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Dermal angiomyoma of the upper extremity.

Twenty-four of a series of 85 dermal angiomyomata were located in the upper extremity distal to the elbow. Eleven occurred in the right arm and 13 appeared in the left. Women exceeded men by 13 to 1 in number. The greatest number occurred in the 40 to 70 year age group. One case recurred as a leiomyosarcoma. This report is intended to bring this lesion to the attention of the surgeon in the differential diagnosis of painless masses of the hand, wrist, or forearm.

Adolescent↗

Upper extremity infections in patients with diabetes mellitus.

Forty-five consecutive diabetic patients with 46 upper extremity infections who underwent surgical debridement were retrospectively reviewed. The infections involved the skin or subcutaneous tissue in 19 patients and the fascia, tendon, muscle, or bone in 27. Twenty-three infections (50%) required a single operation and 23 required more than 1. Eighteen infections (39%) required an amputation and there were 3 deaths directly related to an infection. Six of 7 infections in which anaerobic organisms were cultured culminated in amputation. Four patients were diagnosed with necrotizing fasciitis. Twenty-one cultures (46%) were polymicrobial. An increased rate of amputation was associated with deep infections below the subcutaneous tissue, renal failure, and infections with gram-negative, anaerobic, or polymicrobial cultures. An increased rate of repeat surgery and a prolonged hospitalization were associated with deep infection and polymicrobial infections.

Amputation, Surgical↗

Upper extremity deep venous thrombosis.

About 10% of all episodes of venous thrombosis are due to upper extremity deep vein thrombosis (UEDVT). Associated risk factors are indwelling central venous catheters, cancer, and coagulation defects; 20% of the episodes are unexplained. The onset of UEDVT is usually heralded by complaints such as arm swelling and pain, but may also be completely asymptomatic, especially in carriers of central venous lines. Objective confirmation is mandatory prior to instituting anticoagulation because the clinical diagnosis is unreliable; ultrasound-based methods represent the preferred diagnostic approach. Prophylaxis with low-dose heparin or low-dose warfarin may be used, especially in carriers of central venous catheters, although its efficacy is still uncertain. Unfractionated or low molecular weight heparins followed by oral anticoagulants should be regarded as the treatment of choice, whereas thrombolysis and surgery may be indicated in selected cases. Up to one third of the patients develop pulmonary embolism that may be fatal; postthrombotic syndrome and recurrent thromboembolism are also frequent complications. UEDVT should no longer be regarded as a rare and benign disease, as reported previously.

Arm↗

[Digital subtraction angiography (DSA) of the upper extremities].

Amongst 1500 digital subtraction angiograms, there were 93 examinations of the arteries of the upper extremities. After intravenous contrast injection, DSA provided good demonstration of the subclavian, axillary, brachial, radial and ulnar arteries. In order to demonstrate the arteries in the hand and fingers, an intra-arterial injection of 5 ml contrast into the brachial artery has proved satisfactory. DSA makes the examination easier and quicker and reduces the risk of complications. Conventional catheter angiography is now required only for a few selected problems.

Angiography↗

Iatrogenic nerve lesions of the upper extremity.

Thirty-three patients are presented who suffer from iatrogenic nerve injury of the upper extremity. Depending on the nature, duration, and degree of nerve injury, we performed neurolysis (16), direct nerve coaptation (4), and nerve grafting (13). Fourteen (70%) of 20 patients presenting with motor nerve injury achieved motor function against resistance. In 26 of 30 patients (87%) with sensory nerve involvement, at least some superficial sensory function was restored. Surgeons should be familiar with clinical and electroneurophysiological tests for early diagnosis of iatrogenic nerve injuries to allow early intervention for maximal nerve recovery.

Adolescent↗

Non familial juvenile distal spinal muscular atrophy of upper extremity.

An uncommon variety of non familial, juvenile onset, spinal muscular atrophy with asymmetric distal upper extremity affection is described. One hundred and two patients with a one to 14 year follow up are analysed. Spinal muscular atrophies with a distal distribution are rare. However, in the past three decades, previously unrecognised varieties of neurogenic muscular atrophy have been described in Asia (Japan, India, Sri Lanka and Singapore) under a variety of names. These provide interesting data for discussion of Asian neurogenic muscular atrophies with distal affection, in the context of diseases of the motor neuron.

Adolescent↗

Lateral arm free flaps in the defects of the upper extremity--a review of 72 cases.

Lateral arm flaps are versatile in the use of upper extremity moderate-sized defects with little morbidity and with acceptable cosmesis. The conditions are outlined in a series of 74 lateral arm flaps performed on 72 patients and the results are given. Five patients were operated on as emergencies, 12 were operated within the first 72 hours of injury and 57 patients were treated electively. Skin defects were between 6 x 4 cm and 20 x 9 cm. Five (7%) flaps were lost due to venous thrombosis, three that sustained a high-voltage electric burn. Two other patients that were treated for a high-voltage electric burn had a successful revision of the anastomosis site in the early post-operative duration. One flap was abandoned due to very thin pedicle and obesity of the patient. A higher failure rate is encountered most frequently with the cases of high-voltage electric burn. To deal with this problem, a modified approach such as an extended approach and/or including the forearm skin to the flap is recommended during the flap harvest. For a longer pedicle to be anatomized more proximally, perforator flaps with longer pedicles may be used as an alternative.

Adolescent↗

Upper extremity control in adults post stroke with mild residual impairment.

Motor control deficits in the upper extremity (UE) ipsilateral to the side of brain damage persist after stroke, but it is not known if the presence of these deficits is related to impairment of the contralateral UE. The purpose of this study was to investigate whether motor deficits are present in the ipsilateral UE when contralateral UE impairment is mild in adults with chronic stroke. Right-handed adults (10 controls, 10 right stroke, 10 left stroke) performed rapid continuous aiming movements to small and large targets. Using kinematic analysis, temporal measures of the movement were defined, including movement time (MT) and the three components of MT: acceleration, deceleration, and dwell time (i.e., time on target). Participants with right stroke had prolonged MT only with the left UE, primarily due to longer dwell times. Participants with left stroke had prolonged MT with both UEs as a result of longer dwell times. The results indicate that control deficits of the ipsilateral UE are evident in individuals with left but not right brain damage who have minimal impairment of the contralateral UE. These findings are consistent with the role of the left hemisphere in the control of both UEs.

Aged↗

Therapeutic interventions to improve upper extremity recovery and function.

In this article, the authors discuss motor control deficits in the upper extremity following stroke that interfere with the ability to perform daily life activities. The authors then review conditions of practice that promote learning of motor skills and how well several current intervention approaches adhere to these practice conditions. For each intervention approach, the authors discuss the evidence for effectiveness of the approach in facilitating motor skill gains.

Activities of Daily Living↗

[Use of pedicled radial forearm flaps for covering of extensive soft tissue defects in the upper extremity].

Results of treatment of 13 patients with extensive defects of soft tissues in the upper extremities treated with pedicled radial forearm flaps are presented (11 fascio-cutaneous flaps and 2 adiposo-cutaneous). The group included 5 females and 8 males aged 9-85 years (mean age: 37 years). The defects followed trauma in 12 cases and in one case it was the result of oncological resection. The flap was used as a primary procedure in 4 cases after amputation of the finger or degloving of the hand. The flap appeared very useful in delayed reconstructions in older patients with extensive defects of soft tissues and bones, especially in the elbow region. Complete survival of all flaps with very good late results were obtained. Donor sites were covered with skin grafts and healed correctly in 11 patients. In two patients healing of the donor site prolonged in time for over 6 weeks. No other complications were observed using this method.

Adolescent↗

Upper extremity proprioception in idiopathic scoliosis.

Twenty-three patients with idiopathic scoliosis were tested for upper extremity proprioceptive function. All subjects had documented progression of deformity, with an average curvature of 34 degrees. The average ages for scoliotics and 18 control subjects were 16.1 and 20.8 years, respectively. Controls had no spinal deformity and underwent identical test procedures. The test results showed that scoliotic subjects had significant asymmetry between right and left limbs in their threshold for detection of joint motion (p less than or equal to 0.005) and in their ability to reproduce angles to which their elbow joint had been previously positioned (p less than or equal to 0.025). Slight asymmetry also was observed in the reproduction tests of the control group (p less than or equal to 0.013); however, there was no significant asymmetry seen in this group for the threshold test. Performance of bilateral limbs was designated good and bad for both groups; the limb that performed better in proprioceptive function was designated good limb. Analysis of data showed that the scoliotics' good and bad limbs performed inferiorly in both threshold and angle reproduction tests when compared with normal controls. The results of this study imply, but do not localize, a neurologic deficit in scoliotic patients.

Adolescent↗

[Thromboembolectomy with the Fogarty catheter in acute ischemia of the upper extremities].

Over a period of about 17 years 251 thrombembolectomies using the Fogartycatheter on the upper extremities were performed on 220 patients. In 9.5% of the cases reoperation and in 1.8% amputation were necessary; perioperative lethality was 5.5% and 19.5% developed local complications. Due to multimorbidity and the age of patients at the time of examination 46% had already died, while of the 101 surviving patients 94.1% showed good long-term results.

Acute Disease↗

Preventing upper extremity cumulative trauma disorders. An approach to employee wellness.

1. Employee education and training about upper extremity anatomy/physiology, risk factors and intervention strategies, including ergonomics, may promote wellness and prevent injuries in the workplace. 2. It is important that nurses in the workplace be proactive in the development and implementation of injury prevention and education programs related to CTDs. 3. Reducing known risk factors and educating workers could have financial benefit for management and should result in healthier, happier employees.

Arm Injuries↗

Movement patterns of the upper extremity and trunk associated with impaired forearm rotation in patients with hemiplegic cerebral palsy compared to healthy controls.

The aim of this study was to objectively assess the relationship between impaired forearm rotation and movement patterns of the upper arm and trunk in patients with hemiplegic cerebral palsy. For this purpose, 'extrinsic forearm rotation' was introduced as a parameter to quantify the cumulative result of all movements that supplement forearm rotation. The results of three-dimensional video analysis of the upper extremity and trunk in different reaching tasks in eight male and two female patients (mean age, 16 years and 2 months) were compared to those of 10 case-matched controls. The active forearm rotation impairment in the patient group as compared to the controls was combined with a significantly higher value for 'extrinsic forearm rotation'. In this way, we objectively measured compensatory movement patterns associated with impaired forearm rotation and, consequently, we advocate assessment of the overall movement strategy rather than just the forearm deformity in patients with hemiplegic cerebral palsy.

Abdomen↗

Cortical plasticity following upper extremity injury and reconstruction.

Today's view of the adult central nervous system is that of an adaptive and responsive system. Plastic surgeons, because of the motor and sensory reconstructions they perform, need to have an understanding of brain plasticity following upper extremity injury, reconstruction, and rehabilitation. Functional MRI and transcranial magnetic stimulation can identify cortical plasticity in humans. For instance, these techniques have identified changes in excitability and body site representation in the motor cortex in patients following motor reconstruction and motor relearning. Therefore, cortical plasticity and its manipulation may be an important contributor to functional outcome following reconstruction. In the future, cortical plasticity may have implications for reconstruction and rehabilitation.

Amputation, Traumatic↗

Microvascular reconstruction in burn and electrical burn injuries of the severely traumatized upper extremity.

BACKGROUND: As the versatility and variability of free flaps have significantly increased during recent years, so have the indications for free tissue transplantation in burn reconstruction expanded. METHODS: The authors report retrospectively the results of 42 free flaps for upper extremity reconstruction in 35 severely burned patients using 13 different free flaps. This experience enabled the authors to establish reconstructive principles pertinent to the type of injury (burn versus high-voltage injuries) and the timing of reconstruction procedures. RESULTS: In high-voltage injuries (n = 17), early free flap coverage with muscular flaps was the most frequently used type of reconstruction. The reconstruction site was predominately the forearm. In burn injuries, free flap coverage was performed during a later stage of the treatment course. Reconstruction with cutaneous or fascial flaps was the preferred method. The elbow and dorsum of the hand underwent defect coverage in most circumstances. For reconstruction of complex or large defects (n = 6), combined "chimeric" flaps were used. Overall, the flap failure rate was 12 percent (n = 5). Interestingly, there was a relationship between flap failure rate and timing of the procedure. Four of five flap failures occurred within 5 to 21 days after trauma, and all five flap failures occurred between 5 days and 6 weeks. No flap failure occurred during secondary reconstruction. CONCLUSIONS: The authors' data demonstrate that burn and high-voltage injuries are distinct entities, each requiring custom-tailored reconstructive solutions for limb salvage. Even if the authors' flap failures all occurred during the first 6 weeks, it should not be forgotten that this type of coverage is the only alternative to amputation in selected cases.

Adolescent↗

Work-related upper extremity injuries: prevalence, cost and risk factors in military and civilian populations.

Persons with musculoskeletal-related disorders represent a prevalent source of outpatient visits, lost work time and disability in the military; however, research concerning the extent of work-related upper extremity disorders (WRUEDs) within this population is lacking. This literature review examined studies in civilian and military settings to ascertain the prevalence, cost and risk factors associated with WRUEDs. The results indicated that the prevalence and cost of WRUEDs in the civilian workforce are significant, justifying the need to research the military population. The literature also outlined physical, individual and psychosocial factors associated with WRUEDs that will help identify potential risk factors within military occupations.

Humans↗