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At least 1,063 records · Page 59Linked to original sources
PubMed2006

[Our experience with surgical management of injuries to peripheral nerves of the upper extremities].

OBJECTIVES: The authors present their results of 44 microsurgical procedures of 47 nerves in 44 patients subjects over a period of 19 years, from 1985 to 2003. STUDY GROUP SUBJECTS AND METHODS: 44 patients with injuries to peripheral nerves of the upper extremities underwent reconstructions of 47 nerves using autotransplants. The procedures effectivity results were analysed using the following indicators: the injury to the procedure time, the patient's age, the autotransplant length, the injury type, the injury site, the injured nerve type. RESULTS: The best results were reached: in young patients up to the age of 20, in cases of early operations up to 3 months, in cases when grafts up to 5 cm were used. Clean, for instance incision injury, has much better prospects for successful nerve graft autotransplantation than others, more complicated injuries (e.g. lacerated injury or contusion).

Adult↗
PubMed2006

Cost-effectiveness of multidisciplinary treatment in sick-listed patients with upper extremity musculoskeletal disorders: a randomized, controlled trial with one-year follow-up.

OBJECTIVE: To determine the effectiveness and cost-effectiveness of a return-to-work outpatient multidisciplinary treatment programme for sick-listed workers with non-specific upper extremity musculoskeletal complaints. METHODS: A randomized controlled trial with a 1-year follow-up was carried out. Thirty-eight subjects were allocated to multidisciplinary treatment (intervention, n=23), or to usual care provided by occupational health services (n=15). The intervention consisted of psychological and physical sessions provided by a medical specialist, a psychologist, a physiotherapist and an occupational therapist. It aims at reconditioning, "de-medicalizing", unrestrained moving and return-to-work. The intervention process was evaluated on compliance to the protocol and the effectiveness of its components. The individual outcome variable was the severity of complaints. The societal outcomes included return-to-work and costs. Measurements were performed at baseline and after 2, 6 and 12 months. Mixed model analyses were used for analysis. RESULTS: The intervention achieves its aims: physical disabilities (P=0.039), kinesiophobia (P<0.001) and physical functioning (P=0.016) improved significantly as compared to usual care. In addition, the intervention was significantly more effective in reducing the severity of complaints than usual care. The intervention was equally effective compared to usual care in terms of return-to-work (86% in the intervention group vs. 73% in the usual care group). The extra total costs and the extra gains in terms of return-to-work were not significantly higher for the intervention as compared to usual care after 12 months. CONCLUSION: Multidisciplinary treatment affects individuals positively, but shows no significant difference in (cost-) effectiveness on the societal level as compared to usual care.

Combined Modality Therapy↗
PubMed2005

Lateral cervical epidural catheter placement using nerve stimulation for continuous unilateral upper extremity analgesia following a failed continuous peripheral nerve block.

This case report describes the application of electrical stimulation (Tsui test) to confirm placement of a cervical epidural catheter for postoperative pain management in a patient with a failed brachial plexus block who underwent upper extremity surgery. An epidural catheter was easily advanced under nerve stimulation guidance to the surgical dermatome C4 level without any resistance from the C7-T1 level. Successful analgesia was achieved with a bolus of 2 mg ml(-1) ropivacaine 2 ml and fentanyl 20 microg, followed by a continuous infusion of 2 mg ml(-1) ropivacaine with 2 microg ml(-1) of fentanyl at a rate of 2 ml h(-1). This case reminds the clinician that cervical epidural analgesia may serve as an alternative to a difficult continuous peripheral nerve block. Electrical stimulation may also help to confirm cervical epidural catheter placement at the appropriate dermatome to provide effective analgesia with minimal side-effects.

Amides↗
PubMedDate not supplied

Hemodialysis vascular access: upper extremity graft versus anterior chest wall graft.

The primary goal of this study was to compare two types of grafts used for vascular access in patients on chronic hemodialysis. The population of interest includes patients on chronic hemodialysis who have had both an upper extremity arteriovenous graft and an anterior chest wall arteriovenous graft (n = 23). In addition to comparing the time to first intervention, the primary and secondary patency rates of the two types of grafts were evaluated. Medical record review was used to gather information related to the placement of the vascular access. The correlated t-test was utilized to analyze the data. Although the trend towards longer time to first intervention with the chest wall grafts was demonstrated numerically, significance was not reached statistically. However, analysis of the secondary findings revealed that both the primary and secondary patency rates were longer in the anterior chest wall graft group. The chi square test was used to analyze the patency rates and statistical significance was reached for secondary patency rate at 3 months with chi2 (1) = 10.1, p < .01. The findings of this study are promising in regards to the patency rates of the anterior chest wall grafts. Future research should include an expanded study of both primary and secondary patency rates in the chest wall graft looking at their patency at 6, 12, and 18 months. Because of the aging population on hemodialysis and the higher acuity of these patients, alternate vascular access sites are going to be a priority.

Adult↗
PubMed1994

Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study.

Time course and degree of recovery of upper extremity (UE) function after stroke and the influence of initial UE paresis were studied prospectively in a community-based population of 421 consecutive stroke patients admitted acutely during a 1-year period. UE function was assessed weekly, using the Barthel Index subscores for feeding and grooming. UE paresis was assessed by the Scandinavian Stroke Scale subscores for hand and arm. The best possible UE function was achieved by 80% of the patients within 3 weeks after stroke onset and by 95% within 9 weeks; in patients with mild UE paresis, function was achieved within 3 and 6 weeks, respectively, and in patients with severe UE paresis within 6 and 11 weeks, respectively. Full UE function was achieved by 79% of patients with mild UE paresis and only by 18% of patients with severe UE paresis. A valid prognosis of UE function can be made within 3 and 6 weeks in patients with mild and severe UE paresis, respectively. Further recovery of UE function should not be expected after 6 and 11 weeks respectively, in these groups of patients.

Activities of Daily Living↗
PubMed1979

Dynamic electromyography and decision-making for surgery in the upper extremity of patients with cerebral palsy.

Seventeen children with cerebral palsy were selected for improvement in upper extremity function. Each had normal or nearly normal intelligence; each hand had good or mildly impaired sensibility; each arm had relatively good placement. Electromyograms with wire electrodes were utilized to study the patterns of activity of the planned tendon transfers. Only muscles with isolated activity in grasp were utilized to transfer in hands with weak grasp. Only muscles with isolated activity in release were utilized to transfer in hands with poor release.

Adolescent↗
PubMed1999

Upper extremity pain after spinal cord injury.

OBJECTIVE: Patients with spinal cord injury (SCI) may complain of upper extremity (UE) pain. The purpose of this study was to determine the frequency and severity of UE pain as well as its association with functional activities. Types of treatments that SCI patients received for UE pain and the benefits of these treatments were also identified. STUDY DESIGN AND METHODS: A questionnaire of demographic variables and measures of UE pain intensity, location, treatment, and interference with functional activities was mailed to 170 persons with SCI. Data was analyzed by descriptive and comparative statistics. RESULTS: Of the 130 persons who responded, 76 (58.5%) (38 paraplegic, 38 tetraplegic patients) reported UE pain: 71% had shoulder pain, 53% wrist pain, 43% hand pain, and 35% elbow pain. Pain interfered with transfers in 65% (36/55) of the patients who were doing them. Of ten functional activities, pain was more likely to be associated with pressure reliefs, transfers, and wheelchair mobility. Sixty-three per cent sought medical treatment for pain, and of those, 90% received either physical therapy, pharmacological treatment or massage. Although only 27% had wheelchair or home modification or joint protection education, these approaches were helpful for almost all and very helpful or extremely helpful in 26.6% and 63.6% of the patients, respectively. CONCLUSION: UE pain is a common problem in individuals with SCI and has impact on daily activities. UE pain prevention and management programs are needed for SCI patients.

Adult↗
PubMed2005

The association between restraint system and upper extremity injury after motor vehicle collisions.

OBJECTIVES: This study was designed to investigate the relationship between upper extremity (UE) injuries and occupant restraint systems among front seat occupants who were involved in frontal motor vehicle collisions (MVCs). DESIGN: Case-control. SETTING: The 1995 through 2002 National Automotive Sampling System (NASS) Crashworthiness Data System (CDS). PARTICIPANTS: Subjects were identified from the NASS-CDS. All cases sustained an UE injury with a > or = 2 Abbreviated Injury Scale Score. OUTCOMES: Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated comparing risk of UE in 3 mutually exclusive restraint system groups (seatbelt-only, airbag-only, seatbelt-airbag-combined) to the unrestrained group. Data analysis was adjusted for significant occupant, vehicle, and collision characteristics. RESULTS: Seatbelt-only occupants had a reduced UE injury risk (OR, 0.41; 95% CI, 0.22-0.76). Near null associations were found for airbag-only (OR, 1.1; 95% CI, 0.68-1.76) and seatbelt-airbag-combined (OR, 0.97; 95% CI, 0.56-1.69). CONCLUSION: The results of this study suggest that UE injuries may become more common as a result of MVCs as the proportion of airbags in motor vehicles increases.

Abbreviated Injury Scale↗
PubMedDate not supplied

The relationship of upper extremity strength to throwing speed.

Cybex II Isokinetic Dynamometer (Lumex Corp. Ronkonkoma, NY) tests for the upper extremity strength of eight professional baseball players, together with radar gun measurements of their individual throwing speeds, were subjected to statistical analysis. Results of simple and multiple regression analysis showed a relationship between the strength of the elbow extension and wrist extension movements and throwing speed.

Arm↗
PubMed1976

Peripheral nerve injuries of the upper extremity. Sensory return of 137 neurorrhaphies.

The results of sensory recovery of 137 neurorrhaphies of the upper extremity in 96 patients are reviewed. There were 85 primary and 52 secondary repairs. Various factors influencing the results and an evaluation based on the 2-point discrimination test are presented. Secondary repair within 3 months in the hand area gives better results than primary repair.

Adolescent↗
PubMed1989

Incidence of upper extremity discomfort among piano students.

The purpose of this study was to determine the incidence of upper extremity discomfort among piano majors at seven Philadelphia-area music schools. A questionnaire was distributed to 232 students, and a 31% return rate was obtained. Thirty (42%) of the 71 respondents reported experiencing discomfort that lasted more than 1 week, and 41 (58%) of the respondents reported experiencing little or no discomfort. Twenty-six (87%) of the students with discomfort suspended practice for a period of time or made adjustments at the piano. Pain/aching was the predominant discomfort reported among students. Students experienced their discomforts most frequently in the band (49% of respondents), the forearm (19% of respondents), and the wrist (16% of respondents). The majority of students reported an impaired ability to play the piano that lasted for 6 months or less. Further research is needed to verify the scope of the problem among student pianists and to substantiate the numerous causes of discomfort that were uncovered in this study. This occupational group could benefit from the knowledge and skills of occupational therapists in the area of occupational performance and physical function.

Adult↗
PubMed1984

[Treatment of postmastectomy edema of the upper extremity using microsurgical technics].

Reconstructive microsurgery carried out in 25 cases of postmastectomy edema of the upper extremity proved to be the most effective and safest in treatment of the said complication. The procedure should be supplemented with phlebolysis of the subclavicular vein (when occlusion of the latter exceeds 50%) or with resection of dermatofascial flap of the brachial area (fibrous stage of lymphostasis). Sequence of stages and the results of the surgical treatment are discussed.

Adult↗
PubMed1994

[Severe roller crush injuries of the upper extremities].

During the past ten years, 57 patients with severe roller-crush injuries of the upper extremities were treated. The surgical intervention, duration of therapy, vocational rehabilitation, and residual disabilities are described and results of 39 patients from this collective are presented.

Accidents, Occupational↗
PubMed1993

Biomechanical properties and design considerations in upper extremity external fixation.

External fixation is an excellent technique for the osteosynthesis of fractures affecting the upper extremity. The rational use of the technique is based on sound principles of biology and biomechanics. Good pin design and application techniques are among the important factors for successful outcome. These factors are discussed in this article along with the advantages of external fixation.

Arm Injuries↗
PubMed1997

Primary upper-extremity deep venous thrombosis.

Using an illustrative case, this report reviews the entity of primary upper-extremity deep venous thrombosis, also known as Paget-Schroetter syndrome. The entity of Paget-Schroetter syndrome is important to military physicians because of its occurrence in young, healthy, active individuals such as those in our active duty population. A review of the literature was performed and it was concluded that a multimodal approach to therapy, as was done in this case, gives the best overall results.

Adult↗
PubMed1997

The use of upper extremity anthropometrics in the clinical assessment of patients with amyotrophic lateral sclerosis.

We evaluated the feasibility of using upper extremity anthropometrics to monitor the clinical status of 18 patients with amyotrophic lateral sclerosis (ALS). The bone-free arm muscle area (AMA) was computed using measurement of triceps skinfold thickness and the mid-upper arm circumference according to published formulae. The AMA correlated significantly with body mass, isokinetic muscle force generation, cross-sectional muscle area on computerized tomography scanning, and pulmonary functions including forced vital capacity and maximal voluntary ventilation. Serial determinations of AMA demonstrated a decline in 10 of 13 patients over 6 months. We pilot tested the use of AMA in a clinical trial of ciliary neurotrophic factor (CNTF) in the treatment of ALS. The AMA progressively decreased by 13%, 15%, and 30% in ALS patients treated with 0 microg CNTF/kg, 15 microg CNTF/kg, and 30/microg CNTF/kg, respectively, over a 9-month treatment period. We conclude that measurement of AMA provides a simple, inexpensive method to monitor the progression of muscle atrophy in ALS patients. The technique does not require effort on the part of the patient and as such, appears to have potential utility as an outcome measure in clinical drug trials.

Adult↗