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At least 145 records · Page 8Linked to original sources
PubMed1997

Juvenile amyotrophy of the distal upper extremity: pathologic findings of the dura mater and surgical management.

STUDY DESIGN: Five cases of juvenile amyotrophy of the distal upper extremity were reviewed retrospectively to elucidate the pathophysiology of spinal cord dysfunction and the results of surgical management. OBJECTIVES: To clarify the pathogenesis of juvenile amyotrophy of the distal upper extremity and to present the results of a new surgical treatment. SUMMARY OF BACKGROUND DATA: Hirayama first reported this disorder in 1959. It is characterized by juvenile onset, slow progression, and involvement of the unilateral distal upper extremity. Recently, compression of the cervical spinal cord during neck flexion was implicated as a possible etiology of the disorder, but the exact etiology is still unknown. The value of surgical treatment for patients with juvenile amyotrophy of the distal upper extremity has not been established. METHODS: The clinical and radiographic characteristics of five patients with juvenile amyotrophy of the distal upper extremity were examined. All five patients were treated surgically with duraplasty in combination with posterior spinal fusion. Dynamic and computed tomographic myelography were performed before and after surgery. Intraoperative ultrasonography and conductive spinal cord evoked potentials were recorded before and after duraplasty. The surgical results and the histology of the resected dura were studied. RESULTS: Myelograms taken with the neck in a neutral position showed that the spinal cord was flattened in all five patients. When the neck was flexed, the dura and the spinal cord were compressed further. Intraoperative ultrasonography during neck flexion revealed an anterior shift of the spinal cord and decreased spinal cord pulsation. Amplitude of the conductive spinal cord evoked potentials decreased with neck flexion but increased after dural incision. Histologically, the dura appeared abnormal in that it contained few elastic fibers without the normal wavy structure. CONCLUSIONS: Juvenile amyotrophy of the distal upper extremity was characterized by inelastic dura that constricts and compresses the cervical spinal cord when the neck is in either a neutral or a flexed position. Abnormal dura appeared to be the cause of juvenile amyotrophy of the distal upper extremity. Duraplasty with spinal fusion are proposed as treatments.

Adolescent↗
PubMed2003

Rings and things on upper extremity radiographs of emergency patients.

Rings, intravenous lines, and other objects on the injured upper extremities of trauma patients are frequently overlooked by radiology and emergency department (ED) personnel. This can impair proper radiologic evaluation of the injured extremity as well as negatively affect the quality of the patient's treatment. A 1-week sample of radiographs of injured upper extremities from the ED of University Medical Center (UMC), Tucson, Arizona, showed that 20% of the studies (19 of 95) contained at least one object on the injured upper extremity, but only one radiology report (1.1%) mentioned such an object. A review of 2489 upper extremity ED radiology reports from January to June 2002 showed only 47 reports (1.9%) that mentioned the presence of an overlying object. It is important to educate radiology department and ED personnel to remove upper extremity jewelry and place necessary medical devices on noninjured extremities.

Journal Article↗
PubMed2005

Requirements for upper extremity motions during activities of daily living.

BACKGROUND: Functioning of the upper extremity after implantation of an endoprosthesis remains limited despite the achieved pain relief. Upper extremity kinematics can give insight into function after shoulder arthroplasty. Data on ranges of motion related to the performance of a selection of activities of daily living can aid the clinician in evaluating the outcome of the shoulder and elbow arthroplasties. METHODS: Cross-sectional descriptive study of range of motion and activities of daily living kinematics, conducted on non-impaired subjects. The shoulder and elbow motions of 24 healthy female subjects are measured with an electromagnetic tracking device while performing 8 range of motion tasks and five activities of daily living. The angles of shoulder and elbow are calculated during these tasks. RESULTS: A data set with upper extremity joint angles has been obtained. Large glenohumeral rotations are found for the tasks that require high elevation angles. Large axial rotations of the humerus are found for two of the activities of daily living tasks: the perineal care task and the hair-combing task. Large elbow flexions were seen in the following tasks: combing hair, washing the axilla and eating with a spoon. INTERPRETATION: This study shows a suitable method to describe range of motion and activities of daily living and can serve as a starting point for developing a database on how activities of daily living are performed in a larger population and which joint angles are required to perform these tasks. Results can be used to identify restrictions in upper extremity functioning in patients with shoulder impairments.

Activities of Daily Living↗
PubMed2001

Gender differences in upper extremity musculoskeletal complaints in the working population.

OBJECTIVES: This study analysed the association between gender and upper extremity musculoskeletal complaints, among the general working population and in various occupational groups. The hypothesis was tested whether the higher risk for women in the general working population for these complaints could partly be explained by differences in the distribution of men and women in occupations with different risks for the onset of upper extremity musculoskeletal complaints. METHODS: The data for this study came from cross-sectional questionnaire data from 16,874 employees categorised in 21 different occupational classes. Associations between gender and complaints of the upper extremities were analysed for the total study sample and for each occupational class separately. An adjustment was made for the variable 'occupational class' in the final model in order to study the impact of occupational gender segregation on gender differences in upper extremity complaints in the working population. RESULTS: In the total study sample, significantly higher risks of complaints of the neck, shoulder, elbow, and wrist among the women were observed. Within many occupational classes, women reported significantly higher risks than did men, in particular for complaints of the neck and shoulder. Adjustment for occupational class showed increased risks for female workers for complaints of the neck, shoulder, elbow, and wrist, hence, rejecting our hypothesis on occupational gender segregation as an explanation for the higher risks for upper extremity complaints among women in the general working population. CONCLUSIONS: This study confirmed the presence of gender differences in upper extremity musculoskeletal complaints among the working population and in many occupational classes, with female workers having the higher risk. The results, however, do not lend support to a differential occupational exposure theory as an explanation for the higher risks for these complaints among women in the general working population. Careful consideration of gender influence in ergonomic epidemiological studies is recommended.

Adult↗
PubMed1994

Evoked potential monitoring of the upper extremities during thoracic and lumbar spinal deformity surgery: a prospective study.

We prospectively investigated the usefulness of somatosensory evoked potential (SEP) monitoring to detect clinically significant peripheral nerve or brachial plexus compression in the upper extremities during spinal deformity surgery. All patients had bilateral median and ulnar nerve SEPs evaluated as a baseline, both intermittently throughout the surgical procedure and at termination of surgery. This information was correlated with pre- and postoperative upper extremity neurologic examinations. Twenty-five upper extremities in 21 patients had intraoperative SEP changes consisting of at least a 60% decline in amplitude or a 10% increase in latency. On many occasions, repositioning of the upper extremities improved the SEP responses to acceptable baselines. Overall, SEP monitoring of the upper extremities was 78% sensitive for detecting upper extremity sensory deficits, 100% sensitive for detecting combined sensory and motor deficits, and 98.5% specific for predicting normal postoperative upper extremity function. We recommend the simultaneous electrophysiologic monitoring of the upper and lower extremities during spinal surgery to allow identification of brachial plexus and/or peripheral nerve stretch/compression that may be amenable to intraoperative correction.

Adolescent↗
PubMed1997

Computer keyboard force and upper extremity symptoms.

This case-control study assessed whether office workers who report more severe levels of musculoskeletal symptoms of the upper extremities demonstrate higher levels of keyforce in comparison to controls with less severe symptoms. Office workers reporting working on computer keyboards for four hours per day were classified as cases or controls based upon a median split on a Composite Symptom Severity score (cases = 23, controls = 25). Keyboard force and keying rate were measured during a 15-minute keyboarding task. Measures of task-related discomfort, muscular fatigue, pain, upper extremity symptoms, psychological distress and force were collected at baseline, post-keyboard task, and recovery. Ratings of perceived effort and task credibility were also obtained. Measures of work demands, perceived job stress, and upper extremity strength and flexibility were also collected. The results indicated group equivalence on reported work demands and upper extremity strength. Cases were more likely to receive a medical diagnosis of upper extremity cumulative trauma disorder, awaken from sleep due to symptoms, report higher levels of pain during work, experience greater impact of pain on function, and report higher workload pressure and lower support. Cases generated significantly higher keyboarding forces than controls, although both groups produced forces well above that required to operate the keyboard (4-5 times activation force). Cases reported higher levels of upper extremity symptoms and discomfort than controls, and these measures were highest after the keyboarding task for both groups. No significant correlation between keyforce and key rate was observed in either group. Results suggest that generation of excessive force while working on a computer keyboard may contribute to the severity of upper extremity symptoms. Clinically, the findings suggest that evaluating how an individual worker performs keyboarding tasks, or his or her workstyle, may be helpful in the management of these symptoms and disorders.

Adult↗
PubMed1991

Upper extremity function in spina bifida.

Poor upper extremity function is often recorded in meningomyelocele patients. Only 2 of the 25 patients we assessed, 5 to 19 years old, showed normal upper extremity function in the clinical neurological examination and a timed hand function test simulating daily activities. Slow performance with unsystematic variability was typical. Poor hand function correlated strongly with hydrocephalus. A trend towards better performance with increasing age may indicate that the difficulties are overcome in some patients. While patients without hydrocephalus showed a near-normal distribution in the seven subtests, patients with hydrocephalus needed more time than normal children. Patients with shunt-treated hydrocephalus did not cope as well as patients without a shunt. Mean age in the three groups differed and may partly explain the differences.

Adolescent↗
PubMed1998

Prevalence of upper extremity symptoms and possible risk factors in workers handling paper currency.

The prevalence of upper extremity symptoms in the workforce is high, particularly in industries characterized by forceful, repetitive or awkward movements. A study was undertaken to assess the prevalence of upper extremity symptoms in bank workers in a paper currency processing operation and to examine the role of possible risk factors for these complaints. Thirty-nine workers of a total workforce of 47 were assessed with a questionnaire and physical examination. The questionnaire collected information about demographics, health status, symptom reporting, psychosocial work stressors and other work exposure characteristics. Overall, 59% of the workers reported having significant work-related upper extremity musculoskeletal symptoms in the preceding year, including 49% with neck and shoulder symptoms and 49% with arm and wrist symptoms. In this study the key predictive factor for upper extremity musculoskeletal symptoms was psychological job demands. The workers had similar ergonomic stressors (with little gradient of exposure) and therefore our results do not contradict the importance of ergonomic factors in the development of upper extremity symptoms. However, the results do suggest that within a group exposed to similar ergonomic stressors, psychological job demands may be an important factor associated with musculoskeletal symptoms.

Adult↗
PubMed1986

Civilian vascular trauma of the upper extremity.

One hundred forty-three patients with 163 upper extremity vascular injuries were reviewed. Penetrating trauma accounted for 94% of the injuries and blunt trauma for 6%. Absent pulses are not a completely reliable sign of upper extremity arterial injury. The most frequently injured upper extremity vessel is the brachial artery, followed in decreasing frequency by ulnar, radial, and axillary arterial injuries and axillary venous injuries. The most common technique of vascular repair was end-to-end anastomosis, followed by vein graft interposition. No amputations were required. Despite excellent results of vascular reconstruction, functional impairment due to associated nerve injuries was a distressingly predominant finding.

Arm Injuries↗
PubMed2004

Free vascularized bone transfer in limb salvage surgery of the upper extremity.

Salvage of the upper extremity following tumor resection may require reconstruction of massive bone defects. This more commonly results from malignant bone tumors, but defects requiring reconstruction also may occur following resection of locally aggressive benign tumors. Examples include osteosarcoma, chondrosarcoma, Ewing sarcoma, giant cell tumor, and certain soft tissue sarcomas invading bone. Obtaining satisfactory results using conventional bone grafting techniques is at best challenging when defects of substantial size are encountered. Free vascularized bone grafting procedures provide the appealing option of transferring living bone based on a vascular pedicle.

Animals↗
PubMed1989

Sickness absenteeism in an engineering industry--an analysis with special reference to absence for neck and upper extremity symptoms.

Neck and upper extremity symptoms (NES) are reported to increase among industrial workers. In order to quantify sickness absenteeism and relate it to some factors a questionnaire study was performed among 2,814 workers occupied at a Swedish engineering industry. Questions pertaining to age, sex, worker category, work with vibrating handtools, type of job and smoking habits were analyzed and correlated to sickness absenteeism for the previous year (1983). We found that the average days lost for personal illness was 17.2 days; 16.2 for men and 23.5 days for women. Ninety-four persons, 77 men and 17 women comprising 3.0% of all employees were sicklisted for NES corresponding to 3.3% of total sickness time lost. Blue-collar workers were sicklisted for NES five times more often than white collar workers and women in type 3 jobs (high NE stress), twice that of men occupied in the same type of job. Smokers had significantly higher absenteeism than non-smokers for any reason studied including NES. The study indicated a high prevalence of present NES problems (23%) but also that NES as a cause of leave of absence was relatively rare (3%).

Absenteeism↗
PubMed1980

Arterial occlusive disease of the upper extremity.

Twenty-five upper extremities were operated upon in 24 patients because of arterial occlusive disease. Transthoracic endarterectomy was performed in 4 patients with short central occlusions of the subclavian artery. In the remaining patients, various bypass procedures were performed using reversed autogenous veins or prosthetic grafts. There were 2 early and 6 late deaths. One prosthetic graft had to be removed 2 months after the operation because of infection. At follow-up, 9 months to 17 years after surgery, 11 bypass grafts were patent. One vein graft and one prosthetic graft had occluded. The surgical technique, types of graft to be used, and the relation to long-term patency are briefly discussed.

Adolescent↗
PubMed1992

Lymphangioma of the upper extremity.

Lymphangioma of the upper extremity is rare; its treatment is unstandardized. We reviewed five female and one male patient with cavernous lymphangioma of the hand and forearm. Each of them underwent at least one surgical procedure. Five patients had satisfactory results with cosmesis and hand function. Satisfactory results are expected in those treated initially in early childhood, as most lymphangiomas tend to increase gradually in size and infiltrate previously uninvolved normal tissues.

Arm↗
PubMed1991

The "Z" strap: harnessing modification for patients with upper extremity amputations.

High level, upper extremity amputees have been observed to have problems affecting overall prosthetic function. These include: tendency of the Northwestern Ring to ride upward and difficulty with terminal device function above 90 degrees of elbow flexion. A simple modification of the control strap was tried to resolve these problems of function. The control strap was attached across the back to a buckle on the unamputated side at the shoulder to provide a more efficient anchor. This created more body contact across the back and formed a type of "Z" strap allowing full freedom of movement in any direction. Less forward shoulder flexion was necessary due to decreased cable travel and because the strap was not sliding up and over the shoulder. A single case study is described and the successful outcome for the amputee.

Adult↗
PubMed1990

Soft tissue rheumatism of the upper extremities: diagnosis and management.

Upper extremity tendinitis and bursitis are usually the result of repetitive microtrauma, probably resulting in disruption of fibers. A focus of inflammation often occurs, producing pain, spasm, and disability. With a careful history and physical exam, the diagnosis can be made, distinguishing soft tissue rheumatism from arthritis. Treatment consists of rest, heat or ice, and frequently, the use of non-steroidal anti-inflammatory drugs or injections to control the inflammatory response. Protection from repeated trauma may be beneficial in preventing recurrence.

Aged↗
PubMed1978

[Embolisms of the upper extremities].

6 cases of upper extremity embolism observed over the past three years are reported. Fogarty embolectomy was carried out in all patients, favourable revascularization results being obtained in 5. Forearm amputations was necessary in 1 case owing to the presence of ischaemic lesions that were already advanced at admittance, further proof that results depend above all on the vitality of the extremity rather than on the duration of the arterial occlusion.

Adult↗
PubMed1993

Ergonomics for the upper extremity.

"Ergonomics for the Upper Extremity" provides a medical analysis framework integrated into ergonomic redesign concepts. Within the ergonomic redesign discussion, general design guidelines and standards are presented. For example, ergonomic stress on the wrist is discussed as it relates to arm function. Then, ergonomic design changes are introduced.

Anthropometry↗