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PubMed1983

Current status of noninvasive techniques in the diagnosis of upper extremity disorders. Part I. Evaluation of vascular competency.

To determine vascular competency in the upper extremity, one must completely evaluate both structural anatomy and the functional performance capabilities of the vascular system. Unfortunately, no single noninvasive test currently available is capable of providing all that information (Table 4-1). Definitive structural anatomy can only be ascertained by surgery or arteriography, although gross anatomic detail can be provided by Doppler techniques and radionuclide scans. Radionuclide scans give good dynamic and static perfusion data and can be coupled with stress testing, but their repeatability is limited by radiation. Isotope clearance techniques are difficult to combine with stress testing, but they do provide excellent information on vascular perfusion. Measurement of segmental arterial pressures, plethysmography, thermography, thermometry, and Allen testing all provide excellent perfusion data and can all be combined with stress testing. The future is bright. Current advances in high-resolution ultrasound real-time imaging combined with quantitative flow by Doppler assessment will provide noninvasive information about structural anatomy and blood-flow characteristics.

Angiography↗
PubMed1978

High tension electrical injury of the upper extremity.

A group of 18 patients received a high tension electrical injury of the upper extremity. The over-all results were dismal. Opportunity for improvement appears to lie in a regimen of rapid and complete removal of devitalized skin and muscle, avoidance of contamination and desication and the early provision of blood supply and wound coverage with pedicled flap coverage.

Arm Injuries↗
PubMed1995

Non-neoplastic tumors of the hand and upper extremity.

A variety of non-neoplastic, tumor-like conditions exist in the upper extremity. Some are common, others rare. Careful history, physical diagnosis, and a variety of imaging modalities can be helpful in arriving at an accurate diagnosis and developing a successful treatment plan for this group of lesions.

Arm↗
PubMed1993

Primary thrombosis in the upper extremity.

Deep vein thrombosis may occur in the axillary or subclavian veins in the upper extremities, sometimes in young patients without the typical risk factors for thrombus development. This unusual clinical situation usually follows strenuous activity and is often referred to as "effort" thrombosis. Since some cases have occurred with mild exertion and there is a lack of obvious predisposing vessel trauma, a more correct term might be "primary" thrombosis. Early recognition of this condition is necessary to prevent potentially fatal acute effects and minimize chronic sequelae.

Adult↗
PubMed1989

EMG feedback for the treatment of upper-extremity dysfunction: can it be effective?

This paper examines the application of EMG feedback for upper-extremity dysfunction secondary to neurologic injury. A rationale for the use of EMG feedback to enhance rotational components of upper-limb movement, train recruitment of the prime movers, and promote inhibition of motor responses that interfere with efficient and effortless movement is presented. Specific strategies that can be used to reinforce functional movement patterns are elaborated. A case study illustrating the application of the feedback strategies is provided. Despite sensory, perceptual, and cognitive impairments, a 53-year-old left hemiplegic obtained significant clinical upper-limb functional gains when given EMG feedback in conjunction with occupational therapy.

Arm↗
PubMed1975

[Choice of surgical approach for embolectomy of an artery of the upper extremity].

According to the authors' observations 236 patients with embolism of major arteries of the upper extremities were treated: conservative therapy-in 43, surgery-in 193. Since 1972 in the clinic a unique access in the ulnar fossa with exposure of the brachial artery bifurcation has beem employed for embolectomy from any artery of the upper extemity. A direct access is used only if the necessity of simultaneous correction of the affection leading to embolism (proximally located aneurysms, jugular ribs) might arise.

Arm↗
PubMed2004

CT angiography in complex upper extremity reconstruction.

Computed tomography angiography is a new technique that provides high-resolution, three-dimensional vascular imaging as well as excellent bone and soft tissue spatial relationships. The purpose of this study was to examine the use of computed tomography angiography in planning upper extremity reconstruction. Seventeen computed tomography angiograms were obtained in 14 patients over a 20-month period. All studies were obtained on an outpatient basis with contrast administered through a peripheral vein. All the studies demonstrated the pertinent anatomy and the intraoperative findings were as demonstrated in all cases. Information from two studies significantly altered pre-operative planning. The average charge for computed tomography angiography was 1,140 dollars, compared to 3,900 dollars for traditional angiography.

Adolescent↗
PubMed2006

Hybrid power-assisted functional electrical stimulation to improve hemiparetic upper-extremity function.

OBJECTIVE: The effect on spastic hemiparesis of a hybrid therapy consisting of functional electrical stimulation and block therapy was examined. DESIGN: Sixteen consecutively enrolled stroke patients who had spastic upper-extremity impairments more than 1 yr after stroke were recruited for this nonblinded randomized controlled trial. Patients underwent hybrid functional electrical stimulation therapy on their extensor carpi radialis longus and brevis, extensor digitorum communis, and extensor indicis proprius muscles once or twice a week for 4 mos after motor point blocks at the spastic finger flexor muscles. Surface electrodes picked up the electromyography signal and stimulated those muscles in proportion to the integrated electromyography signal obtained by the functional electrical stimulation device. The root mean square of the extensor carpi radialis longus and extensor digitorum communis maximum voluntary electromyography, active range of motion of wrist extension, finger extension, Modified Ashworth Scale, and two clinical tests were examined before and after training. RESULTS: Root mean square, active range of motion, Modified Ashworth Scale, and two clinical tests showed marked improvement in all patients as compared with the control subjects. CONCLUSIONS: The hybrid therapy was effective for patients with chronic spastic hemiparesis. Proprioceptional sensory feedback may have an important role in power-assisted functional electrical stimulation therapy.

Adult↗
PubMed1997

Upper extremity versus lower extremity deep venous thrombosis.

BACKGROUND: In contrast to lower extremity deep venous thrombosis (LEDVT), it is widely believed that upper extremity deep venous thrombosis (UEDVT) is associated with minimal morbidity or mortality. METHODS: In an attempt to compare the two disease processes with respect to pulmonary embolism and mortality, we have reviewed records and performed interviews of 430 patients with LEDVT and 52 patients with UEDVT presenting to our institution between January 1994 and June 1995. RESULTS: Pulmonary embolism was documented by ventilation/perfusion lung scan in 9 of 52 patients (17%) with UEDVT and 33 of 430 patients (8%) with LEDVT (P <0.05). Twenty-five of the UEDVT patients (48%) died within 6 months of the diagnosis of UEDVT. Conversely, 14 patients (13%) in the LEDVT group died within 6 months of the diagnosis of LEDVT (P <0.0002). CONCLUSION: Contrary to previous reports, this study suggests that UEDVT is associated with a higher morbidity and mortality as compared with LEDVT. These data show that UEDVT has been an underrecognized predictor of morbidity and mortality.

APACHE↗
PubMed2004

Follow-up evaluation of neurolysis of brachial plexus and peripheral nerves of upper extremities.

BACKGROUND: The work presents the results of neurolysis of brachial plexus and peripheral nerves of upper extremities performed in the Neurosurgical clinic of the Faculty Hospital Bratislava during the 18-year period from 1985 to 2003. PATIENTS AND METHODS: 59 patients were subject to surgical therapy by neurolysis, including 10 treatments of brachial plexus and 49 treatments of the upper limb nerves. The average age in the patient group was 35 years. The average period between the injury and surgical treatment was 6.9 months. Extremely long period over 12 months occurred in 3 cases. The treatment was performed in patients with complete or persisting neurological deficit. The external neurolysis was performed in 59 patients and this treatment was supplemented also by internal neurolysis in two cases. Cases requiring resection of fascicles and reconstruction with autotransplants and cases where reconstruction surgery has been already performed in the past have not been included into the study. The analysis of results was performed with respect to the period between the injury and operation, patient age, the type of injured nerve and the degree of fibrotic changes that have been identified peroperationally. RESULTS: The evaluation of results has been performed according to Seddon classification (1975). The complete recovery of mobility, strength and BMG findings (classification grade M5) was observed in 25 patients. The functional grade M3 and more was present in 52 patients. The best results were observed in the youngest patient group aged below 20 years, in cases of early therapy onset, in patients with distal traumatic lesions and for neurolyses of n. radialis. CONCLUSION: Based on our experience we believe that the early surgical revision is the critical factor determining the outcome of the operations in indicated cases. (Tab. 6, Ref. 3.)

Adult↗
PubMed2004

The incidence of a superficial arterial pattern in the human upper extremities.

The incidence of superficial arteries was studied in 68 (38 right and 30 left) upper extremities. One right limb of an adult male presented a superficial arterial pattern (2.63%, total 1.47%) resembling a superficial brachio-ulno-radial artery (SBUR). The median nerve crossed the superficial brachial artery (SBA) from the posterior to the medial side and again posterior to the same at the cubital fossa. The superficial brachial artery divided into superficial radial and superficial ulnar arteries, which coursed distally superficial to the muscles but deep to the deep fascia. The superficial radial artery passed deep to the extensor tendons of the thumb. The superficial ulnar artery gave only muscular branches in the forearm. The superficial radial artery gave origin to the radial recurrent artery and the common interosseous trunk. The latter gave origin to a palmar type of median artery, muscular branches, and an artery that divided into anterior and posterior ulnar recurrent arteries. It also gave origin to the anterior and posterior interosseous arteries. The latter provided the interosseous recurrent artery and a branch that coursed towards the olecranon process of the ulna. The knowledge of this variation is important since it may be compromised in surgical procedures of the upper limb.

Adult↗
PubMed2004

Primary upper-extremity deep vein thrombosis: high prevalence of thrombophilic defects.

Primary deep venous thrombosis of the upper extremity (UEDVT) is an unusual disorder. Limited data are available on the contribution of hypercoagulable status in the pathogenesis of this disease. This study aims to report the prevalence of inherited and acquired thrombophilic risk factors (TF) in patients with primary (effort-related and spontaneous) UEDVT. From 1993 to 2002, 31 patients (17 females, median age 38.8 years, range 16-60 years; and 14 males, median age 31.4 years, range 20-56 years) with primary UEDVT (n = 15 effort-related and n = 16 spontaneous) were referred for screening of hypercoagulable status. Nineteen (61.3%) patients had at least one coagulation abnormality. The most common acquired TF were antiphospholipid antibodies (31% lupus anticoagulant and 12.9% anticardiolipin antibodies). Factor V Leiden (12.9%) and prothrombin G20210A mutation (20%) were the most prevalent genetic risk factors. Five patients (16.1%) had high plasma homocysteine levels, and one patient (4.7%) had protein S deficiency. Effort-related UEDVT was associated with male gender (P = 0.04) and younger age (P = 0.02). There was no significant difference in the prevalence of acquired or inherited TF between patients with effort-related or spontaneous UEDVT. A local anatomic abnormality was detected in seven patients (22.5%), and the prevalence of TF was significantly lower within this group (P = 0.006). The incidence of TF in patients without an anatomic abnormality was 75% (RR 5.25). This study found a high prevalence of an underlying thrombophilic status in spontaneous and effort-related UEDVT. Hypercoagulable status may play a significant role in both groups. Screening for local anatomical abnormalities and thrombophilia should be included in the evaluation of primary UEDVT.

3' Untranslated Regions↗
PubMed1981

Autonomic hyperreflexia during upper extremity surgery.

A case is presented of autonomic hyperreflexia in a quadriplegic patient occurring during upper extremity surgery. Tourniquet ischaemia is proposed as the likely causative stimulus. An understanding of the afferent neural pathways involved in this physiological response may be useful in better understanding the subjective phenomena of tourniquet pain in neurologically intact individuals.

Adult↗
PubMed1984

Upper extremity vein graft for aortocoronary bypass.

Twenty-four autologous vein grafts taken from the upper extremities were used in 13 patients undergoing aortocoronary bypass procedures. All of these patients had had previous bilateral saphenous vein stripping. Clinical follow-up between 3 months and 6 1/2 years is reported. Ten patients were recatheterized. There was neither operative mortality nor appreciable morbidity. All the patients are alive and well at the present time. Eleven out of 13 were in New York Heart Association (NYHA) Class I 3 months after operation. Nine patent grafts out of 10 were seen during recatheterization in 6 patients studied less than 9 months after operation. In a subgroup of 5 patients followed for more than 1 year, 2 are now in NYHA Functional Class I, 2 in Class II, and 1 in Class III. Graft patency had been determined in 4 of these patients. Five grafts out of 8 were patent, 2 of them with gross abnormalities. In conclusion, we have some reservations about the long-term fate of these grafts.

Adult↗
PubMed1998

Prediction of upper extremity impact forces during falls on the outstretched hand.

Among the most common causes of upper extremity fracture is a fall on the outstretched hand. Yet few data exist on the biomechanical factors which affect injury risk during this event. In this study, we measured impact forces during low-height (0-5 cm), forward falls onto the outstretched hand, and found that these are governed by an initial high-frequency peak and a subsequent, lower-frequency oscillation. This behavior was well-simulated by a two-degree-of-freedom, lumped-parameter mathematical model. Increases in body mass caused greater increases in the peak magnitude of the low-frequency component (Fmax2) than the high-frequency component (Fmax1). However, increases in fall height more strongly influenced Fmax1, which exceeded Fmax2 for all but very low fall heights. Model predictions suggest that fall heights greater than 0.6 m carry significant risk for wrist fracture, since above this height, peak forces surpass the average fracture force of the distal radius. Finally, while the shoulder experiences lower peak force than the wrist (since Fmax1 is not transmitted proximally), it undergoes considerably greater deflection, and thereby absorbs the majority of impact energy during a fall.

Accidental Falls↗