

PubMed1989

Reconstruction of severe burn deformities of the upper extremity.

A case of severe post burn deformity involving multiple joints in both upper extremities is presented. Principles of rehabilitation and surgical reconstruction are detailed which demonstrate the importance of a close working relationship between surgeon, patient and therapist. This case serves as an excellent example of how a systematic approach to severe burn deformities can transform disaster into a favorable functional outcome.

Burns↗

PubMed1986

The care of burned upper extremities.

Two sets of factors will ultimately influence the outcome of the burned upper extremity. The first set of factors is the depth and severity of the burn. The second set is the group of complications of the burn injury attributable to edema, inflammation, immobility, and malposition. An awareness of the potential pitfalls that follow burn injury has resulted in improved primary care and a lessening of deformity. Progressive acute care with topical chemotherapy, early motion, thoughtful splinting, and timely burn wound closure are essential to reduce the need for secondary operations. Reconstructive efforts should be tailored to the individual needs of the patient. These procedures should be carefully planned with a view toward balancing aesthetic and functional considerations and minimizing the time required for rehabilitation.

Arm Injuries↗

PubMed1985

[Diabetes mellitus with atrophy of the mm. interossei of the upper extremities].

Two cases are described with atrophy of the interosseous muscles of the upper extremities as a manifestation of peripheral diabetic polyneuropathy with a main motor damage. In both cases, a long-term diabetes is concerned--insulin-independent type, perorally treated. Retino- and nephropathy were present in the patients as well as macroangiopathy in one of the cases. The lesions were in the frame of generalized polyneuropathy of the four extremities, confirmed, in one of the cases, by electromyographic examination. No changes in muscular atrophy were observed by the treatment carried out.

Diabetic Neuropathies↗

PubMed1983

Injuries to the neck and upper extremities of dancers.

In general, injuries to dancers involving the cervical spine and upper extremities are quite mild and cause only limited disability. When such injuries do not involve specific elements of the musculoskeletal system, their origin may be in the more subtle neurovascular structures of the neck. The importance of a thorough examination is emphasized.

Arm Injuries↗