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At least 1,099 records · Page 61Linked to original sources
PubMed1995

Decision making in upper extremity problems in the elderly.

As life expectancy continues to increase, orthopaedists must become more knowledgeable about upper extremity problems common to geriatric patients. Alternatives to direct repair of certain soft tissue injuries must be considered, because of their diminished healing ability and the morbidity associated with prolonged immobilization. Osteoporosis present in these patients affects surgical management of difficult fractures. Acquired soft tissue disorders such as nerve compression and Dupuytren's contractures often will require operative intervention to improve hand function. Osteoarthritis and rheumatoid arthritis disproportionately affect this age group. A variety of conservative and operative treatments are available to improve quality of life in these patients.

Aged↗
PubMedDate not supplied

Tunnel syndromes of the upper extremities in workers using hand-operated vibrating tools.

Neurological and electrophysiological (EMG, ENG) examinations of the upper extremities were carried out in 167 patients exposed to hand-arm vibrations. All patients had typical symptoms (Raynaud's phenomenon and/or numbness, muscle weakness). The results showed that the circumscribed lesions of the tunnel nerves are far more common (92.8%) than diffuse peripheral neuropathies (22.7%). The most common alteration (71.4% below the border-line values) was the lesion of the brachial plexus in the thoracic outlet. In 16.2% of the patients compression of the subclavian artery was also demonstrated by means of a Doppler flowmeter. Cubital tunnel syndrome was observed in 42.5% of the patients. The results suggest that hand-arm vibration can play a part in the development of the thoracic outlet and cubital tunnel syndromes. On the other hand the thoracic outlet syndrome can contribute to the development of vibration-induced Raynaud's phenomenon.

Adult↗
PubMedDate not supplied

Occupational contact dermatitis of the upper extremity.

Workers in certain occupations are at particular risk for developing contact dermatitis of the hand and upper extremity. Recently published findings concerning risks faced by food handlers, hairdressers, and horticulturists are addressed here. Preventive measures, including protective clothing and barrier creams, also are discussed.

Beauty Culture↗
PubMed1997

Pulmonary embolism in deep venous thrombosis of the upper extremity: more often in catheter-related thrombosis.

BACKGROUND: Pulmonary embolism (PE) is a major complication of deep venous thrombosis (DVT) of the lower extremities. The incidence is approximately 50%. The incidence of DVT of the upper extremity (DVTUE) is increasing mainly due to the increasing use of central venous catheters. The percentage of PE secondary to DVTUE is still being investigated. METHODS: The occurrence of PE in DVTUE was retrospectively analyzed in 78 patients with proven DVTUE. Furthermore, the literature was reviewed. RESULTS: Of the identified patients with DVTUE 16 showed a primary DVTUE and 62 a secondary DVTUE. Secondary DVTUE was catheter-related in 41 (60%), which is 53% of all DVTUE. In this study the percentage of PE as a complication of DVTUE was 6 (95% CI: 0.2-30) in primary DVTUE, 13 (95% CI: 6-24) in secondary DVTUE and 17 (95% CI: 7-32) in catheter-related DVTUE. The relative risk for PE of catheter-related DVTUE versus other causes was 3.4 (95% CI: 0.4-53.5). The overall percentage was 12 (95% CI: 5-21). The literature review showed a percentage of 7 (95% CI: 4-9) in the retrospective studies and 17 (95% CI: 12-23) in the prospective studies. CONCLUSIONS: Indwelling catheters are the most common cause of DVTUE. PE is not an uncommon complication of DVTUE, and is more common in catheter-related DVTUE. The difference between the incidence of PE in DVTUE and DVT of the lower extremity may be explained by a number of factors, such as differences in fibrinolytic activity, mechanical forces and venous flow patterns.

Adult↗
PubMed2000

Nerve transfers in the upper extremity.

Restoration of extremity function following nerve injury is often unpredictable. Nerve transfers in the upper extremity are important techniques in the management of many types of peripheral nerve injury. The physiologic principles of nerve transfer lead to the indications for use. The elements of planning and execution of common nerve transfers are presented in this article.

Arm↗
PubMed2003

Entrapment neuropathies of the upper extremity.

Symptoms of entrapment neuropathies are often intermittent, making the diagnosis a challenge; pain, paresthesias, exertional fatigue, weakness, and atrophy may be present. An accurate, detailed history and physical examination, often after activity, is essential to make an accurate diagnosis. Laboratory, radiographic, and electromyographic studies may be helpful, but are often normal. This article reviews the etiology, evaluation, and treatment of the most common upper extremity entrapment neuropathies related to sports participation. Most conditions respond to conservative measures of rehabilitation exercises, relative rest, correction of training and equipment errors, anti-inflammatory medications, and protective padding or bracing; occasionally surgical intervention is necessary.

Humans↗
PubMedDate not supplied

Extensive upper extremity arterial thrombosis as the initial manifestation of nephrotic syndrome.

The metabolic derangement and resultant hypercoagulable diathesis associated with nephrotic syndrome (NS) has been clearly defined. Although venous thrombosis is frequently encountered in NS, arterial thrombosis is rare. This report describes an index case of a patient without known renal disease who presented with spontaneous arterial thrombosis of an upper extremity as the initial manifestation of NS. The case was complicated by subsequent deep venous thrombosis and pulmonary embolus in the absence of a patent foramen ovale. The patient was successfully treated with brachial artery thrombectomy followed by anticoagulation and immunosuppressive therapy. A renal biopsy was considered, but this would have required interruption of anticoagulation. This case illustrates the importance of performing a simple screening urinalysis for occult protein in patients with unexplained venous or arterial non-embolic thrombosis.

Adult↗
PubMed2004

Shrinkage of somatosensory hand area in subjects with upper extremity dysmelia revealed by magnetoencephalography.

The effect of peripheral lesions on cerebral somatosensory representations is well studied for experimentally induced amputations and deafferentations acquired later in life. However, few studies have investigated the brain's capacity for plastic changes in congenital malformations. We studied somatosensory-evoked fields to electrical stimulation of the bordering fingers in 10 subjects with upper extremity dysmelia in comparison with 10 control subjects using a 122-channel whole-head magnetometer. The number of developed fingers varied between two and four in the affected subjects. We localized finger representations in the primary somatosensory cortex and calculated Euclidian distances to estimate the size of the somatosensory hand area. Euclidian distances were significantly smaller in dysmelic subjects (5.7 mm) than in control subjects (11.6 mm) and were related to the number of the developed fingers on the contralateral hand. In contrast, individual finger representations were not found to be reduced. We suggest that the shrinkage of the somatosensory hand area might be related to the congenital nature of the malformation, to the smaller anatomical hand size in the affected subjects, and/or to use-dependent effects due to impaired hand function.

Adult↗
PubMed2005

Upper extremity mononeuropathy among engineers.

OBJECTIVES: The objectives of this study were to estimate the prevalence of mononeuropathy at the wrist among engineers who use computers and to identify associated risk factors. METHODS: This is a cross-sectional study of 202 engineers using questionnaires and electrophysiological nerve testing. The definition for median or ulnar mononeuropathy required the combination of distal upper extremity discomfort and abnormal distal motor latency. RESULTS: The prevalence of neuropathy at the wrist among engineers was 10.3% (right median), 3.4% (left median), 1.8% (right ulnar), and 2.9% (left ulnar). Logistic regression analysis identified three variables with positive associations (body mass index, hours of computer use, and antihypertensive medication) and three variables with negative associations (typing speed, driving hours, total break time). CONCLUSIONS: Mononeuropathies at the wrist occur among computer-using engineers and are related to a number of factors, including hours of computer use.

Adult↗
PubMed2005

Segmental zoster paresis of the upper extremity: a case report.

Segmental zoster paresis, a rare complication of herpes zoster, is characterized by focal, asymmetric motor weakness in the myotome that corresponds to the dermatome of the rash. The pathogenesis of segmental zoster paresis is inflammation caused by the spread of the herpes virus. Motor damage may affect the root, plexus, or peripheral nerve. A woman in her early seventies with right shoulder pain and shoulder girdle muscle weakness was diagnosed with involvement of the C5-7 motor roots and upper truncus of the brachial plexus as a complication of herpes zoster. Recognition of herpes zoster as a cause of acute motor weakness is important in avoiding unnecessary interventions as well as in determining the treatment and outcome of the patient. This case is presented to emphasize that herpes zoster infection may be complicated by segmental paresis, which should be considered in the differential diagnosis of acute painful motor weakness of the upper extremity.

Aged↗
PubMed1991

Monobloc resection of the upper extremity of the leg for bone tumor with distal vascular reconstruction.

A patient with juxtacortical osteosarcoma of the upper extremity of the left tibia which encased the popliteal neurovascular bundle was treated by monobloc resection of the superior extremity of the tibia and the tibial nerve. The knee joint was replaced by a Guepar prosthetic knee. Arterial and venous continuity was reestablished by a double bypass using the contralateral greater saphenous vein. One year later the patient had good lower limb function and was free of local or general disease. This observation confirms that preservation of lower limb function is possible using reconstruction techniques of bone, nerves, and vessels in sarcoma of the musculoskeletal system.

Adult↗
PubMed2003

[Musculoskeletal disorders of the upper extremity associated with work: from presentation to work maintenance].

The so called Musculo-Squeletal-Disorders in the upper extremity are frequent and are responsible for a significant cost. The increase in registered work-related affections has been quite impressive in the past few years. The type of social undertaking is determinant on the evolution and final outcome of the pathology. Our proposal for a "Passport to work continuation" follows two goals: facilitate and enhance the relations between medical and social workers concerned by the patient's course reduce the time off-work, improve prevention of work related pathologies, avoid dismissal for inaptitude, start earlier a vocational training, a rehabilitation or an adaptation of the work station.

Arm↗
PubMed1997

The combined scapular/parascapular flap for the treatment of extensive electrical burns of the upper extremity.

The combined scapular parascapular flap was used for coverage of six high voltage electrical burn defects of upper extremity. The flaps resurfaced the exposed tendon, nerve, bone or blood vessels on the volar and dorsal side of the distal forearm and the hand. In all cases successful soft tissue coverage and wound healing was achieved. After the stabilisation of the wounds, secondary reconstructive procedures, such as nerve grafting, tendon grafting, tendon transfers were performed. Nerve healing and tendon gliding was found to be successful under the flap.

Adult↗
PubMed1998

Pain responses in patients with upper-extremity disorders.

The purpose of this study was to evaluate the relationship between pain response factors and upper-extremity disorders associated with work-related compensable disorders. In this retrospective study, the charts of 113 patients were examined. Compensation was not found to have any statistically significant association with pain levels. The degree of functional overlay in these patients, indicated by pain questionnaire scores, differed only slightly between compensated and noncompensated patients and indicated no significant difference between the 2 groups, except that the compensated group used a higher number of descriptors to describe their pain (p = .0143). These results indicate that compensation affects the verbalization of pain but does not affect the degree of pain experienced. Working status was found to be significantly correlated with a better ability to cope with stress at home, suggesting that employment status may be a more important factor than compensation status in the presentation of these patients.

Adaptation, Psychological↗
PubMed1992

Management of acute arterial trauma of the upper extremity.

During a 3.5 year period ending in September 1991, 50 patients with 51 arterial injuries of the upper extremity were operated on and followed up for more than 6 months. The majority of the cases suffered penetrating injuries, but in 18% blunt trauma led to thrombosis. The most frequently observed signs were haemorrhage, neurological disorders and a peripheral pulse deficit. The brachial artery was most frequently injured. Preoperative arteriography was performed in 20% and peroperative angiography in 16% of cases. Reconstructive surgery was performed in 88% and the brachial artery was ligated in a single patient who was in shock. An end to end anastomosis was possible in 55% and in 45% of cases an autogenous vein graft was used. A microsurgical technique was used in cases of forearm arterial injuries. In five patients with prolonged ischaemia, forearm fasciotomies were needed. Additional procedures such as venous, bone or nerve repair was also necessary. In four cases a temporary shunt was used. All patients were alive with late patency of 91% in the axillobrachial arterial segment. A single failure after repeated brachial artery reconstruction was observed following severe traumatic amputation with large tissue defects. Post-operative arteriography revealed a good anastomosis with patent grafts. Arterial reconstruction is clearly necessary in these injuries and we believe that an experienced vascular surgeon should be involved.

Adolescent↗
PubMed1999

Evaluation of the lower motor neuron integrity of upper extremity muscles in high level spinal cord injury.

PURPOSE: To evaluate the lower motor neuron (LMN) integrity of upper extremity muscles of persons with high tetraplegia (C1-C4) in order to determine muscles available for stimulation. METHODS: Fourteen subjects (23 arms) were evaluated for LMN integrity. Muscles that elicited a functional response (grade 3 or better) to surface electrical stimulation were considered to have intact LMN and good candidates for FES. Strength-duration (S-D) curves were generated on muscles that showed weak (less than grade 3) or no response to surface stimulation. Muscles were considered denervated if S-D curves were discontinuous or depicted steep, increasing amplitude for pulse durations greater than 1 m. RESULTS: Muscles for grasp and release had intact LMN in 19 of 23 (83%) arms. The wrist extensors and flexors and pronator were excitable in 17 (74%), 20 (87%) and 19 (83%) arms, respectively. The supinator demonstrated LMN lesion in 80% of the arms. Over 90% of the biceps muscles were unresponsive to electrical stimulation and 85% and 87% of the deltoid and supraspinatus muscles, respectively, were not electrically excitable. The latissimus dorsi and triceps muscles were typically innervated (78% and 91%, respectively) and slightly more than half (52%) of the pectoralis major muscles were excitable. CONCLUSION: These data suggest that application of FES in high tetraplegia for hand and arm function would require augmentation because of the inability to stimulate the elbow flexors, deltoid and rotator cuff muscles. These data also show that several paralyzed proximal muscles with intact LMN that have been historically transferred to address shoulder paralysis in other patient populations are available for transfer and stimulation in the population with high level spinal injuries.

Adolescent↗
PubMed2001

The reliability of the wolf motor function test for assessing upper extremity function after stroke.

OBJECTIVE: To examine the reliability of the Wolf Motor Function Test (WMFT) for assessing upper extremity motor function in adults with hemiplegia. DESIGN: Interrater and test-retest reliability. SETTING: A clinical research laboratory at a university medical center. PATIENTS: A sample of convenience of 24 subjects with chronic hemiplegia (onset >1yr), showing moderate motor impairment. INTERVENTION: The WMFT includes 15 functional tasks. Performances were timed and rated by using a 6-point functional ability scale. The WMFT was administered to subjects twice with a 2-week interval between administrations. All test sessions were videotaped for scoring at a later time by blinded and trained experienced therapists. MAIN OUTCOME MEASURE: Interrater reliability was examined by using intraclass correlation coefficients and internal consistency by using Cronbach's alpha. RESULTS: Interrater reliability was.97 or greater for performance time and.88 or greater for functional ability. Internal consistency for test 1 was.92 for performance time and.92 for functional ability; for test 2, it was.86 for performance time and.92 for functional ability. Test-retest reliability was.90 for performance time and.95 for functional ability. Absolute scores for subjects were stable over the 2 test administrations. CONCLUSION: The WMFT is an instrument with high interrater reliability, internal consistency, test-retest reliability, and adequate stability.

Adolescent↗