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PubMed1990

Doppler ultrasonic diagnosis for deep venous thrombosis of lower limbs.

Seventy-one patients with 80 lower limbs clinically suspected of deep venous thrombosis (DVT) were investigated by both Doppler ultrasound and venography. Sixty-seven lower limbs demonstrated by venography to have DVT, in 5 the thrombus was confined to the calf, and all were detected by the Doppler ultrasound. In 62 limbs thrombus extended into the popliteal and more proximal veins, the Doppler ultrasound detected 61 of them, a sensitivity of 98%. Venography showed a deep venous system without any evidence of thrombosis in 13, the Doppler findings were normal in all of the 13 lower limbs, a specificity of 100%. We found that the examination of the popliteal vein with patient in a semi-lateral prone position was important in detecting the presence of thrombosis in popliteal and more proximal vein.

Adolescent↗

PubMed2001

The inflammatory response to upper and lower limb exercise and the effects of exercise training in patients with claudication.

PURPOSE: We have previously shown that a program of upper limb exercise training can induce significant improvements in walking distance in patients with claudication. This study assessed whether upper limb exercise avoids the systemic inflammatory responses associated with lower limb exercise and also whether the inflammatory response to acute lower limb exertion is modified by a program of supervised exercise training. METHODS: Fifty-two patients with stable intermittent claudication were randomized into two groups who underwent 6 weeks of supervised upper (n = 26) or lower (n = 26) limb cardiorespiratory exercise training. A parallel control group (n = 15) was provided with lifestyle advice only. Neutrophil activation markers (CD11b and CD66b) and plasma levels of von Willebrand factor (marker of endothelial damage) in response to an acute bout of sustained upper and lower limb exercise were assessed before and after the period of training. Plasma levels of soluble E-selectin (marker of endothelial activation) were also determined before and after the training period. RESULTS: An acute bout of sustained lower limb exercise significantly increased the intensity of CD11b and CD66b expression by peripheral blood neutrophils in all groups, whereas upper limb exercise had no effect. Resting neutrophil expression of CD11b and CD66b and circulating von Willebrand factor levels were unaffected by the training program, as were the inflammatory responses to an acute bout of sustained upper and lower limb muscular work, despite the fact that both training programs significantly increased walking distances. CONCLUSIONS: These findings indicate that upper limb exercise training programs may offer certain advantages over currently prescribed lower limb programs. Our results show that exercising nonischemic muscles in a way that promotes improved cardiorespiratory function and walking capacity can avoid the potentially deleterious systemic inflammatory responses associated with lower limb exertion in patients with stable intermittent claudication.

Adult↗

PubMed2004

Effects of rotation on measurement of lower limb alignment for knee osteotomy.

The purposes of this study were to clarify the effects of rotation on two-dimensional measurement of lower limb alignment for knee osteotomy using a three-dimensional method and to determine whether this 3-D simulation method could help with planning of knee osteotomy. We developed computer software to calculate femorotibial angle (FTA) and hip-knee-ankle angle (HKA) and simulate knee osteotomy from a CT-based 3-D bone model of the lower limb. Lower limb rotation on anteroposterior long-standing radiographs was measured by superimposing the 3-D bone models. Changes in alignment with limb rotation were calculated using the software. FTA after virtual closed-wedged osteotomy was measured for a hypothetical case of a rotation error of the osteotomy plane in reattaching the proximal cutting surface to the distal cutting surface. For 31 varus knees in 20 patients with medial compartment arthritis, the mean rotation angle, relative to the epicondylar axis, with variable limb position was 7.4 +/- 3.9 degrees of internal rotation (mean +/- SD), ranging from 8 degrees of external rotation to 14 degrees of internal rotation; the mean changes in FTA and HKA were 3.5 +/- 2.2 degrees (range, 0.4-8.6) and 1.6 +/- 1.3 degrees (range, 0.2-4.9), respectively. The FTA "flexion angle" (lateral view alignment from neutral AP) and the absolute HKA "flexion angle" correlated with the change in FTA and HKA with limb rotation, respectively (FTA, R = 0.999; HKA, R = 0.993). The mean change in FTA after virtual closed-wedged osteotomy was 3.2 degrees for internal and external 10 degrees rotation errors in reattaching the osteotomy plane. Rotation may affect measurement of lower limb alignment for knee osteotomy, and 3-D methods are preferable for surgical planning.

Adult↗

PubMed1994

Isolated limb perfusion with urokinase in the treatment of extensive vascular thrombosis of the lower limbs.

Isolated limb perfusion with urokinase was used in combination with balloon catheter embolectomy in three patients with extensive vascular thrombosis in the lower limbs after conventional methods of treatment failed to restore perfusion to the lower limb. The technique and its results are described and discussed. It is suggested that isolated limb perfusion with urokinase is safe and is worthy of further investigation in the treatment of critically ischaemic lower limbs.

Aged↗

PubMed1995

Prediction and portrayal of repetitive stress-induced lower limb pain disorders among soldiers in basic training using videothermography.

OBJECTIVE: Thermography has been widely espoused for both detecting and portraying pain problems. Development of repetitive stress-induced lower limb pain during army basic training is a relatively common occurrence. This study was designed to assess the usefulness of thermography for differentiating soldiers who developed lower limb pain during training from those who did not. This information was intended to be used to determine the usefulness of pretraining thermograms taken just as people came into the army in predicting which trainees would develop these conditions during training. DESIGN: Videothermographic pictures were taken of the lower limbs of 639 newly enlisted soldiers who had just arrived at a large U.S. Army base but had not yet begun basic training. The amount of symmetry was correlated with the development of lower limb pain. Each soldier reporting lower limb pain and "controls" with nonpain problems (usually minor colds) received a thermographic evaluation identical to the original evaluation when they came for their medical examination. RESULTS: Among prebasic trainees, 37% showed 1.0 degrees C of asymmetry somewhere in their lower limbs, 14% were asymmetrical by between 1.1 degrees and 2.0 degrees C, 5% by 3.0 degrees C and 4% by 4.0 degrees C or more. Thus, only 40% of the prebasic trainees were within accepted "normal" limits before participating in training. Thirty-nine percent of those with asymmetrical thermograms developed lower limb pain compared with 28% of those with symmetrical thermograms (significant at p < 0.05). It was impossible to predict from any thermographic measurement on the lower limbs which soldiers were most likely to develop lower limb pain. This held true even for those pretrainees with the greatest asymmetries. Eighty-four percent of trainees reporting lower limb pain produced abnormal thermograms regardless of whether or not they produced abnormal thermograms prior to training. CONCLUSION: Thermograms were of little value for either predicting or portraying repetitive stress-induced lower limb pain in this population.

Cumulative Trauma Disorders↗

PubMed2002

Long term effects of intensity of upper and lower limb training after stroke: a randomised trial.

OBJECTIVE: To assess long term effects at 1 year after stroke in patients who participated in an upper and lower limb intensity training programme in the acute and subacute rehabilitation phases. DESIGN: A three group randomised controlled trial with repeated measures was used. METHOD: One hundred and one patients with a primary middle cerebral artery stroke were randomly allocated to one of three groups for a 20 week rehabilitation programme with an emphasis on (1) upper limb function, (2) lower limb function or (3) immobilisation with an inflatable pressure splint (control group). Follow up assessments within and between groups were compared at 6, 9, and 12 months after stroke. RESULTS: No statistically significant effects were found for treatment assignment from 6 months onwards. At a group level, the significant differences in efficacy demonstrated at 20 weeks after stroke in favour of the lower limb remained. However, no significant differences in functional recovery between groups were found for Barthel index (BI), functional ambulation categories (FAC),action research arm test (ARAT), comfortable and maximal walking speed, Nottingham health profile part 1(NHP-part 1), sickness impact profile-68 (SIP-68), and Frenchay activities index (FAI) from 6 months onwards. At an individual subject level a substantial number of patients showed improvement or deterioration in upper limb function (n=8 and 5, respectively) and lower limb function (n=19 and 9, respectively). Activities of daily living (ADL) scores showed that five patients deteriorated and four improved beyond the error threshold from 6 months onwards. In particular, patients with some but incomplete functional recovery at 6 months are likely to continue to improve or regress from 6 months onwards. CONCLUSIONS: On average patients maintained their functional gains for up to 1 year after stroke after receiving a 20 week upper or lower limb function training programme. However, a significant number of patients with incomplete recovery showed improvements or deterioration in dexterity, walking ability, and ADL beyond the error threshold.

Activities of Daily Living↗

PubMed1985

Upper- vs lower-limb systolic blood pressure in full-term normal newborns.

The difference between upper- vs lower-limb systolic blood pressure (BP) was investigated in 100 normal full-term newborns younger than 24 hours of age by the oscillometric method. The mean systolic BP of both upper limbs was 72.3 +/- 7.6 mm Hg (mean +/- SD). The mean +/- SD systolic BP of both lower limbs was 71.3 +/- 8.2 mm Hg. Systolic BP in the upper limb was greater than that in the lower limb in 66% of newborns by as much as 20 mm Hg (mean +/- SD, 3.5 +/- 3.1). Systolic upper-limb BP was lower than systolic lower-limb BP in 28% of newborns by as much as 21 mm Hg (mean +/- SD, 5.1 +/- 5.1). Systolic BP did not correlate with birth weight. Follow-up evaluation of BP in 25 of the infants up to 3 years of age revealed higher systolic BP in the lower extremities in 24 of the 25 infants. We conclude that (1) it is normal to have a higher systolic BP in either the upper limb or the lower limb in newborns younger than 24 hours of age, and (2) there is no correlation of systolic BP with birth weight in full-term normal neonates younger than 24 hours of age.

Arm↗

PubMed2006

[Algodystrophy of the lower limbs during pregnancy].

Algodystrophy (AD) of the lower limbs during pregnancy is rare and probably underdiagnosed. The physiopathologic mechanisms remain under discussion and seem multiple and complex. This report describes a retrospective survey of 6 patients seen between 1993 and 2004 who had algodystrophy of the lower limbs during pregnancy. Comparing the clinical, radiological and evolutionary results to the literature allows for identifying the main features of AD during pregnancy: disease progression during the second or third trimester, preferential localization of the left hip associated or not with other lower limb joint involvement and decalcification as seen on radiography. Magnetic resonance imaging (MRI), which is accurate, specific and non-invasive, is currently the exam of choice in early and differential diagnosis. The evolution is favourable in a few months, with general recovery without disability.

Adult↗

PubMed1991

Dual-task assessment of reorganization of postural control in persons with lower limb amputation.

Postural control in persons with lower limb amputation was studied using a cognitive approach to motor learning. The aim of this study was to show that an important characteristic of the central reorganization process after a lower limb amputation is the gradually decreasing need of attentional resources to perform a motor task. A dual-task procedure was developed to estimate the level of automaticity of a quiet, upright standing task. The effect of a concurrent attention-demanding task (Stroop task) on the efficiency of balance control was determined using force-platform measurements at the start and the end of the rehabilitation process. In contrast with a control group, the amputation group showed interference effects on body sway caused by the concurrent task both at the start (p less than .05) and, less severe, at the end of rehabilitation (p less than .05). Improvement of balance control was significant only for the dual-task condition (p less than .05). The results corroborated the hypothesis that dual tasks give information about the restoration of automaticity of postural control as an essential characteristic of the central reorganization process in persons with lower limb amputation. The role of dual-task procedures as a useful approach to skill assessment is discussed.

Adult↗

PubMed2026

Effects of Vacuum Compression Therapy on Healing of Chronic Lower Limb Ulcers: A Randomised Controlled Study.

Chronic lower limb ulcers remain difficult to manage when unresponsive to conventional treatment. This study evaluated the clinical and physiological effects of vacuum compression therapy on wound healing and quality of life. Fifty patients with chronic lower limb ulcers were randomised to receive 12 sessions of vacuum compression therapy plus standard care or standard care alone over 4 weeks. Wound dimensions, exudate, pain intensity and quality of life were assessed at baseline and post-treatment. Estimated wound volume was calculated as length × width × depth. Tissue oxygenation was measured at the dorsum of the foot in the experimental group. The vacuum compression therapy group showed greater improvements in wound width, depth, volume and quality of life. Estimated wound volume decreased by 61% in the intervention group, whereas no statistically significant volume reduction was observed in controls. Local tissue oxygenation in the experimental group increased by 43%. Baseline wound size was associated with poorer quality of life. Vacuum compression therapy may enhance wound healing and quality of life in patients with chronic lower limb ulcers. Observed increases in local tissue oxygenation represent exploratory physiological findings within the treated cohort that warrant controlled comparative evaluation. Trial Registration: ClinicalTrials.gov identifier: NCT07737184.

Humans↗

PubMed2004

[Critical ischemia resulted from inadequate outpatient management of lower limb chronic arterial obliterations].

Management of critical and subcritical lower limb ischemia poses a challenge due to poor effectiveness and high costs of therapy. Problem solving supposes not only the development of effective surgical and medical management of severe arterial insufficiency, but also preventive efforts on early outpatient stage. The paper reviews 611 patients with lower limb arterial obliterative lesions and correlates age, sex, concomitant diseases, stage of arterial insufficiency and risk factors. Consideration of these parameters can be useful in choosing the most effective management strategy. Authors mention that in community outpatient facilities treatment effectiveness of chronic lower limb arterial obliterative lesions does not exceed 40%, white the success of conservative treatment according to the protocol developed in their clinics reaches 90%. It means that there is a real perspective of lowering the incidence of severe lower limb arterial insufficiency managed in hospital environment by improving preventive and therapeutic strategies at outpatient care level.

Adult↗

PubMed1989

A three-dimensional kinematic and dynamic model of the lower limb.

A model describing the kinematics and dynamics of the lower limb is presented. The lower limb is modeled as a sequence of four rigid links connected by three universal rotary joints representing the hip, knee and ankle joints. Each joint is modeled as a sequence of three single axis rotational joints thus ascribing to the lower limb a total of 12 degrees of freedom. A method is described to measure the gait variables so that all nine angles can be computed based on the positions of nine markers placed on the subject during a gait study. The gait variables are then used in an iterative Newton-Euler formulation to compute the moments exerted about the axes of each joint during gait.

Adult↗

PubMed2006

Quantification of functional weakness and abnormal synergy patterns in the lower limb of individuals with chronic stroke.

BACKGROUND: The presence of abnormal muscle activation patterns is a well documented factor limiting the motor rehabilitation of patients following stroke. These abnormal muscle activation patterns, or synergies, have previously been quantified in the upper limbs. Presented here are the lower limb joint torque patterns measured in a standing position of sixteen chronic hemiparetic stroke subjects and sixteen age matched controls used to examine differences in strength and coordination between the two groups. METHODS: With the trunk stabilized, stroke subjects stood on their unaffected leg while their affected foot was attached to a 6-degree of freedom load cell (JR3, Woodland CA) which recorded forces and torques. The subjects were asked to generate a maximum torque about a given joint (hip abduction/adduction; hip, knee, and ankle flexion/extension) and provided feedback of the torque they generated for that primary joint axis. In parallel, EMG data from eight muscle groups were recorded, and secondary torques generated about the adjacent joints were calculated. Differences in mean primary torque, secondary torque, and EMG data were compared using a single factor ANOVA. RESULTS: The stroke group was significantly weaker in six of the eight directions tested. Analysis of the secondary torques showed that the control and stroke subjects used similar strategies to generate maximum torques during seven of the eight joint movements tested. The only time a different strategy was used was during maximal hip abduction exertions where stroke subjects tended to flex instead of extend their hip, which was consistent with the classically defined "flexion synergy." The EMG data of the stroke group was different than the control group in that there was a strong presence of co-contraction of antagonistic muscle groups, especially during ankle flexion and ankle and knee extension. CONCLUSION: The results of this study indicate that in a standing position stroke subjects are significantly weaker in their affected leg when compared to age-matched controls, yet showed little evidence of the classic lower-limb abnormal synergy patterns previously reported. The findings here suggest that the primary contributor to isometric lower limb motor deficits in chronic stroke subjects is weakness.

Journal Article↗

PubMed2007

The effect of eccentric exercise on position sense and joint reaction angle of the lower limbs.

Impaired position sense and impaired joint reaction angle of the lower limbs after muscle-damaging activities is a serious functional limitation that may lead to an increased risk of injury, particularly in older populations. The purpose of the present study was to examine whether position sense and joint reaction angle to release can be affected by eccentric exercise-induced muscle damage. Twelve women underwent an isokinetic exercise session of the lower limb. Isometric peak torque, delayed-onset muscle soreness, serum creatine kinase, position sense, and knee joint reaction angle to release were examined before, immediately after, and 24, 48, and 72 h post-exercise. Due to the effect of eccentric exercise, subjects persistently placed their lower limb at a more extended position, representing a shorter knee extensor muscle. Eccentric exercise increased the knee reaction angle of the lower limb after release from 0 degrees and 15 degrees but not from 30 degrees and 45 degrees . Position sense and joint reaction to release were similarly affected by eccentric exercise and independently of visual feedback. Position sense was impaired only immediately post-exercise (probably due to muscle fatigue), whereas impairment of the reaction angle to release persisted up to 3 days post-exercise (probably due to muscle damage). Attenuation of position sense and joint reaction angle of the lower limbs after damaging activities is a serious functional limitation that may lead to an increase risk of injury, particularly in older populations.

Adult↗

PubMedDate not supplied

Severe lower limbs lymphedema following breast carcinoma treatment revealing radiation-induced constrictive pericarditis--a case report.

In patients treated for breast carcinoma, unilateral lymphedema of the upper limb is usual. However, to the authors' knowledge, lower limb lymphedema has never been reported as a complication of breast carcinoma therapy. They report here the first case of a radiation-induced constrictive pericarditis revealed by severe lower limbs lymphedema. A 60-year-old woman was treated for left breast carcinoma with quadrantectomy, axillary lymphadenectomy, and combined radio chemotherapy (60 grays). Three and a half years later she suffered from a diffuse and increasing lower limbs lymphedema, which became huge and disabling. Radiation-induced constrictive pericarditis was evidenced by right cardiac cavities catheterization. A dramatic improvement was rapidly obtained after pericardectomy. Histopathologic analysis of the pericardium did not reveal neoplastic cells. Radiation-induced constrictive pericarditis is usually responsible for lower limbs edema, but lymphedema is exceptional. This case highlights the need to search for a constrictive pericarditis also in the case of lower limbs lymphedema, particularly in a patient treated with mediastinal radiotherapy or combined radio chemotherapy.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2005

Impaired visuo-motor skills in the unaffected lower limb of patients with stroke.

To study the motor skills of the unaffected lower limb of patients with stroke, the visuo-motor skills of the unaffected lower limb in patients with stroke was compared with those in healthy control subjects using a computerized motor skill analyzer that calculated the accuracy in the tracking task in terms of lap time and trajectory error. Trajectory errors in the task by the unaffected lower limb in the patients with stroke were significantly greater than those in the lower limb of healthy control subjects. These results suggest that patients with stroke have impaired visuo-motor skills of the unaffected lower limb.

Adult↗

PubMed2001

Visual demonstration of calcium accumulation in human arteries of upper and lower limbs.

To elucidate the calcium content of the arteries in the upper and lower limbs, the authors determined the calcium content of all the arteries in the upper and lower limbs continuously by microwave-induced plasma-atomic emission spectrometry. The subjects were an 87-yr-old man and a 72-yr-old woman. The calcium content was determined both in the arteries of the upper limbs continuously, such as the subclavian arteries and its distal arteries, and in the arteries of the lower limbs, such as the common iliac arteries and its distal arteries. The common finding that the higher accumulation of calcium occurred in the arteries of the lower limbs in comparison to the arteries of the upper limbs and extremely high accumulation of calcium occurred in the common, external, and internal iliac arteries was obtained in the two subjects. The calcium content of the arteries in the upper and lower limbs was visually demonstrated.

Aged↗

PubMed1994

Foot types and lower limb injuries in elite netball players.

In assessing the foot types and lower limb injuries of elite netball players, the following summary seems warranted. Ninety percent of elite female netball players had symmetrical foot types for both feet and these players had experienced at least one lower limb injury. Only 7.6% players (N = 16) of the 204 players surveyed had never sustained a lower limb injury during their netball careers. Regardless of foot type, the injury history of these elite netball players presented with a total number of 449 injuries that occurred to both ankle joints (36%), one ankle joint (16%), both knee joints (6%), one knee joint (13%), shin soreness (18%), and retropatellar pain problems (11%). On further inspection, 55% of players experienced one to two lower limb injuries throughout their netball careers. Injured players showed that players with the pronating foot types with rearfoot abnormalities (57%) were the most commonly injured and that compensated rearfoot varus foot type presented the most lower limb injuries for all body sites.

Adolescent↗