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PubMed2002

Both Trevor and Ollier disease limited to one upper extremity.

A case is presented of a young boy in whom features of Trevor's dysplasia epiphysealis hemimelica and Ollier's enchondromatosis coexisted in a single extremity, the right upper. As Trevor disease consists of osteochondromas of epiphyses and their equivalents, such as carpal and tarsal bones, it is of interest that exostosis-like centers of the neck of radius and perhaps the proximal third metacarpal are present as well. Advanced maturation of selected centers was most marked at the right scaphoid. The child shows alignment abnormalities as a consequence of the varied lesions, including a varus of the right wrist. The coexistence of these varied osteochondromatous abnormalities in one extremity suggests a relationship in their etiologies.

Arm↗

PubMed1986

Arterial embolism of the upper extremities.

The angiographic signs, the frequency and the site of distribution of acute emboli of the arteries of the upper extremity are described. The conclusions are based on the author's own experience gained from selective studies of acute arterial embolism of the upper limb, during a period of 15 years. A comparison is made with the results of two of the largest series reported in the literature. In addition, a brief review of the aetiology, pathogenesis, the clinical and roentgenological signs of the condition is given.

Adult↗

PubMed1978

Chronic upper extremity arterial insufficiency. Etiology, manifestations, and operative management.

Forty-eight arterial reconstructions were performed for chronic upper extremity ischemia in 43 patients, aged 31 to 81 years. Diagnostic arterial catheterization was the most frequent cause of symptomatic occlusion, followed by proximal arteriosclerotic lesions and noniatrogenic trauma. Doppler ultrasound evaluation provided important diagnostic and prognostic data that complemented information derived from arteriography. Indications for operation included disabling claudication (39 cases) or digital gangrene (four cases). Restoration of normal extremity function can be anticipated except in instances where poor forearm runoff exists. Autogenous saphenous and basilic interposition vein grafts have proved excellent for axillary-brachial revascularizations. Axillary-axillary bypass procedures for innominate-subclavian artery occlusions appear hemodynamically sound and technically simple. Follow-up, averaging 48 months, extended to 144 months. Late vein graft failure or progressive distal occlusive disease was not encountered.

Adult↗

PubMed2000

Patterns and predictors of employer risk-reduction activities (ERRAs) in response to a work-related upper extremity cumulative trauma disorder (UECTD): reports from workers' compensation claimants.

BACKGROUND: Despite being preventable, work-related upper extremity cumulative trauma disorders (UECTDs) remain problematic. This study is unique in its focus on predictors of employer risk-reduction activities (ERRAs) in response to a UECTD case. METHODS: Workers' compensation claimants (N = 537) completed a telephone survey about employer risk-reduction activities, workplace characteristics, safety programs, and physician recommendations for job modifications. RESULTS: Only 52% of respondents reported employer actions to investigate or reduce UECTD risk. Engineering and pace changes were prominent for keyboard workers and transfer to another job for manufacturing workers. Safety programs and physician recommendations increased the likelihood of risk-reduction activities. CONCLUSIONS: An opportunity to intervene post-injury to reduce risks for the injured worker and prevent new UECTD cases is being missed. Physician recommendations are strongly associated with specific ERRAs thought to be most effective. Educating employers and physicians about ergonomics could result in prevention of UECTDs.

Adult↗

PubMed1984

Experimental foundations of EMG biofeedback with the upper extremity: a review of the literature.

This article reviews the experimental foundations of EMG biofeedback with the upper extremity. Considered are investigations on recruitment and training of single and multiple motor units in both normal and nonnormal subjects, on transfer of training effects from trained to untrained muscles, and on the relationship of reduced muscle output to relaxation. Examined are procedures, results, and conclusions of these basic studies. Problems noted in the research are discussed and suggestions are made for further work in the area.

Arm↗

PubMed2000

Salvage of the upper extremity in cases of tumorous destruction of the proximal humerus.

Malignant bone tumours or metastasis of the upper humerus may cause significant loss of function especially in those patients with resectional arthroplasty of the shoulder. One method for achieving functional reconstruction of the humerus concerned is replacement with a modular endoprosthesis. Little is known about clinical and radiological results in these rare circumstances. Between 1993 and 1997 we treated 21 patients (22 shoulders) with enlarged osteolytic destructions of the proximal humerus caused by metastatic spread or primary malignant tumours. Patients with additional involvement of the glenoid were excluded from this study. The average follow-up was 3.9 years. Every 3 months all patients were followed-up clinically and radiographically. Prior to surgery, diagnosis was established by incisional biopsy and the outcome determined the therapeutic algorithm (radiotherapy, chemotherapy, surgery). In most cases of metastatic lesions, surgery was the first treatment. According to the regional spread of the tumour, various amount of bone and soft tissues had to be removed. The distal stem of the prosthesis was inserted in a cementless way and secured to bone with two interlocking screws. The length of the diaphyseal part depended on the site of osteotomy. Soft-tissue coverage of the large implant was achieved in all patients. Early complications were lymphogenic oedema and superficial wound dehiscence. One patient developed a deep infection, which had to be managed surgically. According to the functional rating system of the Musculoskeletal Tumour Society for the upper extremity the overall results were inversely proportional to the extent of resection. None of our patients achieved unrestricted motion of the shoulder concerned. The most important finding was a proximal migration of the prosthesis causing a painful subacromial impingement, mainly a consequence of the resection of the deltoid muscle and the rotator cuff. In summary, a modular endoprosthesis cannot be recommended generally as the method of choice. If the muscular balance of the shoulder is too weak to act as a joint centralizer the endoprosthesis has no advantage over a simple diaphyseal spacer.

Adult↗

PubMed2001

Determinates of functional disability after complex upper extremity trauma.

This is a retrospective chart review of 71 patients who were operated on for presumed upper extremity arterial trauma between June 1992 and June 1998. Penetrating trauma occurred in 50 (70%) patients, and blunt trauma in 21 (30%). There were 2 innominate, 6 subclavian, 13 axillary, 26 brachial, 5 radial, 6 ulnar, and 6 multiple arterial injuries. There were 7 negative explorations (4 venous injuries, 2 false-positive angiograms, and 1 branch artery injury). In addition to the vascular injury, 44 patients (69%) had another injury in the extremity, including 8 (12.5%) orthopedic injuries, 12 (19%) nerve injuries, and 24 (37.5%) combination nerve and orthopedic injuries. There were three arterial thromboses, one arterial disruption, and four amputations, resulting in a patency rate and limb salvage rate of 94%. Persistent disability was more common in those patients with blunt injury (p = 0.02) and in those patients with associated neurologic and orthopedic injuries (p < 0.05). Full functional recovery was seen in 21 (33%) patients, while some form of disability was noted in the remaining 67%. The magnitude of the concomitant neurologic injury was the major determinate of functional outcome in this patient population.

Adolescent↗

PubMed2004

MR imaging of tumors and tumor-like lesions of the upper extremity.

Many tumor and tumor-like lesions of the bone and soft tissues may involve the upper extremity. Certain lesions, however, are unique to this location. As is usually the case, MR is most sensitive to detection and most accurate in depicting the extent of involvement of these lesions. MR signal characteristics may aid in differential diagnosis. Conventional radiographs are often more specific in regard to the underlying histopathology.

Arm↗

PubMed1980

The management of upper extremity pit viper wounds.

In a series of 56 rattlesnake bites, there were 31 injuries involving the upper extremity and hand with a clinical complication rate of 32% that ranged from Volkmann's contracture to coagulopathies. The most frequent was tissue necrosis with functional joint stiffness and loss of sensibility. Because these patients were treated with a variety of regimens, an animal model was developed to determine the efficacy of the individual treatments. Sublethal intramuscular injections of Crotalus atrox venom were made in the extremity of New Zealand white rabbits. Tissue reaction monitored by swelling and hemorrhage was decreased significantly (P less than 0.05) with antivenin and antivenin-steroids, but no treatment modality prevented tissue necrosis. Clinical and laboratory experience indicates that one cannot rely on injectable medications to prevent tissue necrosis in pit viper envenomations and that operative treatment should be used in conjunction with other forms of therapy.

Adolescent↗

PubMed2005

Bilateral upper extremity thrombophlebitis related to intravenous amiodarone: a case report.

A 47-year-old male had bilateral upper extremity thrombophlebitis after use of intravenous amiodarone for sustained ventricular tachycardia complicating myocardial infarction. Intravenous amiodarone has been widely used since it was introduced 20 years ago for severe intractable arrhythmias. Superficial thrombophlebitis was frequently noted in the early case reports when high-dose intravenous amiodarone was used. Superficial thrombophlebitis could extend hospitalization and become a significant source of distress to our patients. Some authors recommend insertion of a central line to administer intravenous amiodarone especially with expected extended use of therapy. The treating physician should be vigilant and switch from intravenous therapy to oral therapy as soon as the patient's condition stabilizes and oral therapy can be started.

Amiodarone↗

PubMed1996

Development of an upper extremity FES system for individuals with C4 tetraplegia.

The application of functional electrical stimulation (FES) to provide upper extremity function for individuals with C4 tetraplegia is under investigation. In this study, a FES system was designed that allowed one individual with complete C4 tetraplegia to coordinate stimulated lateral or palmar prehension with stimulated arm movements using contralateral shoulder position. The system consisted of percutaneous intramuscular electrodes implanted to muscles for hand grasp and release, supination, elbow flexion, and extension and arm adduction. Due to peripheral denervation, transposition and subsequent stimulation of the paralyzed latissimus dorsi muscle provided elbow flexion and transfer and stimulation of the paralyzed extensor carpi ulnaris muscle provided forearm supination. A suspended sling provided shoulder joint stability. The subject controlled stimulation proportionally using contralateral shoulder motion sensed by a position transducer. Control of stimulated hand grasp and release were coupled with stimulated arm motions so that hand-to-mouth activities could be accomplished with one motion of the contralateral shoulder. With this system, the subject was able to grasp a milk carton placed in the hand and lift and lower it from his mouth to drink from a short straw. He could also scoop a semisolid substance with an adapted spoon and lift and lower it from the work surface to his mouth to eat. The subject required assistance to place the milk carton or spoon in his hand and position the plate for scooping. Further investigation is needed to generate the necessary arm movements to make completion of these tasks possible without assistance and to expand the range of activities possible with the FES system.

Accidents, Traffic↗

PubMed1987

Focal cervical poliopathy causing juvenile muscular atrophy of distal upper extremity: a pathological study.

A new clinical entity under the name of "juvenile muscular atrophy of unilateral upper extremity" was first described in 1959. Although about 150 cases in Japan, and several additional cases in other countries, have been clinically reported in the literature, the pathology has remained unknown because of the benign course of the disease. The first necropsy findings are reported, obtained from a patient with this disease, who died of lung cancer at the age of 38, 23 years after the onset of the disease. The lesions existed only in the anterior horns of the spinal cord at C5 approximately T1, particularly marked at C7 and C8, showing shrinkage and necrosis, degeneration of various degrees of large and small nerve cells, and mild gliosis. The pathological findings differ from those of reported cases of spinal vascular disorders, but some circulatory insufficiency in the territory of the spinal cord would seem to be suggested, although the underlying aetiology remains unknown.

Adult↗

PubMed1975

Bone and soft tissue abnormalities of the upper extremity in diabetes mellitus.

Roentgenographic evidence of bone and soft tissue abnormalities may be noted in the upper extremities of diabetics. Major shoulder changes, typically associated with peripheral neuropathy, include humeral head deformity due to bone resorption, joint space narrowing, subchondral cysts and sclerosis, subluxation, and juxtra-articular soft tissue bone fragments. Charcot-type joints, characterized by severe joint destruction, sclerosis, multiple bone fragments, and soft tissue swelling may occur. Diabetic neuropathy can produce flexion contractures of the hand. Abnormalities not necessarily associated with clinical neuropathy include cystic bone changes, cortical bone erosions, soft tissue calcification (calcific tendinitis), and vascular calcification.

Aged↗

PubMed1992

Motor recovery of the upper extremities in traumatic quadriplegia: a multicenter study.

Clinicians need to know recovery of neurologic function in the upper extremities after traumatic quadriplegia to prognosticate function in self-care, to determine the effectiveness of various interventions, and to develop a comprehensive rehabilitation plan. This study was undertaken to determine the extent of recovery of key muscles of the arms in motor complete quadriplegic subjects. The hypothesis stated that patients with some motor power (grades 1.0 to 2.5/5) in muscles in the zone of partial preservation would recover at an earlier time and to a greater extent than those with no motor power (grade 0/5). One hundred fifty subjects, C4, C5, and C6 motor complete, were entered in the study within one week of injury from four centers. Serial muscle examinations of the biceps, wrist extensors, and triceps on the right and left sides were performed up to 24 months after spinal cord injury. The pattern of recovery in the key muscles of the 67 subjects with some motor power in the zone of partial preservation to grade 3/5 was significantly greater than the 83 subjects with no motor power (68% to 82% vs 14% to 36%, p less than .001) at three to six months postinjury. The plateau of the median manual muscle test score determined the extent of recovery and reached grade 4/5 in subjects with some motor power at three to six months. The pattern of recovery revealed more subjects with some motor power improved to grade 3/5 at all intervals earlier than those with no motor power (p less than .005).(ABSTRACT TRUNCATED AT 250 WORDS)

Arm↗

PubMed1989

Congenital anomalies of the upper extremity.

This article has reviewed some of the current methods of management of congenital problems in the upper extremity. Not all problems have been included in this review but some of the landmark advances in this field have been considered. The management of congenital anomalies may change significantly in the future.

Arm↗

PubMed1987

[Indications for preventive axillary lymphadenectomy in melanoma of the skin of the upper extremity].

Based upon clinico-morphological analyses of data of 79 patients with primary melanomas of the upper extremity skin the authors have found 3 risk factors of the regional metastasing process. It was shown that in patients having these risk factors there is 50% higher probability of regional metastases of melanomas which may be taken as indications for performing prophylactic axillary lymphadenectomy in such patients.

Axilla↗

PubMed1976

Chemical injuries of the upper extremity.

The prompt recognition and management (Tables 8-1 and 8-2) of chemical burns of the upper extremity may prevent injury to the deep structures of the hand and may make the difference between satisfactory rehabilitation and crippling deformities. Immediate irrigation with water is the single most important treatment that can be carried out, and should be continued for at least an hour and often for several hours, depending on the severity of the injury. Precious time should not be wasted hunting for a specific neutralizing agent. Hydrofluoric acid injuries and phosphorus injuries are the two exceptions to this principle. After copious irrigation and débridement, small superficial burns may be treated without dressings or topical therapy. Large partial-thickness burns are best treated with Sulfamylon burn cream and then with with biologic dressings until healing is achieved. Full-thickness injuries of limited extent should be excised and skin-grafted to regain maximum function, and more extensive burns treated in a nonexicisional regimen.

Acids↗

PubMed1979

Free flap transfers for upper extremity reconstruction.

Ihre clinical cases are presented using different donor sites for free flap transfer to the upper extremity. The advantages and disadvantages of the 3 donor sites namely Iliofemoral, dorsalis pedis and latissimus dorsi are discussed.

Adolescent↗