Nakipoğlu, Güldal Funda; Dogan-Aslan, Meryem; Ozgirgin, Neşe
We investigated the effects of the complex regional pain syndrome (CRPS) type 1 on upper extremity rehabilitation in hemiplegic patients. Eighty patients were enrolled and were randomly assigned to either study (40 hemiplegic patients with CRPS) or control (40 hemiplegic patients without CRPS) groups. All patients participated in a hemiplegia rehabilitation program consisting of neurodevelopmental techniques, stretching and strengthening exercises, and conventional methods. Additionally, participants in the study group received analgesic and calcitonin therapy, elevation, range of movement therapy for the affected joints, and contrast baths. Clinical findings were assessed before and after rehabilitation using the upper-limb function (ULF), hand movements (HM), and advanced hand activities (AHA) subscales of the Motor Assessment Scale (MAS) and the Ashworth scale for upper extremities. A statistically significant difference in MAS ULF was apparent at admission and upon discharge in both groups. In the control group, a significant difference was found between MAS HM and MAS AHA on admission and at discharge, no difference was found in the study group for these parameters. No difference was found for either group with regard to the Ashworth scale. No between-group differences were found regarding MAS ULF, MAS HM, and MAS AHA at admission and at discharge. Our data showed no influence of CRPS on MAS ULF, MAS HM, and MAS AHA and the Ashworth scale for upper extremities.
Kim, Won-Seok; Cho, Sungmin; Baek, Dongyoub; Bang, Hyunwoo; Paik, Nam-Jong
Virtual home-based rehabilitation is an emerging area in stroke rehabilitation. Functional assessment tools are essential to monitor recovery and provide current function-based rehabilitation. We developed the Fugl-Meyer Assessment (FMA) tool using Kinect (Microsoft, USA) and validated it for hemiplegic stroke patients. Forty-one patients with hemiplegic stroke were enrolled. Thirteen of 33 items were selected for upper extremity motor FMA. One occupational therapist assessed the motor FMA while recording upper extremity motion with Kinect. FMA score was calculated using principal component analysis and artificial neural network learning from the saved motion data. The degree of jerky motion was also transformed to jerky scores. Prediction accuracy for each of the 13 items and correlations between real FMA scores and scores using Kinect were analyzed. Prediction accuracies ranged from 65% to 87% in each item and exceeded 70% for 9 items. Correlations were high for the summed score for the 13 items between real FMA scores and scores obtained using Kinect (Pearson's correlation coefficient = 0.873, P<0.0001) and those between total upper extremity scores (66 in full score) and scores using Kinect (26 in full score) (Pearson's correlation coefficient = 0.799, P<0.0001). Log transformed jerky scores were significantly higher in the hemiplegic side (1.81 ± 0.76) compared to non-hemiplegic side (1.21 ± 0.43) and showed significant negative correlations with Brunnstrom stage (3 to 6; Spearman correlation coefficient = -0.387, P = 0.046). FMA using Kinect is a valid way to assess upper extremity function and can provide additional results for movement quality in stroke patients. This may be useful in the setting of unsupervised home-based rehabilitation.
Baek, Dongyoub; Bang, Hyunwoo; Paik, Nam-Jong
Virtual home-based rehabilitation is an emerging area in stroke rehabilitation. Functional assessment tools are essential to monitor recovery and provide current function-based rehabilitation. We developed the Fugl-Meyer Assessment (FMA) tool using Kinect (Microsoft, USA) and validated it for hemiplegic stroke patients. Forty-one patients with hemiplegic stroke were enrolled. Thirteen of 33 items were selected for upper extremity motor FMA. One occupational therapist assessed the motor FMA while recording upper extremity motion with Kinect. FMA score was calculated using principal component analysis and artificial neural network learning from the saved motion data. The degree of jerky motion was also transformed to jerky scores. Prediction accuracy for each of the 13 items and correlations between real FMA scores and scores using Kinect were analyzed. Prediction accuracies ranged from 65% to 87% in each item and exceeded 70% for 9 items. Correlations were high for the summed score for the 13 items between real FMA scores and scores obtained using Kinect (Pearson’s correlation coefficient = 0.873, P<0.0001) and those between total upper extremity scores (66 in full score) and scores using Kinect (26 in full score) (Pearson’s correlation coefficient = 0.799, P<0.0001). Log transformed jerky scores were significantly higher in the hemiplegic side (1.81 ± 0.76) compared to non-hemiplegic side (1.21 ± 0.43) and showed significant negative correlations with Brunnstrom stage (3 to 6; Spearman correlation coefficient = -0.387, P = 0.046). FMA using Kinect is a valid way to assess upper extremity function and can provide additional results for movement quality in stroke patients. This may be useful in the setting of unsupervised home-based rehabilitation. PMID:27367518
Kho, Adeline Y; Liu, Karen P Y; Chung, Raymond C K
Studies have shown that mental imagery can enhance relearning and generalisation of function after stroke. The aim of this meta-analysis was to evaluate evidence on the effects of mental imagery on motor recovery of the hemiplegic upper extremities after stroke. A comprehensive data base search of the literature up to December 2012 was performed using PubMed, EBSCO host (Academic Search Premier, CINAHL and Educational Resource Information Center), PsycINFO, Medline, and ISI Web of Knowledge (Science Citation Index and Social Sciences Citation Index). Randomised clinical trials or controlled clinical trials that included mental imagery for improving upper extremity motor function for stroke patients were located. Relevant articles were critically reviewed and methodological quality was evaluated using the PEDro Scale, and study results synthesised. Five randomised clinical trials and one controlled clinical trial met the inclusion criteria. Five of the six studies yielded positive findings in favour of mental imagery. Quantitative analysis showed a significant difference in the Action Research Arm Test (overall effect: Z=6.75; P<0.001). Review of the literature revealed a trend in support of the use of motor imagery for upper extremity motor rehabilitation after stroke. Mental imagery could be a viable intervention for stroke patients given its benefits of being safe, cost-effective and rendering multiple and unlimited practice opportunities. It is recommended that researchers incorporate imaging techniques into clinical studies so that the mechanism whereby mental imagery mediates motor recovery or neural adaptation for people with stroke can be better understood. © 2013 Occupational Therapy Australia.
Batool, Sana; Soomro, Nabila; Amjad, Fareeha; Fauz, Rabia
Objective: To compare the effectiveness of constraint induced movement therapy versus motor relearning programme to improve motor function of hemiplegic upper extremity after stroke. Method: A sample of 42 patients was recruited from the Physiotherapy Department of IPM&R and Neurology OPD of Civil Hospital Karachi through non probability purposive sampling technique. Twenty one patients were placed to each experimental and control groups. Experimental group was treated with Constraint Induced Movement Therapy (CIMT) and control group was treated with motor relearning programme (MRP) for three consecutive weeks. Pre and post treatment measurements were determined by upper arm section of Motor Assessment Scale (MAS) and Self Care item of Functional Independence Measure (FIM) Scale. Results: Intra group analysis showed statistically significant results (p-value<0.05) in all items of MAS in both groups. However, advanced hand activities item of MAS in MRP group showed insignificant result (p-value=0.059). Self-care items of FIM Scale also showed significant result (p-value< 0.05) in both groups except dressing upper body item (p-value=0.059) in CIMT group and grooming and dressing upper body items (p-value=0.059 & 0.063) in MRP group showed insignificant p-values. Conclusion: CIMT group showed more significant improvement in motor function and self-care performance of hemiplegic upper extremity as compared to MRP group in patients with sub-acute stroke assessed by the MAS and FIM scales. Thus CIMT is proved to be more statistically significant and clinically effective intervention in comparison to motor relearning programme among the patients aged between 35-60 years. Further studies are needed to evaluate CIMT effects in acute and chronic post stroke population. PMID:26649007
Li, Yanran; Zhang, Xu; Gong, Yanan; Cheng, Ying; Gao, Xiaoping; Chen, Xiang
Quantitative evaluation of motor function is of great demand for monitoring clinical outcome of applied interventions and further guiding the establishment of therapeutic protocol. This study proposes a novel framework for evaluating upper limb motor function based on data fusion from inertial measurement units (IMUs) and surface electromyography (EMG) sensors. With wearable sensors worn on the tested upper limbs, subjects were asked to perform eleven straightforward, specifically designed canonical upper-limb functional tasks. A series of machine learning algorithms were applied to the recorded motion data to produce evaluation indicators, which is able to reflect the level of upper-limb motor function abnormality. Sixteen healthy subjects and eighteen stroke subjects with substantial hemiparesis were recruited in the experiment. The combined IMU and EMG data yielded superior performance over the IMU data alone and the EMG data alone, in terms of decreased normal data variation rate (NDVR) and improved determination coefficient (DC) from a regression analysis between the derived indicator and routine clinical assessment score. Three common unsupervised learning algorithms achieved comparable performance with NDVR around 10% and strong DC around 0.85. By contrast, the use of a supervised algorithm was able to dramatically decrease the NDVR to 6.55%. With the proposed framework, all the produced indicators demonstrated high agreement with the routine clinical assessment scale, indicating their capability of assessing upper-limb motor functions. This study offers a feasible solution to motor function assessment in an objective and quantitative manner, especially suitable for home and community use.
Li, Yanran; Zhang, Xu; Gong, Yanan; Cheng, Ying; Gao, Xiaoping; Chen, Xiang
Quantitative evaluation of motor function is of great demand for monitoring clinical outcome of applied interventions and further guiding the establishment of therapeutic protocol. This study proposes a novel framework for evaluating upper limb motor function based on data fusion from inertial measurement units (IMUs) and surface electromyography (EMG) sensors. With wearable sensors worn on the tested upper limbs, subjects were asked to perform eleven straightforward, specifically designed canonical upper-limb functional tasks. A series of machine learning algorithms were applied to the recorded motion data to produce evaluation indicators, which is able to reflect the level of upper-limb motor function abnormality. Sixteen healthy subjects and eighteen stroke subjects with substantial hemiparesis were recruited in the experiment. The combined IMU and EMG data yielded superior performance over the IMU data alone and the EMG data alone, in terms of decreased normal data variation rate (NDVR) and improved determination coefficient (DC) from a regression analysis between the derived indicator and routine clinical assessment score. Three common unsupervised learning algorithms achieved comparable performance with NDVR around 10% and strong DC around 0.85. By contrast, the use of a supervised algorithm was able to dramatically decrease the NDVR to 6.55%. With the proposed framework, all the produced indicators demonstrated high agreement with the routine clinical assessment scale, indicating their capability of assessing upper-limb motor functions. This study offers a feasible solution to motor function assessment in an objective and quantitative manner, especially suitable for home and community use. PMID:28335394
DeCoster, Thomas A.; Ritterbusch, John; Crawford, Mark
Significant upper extremity length inequality is uncommon but can cause major functional problems. The ability to position and use the hand may be impaired by shortness of any of the long bones of the upper extremity. In many respects upper and lower extremity length problems are similar. They most commonly occur after injury to a growing bone and the treatment modalities utilized in the lower extremity may be applied to the upper extremity. These treatment options include epiphysiodesis, shortening osteotomy, angulatory correction osteotomy and lengthening. This report reviews the literature relative to upper extremity length inequality and equalization and presents an algorithm for evaluation and planning appropriate treatment for patients with this condition. This algorithm is illustrated by two clinical cases of posttraumatic shortness of the radius which were effectively treated. ImagesFigure 1Figure 2Figure 3
Cohn, Michael A; Lee, Steven K; Strauss, Eric J
Golf is a global sport enjoyed by an estimated 60 million people around the world. Despite the common misconception that the risk of injury during the play of golf is minimal, golfers are subject to a myriad of potential pathologies. While the majority of injuries in golf are attributable to overuse, acute traumatic injuries can also occur. As the body's direct link to the golf club, the upper extremities are especially prone to injury. A thorough appreciation of the risk factors and patterns of injury will afford accurate diagnosis, treatment, and prevention of further injury.
Neal, Joseph M.; Gerancher, J.C.; Hebl, James R.; Ilfeld, Brian M.; McCartney, Colin J.L.; Franco, Carlo D.; Hogan, Quinn H.
Brachial plexus blockade is the cornerstone of the peripheral nerve regional anesthesia practice of most anesthesiologists. As part of the American Society of Regional Anesthesia and Pain Medicine’s commitment to providing intensive evidence-based education related to regional anesthesia and analgesia, this article is a complete update of our 2002 comprehensive review of upper extremity anesthesia. The text of the review focuses on (1) pertinent anatomy, (2) approaches to the brachial plexus and techniques that optimize block quality, (4) local anesthetic and adjuvant pharmacology, (5) complications, (6) perioperative issues, and (6) challenges for future research. PMID:19282714
Yang, Byung Il; Song, Bo Kyoung; Joung, Sang Mi
[Purpose] The purpose of this study was to determine whether two-handed task training is effective on motor learning of injured cerebral cortex activation and upper extremity function recovery after stroke. [Subjects and Methods] Two hemiplegic subjects participated in this study: one patient was affected on the dominant side of the body and the other was affected on the non-dominant side of the body, and both scored in the range of 58–66 in the Fugl-Meyer assessment. The excitability of the corticospinal tract and Manual Function Test were examined. [Results] The excitability of the corticospinal tract and the Manual Function Test showed significant differences in the activation of both sides of the cerebral cortex and in the variation in learning effect of upper extremity motor function recovery in patients with hemiplegic non-dominant hand (left). [Conclusion] The results suggested that two-handed task training had a different influence on dominant hand (right) and non-dominant hand (left) motor recovery. PMID:28210051
Ovadia, Steven A.; Askari, Morad
Upper extremity amputations are most frequently indicated by severe traumatic injuries. The location of the injury will determine the level of amputation. Preservation of extremity length is often a goal. The amputation site will have important implications on the functional status of the patient and options for prosthetic reconstruction. Advances in amputation techniques and prosthetic reconstructions promote improved quality of life. In this article, the authors review the principles of upper extremity amputation, including techniques, amputation sites, and prosthetic reconstructions. PMID:25685104
Ovadia, Steven A; Askari, Morad
Upper extremity amputations are most frequently indicated by severe traumatic injuries. The location of the injury will determine the level of amputation. Preservation of extremity length is often a goal. The amputation site will have important implications on the functional status of the patient and options for prosthetic reconstruction. Advances in amputation techniques and prosthetic reconstructions promote improved quality of life. In this article, the authors review the principles of upper extremity amputation, including techniques, amputation sites, and prosthetic reconstructions.
Knutsen, Elisa J; Calfee, Ryan P
Hand surgeons routinely treat carpal and cubital tunnel syndromes, which are the most common upper extremity nerve compression syndromes. However, more infrequent nerve compression syndromes of the upper extremity may be encountered. Because they are unusual, the diagnosis of these nerve compression syndromes is often missed or delayed. This article reviews the causes, proposed treatments, and surgical outcomes for syndromes involving compression of the posterior interosseous nerve, the superficial branch of the radial nerve, the ulnar nerve at the wrist, and the median nerve proximal to the wrist. Copyright © 2013 Elsevier Inc. All rights reserved.
Jaspers, Ellen; Desloovere, Kaat; Bruyninckx, Herman; Klingels, Katrijn; Molenaers, Guy; Aertbelien, Erwin; Van Gestel, Leen; Feys, Hilde
The aim of this study was to measure which three-dimensional spatiotemporal and kinematic parameters differentiate upper limb movement characteristics in children with hemiplegic cerebral palsy (HCP) from those in typically developing children (TDC), during various clinically relevant tasks. We used a standardized protocol containing three reach…
Jaspers, Ellen; Desloovere, Kaat; Bruyninckx, Herman; Klingels, Katrijn; Molenaers, Guy; Aertbelien, Erwin; Van Gestel, Leen; Feys, Hilde
The aim of this study was to measure which three-dimensional spatiotemporal and kinematic parameters differentiate upper limb movement characteristics in children with hemiplegic cerebral palsy (HCP) from those in typically developing children (TDC), during various clinically relevant tasks. We used a standardized protocol containing three reach…
Kowalczewski, Jan; Prochazka, Arthur
Stroke survivors with hemiparesis and spinal cord injury (SCI) survivors with tetraplegia find it difficult or impossible to perform many activities of daily life. There is growing evidence that intensive exercise therapy, especially when supplemented with functional electrical stimulation (FES), can improve upper extremity function, but delivering the treatment can be costly, particularly after recipients leave rehabilitation facilities. Recently, there has been a growing level of interest among researchers and healthcare policymakers to deliver upper extremity treatments to people in their homes using in-home teletherapy (IHT). The few studies that have been carried out so far have encountered a variety of logistical and technical problems, not least the difficulty of conducting properly controlled and blinded protocols that satisfy the requirements of high-level evidence-based research. In most cases, the equipment and communications technology were not designed for individuals with upper extremity disability. It is clear that exercise therapy combined with interventions such as FES, supervised over the Internet, will soon be adopted worldwide in one form or another. Therefore it is timely that researchers, clinicians, and healthcare planners interested in assessing IHT be aware of the pros and cons of the new technology and the factors involved in designing appropriate studies of it. It is crucial to understand the technical barriers, the role of telesupervisors, the motor improvements that participants can reasonably expect and the process of optimizing IHT-exercise therapy protocols to maximize the benefits of the emerging technology.
Kawahira, Kazumi; Shimodozono, Megumi; Etoh, Seiji; Kamada, Katsuya; Noma, Tomokazu; Tanaka, Nobuyuki
Objective To study the effects on the hemiplegic upper limb of repetitive facilitation exercises (RFEs) using a novel facilitation technique, in which the patient's intention to move the hemiplegic upper limb or finger was followed by realization of the movement using multiple sensory stimulations. Methods Twenty-three stroke patients were enrolled in a cross-over study in which 2-week RFE sessions (100 repetitions each of five-to-eight types of facilitation exercise per day) were alternated with 2-week conventional rehabilitation (CR) sessions, for a total of four sessions. Treatments were begun with the 2-week RFE session in one group and the 2-week CR session in the second group. Results After the first 2-week RFE session, both groups showed improvements in the Brunnstrom stages of the upper limb and the hand, in contrast to the small improvements observed during the first CR session. The Simple Test for Evaluating Hand Function (STEF) score, which evaluates the ability of manipulating objects, in both groups improved during both sessions. After the second 2-week RFE and CR sessions, both groups showed little further improvement except in the STEF score. Conclusion The novel RFEs promoted the functional recovery of the hemiplegic upper limb and hand to a greater extent than the CR sessions. PMID:20715890
Popinchalk, Samuel P; Schaffer, Alyssa A
A thorough history and physical examination are vital to the assessment of upper extremity compressive neuropathies. This article summarizes relevant anatomy and physical examination findings associated with upper extremity compressive neuropathies. Copyright © 2012 Elsevier Inc. All rights reserved.
Zlotolow, Dan A; Kozin, Scott H
Until recently, upper extremity prostheses had changed little since World War II. In 2006, the Defense Advanced Research Projects Agency responded to an increasing number of military amputees with the Revolutionizing Prosthetics program. The program has yielded several breakthroughs both in the engineering of new prosthetic arms and in the control of those arms. Direct brain-wave control of a limb with 22° of freedom may be within reach. In the meantime, advances such as individually powered digits have opened the door to multifunctional full and partial hand prostheses. Restoring sensation to the prosthetic limb remains a major challenge to full integration of the limb into a patient's self-image.
Mazzone, S; Serafini, A; Iosa, M; Aliberti, M N; Gobbetti, T; Paolucci, S; Morelli, D
Functional taping with elastic bandages and adhesive tapes could limit the action of upper limb spastic muscles and sustain that of weaker muscles in children with hemiplegic cerebral palsy (CP). 16 young children with CP (3±2 years old) were enrolled in this pilot study including 5 months of taping in conjunction with conventional physical therapy, followed by 7 months of physical therapy alone (taping wash-out), and other 5 months of taping plus therapy. Large improvements in the Melbourne assessment score were found in the first period in which taping was used (+15.4%, p<0.001) and also in the second one despite 8 drop-outs (+8.4%, p=0.012), but not during the taping wash-out (- 4.6%; p=0.093). These results suggest that children with CP could benefit from the continuous correction provided by taping in order to limit the development of improper upper limb motor schemas and to favour that of proper ones.
Yildirim, Cengiz; Ozyürek, Selahattin; Ciçek, Engin Ilker; Kuskucu, Mesih
Melorheostosis is a rare mesodermal disease affecting the skeleton and adjacent soft tissues. Often it is incidentally detected on radiographs. In the standard radiology and orthopedics literature, melorheostosis is described as a "flowing hyperostosis, resembling dripping candle wax as an incidental radiographic finding." A 22-year-old man presented with a 2-year history of right-hand pain. Radiologic evaluation of the hand showed massive sclerotic changes in the first and second metacarpal and phalangeal bones on the right side. Further radiographic evaluation of the right upper extremity revealed the same sclerotic changes in the right scapula, humerus, radius, and scaphoid. Computed tomography (CT) scans showed a high attenuation undulating cortical hyperostosis with a "dripping candle wax appearance" involving the radial and/or dorsal aspects of humerus, radius, scaphoid, and first and second ray bones of the hand. Radionuclide triphasic bone scintigraphy showed diffuse homogenous radiotracer uptake within the entire right upper extremity involving the scapula, humerus, radius, scaphoid, and first and second metacarpals and phalangeal bones of the hand. The patient was followed conservatively, and 1-year follow-up revealed no change in the clinical, laboratory, or radiological findings. The diagnosis of melorheostosis was made on the basis of the characteristic distribution, location, and combined radiographic, CT, and radionuclide imaging features of the abnormalities. Conservative treatment was recommended for the patient. After 26 months of follow-up, despite the persistence of the radiologic findings, the patient is currently well, with no painful symptoms unless he performs forceful exercise.
Schweizer, Katrin; Brunner, Reinald; Romkes, Jacqueline
It has previously been discussed that treatment of the hemiplegic arm in patients with cerebral palsy can improve gait parameters in the lower body. Our question was whether improving the ankle rocker with an orthosis has an effect on the upper body during walking. The main aim was to investigate, which trunk and arm kinematics of toe walking children with hemiplegic cerebral palsy are changed by wearing a hinged ankle-foot orthosis, restoring an initial heel contact. Specific parameters of the pelvis, thorax, and arm kinematics were investigated. Differences in the hemiplegic side between the barefoot and the orthotic condition were calculated by Students t-tests. Additionally, the 95% confidence intervals were used to explore clinically relevant differences between the controls and the patients and asymmetries within the patients' affected and unaffected sides. Pelvic tilt range of motion (barefoot: 7.5° (6.1-9.0°), orthosis: 6.6° (5.1-8.1) P=0.040) and mean shoulder abduction (barefoot: 14.3° (10.2-18.4°), orthosis: 12.1° (8.4-15.8) P=0.027) were the only two parameters with statistically significant differences, although not clinically relevant, between the barefoot and orthotic conditions. Abnormalities in all three planes were explored between the patients and controls. The entire trunk was more externally rotated, the pelvis stood lower, and the elbow was more flexed on the hemiplegic side compared to the unaffected side. A hinged ankle-foot orthosis, restoring the first ankle rocker, had no clinically relevant effects on trunk kinematics. None of the observed upper body gait deviations seemed to be secondary to or caused by toe walking. Copyright © 2014 Elsevier Ltd. All rights reserved.
Gauger, Erich M; Casnovsky, Lauren L; Gauger, Erica J; Bohn, Deborah C; Van Heest, Ann E
This study reviewed the clinical history and management of acquired growth arrest in the upper extremity in pediatric patients. The records of all patients presenting from 1996 to 2012 with radiographically proven acquired growth arrest were reviewed. Records were examined to determine the etiology and site of growth arrest, management, and complications. Patients with tumors or hereditary etiology were excluded. A total of 44 patients (24 boys and 20 girls) with 51 physeal arrests who presented at a mean age of 10.6 years (range, 0.8-18.2 years) were included in the study. The distal radius was the most common site (n=24), followed by the distal humerus (n=8), metacarpal (n=6), distal ulna (n=5), proximal humerus (n=4), radial head (n=3), and olecranon (n=1). Growth arrest was secondary to trauma (n=22), infection (n=11), idiopathy (n=6), inflammation (n=2), compartment syndrome (n=2), and avascular necrosis (n=1). Twenty-six patients (59%) underwent surgical intervention to address deformity caused by the physeal arrest. Operative procedures included ipsilateral unaffected bone epiphysiodesis (n=21), shortening osteotomy (n=10), lengthening osteotomy (n=8), excision of physeal bar or bone fragment (n=2), angular correction osteotomy (n=1), and creation of single bone forearm (n=1). Four complications occurred; 3 of these required additional procedures. Acquired upper extremity growth arrest usually is caused by trauma or infection, and the most frequent site is the distal radius. Growth disturbances due to premature arrest can be treated effectively with epiphysiodesis or osteotomy. In this series, the specific site of anatomic growth arrest was the primary factor in determining treatment. [Orthopedics. 2017; 40(1):e95-e103.]. Copyright 2016, SLACK Incorporated.
Do, Ji-Hye; Yoo, Eun-Young; Jung, Min-Ye; Park, Hae Yean
Hemiplegic cerebral palsy is a neurological symptom appearing on the unilateral arm and leg of the body that causes affected upper/lower limb muscle weakening and dysesthesia and accompanies tetany and difficulties in postural control due to abnormal muscle tone, and difficulties in body coordination. The purpose of this study was to examine the impact of virtual reality-based bilateral arm training on the motor skills of children with hemiplegic cerebral palsy, in terms of their upper limb motor skills on the affected side, as well as their bilateral coordination ability. The research subjects were three children who were diagnosed with hemiplegic cerebral palsy. The research followed an ABA design, which was a single-subject experimental design. The procedure consisted of a total of 20 sessions, including four during the baseline period (A1), 12 during the intervention period (B), and four during the baseline regression period (A2), For the independent variable bilateral arm training based on virtual reality, Nintendo Wii game was played for 30 minutes in each of the 12 sessions. For the dependent variables of upper limb motor skills on the affected side and bilateral coordination ability, a Wolf Motor Function Test (WMFT) was carried out for each session and the Pediatric Motor Activity Log (PMAL) was measured before and after the intervention, as well as after the baseline regression period. To test bilateral coordination ability, shooting baskets in basketball with both hands and moving large light boxes were carried out under operational definitions, with the number of shots and time needed to move boxes measured. The results were presented using visual graphs and bar graphs. The study's results indicated that after virtual reality-based bilateral arm training, improvement occurred in upper limb motor skills on the affected sides, and in bilateral coordination ability, for all of the research subjects. Measurements of the effects of sustained therapy after
Objective To Investigate the synergic effects of short-term constraint-induced movement therapy (CIMT) and visual biofeedback training (VBT) in subacute stroke patients. Methods Thirty-two subacute stroke patients were enrolled and randomly assigned to one of three groups: short-term CIMT with VBT, VBT only, and control groups. We applied CIMT for an hour daily during VBT instead of the ordinary restraint time, referred to as 'short-term' CIMT. Short-term CIMT with VBT group received simultaneous VBT with CIMT, whereas the VBT the only group received VBT without CIMT for an hour a day for 2 weeks. The control group received conventional occupational therapy (OT) alone. Patients underwent the Purdue Pegboard Test, the JAMAR grip strength test, the Wolf Motor Function Test, the Fugl-Meyer Assessment (upper extremity), Motricity index and the Korean version of Modified Barthel Index test to evaluate motor functions of the hemiplegic upper limb at baseline, post-treatment, and 2 weeks after treatment. Results No significant differences were observed between short-term CIMT with VBT and VBT only groups. Both groups showed significantly higher scores compared to the control group in the WMFT and FMA tests. However, the short-term CIMT with VBT group showed significant improvement (p<0.05) compared with the control group in both grasp and pad pinch at post-treatment and 2 weeks after treatment while the VBT only group did not. Conclusion Short-term CIMT with VBT group did not show significant improvement of hemiplegic upper limb function of subacute stroke patients, compared to VBT only group. Larger sample sizes and different restraint times would be needed to clarify the effect. PMID:28119829
Russo, Remo Nunzio; Atkins, Renae; Haan, Eric; Crotty, Maria
To describe the use of upper limb orthoses and assistive technologies (AT) in a representative community-based sample of children with hemiplegic cerebral palsy (HCP) and compare children on the basis of their prescription. Survey of all children with HCP entered on a population register. Outcome measures included a clinical examination; Assessment of Motor and Process skills; Self-perception Profile for Children; PedsQL version 4; Paediatric Evaluation of Disability Inventory. Of 107 respondents, 56% were prescribed upper limb orthoses and 46% AT; 48% of children prescribed upper limb orthoses were using them, compared to 98% of children prescribed AT. Greater tone at the wrist was associated with orthotic prescription (OR [95% CI] 39.6 [4.8, 323]). Children with HCP prescribed orthoses and AT are a more severely affected group. AT have higher utility than upper limb orthoses in children with HCP, with orthoses having a high rate of abandonment.
Hayashi, Ryota; Ishimine, Tomoyasu; Kawahira, Kazumi; Yu, Yong; Tsujio, Showzow
In this research, we focus on the method of rehabilitation with stretch reflexes for the hemiplegic upper limb in stroke patients. We propose a new device which utilizes electromagnetic force to evoke stretch reflexes. The device can exert an assisting force safely, because the electromagnetic force is non contact force. In this paper, we develop a support system applying the proposed device for the functional recovery training of the hemiplegic upper limb. The results obtained from several clinical tests with and without our support system are compared. Then we discuss the validity of our support system.
Stephens, M B
Deep venous thrombosis (DVT) of the upper extremity is a relatively uncommon but important cause of morbidity, especially in young active persons. The causes of upper extremity DVT may be categorized as catheter-related, spontaneous (effort-related) and miscellaneous (e.g., trauma, intravenous drug use). Diagnosis is based on clinical history and confirmed by either duplex ultrasonography or contrast venography. Significant controversy surrounds the optimal management of upper extremity DVT. Treatment options include conservative therapy, anticoagulation, catheter-directed thrombolysis and surgical intervention to remove intravascular clot or revise the anatomy of the costoclavicular space. Early aggressive treatment of active young patients may decrease long-term morbidity.
Each subject lay on a bed, and his forearm was supported with a jig to measure the elbow joint angle. The subject was instructed to relax and not to...resist the step-like load which was applied to extend the elbow joint. The elbow joint angle and electromyograms of the biceps muscle, tri- ceps muscle...depending on both muscle activities and elbow joint angle. The response of hemiplegic subjects were ap- proximated well with the model. The torque gener
Wiesler, Ethan R; Lumsden, Boyd
Golf has demonstrated increasing popularity and with this heightened enthusiasm has come an increased awareness of the significant number of injuries associated with playing golf. While back injuries represent the most commonly injured specific body part, upper extremity injuries are most frequent overall and the most likely to result in loss of play. Patterns of injury differ based on level of play and time spent playing or practicing golf. Among golf professionals, the hand/wrist is the most commonly injured upper extremity structure. Among amateurs, the elbow is most commonly injured. The vast majority of upper extremity injuries are due to overuse. Age, ability, equipment, and swing mechanics also play contributing roles. Most upper extremity golf injuries can be successfully treated with appropriate cessation or modification of play, anti-inflammatory modalities, and rehabilitation. Surgical treatment is rarely required, but if needed can prove successful in a high percentage of patients.
Wolf, Megan R; Avery, Daniel; Wolf, Jennifer Moriatis
Gymnastics is a unique sport, which loads the wrist and arms as weight-bearing extremities. Because of the load demands on the wrist in particular, stress fractures, physeal injury, and overuse syndromes may be observed. This spectrum of injury has been termed "gymnast's wrist," and incorporates such disorders as wrist capsulitis, ligamentous tears, triangular fibrocartilage complex tears, chondromalacia of the carpus, stress fractures, distal radius physeal arrest, and grip lock injury.
Hemiplegia in the upper limb and shoulder complex is a common secondary impairment resulting from a cerebrovascular event; evidence-based intervention is required for effective treatment. Prior to addressing shoulder movement, biomechanical alignment of the pelvis and trunk must first be assessed. Extreme care must be taken when completing passive range of motion with the hemiplegic shoulder; motion should not exceed beyond 90° of shoulder flexion and abduction without scapular upward rotation and humeral head external rotation. It is recommended that the use of slings with upper limb hemiplegia be limited. A subluxation of the shoulder can be treated with surface neuromuscular electrical stimulation if the recommended protocol of 6 hours daily, 5 days a week, for 6 weeks is utilized. Taping/strapping for a subluxation has conflicting evidence for reducing the development of hemiplegic shoulder pain, and it does not improve upper limb function or range of motion.
Stone, W M; Fowl, R J; Money, S R
Upper extremity trauma can be penetrating or blunt in etiology. The close proximity of vein, artery and nerve makes for a complicated presentation and potentially complicated reconstruction. Orthopedic and neurologic injuries can cause the more long term disability of these patients, but vascular injuries are initially more life threatening. Control of vascular injuries can be particularly difficult due to anatomic issues in the upper extremities. The intervention carried significant morbidity until evolution to endovascular approaches occurred. By reconstructing the injury from a more ''remote'' access site, less concomitant injury to the extremity can be encountered. However, although control of vascular injuries may result in greater survival rates with less morbidity from the procedure, long term outcome remains dependent upon concomitant injuries. This review will encompass both vascular and neurologic injuries secondary to trauma to the upper extremity and outline some of the trends in management.
Hefter, Harald; Rosenthal, Dietmar
It has been hypothesized that altered trunk movements during gait in post-stroke patients or children with cerebral palsy are compensatory to lower limb impairment. Improvement of trunk movements and posture after injections of botulinum toxin into the affected arm would be at variance with this hypothesis and hint towards a multifactorial trunk control deficit. Clinical gait analysis was performed in 11 consecutively recruited hemiplegic patients immediately before and 4weeks after a botulinum toxin type A-injection into the affected arm. Kinematic data were collected using an 8 camera optical motion-capturing system and reflective skin-markers were attached according to a standard plug-in-gait model. Deviation of the trunk in lateral and forward direction and the trajectory of the C7-marker in a sacrum-fixed horizontal plane were analyzed in addition to classical gait parameters. The Wilson-signed-rank test was used for pre/post-botulinum toxin comparisons. After botulinum toxin injections a significant improvement of forearm flexion scores from 2.57 to 2.0 (p<0.014), and a reduced lateral deviation of the upper trunk from 3.5degrees to 2.5degrees (p<0.014) were observed. Free-walkers tended to walk faster (p<0.046, 1-sided), with reduced pre-swing duration of both legs and an increased step length of the non-affected leg. The C7-marker trajectory was shifted towards the midline. Injections of botulinum toxin into the affected arm of hemiplegic patients improve abnormal trunk lateral flexion. This shift of the center of mass of the upper body towards the midline improves various gait parameters including gait speed. Copyright © 2017. Published by Elsevier Ltd.
Taspinar, Ozgur; Kepekci, Muge; Ozaras, Nihal; Aydin, Teoman; Guler, Mustafa
[Purpose] Doner kebab is a food specific to Turkey; it is a cone-shaped meat placed vertically on a high stand. The doner kebab chefs stand against the meat and cut it by using both of their upper extremities. This work style may lead to recurrent trauma and correspondingly the upper extremity problems. The aim of this study was to investigate the upper extremity disorders of doner chefs. [Subjects and Methods] Doner kebab chefs were selected as the study group, and volunteers who were not doner kebab chefs and didn’t exert intense effort with upper extremities their business lives were selected as the control group. A survey form was prepared to obtain data about the participants’ ages, working experience (years), daily work hours, work at a second job, diseases, drug usage, and any musculoskeletal (lasting at least 1 week) complaint in last 6 months. [Results] A total of 164 individuals participated in the study, 82 doner chefs and 82 volunteers. In 20.6% of the study group and 15.6% of the control group, an upper extremity musculoskeletal system disorder was detected. Lateral epicondylitis was more frequently statistically significant in the work group. [Conclusion] Hand pain and lateral epicondylitis are more frequent in doner chefs than in other forms of business. PMID:25276030
Romero-Zárate, J L; Pastrana-Figueroa, J M; Granados-Martínez, R
Microsurgery in Mexico was initiated in 1967, when the first report of the subspecialty was published. At our hospital, we have had a well-organized microsurgery department since 1995. This has improved our management of patients with amputations of the upper extremity. This article presents our experience with upper extremity replantation, including hand and fingers. During the first 3 years, we managed 55 patients, 42 male and 13 female, aged 2-52 years, who had suffered amputations of some part of their upper extremity or even of the complete limb. These patients underwent surgical exploration for replantation. We analyzed 103 amputations in the 55 patients operated. The amputated parts are summarized as follows: 11 thumbs, 25 index, 24 middle, 22 ring, and 12 little fingers; 5 hands, 5 forearms, and 2 arms. The average hospital stay was 10 days. The follow-up was 6-24 months. Replantation success was 82%, with 18% failure for survival of the replanted part. Functional recovery was satisfactory in the 50% of cases, and sensitive recovery was satisfactory in 75% of cases. We conclude that although our experience on upper extremity replantation is not so large, our results are similar to those from other series. We discussed our results.
Andersen, John C; Majnemer, Annette; O'Grady, Kathleen; Gordon, Andrew M
For children with hemiplegic cerebral palsy, bimanual abilities are central to independent function. Over the last decade, considerable attention has been given to 2 forms of extended practice therapy for the upper limb, constraint-induced movement therapy and intensive bimanual training. This article reviews the varying nature of these 2 approaches and the existing scientific rationale supporting them. Comparisons between these 2 intensive upper extremity training approaches indicate similar improvements in unimanual capacity and bimanual performance outcomes; however, when considering participant and caregiver goal achievement, evidence favors a bimanual approach. Careful selection of either therapy for this population requires consideration of individual and contextual factors in relation to treatment goals. The key ingredients and dose responses remain unknown. Treatment intensity, intrinsic motivation, and individualization of treatment are hypothesized as requisite in either approach. Copyright © 2013 Elsevier Inc. All rights reserved.
Sgandurra, Giuseppina; Ferrari, Adriano; Cossu, Giuseppe; Guzzetta, Andrea; Biagi, Laura; Tosetti, Michela; Fogassi, Leonardo; Cioni, Giovanni
Rehabilitation for children with hemiplegic cerebral palsy (HCP) aimed to improve function of the impaired upper limb (UL) uses a wide range of intervention programs. A new rehabilitative approach, called Action-Observation Therapy, based on the recent discovery of mirror neurons, has been used in adult stroke but not in children. The purpose of the present study is to design a randomised controlled trial (RCT) for evaluating the efficacy of Action-Observation Therapy in improving UL activity in children with HCP. The trial is designed according to CONSORT Statement. It is a randomised, evaluator-blinded, match-pair group trial. Children with HCP will be randomised within pairs to either experimental or control group. The experimental group will perform an Action-Observation Therapy, called UP-CAT (Upper Limb-Children Action-Observation Training) in which they will watch video sequences showing goal-directed actions, chosen according to children UL functional level, combined with motor training with their hemiplegic UL. The control group will perform the same tailored actions after watching computer games. A careful revision of psychometric properties of UL outcome measures for children with hemiplegia was performed. Assisting Hand Assessment was chosen as primary measure and, based on its calculation power, a sample size of 12 matched pairs was established. Moreover, Melbourne and ABILHAND-Kids were included as secondary measures. The time line of assessments will be T0 (in the week preceding the onset of the treatment), T1 and T2 (in the week after the end of the treatment and 8 weeks later, respectively). A further assessment will be performed at T3 (24 weeks after T1), to evaluate the retention of effects. In a subgroup of children enrolled in both groups functional Magnetic Resonance Imaging, exploring the mirror system and sensory-motor function, will be performed at T0, T1 and T2. The paper aims to describe the methodology of a RCT for evaluating the
Background Rehabilitation for children with hemiplegic cerebral palsy (HCP) aimed to improve function of the impaired upper limb (UL) uses a wide range of intervention programs. A new rehabilitative approach, called Action-Observation Therapy, based on the recent discovery of mirror neurons, has been used in adult stroke but not in children. The purpose of the present study is to design a randomised controlled trial (RCT) for evaluating the efficacy of Action-Observation Therapy in improving UL activity in children with HCP. Methods/Design The trial is designed according to CONSORT Statement. It is a randomised, evaluator-blinded, match-pair group trial. Children with HCP will be randomised within pairs to either experimental or control group. The experimental group will perform an Action-Observation Therapy, called UP-CAT (Upper Limb-Children Action-Observation Training) in which they will watch video sequences showing goal-directed actions, chosen according to children UL functional level, combined with motor training with their hemiplegic UL. The control group will perform the same tailored actions after watching computer games. A careful revision of psychometric properties of UL outcome measures for children with hemiplegia was performed. Assisting Hand Assessment was chosen as primary measure and, based on its calculation power, a sample size of 12 matched pairs was established. Moreover, Melbourne and ABILHAND-Kids were included as secondary measures. The time line of assessments will be T0 (in the week preceding the onset of the treatment), T1 and T2 (in the week after the end of the treatment and 8 weeks later, respectively). A further assessment will be performed at T3 (24 weeks after T1), to evaluate the retention of effects. In a subgroup of children enrolled in both groups functional Magnetic Resonance Imaging, exploring the mirror system and sensory-motor function, will be performed at T0, T1 and T2. Discussion The paper aims to describe the
previously reported by Stansbury et al. . This study incorporated data from multiple databases designed to track injury characteristics at multiples...without the use of the service member’s hands , and due to the reported increased difficulty with the use of upper extremity prosthetics [14–16]. There...30 630 4 Facial injury 15 8.62 32 480 5 Loss of hand function 18 10.40 25 450 6 Scar to an extremity 18 10.40 25 450 7 Traumatic brain injury 16 9.25
Azouz, E M; Oudjhane, K
This article presents a brief overview of the indications of MR imaging in a variety of disorders of the upper extremity of the pediatric patient. This covers congenital anomalies: Sprengel shoulder, Poland sequence, arthrogryposis; posttraumatic lesions of cartilage, bone, tendon, muscle and nerve including the brachial plexus injury; inflammatory arthritis and synovitis; bone and joint infection; osteochondritis dissecans, bone necrosis and infarcts in sickle cell anemia and juvenile Gaucher disease, as well as tumors. In this last category, the authors briefly describe the appearances of cysts and tumors of bones and soft tissues of the upper extremity. Indications for the intravenous administration of Gadolinium are given throughout the article with emphasis on the synovial enhancement seen in active arthritis and synovitis.
Birman, Michael V; Lee, Donald H
Factitious disorders of the upper extremity can manifest in many different forms; therefore, it is critical to recognize warning signs in the history and examination indicating that the patient may be creating the symptoms and physical manifestations of the presenting illness. These disorders present in such predictable patterns as lymphedema, Secretan syndrome, ulcerations and wound manipulation, clenched fist, subcutaneous emphysema, pachydermodactyly, nail deformities, and self-mutilation. Management recommendations include assigning therapeutic responsibility to one person and the involvement of a multidisciplinary team. Thorough documentation is essential for the protection of both the patient and the treating physician. Treatment of patients with factitious disorders of the upper extremity requires patience and insight to avoid being manipulated into performing unnecessary surgical procedures.
du Breuil, Anne L.; Close, Jeremy
Effort thrombosis of the upper extremity refers to a deep venous thrombosis of the upper extremity resulting from repetitive activity of the upper limb. Most cases of effort thrombosis occur in young elite athletes with strenuous upper extremity activity. This article reports two cases who both developed upper extremity deep vein thromboses, the first being a 67-year-old bowler and the second a 25-year-old barista, and illustrates that effort thrombosis should be included in the differential diagnosis in any patient with symptoms concerning DVT associated with repetitive activity. A literature review explores the recommended therapies for upper extremity deep vein thromboses. PMID:27800207
Gurbuz, Nigar; Afsar, Sevgi Ikbali; Ayaş, Sehri; Cosar, Sacide Nur Saracgil
[Purpose] This study aimed to evaluate the effectiveness of mirror therapy combined with a conventional rehabilitation program on upper extremity motor and functional recovery in stroke patients. [Subjects and Methods] Thirty-one hemiplegic patients were included. The patients were randomly assigned to a mirror (n=16) or conventional group (n=15). The patients in both groups underwent conventional therapy for 4 weeks (60–120 minutes/day, 5 days/week). The mirror group received mirror therapy, consisting of periodic flexion and extension movements of the wrist and fingers on the non-paralyzed side. The patients in the conventional group performed the same exercises against the non-reflecting face of the mirror. The patients were evaluated at the beginning and end of the treatment by a blinded assessor using the Brunnstrom stage, Fugl-Meyer Assessment (FMA) upper extremity score, and the Functional Independence Measure (FIM) self-care score. [Results] There was an improvement in Brunnstrom stage and the FIM self-care score in both groups, but the post-treatment FMA score was significantly higher in the mirror therapy group than in the conventional treatment group. [Conclusion] Mirror therapy in addition to a conventional rehabilitation program was found to provide additional benefit in motor recovery of the upper extremity in stroke patients. PMID:27799679
Gurbuz, Nigar; Afsar, Sevgi Ikbali; Ayaş, Sehri; Cosar, Sacide Nur Saracgil
[Purpose] This study aimed to evaluate the effectiveness of mirror therapy combined with a conventional rehabilitation program on upper extremity motor and functional recovery in stroke patients. [Subjects and Methods] Thirty-one hemiplegic patients were included. The patients were randomly assigned to a mirror (n=16) or conventional group (n=15). The patients in both groups underwent conventional therapy for 4 weeks (60-120 minutes/day, 5 days/week). The mirror group received mirror therapy, consisting of periodic flexion and extension movements of the wrist and fingers on the non-paralyzed side. The patients in the conventional group performed the same exercises against the non-reflecting face of the mirror. The patients were evaluated at the beginning and end of the treatment by a blinded assessor using the Brunnstrom stage, Fugl-Meyer Assessment (FMA) upper extremity score, and the Functional Independence Measure (FIM) self-care score. [Results] There was an improvement in Brunnstrom stage and the FIM self-care score in both groups, but the post-treatment FMA score was significantly higher in the mirror therapy group than in the conventional treatment group. [Conclusion] Mirror therapy in addition to a conventional rehabilitation program was found to provide additional benefit in motor recovery of the upper extremity in stroke patients.
Hoexum, Frank; Coveliers, Hans M; Lu, Joyce J; Jongkind, Vincent; Yeung, Kakkhee K; Wisselink, Willem
Thoracic sympathectomy is performed in the management of a variety of disorders of the upper extremity. To evaluate the contemporary results of thoracic sympathectomy for upper extremity ischemia a systematic review of the literature was conducted. We performed a PubMed, EMBASE and Cochrane search of the literature written in the English language from January 1975 to December 2015. All articles presenting original patient data regarding the effect of treatment on symptoms or on the healing of ulcers were eligible for inclusion. Individual analyses for Primary Raynaud's Disease (PRD) and Secondary Raynaud's Phenomenon (SRP) were performed. We included 6 prospective and 23 retrospective series with a total of 753 patients and 1026 affected limbs. Early beneficial effects of thoracic sympathectomy were noticed in 63-100% (median 94%) of all patients, in 73-100% (median 98%) of PRD patients and in 63-100% (median 94%) of SRP patients. The beneficial effect was noted to lessen over time. Long-term beneficial effects were reported in 13-100% (median 75%) of all patients, in 22-100% (median 58%) of PRD patients, and in 13-100% (median 79%) of SRD patients. Complete or improved ulcer healing was achieved in 33-100% and 25-67% respectively, of all patients. Thoracic sympathectomy can be beneficial in the treatment of upper extremity ischemia in select patients. Although the effect in patients with PRD will lessen over time, it may still reduce the severity of symptoms. In SRD, effects are more often long-lasting. In addition, thoracic sympathectomy may maximize tissue preservation or prevent amputation in cases of digital ulceration.
Rozmaryn, L M
Studies in the past decade have shown that a significant proportion of instrumentalists report musculoskeletal problems severely affecting their musical performance. Musicians endure daily intensive use of their upper extremities, frequently placing them in bizarre positions. Their training schedules are rigorous and long term Predisposing factors to, and treatment for, overuse syndromes, tendinitis, and tendon trauma commonly encountered by musical performers are discussed at length. Nerve entrapment has also surfaced as a major problem in musicians, and the means of evaluation and treatment and the role of surgery are put forth. Techniques for studying and analyzing the difficulties faced by instrumentalists are summarized.
Tse, Raymond; Ko, Jason H
Nerve glue is an attractive alternative to sutures to improve the results of nerve repair. Improved axon alignment, reduced scar and inflammation, greater and faster reinnervation, and better functional results have been reported with the use of nerve glue. The different types of nerve glue and the evidence to support or oppose their use are reviewed. Although the ideal nerve glue has yet to be developed, fibrin sealants can be used as nerve glue in select clinical situations. Technology to allow suture-free nerve repair is one development that can potentially improve functional nerve recovery and the outcomes of upper extremity reconstruction.
Rozental, Tamara D; George, Tina M; Chacko, Aron T
Despite their rising popularity, the health care profession has been slow to embrace social networking sites. These are Web-based initiatives, designed to bring people with common interests or activities under a common umbrella. The purpose of this study is to evaluate social networking patterns among upper extremity patients. A total of 742 anonymous questionnaires were distributed among upper extremity outpatients, with a 62% response rate (462 were completed). Demographic characteristics (gender, age, level of education, employment, type of health insurance, and income stratification) were defined, and data on computer ownership and frequency of social networking use were collected. Social network users and nonusers were compared according to their demographic and socioeconomic characteristics. Our patient cohort consisted of 450 patients. Of those 450 patients, 418 had a high school education or higher, and 293 reported a college or graduate degree. The majority of patients (282) were employed at the time of the survey, and income was evenly distributed among U.S. Census Bureau quintiles. A total of 349 patients reported computer ownership, and 170 reported using social networking sites. When compared to nonusers, social networking users were younger (p<.001), more educated (p<.001), and more likely to be employed (p = .013). Users also had higher income levels (p=0.028) and had high rates of computer ownership (p<.001). Multivariate regression revealed that younger age (p<.001), computer ownership (p<.001), and higher education (p<.001) were independent predictors of social networking use. Most users (n = 114) regularly visit a single site. Facebook was the most popular site visited (n=142), followed by MySpace (n=28) and Twitter (n=16). Of the 450 upper extremity patients in our sample, 170 use social networking sites. Younger age, higher level of education, and computer ownership were associated with social networking use. Physicians should consider
Swanson, A B; Göran-Hagert, C; de Groot Swanson, G
A system for evaluation of physical impairment in the hand and upper extremity was developed and has been tested and used by many hand surgeons around the world. It was approved for international application by the International Federation of Societies for Surgery of the Hand. A method for evaluating amputation and sensory and motion impairments has been devised for the hand and upper extremity. Amputation impairment percentage values were determined for each digit or position thereof for the hand, wrist, elbow, and shoulder. By a principle of progressive multiplication of percentage values, impairment of a part can be related to the hand, upper extremity, and eventually the whole person. Sensory impairment is given 50% that of an amputation. Impairment of finger motion can result from lack of flexion (F), extension (E), or ankylosis (A). The method for evaluating flexion impairment is based on a combined angular measurement principle that was correlated with the linear measurement of Boyes. Values for flexion and ankylosis impairment were obtained from the American Medical Association guide. Values for extension impairment were derived from the formula A = E + F. Values for hyperextension were given consideration in the impairment tables. The sum of impairments as related to the whole hand equals the total impairment. The method to combine various impairments is based on the principle that each impairment acts not on the whole part (e.g., the finger) but on the remaining portion (e.g., proximal interphalangeal joint and proximally) after the preceding impairment has acted (e.g., on the distal interphalangeal joint). When there is more than one impairment to a given part, these must be combined before conversion to a larger part. The combined values determination is based on the formula "A% + B% (100% - A%) = the combined values of A% + B%." Based on this principle, the physical loss of each anatomic segment is related to the part, to the entire hand, and then to
Bumbasirević, Marko Z; Vucković, Cedo D; Vucetić, Cedomir; Manojlović, Radovan; Andjelkovic, Sladjana Z; Palibrk, Tomislav D; Milutinović, Suzana M; Raspopović, Emilija Dubljanin
Replantation is defined as reattachment of the part that has been completely amputated and there is no connection between the severed part and the patient. In Boston in 1962 Malt successfully replanted a completely amputated arm of a 12-year-old boy. Komatsu and Tamai reported the first successful replantation of an amputated digit by microvascular technique. There are no strict indications and contraindications for replantation. It's on surgeon to explain to the patient the chances of success of viability, expected function, length of operation, hospitalization and long rehabilitation protocol. Survival and useful function in replantation of upper extremity amputations is questionable. Success depends on microvascular anastomoses, but the final function is related with tendon, nerve, bone and joint repair.
Brochard, Sylvain; Lempereur, Mathieu; Mao, Linda; Rémy-Néris, Olivier
The pathophysiology of abnormal shoulder motion in children with hemiplegic cerebral palsy is not yet well understood. The aim of this study was to compare the motion of the two principle shoulder joints in children with hemiplegic cerebral palsy and typically developing children. 10 children in each group carried out 6 tasks recorded by an optoelectronic system. The analysis protocol was based on an acromion marker cluster, a functional method to determine the gleno-humeral rotation center and different Euler sequences thus providing three dimensional thoraco-humeral, scapulo-thoracic and gleno-humeral kinematics during upper-limb motion. In the children with hemiplegic cerebral palsy, the scapulo-thoracic joint was more protracted (P<0.05) and tended to be more laterally rotated depending on the tasks and the degree of humeral elevation. The gleno-humeral joint was limited in elevation (P<0.09), internal rotation (P<0.05) and plane of elevation (P<0.05) depending on the task. At rest, the orientation of the arm was more related to the scapular posture than to the gleno-humeral orientation, the latter which appeared to compensate the initial internal arm rotation at the beginning of the motion. The scapulo-thoracic joint plays a key role in arm posture at rest and during motion but does not seem to limit arm motion. The gleno-humeral joint compensates the scapula orientation at small degrees of humeral elevation but has a reduced total range of motion. Clinical management should focus on both joints taking into account their respective roles in upper-limb motion in this population. Copyright © 2012 Elsevier Ltd. All rights reserved.
Lee, Je-hyeok; Choi, Jong-duk
[Purpose] The purpose of this study is to examine the effects of upper extremity task training employing the bracing method on the trunk control and balance of stroke patients. [Subjects and Methods] The subjects were 46 stroke patients whose strokes had occurred six months or more prior to the study. The subjects were divided into two groups. One group underwent upper extremity task training with symmetric abdominal muscle contraction (bracing) applied. The other group simply underwent upper extremity task training, without bracing. [Results] The experimental group’s Trunk Impairment Scale (TIS) significantly increased after the intervention, whereas the control group did not see any significant difference. There was significant improvement in balance after the intervention in both the experimental group and the control group. According to the between-group comparisons, the improvements in the experimental group were significantly greater in the control group, except in the Postural Assessment Scale (PASS). [Conclusion] Based on the results of this study, upper extremity task exercises with symmetric abdominal muscle contraction, conducted as part of adult hemiplegic patients’ trunk stabilization exercises, can be applied to a diverse range of hemiplegic patients and implemented as an exercise program after discharge from hospital. PMID:28356639
Delgado, Jorge; Jaramillo, Diego; Chauvin, Nancy A
Increased physical activity in childhood has resulted in a large number of sports-related injuries. Although there is overlap between the sports-related injuries seen in pediatric and adult patients, important differences exist in the injury patterns of pediatric patients. These differences are related to the continuous changes in the developing skeleton and its relationship with adjacent soft tissues. The imbalance in strength between the growing bones and the nearby tendons and ligaments makes the bones prone to acute and chronic injuries. Acute injuries are more common in contact sports such as football and wrestling, whereas chronic injuries are often seen in baseball pitchers and gymnasts. Acute injuries unique to pediatric athletes include physeal fractures of the proximal and distal portions of the clavicle (periosteal sleeve fracture), the proximal humeral physis, and the coracoid process, as well as supracondylar, lateral condylar, and medial condylar fractures around the elbow. Chronic injuries, most commonly caused by repetitive microtrauma, include acromial apophyseolysis, Little Leaguer's shoulder, the constellation of findings seen in Little Leaguer's elbow, and injuries to the medial, lateral, and posterior elbow compartments. In addition, trochlear osteochondral lesions, gymnast's wrist, and rock climber's finger are less-common injuries that may be seen in children. In this article, the normal osseous development of the upper extremity is reviewed, with emphasis on the structures that are most commonly injured. The pathophysiology, imaging appearance, and imaging findings of pediatric athletic injuries are described, along with the prognostic implications. (©)RSNA, 2016.
Ozer, Kagan; Chesher, Stephen P; Scheker, Luis R
A prospective study was designed to determine whether the combined use of neuromuscular electrical stimulation (NMES) and dynamic bracing was more effective than use of either alone in reducing upper-extremity spasticity in children with spastic hemiplegic cerebral palsy. Twenty-four patients (12 males, 12 females; mean age 8y 7mo [SD 4y 2mo]; age range 3-18y) diagnosed with spastic hemiplegic CP were randomly allocated to three groups: group 1 had two 30-minute sessions of NMES a day applied on the antagonist extensors without bracing; group 2 had two 30-minute sessions of dynamic bracing per day; and group 3 had two 30-minute sessions of NMES and dynamic bracing every day. Treatment was continued for 6 months in all groups and applied only to the affected extremity. Patients were evaluated before therapy, at monthly intervals during the therapy, and 3 months after completion of the therapy. Three measures of outcome were taken: the Melbourne Assessment, grip strength, and posture evaluation with Zancolli's classification. The therapist performing the outcome assessments was blinded as to groups. Statistically significant differences were found in all three measures for only those treated with combined NMES and dynamic bracing. However, this significant effect lasted for only 2 months after discontinuation of the treatment. We conclude that the combined use of NMES and bracing is more effective than either alone but requires continuous application.
Wang, Po T; King, Christine E; McCrimmon, Colin M; Shaw, Susan J; Millett, David E; Liu, Charles Y; Chui, Luis A; Nenadic, Zoran; Do, An H
Electrocorticogram (ECoG) is a promising long-term signal acquisition platform for brain-computer interface (BCI) systems such as upper extremity prostheses. Several studies have demonstrated decoding of arm and finger trajectories from ECoG high-gamma band (80-160 Hz) signals. In this study, we systematically vary the velocity of three elementary movement types (pincer grasp, elbow and shoulder flexion/extension) to test whether the high-gamma band encodes for the entirety of the movements, or merely the movement onset. To this end, linear regression models were created for the durations and amplitudes of high-gamma power bursts and velocity deflections. One subject with 8×8 high-density ECoG grid (4 mm center-to-center electrode spacing) participated in the experiment. The results of the regression models indicated that the power burst durations varied directly with the movement durations (e.g. R(2)=0.71 and slope=1.0 s/s for elbow). The persistence of power bursts for the duration of the movement suggests that the primary motor cortex (M1) is likely active for the entire duration of a movement, instead of providing a marker for the movement onset. On the other hand, the amplitudes were less co-varied. Furthermore, the electrodes of maximum R(2) conformed to somatotopic arrangement of the brain. Also, electrodes responsible for flexion and extension movements could be resolved on the high-density grid. In summary, these findings suggest that M1 may be directly responsible for activating the individual muscle motor units, and future BCI may be able to utilize them for better control of prostheses.
Kang, Youn Joo; Park, Hae Kyung; Kim, Hyun Jung; Lim, Taeo; Ku, Jeonghun; Cho, Sangwoo; Kim, Sun I; Park, Eun Sook
Several experimental studies in stroke patients suggest that mirror therapy and various virtual reality programs facilitate motor rehabilitation. However, the underlying mechanisms for these therapeutic effects have not been previously described. We attempted to delineate the changes in corticospinal excitability when individuals were asked to exercise their upper extremity using a real mirror and virtual mirror. Moreover, we attempted to delineate the role of visual modulation within the virtual environment that affected corticospinal excitability in healthy subjects and stroke patients. A total of 18 healthy subjects and 18 hemiplegic patients were enrolled into the study. Motor evoked potential (MEP)s from transcranial magnetic stimulation were recorded in the flexor carpi radialis of the non-dominant or affected upper extremity using three different conditions: (A) relaxation; (B) real mirror; and (C) virtual mirror. Moreover, we compared the MEPs from the virtual mirror paradigm using continuous visual feedback or intermittent visual feedback. The rates of amplitude increment and latency decrement of MEPs in both groups were higher during the virtual mirror task than during the real mirror. In healthy subjects and stroke patients, the virtual mirror task with intermittent visual feedback significantly facilitated corticospinal excitability of MEPs compared with continuous visual feedback. Corticospinal excitability was facilitated to a greater extent in the virtual mirror paradigm than in the real mirror and in intermittent visual feedback than in the continuous visual feedback, in both groups. This provides neurophysiological evidence supporting the application of the virtual mirror paradigm using various visual modulation technologies to upper extremity rehabilitation in stroke patients.
Background Several experimental studies in stroke patients suggest that mirror therapy and various virtual reality programs facilitate motor rehabilitation. However, the underlying mechanisms for these therapeutic effects have not been previously described. Objectives We attempted to delineate the changes in corticospinal excitability when individuals were asked to exercise their upper extremity using a real mirror and virtual mirror. Moreover, we attempted to delineate the role of visual modulation within the virtual environment that affected corticospinal excitability in healthy subjects and stroke patients. Methods A total of 18 healthy subjects and 18 hemiplegic patients were enrolled into the study. Motor evoked potential (MEP)s from transcranial magnetic stimulation were recorded in the flexor carpi radialis of the non-dominant or affected upper extremity using three different conditions: (A) relaxation; (B) real mirror; and (C) virtual mirror. Moreover, we compared the MEPs from the virtual mirror paradigm using continuous visual feedback or intermittent visual feedback. Results The rates of amplitude increment and latency decrement of MEPs in both groups were higher during the virtual mirror task than during the real mirror. In healthy subjects and stroke patients, the virtual mirror task with intermittent visual feedback significantly facilitated corticospinal excitability of MEPs compared with continuous visual feedback. Conclusion Corticospinal excitability was facilitated to a greater extent in the virtual mirror paradigm than in the real mirror and in intermittent visual feedback than in the continuous visual feedback, in both groups. This provides neurophysiological evidence supporting the application of the virtual mirror paradigm using various visual modulation technologies to upper extremity rehabilitation in stroke patients. PMID:23035951
Balakrishnan, Chenicheri; Bradt, Lisa M; Khalil, Abdullah J; Trupiano, John M
Lymphedema is characterized by edema of the extremity due to the inability of the lymphatic system to remove lymph into the circulation. This condition can result from destruction of the superficial lymphatics from burn injury and recurrent infection of the extremity. Due to its rare occurrence, two cases of upper extremity lymphedema following burns are reported.
Sung, In-Young; Ryu, Ju-Seok; Pyun, Sung-Bom; Yoo, Seung-Don; Song, Woo-Hyun; Park, Mi-Jeong
To determine the efficacy of forced-use therapy (FUT) on the improvement of upper-extremity function in children with hemiplegic cerebral palsy (CP). Prospective case series. Outpatient ambulatory clinic in South Korea. Thirty-one patients with hemiplegic CP were assigned to the FUT group (n=18) or to the control group (n=13). The mean age of the patients in the FUT group was 33.2 months and in the control group it was 43.2 months. The FUT group wore a short-arm Scotchcast on the unaffected arm for 6 weeks and also participated in a conventional rehabilitation program that included stretching exercises and functional occupational therapy for the upper extremity. The control group underwent the conventional rehabilitation program only. Hand function tests, including the box and block test (BBT), Erhardt Developmental Prehension Assessment (EDPA), and WeeFIM instrument taken before and after 6 weeks of treatment. Before treatment, there was no significant difference between groups in the BBT, EDPA, and WeeFIM scores. After 6 weeks of treatment, however, the FUT group showed significant improvement in the affected arm in the BBT and EDPA scores, compared with the control group (P<.05). The self-care score on the WeeFIM was also significantly improved in the FUT group (P<.05). FUT combined with a conventional rehabilitation program appears to be more effective than a rehabilitation program alone in improving affected hand function in children with hemiplegic CP.
Guclu-Gunduz, Arzu; Citaker, Seyit; Nazliel, Bijen; Irkec, Ceyla
The purpose of this study was to investigate the relationships between the upper extremity functions, upper extremity strength and hand sensation in patients with Multiple Sclerosis (MS). Twenty-two patients with MS (mean age: 38.5 ± 8.31 years, median Expanded Disability Status Scale (EDSS): 2) and 10 healthy subjects were included. Upper extremity function was measured with the Nine-hole peg test, upper extremity strength (shoulder flexion-abduction, elbow flexion, pinch and grip) with hand-held dynamometer, hand grip dynamometer and manual pinch meter, threshold of light touch-pressure with Semmes-Weinstein monofilament, duration of vibration with 128-Hz frequency tuning fork, and distance of two-point discrimination with an aesthesiometer. Strength and functional level of the upper extremity, light touch-pressure, two-point discrimination, vibration sensations of the hand were lower in patients with MS compared with healthy controls (p < 0.05). Light touch-pressure sensation of thumb and index fingers, two-point discrimination of index finger and elbow flexion strength were found to be related with upper extremity function in patients with MS (p< 0.05). These results indicate that the hand sensation, upper extremity strength and function were affected in MS patients. Additionally upper extremity functions seem to be related with light touch-pressure and two-point discrimination sensations of the hand and elbow flexion strength. Upper extremity strengthening and sensorial training of the hand may contribute to the upper extremity function in patients with MS.
Moran, Steven L; Strickland, Justin; Shin, Alexander Y
Mucormycosis can produce an aggressive and sometimes fatal soft tissue infection seen most commonly in immunocompromised individuals. Eradication consists of surgical resection and antifungal chemotherapy. Knowledge regarding infectious mucormycosis in the upper extremity has been limited to case reports involving mainly immunocompromised individuals. The purpose of this study was to identify risk factors for the development of mucormycosis infections within the upper extremity in immunocompetent individuals and to evaluate the effectiveness of the present therapies. A 12-year retrospective review of all fungal infections involving the upper extremity was conducted in our institution. Seven immunocompetent patients with infectious cutaneous mucormycosis of the upper extremity were identified from 223 primary upper-extremity fungal infections. In the 7 patients 3 infections resulted from heavy soil contamination after motor vehicle collisions and 4 resulted from conveyor belt injuries in agricultural facilities. All patients had considerable upper-extremity soft tissue loss and 6 of the 7 patients had upper-extremity fractures or dislocations. Patients had an average of 10 surgical debridements. Four infections resulted in amputations: 1 partial hand amputation, 1 below the elbow, 1 above the elbow, and 1 at the glenohumeral joint. Mucormycosis can produce limb-threatening infections in an immunocompetent host. Hand surgeons must have suspicion of such infections in patients with grossly contaminated open wounds.
Spencer, Frederick A.; Emery, Cathy; Lessard, Darleen; Goldberg, Robert J.
Purpose The purpose of this study was to examine the magnitude, risk factors, management strategies, and outcomes in a population-based investigation of patients with upper, as compared to lower, extremity deep vein thrombosis diagnosed in 1999. Methods The medical records of all residents from Worcester, Massachusetts (2000 census=478,000) diagnosed with ICD-9 codes consistent with possible deep vein thrombosis at all Worcester hospitals during 1999 were reviewed and validated. Results The age-adjusted attack rate (per 100,000 population) of upper extremity deep vein thrombosis was 16 (95% CI 13, 20) compared to 91 (83,100) for lower extremity deep vein thrombosis. Patients with upper extremity deep vein thrombosis were significantly more likely to have undergone recent central line placement, a cardiac procedure, or an intensive care unit admission than patients with lower extremity deep vein thrombosis. Although short and 1-year recurrence rates of venous thromboembolism and all-cause mortality were not significantly different between patients with upper, versus lower, extremity deep vein thrombosis, patients with upper extremity deep vein thrombosis were less likely to have pulmonary embolism at presentation or in follow-up. Conclusions Patients with upper extremity deep vein thrombosis represent a clinically important patient population in the community setting. Risk factors, occurrence of pulmonary embolism, and timing and location of venous thromboembolism recurrence differ between patients with upper as compared to lower extremity deep vein thrombosis. These data suggest that strategies for prophylaxis and treatment of upper extremity deep vein thrombosis need further study and refinement. PMID:17679126
... Therapist? Media Find a Hand Surgeon Home Anatomy Skin Cancer of the Hand and Upper Extremity Email to ... E – Evolving (changing in any way) How is Skin Cancer Diagnosed? Diagnosis starts with you asking your doctor ...
Hermanussen, Hugo H.; Menendez, Mariano E.; Chen, Neal C.; Ring, David; Vranceanu, Ana-Maria
Background: Little is known about the influence of habitual participation in physical exercise and diet on upper-extremity physical function in older adults. To assess the relationship of general physical exercise and diet to upper-extremity physical function and pain intensity in older adults. Methods: A cohort of 111 patients 50 or older completed a sociodemographic survey, the Rapid Assessment of Physical Activity (RAPA), an 11-point ordinal pain intensity scale, a Mediterranean diet questionnaire, and three Patient- Reported Outcomes Measurement Information System (PROMIS) based questionnaires: Pain Interference to measure inability to engage in activities due to pain, Upper-Extremity Physical Function, and Depression. Multivariable linear regression modeling was used to characterize the association of physical activity, diet, depression, and pain interference to pain intensity and upper-extremity function. Results: Higher general physical activity was associated with higher PROMIS Upper-Extremity Physical Function and lower pain intensity in bivariate analyses. Adherence to the Mediterranean diet did not correlate with PROMIS Upper-Extremity Physical Function or pain intensity in bivariate analysis. In multivariable analyses factors associated with higher PROMIS Upper-Extremity Physical Function were male sex, non-traumatic diagnosis and PROMIS Pain Interference, with the latter accounting for most of the observed variability (37%). Factors associated with greater pain intensity in multivariable analyses included fewer years of education and higher PROMIS Pain Interference. Conclusions: General physical activity and diet do not seem to be as strongly or directly associated with upper-extremity physical function as pain interference. PMID:27847850
Diesselhorst, Matthew M; Rayan, Ghazi M; Pasque, Charles B; Peyton Holder, R
To survey participants at various experience levels of different martial arts (MA) about upper extremity injuries sustained during training and fighting. A 21-s question survey was designed and utilised. The survey was divided into four groups (Demographics, Injury Description, Injury Mechanism, and Miscellaneous information) to gain knowledge about upper extremity injuries sustained during martial arts participation. Chi-square testing was utilised to assess for significant associations. Males comprised 81% of respondents. Involvement in multiple forms of MA was the most prevalent (38%). The hand/wrist was the most common area injured (53%), followed by the shoulder/upper arm (27%) and the forearm/elbow (19%). Joint sprains/muscle strains were the most frequent injuries reported overall (47%), followed by abrasions/bruises (26%). Dislocations of the upper extremity were reported by 47% of participants while fractures occurred in 39%. Surgeries were required for 30% of participants. Females were less likely to require surgery and more likely to have shoulder and elbow injuries. Males were more likely to have hand injuries. Participants of Karate and Tae Kwon Do were more likely to have injuries to their hands, while participants of multiple forms were more likely to sustain injuries to their shoulders/upper arms and more likely to develop chronic upper extremity symptoms. With advanced level of training the likelihood of developing chronic upper extremity symptoms increases, and multiple surgeries were required. Hand protection was associated with a lower risk of hand injuries. Martial arts can be associated with substantial upper extremity injuries that may require surgery and extended time away from participation. Injuries may result in chronic upper extremity symptoms. Hand protection is important for reducing injuries to the hand and wrist.
Kim, Chang-Yong; Lee, Jung-Sun; Kim, Hyeong-Dong; Kim, June-Sun
The purpose of this study was to determine the influence of progressive task-oriented training on a supplementary tilt table on the lower extremity (LE) muscle strength and spatiotemporal parameters of gait in subjects with hemiplegic stroke. Thirty subjects between three and nine months post stroke were included in this study. Thirty subjects were randomly allocated to a control group (CG, n1=10), experimental group I (EG1, n2=10), and experimental group II (EG2, n3=10). All of the subjects received routine therapy for half an hour, five times a week for three weeks and additionally received training on the following three different tilt table applications for 20min a day: (1) both knee belts of the tilt table were fastened (CG), (2) only the affected side knee belt of the tilt table was fastened and one-leg standing training was performed using the less-affected LE (EG1), and (3) only the affected side knee belt of the tilt table was fastened and progressive task-oriented training was performed using the less-affected LE (EG2). The effect of tilt table applications was assessed using a hand-held dynamometer for LE muscle strength and GAITRite for spatiotemporal gait data. Our results showed that there was a significantly greater increase in the strength of all LE muscle groups, gait velocity, cadence, and stride length, a decrease in the double limb support period, and an improvement in gait asymmetry in subjects who underwent progressive task-oriented training on a supplementary tilt table compared to those in the other groups. These findings suggest that progressive task-oriented training on a supplementary tilt table can improve the LE muscle strength and spatiotemporal parameters of gait at an early stage of rehabilitation of subjects with hemiplegic stroke. Copyright © 2014 Elsevier B.V. All rights reserved.
Unlü, Yahya; Ezirmik, Naci; Vural, Unsal; Velioğlu, Yusuf
Trauma of the upper extremity can be a cause of significant morbidity and disability to otherwise productive people. Wounded extremity can be saved by replantation of the amputated parts. Replantation of traumatic amputations can be performed with reasonable success at a regional medical center when experienced surgeons, appropriate and experienced equipment, and skilled ancillary care are available. Successful replantation significantly reduces the morbidity of upper extremity amputations. We presented one case that, 9 year-old, was bridged to our hospital because of total arm amputation after sustained during use of a lawn mover. His arm was saved by urgency surgery.
Page, Stephen J; Hill, Valerie; White, Susan
To compare the efficacy of a repetitive task-specific practice regimen integrating a portable, electromyography-controlled brace called the 'Myomo' versus usual care repetitive task-specific practice in subjects with chronic, moderate upper extremity impairment. Sixteen subjects (7 males; mean age 57.0 ± 11.02 years; mean time post stroke 75.0 ± 87.63 months; 5 left-sided strokes) exhibiting chronic, stable, moderate upper extremity impairment. Subjects were administered repetitive task-specific practice in which they participated in valued, functional tasks using their paretic upper extremities. Both groups were supervised by a therapist and were administered therapy targeting their paretic upper extremities that was 30 minutes in duration, occurring 3 days/week for eight weeks. One group participated in repetitive task-specific practice entirely while wearing the portable robotic, while the other performed the same activity regimen manually. The upper extremity Fugl-Meyer, Canadian Occupational Performance Measure and Stroke Impact Scale were administered on two occasions before intervention and once after intervention. After intervention, groups exhibited nearly identical Fugl-Meyer score increases of ≈2.1 points; the group using robotics exhibited larger score changes on all but one of the Canadian Occupational Performance Measure and Stroke Impact Scale subscales, including a 12.5-point increase on the Stroke Impact Scale recovery subscale. Findings suggest that therapist-supervised repetitive task-specific practice integrating robotics is as efficacious as manual practice in subjects with moderate upper extremity impairment.
Kim, Seong-Sik; Lee, Byoung-Hee
[Purpose] The purpose of this study was to investigate whether motor imagery training has a positive influence on upper extremity performance in stroke patients. [Subjects and Methods] Twenty-four patients were randomly assigned to one of the following two groups: motor imagery (n = 12) or control (n = 12). Over the course of 4 weeks, the motor imagery group participated in 30 minutes of motor imagery training on each of the 18 tasks (9 hours total) related to their daily living activities. After the 4-week intervention period, the Fugl-Meyer Assessment-Upper Extremity outcomes and Wolf Motor Function Test outcomes were compared. [Results] The post-test score of the motor imagery group on the Fugl-Meyer Assessment-Upper Extremity outcomes was significantly higher than that of the control group. In particular, the shoulder and wrist sub-items demonstrated improvement in the motor imagery group. [Conclusion] Motor imagery training has a positive influence on upper extremity performance by improving functional mobility during stroke rehabilitation. These results suggest that motor imagery training is feasible and beneficial for improving upper extremity function in stroke patients. PMID:26311968
Chen, Chih-Chen; Chen, Yu-Luen; Chen, Shih-Ching
[Purpose] Upper extremity rehabilitation after an injury is very important. This study proposes radio frequency identification (RFID) technology to improve and enhance the effectiveness of the upper extremity rehabilitation. [Subjects and Methods] People use their upper extremities to conduct daily activities. When recovering from injuries, many patients neglect the importance of rehabilitation, which results in degraded function. This study recorded the training process using the traditional rehabilitation hand gliding cart with a RFID reader, RFID tags in the panel, and a servo host computer. [Results] Clinical evidence, time taken to achieve a full score, counts of missing the specified spots, and Brunnstrom stage of aided recovery, the proximal part of the upper extremity show that the RFID-based upper extremity training significantly and reduce negative impacts of the disability in daily life and activities. [Conclusion] This study combined a hand-gliding cart with an RFID reader, and when patients moved the cart, the movement could be observed via the activated RFID tags. The training data was collected and quantified for a better understanding of the recovery status of the patients. Each of the participating patients made progress as expected. PMID:27065539
Maldjian, Catherine; Khanna, Vineet; Tandon, Bevan; Then, Matthew; Yassin, Mohamed; Adam, Richard; Klein, Michael J.
Lymphatic filariasis is the most common cause of acquired lymphedema worldwide (Szuba and Rockson, 1998). It is endemic to tropical and subtropical regions, and its effects are devastating. With over 100 million infected persons, it ranks second only to leprosy as the leading cause of permanent and long-term disability. Wuchereria bancrofti is the etiologic agent in 90% of cases. There is a dearth of published MRI findings with pathologically proven active infections, making this entity even more of a diagnostic dilemma. Imaging may provide the first clue that one is dealing with a parasite and may facilitate proper treatment and containment of this disease. This is the first report of pathologic correlation with MRI findings in the extremity in active filariasis. The magnetic resonance images demonstrate an enhancing, infiltrative, mass-like appearance with partial encasement of vasculature that has not been previously described in filariasis. Low signal strands in T2-hyperintense dilated lymphatic channels are seen and may depict live adult worms. We hypothesize that the low signal strands correspond to the collagen rich acellular cuticle. This, in combination with the surrounding hyperintense T2 signal, corresponding to a dilated lymphatic channel, may provide more specific MRI findings for active nematodal infection, which can prompt early biopsy, pathological correlation, and diagnosis. PMID:24707427
Kanellopoulos, A D; Mavrogenis, A F; Mitsiokapa, E A; Panagopoulos, D; Skouteli, H; Vrettos, S G; Tzanos, G; Papagelopoulos, P J
Botulinum toxin A injections and orthotics have been used to manage upper extremity spasticity in hemiplegic children. The authors performed a study to evaluate the necessity and effectiveness of a static night splint following outpatient botulinum toxin A treatment in children with upper limb spastic cerebral palsy. Twenty children with upper limb spastic cerebral palsy were treated with botulinum toxin A injections. A static night splint was applied in half of them. Objective assessment of upper limb function was performed at baseline, at 2 and 6 months after botulinum toxin A injection using the Quality of Upper Extremity Skills Test. After botulinum toxin A treatment, both groups showed an improvement on their previous functional level of the injected upper extremity. At 2 months, children in group A showed a 15.4% improvement, whereas children in group B improved by 12.2% from baseline; these were not statistically significant (P=0.326). At 6 months, group A still maintained a 15.9% improvement in function compared to group B which differed only by 4.2% from prebotulinum toxin A baseline; these differences were statistically significant (P=0.000). Complications related to the botulinum toxin A injection were not observed. The static Static night splinting following botulinum toxin A injections has shown a definite treatment effect in reducing spasticity and improving function in children with upper limb spastic cerebral palsy.
Chesworth, Bert M.
Background The original 20-item Upper Extremity Functional Index (UEFI) has not undergone Rasch validation. Objective The purpose of this study was to determine whether Rasch analysis supports the UEFI as a measure of a single construct (ie, upper extremity function) and whether a Rasch-validated UEFI has adequate reproducibility for individual-level patient evaluation. Design This was a secondary analysis of data from a repeated-measures study designed to evaluate the measurement properties of the UEFI over a 3-week period. Methods Patients (n=239) with musculoskeletal upper extremity disorders were recruited from 17 physical therapy clinics across 4 Canadian provinces. Rasch analysis of the UEFI measurement properties was performed. If the UEFI did not fit the Rasch model, misfitting patients were deleted, items with poor response structure were corrected, and misfitting items and redundant items were deleted. The impact of differential item functioning on the ability estimate of patients was investigated. Results A 15-item modified UEFI was derived to achieve fit to the Rasch model where the total score was supported as a measure of upper extremity function only. The resultant UEFI-15 interval-level scale (0–100, worst to best state) demonstrated excellent internal consistency (person separation index=0.94) and test-retest reliability (intraclass correlation coefficient [2,1]=.95). The minimal detectable change at the 90% confidence interval was 8.1. Limitations Patients who were ambidextrous or bilaterally affected were excluded to allow for the analysis of differential item functioning due to limb involvement and arm dominance. Conclusion Rasch analysis did not support the validity of the 20-item UEFI. However, the UEFI-15 was a valid and reliable interval-level measure of a single dimension: upper extremity function. Rasch analysis supports using the UEFI-15 in physical therapist practice to quantify upper extremity function in patients with musculoskeletal
Koh, Chia-Lin; Pan, Shin-Liang; Jeng, Jiann-Shing; Chen, Bang-Bin; Wang, Yen-Ho; Hsueh, I-Ping; Hsieh, Ching-Lin
Prediction of voluntary upper extremity (UE) movement recovery is largely unknown in patients with little voluntary UE movement at admission. The present study aimed to investigate (1) the extent and variation of voluntary UE movement recovery, and (2) the best predictive model of the recovery of voluntary UE movement by clinical variables in patients with severe UE paresis. Prospective cohort study. 140 (out of 590) stroke patients with severe UE paresis completed all assessments. Voluntary UE movement was assessed using the UE subscale of the Stroke Rehabilitation Assessment of Movement (STREAM-UE). Two outcome measures, STREAM-UE scores at discharge (DC(STREAM-UE)) and changes between admission and discharge (Δ(STREAM-UE)), were investigated to represent the final states and improvement of the recovery of voluntary UE movement. Stepwise regression analyses were used to investigate 19 clinical variables and to find the best predictive models of the two outcome measures. The participants showed wide variation in both DC(STREAM-UE) and Δ(STREAM-UE). 3.6% of the participants almost fully recovered at discharge (DC(STREAM-UE) > 15). A large improvement (Δ(STREAM-UE) >= 10) occurred in 16.4% of the participants, while 32.9% of the participants did not have any improvement. The four predictors for the DC(STREAM-UE) (R(2) = 35.0%) were 'baseline STREAM-UE score', 'hemorrhagic stroke', 'baseline National Institutes of Health Stroke Scale (NIHSS) score', and 'cortical lesion excluding primary motor cortex'. The three predictors for the Δ(STREAM-UE) (R(2) = 22.0%) were 'hemorrhagic stroke', 'baseline NIHSS score', and 'cortical lesion excluding primary motor cortex'. Recovery of voluntary UE movement varied widely in patients with severe UE paresis after stroke. The predictive power of clinical variables was poor. Both results indicate the complex nature of voluntary UE movement recovery in patients with severe UE paresis after stroke.
Nemec, S F; Kasprian, G; Brugger, P C; Bettelheim, D; Amann, G; Nemec, U; Rotmensch, S; Graham, J M; Rimoin, D L; Lachman, R S; Prayer, D
In view of the increasing use of fetal magnetic resonance imaging (MRI) as an adjunct to prenatal ultrasonography, we sought to demonstrate the visualization of upper extremity abnormalities and associated defects on MRI, with regard to fetal outcomes and compared with ultrasound imaging. This retrospective study included 29 fetuses with upper extremity abnormalities visualized with fetal MRI following suspicious ultrasound findings and confirmed by postnatal assessment or autopsy. On a 1.5-Tesla unit, dedicated sequences were applied to image the extremities. Central nervous system (CNS) and extra-CNS anomalies were assessed to define extremity abnormalities as isolated or as complex, with associated defects. Fetal outcome was identified from medical records. MRI and ultrasound findings, when available, were compared. Isolated upper extremity abnormalities were found in three (10.3%) fetuses. In 26 (89.7%) fetuses complex abnormalities, including postural extremity disorders (21/26) and structural extremity abnormalities (15/26), were demonstrated. Associated defects involved: face (15/26); musculoskeletal system (14/26); thorax and cardio/pulmonary system (12/26); lower extremities (12/26); brain and skull (10/26); and abdomen (8/26). Of the 29 cases, 18 (62.1%) pregnancies were delivered and 11 (37.9%) were terminated. MRI and US findings were compared in 27/29 cases: the diagnosis was concordant in 14 (51.9%) of these cases, and additional findings were made on MRI in 13/27 (48.1%) cases. Visualization of upper extremity abnormalities on fetal MRI enables differentiation between isolated defects and complex ones, which may be related to poor fetal prognosis. MRI generally confirms the ultrasound diagnosis, and may provide additional findings in certain cases. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.
Chiu, Hsiu-Ching; Ada, Louise; Lee, Hsin-Min
To investigate whether Wii Sports Resort training is effective and if any benefits are maintained. Randomized, single-blind trial. Sixty-two hemiplegic children with cerebral palsy (6-13 years). Experimental group undertook six weeks of home-based Wii Sports Resort training plus usual therapy, while the control group received usual therapy. Outcomes were coordination, strength, hand function, and carers' perception of hand function, measured at baseline, six, and 12 weeks by a blinded assessor. There was a trend of mean difference (MD) for the experimental group to have more grip strength by six (MD 4.0 N, 95% confidence interval (CI) -0.8 to 8.8, p = 0.10) and 12 (MD 4.1 N, 95% CI -2.1 to 10.3, p = 0.19) weeks, and to have a higher quantity of hand function according to carers' perception by six (MD 4.5 N, 95% CI -0.7 to 9.7, p = 0.09) and strengthened by 12 (MD 6.4, 95% CI 0.6 to 12.3, p = 0.03) weeks than the control group. There was no difference between groups in coordination and hand function by six or 12 weeks. Wii training did not improve coordination, strength, or hand function. Beyond the intervention, carers perceived that the children used their hands more. © The Author(s) 2014.
Gruson, Konrad I; Huang, Kevin; Wanich, Tony; Depalma, Anthony A
Clinical outcomes following upper extremity surgery among workers' compensation patients have traditionally been found to be worse than those of non-workers' compensation patients. In addition, workers' compensation patients take significantly longer to return to their jobs, and they return to their preinjury levels of employment at a lower overall rate. These unfavorable prognoses may stem from the strenuous physical demands placed on the upper extremity in this group of patients. Further, there is a potential financial benefit within this patient population to report severe functional disability following surgery. Orthopaedic upper extremity surgeons who treat workers' compensation patients should be aware of the potentially prolonged period before return to work after surgical intervention and should counsel this group of patients accordingly. Vocational training should be considered if a patient's clinical progress begins to plateau.
Dean, Lorraine T; DeMichele, Angela; LeBlanc, Mously; Stephens-Shields, Alisa; Li, Susan Q; Colameco, Chris; Coursey, Morgan; Mao, Jun J
Over one-third of breast cancer survivors experience upper extremity disability. Black women present with factors associated with greater upper extremity disability, including: increased body mass index (BMI), more advanced disease stage at diagnosis, and varying treatment type compared with Whites. No prior research has evaluated the relationship between race and upper extremity disability using validated tools and controlling for these factors. Data were drawn from a survey study among 610 women with stage I-III hormone receptor positive breast cancer. The disabilities of the arm, shoulder and hand (QuickDASH) is an 11-item self-administered questionnaire that has been validated for breast cancer survivors to assess global upper extremity function over the past 7 days. Linear regression and mediation analysis estimated the relationships between race, BMI and QuickDASH score, adjusting for demographics and treatment types. Black women (n = 98) had 7.3 points higher average QuickDASH scores than White (n = 512) women (p < 0.001). After adjusting for BMI, age, education, cancer treatment, months since diagnosis, and aromatase inhibitor status, Black women had an average 4-point (95 % confidence interval 0.18-8.01) higher QuickDASH score (p = 0.04) than White women. Mediation analysis suggested that BMI attenuated the association between race and disability by 40 %. Even several years post-treatment, Black breast cancer survivors had greater upper extremity disability, which was partially mediated by higher BMIs. Close monitoring of high BMI Black women may be an important step in reducing disparities in cancer survivorship. More research is needed on the relationship between race, BMI, and upper extremity disability.
Laudner, Kevin G
Injuries stemming from shoulder instability are very common among athletes participating in contact sports, such as football. Previous research has shown that increased laxity negatively affects the function of the sensorimotor system potentially leading to a pathological cycle of shoulder dysfunction. Currently, there are no data detailing such effects among football players. Therefore, the purpose of this study was to examine the differences in upper extremity sensorimotor control among football players compared with that of a control group. Forty-five collegiate football players and 70 male control subjects with no previous experience in contact sports participated. All the subjects had no recent history of upper extremity injury. Each subject performed three 30-second upper extremity balance trials on each arm. The balance trials were conducted in a single-arm push-up position with the test arm in the center of a force platform and the subjects' feet on a labile device. The trials were averaged, and the differences in radial area deviation between groups were analyzed using separate 1-way analyses of variance (p < 0.05). The football players showed significantly more radial area deviation of the dominant (0.41 ± 1.23 cm2, p = 0.02) and nondominant arms (0.47 ± 1.63 cm2, p = 0.03) when compared with the control group. These results suggest that football players may have decreased sensorimotor control of the upper extremity compared with individuals with no contact sport experience. The decreased upper extremity sensorimotor control among the football players may be because of the frequent impacts accumulated during football participation. Football players may benefit from exercises that target the sensorimotor system. These findings may also be beneficial in the evaluation and treatment of various upper extremity injuries among football players.
Speirs, Joshua; Showery, James; Abdou, Marwa; Pirela-Cruz, Miguel A; Abdelgawad, Amr A
Dog bites are common injuries in children. A large percentage of these dog bites affect the upper extremity. There is little information describing the results of treatment of upper extremity injuries in children. We retrospectively reviewed the medical records for all children less than 19 years old who presented to the emergency department in our level one trauma centre because of dog bites from 2005 to 2011. During the study period, there were 254 paediatric emergency department visits for animal bites, among these there were 118 dog bites, two were excluded because of inadequate documentation leaving 116 patients; 26 of them (22.4%) had bites to the upper extremity. Among the 26 children with dog bites to the upper extremity, 6 (23.1%) were admitted to the hospital for surgery (four patients) or parenteral antibiotics (two patients). Among the four surgeries, two were for extensive laceration and two were for abscess debridement. Of the 41 who presented with bites to the lower extremities, none were admitted to the hospital (P = 0.002). Compared with those who presented the same day they were injured, the relative risk of hospitalization or surgery in patients who presented 1 and 2 days after their injury was 3.5 and 7.0, respectively. Dog bites at the upper extremity are more prone to require surgical intervention and develop infection than those at the lower extremity, and delayed presentation of these injuries is associated with higher incidence of developing infection. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).
Choi, Soo-Jung; Ahn, Jae Hong; Ryu, Dae Shik; Kang, Chae Hoon; Jung, Seung Mun; Park, Man Soo; Shin, Dong-Rock
Nerve compression syndromes commonly involve the nerves in the upper extremity. High-resolution ultrasonography (US) can satisfactorily assess these nerves and may detect the morphological changes of the nerves. US can also reveal the causes of nerve compression when structural abnormalities or space-occupying lesions are present. The most common US finding of compression neuropathy is nerve swelling proximal to the compression site. This article reviews the normal anatomic location and US appearances of the median, ulnar, and radial nerves. Common nerve compression syndromes in the upper extremity and their US findings are also reviewed. PMID:25682987
Kassee, Caroline; Hunt, Carolyn; Holmes, Michael W R; Lloyd, Meghann
This pilot study compared a Nintendo Wii intervention to single-joint resistance training for the upper limb in children ages 7 to 12 with spastic hemiplegic cerebral palsy (CP). Children were randomized to Wii training (n= 3), or resistance training (n= 3) and trained at home for 6 weeks. Pre, post and 4-week follow-up measures were collected. Outcome measures were the Melbourne Assessment (MA2), and ABILHAND-Kids, and grip strength. Compliance, motivation and feasibility of each intervention was explored using daily logbook responses and questionnaires. Descriptive statistics were used. Three children improved in the MA2, two of which were in the Wii training group. Improvements in the ABILHAND-Kids were minimal for all participants. Grip strength improvements were observed in 3 participants, two of which were in the resistance training group. The Wii training group reported higher compliance and more consistently positive responses to motivation and feasibility questions. Therefore, Wii training may be an effective home-based rehabilitation strategy, and is worth exploring in a larger trial. Implications of Wii training in the context of motivation theory are discussed.
Koh, Chia-Lin; Pan, Shin-Liang; Jeng, Jiann-Shing; Chen, Bang-Bin; Wang, Yen-Ho; Hsueh, I-Ping; Hsieh, Ching-Lin
Background and Objective Prediction of voluntary upper extremity (UE) movement recovery is largely unknown in patients with little voluntary UE movement at admission. The present study aimed to investigate (1) the extent and variation of voluntary UE movement recovery, and (2) the best predictive model of the recovery of voluntary UE movement by clinical variables in patients with severe UE paresis. Design Prospective cohort study. Methods 140 (out of 590) stroke patients with severe UE paresis completed all assessments. Voluntary UE movement was assessed using the UE subscale of the Stroke Rehabilitation Assessment of Movement (STREAM-UE). Two outcome measures, STREAM-UE scores at discharge (DCSTREAM-UE) and changes between admission and discharge (ΔSTREAM-UE), were investigated to represent the final states and improvement of the recovery of voluntary UE movement. Stepwise regression analyses were used to investigate 19 clinical variables and to find the best predictive models of the two outcome measures. Results The participants showed wide variation in both DCSTREAM-UE and ΔSTREAM-UE. 3.6% of the participants almost fully recovered at discharge (DCSTREAM-UE > 15). A large improvement (ΔSTREAM-UE >= 10) occurred in 16.4% of the participants, while 32.9% of the participants did not have any improvement. The four predictors for the DCSTREAM-UE (R2 = 35.0%) were ‘baseline STREAM-UE score’, ‘hemorrhagic stroke’, ‘baseline National Institutes of Health Stroke Scale (NIHSS) score’, and ‘cortical lesion excluding primary motor cortex’. The three predictors for the ΔSTREAM-UE (R2 = 22.0%) were ‘hemorrhagic stroke’, ‘baseline NIHSS score’, and ‘cortical lesion excluding primary motor cortex’. Conclusions Recovery of voluntary UE movement varied widely in patients with severe UE paresis after stroke. The predictive power of clinical variables was poor. Both results indicate the complex nature of voluntary UE movement recovery in patients
Page, Stephen J.; Hill, Valerie; White, Susan
Objective To compare the efficacy of a repetitive task specific practice regimen integrating a portable, electromyography-controlled brace called the “Myomo” versus usual care repetitive task specific practice in subjects with chronic, moderate upper extremity impairment. Subjects 16 subjects (7 males; mean age = 57.0 ± 11.02 years; mean time post stroke = 75.0 ± 87.63 months; 5 left-sided strokes) exhibiting chronic, stable, moderate upper extremity impairment. Interventions Subjects were administered repetitive task specific practice in which they participated in valued, functional tasks using their paretic upper extremities. Both groups were supervised by a therapist and were administered therapy targeting their paretic upper extremities that was 30-minutes in duration, occurring 3 days/week for 8 weeks. However, one group participated in repetitive task specific practice entirely while wearing the portable robotic while the other performed the same activity regimen manually.. Main Outcome Measures The upper extremity Fugl-Meyer, Canadian Occupational Performance measure and Stroke Impact Scale were administered on two occasions before intervention and once after intervention. Results After intervention, groups exhibited nearly-identical Fugl-Meyer score increases of ≈ 2.1 points; the group using robotics exhibited larger score changes on all but one of the Canadian occupational performance measure and Stroke Impact Scale subscales, including a 12.5-point increase on the Stroke Impact Scale recovery subscale. Conclusions Findings suggest that therapist-supervised repetitive task specific practice integrating robotics is as efficacious as manual in subjects with moderate upper extremity impairment. PMID:23147552
Hanel, Douglas P; Chin, Simon H
Since Malt and McKhan's first successful arm replantation in 1962, upper extremity replantation surgery techniques have been refined and spread worldwide. Nevertheless, replantation at or proximal to the wrist, referred to as wrist-proximal replants, remains a daunting challenge that presents the hand surgeon with an array of difficulties distinct from digital replantation.
Ng, Wendy KY; Kaur, Manraj Nirmal; Thoma, Achilleas
BACKGROUND: Long-term outcomes of major upper extremity replantations are infrequently reported. It is believed that replantation is indicated for amputations at all levels in children and for all distal amputations in adults. Replantations of arm or proximal forearm amputations in adults are controversial. OBJECTIVE: To evaluate the results of major upper extremity replantations, defined as those that are transmetacarpal, through the wrist, forearm, elbow or arm. METHODS: A review of these types of replantations performed at the authors’ institution from 2002 to 2012 was conducted. Patients’ strength, range of motion and two-point discrimination were assessed. Patients completed the Disabilities of the Arm, Shoulder and Hand (DASH), the Michigan Hand Questionnaire (MHQ), and the Hospital Anxiety and Depression scale (HADS). RESULTS: Seventeen patients underwent major upper extremity replantation surgery. The majority (16 of 17 [94%]) of the included patients were male. Of 17 patients, 13 (76.5%) required reoperations. The mean (± SD) DASH score of seven patients who consented to completing all questionnaires was 75.4±14.2 of 100 (range 59.2 to 91.1). On the MHQ, the mean score for affected hand function was 16% compared with 84% in the unaffected hand. Patients generally demonstrated at least mild levels of anxiety and depression on the HADS. DISCUSSION: The results suggest that major upper extremity injuries and replantations have a significant impact on patients’ long-term hand function, and produce long-term anxiety and depressive symptoms. PMID:25152640
Simpson, Lisa A
Background and Purpose Augmenting changes in recovery is core to the rehabilitation process following a stroke. Hence, it is essential that outcome measures are able to detect change as it occurs; a property known as responsiveness. This paper critically reviewed the responsiveness of functional outcome measures following stroke, specifically examining tools that captured upper extremity functional recovery. Methods A systematic search of the literature was undertaken to identify articles providing responsiveness data for three types of change (observed, detectable, important). Results Data from 68 articles for 14 upper extremity functional outcome measures were retrieved. Larger percent changes were required to be considered important when obtained through anchor-based methods (eg. based on patient opinion or comparative measure) compared to distribution methods (eg. statistical estimates). Larger percent changes were required to surpass the measurement error for patient-perceived functional measures (eg. Motor Activity Log) compared to lab-based performance measures (eg. Action Research Arm Test). The majority of rehabilitation interventions have similarly sized effects on patient-perceived upper extremity function versus lab-based upper extremity function. Conclusions The magnitude of important change or change that surpasses measurement error can vary substantially depending on the method of calculation. Rehabilitation treatments can affect patient perceptions of functional change as effectively as lab-based functional measures; however higher sample sizes may be required to account for the larger measurement error associated with patient-perceived functional measures. PMID:23077144
Digiovine, N M; Jobe, F W; Pink, M; Perry, J
The upper extremity is vulnerable to injury during the baseball pitch because of the repetitious nature of the action, the extremes in range of motion, and the high angular velocities and torques generated at the shoulder and elbow. Hence this study was designed to describe the muscle-firing patterns through fine-wire electromyography in 29 muscle bellies in the upper extremities of skilled pitchers during the fastball pitch. The results demonstrated that the muscles functioned with precise timing for joint stabilization to prevent injury, joint activation to transfer forces to the ball, and joint deceleration to dissipate forces after ball release. The synchrony of reciprocal and sequential muscle contraction necessary to accomplish these functions was clearly evident. This study provides a better understanding of the coordinated sequence of muscle activity during the throwing motion; this understanding is crucial to the development of exercise protocols and surgical procedures used for treatment and prevention of shoulder and elbow injuries in the throwing athlete.
Ege, Tolga; Unlu, Aytekin; Tas, Huseyin; Bek, Dogan; Turkan, Selim; Cetinkaya, Aytac
Background: Decision of limb salvage or amputation is generally aided with several trauma scoring systems such as the mangled extremity severity score (MESS). However, the reliability of the injury scores in the settling of open fractures due to explosives and missiles is challenging. Mortality and morbidity of the extremity trauma due to firearms are generally associated with time delay in revascularization, injury mechanism, anatomy of the injured site, associated injuries, age and the environmental circumstance. The purpose of the retrospective study was to evaluate the extent of extremity injuries due to ballistic missiles and to detect the reliability of mangled extremity severity score (MESS) in both upper and lower extremities. Materials and Methods: Between 2004 and 2014, 139 Gustillo Anderson Type III open fractures of both the upper and lower extremities were enrolled in the study. Data for patient age, fire arm type, transporting time from the field to the hospital (and the method), injury severity scores, MESS scores, fracture types, amputation levels, bone fixation methods and postoperative infections and complications retrieved from the two level-2 trauma center's data base. Sensitivity, specificity, positive and negative predictive values of the MESS were calculated to detect the ability in deciding amputation in the mangled limb. Results: Amputation was performed in 39 extremities and limb salvage attempted in 100 extremities. The mean followup time was 14.6 months (range 6–32 months). In the amputated group, the mean MESS scores for upper and lower extremity were 8.8 (range 6–11) and 9.24 (range 6–11), respectively. In the limb salvage group, the mean MESS scores for upper and lower extremities were 5.29 (range 4–7) and 5.19 (range 3–8), respectively. Sensitivity of MESS in upper and lower extremities were calculated as 80% and 79.4% and positive predictive values detected as 55.55% and 83.3%, respectively. Specificity of MESS score for
Ege, Tolga; Unlu, Aytekin; Tas, Huseyin; Bek, Dogan; Turkan, Selim; Cetinkaya, Aytac
Decision of limb salvage or amputation is generally aided with several trauma scoring systems such as the mangled extremity severity score (MESS). However, the reliability of the injury scores in the settling of open fractures due to explosives and missiles is challenging. Mortality and morbidity of the extremity trauma due to firearms are generally associated with time delay in revascularization, injury mechanism, anatomy of the injured site, associated injuries, age and the environmental circumstance. The purpose of the retrospective study was to evaluate the extent of extremity injuries due to ballistic missiles and to detect the reliability of mangled extremity severity score (MESS) in both upper and lower extremities. Between 2004 and 2014, 139 Gustillo Anderson Type III open fractures of both the upper and lower extremities were enrolled in the study. Data for patient age, fire arm type, transporting time from the field to the hospital (and the method), injury severity scores, MESS scores, fracture types, amputation levels, bone fixation methods and postoperative infections and complications retrieved from the two level-2 trauma center's data base. Sensitivity, specificity, positive and negative predictive values of the MESS were calculated to detect the ability in deciding amputation in the mangled limb. Amputation was performed in 39 extremities and limb salvage attempted in 100 extremities. The mean followup time was 14.6 months (range 6-32 months). In the amputated group, the mean MESS scores for upper and lower extremity were 8.8 (range 6-11) and 9.24 (range 6-11), respectively. In the limb salvage group, the mean MESS scores for upper and lower extremities were 5.29 (range 4-7) and 5.19 (range 3-8), respectively. Sensitivity of MESS in upper and lower extremities were calculated as 80% and 79.4% and positive predictive values detected as 55.55% and 83.3%, respectively. Specificity of MESS score for upper and lower extremities was 84% and 86.6%; negative
Mohd Khairuddin, Ismail; Taha, Zahari; Majeed, Anwar P. P. Abdul; Hakeem Deboucha, Abdel; Azraai Mohd Razman, Mohd; Aziz Jaafar, Abdul; Mohamed, Zulkifli
This paper presents the modelling and control of a two degree of freedom upper extremity exoskeleton. The Euler-Lagrange formulation was used in deriving the dynamic modelling of both the human upper limb as well as the exoskeleton that consists of the upper arm and the forearm. The human model is based on anthropometrical measurements of the upper limb. The proportional-derivative (PD) computed torque control (CTC) architecture is employed in this study to investigate its efficacy performing joint-space control objectives specifically in rehabilitating the elbow and shoulder joints along the sagittal plane. An active force control (AFC) algorithm is also incorporated into the PD-CTC to investigate the effectiveness of this hybrid system in compensating disturbances. It was found that the AFC- PD-CTC performs well against the disturbances introduced into the system whilst achieving acceptable trajectory tracking as compared to the conventional PD-CTC control architecture.
Nemmers, D W; Thorpe, P E; Knibbe, M A; Beard, D W
Upper extremity venous thrombosis is a clinical entity with numerous etiologic factors. Only 2% of all cases of deep venous thrombosis involve the upper extremity, and the incidence of pulmonary embolism related to thrombosis in this location is approximately 12%. Primary or "effort" thrombosis of the upper limb is related to the inherent anatomical structure of the thoracic outlet and axillary region. Secondary thrombosis may have such diverse origins as trauma, infection, congestive heart failure, central venous catheters, neoplasms, septic phlebitis, intravenous drug use, and hypercoagulable states. Patients present with peripheral edema and prominent superficial veins, and neurologic symptoms (pain and paresthesias) are usually present as well. Clinical diagnosis is confirmed by venography or sonography. Treatment regimens include conservative measures, thrombolysis with fibrinolytic agents, and surgical correction of indicated thoracic outlet and axillary structures. We present an unusual case in which upper extremity venous thrombosis in a young healthy female athlete was associated with the presence of cervical ribs. The patient was successfully treated with focal thrombolysis and surgical resection of her ipsilateral cervical rib.
Nelson, Clayton E; Rayan, Ghazi M; Judd, Dustin I; Ding, Kai; Stoner, Julie A
Rock climbing first evolved as a sport in the late 18th century. With its growing popularity, the number of rock climbing-related injuries has potential to increase, spurring a rise in the number of articles associated with it. Despite the available literature, there remains a paucity of information about upper extremity injuries sustained by rock climbers, and no studies to date have focused on gender-specific injuries. A 24-question online survey was distributed to rock climbers about upper extremity injuries sustained during rock climbing. Statistical analysis was used to study association between participants' demographics and injuries. A total of 397 participants responded to the survey. Mean age was 32.5 years with males comprising 85%. No significant differences in demographics or climbing behaviors were found between males and females. Ninety percent of participants reported sustaining an upper extremity injury. Fingers were the most common injury followed by shoulder/arm and elbow/forearm. Our study found females to be more likely to report a rock climbing-related injury, and more likely to undergo surgery for it. Female rock climbers were significantly more likely to report a shoulder/upper arm injury and were also more likely to report undergoing surgery compared with males, where these differences were not due to age or climbing behaviors. Further investigation is warranted into the association between shoulder injuries and female athletes to determine how the gender differences relate to extent of injury as well as health service utilization behaviors.
Houdek, Matthew T.; Wagner, Eric R.; Wyles, Cody C.; Nanos, George P.; Moran, Steven L.
Originally described in the 1970s, vascularized bone grafting has become a critical component in the treatment of bony defects and non-unions. Although well established in the lower extremity, recent years have seen many novel techniques described to treat a variety of challenging upper extremity pathologies. Here the authors review the use of different techniques of vascularized bone grafts for the upper extremity bone pathologies. The vascularized fibula remains the gold standard for the treatment of large bone defects of the humerus and forearm, while also playing a role in carpal reconstruction; however, two other important options for larger defects include the vascularized scapula graft and the Capanna technique. Smaller upper extremity bone defects and non-unions can be treated with the medial femoral condyle (MFC) free flap or a vascularized rib transfer. In carpal non-unions, both pedicled distal radius flaps and free MFC flaps are viable options. Finally, in skeletally immature patients, vascularized fibular head epiphyseal transfer can provide growth potential in addition to skeletal reconstruction. PMID:25685100
Ng, Zhi Yang; Salgado, Christopher J.; Moran, Steven L.; Chim, Harvey
Mangled upper extremity injuries usually involve high-impact trauma with crushing and tearing of the limb and its associated soft tissue structures. Such trauma is particularly mutilating because of the nature of the injury and the involvement of structures vital for proper function. Although advancements in flap technique and improvements in bone fixation methods have enabled good functional and clinical outcomes in limb salvage reconstruction, this remains a challenging area. Attempts at limb preservation should be fully exhausted before consideration is given for amputation, which results in significantly decreased function. Here the authors focus on the various modalities of soft tissue coverage available including allogenic substitutes, the adjunctive use of negative pressure wound therapy, and the design and utilization of flaps to address various defect configurations for the goals of wound healing, aesthetics, and functional restoration in the mangled upper extremity. PMID:25685103
Kostić, Miloš D; Popović, Mirjana B; Popović, Dejan B
The assisted movement in humans with paresis of upper extremities is becoming popular for neurorehabilitation. We propose a novel method for trajectory selection and assistance control. This paper presents simulation of a planar two degrees of freedom robot that assists horizontal movement of the hand. The control assumes that during the exercise the hand needs to follow healthy alike trajectories. The robot is assumed to provide minimal assistance and operate as a teacher of the movement.
Spindler, Nick; Al-Benna, Sammy; Ring, Andrej; Homann, Heinz; Steinsträsser, Lars; Steinau, Hans-Ulrich; Langer, Stefan
Introduction: Limb-threatening wounds of the upper extremity pose a challenge to the micro vascular surgeon. The aim of this study is to analyze the outcome of free anterolateral thigh flaps for upper extremity soft tissue reconstruction. Methods: A retrospective review of patients undergoing this procedure from 2005 to 2012 was performed. Case note analysis was performed to determine demographic and perioperative factors, and complications and outcomes. Results: Thirty-two patients with a mean age of 53 years (9–84 yrs) underwent upper extremity reconstruction with an anterolateral thigh (ALT) flap. There were 24 (75%) males and 8 (25%) females. The etiology of the soft tissue defects was: infection (44.6%); post-tumor ablation (40%); and trauma (15.6%). The defect site was most commonly in the forearm (53.1%), followed by the elbow (12.5 %), arm (12.5%) and hand (21.9%). The mean timing of free flap transfer was 6.8 days after admission to our institution (minimum 1 days, maximum 9 days). Mean operative time of surgery was 4 h 39 min (minimum 3 h 2 min, maximum 6 h 20 min). The mean hospitalization was 24.8 days (minimum 5, maximum 85). The ALT success rate was at 92.3%. Partial flap necrosis was documented in five cases (15.6%). Complete flap loss occurred in two post-traumatic cases who both lost their limbs. Discussion: This flap, in the hands of experienced surgeons, provides reliable coverage of upper extremity defects. PMID:26504734
Dukelow, Sean P
Two decades of research on robots and upper extremity rehabilitation has resulted in recommendations from systematic reviews and guidelines on their use in stroke. Robotics are often cited for their ability to encourage mass practice as a means to enhance recovery of movement. Yet, stroke recovery is a complex process occurring across many aspects of neurologic function beyond movement. As newer devices are developed and enhanced assessments are integrated into treatment protocols, the potential of robotics to advance rehabilitation will continue to grow.
Taha, Zahari; Majeed, Anwar P. P. Abdul; Tze, Mohd Yashim Wong Paul; Abdo Hashem, Mohammed; Mohd Khairuddin, Ismail; Azraai Mohd Razman, Mohd
This paper presents the modelling and control of a two degree of freedom upper extremity exoskeleton for rehabilitation. The Lagrangian formulation was employed to obtain the dynamic modelling of both the anthropometric based human upper limb as well as the exoskeleton that comprises of the upper arm and the forearm. A proportional-derivative (PD) architecture is employed to investigate its efficacy performing a joint task trajectory tracking in performing flexion/extension on the elbow joint as well as the forward adduction/abduction on the shoulder joint. An active force control (AFC) algorithm is also incorporated into the aforementioned controller to examine its effectiveness in compensating disturbances. It was found from the study that the AFC-PD performed well against the disturbances introduced into the system without compromising its tracking performances as compared to the conventional PD control architecture.
Brill, Natalie A; Tyler, Dustin J
In this study we provide detailed quantification of upper extremity nerve and fascicular anatomy. The purpose is to provide values and trends in neural features useful for clinical applications and neural interface device design. Nerve cross-sections were taken from 4 ulnar, 4 median, and 3 radial nerves from 5 arms of 3 human cadavers. Quantified nerve features included cross-sectional area, minor diameter, and major diameter. Fascicular features analyzed included count, perimeter, area, and position. Mean fascicular diameters were 0.57 ± 0.39, 0.6 ± 0.3, 0.5 ± 0.26 mm in the upper arm and 0.38 ± 0.18, 0.47 ± 0.18, 0.4 ± 0.27 mm in the forearm of ulnar, median, and radial nerves, respectively. Mean fascicular diameters were inversely proportional to fascicle count. Detailed quantitative anatomy of upper extremity nerves is a resource for design of neural electrodes, guidance in extraneural procedures, and improved neurosurgical planning. Muscle Nerve 56: 463-471, 2017. © 2016 Wiley Periodicals, Inc.
Triolo, R J; Werner, K N; Kirsch, R F
This paper describes the design, validation, and application of a dynamic, three-dimensional (3-D) model of the upper extremity for the purpose of estimating postural disturbances generated by movements of the arms. The model consists of two links representing the upper and lower arms, with the shoulder and elbow modeled as gimbal joints to allow three rotational degrees of freedom. With individualized segment inertial parameters based on anthropometric measurements, the model performs inverse dynamic analysis of recorded arm movements to calculate reaction forces and moments acting on the body at the shoulder in three dimensions. The method was validated by comparing the output of the model to estimates obtained from ground reaction loads during stereotypical and free form unilateral movements at various velocities and with different loads carried by human subjects while seated on biomechanical force platforms. The correlation between predicted and measured reaction forces and moments was very good under all conditions and across all subjects, with average rms errors less than 8% of measured peak-to-peak values. The model was then applied to bimanual activities representative of functional movements that would typically be performed while standing at a counter. The resulting estimates were consistent and adequate for the purpose of evaluating postural disturbances caused by upper extremity movements.
Bar-On, Shikma; Cohen, Aviad; Levin, Ishai; Avni, Amiran; Lessing, Joseph B; Atmog, Benny
Upper extremity deep venous thrombosis (UEDVT) is uncommon as a spontaneous event in the general population and is associated with well-defined risk factors. Thromboembotic events are serious, but fortunately rare, complications following ovarian stimulation for IVF. A review of the Literature indicates that thromboembolic events after ovarian stimulation are usually associated with ovarian hyperstimulation syndrome (OHSS). The incidence of UEDVT is higher in women undergoing assisted reproductive technology (ART) compared to the general population. The incidence of this condition is estimated to be 0.08%-0.11% of treatment cycles. While lower extremity DVT may be considered a natural consequence of OHSS, given the diminished venous return secondary to enlarged ovaries and ascites, it is unclear why there appears to be a predilection for thrombi in the upper extremities in women undergoing ART. Early diagnosis and treatment is crucial for both maternal and fetal well-being. Since infertility treatment is becoming commonplace in today's society, women undergoing treatment and their clinicians should be better informed of the presentation and clinical course of UEDVT to enable early diagnosis and start treatment. Consideration must be given to screening patients at risk for OHSS for thrombophilias, as well as administrating prophylactic anticoagulation therapy to patients who develop OHSS.
Holt, Taylor; Oliver, Gretchen D
The purpose of this study was to examine the relationship between dynamic hip rotational range of motion and upper extremity kinematics during baseball pitching. Thirty-one youth baseball pitchers (10.87 ± 0.92 years; 150.03 ± 5.48 cm; 44.83 ± 8.04 kg) participated. A strong correlation was found between stance hip rotation and scapular upward rotation at maximum shoulder external rotation (r = 0.531, P = 0.002) and at ball release (r = 0.536, P = 0.002). No statistically significant correlations were found between dynamic hip rotational range of motion and passive hip range of motion. Hip range of motion deficits can constrain pelvis rotation and limit energy generation in the lower extremities. Shoulder pathomechanics can then develop as greater responsibility is placed on the shoulder to generate the energy lost from the proximal segments, increasing risk of upper extremity injury. Additionally, it appears that passive seated measurements of hip range of motion may not accurately reflect the dynamic range of motion of the hips through the progression of the pitch cycle.
Slauterbeck, J R; Britton, C; Moneim, M S; Clevenger, F W
The mangled extremity severity score (MESS) is a scoring system that can be applied to mangled extremities and help one determine which mangled limbs will eventually come to amputation. The MESS is a graduated grading system based on skeletal and soft tissue injury, shock, ischemia, and age. The records of 37 patients having sustained 43 open fractures or mangled upper extremity injuries, seen and treated at the University of New Mexico's Regional Trauma Center between April 1987 and September 1990, have been reviewed. All nine extremity injuries with a MESS of greater than or equal to seven were amputated, and 34 of 34 with a MESS of less than seven were salvaged. Nine Grade IIIC and six mangled extremities were identified in our study. Five of these Grade IIIC and four of the mangled extremities with a MESS of greater than or equal to seven were amputated. All Grade IIIC or mangled extremities with a MESS of less than seven were salvaged. In conclusion, the MESS is an early and accurate predictor for identifying the extremities that may be best treated by amputation.
Lawinger, Elizabeth; Uhl, Tim L; Abel, Mark; Kamineni, Srinath
The overarching goal of this study was to examine the use of triaxial accelerometers in measuring upper-extremity motions to monitor upper-extremity-exercise compliance. There were multiple questions investigated, but the primary objective was to investigate the correlation between visually observed arm motions and triaxial accelerometer activity counts to establish fundamental activity counts for the upper extremity. Cross-sectional, basic research. Clinical laboratory. Thirty healthy individuals age 26 ± 6 y, body mass 24 ± 3 kg, and height 1.68 ± 0.09 m volunteered. Participants performed 3 series of tasks: activities of daily living (ADLs), rehabilitation exercises, and passive shoulder range of motion at 5 specific velocities on an isokinetic dynamometer while wearing an accelerometer on each wrist. Participants performed exercises with their dominant arm to examine differences between sides. A researcher visually counted all arm motions to correlate counts with physical activity counts provided by the accelerometer. Physical activity counts derived from the accelerometer and visually observed activity counts recorded from a single investigator. There was a strong positive correlation (r = .93, P < .01) between accelerometer physical activity counts and visual activity counts for all ADLs. Accelerometers activity counts demonstrated side-to-side difference for all ADLs (P < .001) and 5 of the 7 rehabilitation activities (P < .003). All velocities tested on the isokinetic dynamometer were shown to be significantly different from each other (P < .001). There is a linear relationship between arm motions counted visually and the physical activity counts generated by an accelerometer, indicating that arm motions could be potentially accounted for if monitoring arm usage. The accelerometers can detect differences in relatively slow arm-movement velocities, which is critical if attempting to evaluate exercise compliance during early phases of shoulder
Bullock, Charlotte; Johnston, A McD
We describe the case of a 23-year-old serviceman on overseas deployment who presented with a painful, swollen arm. Investigations showed an upper extremity deep vein thrombosis (UEDVT) of the right arm with an associated asymptomatic pulmonary embolism, which was treated with warfarin anticoagulation. Further investigation identified positional obstruction at the thoracic outlet, and the patient was diagnosed with Paget-Schroetter syndrome. He underwent elective resection of the first rib, and has now returned to normal duties. After review of the literature on UEDVT, it is suggested that in this military patient, the occurrence of an anatomical variant put him at risk of upper limb venous thrombosis, which was probably potentiated by the occupational factor of carrying a rifle. The external compression of the subclavian vein from the rifle butt and hypertrophied muscles, in addition to the anatomical variation, caused repetitive microtrauma of the vessel intima, which precipitated venous thrombosis.
Mirela Cristina, Luca; Matei, Daniela; Ignat, Bogdan; Popescu, Cristian Dinu
The purpose of this study was to evaluate the effects of mirror therapy program in addition with physical therapy methods on upper limb recovery in patients with subacute ischemic stroke. 15 subjects followed a comprehensive rehabilitative treatment, 8 subjects received only control therapy (CT) and 7 subjects received mirror therapy (MT) for 30 min every day, five times a week, for 6 weeks in addition to the conventional therapy. Brunnstrom stages, Fugl-Meyer Assessment (upper extremity), the Ashworth Scale, and Bhakta Test (finger flexion scale) were used to assess changes in upper limb motor recovery and motor function after intervention. After 6 weeks of treatment, patients in both groups showed significant improvements in the variables measured. Patients who received MT showed greater improvements compared to the CT group. The MT treatment results included: improvement of motor functions, manual skills and activities of daily living. The best results were obtained when the treatment was started soon after the stroke. MT is an easy and low-cost method to improve motor recovery of the upper limb.
Fitzgibbons, Peter; Medvedev, Gleb
Upper extremity amputation is an uncommon but often necessary procedure. It can be required as a result of trauma, infection, or malignancy. Amputation is a life-changing procedure. Careful planning for it must not only include the level of amputation and assurance of durable soft-tissue coverage of the amputation site, but it must also consider patients' goals and occupations, as well as social factors affecting amputees. The choice of prosthesis is an individual matter, but new technology permits lighter and more multifunctional prostheses. Targeted muscle reinnervation can be used to achieve improved myoelectric signaling and possibly decrease limb pain following amputation. Rehabilitation is crucial to achieving favorable results.
Nota, Sjoerd P F T; Spit, Silke A; Oosterhoff, Thijs C H; Hageman, Michiel G J S; Ring, David C; Vranceanu, Ana-Maria
Pain intensity and disability correlate with psychosocial factors such as depression and pain interference (the degree to which pain interferes with activities of daily living) as much or more than pathophysiology in upper extremity illness. However, other factors like emotional support (perception of being cared for and valued as a person), instrumental support (perception of availability of tangible assistance when needed), positive psychosocial impact (perception and focus on the positive side of a difficult situation, sometimes characterized as posttraumatic growth, benefit-finding, or meaning making), also might be associated with disability in patients with upper extremity orthopaedic illness. This is the first published study, to our knowledge, addressing the potential association of emotional support, instrumental support, and positive psychosocial illness impact with disability in patients with upper extremity illness. We asked: (1) Is there a correlation between the QuickDASH and the Patient-reported Outcomes Measurement Information System (PROMIS(®)) emotional support Computer Adaptive Testing (CAT)? (2) Is there a correlation between the QuickDASH and PROMIS(®) instrumental support CAT? (3) Is there a correlation between the QuickDASH and PROMIS(®) positive psychosocial illness impact CAT? (4) Among the PROMIS(®) measures of depression, emotional support, instrumental support, positive illness impact, and pain interference, which accounts for the most variance in QuickDASH scores? One hundred ninety-three patients with upper extremity illness (55% women; average age, 51 ± 18 years) of 213 approached (91% recruitment rate) completed the QuickDASH, and five different PROMIS(®) CATs: pain interference (the degree to which pain interferes with accomplishing one's goals), depression, emotional support, psychosocial illness impact, and instrumental support. We recruited patients from the practice of three surgeons in hand service of the department of
Mathieu, L; Bertani, A; Gaillard, C; Chaudier, P; Ollat, D; Bauer, B; Rigal, S
This review presents the current surgical management of combat-related upper extremity injuries during the acute phase. The strategy consists of saving the life, saving the limb and retaining function. Surgical tactics are based on damage control orthopaedics techniques of haemorrhage control, wound debridement, and temporary bone stabilization prior to evacuation out of the combat zone. Features of the definitive management of local casualties in battlefield medical facilities are also discussed. In this situation, reconstructive procedures have to take into account the limited resources and operational constraints. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
The treatment of pain is a complex process that requires a team approach. This article provides an overview of the pharmaceutical treatments available. It gives providers treating upper extremity disorders more tools to treat their patients with chronic pain. Another goal is to improve hand providers' understanding of the medications their pain colleagues prescribe in shared patients. Pharmaceuticals are an important component in the treatment of chronic pain and opioids are often not a good solution. Knowing what other medications are available can improve the care for these challenging patients.
Pavlov-Dolijanovic, Slavica R; Vujasinovic Stupar, Nada Z; Gavrilov, Nikola; Seric, Srdjan
Juvenile dermatomyositis (JDM) is a rare but complex and potentially life-threatening autoimmune disease of childhood. Significant proportions of patients have residual weakness, muscle atrophy, joint contractures, and calcinosis. Recently, new clinical findings, such as lipodystrophy accompanied with increased fat deposition in certain areas, have been reported. So far, it is not known whether the redistribution of body fat may be the type of lipedema of lower extremity. We describe a 39-year-old woman who was diagnosed with JDM at the age of 7. Later she developed symmetrical lipodystrophy of upper extremities and symmetrical lipedema of lower extremities (making 2 and 58.3 % of total body fat mass, respectively), with multiple calcified nodules in the subcutaneous tissues. These nodules gradually increased in size despite therapy. Capillaroscopy findings showed scleroderma-like abnormalities. ANA and anti-U1RNP antibodies were positive. Similar cases with simultaneous occurrence of the lipedema of lower extremities, lipodystrophy of upper extremities, and severe calcinosis complicating JDM have not been published so far. We showed that the calcinosis and lipodystrophy were associated with short duration of active disease. Also, we display case that raises the question whether it is possible overlapping autoimmune diseases revealed during follow-up.
Huang, Yu C; Leong, Chau P; Wang, Lin; Wang, Lin Y; Yang, Yu C; Chuang, Chien Y; Hsin, Yi J
Hemiplegic shoulder pain (HSP) impedes functional motor recovery of the affected limbs and negatively affects quality of life and daily activities. Kinesiology taping (KT) may provide improvement in hemiplegic shoulder pain and upper extremity function after an acute stroke. To assess the impact of KT on HSP, upper extremity functional outcomes, and the prevention of shoulder soft tissue injury in subacute stroke patients with hemiplegic shoulders during rehabilitation. Randomized, double-blind controlled trial. Rehabilitation unit at a single medical center. Forty-four subacute stroke patients with hemiplegia. Forty-four subacute stroke patients with hemiplegia participated in this study and were randomly allocated to the control group (sham KT) or experimental group (therapeutic KT). In the experimental group, a 3-week therapeutic KT with conventional inpatient rehabilitation was applied for 5 days per week. In the control group, the patients received a 3-week sham KT with conventional inpatient rehabilitation for 5 days per week. Shoulder subluxation, spasticity, hemiplegic shoulder pain, the Fugl-Meyer Assessment for Upper Extremity (FMA-UE), modified Barthel Index (MI), Stroke-Specific Quality of Life (SSQOL) scale, and shoulder sonography were measured before and after treatment. Pain-free flexion was significantly increased in hemiplegic shoulders after therapeutic KT. From 16 (70%) to 20 (87%) patients in the control and from 12 (57%) to 12 (57%) in the experimental groups had HSP after intervention, and a significant difference in the occurrence of HSP was found between these groups after treatment (P<0.05). Significant improvements (P<0.05) were noted in the FMA-UE, modified BI, and SSQOL scales after treatment in both groups. No significant differences between the groups were seen on shoulder sonography (P>0.05). Therapeutic KT may limit the development of HSP and improve shoulder flexion in subacute stroke patients with flaccid shoulders during
Ng, Zhi Yang; Askari, Morad; Chim, Harvey
Patients with complex upper extremity injuries represent a unique subset of the trauma population. In addition to extensive soft tissue defects affecting the skin, bone, muscles and tendons, or the neurovasculature in various combinations, there is usually concomitant involvement of other body areas and organ systems with the potential for systemic compromise due to the underlying mechanism of injury and resultant sequelae. In turn, this has a direct impact on the definitive reconstructive plan. Accurate assessment and expedient treatment is thus necessary to achieve optimal surgical outcomes with the primary goal of limb salvage and functional restoration. Nonetheless, the characteristics of these injuries places such patients at an increased risk of complications ranging from limb ischemia, recalcitrant infections, failure of bony union, intractable pain, and most devastatingly, limb amputation. In this article, the authors present an algorithmic approach toward complex injuries of the upper extremity with due consideration for the various reconstructive modalities and timing of definitive wound closure for the best possible clinical outcomes. PMID:25685098
Hamilton, K L; Meyers, M C; Skelly, W A; Marley, R J
The purpose of this study was to investigate the influence of creatine monohydrate (CrH2O) on upper extremity anaerobic response in strength-trained females involved in overhand sports. Two movements were utilized in this evaluation: elbow flexion (EF) and shoulder internal rotation (IR). Subjects were pair-matched and assigned to receive placebo (n = 13) or 25 g CrH2O (n = 11) for 7 days. Pre- and post-treatment measurements included peak concentric and eccentric isokinetic torque, isotonic 1RM, and fatigue (FAT) during EF; isotonic 1RM, FAT, and peak velocity during IR; and body weight. MANOVAs revealed significant interaction between treatment and trial for EF (p <.05) but not for IR or weight. Univariate analysis indicated a significantly greater change in EFFAT following CrH2O than following placebo. Thus, CrH2O did not influence peak EF or IR strength, IR work to fatigue, or IR velocity, but was associated with greater work capacity during fatiguing EF. These data suggest that CrH2O may enhance upper extremity work capacity, but this enhancement may not extend to the muscles primarily responsible for overhand sports performance.
Matzon, Jonas L; Lutsky, Kevin F; Maloney, Michael; Beredjiklian, Pedro K
The American Academy of Orthopaedic Surgeons (AAOS) recently developed several clinical practice guidelines (CPGs) involving upper-extremity conditions. The purpose of this study was to evaluate the adherence to these CPGs by members of the American Society for Surgery of the Hand (ASSH). An e-mail containing a brief study description and access to the survey was sent to ASSH current and candidate members. The survey contained questions involving the existing upper-extremity AAOS CPGs: diagnosis and treatment of carpal tunnel syndrome, treatment of distal radius fractures, and treatment of glenohumeral arthritis. Overall, 469 responses were obtained, for a response rate of 32%. Descriptive statistics were used to evaluate the responses. Members of ASSH do not universally adhere to the AAOS CPGs. For patients with carpal tunnel syndrome, 53% of respondents wait the recommended time to change nonoperative treatment after failure of a given modality, and 32% of respondents always order electrodiagnostic testing when considering surgery. Furthermore, 30% of respondents immobilize the wrist postoperatively. In regard to distal radius fractures, 11% of respondents always prescribe vitamin C after treatment, and 49% respondents never do so. However, ASSH members follow some of the recommendations. These include nighttime splinting (98%) and corticosteroid injections (85%) in the nonoperative treatment of carpal tunnel syndrome. For distal radius fractures, almost 85% of respondents consider the suggested postreduction criteria when determining operative versus cast treatment. Further study is warranted to understand the reasons for and possible solutions to the inconsistent adherence to the AAOS CPGs.
Sytema, Renee; Dekker, Rienk; Dijkstra, Pieter U; ten Duis, Hendrik J; van der Sluis, Corry K
To analyze differences in sports injury characteristics of the upper and lower extremity and to identify factors that contribute to the risk of sustaining an upper extremity injury compared with the risk of sustaining a lower extremity injury. Retrospective cohort study. An emergency department of a large European level I trauma center. A total of 25 120 patients with a simple sports injury, attending during 1990-2005. Independent variables used to assess risk factors were extracted from a local database. These include age, sex, type of injury, site and side of the injury, type of sport, injury mechanism, and data on admission. Main outcome measure was the relation of various risk factors to the occurrence of either upper or lower extremity injury. Logistic regression analysis was used to identify predictors for upper extremity injury. Thirty-five percent upper and 53% lower extremity injuries were recorded. Most injuries were sustained when playing soccer (36%). Fractures were more frequently diagnosed in the upper than in the lower extremities (44% and 14%, respectively), especially in children. Falling was the main cause of upper extremity injury. Further risk factors were young age and playing individual sports, no-contact sports, or no-ball sports. Women were at risk in speed skating, inline skating, and basketball, whereas men mostly got injured during skiing and snowboarding. A high percentage of sports injuries are sustained to the upper extremity. Different risk factors were identified for both sexes. These risk factors should be taken into account when designing preventive measures.
Won, Erik J; Johnson, Peter W; Punnett, Laura; Dennerlein, Jack T
This laboratory study examined gender differences in upper extremity postures, applied forces, and muscle activity when a computer workstation was adjusted to individual anthropometry according to current guidelines. Fifteen men and 15 women completed five standardized computer tasks: touch-typing, completing a form, editing text, sorting and resizing graphical objects and navigating intranet pages. Subjects worked at a height-adjustable workstation with the keyboard on top of the work surface and the mouse to the right. Subjects repeated the text editing task with the mouse in two other locations: a "high" mouse position, which simulated using a keyboard drawer with the mouse on the primary work surface, and "center" mouse position with the mouse between the keyboard and the body, centered with the body's center line. Surface electromyography measured muscle activity; electrogoniometric and magnetic motion analysis system measured wrist, forearm and upper arm postures; load-cells measured typing forces; and a force-sensing mouse measured applied forces. Relative forces applied to the keyboard, normalized muscle activity of two forearm muscles, range of motion for the wrist and shoulder joints and external rotation of the shoulder were higher for women (p<0.05). When subjects were dichotomized instead by anthropometry (either large/small shoulder width or arm length), the differences in forces, muscle activity of the shoulder and wrist posture and shoulder posture became more pronounced with smaller subjects having higher values. Postural differences between the genders increased in the high mouse position and decreased in the center mouse location. When a workstation is adjusted per current guidelines differences in upper extremity force, muscle activity and postural factors still exist between genders. However, these were often stronger when subjects were grouped by anthropometry suggesting that perhaps the computer input devices themselves should be scaled to be
Gupta, Ena; Siddiqi, Furqan; Faisal, Muhammad; Jones, Lisa M.; Louis, Mariam; Cury, James D.; Bajwa, Abubakr A.
Background. We hypothesized that positive end-exploratory pressure (PEEP) may promote venous stasis in the upper extremities and predispose to upper extremity deep vein thrombosis (UEDVT). Methods. We performed a retrospective case control study of medical intensive care unit patients who required mechanical ventilation (MV) for >72 hours and underwent duplex ultrasound of their upper veins for suspected DVT between January 2011 and December 2013. Results. UEDVT was found in 32 (28.5%) of 112 patients. Nineteen (67.8%) had a central venous catheter on the same side. The mean ± SD duration of MV was 13.2 ± 9.5 days. Average PEEP was 7.13 ± 2.97 cm H2O. Average PEEP was ≥10 cm H2O in 23 (20.5%) patients. Congestive heart failure (CHF) significantly increased the odds of UEDVT (OR 4.53, 95% CI 1.13–18.11; P = 0.03) whereas longer duration of MV (≥13 vs. <13 days) significantly reduced it (OR 0.29, 95% CI 0.11–0.8; P = 0.02). Morbid obesity showed a trend towards significance (OR 3.82, 95% CI 0.95–15.4; P = 0.06). Neither PEEP nor any of the other analyzed predictors was associated with UEDVT. Conclusions. There is no association between PEEP and UEDVT. CHF may predispose to UEDVT whereas the risk of UEDVT declines with longer duration of MV. PMID:25922762
Riemann, Bryan L; Davis, Sarah E; Huet, Kevin; Davies, George J
Based on the frequency pushing and pulling patterns are used in functional activities, there is a need to establish an objective method of quantifying the muscle performance characteristics associated with these motions, particularly during the later stages of rehabilitation as criteria for discharge. While isokinetic assessment offers an approach to quantifying muscle performance, little is known about closed kinetic chain (CKC) isokinetic testing of the upper extremity (UE). To determine the intersession reliability of isokinetic upper extremity measurement of pushing and pulling peak force and average power at slow (0.24 m/s), medium (0.43 m/s) and fast (0.61 m/s) velocities in healthy young adults. The secondary purpose was to compare pushing and pulling peak force (PF) and average power (AP) between the upper extremity limbs (dominant, non-dominant) across the three velocities. Twenty-four physically active men and women completed a test-retest (>96 hours) protocol in order to establish isokinetic UE CKC reliability of PF and AP during five maximal push and pull repetitions at three velocities. Both limb and speed orders were randomized between subjects. High test-retest relative reliability using intraclass correlation coefficients (ICC2, 1) were revealed for PF (.91-.97) and AP (.85-.95) across velocities, limbs and directions. PF typical error (% coefficient of variation) ranged from 6.1% to 11.3% while AP ranged from 9.9% to 26.7%. PF decreased significantly (p < .05) as velocity increased whereas AP increased as velocity increased. PF and AP during pushing were significantly greater than pulling at all velocities, however the push-pull differences in PF became less as velocity increased. There were no significant differences identified between the dominant and nondominant limbs. Isokinetically derived UE CKC push-pull PF and AP are reliable measures. The lack of limb differences in healthy normal participants suggests that clinicians can
Yaffe, Mark Aaron; Kaplan, F Thomas
Agricultural injuries involving the hand and upper extremity are common, debilitating injuries that reflect the significant occupational hazards associated with the agricultural industry. Farm injuries occur in all age groups and are associated with significant resource utilization and treatment costs. Most of these injuries are associated with machinery, including tractors, power take-off devices, grain augers, hay balers, and combine harvesters. Each piece of machinery produces specific injury patterns and a spectrum of bone and soft-tissue injuries that are frequently characterized by the loss of a digit or limb, permanent disability, loss of function, and serious complications such as infection. Management of agricultural injuries includes expedient administration of antibiotic and tetanus prophylaxis, aggressive irrigation, serial débridement, consideration of delayed wound closure, and reconstruction or replantation of amputated digits and limbs, if feasible. Copyright 2014 by the American Academy of Orthopaedic Surgeons.
Milanowicz, Marcin; Kędzior, Krzysztof
About 3.8 million people are injured in accidents at work in Europe every year. The resulting high costs are incurred by the victims themselves, their families, employers and society. We have used a numerical simulation to reconstruct accidents at work for several years. To reconstruct these accidents MADYMO R7.5 with a numerical human model (pedestrian model) is used. However, this model is dedicated to the analysis of car-to-pedestrian accidents and thus cannot be fully used for reconstructing accidents at work. Therefore, we started working on the development of a numerical model of the human body for the purpose of simulating accidents at work. Developing a new numerical model which gives an opportunity to simulate fractures of the upper extremity bones is a stage of that work. PMID:26651896
Chiang, Chia-Liang; Liao, Chu-Yung; Kuo, Hsien-Wen
Non-medical hospital staff members are in frequent contact with patients and therefore are required to perform a wide variety of repetitive and high-frequency activities. The objective of this study was to assess the relationships between upper extremity activity and carpal tunnel syndrome (CTS) among non-medical hospital staff members. Carpal tunnel syndrome in 144 non-medical hospital staff members was diagnosed using the Nordic Musculoskeletal Questionnaire (NMQ), a physician's diagnosis, physical examination (Tinel's signs and Phalen test) and a nerve conduction velocity (NCV) test. In addition, an ergonomic assessment was performed and a video camera was used to record the physical activities at work. The prevalence rate of CTS was highest for the NMQ (51.9%), followed by physician's diagnosis (49.5% for the right hand, 29.9% for the left hand), physical examination (54.7%), and nerve conduction test (motor nerve 27.5% and 25%, sensory nerve 21.7% and 15%, for right and left hands, respectively). Based on logistic regression models for the NMQ and physician's diagnoses, there was a dose-dependently higher risk of CTS with the upper extremity index among participants, but this was non-significant based on the physical examination and nerve conduction tests. Nerve conduction velocity is the gold standard in diagnosis of CTS, but use of NMQ and physician's diagnosis may overestimate the incidence of CTS in workers who have been engaging in repetitive stress activities for a relatively short time. Int J Occup Med Environ Health 2017;30(2):281-290.
Wertman, Gary; Gaston, R. Glenn; Heisel, William
Background: Understanding the position-specific musculoskeletal forces placed on the body of athletes facilitates treatment, prevention, and return-to-play decisions. While position-specific injuries are well documented in most major sports, little is known about the epidemiology of position-specific injuries in National Association for Stock Car Automobile Racing (NASCAR) drivers and pit crew. Purpose: To investigate position-specific upper extremity injuries in NASCAR drivers and pit crew members. Study Design: Descriptive epidemiological study. Methods: A retrospective chart review was performed to assess position-specific injuries in NASCAR drivers and pit crew members. Included in the study were patients seen by a single institution between July 2003 and October 2014 with upper extremity injuries from race-related NASCAR events or practices. Charts were reviewed to identify the diagnosis, mechanism of injury, and position of each patient. Results: A total of 226 NASCAR team members were treated between July 2003 and October 2014. Of these, 118 injuries (52%) occurred during NASCAR racing events or practices. The majority of these injuries occurred in NASCAR changers (42%), followed by injuries in drivers (16%), carriers (14%), jack men (11%), fuel men (9%), and utility men (8%). The majority of the pit crew positions are at risk for epicondylitis, while drivers are most likely to experience neuropathies, such as hand-arm vibration syndrome. The changer sustains the most hand-related injuries (42%) on the pit crew team, while carriers commonly sustain injuries to their digits (29%). Conclusion: Orthopaedic injuries in NASCAR vary between positions. Injuries in NASCAR drivers and pit crew members are a consequence of the distinctive forces associated with each position throughout the course of the racing season. Understanding these forces and position-associated injuries is important for preventive measures and facilitates diagnosis and return-to-play decisions
van Andel, Carolien J; Wolterbeek, Nienke; Doorenbosch, Caroline A M; Veeger, DirkJan H E J; Harlaar, Jaap
Upper extremity (UX) movement analysis by means of 3D kinematics has the potential to become an important clinical evaluation method. However, no standardized protocol for clinical application has yet been developed, that includes the whole upper limb. Standardization problems include the lack of a single representative function, the wide range of motion of joints and the complexity of the anatomical structures. A useful protocol would focus on the functional status of the arm and particularly the orientation of the hand. The aim of this work was to develop a standardized measurement method for unconstrained movement analysis of the UX that includes hand orientation, for a set of functional tasks for the UX and obtain normative values. Ten healthy subjects performed four representative activities of daily living (ADL). In addition, six standard active range of motion (ROM) tasks were executed. Joint angles of the wrist, elbow, shoulder and scapula were analyzed throughout each ADL task and minimum/maximum angles were determined from the ROM tasks. Characteristic trajectories were found for the ADL tasks, standard deviations were generally small and ROM results were consistent with the literature. The results of this study could form the normative basis for the development of a 'UX analysis report' equivalent to the 'gait analysis report' and would allow for future comparisons with pediatric and/or pathologic movement patterns.
Salminger, S; Sturma, A; Herceg, M; Riedl, O; Bergmeister, K; Aszmann, O C
Conventional upper arm prostheses are controlled via two surface electrodes that measure motor activity of two separately innervated muscle groups. The various prosthetic joints are chosen by co-contractions and controlled linearly by these two muscles. A harmonious and natural course of movements is not possible in this way. Overview regarding surgical, therapeutical and prosthetic options in high amputations of the upper extremity. Selective literature research including the authors' own experience in everyday clinical practice as well as a review of medical records. Selective nerve transfers of the amputated nerves of the brachial plexus to the remaining stump muscles can create up to six myosignals for intuitive and simultaneous control of the different prosthetic joints. In this way, an efficient and harmonious control of the prosthetic device is possible without the need to change between the different control levels. At the same time, possible neuromas are treated and painless wear of the prosthesis is achieved. Due to the resulting extended use of the prosthetic device, the demands regarding stump quality are increased. Thus, both surgically and by the means of the orthopedic technician a stable stump-socket connection should be achieved to enable optimal prosthetic function.
Lampe, R.; Kawelke, S.; Mitternacht, J.; Turova, V.; Blumenstein, T.; Alves-Pinto, A.
Trophic disorders like reduced skin blood circulation are well-known epiphenomenon of cerebral palsy (CP). They can influence quality of life and can lead to skin damages and, as a consequence, to decubitus. Therefore, it is important to analyse temperature regulation in patients with CP. Thermal imaging camera FLIR BCAM SD was used to study the dependency of skin blood circulation in upper extremities of patients with CP on hand dominance, hand force and hand volume. The hand force was evaluated using a conventional dynamometer. The hand volume was measured with a volumeter. A cold stress test for hands was applied in 22 patients with CP and 6 healthy subjects. The warming up process after the test was recorded with the thermal camera. It was confirmed that the hands of patients warm up slower comparing to healthy persons. The patients' working hands warm up faster than non-working ones. A slight correlation was established between the hand grip force of the working hands and their warm up time. No correlation was found between the warming up time and the volume of the hand. The results confirm our assumption that there is a connection of peripheral blood circulation to upper limb motor functions.
Hung, Ya-Ching; Charles, Jeanne; Gordon, Andrew M
Previously we found that children with hemiplegic cerebral palsy (CP) have impaired bimanual coordination compared to typically developing children during a functional drawer-opening task. However, performance of the task under time constraints (fast-as-possible) facilitated better bimanual coordination for these children. Accuracy is another important task constraint that could influence the coordination of the two hands during such tasks. The effect of accuracy constraints on bimanual coordination in children with hemiplegic CP is not well understood. In the present study, children were asked to reach forward and open a drawer with one hand and then activate a light switch inside the drawer with the contralateral hand. Task accuracy constraints (different handles and switch sizes) were manipulated in order to determine their effect on upper extremity coordination. Eleven children with hemiplegic CP (age 8-16 years) and eleven age-matched typically developing children participated in this study. The results show that higher accuracy constraints prolong the total movement completion time for both groups of children. However, children with hemiplegic CP demonstrated less sequential movement with a higher accuracy constraint (a smaller knob handle) than a lower accuracy constraint (a larger loop handle). Nevertheless, presentation of both higher accuracy constraints (handle and switch) at the same time was detrimental to their performance. These influences of task constraints were similar regardless of which hand was used to open the drawer. The results suggest that performance may not be linearly related to the constraints, and in some cases "more is not better".
Viegas, Steven F; Williams, David; Jones, Jeffrey; Strauss, Samuel; Clark, Jonathan
Hand and upper-extremity overuse and repetitive injuries in astronauts have been and continue to be a common problem in the space program. The demands on upper-extremity use in the astronaut training program, the zero-gravity environment, the extreme temperature conditions of space, the effects of space travel on human physiology/anatomy, and the constraints and pressures of space suits and gloves all can negatively impact upper-extremity function in ways that can result in overuse/repetitive injuries. Future plans for space exploration include endeavors that will continue and even increase the demands on the hand and upper extremity.
Silverstein, A.M.; Turbiner, E.H.
The efficacy of Tc-99m RBC venography has been demonstrated with respect to the study of lower extremity deep venous thrombosis. A case is presented where Tc-99m RBC venography was used to study the upper as well as lower extremities in a patient with upper extremity deep venous thrombosis (DVT) who was found to have pulmonary embolism.
Fong, Kenneth N K; Jim, Eska S W; Dong, Vicky A Q; Cheung, Hobby K Y
To investigate the effects of sensory cueing with repetitive practice on hemiplegic arm functions in children with unilateral cerebral palsy. A single-group pre/post comparison. A special school for children with physical disabilities. Eight children with unilateral cerebral palsy aged 6-18 years. Participants were required to wear for three weeks a sensory cueing, non-activated wristwatch device and complete 5 hours of conventional therapy per week (treatment A). This was followed by three weeks of continuing conventional therapy and wearing the now activated wristwatch, which prompted the children to do predetermined exercises on the hemiplegic arm for 6 hours daily, 5 days per week, for three weeks (treatment B), and three weeks follow-up. Assessments of arm efficiency, functional hand use and arm impairments were carried out at baseline (day before treatment A), posttest 1 (day after treatment A), posttest 2 (day after treatment B) and follow-up (three weeks after treatment B). Arm efficiency as revealed by the Jebsen-Taylor Hand Function Test and the Bruininks-Oseretsky Test of Motor Proficiency - but not actual arm use and grip strength - showed significant improvement after treatment B to follow-up (from 286.0 ± 73.9 to 191.9 ± 73.5, P = 0.002, and from 15.5 ± 5.0 to 18.1 ± 7.7, P = 0.021). This pilot study provides proof-of-concept data showing that a wearable device might be used to remind children with cerebral palsy to perform a set of predetermined arm exercises in order to promote hemiplegic arm function.
Klitfod, L; Broholm, R; Baekgaard, N
Upper extremity deep venous thrombosis (UEDVT) occurs either spontaneously, as a consequence of strenuous upper limb activity (also known as the Paget-Schroetter syndrome) or secondary to an underlying cause. Primary and secondary UEDVT differs in long-term sequelae and mortality. This review will focus on the clinical presentation, risk factors, diagnosis, and treatment strategies of UEDVT. In the period from January to October 2012 an electronic literature search was performed in the PubMed/MEDLINE database, and 27 publications were included. swelling, pain and functional impairment are typical symptoms of UEDVT, although completely asymptomatic cases have been described. However life-threatening, massive pulmonary embolism (PE) can also be a sign of UEDVT. for the primary condition anatomical abnormalities (Thoracic Outlet Syndrome, TOS) may dispose to the condition. Malignancy and therapeutic interventions are major risk factors for the secondary deep vein thrombosis in combination with the patient's characteristics, comorbidities and prior history of deep vein thrombosis. recurrent deep venous thrombosis, pulmonary embolism and Post Thrombotic Syndrome (PTS) are the major complications after UEDVT. PTS is a chronic condition leading to significant functional disability and impaired quality of life. compression ultrasonography is noninvasive and the most frequently used objective test with a high accuracy in experienced hands. Treatment modalities and strategies: the treatment modalities include anticoagulation therapy, catheter-directed thrombolysis, surgical decompression, percutaneous transluminal angioplasty and stenting and they may be combined. However, the optimal treatment and timing of treatment remains controversial. Early diagnosis and treatment is essential to prevent PTS in primary UEDVT; however, there is no consensus on which treatment is the best. Anticoagulation is still considered the treatment of choice for at least 3-6 months, until
Lemmens, Ryanne J. M.; Janssen-Potten, Yvonne J. M.; Timmermans, Annick A. A.; Smeets, Rob J. E. M.; Seelen, Henk A. M.
To evaluate arm-hand therapies for neurological patients it is important to be able to assess actual arm-hand performance objectively. Because instruments that measure the actual quality and quantity of specific activities in daily life are lacking, a new measure needs to be developed. The aims of this study are to a) elucidate the techniques used to identify upper extremity activities, b) provide a proof-of-principle of this method using a set of activities tested in a healthy adult and in a stroke patient, and c) provide an example of the method’s applicability in daily life based on readings taken from a healthy adult. Multiple devices, each of which contains a tri-axial accelerometer, a tri-axial gyroscope and a tri-axial magnetometer were attached to the dominant hand, wrist, upper arm and chest of 30 healthy participants and one stroke patient, who all performed the tasks ‘drinking’, ‘eating’ and ‘brushing hair’ in a standardized environment. To establish proof-of-principle, a prolonged daily life recording of 1 participant was used to identify the task ‘drinking’. The activities were identified using multi-array signal feature extraction and pattern recognition algorithms and 2D-convolution. The activities ‘drinking’, ‘eating’ and ‘brushing hair’ were unambiguously recognized in a sequence of recordings of multiple standardized daily activities in a healthy participant and in a stroke patient. It was also possible to identify a specific activity in a daily life recording. The long term aim is to use this method to a) identify arm-hand activities that someone performs during daily life, b) determine the quantity of activity execution, i.e. amount of use, and c) determine the quality of arm-hand skill performance. PMID:25734641
Ring, David; Kadzielski, John; Fabian, Lauren; Zurakowski, David; Malhotra, Leah R; Jupiter, Jesse B
The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is the most widely used upper extremity-specific health-status measure. The DASH score often demonstrates greater variability than would be expected on the basis of objective pathology. This variability may be related to psychosocial factors. The purpose of the present study was to investigate the correlation between the DASH score and psychological factors for specific diagnoses with relatively limited variation in objective pathology. Two hundred and thirty-five patients with a single, common, discrete hand problem known to have limited variations in objective pathology completed the DASH questionnaire, the Eysenck Personality Questionnaire-Revised (EPQ-R) to assess neuroticism, the Center for Epidemiologic Studies-Depression (CES-D) scale to quantify depressive symptoms, and the Pain Anxiety Symptoms Scale (PASS). Forty-five patients had carpal tunnel syndrome, forty-four had de Quervain tenosynovitis, forty-eight had lateral elbow pain, and seventy-one had a single trigger finger. In addition, twenty-seven patients were evaluated six weeks after a nonoperatively treated fracture of the distal part of the radius. Relationships between psychosocial factors and the DASH score were determined. A significant positive correlation between the DASH score and depression was noted for all diagnoses (r = 0.38 to 0.52; p < 0.01 for all). The DASH score also correlated with pain anxiety for four of the five diagnoses (carpal tunnel syndrome, r = 0.40; de Quervain tendinitis, r = 0.46; lateral elbow pain, r = 0.42; and trigger finger, r = 0.24) (p < 0.05 for all). The DASH score was not correlated with neuroticism for any diagnosis. There was a highly significant effect of depression (as measured with the CES-D score) on the DASH score for all diagnoses. Both the CES-D score (F = 62.68, p < 0.0001) and gender (F = 11.36, p < 0.001) were independent predictors of the DASH score. Self-reported upper extremity
Kreulen, M; Smeulders, M J C; Veeger, H E J; Hage, J J
The effect of surgical correction of impaired forearm rotation on associated body movement patterns was studied prospectively by comparison of preoperative and postoperative three-dimensional video analysis of the upper extremity and trunk in eight male and two female patients with hemiplegic cerebral palsy (CP; mean age 16y 2mo [SD 4y 11mo]; range 11-27y). A customized parameter, 'extrinsic forearm rotation', was used to quantify associated movements supplementing forearm rotation. After surgical correction of the pronation deformity, active forearm supination during a functional reaching task had improved by a mean of 37 degrees in combination with significantly decreased extrinsic forearm rotation by a mean of 13 degrees . In addition, an average loss of 16 degrees of active pronation in combination with increased extrinsic forearm rotation (mean 8 degrees ) was observed. On the basis of these results we conclude that successful surgical correction of a pronation deformity in patients with CP directly affects related movement patterns of the upper extremity and trunk.
Beutel, Bryan G.; Lifchez, Scott D.; Melamed, Eitan
Background Cardiovascular procedures are common and are trending toward endovascular interventions. With this increase in endovascular procedures, there is also increasing awareness of upper extremity morbidity resulting from treatment. Methods Articles indexed within PubMed between the years 1975 and 2015 that discussed such complications were reviewed. Results Percutaneous radial artery access can lead to nerve ischemia, especially in the setting of an incomplete arterial arch, whereas radial artery harvesting for bypass surgery more commonly causes frank tissue ischemia and radial neuropathy. Transulnar catheterization may cause ischemic hand injuries, while transbrachial angiography has resulted in compartment syndrome. Injuries to the nerves themselves often result from surgical equipment, such as sternal retractors, or from patient positioning leading to compression of the ulnar nerve. For percutaneous radial artery access, the incidence of ischemic injury is as high as 24%, whereas nerve injury is too rare to be estimated. In the setting of radial artery harvesting, ischemic injury is limited to case reports, and radial neuropathy is estimated to occur in as many as 25% of patients at discharge. Open heart surgery is the primary setting in which equipment or patient positioning plays a role, affecting 10% of patients with brachial plexus injuries and 15% with ulnar neuropathies. Conclusion Complications following cardiovascular interventions are varied and are typically associated with specific procedures. Careful preoperative and postoperative assessments of patients may aid in preventing, minimizing, and treating these often undiagnosed complications. PMID:27625533
Sancini, Angela; Capozzella, Assunta; Caciar, Tiziana; Tomei, Francesco; Nardone, Nadia; Scala, Barbara; Fiaschetti, Maria; Cetica, Carlotta; Scimitto, Lara; Gioffrrè, PierAgostino; Sinibaldi, Federica; Di Pastena, Claudia; Corbosiero, Paola; Schifano, Maria Pia; Tomei, Gianfranco; Ciarrocca, Manuela
To assess the risk factors for upper extremity-work-related musculoskeletal disorders (UE-WMSD) on 13 production lines in an airbag factory using the threshold limit values-American conference of industrial hygienists- hand activity level (TLV-ACGIH-HAL) method and introduce the ergonomic improvement to reduce the repetitiveness and the peak force (Pf). Professional exposure level on 13 production lines in a automobile factory was measured using the TLV-ACGIH-HAL method and a further risk was assessed according to the ergonomic improvement. The first assessment of 9 production lines showed that the professional exposure level was above the TLV or HAL limit. The second assessment showed that the professional exposure level was below the AL limit on all production lines except 1, in which the professional exposure level was between TLV and HAL. The assessment of UE-WMSD-related risk can identify the riskiest emplacements and evaluate the reduction of risk in professional exposure through interventions of structural- organizational type. Copyright © 2013 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.
Transplantation of solid organs and bone marrow has become a highly acceptable and often the only available clinical solution in many situations. It has been practiced across the globe for quite a long time since the first kidney transplant in 1954. Transplantation of tissues other than these, which was termed composite tissue allotransplantation and currently as vascularised composite allotransplantation (VCA) is gaining acceptance as a solution for complex reconstructive problems. This involves the transfer of multiple types of tissue such as bone, muscle, nerve, skin and blood vessels. The advantage of these over the conventional reconstructive methods is its ability to give aesthetically and functionally superior equal composite substitute to the missing or deformed part. The composite tissues transplanted commonly include the upper extremities, face and abdominal wall. Among these, hand transplants were the first to be done and have been carried out more than any other VCA. This article reviews the current scenario of VCA especially of the hand and face, in the light of experience of the two bilateral hand transplants done recently in India. PMID:26424972
Beasley, R; Braithwaite, I; Evans, R
We report the case of a 40-year-old right-handed man who developed a right subclavian vein thrombosis due to work as a TV cameraman. He presented with a sudden onset of marked swelling and blue discolouration of his right arm 3 weeks after the most strenuous and prolonged episode of TV camera work that he had ever undertaken. This involved carrying a 9kg camera on his shoulder, with his right arm flexed and abducted, for a 60min period with provocation of severe pain and marked discomfort persisting during the subsequent 3 weeks before presentation. A clinical diagnosis of upper extremity deep vein thrombosis (UEDVT) was made, with the diagnosis confirmed by ultrasound. He was treated with catheter-induced thrombolysis and a 3 month course of anticoagulation. He was advised that his UEDVT was caused by his occupation and that he should no longer work as a cameraman. This case shows the importance of identifying any occupational cause of UEDVT. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: firstname.lastname@example.org.
Yan, Hede; Fan, Cunyi; Gao, Weiyang; Chen, Zenggan; Li, Zhejie; Chi, Zhenglin
Although never exceeding a few square centimeters, finger pulp defects are reconstructive challenges due to their special requirements and lack of neighboring tissue reserve. Local flaps are the common choice in the management of this injury. However, the development of microsurgery and clinical practice have greatly boosted the application of different free flaps for finger pulp reconstruction with excellent results, especially when local flaps are unsuitable or impossible for the coverage of large pulp defects. These flaps are all located in the same operation field and can be performed under one tourniquet; therefore, they are more convenient with better patients' compliance in clinical setting. Nonetheless, there is still no consensus about which type of these flaps should be preferred among various finger pulp reconstructive options. In this article, we attempt to review articles describing finger pulp reconstruction using free flaps from the upper extremity from the literature. We summarize the clinical applications of these free flaps and detail their advantages and drawbacks, respectively. The algorithm of flap selection for finger pulp reconstruction based on our experience and literature review is also discussed.
Grandizio, Louis C; Wagner, Benjamin; Graham, Jove; Klena, Joel C
Farming remains the most dangerous occupation in the United States and upper extremity (UE) injuries occur frequently in agricultural accidents. The purpose of this study is to describe the injury mechanisms, severity, and health care costs of UE injuries resulting from agricultural accidents and to compare patients with and without injuries to the UE. We performed a 6-year retrospective review of our level I trauma center registry from January 2006 to May 2013, identifying all patients injured in an agricultural accident. Data collection included baseline demographics, injury type and mechanism, costs and treatment. Patients with UE injuries were compared with those without UE injuries. Ninety-six of 273 patients (35%) sustained an UE injury with fractures of the phalanx and radius/ulna occurring most frequently. Patients with UE injuries were more likely to be injured from table saws ( P = .0003) and farm machinery ( P < .0001). Twenty-one percent with UE injuries sustained a mangled extremity. Patients with UE injuries were more likely to require surgery (68% vs 36%, P < .0001) and were more likely to be readmitted (17% vs 5%, P = .0007) with risk factors for readmission including age >18 years, falls from height, and surgery. Mean hospital charges were $95 147. Patients sustaining agricultural UE injuries have longer lengths of stay and more frequently require surgery despite similar hospital charges compared with non-UE injured patients. Hospital readmissions occur frequently for patients with UE injuries. Understanding injury mechanisms and the epidemiology of these potentially devastating and costly injuries may help guide agricultural injury prevention programs.
Chang, Won Hyuk; Park, Eunhee; Lee, Jungsoo; Lee, Ahee; Kim, Yun-Hee
The identification of intrinsic factors for predicting upper extremity motor outcome could aid the design of individualized treatment plans in stroke rehabilitation. The aim of this study was to identify prognostic factors, including intrinsic genetic factors, for upper extremity motor outcome in patients with subacute stroke. A total of 97 patients with subacute stroke were enrolled. Upper limb motor impairment was scored according to the upper limb of Fugl-Meyer assessment score at 3 months after stroke. The prediction of upper extremity motor outcome at 3 months was modeled using various factors that could potentially influence this impairment, including patient characteristics, baseline upper extremity motor impairment, functional and structural integrity of the corticospinal tract, and brain-derived neurotrophic factor genotype. Multivariate ordinal logistic regression models were used to identify the significance of each factor. The independent predictors of motor outcome at 3 months were baseline upper extremity motor impairment, age, stroke type, and corticospinal tract functional integrity in all stroke patients. However, in the group with severe motor impairment at baseline (upper limb score of Fugl-Meyer assessment <25), the number of Met alleles in the brain-derived neurotrophic factor genotype was also an independent predictor of upper extremity motor outcome 3 months after stroke. Brain-derived neurotrophic factor genotype may be a potentially useful predictor of upper extremity motor outcome in patients with subacute stroke with severe baseline motor involvement. © 2017 American Heart Association, Inc.
Beom, Jaewon; Jang, Hye Jin; Han, Tai Ryoon; Oh, Byung-Mo; Paik, Nam-Jong; Yang, Eun Joo; Lee, Shi-Uk
The association between fatty replacement of rotator cuff and hemiplegic upper extremity function has not been defined yet. Moreover, the relationships among rotator cuff tears, shoulder pain, spasticity, and fatty replacement were not clearly studied. We investigated the association of fatty replacement of the supraspinatus and infraspinatus muscles with tendon tear in stroke or brain-injured patients. A total of 72 hemiplegic patients were enrolled in 3 hospitals, and ultrasonography of both shoulders was performed once. Fatty replacement of the supraspinatus and infraspinatus was graded by the visibility of outer contours, pennate pattern, central tendon, and echogenicity. Fatty replacement was observed in 22 (30.6%) out of the 72 patients (in 18 supraspinatus muscles and 12 infraspinatus). Inter-rater agreement (kappa value) between the 2 physiatrists was 0.530 for the supraspinatus, and 0.411 for the infraspinatus. The Fugl-Meyer assessment score, Brunnstrom stage, and modified Barthel index were significantly lower in patients with fatty replacement of the supraspinatus or infraspinatus (group 1) than in those without (group 2). The motor power of both shoulders, the pain-free range of motion, spasticity, and hemiplegic shoulder pain were comparable between the two groups. The tear rate of the supraspinatus, infraspinatus, or subscapularis tendon at the hemiplegic side was higher than that at the contralesional side in each group, although there was no significant difference between group 1 and group 2. Disuse leading to muscle atrophy rather than rotator cuff tear might be the cause of fatty replacement of these muscles, which may be associated with decreased function of the hemiplegic upper extremities.
Girtler, M-T; Krasinski, A; Dejaco, C; Kitzler, H H; Cui, L G; Sherebrin, S; Gardi, L; Chhem, R K; Fenster, A; Romagnoli, C; De Zordo, T
This study investigates the performance of a 3 D Ultrasound (US) system in imaging elbow and wrist nerves. Twenty healthy volunteers with asymptomatic median, ulnar and radial nerves were prospectively investigated. Bilateral 3DUS scans of the elbows and wrists were acquired by using a commercially available US scanner (18 MHz, AplioXG, Toshiba) and stored as a 3 D volume by a dedicated software (CURE, Robarts Research Institute). Retrospectively, qualitative (image quality, atypical nerve location, findings potentially associated with compression neuropathy) and quantitative (cross-sectional area measurements) evaluations were performed. In all 200 nerves 3DUS was feasible (100%). Image quality was insufficient in 13.5% (25 ulnar nerve elbow, 2 radial nerve) and sonomorphology was not assessable in those nerves. Measurement of cross sectional areas was feasible in all nerves (100%). Median cross-sectional area (range) were: median nerve elbow 7 mm2 (6-9), radial nerve 3 mm2 (1-4), ulnar nerve elbow 8 mm2 (5-11), median nerve wrist 8 mm2 (5-10), and ulnar nerve wrist 4 mm2 (2-6). No significant changes in nerve cross-sectional area along each nerve was found. Ulnar nerve subluxation was found in 2 nerves (6.7%). No anconeus epitrochlearis muscle or osteophytes were found. 3DUS is a feasible method for assessing nerves of the upper extremity and has been shown to provide a good overview of the median, ulnar and radial nerve at the elbow and wrist, but is limited for evaluation of the ulnar nerve in the cubital tunnel. This technique enables reliable measurements at different locations along the nerve. © Georg Thieme Verlag KG Stuttgart · New York.
Jacobs, Nora W; Berduszek, Redmar J; Dijkstra, Pieter U; van der Sluis, Corry K
Purpose To evaluate validity and reliability of the upper extremity work demands (UEWD) scale. Methods Participants from different levels of physical work demands, based on the Dictionary of Occupational Titles categories, were included. A historical database of 74 workers was added for factor analysis. Criterion validity was evaluated by comparing observed and self-reported UEWD scores. To assess structural validity, a factor analysis was executed. For reliability, the difference between two self-reported UEWD scores, the smallest detectable change (SDC), test-retest reliability and internal consistency were determined. Results Fifty-four participants were observed at work and 51 of them filled in the UEWD twice with a mean interval of 16.6 days (SD 3.3, range = 10-25 days). Criterion validity of the UEWD scale was moderate (r = .44, p = .001). Factor analysis revealed that 'force and posture' and 'repetition' subscales could be distinguished with Cronbach's alpha of .79 and .84, respectively. Reliability was good; there was no significant difference between repeated measurements. An SDC of 5.0 was found. Test-retest reliability was good (intraclass correlation coefficient for agreement = .84) and all item-total correlations were >.30. There were two pairs of highly related items. Conclusion Reliability of the UEWD scale was good, but criterion validity was moderate. Based on current results, a modified UEWD scale (2 items removed, 1 item reworded, divided into 2 subscales) was proposed. Since observation appeared to be an inappropriate gold standard, we advise to investigate other types of validity, such as construct validity, in further research.
Halar, E M; DeLisa, J A; Soine, T L
The relationship of skin to near nerve (NN) temperature and to nerve conduction velocity (NCV) and distal latency (DL) was studied in 34 normal adult subjects before and after cooling both upper extremities. Median and ulnar motor and sensory NCV, DL, and NN temperature were determined at ambient temperature (mean X skin temp = 33 C) and after cooling, at approximately 26, 28, and 30 C of forearm skin temperature. Skin temperatures on the volar side of the forearm, wrist, palm, and fingers and NN temperature at the forearm, midpalm, and thenar or hypothenar eminence were compared with respective NCV and DL. Results showed a significant linear correlation between skin temperature and NN temperature at corresponding sites (r2 range, 0.4-0.84; p less than 0.005). Furthermore, both skin and NN temperatures correlated significantly with respective NCV and DL. Midline wrist skin temperature showed the best correlation to NCV and DL. Median motor and sensory NCV were altered 1.5 and 1.4m/sec/C degree and their DL 0.2 msec/C degree of wrist skin temperature change, respectively. Ulnar motor and sensory NCV were changed 2.1 and 1.6m/sec/C degree respectively, and 0.2 msec/C degree wrist temperature for motor and sensory DL. Average ambient skin temperature at the wrist (33 C) was used as a standard skin temperature in the temperature correction formula: NCV or DL(temp corrected) = CF(Tst degree - Tm degree) + obtained NCV or DL, where Tst = 33 C for wrist, Tm = the measured skin temperature, and CF = correction factor of tested nerve. Use of temperature correction formula for NCV and DL is suggested in patients with changed wrist skin temperature outside 29.6-36.4C temperature range.
Trigeminal Neuralgia (Burchiel Type I); Trigeminal Neuralgia (Burchiel Type II); Trigeminal Neuropathic Pain; Trigeminal Deafferentation Pain; Complex Regional Pain Syndrome (Types I and II, Involving the Upper Extremity); Glossopharyngeal Neuralgia; Upper Extremity Pain Due to Deafferentation of the Cervical Spine; Central Pain Syndromes
Fletcher, Nicholas D; Rathjen, Karl E; Bush, Patricia; Ezaki, Marybeth
The term arthrogryposis is a descriptive term referring to a variety of clinical conditions characterized by multiple joint contractures. The spine may be involved; however, the presence of associated congenital vertebral abnormalities is rare. A retrospective chart review of 6 patients with asymmetric upper extremity joint contractures and concomitant congenital scoliosis of the cervical spine was performed. Six patients with congenital anomalies of the cervical spine and asymmetric contractures of the upper extremities were identified. Clinical findings and radiographic studies were reviewed. Upper extremity involvement was contralateral to the convexity of the spinal curvature in 5 of the 6 cases. Reconstruction of the upper extremity was required in 5 of 6 patients; however, no patient required operative intervention for their congenital cervical scoliosis. Congenital cervical spine anomalies can be associated with asymmetric arthrogryposis of the upper extremities. Physicians who take care of pediatric patients with arthrogryposis should carefully evaluate the cervical spine. Level IV, case series.
de Bie, Evan; Oskarsson, Bjorn; Joyce, Nanette C; Nicorici, Alina; Kurillo, Gregorij; Han, Jay J
Our objective was to evaluate longitudinal changes in Microsoft Kinect measured upper extremity reachable workspace relative surface area (RSA) versus the revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R), ALSFRS-R upper extremity sub-scale and Forced Vital Capacity (FVC) in a cohort of patients diagnosed with amyotrophic lateral sclerosis (ALS). Ten patients diagnosed with ALS (ages 52-76 years, ALSFRS-R: 8-41 at entry) were tested using single 3D depth sensor, Microsoft Kinect, to measure reachable workspace RSA across five visits spanning one year. Changes in RSA, ALSFRS-R, ALSFRS-R upper extremity sub-scale, and FVC were assessed using a linear mixed model. Results showed that upper lateral quadrant RSA declined significantly in one year by approximately 19% (p <0.01) while all other quadrants and total RSA did not change significantly in this time-period. Simultaneously, ALSFRS-R upper extremity sub-scale worsened significantly by 25% (p <0.01). In conclusion, upper extremity reachable workspace RSA as a novel ALS outcome measure is capable of objectively quantifying declines in upper extremity ability over time in patients with ALS with more granularity than other common outcome measures. RSA may serve as a clinical endpoint for the evaluation of upper extremity targeted therapeutics.
Welsch, K; Bialas, P; Köllner, V; Volk, T
Neglect-like symptoms (NLS) describe the experience of perceiving a limb as foreign and could be detected in chronic pain disorders as well as after knee joint replacement. The aim of the present study was to find out whether patients with and without NLS after surgery of the upper extremities differ with respect to pain intensity and psychosocial variables and if NLS are associated with chronic postoperative pain (CPSP). In this study 241 patients were interviewed using a validated questionnaire preoperatively as well as 1 day, 4 weeks, 3 months and 6 months postoperatively. Patients with and without NLS were compared using the χ(2)-test or Mann-Whitney U‑test. The level of significance was adjusted for multiple testing. The NLS could be found to a slight extent throughout the entire study period. Patients with NLS showed significantly higher maximum pain scores at every measurement time point: average difference (∆ = 3, adjusted p < 0.005), a higher impairment due to pain (∆ = 15, adjusted p < 0.005), more anxiety (∆ = 3, adjusted p < 0.005), depression (∆ = 3, average adjusted p < 0.003) and kinesiophobia (∆ = 4, preoperative not significant, average postoperative adjusted p = 0.004). Preoperatively, more stressful life events (p = 0.002) and higher stress values (p < 0.001) were reported. In patients with CPSP, NLS occurred significantly more often (74%) than in patients without clinically relevant pain (17.5%. p < 0.001). The occurrence of NLS is associated with higher pain scores, more impairment due to pain and a higher psychosocial burden and they are more frequent in patients with CPSP. Further investigations are needed to show if NLS are an independent risk factor for the chronification of pain and if NLS play an independent role in the pathogenesis of pain.
VanHeest, Ann; Kuzel, Bradley; Agel, Julie; Putnam, Matthew; Kalliainen, Loree; Fletcher, James
Objective assessment of technical skills in hand surgery has been lacking. This article reports on an Objective Structured Assessment of Technical Skills format of a multiple bench-station evaluation of orthopedic surgery residents' technical skills for 3 common upper extremity surgeries. Twenty-seven residents (6 postgraduate year [PGY] 2, 8 PGY 3, 8 PGY 4, and 5 PGY 5) participated in the examination. Each resident performed surgery on a cadaveric specimen at 3 stations, trigger finger release (TFR), open carpal tunnel release, and distal radius fracture fixation. A board-certified hand surgeon evaluated trainee performance at each station, using a procedure-specific detailed checklist, a validated global rating scale, and pass/fail assessment. A resident post-testing evaluation was collected. Construct validity with correlation between year in training and detailed checklist scores was demonstrated for TFR and carpal tunnel release; between year in training and global rating scores for TFR and distal radius fracture fixation; and between year in training and pass/fail assessment for TFR. Criterion validity was demonstrated by the correlation between global rating scale scores, detailed checklist scores, and pass/fail assessment for TFR, carpal tunnel release, and distal radius fracture fixation. Time to complete the surgery was not correlated with surgical performance. Residents rated the multiple-station Objective Structured Assessment of Technical Skills format as highly educational. This study reports that a surgeon's ability to release a trigger finger does not correlate specifically to his or her ability to perform a carpal tunnel release or to perform plate fixation of a radius fracture. The results of this study would indicate that, for 3 different surgical simulations representing procedures of varying complexity, assessments by a single assessment tool is not adequate. To completely understand a resident's abilities, assessment by checklist
McKenzie, Alison; Dodakian, Lucy; See, Jill; Le, Vu; Quinlan, Erin Burke; Bridgford, Claire; Head, Daniel; Han, Vy L; Cramer, Steven C
To examine the validity of 5 robot-based assessments of arm motor function poststroke. Cross-sectional study. Outpatient clinical research center. Volunteer sample of participants (N=40; age, >18y; 3-6mo poststroke) with arm motor deficits that had reached a stable plateau. Not applicable. Clinical standards included the arm motor domain of the Fugl-Meyer Assessment (FMA) and 5 secondary motor outcomes: hand/wrist subsection of the arm motor domain of the FMA, Action Research Arm Test, Box and Block test (BBT), hand motor subscale of the Stroke Impact Scale Version 2.0, and Barthel Index. Robot-based assessments included wrist targeting, finger targeting, finger movement speed, reaction time, and a robotic version of the BBT. Anatomical measures included percent injury to the corticospinal tract (CST) and extent of injury of the hand region of the primary motor cortex obtained from magnetic resonance imaging. Participants had moderate to severe impairment (arm motor domain of the FMA scores, 35.6±14.4; range, 13.5-60). Performance on the robot-based tests, including speed (r=.82; P<.0001), wrist targeting (r=.72; P<.0001), and finger targeting (r=.67; P<.0001), correlated significantly with the arm motor domain of the FMA scores. Wrist targeting (r=.57-.82) and finger targeting (r=.49-.68) correlated significantly with all 5 secondary motor outcomes and with percent CST injury. The robotic version of the BBT correlated significantly with the clinical BBT but was less prone to floor effects. Robot-based assessments were comparable to the arm motor domain of the FMA score in relation to percent CST injury and superior in relation to extent of injury to the hand region of the primary motor cortex. The present findings support using a battery of robot-based methods for assessing the upper extremity motor function in participants with chronic stroke. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
Karaahmet, Ozgur Zeliha; Eksioglu, Emel; Gurcay, Eda; Karsli, Pınar Bora; Tamkan, Ugur; Bal, Ajda; Cakcı, Aytul
To analyze the incidence of and the factors associated with shoulder pain in people with hemiplegia and to understand the effect of rehabilitation programs on the parameters of motor function and activity limitations in patients with and without hemiplegic shoulder pain. Patients in the initial 6-month period after stroke who were hospitalized in the physical medicine and rehabilitation clinic were included in the study. Patients were considered early rehabilitation entrants if they were admitted in the first 0 to 30 days after a stroke and late rehabilitation entrants if they were admitted 30 to 120 days after a stroke. Demographic and clinical features, complications, and medical histories of the patients were recorded. Upper extremity Fugl-Meyer Motor Assessment (FMA), Frenchay Arm Test (FAT), and Functional Independence Measure (FIM) were applied to the patients on admission, at discharge, and after 1 month of follow-up. Twenty-one (38%) patients did not have shoulder pain, and 34 (62%) patients had decreased shoulder pain. Immobilization, duration of disease, and late rehabilitation were shown to be effective treatments for shoulder pain. The major risk factors were disease duration and poor initial motor function. In both groups, the FMA, FAT, and FIM scores showed significant changes. This improvement did not differ between the 2 groups. Duration of disease and low motor functional capacities have the most important impact on shoulder pain. In patients with and without shoulder pain, a systematic rehabilitation program is beneficial with respect to motor function and daily living activities.
Beks, Reinier B; Mellema, Jos J; Menendez, Mariano E; Chen, Neal C; Ring, David; Vranceanu, Ana Maria
Mindfulness skills training interventions seem efficacious in increasing physical function and decreasing pain intensity in patients with chronic pain. The relationship of mindfulness and upper extremity complaints in patients presenting to orthopedic surgical practices is not known. The aim of this study was to assess if mindfulness has a relationship to physical function and pain intensity in patients with upper extremity illness. In this cross-sectional study, a total of 126 patients with a nontraumatic upper extremity condition were asked to fill out questionnaires assessing the 5 facets of mindfulness, pain intensity, and upper extremity physical function, along with clinical and demographic variables prior to their visit with the surgeon. Nonreactivity to inner experiences was the only facet of mindfulness that was correlated with upper extremity physical function and pain intensity. The overall mindfulness score was correlated with pain intensity only. In multivariable analyses, mindfulness was not associated with either physical function or with pain intensity. Pain interference was the most important predictor of both pain intensity and physical function. Greater overall mindfulness was associated with lower pain intensity, and greater ability to be nonreactive to inner experiences was associated with both pain intensity and upper extremity physical function in bivariate but not multivariable analyses. Pain interference was the most important predictor of both pain intensity and upper extremity physical function. Psychosocial interventions focused on improving physical function and decreasing pain intensity in this population should focus primarily on reducing pain interference, and secondarily on teaching patients mindfulness skills.
Andrade, Alonso; Tyroch, Alan H.; McLean, Susan F.; Smith, Jody; Ramos, Alex
Background: Due to the high incidence of thromboembolic events (deep venous thrombosis [DVT] and pulmonary embolus [PE]) after injury, many trauma centers perform lower extremity surveillance duplex ultrasounds. We hypothesize that trauma patients are at a higher risk of upper extremity DVTs (UEDVTs) than lower extremity DVTs (LEDVTs), and therefore, all extremities should be evaluated. Materials and Methods: A retrospective chart and trauma registry review of Intensive Care Unit trauma patients with upper and LEDVTs detected on surveillance duplex ultrasound from January 2010 to December 2014 was carried out. Variables reviewed were age, gender, injury severity score, injury mechanism, clot location, day of clot detection, presence of central venous pressure catheter, presence of inferior vena cava filter, mechanical ventilation, and fracture. Results: A total of 136 patients had a DVT in a 5-year period: upper - 71 (52.2%), lower - 61 (44.9%), both upper and lower - 4 (2.9%). Overall, 75 (55.2%) patients had a UEDVT. Upper DVT vein: Brachial (62), axillary (26), subclavian (11), and internal jugular (10). Lower DVT vein: femoral (58), popliteal (14), below knee (4), and iliac (2). 10.3% had a PE: UEDVT - 5 (6.7%) and LEDVT - 9 (14.8%) P = 0.159. Conclusions: The majority of the DVTs in the study were in the upper extremities. For trauma centers that aggressively screen the lower extremities with venous duplex ultrasound, surveillance to include the upper extremities is warranted. PMID:28367009
Rameckers, E A A; Speth, L A W M; Duysens, J; Vles, J S H; Smits-Engelsman, B C M
Rehabilitation of the upper extremity in children with hemiplegic cerebral palsy has not been compared to the same intensity of therapy combined with injected botulinum toxin (BTX). To measure the short-term (2 weeks) and long-term (6 and 9 months) effects of a standardized functional training program versus without the addition of chemodenervation of forearm and hand muscles. Twenty children with spastic hemiplegia, aged 4 to 16 years, were matched for baseline characteristics and then randomized to standardized functional physical and occupational therapies for 6 months (PT/OT group) or to the same therapies plus multimuscle BTX-A (BTX+ group). were isometric generated force, overshoot and undershoot (force production error), active and passive range of motion by goniometry (ROM), stretch restricted angle (SRA) of joints, Ashworth scores at the elbow and wrist, and the Melbourne assessment of unilateral upper limb function. All measures were performed at baseline, 2 weeks after BTX-A, 6 months (end of therapy), and then 3 months after termination of the therapy. Clinical measures (muscle tone, active ROM of wrist and elbow) showed improvement in both groups. However, no significant differences emerged between groups on functional measures. Generated force decreased directly after the BTX-A injection but increased during the therapy period. The PT/OT group, however, showed a significantly higher increase in force and accuracy with therapy compared with the BTX+ therapy group. Functional rehabilitation therapies for the upper extremity increase manual isometric flexor force at the wrist and ROM, but BTX injections cause weakness and do not lead to better outcomes than therapy alone.
Park, Juri; Kim, Dong Jin; Kim, Hee Young; Seo, Ji A; Baik, Sei Hyun; Choi, Dong Seop
We report a case of extensive venous thrombosis of the upper extremity in a patient with a hyperosmolar hyperglycemic state (HHS). Thrombosis of the upper extremities is generally found in 4% of cases with deep venous thrombosis. Extensive, symptomatic venous thrombosis of the upper extremity, as seen in this patient, is rare except with catheter-related thrombosis. Recent studies have supported the safety and efficacy of catheter-directed thrombolysis in patients with no contraindication to thrombolytic therapy, and have recommended early catheter-directed thrombolysis. Therefore, our patient was treated with early catheter-directed thrombolysis followed by anticoagulation. PMID:17249507
Findlater, Sonja E; Dukelow, Sean P
Proprioception is an important aspect of function that is often impaired in the upper extremity following stroke. Unfortunately, neurorehabilitation has few evidence based treatment options for those with proprioceptive deficits. The authors consider potential reasons for this disparity. In doing so, typical assessments and proprioceptive intervention studies are discussed. Relevant evidence from the field of neuroscience is examined. Such evidence may be used to guide the development of targeted interventions for upper extremity proprioceptive deficits after stroke. As researchers become more aware of the impact of proprioceptive deficits on upper extremity motor performance after stroke, it is imperative to find successful rehabilitation interventions to target these deficits and ultimately improve daily function.
Shim, Je-myung; Kwon, Hae-yeon; Kim, Ha-roo; Kim, Bo-in; Jung, Ju-hyeon
[Purpose] The aim of this study was to assess the effect of Nordic pole walking on the electromyographic activities of upper extremity and lower extremity muscles. [Subjects and Methods] The subjects were randomly divided into two groups as follows: without Nordic pole walking group (n=13) and with Nordic pole walking group (n=13). The EMG data were collected by measurement while the subjects walking on a treadmill for 30 minutes by measuring from one heel strike to the next. [Results] Both the average values and maximum values of the muscle activity of the upper extremity increased in both the group that used Nordic poles and the group that did not use Nordic poles, and the values showed statistically significant differences. There was an increase in the average value for muscle activity of the latissimus dorsi, but the difference was not statistically significant, although there was a statistically significant increase in its maximum value. The average and maximum values for muscle activity of the lower extremity did not show large differences in either group, and the values did not show any statistically significant differences. [Conclusion] The use of Nordic poles by increased muscle activity of the upper extremity compared with regular walking but did not affect the lower extremity. PMID:24409018
Sripada, Ramprasad; Bowens, Clifford
This review of the literature since 2005 assesses developments of RA techniques commonly used for shoulder surgery, and their effectiveness for postoperative analgesia. Advantages of regional techniques include site-specific anesthesia and decreased postoperative opioid use. For shoulder surgeries, the ISB provides effective analgesia with minimal complications, whereas the impacts of IA single-injections remain unclear. When combined with GA, ISB can be used in lower volumes and reducing the complications for shoulder and proximal upper extremity. USG ISB and SCB are both effective and safe for shoulder surgery with a low incidence of complications, especially PONS.53 When compared with intravenous patient-controlled opioid analgesia, a perineural LA infusion using a disposable pump with patient-controlled LA bolus function has led to better pain relief and functional recovery while decreasing the need for rescue analgesics and the number of adverse events after ambulatory orthopedic surgery. The most remarkable advance in RA in the past 5 years is the increased usage of USG. Although there are no large-scale prospective studies to show the safety, efficacy, and success and complication rates for USG blocks, USG RA theoretically could have less risk for neurologic symptoms, except for those induced by LA (less likely perineurally, much more likely intraneurally). The next "quantum leap" lies in reducing LA concentrations and augmenting anesthetic-analgesic effects with perineural additives (including clonidine, buprenorphine, and likely low-dose dexamethasone). Since 2005, perineural catheters have been an analgesic option that offers improved pain relief among other benefits, and are now being used at home. It is clear that patients benefit greatly from a single injection and continuous nerve block for postoperative pain management,but the financial and logistical aspects need to be resolved, not to mention the phrenic hemiparesis coin toss. Whether combined
Nagpal, Prashant; Maller, Vinod; Garg, Gunjan; Hedgire, Sandeep; Khandelwal, Ashish; Kalva, Sanjeeva; Steigner, Michael L; Saboo, Sachin S
Upper extremity vasculature can be affected by various traumatic and nontraumatic pathologies; however, the evaluation of these arteries can be challenging for the radiologists as well as for the clinicians. After an accurate history and clinical examination, imaging plays a vital role in the diagnosis and treatment planning of these patients. Depending on the urgency and the indication, upper extremity arteries may be evaluated by ultrasonography with color Doppler, computed tomography (CT), magnetic resonance imaging (MRI), or digital subtraction angiography. This review article discusses relevant imaging anatomy of the upper extremity arteries, presents CT and MRI protocols, briefly describes the state-of-the-art CT and MRI of various pathologies affecting the upper extremity arteries, and summarizes the important pearls needed for busy practicing radiologist. Copyright © 2017 Elsevier Inc. All rights reserved.
Taylor, Raewyn L; O'Brien, Lisa; Brown, Ted
Scoping review. Elastic therapeutic tape is a relatively new intervention for treating a variety of injuries; however, there is little evidence to support its effectiveness for neck or upper extremity conditions. This scoping review examines current evidence on the recommended application, purpose and effectiveness of elastic therapeutic tape for treating neck or upper extremity conditions. A scoping review was conducted to examine the evidence in 14 peer-reviewed published articles that reported on the use of elastic therapeutic tape for neck or upper extremity conditions. Six studies reported statistically significant changes to pain with the use of elastic therapeutic tape. Only three studies found statistically significant changes to range of motion. Elastic therapeutic tape may play a role in reducing short-term neck and upper extremity pain, however future high quality studies that contribute to the evidence base for its use are needed. N/A. Copyright © 2014 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.
Gellman, H; Sie, I; Waters, R L
Paraplegic patients rely almost exclusively on their upper extremities for weight-bearing activities such as transfers and wheelchair propulsion. Eighty-four paraplegic patients whose injury level was T2 or below and who were at least one year from spinal cord injury were screened for upper extremity complaints. Fifty-seven (67.8%) had complaints of pain in one or more areas of their upper extremities. The most common complaints were shoulder pain and/or pain relating to carpal tunnel syndrome. Twenty-five (30%) complained of shoulder pain during transfer activities. Symptoms were found to increase with time from injury. As the long-term survival of spinal cord injured patients continues to improve, an increased awareness of the complications of the weight-bearing upper extremity is necessary to keep these patients functioning in society.
Sinha, A K; Kaeding, C C; Wadley, G M
To review the clinical features of a large series of active patients with a stress fracture in a non-weight-bearing location of the upper extremity or ribs. Multicenter cross-sectional study. Multiple academic medical centers. 44 patients with a diagnosis of upper extremity or rib stress fracture. Clinical features according to anatomic location, primary sport, and subdivided according to the nature of the sport-specific skills involved. A diagnosis of stress fracture was made in 44 patients based on history and physical examination, and confirmed by radiography, scintigraphy, magnetic resonance imaging (MRI), computed tomography (CT), or a combination of imaging techniques. Patients were subjectively divided into four categories based on the predominant type of upper extremity activity required for participation in their sport: 1) weight lifter (e.g., football, weight lifting, wrestling); 2) upper extremity weight bearer (e.g., gymnastics, diving, cheerleading); 3) thrower (e.g., pitcher, soccer goalie, javelin); or 4) swinger (e.g., golf, tennis). We noted that all fractures in the weight bearers occurred distal to the elbow, whereas in the throwers most fractures affected the shoulder girdle. Lower rib stress fractures predominated in the swingers group, whereas weight lifters had fractures located throughout the upper extremity. Stress fracture should be considered in the differential diagnosis of athletes presenting with upper extremity or rib pain of bony origin that is of insidious onset. Further study of the sport-specific patterns of injury described here may improve our ability to treat and prevent these injuries.
Rankin, Jeffery W; Kwarciak, Andrew M; Mark Richter, W; Neptune, Richard R
Manual wheelchair propulsion has been linked to a high incidence of overuse injury and pain in the upper extremity, which may be caused by the high load requirements and low mechanical efficiency of the task. Previous studies have suggested that poor mechanical efficiency may be due to a low effective handrim force (i.e. applied force that is not directed tangential to the handrim). As a result, studies attempting to reduce upper extremity demand have used various measures of force effectiveness (e.g., fraction effective force, FEF) as a guide for modifying propulsion technique, developing rehabilitation programs and configuring wheelchairs. However, the relationship between FEF and upper extremity demand is not well understood. The purpose of this study was to use forward dynamics simulations of wheelchair propulsion to determine the influence of FEF on upper extremity demand by quantifying individual muscle stress, work and handrim force contributions at different values of FEF. Simulations maximizing and minimizing FEF resulted in higher average muscle stresses (23% and 112%) and total muscle work (28% and 71%) compared to a nominal FEF simulation. The maximal FEF simulation also shifted muscle use from muscles crossing the elbow to those at the shoulder (e.g., rotator cuff muscles), placing greater demand on shoulder muscles during propulsion. The optimal FEF value appears to represent a balance between increasing push force effectiveness to increase mechanical efficiency and minimize upper extremity demand. Thus, care should be taken in using force effectiveness as a metric to reduce upper extremity demand.
Lee, Brian; Attenello, Frank J; Liu, Charles Y; McLoughlin, Michael P; Apuzzo, Michael L J
With the loss of function of an upper extremity because of stroke or spinal cord injury or a physical loss from amputation, an individual's life is forever changed, and activities that were once routine become a magnitude more difficult. Much research and effort have been put into developing advanced robotic prostheses to restore upper extremity function. For patients with upper extremity amputations, previously crude prostheses have evolved to become exceptionally functional. Because the upper extremities can perform a wide variety of activities, several types of upper extremity prostheses are available ranging from passive cosmetic limbs to externally powered robotic limbs. In addition, new developments in brain-machine interface are poised to revolutionize how patients can control these advanced prostheses using their thoughts alone. For patients with spinal cord injury or stroke, functional electrical stimulation promises to provide the most sophisticated prosthetic limbs possible by reanimating paralyzed arms of these patients. Advances in technology and robotics continue to help patients recover vital function. This article examines the latest neurorestorative technologies for patients who have either undergone amputation or lost the use of their upper extremities secondary to stroke or spinal cord injury. Copyright © 2014 Elsevier Inc. All rights reserved.
Lee, GyuChang; An, SeungHeon; Lee, YunBok; Lee, DongGeon; Park, Dong-sik
[Purpose] Muscle tone is known to predict the motor function of the upper extremity within 12 months after onset in stroke survivors. The aim of this study was to investigate whether motor function of the upper extremity can predict the risk of hypertonia in chronic stroke survivors, and to analyze the correlation between the two variables to determine the predictive validity. [Subjects and Methods] Forty-three chronic stroke survivors were assessed using the Modified Ashworth Scale (MAS) for elbow flexor tone, the Fugl-Meyer assessment of the upper extremity (FM-UE), and the Action Research Arm Test (ARAT) for upper extremity motor recovery and function. [Results] Elbow flexor tone (MAS≥1+) increased by 0.246 compared with the baseline muscle tone even at month 12 and appeared to negatively affect the motor function of the upper extremity. The cutoff value for predicting muscle tone (MAS≥1+) was 24 for FM-UE and 15.5 for ARAT. FM-UE had the biggest impact on elbow flexor tone (MAS≥1+), and the risk of elbow flexor hypertonia (MAS≥1+) increased 0.764-fold for a cutoff value of FM-UE≤24 compared with a cutoff value of FM-UE>24. [Conclusion] The results show that the most important variable for predicting muscle tone of the elbow flexor in stroke survivors is the FM assessment of the upper extremity. PMID:26357437
Rankin, Jeffery W.; Kwarciak, Andrew M.; Richter, W. Mark; Neptune, Richard R.
Manual wheelchair propulsion has been linked to a high incidence of overuse injury and pain in the upper extremity, which may be caused by the high load requirements and low mechanical efficiency of the task. Previous studies have suggested that poor mechanical efficiency may be due to a low effective handrim force (i.e. applied force that is not directed tangential to the handrim). As a result, studies attempting to reduce upper extremity demand have used various measures of force effectiveness (e.g. fraction effective force, FEF) as a guide for modifying propulsion technique, developing rehabilitation programs and configuring wheelchairs. However, the relationship between FEF and upper extremity demand is not well understood. The purpose of this study was to use forward dynamics simulations of wheelchair propulsion to determine the influence of FEF on upper extremity demand by quantifying individual muscle stress, work and handrim force contributions at different values of FEF. Simulations maximizing and minimizing FEF resulted in higher average muscle stresses (23% and 112%) and total muscle work (28% and 71%) compared to a nominal FEF simulation. The maximal FEF simulation also shifted muscle use from muscles crossing the elbow to those at the shoulder (e.g. rotator cuff muscles), placing greater demand on shoulder muscles during propulsion. The optimal FEF value appears to represent a balance between increasing push force effectiveness to increase mechanical efficiency and minimizing upper extremity demand. Thus, care should be taken in using force effectiveness as a metric to reduce upper extremity demand. PMID:20674921
Russo, Remo N; Crotty, Maria; Miller, Michelle D; Murchland, Sonya; Flett, Peter; Haan, Eric
The purpose of this work was to assess the effect of botulinum toxin A and occupational therapy compared with occupational therapy alone on body structure, activities participation, and self-perception in a sample of children (aged 3-16 years) with hemiplegic cerebral palsy recruited from a statewide register. Participants of this single-blind, randomized, controlled trial identified from a population-based cerebral palsy register received either an individually prescribed and localized injection of botulinum toxin A with 4 sessions of occupational therapy over 4 weeks (intervention) or occupational therapy alone (control). Outcomes were assessed from 2 domains of the World Health Organization International Classification of Functioning, Disability, and Health: body structure (Modified Ashworth Scale and Tardieu Scale) and activities participation (Assessment of Motor and Process Skills, Goal Attainment Scale, Pediatric Evaluation of Disability Inventory, and Pediatric Quality of Life Inventory). Self-perception was also measured. All of the participants (intervention: n = 21; control: n = 22) provided data at baseline and 3 and 6 months. Mean age was 8.6 years; 23 were boys and 20 were girls. At 3 months, children allocated to receive the intervention performed significantly better in terms of body structure and activities participation. They reported improvements in self-perception for the global self-worth domain. At 6 months, the differences between the intervention and control groups persisted for the measures of body structure but not for activities participation or self-perception. Botulinum toxin A injection combined with a low-intensity occupational therapy program achieves significant improvements in body structure, activity participation, and self-perception.
Rugg, Caitlin Marie; Wang, Dean; Mayer, Erik; Berger, Neal; Vail, Jeremy; Sulzicki, Pamela; Hame, Sharon L.
Objectives: Upper extremity injuries are common in youth, collegiate, and professional athletics, and may require operative management. The influence of a prior upper extremity surgery on subsequent athletic participation, injury, and surgery in college is not well understood. The purpose of this study was to investigate the impact of prior upper extremity surgery in Division I collegiate athletes on participation, injury rates, and surgery rates in college. Methods: Division I athletes who began participation in collegiate athletics from 2003 - 2009 were retrospectively identified. These athletes represented 21 sports teams at a single institution. Athletes with prior upper extremity orthopaedic surgery, including shoulder, elbow, and wrist/hand surgery, were identified through preparticipation evaluation forms. Sport, seasons played, injuries sustained during college, days missed, and college orthopaedic surgeries and diagnostic imaging were collected through sports archives, medical records, and the Sports Injury Monitoring System (SIMS) and compared to athletes with no prior history of upper extremity surgery. Subgroup analysis was performed for athletes with a history of shoulder, elbow, and wrist/hand surgeries. Results: Between 2003 and 2009, 1,145 athletes completed pre-participation evaluation forms. In total, 77 athletes (6.7%) had a history of one or more upper extremity surgeries prior to collegiate athletics. History of upper extremity surgery was most common in incoming men's water polo (15.0%), baseball (14.9%), and football (12.6%) athletes. Athletes with a prior upper extremity surgery had a higher rate of upper extremity injury in college compared to controls (Hazard Ratio = 4.127, p <0.01), and missed more days for upper extremity injuries per season (16.5 days vs. 6.7 days, p = 0.03). Athletes with a prior shoulder surgery (n=20) also had a higher rate of upper extremity injury in college compared to controls (Hazard Ratio= 15,083, p=0.02). They
van der Meer, Saskia; Nicolai, Jean-Philippe A; Schut, Simone M; Meek, Marcel F
Macrodystrophia lipomatosa is a rare disease that causes congenital local gigantism of part of an extremity, which is characterised by an increase in all mesenchymal elements, particularly fibroadipose tissue. This is the first report to our knowledge of a case of histologically confirmed bilateral macrodystrophia lipomatosa of the upper extremities with syndactyly and multiple lipomas.
Brochard, Sylvain; Robertson, Johanna; Médée, Béatrice; Rémy-Néris, Olivier
The field of new technologies for upper-limb rehabilitation is exploding. The review presents new trends and studies of effectiveness from recent literature regarding robots, virtual reality and telerehabilitation for neurorehabilitation of the upper limb. There appears to be a greater focus on technological developments than on clinical trials or studies to evaluate the mechanisms behind the effectiveness of these systems. Developments are most abundant in the field of robotics. However, the first well designed and powered randomized-controlled trial on robot rehabilitation has appeared, confirming that the effectiveness of robot therapy lies in the number of repetitions provided. There is a move towards studies in populations other than stroke, particularly cerebral palsy with a few studies on multiple sclerosis and traumatic brain injury. There is also an increasing trend for the use of robotic devices as evaluation tools. Despite the fact that new technologies are based on knowledge from motor control and learning literature and that they provide an exciting potential for varied rehabilitation, recent evidence suggests that the only contribution to clinical practice currently is the provision of intensive, repetitive movements.
Frey, Scott H.
Upper limb amputees receive no proprioceptive or visual sensory feedback about their absent hand. In this study, we asked whether chronic amputees nevertheless retain the ability to accurately plan gripping movements. Fourteen patients and matched controls performed two grip selection tasks: overt grip selection (OGS), in which they used their intact hand to grasp an object that appeared in different orientations using the most natural (under- or overhand) precision grip, and prospective grip selection (PGS), in which they selected the most natural grip for either hand without moving. We evaluated planning accuracy by comparing concordance between grip preferences expressed in PGS vs. OGS for the intact hand and PGS vs. the inverse of OGS responses for the affected hand. Overall, amputees showed no deficits in the accuracy of grip selection planning based on either hand and a consistent preference for less awkward hand postures. We found no evidence for a speed-accuracy tradeoff. Furthermore, selection accuracy did not depend on phantom mobility, phantom limb pain, time since amputation, or the residual limb’s shoulder posture. Our findings demonstrate that unilateral upper limb amputees retain the ability to plan movements based on the biomechanics of their affected hand even many years after limb loss. This unimpaired representation may stem from persistent higher-level activity-independent internal representations or may be sustained by sensory feedback from the intact hand. PMID:21863261
Bot, S; van der Waal, J M; Terwee, C; van der Windt, D A W M; Schellevis, F; Bouter, L; Dekker, J
Objective: To study the incidence and prevalence of neck and upper extremity musculoskeletal complaints in Dutch general practice. Methods: Data were obtained from the second Dutch national survey of general practice. In all, 195 general practitioners (GPs) from 104 practices across the Netherlands recorded all contacts with patients during 12 consecutive months. Incidence densities and consultation rates were calculated. Results: The total number of contacts during the registration period of one year was 1 524 470. The most commonly reported complaint was neck symptoms (incidence 23.1 per 1000 person-years), followed by shoulder symptoms (incidence 19.0 per 1000 person-years). Sixty six GP consultations per 1000 person-years were attributable to a new complaint or new episode of complaint of the neck or upper extremity (incidence density). In all, the GPs were consulted 147 times per 1000 registered persons for complaints of the neck or upper extremity. For most complaints the incidence densities and consultation rates were higher for women than for men. Conclusions: Neck and upper extremity symptoms are common in Dutch general practice. The GP is consulted approximately seven times each week for a complaint relating to the neck or upper extremity; of these, three are new complaints or new episodes. Attention should be paid to training GPs to deal with neck and upper limb complaints, and to research on the prognosis and treatment of these common complaints in primary care. PMID:15608309
Soyer, Kardem; Unver, Banu; Tamer, Seval; Ulger, Ozlem
Objective: To evaluate and point out the importance of prosthetic rehabilitation of upper extremity. Methods: A systematic literature search was performed to identify studies concerning prosthetic rehabilitation in upper extremity. The PRISMA Statement 2009 was used to establish the study and the methodological quality was assessed. Results: The literature search identified 620 studies. Of these 620, 9 studies fulfilled the inclusion criteria and were included for data extraction. The studies pointed out the upper limb prosthetic rehabilitation protocols consist of general exercise programme, motor tasks, phantom exercises, Muscle Training System, edema control, functional activities, signal strengthening, prosthetic education exercises, neuromuscular reeducation, virtual image and virtual reality exercises. Conclusions: The current systematic literature review has shown that the prosthetic rehabilitation seems promising especially for upper extremity amputees. PMID:27882044
Cowin, D J; Wright, T; Cowin, J A
The purpose of this study was to determine long-term complications of upper-extremity snake envenomations. The records of 73 patients, who were seen for snake bites were obtained; 46 of these patients had bites to the upper extremity, and 27 had bites to the lower extremity. These patients were graded according to the severity of the bite. The snakes involved were eastern diamondback rattlesnake, coral snake, pigmy rattlesnake, water moccasin, and unknown. Fourteen of the 46 patients receiving upper extremity bites were examined by a hand surgeon and an occupational hand therapist 1 to 3.2 years after their bite. Subjective pain data, range-of-motion, intrinsic, extrinsic, finger-flexion tightness, grip strength, pinch strength and objective sensory data were collected. Four patients had continued pain and tissue atrophy at the bite site. There were no long-term sequelae from a missed compartment syndrome.
Hofmeister, Eric P; Mazurek, Michael; Ingari, Jack
The formation of the American Society for Surgery of the Hand was related to world conflicts and hostilities. Therefore, it is appropriate that upper-extremity surgeons understand injuries resulting from modern-day combat. Because of ongoing warfare, many countries have experienced a large increase in the number of wounded service members and civilians, particularly wounds of the extremities. As a result of increased rate of survival in battlefield trauma in part because of the use of modern body armor, there is increasing complexity of extremity injuries that require complex reconstructions. Decreased mortality and a consequent increase in the incidence of injured extremities underline the need for the development of new treatment options. The purpose of this presentation is to describe upper-extremity injury patterns in modern warfare, the levels of care available, and the treatment at each level of care based on the experience of the United States Military Medical Support System.
Ma, Tengxiao; Fan, Ke; Li, Lei; Xie, Feng; Li, Hao; Chou, Haiyan; Zhang, Zhengwen
Abstract The aim of our study was to use tissue expansion for the treatment of giant congenital melanocytic nevi of the upper extremity and examine potential advantages over traditional techniques. There were 3 stages in the treatment of giant congenital melanocytic nevi of the upper extremities using tissue expansion: first, the expander was inserted into the subcutaneous pocket; second, the expander was removed, lesions were excised, and the wound of the upper extremity was placed into the pocket to delay healing; third, the residual lesion was excised and the pedicle was removed. The pedicle flap was then unfolded to resurface the wound. During the period between June 2007 and December 2015, there were 11 patients with giant congenital melanocytic nevi of the upper extremities who underwent reconstruction at our department with skin expansion. Few complications were noted in each stage of treatment. The functional and aesthetic results were observed and discussed in this study. Optimal aesthetic and functional results were obtained using tissue expansion to reconstruct the upper extremities due to the giant congenital melanocytic nevi. PMID:28353563
Kim, Eunjoo; Kim, KyeongMi
[Purpose] The purpose of this study was to identify the effect of purposeful action observation on upper extremity function in patients with stroke. [Subjects and Methods] Twelve subjects were randomly to either the experimental group or control group. The experimental group underwent occupational therapy and a purposeful action observation program. The control group underwent occupational therapy and placebo treatment in which the subjects performed a purposeful action observation program without actually observing the purposeful actions. The Wolf Motor Function Test was used to measure upper extremity function before and after the intervention in both groups. [Results] Both the experimental and control groups demonstrated improved upper extremity function after the intervention, but there was no significant difference between groups. Compared with before the intervention, the experimental group showed significantly improved upper extremity function after the intervention. [Conclusion] Based on these results, a purposeful action observation program can improve upper extremity function in patients with stroke. In future research, more subjects should be included for evaluation of different treatments. PMID:26504313
Wallen, Margaret; Stewart, Kirsty
The World Health Organization's International Classification of Functioning, Disability and Health (ICF) provides an ideal framework within which to conceptualize grading and quantification of upper extremity function for children with spasticity. In this article the authors provide an overview of assessments and classification tools used to (1) understand upper extremity function associated with spasticity and the factors that contribute to dysfunction, (2) guide the selection of appropriate interventions, (3) identify specific muscles to target using surgical interventions and botulinum toxin-A injections, and (4) measure the outcomes of upper extremity interventions. Assessments of upper extremity function are briefly described and categorized as to whether they (1) measure children's best ability or actual performance in daily life, (2) are clinician administered or are a child/proxy report, (3) assist in planning intervention and/or measuring outcomes, and (4) evaluate unimanual or bimanual ability. In addition, measures of spasticity and hypertonicity, and classifications of static and dynamic upper extremity postures are summarized. PMID:26869858
Slowik, Jonathan S; Neptune, Richard R
The high physical demands placed on the upper extremity during manual wheelchair propulsion can lead to pain and overuse injuries that further reduce user independence and quality of life. Seat position is an adjustable parameter that can influence the mechanical loads placed on the upper extremity. The purpose of this study was to use a musculoskeletal model and forward dynamics simulations of wheelchair propulsion to identify the optimal seat position that minimizes various measures of upper extremity demand including muscle stress, co-contraction and metabolic cost. Forward dynamics simulations of wheelchair propulsion were generated across a range of feasible seat positions by minimizing the change in handrim forces and muscle-produced joint moments. Resulting muscle stress, co-contraction and metabolic cost were examined to determine the optimal seat position that minimized these values. Muscle stress and metabolic cost were near minimal values at superior/inferior positions corresponding to top-dead-center elbow angles between 110 and 120° while at an anterior/posterior position with a hub-shoulder angle between -10 and -2.5°. This coincided with a reduction in the level of muscle co-contraction, primarily at the glenohumeral joint. Deviations from this position lead to increased co-contraction to maintain a stable, smooth propulsive stroke, which consequentially increases upper extremity demand. These results agree with previous clinical guidelines for positioning the seat to reduce upper extremity overuse injuries and pain for wheelchair users. Copyright © 2013 Elsevier Ltd. All rights reserved.
Huri, Meral; Şahin, Sedef; Kayıhan, Hülya
The present study was designed to compare hand function in autistic children with history of upper extremity trauma with that of autistic children those who do not have history of trauma. The study group included total of 65 children diagnosed with autism spectrum disorder (ASD) and was divided into 2 groups: children with trauma history (Group I) and control group (Group II) (Group I: n=28; Group II: n=37). Hand function was evaluated with 9-Hole Peg Test and Jebsen Hand Function Test. Somatosensory function was evaluated using somatosensory subtests of Sensory Integration and Praxis Test. Results were analyzed with Student's t-test and Mann-Whitney U test using SPSS version 20 software. Hand function and somatosensory perception test scores were statistically significantly better in children without upper extremity trauma history (p<0.05). When association between hand function tests and upper extremity somatosensory perception tests was taken into account, statistically significant correlations were found between all parameters of hand function tests and Manual Form Perception and Localization of Tactile Stimuli Test results (p<0.05). Autistic children with upper extremity trauma history had poor somatosensory perception and hand function. It is important to raise awareness among emergency service staff and inform them about strong relationship between somatosensory perception, hand function, and upper extremity trauma in children with ASD in order to develop appropriate rehabilitation process and prevent further trauma.
Objective To determine the efficacy of a stretching and strengthening exercise program using an upper extremity robot, as compared with a conventional occupational therapy program for upper extremity spasticity in stroke patients. Methods Subjects were randomly divided into a robot-assisted therapy (RT) group and a conventional rehabilitation therapy (CT) group. RT group patients received RT and CT once daily for 30 minutes each, 5 days a week, for 2 weeks. RT was performed using an upper-extremity robot (Neuro-X; Apsun Inc., Seoul, Korea), and CT was administered by occupational therapists. CT group patients received CT alone twice daily for 30 minutes, 5 days a week, for 2 weeks. Modified Ashworth Scale (MAS) was used to measure the spasticity of upper extremity. Manual muscle tests (MMT), Manual Function Tests (MFT), Brunnstrom stage, and the Korean version of Modified Barthel Index (K-MBI) were used to measure the strength and function of upper extremity. All measurements were obtained before and after 2-week treatment. Results The RT and CT groups included 22 subjects each. After treatment, both groups showed significantly lower MAS scores and significant improvement in the MMT, MFT, Brunnstrom stage, and K-MBI scores. Treatment effects showed no significant differences between the two groups. Conclusion RT showed similar treatment benefits on spasticity, as compared to CT. The study results suggested that RT could be a useful method for continuous, repeatable, and relatively accurate range of motion exercise in stroke patients with spasticity. PMID:28119825
Cho, Ki Hun; Song, Won-Kyung
Stroke, as a major risk factor for chronic impairment of upper limb function, can severely restrict the activities of daily living. Recently, robotic devices have been used to enhance the functional upper extremity movement of stroke patients. The purpose of the current study was to assess whether a robot-assisted reach training program using a whole arm manipulator (WAM) could improve upper extremity kinematic performance and functional movement for chronic stroke patients. Using a single-group design, this study followed 10 people with chronic stroke (6 men, 61.5 years; Mini-Mental State Examination score: 27.0; onset duration: 8.9 years). WAM with seven degrees of freedom for the shoulder, elbow, and wrist joints was used during robot-assisted reach exercises. Subjects participated in the training program for 40 minutes per day, 2 times a week, for 4 weeks. The main outcome measures were upper extremity kinematic performance (movement velocity) for three directions and functional movement (Action Research Arm Test). Upper extremity kinematic performance and functional movement measures were performed three times: at baseline, during intervention (at 2 weeks), and post intervention. Upper extremity kinematic performance and functional movement showed improvement after two weeks (P < 0.05) and four weeks (P < 0.05) of training compared to baseline. The findings of the current study demonstrated the positive effects of short-term robot-assisted reach training on upper extremity kinematic performance as well as functional movement in individuals with chronic stroke. In addition, the findings of the current study may provide valuable information for subsequent randomized controlled trials.
Pérez-Cruzado, David; Merchán-Baeza, Jose Antonio; González-Sánchez, Manuel; Cuesta-Vargas, Antonio I
Stroke is a leading cause of disability in developed countries. One of the most widespread techniques in clinical practice is mirror therapy (MT). To determine the effectiveness of MT over other methods of intervention in the recovery of upper limb function in people who have had a stroke. A systematic review was conducted. The search string was established based on the last systematic review about MT that dated from 2009: "upper extremity" OR "upper limb "AND "mirror therapy" AND stroke. For this search Pubmed, Scopus and SciELO databases were used. Fifteen studies were included in the systematic review. Recovery of the upper limb, upper limb function and gross manual dexterity were frequently measured in these studies. In the primary variables in promoting recovery, MT alone showed better results in acute and chronic stroke patients in upper limb functioning than either conventional rehabilitation (CR) or CR plus MT. PROSPERO registration number: CRD42015026869. © 2016 Occupational Therapy Australia.
Nathan, Dominic E; Prost, Robert W; Guastello, Stephen J; Jeutter, Dean C
A key challenge in upper extremity neuroprosthetics is variable levels of skill and inconsistent functional recovery. We examine the feasibility and benefits of using natural neuromotor strategies through the design and development of a proof-of-concept model for a feed-forward upper extremity neuroprosthetic controller. Developed using Artificial Neural Networks, the model is able to extract and classify neural correlates of movement intention from multiple brain regions that correspond to functional movements. This is unique compared to contemporary controllers that record from limited physiological sources or require learning of new strategies. Functional MRI (fMRI) data from healthy subjects (N = 13) were used to develop the model, and a separate group (N = 4) of subjects were used for validation. Results indicate that the model is able to accurately (81%) predict hand movement strictly from the neural correlates of movement intention. Information from this study is applicable to the development of upper extremity technology aided interventions.
Damiao, John; Kean, Danielle
Power mobility is typically used as an accommodative form of assistive technology allowing individuals with impaired ambulation to remain mobile. While research has focused on the cognitive development and social benefits of power mobility for individuals with developmental disabilities, research is lacking on using this technology to rehabilitate physical dysfunction. Recent technology, such as robot-mediated neuro-rehabilitation, is proving effective in upper extremity rehabilitation, but lacks the movement feedback of power mobility. This article presents a case study of a client with cerebral palsy who experienced severe neural impairment following a motor vehicle accident. As a previous power mobility user, the client identified returning to using power mobility with the affected upper extremity as a key functional goal. This case study describes the series of steps that returned the client to independent mobility and increased upper extremity function.
Wittstein, Jocelyn; Queen, Robin; Abbey, Alicia; Moorman, Claude T
The strength and endurance of the contralateral biceps muscle can serve as a useful comparison for the operative limb following distal biceps repairs, mid-substance repairs, or tenotomy or tenodesis of the long head. There are limited data available on the effect of handedness on biceps strength and endurance. The dominant upper extremity has greater elbow flexion and supination peak torque and endurance. Subjects with no history of prior upper extremity injury or limitations completed isokinetic testing of biceps flexion and supination peak torque and endurance on a Biodex machine. A paired student t test was used to compare peak torque and endurance for both supination and flexion for the dominant and nondominant upper extremities. The results were analyzed for the entire group, and for male and female subjects separately as well. A power analysis revealed that 5 subjects were needed to achieve 80% power. Twenty subjects (10 male, 10 female) were tested. No significant difference was detected for peak torque or endurance for supination or flexion between the dominant and nondominant upper extremities. No difference was detected when the group was analyzed as a whole, nor when men and women were analyzed separately. The dominant and nondominant upper extremities demonstrate similar peak torque and endurance for supination and flexion. The normal contralateral upper extremity can be used as a matched control in the evaluation of post operative biceps isokinetic strength and endurance without adjusting results for handedness. (c) 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.
Bendixen, Roxanna M; Butrum, Jocelyn; Jain, Mina S; Parks, Rebecca; Hodsdon, Bonnie; Nichols, Carmel; Hsia, Michelle; Nelson, Leslie; Keller, Katherine C; McGuire, Michelle; Elliott, Jeffrey S; Linton, Melody M; Arveson, Irene C; Tounkara, Fatou; Vasavada, Ruhi; Harnett, Elizabeth; Punjabi, Monal; Donkervoort, Sandra; Dastgir, Jahannaz; Leach, Meganne E; Rutkowski, Anne; Waite, Melissa; Collins, James; Bönnemann, Carsten G; Meilleur, Katherine G
Congenital muscular dystrophy (CMD) comprises a rare group of genetic muscle diseases that present at birth or early during infancy. Two common subtypes of CMD are collagen VI-related muscular dystrophy (COL6-RD) and laminin alpha 2-related dystrophy (LAMA2-RD). Traditional outcome measures in CMD include gross motor and mobility assessments, yet significant motor declines underscore the need for valid upper extremity motor assessments as a clinical endpoint. This study validated a battery of upper extremity measures in these two CMD subtypes for future clinical trials. For this cross-sectional study, 42 participants were assessed over the same 2-5 day period at the National Institutes of Health Clinical Center. All upper extremity measures were correlated with the Motor Function Measure 32 (MFM32). The battery of upper extremity assessments included the Jebsen Taylor Hand Function Test, Quality of Upper Extremity Skills Test (QUEST), hand held dynamometry, goniometry, and MyoSet Tools. Spearman Rho was used for correlations to the MFM32. Pearson was performed to correlate the Jebsen, QUEST, hand-held dynamometry, goniometry and the MyoSet Tools. Correlations were considered significant at the 0.01 level (2-tailed). Significant correlations were found between both the MFM32 and MFM Dimension 3 only (Distal Motor function) and the Jebsen, QUEST, MyoGrip and MyoPinch, elbow flexion/extension ROM and myometry. Additional correlations between the assessments are reported. The Jebsen, the Grasp and Dissociated Movements domains of the QUEST, the MyoGrip and the MyoPinch tools, as well as elbow ROM and myometry were determined to be valid and feasible in this population, provided variation in test items, and assessed a range of difficulty in CMD. To move forward, it will be of utmost importance to determine whether these upper extremity measures are reproducible and sensitive to change over time.
French, James A; Rose, Chad G; O'Malley, Marcia K
This paper presents the performance characterization of the MAHI Exo-II, an upper extremity exoskeleton for stroke and spinal cord injury (SCI) rehabilitation, as a means to validate its clinical implementation and to provide depth to the literature on the performance characteristics of upper extremity exoskeletons. Individuals with disabilities arising from stroke and SCI need rehabilitation of the elbow, forearm, and wrist to restore the ability to independently perform activities of daily living (ADL). Robotic rehabilitation has been proposed to address the need for high intensity, long duration therapy and has shown promising results for upper limb proximal joints. However, upper limb distal joints have historically not benefitted from the same focus. The MAHI Exo-II, designed to address this shortcoming, has undergone a static and dynamic performance characterization, which shows that it exhibits the requisite qualities for a rehabilitation robot and is comparable to other state-of-the-art designs.
French, James A.; Rose, Chad G.; O'Malley, Marcia K.
This paper presents the performance characterization of the MAHI Exo-II, an upper extremity exoskeleton for stroke and spinal cord injury (SCI) rehabilitation, as a means to validate its clinical implementation and to provide depth to the literature on the performance characteristics of upper extremity exoskeletons. Individuals with disabilities arising from stroke and SCI need rehabilitation of the elbow, forearm, and wrist to restore the ability to independently perform activities of daily living (ADL). Robotic rehabilitation has been proposed to address the need for high intensity, long duration therapy and has shown promising results for upper limb proximal joints. However, upper limb distal joints have historically not benefitted from the same focus. The MAHI Exo-II, designed to address this shortcoming, has undergone a static and dynamic performance characterization, which shows that it exhibits the requisite qualities for a rehabilitation robot and is comparable to other state-of-the-art designs. PMID:25984380
OBJECTIVE: To evaluate the association between upper extremity soft tissue disorders and exposure to preventable ergonomic stressors in vehicle manufacturing operations. METHODS: A cross sectional study was conducted in one vehicle stamping plant and one engine assembly plant. A standardised physical examination of the upper extremities was performed on all subjects. An interviewer administered questionnaire obtained data on demographics, work history, musculoskeletal symptoms, non-occupational covariates, and psycho-physical (relative intensity) ratings of ergonomic stressors. The primary exposure score was computed by summing the responses to the psychophysical exposure items. Multivariate regression analysis was used to model the prevalence of disorders of the shoulders or upper arms, wrists or hands, and all upper extremity regions (each defined both by symptoms and by physical examination plus symptoms) as a function of exposure quartile. RESULTS: A total of 1315 workers (85% of the target population) was examined. The prevalence of symptom disorders was 22% for the wrists or hands and 15% for the shoulders or upper arms; cases defined on the basis of a physical examination were about 80% as frequent. Disorders of the upper extremities, shoulders, and wrists or hands all increased markedly with exposure score, after adjustment for plant, acute injury, sex, body mass index, systemic disease, and seniority. CONCLUSIONS: Musculoskeletal disorders of the upper extremities were strongly associated with exposure to combined ergonomic stressors. The exposure- response trend was very similar for symptom cases and for physical examination cases. It is important to evaluate all dimensions of ergonomic exposure in epidemiological studies, as exposures often occur in combination in actual workplaces. PMID:9764102
Wu, Feng L; Sun, Yu; Pan, Sheng F; Zhang, Li; Liu, Zhong J
Postoperative paresis, so-called C5 palsy, of the upper extremities is a common complication of cervical surgery. There have been several reports about upper extremity palsy after cervical laminoplasty for patients with cervical myelopathy. However, the possible risk factors remain unclear. To investigate the factors associated with the development of upper extremity palsy after expansive open-door laminoplasty for cervical myelopathy. A retrospective review of medical records. A total of 102 patients (76 men and 26 women) were eligible for analysis in this study. The mean age of the patients was 58.7 years (range 35-81 years). Sixteen patients (13 men and 3 women, average age 62.8 years) with palsy were categorized as Group P, and eighty-six patients (63 men and 23 women, average age 57.8 years) without palsy as Group C. The demographic data collected from both groups were age, sex, duration of symptoms, disease, and type of surgical procedure. Cervical curvature index, width of the intervertebral foramen (WIF) at C5, anterior protrusion of the superior articular process (APSAP), number of compressed segments, high-signal intensity zone at the level corresponding to C3-C5 (HIZ:C3-C5), and posterior shift of the spinal cord (PSSC) were also evaluated. Upper extremity palsy was defined as weakness of Grade 4 or less of the key muscles in the upper extremity by manual muscle test without any deterioration of myelopathic symptoms after surgery. Comparisons were made with screen for the parameters with significant differences, and then we further analyzed these parameters by logistic regression analysis (the forward method) to verify the risk factors of the upper extremity palsy. Significant differences in diagnosis, the type of procedure, WIF, APSAP, and HIZ:C3-C5 were observed between the two groups. No statistical difference in PSSC between the groups was noted (2.06 vs. 2.53 mm, p=.247). In logistic regression analysis, ossification of the posterior longitudinal
Suresh, S S
Washing machines are part of every household and there are various reports of upper extremity injuries due to inadequate safety precautions while operating the machine. Most of the injuries occur when an attempt is made to remove the clothes from the machine and the hand gets caught in the spinning machine. The presentation can vary from minor soft tissue injuries to a mangled upper extremity. The chance of neurovascular damage resulting in compartment syndrome is very high. The author reports three cases of washing machine injuries to draw attention to this not so uncommon injury. The relevant literature is also considered.
Willcocks, R J; Triplett, W T; Forbes, S C; Arora, H; Senesac, C R; Lott, D J; Nicholson, T R; Rooney, W D; Walter, G A; Vandenborne, K
There is a pressing need for biomarkers and outcomes that can be used across disease stages in Duchenne muscular dystrophy (DMD), to facilitate the inclusion of a wider range of participants in clinical trials and to improve our understanding of the natural history of DMD. Quantitative magnetic resonance imaging (qMRI) and spectroscopy (MRS) biomarkers show considerable promise in both the legs and forearms of individuals with DMD, but have not yet been examined in functionally important proximal upper extremity muscles such as the biceps brachii and deltoid. The primary objective of this study was to examine the feasibility of implementing qMRI and MRS biomarkers in the proximal upper extremity musculature, and the secondary objective was to examine the relationship between MR measures of arm muscle pathology and upper extremity functional endpoints. Biomarkers included MRS and MRI measures of fat fraction and transverse relaxation time (T 2). The MR exam was well tolerated in both ambulatory and non-ambulatory boys. qMR biomarkers differentiated affected and unaffected participants and correlated strongly with upper extremity function (r = 0.91 for biceps brachii T 2 versus performance of upper limb score). These qMR outcome measures could be highly beneficial to the neuromuscular disease community, allowing measurement of the quality of functionally important muscles across disease stages to understand the natural history of DMD and particularly to broaden the opportunity for clinical trial participation.
Santago, Anthony C; Plate, Johannes F; Shively, Carol A; Register, Thomas C; Smith, Thomas L; Saul, Katherine R
Longitudinal studies of upper extremity aging in humans include logistical concerns that animal models can overcome. The vervet is a promising species with which to study aging-related processes. However, age-related changes in upper extremity muscle structure have not been quantified in this species. This study measured age-related changes to muscle structure, examined relationships between muscle structure and measures of physical performance, and evaluated the presence of rotator cuff tears. Muscle structure (volume, optimal fiber length, and physiologic cross-sectional area (PCSA)) of 10 upper extremity muscles was quantified from the right upper limb of 5 middle-aged and 6 older adult female vervets. Total measured PCSA was smaller (P = .001) in the older adult vervets than in the middle-aged vervets. Muscle volume reduction predominate the age-related reductions in PCSA. Total measured PCSA was not correlated to any measures of physical performance. No rotator cuff tears were observed. Supraspinatus volume was relatively larger and deltoid volume relatively smaller in the vervet compared with a human. The vervet is an appropriate translational model for age-related upper extremity muscle volume loss. Functional measures were not correlated to PCSA, suggesting the vervets may have enough strength for normal function despite loss of muscle tissue. Reduced relative demand on the supraspinatus may be responsible for the lack of naturally occurring rotator cuff tears. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
Brown, Jordan M; Yablon, Corrie M; Morag, Yoav; Brandon, Catherine J; Jacobson, Jon A
Ultrasonography (US) has become a first-line modality for the evaluation of the peripheral nerves of the upper extremity. The benefits of US over magnetic resonance (MR) imaging include higher soft-tissue resolution, cost effectiveness, portability, real-time and dynamic imaging, and the ability to scan an entire extremity quickly and efficiently. US can be performed on patients who are not eligible for MR imaging. Metallic implant artifacts are usually not problematic. US has been shown to have equal specificity and greater sensitivity than MR imaging in the evaluation of peripheral nerves. Any abnormal findings can be easily compared with the contralateral side. The published literature has shown that US has demonstrated clinical utility in patients with suspected peripheral nerve disease by guiding diagnostic and therapeutic decisions as well as by confirming electrodiagnostic findings. Common indications for upper extremity peripheral nerve US are the evaluation for injury due to penetrating trauma, entrapment by scar tissue, and tumor. US of the upper extremity is most commonly performed to evaluate carpal and cubital tunnel syndrome. It is important for the radiologist or sonographer to have a detailed knowledge of anatomy and specific anatomic landmarks for each nerve to efficiently and accurately perform an examination. The goal of this article is to introduce readers to the basics of US of the peripheral nerves of the upper extremity with a focus on the median, ulnar, and radial nerves. Common sites of disease and the location of important anatomic landmarks will be reviewed.
Wise, Eric S; Wergin, Justine E; Mace, Eric H; Kallos, Justiss A; Muhlestein, Whitney E; Shelburne, Nicholas J; Hocking, Kyle M; Brophy, Colleen M; Guzman, Raul J
Increased pulse pressure reflects pathologic arterial stiffening and predicts cardiovascular events and mortality. The effect of pulse pressure on outcomes in lower extremity bypass patients remains unknown. We thus investigated whether preoperative pulse pressure could predict amputation-free survival in patients undergoing lower extremity bypass for atherosclerotic occlusive disease. An institutional database identified 240 included patients undergoing lower extremity bypass from 2005 to 2014. Preoperative demographics, cardiovascular risk factors, operative factors, and systolic and diastolic blood pressures were recorded, and compared between patients with pulse pressures above and below 80 mm Hg. Factors were analyzed in bi- and multivariable models to assess independent predictors of amputation-free survival. Kaplan-Meier analysis was performed to evaluate the temporal effect of pulse pressure ≥80 mm Hg on amputation-free survival. Patients with a pulse pressure ≥80 mm Hg were older, male, and had higher systolic and lower diastolic pressures. Patients with pulse pressure <80 mm Hg demonstrated a survival advantage on Kaplan-Meier analysis at six months (log-rank P = 0.003) and one year (P = 0.005) postoperatively. In multivariable analysis, independent risk factors for decreased amputation-free survival at six months included nonwhite race, tissue loss, infrapopliteal target, and preoperative pulse pressure ≥80 mm Hg (hazard ratio 2.60; P = 0.02), while only tissue loss and pulse pressure ≥80 mm Hg (hazard ratio 2.30, P = 0.02) remained predictive at one year. Increased pulse pressure is independently associated with decreased amputation-free survival in patients undergoing lower extremity bypass. Further efforts to understand the relationship between increased arterial stiffness and poor outcomes in these patients are needed.
Benaya, A; Schwartz, Y; Kory, R; Yinnon, A M; Ben-Chetrit, E
Peripheral venous access in elderly, hospitalized patients is often challenging. The usual alternative is insertion of a central venous catheter, with associated risk for complications. The purpose of this investigation was to determine the relative incidence of phlebitis secondary to lower as compared to upper extremity intravenous catheters (IVCs) and associated risk factors. A non-randomized, observational, cohort-controlled study was carried out. Consecutive patients receiving a lower extremity IVC were enrolled and compared with patients receiving an upper extremity IVC. Patients were followed from insertion until removal of the IVC. The major endpoint was phlebitis. The incidence of phlebitis secondary to upper extremity IVCs was 3/50 (6 %) compared to 5/53 (9.4 %) in lower extremity IVCs (χ(2) Yates = 0.08, p = 0.776). Age, gender, obesity, diabetes mellitus, site (arm versus leg, left versus right), and size of needle were not found to be risk factors for phlebitis according to univariate analysis. None of the patients developed bloodstream infection. In elderly patients with poor venous access, lower extremity IVCs are a reasonable and low-risk alternative to central venous catheters.
Liang, Kailu; Zhong, Gang; Yin, Jiahui; Xiang, Zhou; Cen, Shiqiang; Huang, Fuguo
A 40-year-old woman had her right extremity avulsed at the proximal upper arm level and the wrist and hand of her left extremity irretrievably injured in a traffic accident. The right distal forearm was surgically amputated and replanted onto the stump of the left distal forearm. New strategy for nerve repair was applied and the function recovery of the cross-replanted hand was favorable. We thought that cross-extremity replantation was indicated when the patient suffered from bilateral total or subtotal amputation at different levels and orthotopic replantation was impossible.
Waljee, Jennifer; Zhong, Lin; Baser, Onur; Yuce, Huseyin; Fox, David A.; Chung, Kevin C.
Background: For elderly patients with rheumatoid arthritis, aggressive immunosuppression can be difficult to tolerate, and surgery remains an important treatment option for joint pain and deformity. We sought to examine the epidemiology of surgical reconstruction for rheumatoid arthritis among older individuals who were newly diagnosed with the disorder. Methods: We identified a 5% random sample of Medicare beneficiaries (sixty-six years of age and older) newly diagnosed with rheumatoid arthritis from 2000 to 2005, and followed these patients longitudinally for a mean of 4.6 years. We used univariate analysis to compare the time from the diagnosis of rheumatoid arthritis to the first operation among the 360 patients who underwent surgery during the study period. Results: In our study cohort, 589 procedures were performed among 360 patients, and 132 patients (37%) underwent multiple procedures. The rate of upper extremity reconstruction was 0.9%, the rate of lower extremity reconstruction was 1.2%, and knee arthroplasty was the most common procedure performed initially (31%) and overall (29%). Upper extremity procedures were performed sooner than lower extremity procedures (fourteen versus twenty-five months; p = 0.02). In multivariable analysis, surgery rates declined with age for upper and lower extremity procedures (p < 0.001). Conclusions: Knee replacement remains the most common initial procedure among patients with rheumatoid arthritis. However, upper extremity procedures are performed earlier than lower extremity procedures. Understanding the patient and provider factors that underlie variation in procedure rates can inform future strategies to improve the delivery of care to patients with rheumatoid arthritis. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. PMID:25740031
Lee, Su-Hyun; Kim, Yu-Mi; Lee, Byoung-Hee
[Purpose] This study investigated the therapeutic effects of virtual reality-based bilateral upper-extremity training on brain activity in patients with stroke. [Subjects and Methods] Eighteen chronic stroke patients were divided into two groups: the virtual reality-based bilateral upper-extremity training group (n = 10) and the bilateral upper-limb training group (n = 8). The virtual reality-based bilateral upper-extremity training group performed bilateral upper-extremity exercises in a virtual reality environment, while the bilateral upper-limb training group performed only bilateral upper-extremity exercise. All training was conducted 30 minutes per day, three times per week for six weeks, followed by brain activity evaluation. [Results] Electroencephalography showed significant increases in concentration in the frontopolar 2 and frontal 4 areas, and significant increases in brain activity in the frontopolar 1 and frontal 3 areas in the virtual reality-based bilateral upper-extremity training group. [Conclusion] Virtual reality-based bilateral upper-extremity training can improve the brain activity of stroke patients. Thus, virtual reality-based bilateral upper-extremity training is feasible and beneficial for improving brain activation in stroke patients.
Gold, Judith E; d'Errico, Angelo; Katz, Jeffrey N; Gore, Rebecca; Punnett, Laura
A longitudinal cohort of automobile manufacturing workers (n = 1,214) was examined for: (1) prevalence and persistence of specific upper extremity musculoskeletal disorders (UEMSDs) such as lateral epicondylitis and de Quervain's disease, and non-specific disorders (NSDs) defined in symptomatic individuals without any specific disorder, and (2) disorder prognoses based on symptom characteristics and other factors. Eight specific disorders were identified through case definitions based on upper extremity physical examinations and symptom surveys administered on three occasions over 6 years. At baseline, 41% of the cohort reported upper extremity symptoms; 18% (n = 214) of these had NSDs. In each survey, tendon-related conditions accounted for over half of the specific morbidity. Twenty-five percent had UEMSDs in multiple anatomical sites, and most with hand/wrist disorders had two or more hand/wrist UEMSDs. Persistence for all specific disorders decreased with length of follow-up. Specific UEMSDs were characterized by greater pain severity and functional impairment, and more lost work days than NSDs. Upper extremity symptoms and diagnoses vary over time. NSDs may be the early stages of conditions that will eventually become more specific. NSDs and overlapping specific UEMSDs should be taken into account in UEMSD classification. Am. J. Ind. Med. 52:124-132, 2009. (c) 2008 Wiley-Liss, Inc.
Kostopoulos, Vasileios K.
Since 1976, experimental and clinical studies have suggested the superiority of vascularized nerve grafts. In this study, a 27-year experience of the senior author is presented regarding vascularized nerve grafts and fascia for complex upper extremity nerve reconstruction. The factors influencing outcomes as well as a comparison with conventional nerve grafts is presented. Since 1981, 21 vascularized nerve grafts, other than vascularized ulnar nerve, were used for reconstruction of nerve injuries in the upper extremity. Indications were prolonged denervation time, failure of the previously used conventional nerve grafts, and excessive scar in the recipient site. Injury was in the hand/wrist area (n = 5), in the forearm (n = 4), in the elbow (n = 2), in the arm (n = 4), or in the plexus (n = 6). Vascularized sural (n = 9), saphenous (n = 8), superficial radial (n = 3), and peroneal (superficial and deep) nerves were used. The mean follow-up was 31.4 months. Vascularized nerve grafts for upper extremity injuries provided good to excellent sensory return in severely scarred upper extremities in patients in whom conventional nerve grafts had failed. They have also provided relief of causalgia after painful neuroma resection and motor function recovery in selective cases even for above the elbow injuries. Small diameter vascularized nerve grafts should be considered for bridging long nerve gaps in regions of excessive scar or for reconstructions where conventional nerve grafts have failed. PMID:19381727
Novak, Christine B.; von der Heyde, Rebecca L.
Following upper extremity nerve and tendon reconstruction, rehabilitation is necessary to achieve optimal function and outcome. In this review, the authors present current evidence and literature regarding the strategies and techniques of rehabilitation following peripheral nerve and tendon reconstruction. PMID:25685106
Sallés, Laia; Martín-Casas, Patricia; Gironès, Xavier; Durà, María José; Lafuente, José Vicente; Perfetti, Carlo
[Purpose] This study aims to describe a protocol based on neurocognitive therapeutic exercises and determine its feasibility and usefulness for upper extremity functionality when compared with a conventional protocol. [Subjects and Methods] Eight subacute stroke patients were randomly assigned to a conventional (control group) or neurocognitive (experimental group) treatment protocol. Both lasted 30 minutes, 3 times a week for 10 weeks and assessments were blinded. Outcome measures included: Motor Evaluation Scale for Upper Extremity in Stroke Patients, Motricity Index, Revised Nottingham Sensory Assessment and Kinesthetic and Visual Imagery Questionnaire. Descriptive measures and nonparametric statistical tests were used for analysis. [Results] The results indicate a more favorable clinical progression in the neurocognitive group regarding upper extremity functional capacity with achievement of the minimal detectable change. The functionality results are related with improvements on muscle strength and sensory discrimination (tactile and kinesthetic). [Conclusion] Despite not showing significant group differences between pre and post-treatment, the neurocognitive approach could be a safe and useful strategy for recovering upper extremity movement following stroke, especially regarding affected hands, with better and longer lasting results. Although this work shows this protocol’s feasibility with the panel of scales proposed, larger studies are required to demonstrate its effectiveness. PMID:28533607
Sethi, Amit; Patterson, Tara; McGuirk, Theresa; Patten, Carolynn; Richards, Lorie G.; Stergiou, Nicholas
Background The objective of this study was to determine movement variability in the more-affected upper-extremity in chronic stroke survivors. We investigated two hypotheses: (1) individuals with stroke will have increased amount of variability and altered structure of variability in upper-extremity joint movement patterns as compared to age-matched controls; and (2) the degree of motor impairment and joint kinematics will be correlated with the temporal structure of variability. Methods Sixteen participants with chronic stroke and nine age-matched controls performed three trials of functional reach-to-grasp. The amount of variability was quantified by computing the standard deviation of shoulder, elbow, wrist and index finger flexion/extension joint angles. The temporal structure of variability was determined by calculating approximate entropy in shoulder, elbow, wrist and index finger flexion/extension joint angles. Findings Individuals with stroke demonstrated greater standard deviations and significantly reduced approximate entropy values as compared to controls. Furthermore, motor impairments and kinematics demonstrated moderate to strong correlations with temporal structure of variability. Interpretation Changes in the temporal structure of variability in upper-extremity joint angles suggest that movement patterns used by stroke survivors are less adaptable. This knowledge may yield additional insights into the impaired motor system and suggest better interventions that can enhance upper-extremity movement adaptability. PMID:23337766
Cudlip, Alan C; Callaghan, Jack P; Dickerson, Clark R
Sitting or standing work configurations modulate musculoskeletal risk. Most existing investigations of these configurations have either studied them separately or lacked focus on the upper extremity, particularly during manual materials handling (MMH) tasks. To address this gap, upper extremity loading in 20 male and 20 females were assessed in 4 MMH tasks in sitting and standing. Differences in electromyographic (EMG) activity, local joint moments and body discomfort between configurations were examined. Interactions between task and sit/stand configuration resulted in increases of up to 500% in joint moments, 94% in EMG activity and 880% in discomfort when tasks were completed while sitting (p < 0.01). Future MMH task designers should consider placing workers in standing postures when feasible to reduce upper extremity loading, but workers should not remain in either configuration for extended periods of time as the negative effects of both workspace geometries can instigate future musculoskeletal disorders. Practitioner Summary: Sitting and standing modify occupational musculoskeletal risk. We examined how performing identical tasks while sitting or standing altered upper extremity and low back loading. In general, sitting increased muscle activity and discomfort, while standing increased local joint moments. The benefits of standing outweighed those of sitting across the range of tasks.
d'Errico, Angelo; Katz, Jeffrey N.; Gore, Rebecca; Punnett, Laura
Objective A longitudinal cohort of automobile manufacturing workers (n = 1214) was examined for: 1) prevalence and persistence of specific upper extremity musculoskeletal disorders (UEMSDs) such as lateral epicondylitis and de Quervain's disease, and non-specific disorders (NSDs) defined in symptomatic individuals without any specific disorder, and 2) disorder prognoses based on symptom characteristics and other factors. Methods Eight specific disorders were identified through case definitions based on upper extremity physical examinations and symptom surveys administered on three occasions over six years. Results At baseline, 41% of the cohort reported upper extremity symptoms; 18% (n = 214) of these had NSDs. In each survey, tendon-related conditions accounted for over half of the specific morbidity. Twenty-five percent had UEMSDs in multiple anatomical sites, and most with hand/wrist disorders had two or more hand/wrist UEMSDs. Persistence for all specific disorders decreased with length of follow-up. Specific UEMSDs were characterized by greater pain severity and functional impairment, and more lost work days than NSDs. Conclusions Upper extremity symptoms and diagnoses vary over time. NSDs may be the early stages of conditions that will eventually become more specific. NSDs and overlapping specific UEMSDs should be taken into account in UEMSD classification. PMID:19016265
Cintas, Holly Lea; Parks, Rebecca; Don, Sarah; Gerber, Lynn
Content validity and reliability of the Brief Assessment of Motor Function (BAMF) Upper Extremity Gross Motor Scale (UEGMS) were evaluated in this prospective, descriptive study. The UEGMS is one of five BAMF ordinal scales designed for quick documentation of gross, fine, and oral motor skill levels. Designed to be independent of age and…
Sallés, Laia; Martín-Casas, Patricia; Gironès, Xavier; Durà, María José; Lafuente, José Vicente; Perfetti, Carlo
[Purpose] This study aims to describe a protocol based on neurocognitive therapeutic exercises and determine its feasibility and usefulness for upper extremity functionality when compared with a conventional protocol. [Subjects and Methods] Eight subacute stroke patients were randomly assigned to a conventional (control group) or neurocognitive (experimental group) treatment protocol. Both lasted 30 minutes, 3 times a week for 10 weeks and assessments were blinded. Outcome measures included: Motor Evaluation Scale for Upper Extremity in Stroke Patients, Motricity Index, Revised Nottingham Sensory Assessment and Kinesthetic and Visual Imagery Questionnaire. Descriptive measures and nonparametric statistical tests were used for analysis. [Results] The results indicate a more favorable clinical progression in the neurocognitive group regarding upper extremity functional capacity with achievement of the minimal detectable change. The functionality results are related with improvements on muscle strength and sensory discrimination (tactile and kinesthetic). [Conclusion] Despite not showing significant group differences between pre and post-treatment, the neurocognitive approach could be a safe and useful strategy for recovering upper extremity movement following stroke, especially regarding affected hands, with better and longer lasting results. Although this work shows this protocol's feasibility with the panel of scales proposed, larger studies are required to demonstrate its effectiveness.
Takahashi, Kayoko; Domen, Kazuhisa; Sakamoto, Tomosaburo; Toshima, Masahiko; Otaka, Yohei; Seto, Makiko; Irie, Katsumi; Haga, Bin; Takebayashi, Takashi; Hachisuka, Kenji
Our aim was to study the efficacy of robotic therapy as an adjuvant to standard therapy during poststroke rehabilitation. Prospective, open, blinded end point, randomized, multicenter exploratory clinical trial in Japan of 60 individuals with mild to moderate hemiplegia 4 to 8 weeks post stroke randomized to receive standard therapy plus 40 minutes of either robotic or self-guided therapy for 6 weeks (7 days/week). Upper extremity impairment before and after intervention was measured using the Fugl-Meyer assessment, Wolf Motor Function Test, and Motor Activity Log. Robotic therapy significantly improved Fugl-Meyer assessment flexor synergy (2.1±2.7 versus -0.1±2.4; P<0.01) and proximal upper extremity (4.8±5.0 versus 1.9±5.5; P<0.05) compared with self-guided therapy. No significant changes in Wolf Motor Function Test or Motor Activity Log were observed. Robotic therapy also significantly improved Fugl-Meyer assessment proximal upper extremity among low-functioning patients (baseline Fugl-Meyer assessment score <30) and among patients with Wolf Motor Function Test ≥120 at baseline compared with self-guided therapy (P<0.05 for both). Robotic therapy as an adjuvant to standard rehabilitation may improve upper extremity recovery in moderately impaired poststroke patients. Results of this exploratory study should be interpreted with caution. URL: http://www.umin.ac.jp/. Unique identifier: UMIN000001619. © 2016 American Heart Association, Inc.
Wallace, Steve; Anderson, David I.; Trujillo, Michael; Weeks, Douglas L.
The 1992 NIH Research Planning Conference on Prosthetic and Orthotic Research for the 21st Century (Childress, 1992) recognized that the field of prosthetics lacks theoretical understanding and empirical studies on learning to control an upper-extremity prosthesis. We have addressed this problem using a novel approach in which persons without…
Villeneuve, Myriam; Penhune, Virginia; Lamontagne, Anouk
Music-supported therapy was shown to induce improvements in motor skills in stroke survivors. Whether all stroke individuals respond similarly to the intervention and whether gains can be maintained over time remain unknown. We estimated the immediate and retention effects of a piano training program on upper extremity function in persons with chronic stroke. Thirteen stroke participants engaged in a 3-week piano training comprising supervised sessions (9 × 60 min) and home practice. Fine and gross manual dexterity, movement coordination, and functional use of the upper extremity were assessed at baseline, pre-intervention, post-intervention, and at a 3-week follow-up. Significant improvements were observed for all outcomes at post-intervention and follow-up compared to pre-intervention scores. Larger magnitudes of change in manual dexterity and functional use of the upper extremity were associated with higher initial levels of motor recovery. Piano training can result in sustainable improvements in upper extremity function in chronic stroke survivors. Individuals with a higher initial level of motor recovery at baseline appear to benefit the most from this intervention.
Alt Murphy, Margit; Resteghini, Carol; Feys, Peter; Lamers, Ilse
Although use of standardized and scientifically sound outcome measures is highly encouraged in clinical practice and research, there is still no clear recommendation on which tools should be preferred for upper extremity assessment after stroke. As the aims, objectives and methodology of the existing reviews of the upper extremity outcome measures can vary, there is a need to bring together the evidence from existing multiple reviews. The purpose of this review was to provide an overview of evidence of the psychometric properties and clinical utility of upper extremity outcome measures for use in stroke, by systematically evaluating and summarizing findings from systematic reviews. A comprehensive systematic search was performed including systematic reviews from 2004 to February 2014. A methodological quality appraisal of the reviews was performed using the AMSTAR-tool. From 13 included systematic reviews, 53 measures were identified of which 13 met the standardized criteria set for the psychometric properties. The strongest level of measurement quality and clinical utility was demonstrated for Fugl-Meyer Assessment, Action Research Arm Test, Box and Block Test, Chedoke Arm and Hand Activity Inventory, Wolf Motor Function Test and ABILHAND. This overview of systematic reviews provides a comprehensive systematic synthesis of evidence on which outcome measures demonstrate a high level of measurement quality and clinical utility and which can be considered as most suitable for upper extremity assessment after stroke. This overview can provide a valuable resource to assist clinicians, researchers and policy makers in selection of appropriate outcome measures.
Cintas, Holly Lea; Parks, Rebecca; Don, Sarah; Gerber, Lynn
Content validity and reliability of the Brief Assessment of Motor Function (BAMF) Upper Extremity Gross Motor Scale (UEGMS) were evaluated in this prospective, descriptive study. The UEGMS is one of five BAMF ordinal scales designed for quick documentation of gross, fine, and oral motor skill levels. Designed to be independent of age and…
Brown, G. A.; Hayes, W. M.; Cornwal, R.
The use of small dose intravenous lidocaine without exsanguination for upper extremity fractures in children and adults is described. A twenty-plus year experience with this technique in the outpatient setting has shown it to be effective and safe. Attention to detail is essential and inadvertent tourniquet release must be avoided. Images Figure 1 PMID:7634037
Iglesias, Martin; Butrón, Patricia; León-López, Daniela Alejandra; García-Mancilla, Sofía; Espino-Gaucin, Israel; Rubio, Alethia
Although there is a wide list of free flaps options for soft tissue reconstruction of complex upper extremity injuries, the omental flap has some useful anatomical and biochemical advantages. We report 13 patients who underwent hand or upper extremity reconstruction with omental free flaps. Nine patients had extensive tissue damage, resulting with digital cyanosis and hypothermia, and some of them with areas of cutaneous necrosis, or avulsed tissues with tendons and bones exposed or infected. The remaining four patients had minor extensive tissue damage without circulatory problems. Patient's average age was 34.6 years. Twelve flaps were harvested through laparotomy and one laparoscopically. All flaps were covered with a skin graft. None of the flaps were lost. The average follow-up time was 20 months. There was one major and two minor donor site complications. One patient had minor loss of the skin graft in the recipient site, and two required minor additional surgeries to improve the appearance or function of the hand or upper extremity. There were no late abdominal complications in any patient. The morphological appearance and functional results were favorable in 11 of them, and permitted their reincorporation into society without the need for additional complex surgeries. Only two patients had a poor outcome. Our experience confirms that the omental flap may be a good option for reconstruction of some complex hand and upper extremity injuries.
Wallace, Steve; Anderson, David I.; Trujillo, Michael; Weeks, Douglas L.
The 1992 NIH Research Planning Conference on Prosthetic and Orthotic Research for the 21st Century (Childress, 1992) recognized that the field of prosthetics lacks theoretical understanding and empirical studies on learning to control an upper-extremity prosthesis. We have addressed this problem using a novel approach in which persons without…
1998 2. REPORT TYPE 3. DATES COVERED - 4. TITLE AND SUBTITLE Predicting Clinical Outcomes and Lost Work in Patients with Work -related Upper...Extremity Disorders 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT
Fatigue is an unavoidable part of a basketball game, which may affect an athlete's performance. The aim of this study was to investigate the effect of upper extremity fatigue on grip strength and passing accuracy in basketball, and ascertain if the effects of different fatigue protocols on grip strength and passing accuracy are the same. Twenty-four juniors under 18 years old (age: 16.75 ± 0.62 years; body height: 184.5 ± 3.31 cm; body mass: 77.25 ± 3.22 kg) volunteered to participate in the study, and were divided into two groups. After a warm-up, both groups performed the basketball passing test and grip strength was recorded for each group under three different testing conditions: rest, 70% and 90% exercise intensity. The protocol used for the first group was the chest press, and for the second group the wrist curls. Results show that after the upper extremity fatigue protocol all parameters of the study (grip strength and passing accuracy) showed a significant decrease, and there was no significant difference between both groups regarding grip strength and passing accuracy. The study suggested that in order to avoid upper extremity fatigue, basketball trainers and coaches need to include upper extremity conditioning exercises into their training sessions.
Kim, Eun Ja; Lee, Kyoung Bo; Hwang, Byong Yong
[Purpose] This study aimed to examine the effect of upper extremity training in the standing position on trunk alignment of patients with stroke. [Subjects and Methods] Twelve stroke patients were enrolled in the study and divided into two groups: a group of six patients in a sitting position and a group of six patients in a standing position. Upper extremity training for 30 min per day, five times a week for six weeks was given to subjects in both groups. In order to assess trunk alignment, lumbar lordosis and thoracic kyphosis were examined before and after upper extremity training using Formetric 4D. [Results] After training the standing position group had no significant change in lumbar lordosis but a significant change in thoracic kyphosis. The sitting position group showed no significant changes in either lumbar lordosis or thoracic kyphosis. The comparison between groups showed there was no significant difference in the change in lumbar lordosis but there was a significant difference in the change in thoracic kyphosis. [Conclusion] Examination of trunk alignment showed that upper extremity training conducted in a standing position reduced thoracic kyphosis more than in a sitting position. PMID:27799662
Thorley, Megan; Lannin, Natasha; Cusick, Anne; Novak, Iona; Boyd, Roslyn
Aim: The aim of the study was to investigate the construct validity of the Quality of Upper Extremity Skills Test (QUEST) in children with cerebral palsy (CP). Method: A total of 170 QUEST assessments from a convenience sample of 94 children with CP involved in clinical and research treatment programmes (54 males, 40 females; mean age 6y 10mo, SD…
Thorley, Megan; Lannin, Natasha; Cusick, Anne; Novak, Iona; Boyd, Roslyn
Aim: The aim of the study was to investigate the construct validity of the Quality of Upper Extremity Skills Test (QUEST) in children with cerebral palsy (CP). Method: A total of 170 QUEST assessments from a convenience sample of 94 children with CP involved in clinical and research treatment programmes (54 males, 40 females; mean age 6y 10mo, SD…
Kietrys, David M.; Barr-Gillespie, Ann E.; Amin, Mamta; Wade, Christine K.; Popoff, Steve N.; Barbe, Mary F.
We sought to determine if tendon inflammatory and histopathological responses increase in aged rats compared to young rats performing a voluntary upper extremity repetitive task, and if these changes are associated with motor declines. Ninety-six female Sprague-Dawley rats were used in the rat model of upper extremity overuse: 67 aged and 29 young adult rats. After a training period of 4 weeks, task rats performed a voluntary high repetition low force (HRLF) handle-pulling task for 2 hrs/day, 3 days/wk for up to 12 weeks. Upper extremity motor function was assessed, as were inflammatory and histomorphological changes in flexor digitorum and supraspinatus tendons. The percentage of successful reaches improved in young adult HRLF rats, but not in aged HRLF rats. Forelimb agility decreased transiently in young adult HRLF rats, but persistently in aged HRLF rats. HRLF task performance for 12 weeks lead to increased IL-1beta and IL-6 in flexor digitorum tendons of aged HRLF rats, compared to aged normal control (NC) as well as young adult HRLF rats. In contrast, TNF-alpha increased more in flexor digitorum tendons of young adult 12-week HRLF rats than in aged HRLF rats. Vascularity and collagen fibril organization were not affected by task performance in flexor digitorum tendons of either age group, although cellularity increased in both. By week 12 of HRLF task performance, vascularity and cellularity increased in the supraspinatus tendons of only aged rats. The increased cellularity was due to increased macrophages and connective tissue growth factor (CTGF)-immunoreactive fibroblasts in the peritendon. In conclusion, aged rat tendons were overall more affected by the HRLF task than young adult tendons, particularly supraspinatus tendons. Greater inflammatory changes in aged HRLF rat tendons were observed, increases associated temporally with decreased forelimb agility and lack of improvement in task success. PMID:23056540
Tripp, Brady L; Yochem, Eric M; Uhl, Timothy L
Context: The sensorimotor system controls the balance between upper extremity stability and mobility during athletic performance. Research indicates that fatigue hampers sensorimotor system function; however, few investigators have studied functional fatigue or multijoint, multiplanar measures. Objective: To examine the effect of functional fatigue on upper extremity position reproduction in overhead throwing athletes. Design: Single-session, repeated-measures design. Setting: University musculoskeletal laboratory. Patients or Other Participants: Sixteen healthy collegiate baseball players (age = 21.0 ± 1.6 years, height = 175.8 ± 10.2 cm, mass = 82.8 ± 4.3 kg). Intervention(s): Subjects threw a baseball from a single knee with maximum velocity (every 5 seconds) and rated their level of upper extremity exertion after every 20 throws. Subjects stopped after reporting above level 14 on the Borg scale and began posttests immediately. Main Outcome Measure(s): We measured active multijoint reproduction of 2 positions: arm cock and ball release. Dependent variables were absolute and variable error for 10 joint motions: scapulothoracic internal-external rotation, upward rotation, and posterior tilt; glenohumeral internal-external rotation, horizontal abduction-adduction, and flexion-extension; elbow pronation-supination and flexion-extension; and wrist ulnar-radial deviation and flexion-extension. We calculated acuity for each joint and the entire upper extremity using 3-dimensional variable error. Results: Fatigue occurred after an average of 62 ± 28 throws and increased 3-dimensional variable error scores (ie, decreased acuity) of the entire upper extremity and all joints in both positions (P < .05) except for the wrist in arm cock. Fatigue increased errors (ranging from 0.6° to 2.3°) at arm cock for scapulothoracic internal-external rotation, upward rotation, and posterior tilt; glenohumeral internal-external rotation and flexion-extension; elbow flexion
Franz, Randall W; Goodwin, Robert B; Hartman, Jodi F; Wright, Michelle L
Although relatively uncommon, upper extremity arterial injuries are serious and may significantly impact the outcome of the trauma patient. Management of upper extremity arterial injuries at an urban level I trauma center was reviewed to determine incidence, assess the current management strategy, and evaluate hospital outcome. Upper extremity trauma patients with arterial injury who presented between January 2005 and December 2006 were included in this retrospective review. Data collected included age, gender, race, mechanism of injury, type of injury, associated upper extremity injuries, concomitant injuries, injury severity score (ISS), diagnostic modalities employed, surgical procedures and interventions, mortality, length of stay, and discharge disposition. Statistical analysis between blunt and penetrating arterial injuries as well as between proximal and distal arterial injuries also was conducted. During a 2-year period, 28 patients with 30 upper extremity arterial injuries were admitted, yielding an incidence of 0.48%. The study population was comprised primarily of young Caucasian males, with a mean ISS of 9.0. The majority (89.3%) of patients suffered concomitant upper extremity injuries. Twenty-two nerve injuries were identified in 16 (57.1%) patients. The most common injury mechanism was cut by glass (39.3%). Arterial injuries were categorized into 18 (60.0%) penetrating and 12 (40.0%) blunt injuries. Involved artery distribution was as follows: 12 (40.0%) brachial, eight (26.7%) ulnar, seven (23.3%) radial, and three (10.0%) axillary. Over half (56.7%) of the injuries resulted from lacerations. Injuries were managed as follows: 14 (46.7%) primary repairs, eight (26.7%) ligations, six (20.0%) saphenous vein graft bypasses, and two (6.7%) endovascular procedures. Eleven (39.3%) patients required intensive care unit (ICU) admission. The overall mean length of hospitalization for these patients was 7.4 days compared to a mean length of hospitalization of
Hasbullah Mohd Isa, Wan; Taha, Zahari; Mohd Khairuddin, Ismail; Majeed, Anwar P. P. Abdul; Fikri Muhammad, Khairul; Abdo Hashem, Mohammed; Mahmud, Jamaluddin; Mohamed, Zulkifli
This paper presents the modelling and control of a two degree of freedom upper extremity exoskeleton by means of an intelligent active force control (AFC) mechanism. The Newton-Euler formulation was used in deriving the dynamic modelling of both the anthropometry based human upper extremity as well as the exoskeleton that consists of the upper arm and the forearm. A proportional-derivative (PD) architecture is employed in this study to investigate its efficacy performing joint-space control objectives. An intelligent AFC algorithm is also incorporated into the PD to investigate the effectiveness of this hybrid system in compensating disturbances. The Mamdani Fuzzy based rule is employed to approximate the estimated inertial properties of the system to ensure the AFC loop responds efficiently. It is found that the IAFC-PD performed well against the disturbances introduced into the system as compared to the conventional PD control architecture in performing the desired trajectory tracking.
Da Paz, Stephanie Nunes; Stalder, Andreas; Berger, Steffen; Ziebarth, Kai
Objective In the pediatric population traumatic injuries of the upper extremity are common. After therapy a decision has to be made if the mobility of the joint lies within a normal range. The purpose of this study was to give an introduction to normative data. We investigate if there is a significant difference in the range of motion (ROM) between male and female probands and furthermore, if an effect of the age can be detected. Methods We performed an institutional review board-approved study of healthy girls and boys aged between 2 and 16 years without any medical history of an upper extremity fracture. We investigated the active ROM of the elbow, wrist, metacarpophalangeal, and interphalangeal joints. Furthermore, age, handedness, weight, and height were recorded. A total of 171 adolescents with a mean age of 10.6 years were included and separated into four cohorts by age: 2 to 5, 6 to 10, 11 to 13, and 14 to 16 years. Results We found significant differences between the genders in the age group from 11 to 13 years for the flexion of the elbow, the pronation, the flexion of the interphalangeal joint of the thumb, as well as the flexion of the metacarpophalangeal joints of digitus II to V. Furthermore, a significant difference in the same joints except from the elbow flexion could be demonstrated between the genders. Conclusion Our study contributes normative data for upper extremity ROM in the pediatric population and presents a gender-related difference in certain joints. Clinical Relevance Normative data for the ROM of upper extremity joints in children is helpful for the evaluation of pediatric orthopedic patients and provides the framework for therapeutic resolution. Since a great number of traumatic injuries in children affect the upper extremity, this information may help the physician to estimate the impact of the injury and decide on the therapeutic management.
Alluri, Ram K; Pannell, William; Heckmann, Nathanael; Sivasundaram, Lakshmanan; Stevanovic, Milan; Ghiassi, Alidad
Background: Dog bite injuries to the upper extremity can result in traumatic neurovascular and musculotendinous damage. Currently, there are no clear guidelines dictating which patients may benefit from early operative exploration. The purpose of this study was to identify clinical variables that were predictive of abnormal intraoperative findings in patients who sustained an upper extremity dog bite injury. Methods: All patients who presented to a level I trauma center between 2007 and 2015 with an upper extremity dog bite injury who underwent subsequent surgical exploration were retrospectively screened for inclusion in our study. Patients with inadequate documentation or preexisting neurovascular or motor deficits were excluded. Abnormalities on physical exam and injuries encountered during surgical exploration were recorded for each patient. Contingency tables were constructed comparing normal and abnormal nerve, tendon, and vascular physical exam findings with intact or disrupted neurovascular and musculotendinous structures identified during surgical exploration. Results: Between 2007 and 2014, 117 patients sustained a dog bite injury to the upper extremity, of which 39 underwent subsequent surgical exploration and were included in our analysis. Sixty-nine percent of patients with neuropraxia on exam had intraoperative nerve damage. Seventy-seven percent of patients with an abnormal tendon exam had intraoperative musculotendinous damage. One hundred percent of patients with an abnormal vascular physical exam had intraoperative arterial injury. Conclusions: To date, there are no clear guidelines on what clinical criteria indicate the need for operative exploration and possible repair of neurovascular structures in upper extremity dog bite injuries. In our study, nerve, tendon, and vascular abnormalities noted on physical exam were strongly predictive of discovering neurovascular and musculotendinous damage during surgical exploration.
Salerno, D F; Franzblau, A; Werner, R A; Chung, K C; Schultz, J S; Becker, M P; Armstrong, T J
Physical examination is a traditional outcome measure in epidemiological research. Its value as a reliable measure depends, in part, on the prevalence of positive findings. The purpose of this paper is to determine the empirical reliability of physical examination and anthropometry in a field study of upper extremity disorders among keyboard operators. Two experienced examiners independently performed common provocative tests and procedures in physical examinations of the neck and upper extremity among 160 keyboard operators. Two additional examiners conducted anthropometric surveys among 137 workers. Inter-examiner reliability was assessed with observed agreement, kappa statistics, and intra-class correlations (ICC). Observed agreement was between 96% and 100% for neck and upper extremity signs, muscle stretch reflexes, and muscle strength, however, with the exception of provocative tests, reliability statistics were unstable. Among the provocative tests, Phalen and Tinel tests had modest agreement after adjusting for chance (kappa range: 0.20-0.43). The carpal compression test had the best reliability (kappa=0.60 and kappa=0.67, left and right side, respectively). The ICCs for anthropometry ranged from 0.36-0.91. Results from the study showed that statistically, except for the carpal compression test, physical examination contributed minimal reliable information. This was attributed mainly to the low prevalence of positive findings, and generally mild nature of upper extremity disorders in this population. The results are the best estimate of what would be found in a field study with experienced examiners. While it may reduce bias, separating physical examination from medical history may contribute to the poor reliability of findings. With a shift toward reliable measures, resources can be allocated to more effective tools, like questionnaires, in epidemiological research of upper extremity disorders among keyboard operators. Copyright 2000 Wiley-Liss, Inc.
Slowik, Jonathan S; Requejo, Philip S; Mulroy, Sara J; Neptune, Richard R
The hand pattern (i.e., full-cycle hand path) used during manual wheelchair propulsion is frequently classified as one of four distinct hand pattern types: arc, single loop, double loop or semicircular. Current clinical guidelines recommend the use of the semicircular pattern, which is based on advantageous levels of broad biomechanical metrics implicitly related to the demand placed on the upper extremity (e.g., lower cadence). However, an understanding of the influence of hand pattern on specific measures of upper extremity muscle demand (e.g., muscle power and stress) is needed to help make such recommendations, but these quantities are difficult and impractical to measure experimentally. The purpose of this study was to use musculoskeletal modeling and forward dynamics simulations to investigate the influence of the hand pattern used on specific measures of upper extremity muscle demand. The simulation results suggest that the double loop and semicircular patterns produce the most favorable levels of overall muscle stress and total muscle power. The double loop pattern had the lowest full-cycle and recovery-phase upper extremity demand but required high levels of muscle power during the relatively short contact phase. The semicircular pattern had the second-lowest full-cycle levels of overall muscle stress and total muscle power, and demand was more evenly distributed between the contact and recovery phases. These results suggest that in order to decrease upper extremity demand, manual wheelchair users should consider using either the double loop or semicircular pattern when propelling their wheelchairs at a self-selected speed on level ground. Copyright © 2016 Elsevier Ltd. All rights reserved.
Rankin, Jeffery W.; Neptune, Richard R.
Generating muscle-driven forward dynamics simulations of human movement using detailed musculoskeletal models can be computationally expensive. This is due in part to the time required to calculate musculotendon geometry (e.g., musculotendon lengths and moment arms), which is necessary to determine and apply individual musculotendon forces during the simulation. Modeling upper-extremity musculotendon geometry can be especially challenging due to the large number of multi-articular muscles and complex muscle paths. To accurately represent this geometry, wrapping surface algorithms and/or other computationally expensive techniques (e.g., phantom segments) are used. This paper provides a set of computationally efficient polynomial regression equations that estimate musculotendon length and moment arms for thirty-two (32) upper-extremity musculotendon actuators representing the major muscles crossing the shoulder, elbow and wrist joints. Equations were developed using a least squares fitting technique based on geometry values obtained from a validated public-domain upper-extremity musculoskeletal model that used wrapping surface elements (Holzbaur et al., 2005). In general, the regression equations fit well the original model values, with an average root mean square difference for all musculotendon actuators over the represented joint space of 0.39 mm (1.1% of peak value). In addition, the equations reduced the computational time required to simulate a representative upper-extremity movement (i.e., wheelchair propulsion) by more than two orders of magnitude (315 versus 2.3 seconds). Thus, these equations can assist in generating computationally efficient forward dynamics simulations of a wide range of upper-extremity movement tasks. PMID:22520587
Slowik, Jonathan S.; Requejo, Philip S.; Mulroy, Sara J.; Neptune, Richard R.
The hand pattern (i.e., full-cycle hand path) used during manual wheelchair propulsion is frequently classified as one of four distinct hand pattern types: arc, single loop, double loop and semicircular. Current clinical guidelines recommend the use of the semicircular pattern, which is based on advantageous levels of broad biomechanical metrics implicitly related to the demand placed on the upper extremity (e.g., lower cadence). However, an understanding of the influence of hand pattern on specific measures of upper extremity muscle demand (e.g., muscle power and stress) is needed to help make such recommendations, but these quantities are difficult and impractical to measure experimentally. The purpose of this study was to use musculoskeletal modeling and forward dynamics simulations to investigate the influence of the hand pattern used on specific measures of upper extremity muscle demand. The simulation results suggest that the double loop and semicircular patterns produce the most favorable levels of overall muscle stress and total muscle power. The double loop pattern had the lowest full-cycle and recovery-phase upper extremity demand but required high levels of muscle power during the relatively short contact phase. The semicircular pattern had the second-lowest full-cycle levels of overall muscle stress and total muscle power, and demand was more evenly distributed between the contact and recovery phases. These results suggest that in order to decrease upper extremity demand, manual wheelchair users should use either the double loop or semicircular pattern when propelling their wheelchairs at a self-selected speed on level ground. PMID:27062591
Rankin, Jeffery W; Neptune, Richard R
Generating muscle-driven forward dynamics simulations of human movement using detailed musculoskeletal models can be computationally expensive. This is due in part to the time required to calculate musculotendon geometry (e.g., musculotendon lengths and moment arms), which is necessary to determine and apply individual musculotendon forces during the simulation. Modeling upper-extremity musculotendon geometry can be especially challenging due to the large number of multi-articular muscles and complex muscle paths. To accurately represent this geometry, wrapping surface algorithms and/or other computationally expensive techniques (e.g., phantom segments) are used. This paper provides a set of computationally efficient polynomial regression equations that estimate musculotendon length and moment arms for thirty-two (32) upper-extremity musculotendon actuators representing the major muscles crossing the shoulder, elbow and wrist joints. Equations were developed using a least squares fitting technique based on geometry values obtained from a validated public-domain upper-extremity musculoskeletal model that used wrapping surface elements (Holzbaur et al., 2005). In general, the regression equations fit well the original model values, with an average root mean square difference for all musculotendon actuators over the represented joint space of 0.39 mm (1.1% of peak value). In addition, the equations reduced the computational time required to simulate a representative upper-extremity movement (i.e., wheelchair propulsion) by more than two orders of magnitude (315 versus 2.3 s). Thus, these equations can assist in generating computationally efficient forward dynamics simulations of a wide range of upper-extremity movements. Copyright © 2012 Elsevier Ltd. All rights reserved.
Sartori, Michelangelo; Migliaccio, Ludovica; Favaretto, Elisabetta; Cini, Michela; Legnani, Cristina; Palareti, Gualtiero; Cosmi, Benilde
D-dimer role is well established in the diagnostic work-up for lower limb deep vein thrombosis (DVT), however it has not been formally tested for clinically suspected upper extremity DVT and/or superficial vein thrombosis (SVT). To ascertain D-dimer diagnostic accuracy for upper extremity DVT and/or SVT. We performed a single centre management study in outpatients referred by emergency or primary care physicians for clinically suspected upper extremity DVT. All patients underwent D-dimer testing (cut-off value: ≤500 ng/mL), and a B-mode and color Doppler ultrasonography examination. In case of either technical problems or anatomical barriers, ultrasonography was repeated after 5-7 days. All patients were followed up for three months for the occurrence of symptomatic DVT and/or SVT and/or pulmonary embolism. We enrolled 239 patients (F: 63.6%; mean±SD age: 58.3±16.8). At the initial diagnostic work-up, DVT was detected in 24 (10%) patients while SVT in 35 (14.6%) patients. During follow-up, one upper extremity DVT was found. D-dimer levels were higher in patients with DVT than in those without. Sensitivity and specificity of D-dimer for DVT were 92% (95%CI: 73-99%) and 60% (95%CI: 52-67%) respectively, with a negative predictive value of 98% (95%CI: 93-100%), whereas for SVT they were 77% (95%CI: 59-89%) and 60% (95%CI: 52-67%) respectively, with a negative predictive value of 93% (95%CI: 86-97%). D-dimer has a negative predictive value ≥93% for excluding DVT in symptomatic outpatients and it can be a useful test in the diagnostic work-up of suspected upper extremity DVT. Copyright © 2015 Elsevier Ltd. All rights reserved.
Rankin, Jeffery W; Kwarciak, Andrew M; Richter, W Mark; Neptune, Richard R
The majority of manual wheelchair users will experience upper extremity injuries or pain, in part due to the high force requirements, repetitive motion and extreme joint postures associated with wheelchair propulsion. Recent studies have identified cadence, contact angle and peak force as important factors for reducing upper extremity demand during propulsion. However, studies often make comparisons between populations (e.g., able-bodied vs. paraplegic) or do not investigate specific measures of upper extremity demand. The purpose of this study was to use a musculoskeletal model and forward dynamics simulations of wheelchair propulsion to investigate how altering cadence, peak force and contact angle influence individual muscle demand. Forward dynamics simulations of wheelchair propulsion were generated to emulate group-averaged experimental data during four conditions: 1) self-selected propulsion technique, and while 2) minimizing cadence, 3) maximizing contact angle, and 4) minimizing peak force using biofeedback. Simulations were used to determine individual muscle mechanical power and stress as measures of muscle demand. Minimizing peak force and cadence had the lowest muscle power requirements. However, minimizing peak force increased cadence and recovery power, while minimizing cadence increased average muscle stress. Maximizing contact angle increased muscle stress and had the highest muscle power requirements. Minimizing cadence appears to have the most potential for reducing muscle demand and fatigue, which could decrease upper extremity injuries and pain. However, altering any of these variables to extreme values appears to be less effective; instead small to moderate changes may better reduce overall muscle demand. Copyright © 2012 Elsevier Ltd. All rights reserved.
Rankin, Jeffery W.; Kwarciak, Andrew M.; Richter, W. Mark; Neptune, Richard R.
Background The majority of manual wheelchair users will experience upper extremity injuries or pain, in part due to the high force requirements, repetitive motion and extreme joint postures associated with wheelchair propulsion. Recent studies have identified cadence, contact angle and peak force as important factors for reducing upper extremity demand during propulsion. However, studies often make comparisons between populations (e.g., able-bodied vs. paraplegic) or do not investigate specific measures of upper extremity demand. The purpose of this study was to use a musculoskeletal model and forward dynamics simulations of wheelchair propulsion to investigate how altering cadence, peak force and contact angle influence individual muscle demand. Methods Forward dynamics simulations of wheelchair propulsion were generated to emulate group-averaged experimental data during four conditions: 1) self-selected propulsion technique, and while 2) minimizing cadence, 3) maximizing contact angle and 4) minimizing peak force using biofeedback. Simulations were used to determine individual muscle mechanical power and stress as measures of muscle demand. Results Minimizing peak force and cadence had the lowest muscle power requirements. However, minimizing peak force increased cadence and recovery power, while minimizing cadence increased average muscle stress. Maximizing contact angle increased muscle stress and had the highest muscle power requirements. Interpretation Minimizing cadence appears to have the most potential for reducing muscle demand and fatigue, which could decrease upper extremity injuries and pain. However, altering any of these variables to extreme values appears to be less effective; instead small to moderate changes may better reduce overall muscle demand. PMID:22835860
Sevick, Marisa; Eklund, Elizabeth; Mensch, Allison; Foreman, Matthew; Standeven, John; Engsberg, Jack
Movement therapy is one type of upper extremity intervention for children with cerebral palsy (CP) to improve function. It requires high-intensity, repetitive and task-specific training. Tedium and lack of motivation are substantial barriers to completing the training. An approach to overcome these barriers is to couple the movement therapy with videogames. This investigation: (1) tested the feasibility of delivering a free Internet videogame upper extremity motor intervention to four children with CP (aged 8-17 years) with mild to moderate limitations to upper limb function; and (2) determined the level of intrinsic motivation during the intervention. The intervention used free Internet videogames in conjunction with the Microsoft Kinect motion sensor and the Flexible Action and Articulated Skeleton Toolkit software (FAAST) software. Results indicated that the intervention could be successfully delivered in the laboratory and the home, and pre- and post- impairment, function and performance assessments were possible. Results also indicated a high level of motivation among the participants. It was concluded that the use of inexpensive hardware and software in conjunction with free Internet videogames has the potential to be very motivating in helping to improve the upper extremity abilities of children with CP. Future work should include results from additional participants and from a control group in a randomized controlled trial to establish efficacy.
Wu, Zhibin; Li, Nianping; Cui, Haijiao; Peng, Jinqing; Chen, Haowen; Liu, Penglong
Existing thermal comfort field studies are mainly focused on the relationship between the indoor physical environment and the thermal comfort. In numerous chamber experiments, physiological parameters were adopted to assess thermal comfort, but the experiments' conclusions may not represent a realistic thermal environment due to the highly controlled thermal environment and few occupants. This paper focuses on determining the relationships between upper extremity skin temperatures (i.e., finger, wrist, hand and forearm) and the indoor thermal comfort. Also, the applicability of predicting thermal comfort by using upper extremity skin temperatures was explored. Field studies were performed in office buildings equipped with split air-conditioning (SAC) located in the hot summer and cold winter (HSCW) climate zone of China during the summer of 2016. Psychological responses of occupants were recorded and physical and physiological factors were measured simultaneously. Standard effective temperature (SET*) was used to incorporate the effect of humidity and air velocity on thermal comfort. The results indicate that upper extremity skin temperatures are good indicators for predicting thermal sensation, and could be used to assess the thermal comfort in terms of physiological mechanism. In addition, the neutral temperature was 24.7 °C and the upper limit for 80% acceptability was 28.2 °C in SET*.
Sevick, Marisa; Eklund, Elizabeth; Mensch, Allison; Foreman, Matthew; Standeven, John; Engsberg, Jack
Movement therapy is one type of upper extremity intervention for children with cerebral palsy (CP) to improve function. It requires high-intensity, repetitive and task-specific training. Tedium and lack of motivation are substantial barriers to completing the training. An approach to overcome these barriers is to couple the movement therapy with videogames. This investigation: (1) tested the feasibility of delivering a free Internet videogame upper extremity motor intervention to four children with CP (aged 8–17 years) with mild to moderate limitations to upper limb function; and (2) determined the level of intrinsic motivation during the intervention. The intervention used free Internet videogames in conjunction with the Microsoft Kinect motion sensor and the Flexible Action and Articulated Skeleton Toolkit software (FAAST) software. Results indicated that the intervention could be successfully delivered in the laboratory and the home, and pre- and post- impairment, function and performance assessments were possible. Results also indicated a high level of motivation among the participants. It was concluded that the use of inexpensive hardware and software in conjunction with free Internet videogames has the potential to be very motivating in helping to improve the upper extremity abilities of children with CP. Future work should include results from additional participants and from a control group in a randomized controlled trial to establish efficacy. PMID:27338485
Hanney, William J.; Kolber, Morey J.; Davies, George J.; Riemann, Bryan
Introduction: Understanding the relationships between performance tests and sport activity is important to the rehabilitation specialist. The purpose of this study was two- fold: 1) To identify if relationships exist between tests of upper body strength and power (Single Arm Seated Shot Put, Timed Push-Up, Timed Modified Pull-Up, and The Davies Closed Kinetic Chain Upper Extremity Stability Test, and the softball throw for distance), 2) To determine which variable or group of variables best predicts the performance of a sport specific task (the softball throw for distance). Methods: One hundred eighty subjects (111 females and 69 males, aged 18-45 years) performed the 5 upper extremity tests. The Pearson product moment correlation and a stepwise regression were used to determine whether relationships existed between performance on the tests and which upper extremity test result best explained the performance on the softball throw for distance. Results: There were significant correlations (r=.33 to r=.70, p=0.001) between performance on all of the tests. The modified pull-up test was the best predictor of the performance on the softball throw for distance (r2= 48.7), explaining 48.7% of variation in performance. When weight, height, and age were added to the regression equation the r2 values increased to 64.5, 66.2, and 67.5 respectively. Conclusion: The results of this study indicate that several upper extremity tests demonstrate significant relationships with one another and with the softball throw for distance. The modified pull up test was the best predictor of performance on the softball throw for distance. PMID:21712942
Kumar, Anand R; Grewal, Navanjun S; Chung, Thomas L; Bradley, James P
Reconstructive techniques and protocols for limb salvage of upper extremity battlefield injuries remains poorly defined. Our study describes the types of flaps, the timing of reconstruction, and success rates of war upper extremity reconstruction during a 30-month period using the Bethesda limb salvage protocol. Soldiers with significant upper extremity injuries with complex open fractures from Operation Iraqi Freedom and Operation Enduring Freedom-Afghanistan who underwent tissue transfer flaps were reviewed (n = 26, free flaps n = 6). Data analysis included mechanism of injury, associated injuries, types of flap, postoperative complications, wound infection rates, and outcome data. The cause of injury consisted of improvised explosive device (61%), rocket-propelled grenades (15%), motor vehicle crash (8%), land mine (8%), and gunshot wound (4%). Mean age was 25 years. Mean number of prereconstructive washouts was six (range, 3-22). Forty-six percent of wounds were culture positive at admission (75% were Acinetobacter species). All patients had other coexisting extremity, trunk or facial injuries. Average time to flap reconstruction was 31 days (range, 9-161). In 66% of the cases, a fasciocutaneous flap was used, and in the remaining cases, muscle (19%) and adipofascial (15%) flaps were performed. Flap success rate was 96%, with one flap loss because of venous congestion (managed with limb shortening). Infection rate was 8%. Complete coverage was achieved in all upper extremity wounds and early occupational therapy resulted in improved return to function. Despite massive bone and soft tissue defects, high preoperative wound colonization, and delays in definitive reconstruction, devastating war wounds can be successfully reconstructed in the subacute period with low flap failure, infection, and amputation rates.
Pet, Mitchell A; Morrison, Shane D; Mack, Jacob S; Sears, Erika D; Wright, Thomas; Lussiez, Alisha D; Means, Kenneth R; Higgins, James P; Ko, Jason H; Cederna, Paul S; Kung, Theodore A
After major upper extremity traumatic amputation, replantation is attempted based upon the assumption that outcomes for a replanted limb exceed those for revision amputation with prosthetic rehabilitation. While some reports have examined functional differences between these patients, it is increasingly apparent that patient perceptions are also critical determinants of success. Currently, little patient-reported outcomes data exists to support surgical decision-making in the setting of major upper extremity traumatic amputation. Therefore, the purpose of this study is to directly compare patient-reported outcomes after replantation versus prosthetic rehabilitation. At three tertiary care centers, patients with a history of traumatic unilateral upper extremity amputation at or between the radiocarpal and elbow joints were identified. Patients who underwent either successful replantation or revision amputation with prosthetic rehabilitation were contacted. Patient-reported health status was evaluated with both DASH and MHQ instruments. Intergroup comparisons were performed for aggregate DASH score, aggregate MHQ score on the injured side, and each MHQ domain. Nine patients with successful replantation and 22 amputees who underwent prosthetic rehabilitation were enrolled. Aggregate MHQ score for the affected extremity was significantly higher for the Replantation group compared to the Prosthetic Rehabilitation group (47.2 vs. 35.1, p<0.05). Among the MHQ domains, significant advantages to replantation were demonstrated with respect to overall function (41.1 vs. 19.7, p=0.03), ADLs (28.3 vs. 6.0, p=0.03), and patient satisfaction (46.0 vs. 24.4, p=0.03). Additionally, Replantation patients had a lower mean DASH score (24.6 vs. 39.8, p=0.08). Patients in this study who experienced major upper extremity traumatic amputation reported more favorable patient-reported outcomes after successful replantation compared to revision amputation with prosthetic rehabilitation
Panse, Nikhil; Sahasrabudhe, Parag
Background: The introduction of perforator flaps by Koshima et al. was met with much animosity in the plastic surgery fraternity. The safety concerns of these flaps following the intentional twist of the perforators have prevented widespread adoption of this technique. Use of perforator based propeller flaps in the lower extremity is gradually on the rise, but their use in upper extremity reconstruction is infrequently reported, especially in the Indian subcontinent. Materials and Methods: We present a retrospective series of 63 free style perforator flaps used for soft tissue reconstruction of the upper extremity from November 2008 to June 2013. Flaps were performed by a single surgeon for various locations and indications over the upper extremity. Patient demographics, surgical indication, defect features, complications and clinical outcome are evaluated and presented as an uncontrolled case series. Results: 63 free style perforator based propeller flaps were used for soft tissue reconstruction of 62 patients for the upper extremity from November 2008 to June 2013. Of the 63 flaps, 31 flaps were performed for trauma, 30 for post burn sequel, and two for post snake bite defects. We encountered flap necrosis in 8 flaps, of which there was complete necrosis in 4 flaps, and partial necrosis in four flaps. Of these 8 flaps, 7 needed a secondary procedure, and one healed secondarily. Although we had a failure rate of 12-13%, most of our failures were in the early part of the series indicative of a learning curve associated with the flap. Conclusion: Free style perforator based propeller flaps are a reliable option for coverage of small to moderate sized defects. Level of Evidence: Therapeutic IV. PMID:24987209
Swanik, Kathleen A; Thomas, Stephen J; Struminger, Aaron H; Bliven, Kellie C Huxel; Kelly, John D; Swanik, Charles B
Plyometric training is credited with providing benefits in performance and dynamic restraint. However, limited prospective data exist quantifying kinematic adaptations such as amortization time, glenohumeral rotation, and scapulothoracic position, which may underlie the efficacy of plyometric training for upper-extremity rehabilitation or performance enhancement. To measure upper-extremity kinematics and plyometric phase times before and after an 8-wk upper-extremity strength- and plyometric-training program. Randomized pretest-posttest design. Research laboratory. 40 recreationally active men (plyometric group, age 20.43 ± 1.40 y, height 180.00 ± 8.80 cm, weight 73.07 ± 7.21 kg; strength group, age 21.95 ± 3.40 y, height 173.98 ± 11.91 cm, weight 74.79 ± 13.55 kg). Participants were randomly assigned to either a strength-training group or a strength- and plyometric-training group. Each participant performed the assigned training for 8 wk. Dynamic and static glenohumeral and scapular-rotation measurements were taken before and after the training programs. Dynamic measurement of scapular rotation and time spent in each plyometric phase (concentric, eccentric, and amortization) during a ball-toss exercise were recorded while the subjects were fitted with an electromagnetic tracking system. Static measures included scapular upward rotation at 3 different glenohumeral-abduction angles, glenohumeral internal rotation, and glenohumeral external rotation. Posttesting showed that both groups significantly decreased the time spent in the amortization, concentric, and eccentric phases of a ball-toss exercise (P < .01). Both groups also exhibited significantly decreased static external rotation and increased dynamic scapular upward rotation after the training period (P < .01). The only difference between the training protocols was that the plyometric-training group exhibited an increase in internal rotation that was not present in the strength-training group (P < .01
Montpetit, Kathleen; Haley, Stephen; Bilodeau, Nathalie; Ni, Pengsheng; Tian, Feng; Gorton, George, III; Mulcahey, M. J.
This article reports on the content range and measurement precision of an upper extremity (UE) computer adaptive testing (CAT) platform of physical function in children with cerebral palsy. Upper extremity items representing skills of all abilities were administered to 305 parents. These responses were compared with two traditional standardized…
Montpetit, Kathleen; Haley, Stephen; Bilodeau, Nathalie; Ni, Pengsheng; Tian, Feng; Gorton, George, III; Mulcahey, M. J.
This article reports on the content range and measurement precision of an upper extremity (UE) computer adaptive testing (CAT) platform of physical function in children with cerebral palsy. Upper extremity items representing skills of all abilities were administered to 305 parents. These responses were compared with two traditional standardized…
Vorobiev, A. A.; Krivonozhkina, P. S.; Zasypkina, O. A.; Andrewshenko, F. A.
This research considers the first results of the development and implementation of the upper extremity exoskeleton "EXAR". Made anatomical parameterization developed the device the testing of the apparatus have been conducted in accordance with the bioethics regulations with the girl I. Sh. at the age of 4 years suffering the artrogryposis. The parameters of the exoskeleton "EXAR" selected according to our methods allowed us to conduct its use in the period of 4 months. There have been no defects at all. By the analysis of the first results of the passive upper limb skeleton EXAR development we should consider them as positive and worthy of the widespread adoption in the remedial practice.
Khalifa, Mohamed; Patel, Neeral; Moser, Steven
Superior vena cava obstruction (SVCO) and associated thrombus formation can occur in patients with upper mediastinal or right apical masses. While stenting is useful in relieving obstruction, it can facilitate the passage of upper extremity deep vein thrombus to the pulmonary arterial tree, resulting in a potentially fatal pulmonary embolism (PE). We present a case that illustrates a novel technique, which protects the patient from PE while also relieving the SVCO. This involves placing an inferior vena cava filter in an inverted position within a superior vena cava (SVC) stent to capture emboli. This procedure offers a potentially lifesaving endovascular therapeutic option to patients who would otherwise be deemed unsuitable for SVC stenting.
Paul, Alyssa J; Slavens, Brooke A; Graf, Adam; Krzak, Joseph; Vogel, Lawrence; Harris, Gerald F
Current methods for evaluating upper extremity (UE) dynamics during pediatric wheelchair use are limited. We propose a new model to characterize UE joint kinematics and kinetics during pediatric wheelchair mobility. The bilateral model is comprised of the thorax, clavicle, scapula, upper arm, forearm, and hand segments. The modeled joints include: sternoclavicular, acromioclavicular, glenohumeral, elbow and wrist. The model is complete and is currently undergoing pilot studies for clinical application. Results may provide considerable quantitative insight into pediatric UE joint dynamics to improve wheelchair prescription, training and long term care of children with orthopaedic disabilities.
Piligian, George; Glutting, Joseph J.; Hanlon, Alexandra; Frings-Dresen, Monique H. W.; Sluiter, Judith K.
Introduction Some musculoskeletal disorders of the upper extremity are not readily classified. The study objective was to determine if there were symptom patterns in self-identified repetitive strain injury (RSI) patients. Methods Members (n = 700) of the Dutch RSI Patients Association filled out a detailed symptom questionnaire. Factor analysis followed by cluster analysis grouped correlated symptoms. Results Eight clusters, based largely on symptom severity and quality were formulated. All but one cluster showed diffuse symptoms; the exception was characterized by bilateral symptoms of stiffness and aching pain in the shoulder/neck. Conclusions Case definitions which localize upper extremity musculoskeletal disorders to a specific anatomical area may be incomplete. Future clustering studies should rely on both signs and symptoms. Data could be collected from health care providers prospectively to determine the possible prognostic value of the identified clusters with respect to natural history, chronicity, and return to work. PMID:20414797
Woodbury, Michelle L; Velozo, Craig A; Richards, Lorie G; Duncan, Pamela W; Studenski, Stephanie; Lai, Sue-Min
To investigate the longitudinal stability of the Fugl-Meyer Assessment (FMA) of the upper-extremity item difficulties by using Rasch analysis. Secondary analysis of existing data from a cohort longitudinal study of stroke recovery. University research center. A total of 377 people, ages 69.2+/-11.2 years, to whom the assessment was administered at 2 weeks and 6 months poststroke. Not applicable. Differential item function analysis performed by using the Winsteps software program examined whether the item difficulty hierarchical order of a modified 30-item FMA for the upper extremity (reflex items removed) was invariant across 2 testing occasions. Only 2 items (shoulder flexion to 180 degrees, movement with normal speed) showed large differences in test-retest item difficulty calibration. Item instability had no practical consequences on the longitudinal measurement of person ability. The 30-item assessment shows a longitudinally stable item difficulty order and is valid for measuring volitional arm motor ability over time.
Lang, Catherine E.; Bland, Marghuretta D.; Bailey, Ryan R.; Schaefer, Sydney Y.; Birkenmeier, Rebecca L.
The purpose of this review is to provide a comprehensive approach for assessing the upper extremity (UE) after stroke. First, common upper extremity impairments and how to assess them are briefly discussed. While multiple UE impairments are typically present after stroke, the severity of one impairment, paresis, is the primary determinant of UE functional loss. Second, UE function is operationally defined and a number of clinical measures are discussed. It is important to consider how impairment and loss of function affect UE activity outside of the clinical environment. Thus, this review also identifies accelerometry as an objective method for assessing UE activity in daily life. Finally, the role that each of these levels of assessment should play in clinical decision making is discussed in order to optimize the provision of stroke rehabilitation services. PMID:22975740
Lobo, M A; Galloway, J C; Heathcock, J C
This article aims to: 1) highlight general exploration, reaching, and object exploration behaviors as key activities of daily living in infancy, 2) describe how knowledge of early warning signs for these behaviors may improve early assessment, and 3) discuss interventions that may advance performance of these behaviors. Early intervention should focus on improving performance of these behaviors because: a) these early, interrelated upper extremity behaviors serve an integral role in global learning and development in infancy, b) among at-risk populations, differences have been observed in the quantity and quality of performance of these behaviors and, in many cases, these differences are associated with related perceptual-motor and cognitive delays. This article highlights how early assessment and intervention can target these key early behaviors in populations at risk for upper extremity disabilities, such as those born preterm, with Down syndrome, brachial plexus palsy, or arthrogryposis multiplex congentia.
Lineberry, Kyle D; Boettcher, Adam K; Blount, Andrew L; Burgess, Scott D
Cutaneous mucormycosis, a relatively common infection in immunocompromised patients, remains rare in the immunocompetent patient outside the setting of major trauma. We report a case of an immunocompetent patient who developed left upper extremity Rhizopus infection following arterial puncture. Treatment included surgical debridement, liposomal amphotericin B, and hyperbaric oxygen wound therapy; the patient recovered fully. A review of the literature of cases of upper extremity Mucor infection is included for context. We feel that a high degree of suspicion for Mucor infection is warranted in patients with the described risk factors who do not respond to first-line antibiotics. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Kim, Soo Ji; Koh, Iljoo
The purpose of this study was to determine the effects of music therapy on pain perception of stroke patients during upper extremity joint exercises. Ten stroke patients (1 male and 9 females) ranging in age from 61 to 73 participated in the study. Music conditions used in the study consisted of: (a) song, (b) karaoke accompaniment (same music to condition A except singers' voices), and (c) no music. Exercise movements in this study included hand, wrist, and shoulder joints. During the 8-week period music therapy sessions, subjects repeated 3 conditions according to the randomized orders and subjects rated their perceived pain on a scale immediately after each condition. The General Linear Model (GLM) Repeated Measures ANOVA revealed that there were no significant differences in pain rating across the three music conditions. However, positive affects and verbal responses, while performing upper extremity exercises with both music and karaoke accompaniment music, were observed using video observations.
Sloan, R. L.; And Others
This study tested the interrater reliability of the Modified Ashworth Scale in measuring upper and lower limb spasticity in 34 hemiplegic adult patients examined by 2 physiotherapists and 2 doctors. Findings indicated satisfactory reliability for upper limb spasticity but less satisfactory results for lower limb spasticity. (DB)
The timing and pattern of reperfusion following arterial- venous reversal (AVR) in patients with terminal ischemia of an upper extremity is not well understood. The current case series describes the timing and pattern of reperfusion observed in patients with terminal upper extremity ischemia who underwent AVR and repeated postoperative indocyanine green (ICG) angiography between 2004 and 2009. For all included patients, the SPY Near-Infrared Perfusion Assessment System permitted visualization of ICG-labeled blood flow for 60-second sampling periods at scheduled postoperative time points; outflow and rate and amplitude of inflow were objectively quantified with SPY-Q Analysis Toolkit image analysis software. The series comprised 6 male patients (mean age, 46 years) who presented with upper extremity ischemia related to hypothenar hammer syndrome (n = 2), embolism with patent foramen ovale (n = 2), atherosclerosis (n = 1), and avulsion amputation of the thumb (n = 1); the patient with the avulsion amputation was diagnosed with thromboangiitis obliterans at the time of replantation. AVR was successful in all 6 patients. In 5 of 6 patients, ICG angiography and SPY-based visualization/quantification showed that venous outflow and arterial inflow gradually normalized (versus unaffected digits) between postoperative days (PODs) 0 and 3 and was maintained at long-term follow-up (≥3 months); for the patient who underwent thumb replantation, perfusion normalized between POD 3 and month 5 follow-up. AVR effectively reestablished blood flow in patients with terminal upper extremity ischemia. ICG angiography with SPY technology revealed that, in most cases, kinetic curves, timing, and patterns of perfusion gradually normalized over several PODs.
Background: The timing and pattern of reperfusion following arterial- venous reversal (AVR) in patients with terminal ischemia of an upper extremity is not well understood. Methods: The current case series describes the timing and pattern of reperfusion observed in patients with terminal upper extremity ischemia who underwent AVR and repeated postoperative indocyanine green (ICG) angiography between 2004 and 2009. For all included patients, the SPY Near-Infrared Perfusion Assessment System permitted visualization of ICG-labeled blood flow for 60-second sampling periods at scheduled postoperative time points; outflow and rate and amplitude of inflow were objectively quantified with SPY-Q Analysis Toolkit image analysis software. Results: The series comprised 6 male patients (mean age, 46 years) who presented with upper extremity ischemia related to hypothenar hammer syndrome (n = 2), embolism with patent foramen ovale (n = 2), atherosclerosis (n = 1), and avulsion amputation of the thumb (n = 1); the patient with the avulsion amputation was diagnosed with thromboangiitis obliterans at the time of replantation. AVR was successful in all 6 patients. In 5 of 6 patients, ICG angiography and SPY-based visualization/quantification showed that venous outflow and arterial inflow gradually normalized (versus unaffected digits) between postoperative days (PODs) 0 and 3 and was maintained at long-term follow-up (≥3 months); for the patient who underwent thumb replantation, perfusion normalized between POD 3 and month 5 follow-up. Conclusions: AVR effectively reestablished blood flow in patients with terminal upper extremity ischemia. ICG angiography with SPY technology revealed that, in most cases, kinetic curves, timing, and patterns of perfusion gradually normalized over several PODs. PMID:25426368
Ng, Zhi Yang; Tan, Shaun Shi Yan; Lellouch, Alexandre Gaston; Chim, Harvey Wei Ming
Background Upper extremity soft tissue defects with complete circumferential involvement are not common. Coupled with the unique anatomy of the upper extremity, the underlying etiology of such circumferential soft tissue defects represent additional reconstructive challenges that require treatment to be tailored to both the patient and the wound. The aim of this study is to review the various options for soft tissue reconstruction of complete circumferential defects in the upper extremity. Methods A literature review of PubMed and MEDLINE up to December 2016 was performed. The current study focuses on forearm and arm defects from the level at or proximal to the wrist and were assessed based on Tajima's classification (J Trauma 1974). Data reviewed for analysis included patient demographics, causality, defect size, reconstructive technique(s) employed, and postoperative follow-up and functional outcomes (when available). Results In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 14 unique articles were identified for a total of 50 patients (mean=28.1 years). Underlying etiologies varied from extensive thermal or electrical burns to high impact trauma leading to degloving or avulsion, crush injuries, or even occur iatrogenically after tumor extirpation or extensive debridement. Treatment options ranged from the application of negative pressure wound dressings to the opposite end of the spectrum in hand transplantation. Conclusions With the evolution of reconstructive techniques over time, the extent of functional and aesthetic rehabilitation of these complex upper extremity injuries has also improved. The proposed management algorithm comprehensively addresses the inherent challenges associated with these complex cases. PMID:28352600
Zviagin, V N; Sineva, I M
The authors studied the osteological collection of the Chair of Antropology of the Moscow State University. The results of measurement of length of long tubular bones and articular parts of scapula and pelvis were statistically treated. The complex of discriminant models calculated by the Fisher's method is recommended for the sex identification. The diagnostic accuracy is 74 - 83.5% (separated bones) and 85.7 - 95.2% (complex of bones of upper and lower extremities).
Nathan, Dominic E; Guastello, Stephen J; Prost, Robert W; Jeutter, Dean C
The ability to model and quantify brain activation patterns that pertain to natural neuromotor strategy of the upper extremities during functional task performance is critical to the development of therapeutic interventions such as neuroprosthetic devices. The mechanisms of information flow, activation sequence and patterns, and the interaction between anatomical regions of the brain that are specific to movement planning, intention and execution of voluntary upper extremity motor tasks were investigated here. This paper presents a novel method using symbolic dynamics (orbital decomposition) and nonlinear dynamic tools of entropy, self-organization and chaos to describe the underlying structure of activation shifts in regions of the brain that are involved with the cognitive aspects of functional upper extremity task performance. Several questions were addressed: (a) How is it possible to distinguish deterministic or causal patterns of activity in brain fMRI from those that are really random or non-contributory to the neuromotor control process? (b) Can the complexity of activation patterns over time be quantified? (c) What are the optimal ways of organizing fMRI data to preserve patterns of activation, activation levels, and extract meaningful temporal patterns as they evolve over time? Analysis was performed using data from a custom developed time resolved fMRI paradigm involving human subjects (N=18) who performed functional upper extremity motor tasks with varying time delays between the onset of intention and onset of actual movements. The results indicate that there is structure in the data that can be quantified through entropy and dimensional complexity metrics and statistical inference, and furthermore, orbital decomposition is sensitive in capturing the transition of states that correlate with the cognitive aspects of functional task performance.
Rheumatic illnesses are a common cause for musculoskeletal complaints in the general population. All ages can be affected, including people in the prime of their working years. Secondary problems, such as entrapment neuropathies, enthesopathies, and Raynaud's syndrome, can be associated with various inflammatory arthritides. A detailed history and physical are the most important tools in screening for potential inflammatory disease in workers with upper extremity complaints.
Daub, Clifford W
Background Similar upper extremity symptoms can present with varied physiologic etiologies. However, due to the multifaceted nature of musculoskeletal conditions, a definitive diagnosis using physical examination and advanced testing is not always possible. This report discusses the diagnosis and case management of a patient with two episodes of similar upper extremity symptoms of different etiologies. Case Presentation On two separate occasions a forty-four year old female patient presented to a chiropractic office with a chief complaint of insidious right-sided upper extremity symptoms. During each episode she reported similar pain and parasthesias from her neck and shoulder to her lateral forearm and hand. During the first episode the patient was diagnosed with a cervical radiculopathy. Conservative treatment, including manual cervical traction, spinal manipulation and neuromobilization, was initiated and resolved the symptoms. Approximately eighteen months later the patient again experienced a severe acute flare-up of the upper extremity symptoms. Although the subjective complaint was similar, it was determined that the pain generator of this episode was an active trigger point of the infraspinatus muscle. A diagnosis of myofascial referred pain was made and a protocol of manual trigger point therapy and functional postural rehabilitative exercises improved the condition. Conclusion In this case a thorough physical evaluation was able to differentiate between radicular and referred pain. By accurately identifying the pain generating structures, the appropriate rehabilitative protocol was prescribed and led to a successful outcome for each condition. Conservative manual therapy and rehabilitative exercises may be an effective treatment for certain cases of cervical radiculopathy and myofascial referred pain. PMID:17640388
Tsai, Jason; Georgiades, Christos S.; Hong, Kelvin; Kim, Hyun S.
To achieve more effective thrombolysis in a shorter treatment time, percutaneous mechanical thrombectomy has been increasingly used in the treatment of deep venous thrombosis (DVT). The power-pulse spray is a new technique to combine chemical and rheolytic effects on clots. We present a case of presumed pulmonary embolism following power-pulse spray treatment for upper extremity DVT which necessitated resuscitation and intubation. The power-pulse spray technique should be used with caution when treating DVT.
Ayaz, Mehdi; Moein, Reza
Mucormycosis is a rare opportunistic fungal infection that can implicate cranial sinuses, brain, lungs, gastrointestinal tract and skin. Although it can occur in patients with competent and incompetent immunity such as patients with diabetes mellitus, lymphoma, leukemia and burns, but it has an aggressive, malignant and lethal course in patients with incompetent immunity. To enforce the importance of burn in patients with underlaying diseases such as diabetes, we are going to report a rare case of diabetic burnt patient complicated by right upper extremity myocutaneous mucormycosis. We selected this case to emphasis the importance of underlying disease (diabetes mellitus) with cutaneous burn, aggressive treatment of fungal infection in these patients and referring such case to burn center to prevent catastrophic results. A 50-year-old woman was introduced to us after several days of medical and surgical care of right upper extremity and trunk split-thickness burn. Due to gross muscle necrosis of right upper extremity and poor general condition of the patient, she was taken to the operating room that led to right upper extremity amputation and several times of aggressive debridement to save her life. Pathologic report was indicative of mucormycosis. We can conclude from this case that: 1) Burn, even partially thickness and with little body surface area, should be referred to burn center for better care 2) No response to usual medical treatment should make us more sensitive to consider the unusual causes of infection such as fungi 3) Suspected dead tissues should be excised aggressively especially if suspiciousness to wound sepsis and fungal infection is present especially in an immunocompromised patient. PMID:28246626
Ayaz, Mehdi; Moein, Reza
Mucormycosis is a rare opportunistic fungal infection that can implicate cranial sinuses, brain, lungs, gastrointestinal tract and skin. Although it can occur in patients with competent and incompetent immunity such as patients with diabetes mellitus, lymphoma, leukemia and burns, but it has an aggressive, malignant and lethal course in patients with incompetent immunity. To enforce the importance of burn in patients with underlaying diseases such as diabetes, we are going to report a rare case of diabetic burnt patient complicated by right upper extremity myocutaneous mucormycosis. We selected this case to emphasis the importance of underlying disease (diabetes mellitus) with cutaneous burn, aggressive treatment of fungal infection in these patients and referring such case to burn center to prevent catastrophic results. A 50-year-old woman was introduced to us after several days of medical and surgical care of right upper extremity and trunk split-thickness burn. Due to gross muscle necrosis of right upper extremity and poor general condition of the patient, she was taken to the operating room that led to right upper extremity amputation and several times of aggressive debridement to save her life. Pathologic report was indicative of mucormycosis. We can conclude from this case that: 1) Burn, even partially thickness and with little body surface area, should be referred to burn center for better care 2) No response to usual medical treatment should make us more sensitive to consider the unusual causes of infection such as fungi 3) Suspected dead tissues should be excised aggressively especially if suspiciousness to wound sepsis and fungal infection is present especially in an immunocompromised patient.
Sueyoshi, Ted; Nakatani, Takuya; Tsuruta, Takashi; Emoto, Gen
Background: Shoulder range of motion and pitch count in baseball pitchers have been linked to pitching-related upper extremity injury. Purpose: To investigate upper extremity range of motion and pitching profiles in baseball pitchers in Japan as well as to make a comparison between injured and noninjured pitchers. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Forty-one Little League to college-level baseball pitchers were measured for bilateral shoulder and elbow range of motion, including shoulder internal rotation (IR), external rotation (ER), shoulder horizontal adduction (HAD), and elbow extension (EXT). They were also asked to answer a simple questionnaire regarding their past pitching-related medical history and pitching profile. Additionally, 28 participants with baseball-related upper extremity injuries (injury group) were compared with 13 participants without injury (no-injury group) for the same parameters. Collected data were analyzed using analysis of variance. Results: Significant limb differences (dominant vs nondominant side) were noted for ER (117.2° vs 109.8°, P = .02), IR (53.5° vs 61.9°, P = .007), HAD (28.3° vs 32.8°, P = .03), and EXT (1.0° vs 4.6°, P = .01). A significant between-group difference (injury vs no-injury group) was observed for IR in both the dominant (55.4° vs 45.6°, P = .03) and nondominant shoulder (65.3° vs 55.0°, P = .01). Participants in the injury group pitched more games in a season and more innings per game started. Conclusion: Japanese baseball pitchers displayed adaptive changes in upper extremity range of motion similar to American pitchers when compared bilaterally. Injured pitchers exhibited greater IR range of motion in their pitching arm compared with noninjured pitchers. PMID:28781975
Shah, K M; Clark, B R; McGill, J B; Mueller, M J
To determine the severity of, and relationships between, upper extremity impairments, pain and disability in patients with diabetes mellitus, and to compare upper extremity impairments in patients with diabetes with non-diabetic controls. Case-control, cross-sectional design. University-based, outpatient diabetes centre and physical therapy research clinic. Two hundred and thirty-six patients with diabetes attending an outpatient diabetes clinic completed the Shoulder Pain and Disability Index (SPADI) questionnaire. A detailed shoulder and hand examination was conducted on a subgroup of 29 volunteers with type 2 diabetes, and 27 controls matched for age, sex and body mass index. None. SPADI score, passive shoulder range of motion (ROM) and strength, grip strength, hand sensation, dexterity and limited joint mobility of the hand. Sixty-three percent (149/236) of patients with diabetes reported shoulder pain and/or disability [median SPADI score 10.0 (interquartile range 0.0 to 39.6)]. Compared with the control group, the subgroup of patients with diabetes had substantial reductions in shoulder ROM, shoulder muscle strength, grip and key pinch strength (P<0.05). Patients with diabetes had a greater prevalence of decreased sensation (26/27 vs 14/27) and limited joint mobility of the hand (17/27 vs 4/27) compared with the control group. Total SPADI score was negatively correlated (P<0.05) with shoulder ROM (r=-0.42 to -0.74) and strength measures (r=-0.44 to -0.63) in patients with diabetes. Upper extremity impairments in this sample of patients with diabetes were common, severe and related to complaints of pain and disability. Additional research is needed to understand the unique reasons for upper extremity problems in patients with diabetes, and to identify preventative treatments. Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.
Shah, K.M.; Clark, B.R.; McGill, J.B.; Mueller, M.J.
Objectives To determine the severity of, and relationships between, upper extremity impairments, pain and disability in patients with diabetes mellitus, and to compare upper extremity impairments in patients with diabetes with non-diabetic controls. Design Case–control, cross-sectional design. Setting University-based, outpatient diabetes centre and physical therapy research clinic. Participants Two hundred and thirty-six patients with diabetes attending an outpatient diabetes clinic completed the Shoulder Pain and Disability Index (SPADI) questionnaire. A detailed shoulder and hand examination was conducted on a subgroup of 29 volunteers with type 2 diabetes, and 27 controls matched for age, sex and body mass index. Interventions None. Main outcome measures SPADI score, passive shoulder range of motion (ROM) and strength, grip strength, hand sensation, dexterity and limited joint mobility of the hand. Results Sixty-three percent (149/236) of patients with diabetes reported shoulder pain and/or disability [median SPADI score 10.0 (interquartile range 0.0 to 39.6)]. Compared with the control group, the subgroup of patients with diabetes had substantial reductions in shoulder ROM, shoulder muscle strength, grip and key pinch strength (P<0.05). Patients with diabetes had a greater prevalence of decreased sensation (26/27 vs 14/27) and limited joint mobility of the hand (17/27 vs 4/27) compared with the control group. Total SPADI score was negatively correlated (P<0.05) with shoulder ROM (r= −0.42 to −0.74) and strength measures (r= −0.44 to −0.63) in patients with diabetes. Conclusions Upper extremity impairments in this sample of patients with diabetes were common, severe and related to complaints of pain and disability. Additional research is needed to understand the unique reasons for upper extremity problems in patients with diabetes, and to identify preventative treatments. PMID:25442298
Wang, William L; Kruse, Kevin; Fowler, John R
Background: Ultrasound is a versatile imaging modality that can be used by upper extremity surgeons for diagnostic purposes and guided injections. The perceptions of ultrasound for diagnosis and treatment among upper extremity surgeons and its barriers for adoption have not been formally surveyed. The purpose of this study is to determine the current usage of musculoskeletal ultrasound for diagnostic purposes and guided injections by upper extremity surgeons and their reasons for using it or not using it in practice. Methods: A 22-question survey was distributed to the American Society for Surgery of the Hand (ASSH). The survey questions consisted of respondent characteristic questions and questions pertaining to the use of ultrasound. Chi-square analysis was performed to assess for a difference in ultrasound usage across respondent characteristics. Results: Three hundred four (43%) answered that they have an ultrasound machine in their office; Fifty-one percent (362) of the respondents use ultrasound for diagnostic purposes. Fifty-five (8%) of the survey respondents use ultrasound to diagnose carpal tunnel syndrome; 168 (23.5%) respondents reported that they use ultrasound for guided injections. There was a statistically significant difference between access to an ultrasound machine in the office by practice setting and use of ultrasound for diagnostic purposes by practice setting. Conclusions: The use of ultrasound by upper extremity surgeons is split for diagnostic purposes, with fewer surgeons using ultrasound to diagnose carpal tunnel syndrome and guided injections. Ultrasound machine availability and the use of ultrasound for diagnosis appear to be influenced by practice setting.
Sueyoshi, Ted; Nakatani, Takuya; Tsuruta, Takashi; Emoto, Gen
Shoulder range of motion and pitch count in baseball pitchers have been linked to pitching-related upper extremity injury. To investigate upper extremity range of motion and pitching profiles in baseball pitchers in Japan as well as to make a comparison between injured and noninjured pitchers. Cross-sectional study; Level of evidence, 3. Forty-one Little League to college-level baseball pitchers were measured for bilateral shoulder and elbow range of motion, including shoulder internal rotation (IR), external rotation (ER), shoulder horizontal adduction (HAD), and elbow extension (EXT). They were also asked to answer a simple questionnaire regarding their past pitching-related medical history and pitching profile. Additionally, 28 participants with baseball-related upper extremity injuries (injury group) were compared with 13 participants without injury (no-injury group) for the same parameters. Collected data were analyzed using analysis of variance. Significant limb differences (dominant vs nondominant side) were noted for ER (117.2° vs 109.8°, P = .02), IR (53.5° vs 61.9°, P = .007), HAD (28.3° vs 32.8°, P = .03), and EXT (1.0° vs 4.6°, P = .01). A significant between-group difference (injury vs no-injury group) was observed for IR in both the dominant (55.4° vs 45.6°, P = .03) and nondominant shoulder (65.3° vs 55.0°, P = .01). Participants in the injury group pitched more games in a season and more innings per game started. Japanese baseball pitchers displayed adaptive changes in upper extremity range of motion similar to American pitchers when compared bilaterally. Injured pitchers exhibited greater IR range of motion in their pitching arm compared with noninjured pitchers.
Bullock Spt, Garrett S; Brookerson, Nate; Knab, Amy M; Butler, Robert J
Abnormal fundamental movement patterns and upper quarter dynamic balance are proposed mechanisms affecting athletic performance and injury risk. There are few studies investigating functional movement and closed chain upper extremity dynamic stability in swimmers. The purpose of this study was to determine differences in fundamental movement competency and closed chain upper extremity dynamic balance, utilizing the Functional Movement Screen (FMS) and Upper Quarter Y-Balance Test (YBT-UQ), of high school (HS; n=70) and collegiate (COL; n=70) swimmers. Variables included the individual movement tests on the FMS, and the average normalized reach (%LL) for each direction, with the YBT-UQ. Statistical analysis was completed utilizing a chi-square for the independent test scores on the FMS while independent samples t-test to examine performance on the YBT-UQ (p<0.05). HS swimmers exhibited a statistically significant greater percentage of below average performance (score of 0 or 1) on the following FMS tests: lunge (HS:22.9%, COL:4.3%), hurdle step (HS:31.4%, COL:7.1%) and push up (HS:61.4 %, COL:31.4%). Furthermore, COL males performed worse in the lunge (Male 9%, Female 0%), while COL females had poorer efficiency in the pushup (Male: 17.6%, Female 44%). Significant effects of competition level and sex were observed in YBT-UQ medial reach (HS: Female 92.06, Male 101.63, COL: Female 101.3, Male 101.5 %LL). Individual fundamental movement patterns that involved lumbopelvic neuromuscular control differed between HS and COL swimmers. General upper extremity dynamic balance differed between competition levels. These data may be helpful in understanding injury and performance based normative data for participation and return to swimming.
de los Reyes-Guzmán, Ana; Dimbwadyo-Terrer, Iris; Trincado-Alonso, Fernando; Monasterio-Huelin, Félix; Torricelli, Diego; Gil-Agudo, Angel
Quantitative measures of human movement quality are important for discriminating healthy and pathological conditions and for expressing the outcomes and clinically important changes in subjects' functional state. However the most frequently used instruments for the upper extremity functional assessment are clinical scales, that previously have been standardized and validated, but have a high subjective component depending on the observer who scores the test. But they are not enough to assess motor strategies used during movements, and their use in combination with other more objective measures is necessary. The objective of the present review is to provide an overview on objective metrics found in literature with the aim of quantifying the upper extremity performance during functional tasks, regardless of the equipment or system used for registering kinematic data. A search in Medline, Google Scholar and IEEE Xplore databases was performed following a combination of a series of keywords. The full scientific papers that fulfilled the inclusion criteria were included in the review. A set of kinematic metrics was found in literature in relation to joint displacements, analysis of hand trajectories and velocity profiles. These metrics were classified into different categories according to the movement characteristic that was being measured. These kinematic metrics provide the starting point for a proposed objective metrics for the functional assessment of the upper extremity in people with movement disorders as a consequence of neurological injuries. Potential areas of future and further research are presented in the Discussion section. Copyright © 2014 Elsevier Ltd. All rights reserved.
Silfies, Sheri P.; Ebaugh, David; Pontillo, Marisa; Butowicz, Courtney M.
BACKGROUND: Programs designed to prevent or rehabilitate athletic injuries or improve athletic performance frequently focus on core stability. This approach is based upon the theory that poor core stability increases the risk of poor performance and/or injury. Despite the widespread use of core stability training amongst athletes, the question of whether or not sufficient evidence exists to support this practice remains to be answered. OBJECTIVES: 1) Open a dialogue on the definition and components of core stability. 2) Provide an overview of current science linking core stability to musculoskeletal injuries of the upper extremity. 3) Provide an overview of evidence for the association between core stability and athletic performance. DISCUSSION: Core stability is the ability to control the position and movement of the trunk for optimal production, transfer, and control of forces to and from the upper and lower extremities during functional activities. Muscle capacity and neuromuscular control are critical components of core stability. A limited body of evidence provides some support for a link between core stability and upper extremity injuries amongst athletes who participate in baseball, football, or swimming. Likewise, few studies exist to support a relationship between core stability and athletic performance. CONCLUSIONS: A limited body of evidence exists to support the use of core stability training in injury prevention or performance enhancement programs for athletes. Clearly more research is needed to inform decision making when it comes to inclusion or emphasis of core training when designing injury prevention and rehabilitation programs for athletes. PMID:26537806
Silfies, Sheri P; Ebaugh, David; Pontillo, Marisa; Butowicz, Courtney M
Programs designed to prevent or rehabilitate athletic injuries or improve athletic performance frequently focus on core stability. This approach is based upon the theory that poor core stability increases the risk of poor performance and/or injury. Despite the widespread use of core stability training amongst athletes, the question of whether or not sufficient evidence exists to support this practice remains to be answered. 1) Open a dialogue on the definition and components of core stability. 2) Provide an overview of current science linking core stability to musculoskeletal injuries of the upper extremity. 3) Provide an overview of evidence for the association between core stability and athletic performance. Core stability is the ability to control the position and movement of the trunk for optimal production, transfer, and control of forces to and from the upper and lower extremities during functional activities. Muscle capacity and neuromuscular control are critical components of core stability. A limited body of evidence provides some support for a link between core stability and upper extremity injuries amongst athletes who participate in baseball, football, or swimming. Likewise, few studies exist to support a relationship between core stability and athletic performance. A limited body of evidence exists to support the use of core stability training in injury prevention or performance enhancement programs for athletes. Clearly more research is needed to inform decision making when it comes to inclusion or emphasis of core training when designing injury prevention and rehabilitation programs for athletes.
Silfies, Sheri P; Ebaugh, David; Pontillo, Marisa; Butowicz, Courtney M
Programs designed to prevent or rehabilitate athletic injuries or improve athletic performance frequently focus on core stability. This approach is based upon the theory that poor core stability increases the risk of poor performance and/or injury. Despite the widespread use of core stability training amongst athletes, the question of whether or not sufficient evidence exists to support this practice remains to be answered. 1) Open a dialogue on the definition and components of core stability. 2) Provide an overview of current science linking core stability to musculoskeletal injuries of the upper extremity. 3) Provide an overview of evidence for the association between core stability and athletic performance. Core stability is the ability to control the position and movement of the trunk for optimal production, transfer, and control of forces to and from the upper and lower extremities during functional activities. Muscle capacity and neuromuscular control are critical components of core stability. A limited body of evidence provides some support for a link between core stability and upper extremity injuries amongst athletes who participate in baseball, football, or swimming. Likewise, few studies exist to support a relationship between core stability and athletic performance. A limited body of evidence exists to support the use of core stability training in injury prevention or performance enhancement programs for athletes. Clearly more research is needed to inform decision making when it comes to inclusion or emphasis of core training when designing injury prevention and rehabilitation programs for athletes.
Donoso Brown, Elena V; Fichter, Renae
Upper extremity hemiparesis is an impairment post-stroke that impacts quality of life. Home programs are an intervention strategy used by many occupational therapists to support continued motor recovery post-stroke, yet little is known about how these programs are designed and implemented. The purpose of this study was to describe how occupational therapy practitioners approach this task and specifically what strategies they use to support adherence and what types of technology are most commonly used. An on-line survey methodology was used. Participants were recruited through multiple sources including state associations and occupational therapy educational program directors. A total of 73 occupational therapy practitioners submitted complete surveys. It was found that majority of occupational therapy practitioners in the sample (n = 53) reported creating home programs focused on upper extremity motor recovery more than 80% of the time. Range of motion and strengthening were reported as being in the top three most commonly used interventions by more than half the sample, however incorporating clients' goals and interests were reported most often as strategies to create meaning in the home program. Respondents also reported limited incorporation of technology and strategies to support adherence. Personal motivation was reported by occupational therapy practitioners to be a key moderator of adherence to a home program. Occupational therapy practitioners often provide home programs for individuals post-stroke focusing on upper extremity function. Future research that aims to understand stakeholders' perspectives on home programs and determine effective strategies for ensuring adherence is needed.
Hong, Ickpyo; Bonilha, Heather S
The aim of this study was to provide a systematic review of psychometric studies of upper extremity (UE) outcome measures validated by Rasch analysis and assess the extent to which their measurement areas cover the domains of the International Classification of Functioning, Disability and Health model. A literature search from 1966 to 2014 was performed using PubMed, CINAHL, Scopus, PsycINFO, Ovid/MEDLINE, ERIC, and Cochrane library. Fourteen keywords indicating 'upper extremity', 'psychometric properties', and 'outcome measures' were used. From a total of 1039 studies, 17 UE impairment outcome measures that fulfilled the inclusion criteria were selected and reviewed. The instruments targeted adults with various neurological or orthopedic conditions (i.e. stroke, upper and lower extremity impairments, and back pain). Twelve instruments targeted the body structure/function domain and 11 instruments targeted the activity domain of the International Classification of Functioning, Disability and Health model. Only two instruments targeted the participation domain. All outcome measures showed reasonably sound psychometric properties, including construct validity (good fit statistic), moderate to high reliability (r=0.86-0.99), and sound dimensionality (unidimensional). The reviewed psychometric properties of UE outcome measures are useful for clinicians in deciding which measures to use to assess patients' UE impairments.
Rasouli, Mohammad R; Moini, Majid; Khaji, Ali
The determination of the pattern of traumatic vascular injuries of the upper extremity in Iran was the aim of this study. Data of the Iranian national trauma project were used to identify patients with upper extremity vascular injuries. This project was conducted in 8 major cities from 2000-2004. A total of 113 cases with 130 vascular injuries were found, including 2 axillary, 18 brachial, and 69 radial and ulnar arteries. In 91 cases (81%), penetrating trauma was responsible. Associated nerve and/or upper extremity fractures were seen in 20% and 18% of cases, respectively. End-to-end anastomosis, interposition of saphenous graft, and ligation were used for the management of 44%, 28%, and 17%, respectively, of brachial artery injuries. Ulnar and radial artery injuries had been either ligated (n = 36; 52%) or sutured (n = 33; 48%). Median, ulnar, and radial nerve injuries, except for one, had all been sutured primarily. No patients needed fasciotomy. Amputation and mortality resulting from associated injuries occurred in 3 (2.6%) and 5 (4.4%) patients, respectively. This study revealed that stabbings are the most frequent causes of these injuries in Iran, in spite of the management of patients in level 3 trauma centers; the rate of amputation is acceptable. However, this study does not provide limb functions of the patients.
Jourdain, Victor; Goldenberg, William D; Matteucci, Michael; Auten, Jonathan
Paget-Schroetter syndrome is a rare but potentially debilitating condition affecting young, otherwise healthy individuals. This condition, also known as effort thrombosis, is an upper extremity deep vein thrombosis classically caused by anatomical abnormalities compressing the neurovascular structures of the thoracic outlet. The diagnosis is important to emergency medicine providers due to its secondary morbidity and mortality. Common complications affecting these active adults are pulmonary embolism and postthrombotic syndrome. Most patients report a precedent history of vigorous exercise or activity involving the upper extremities. We present a case of a 23-year-old man with redness and swelling of his dominant arm after weightlifting. Previous literature describes Paget-Schroetter syndrome from repetitive activities. The report highlights the limitations of imaging studies in proximal upper extremity deep vein thromboses. The initial selected imaging study, Doppler ultrasound, was negative in our case and was followed by a nondiagnostic computed tomographic venogram. Although ultrasound is the preferred diagnostic imaging modality, it is limited when thrombosis is present in the noncompressible region of the clavicle. Magnetic resonance venogram or computed tomographic venogram is recommended if index of suspicion is high and the ultrasound shows normal results, but these studies are highly dependent on technique, flow, and timing. The eventual diagnosis of axillosubclavian thrombosis was obtained only after specialty consultation and formal venography. This case discusses the limitations of each imaging modality and the importance of a comprehensive clinical approach to this rare diagnosis.
Boocock, M G; McNair, P J; Larmer, P J; Armstrong, B; Collier, J; Simmonds, M; Garrett, N
Considered from medical, social or economic perspectives, the cost of musculoskeletal injuries experienced in the workplace is substantial, and there is a need to identify the most efficacious interventions for their effective prevention, management and rehabilitation. Previous reviews have highlighted the limited number of studies that focus on upper extremity intervention programmes. The aim of this study was to evaluate the findings of primary, secondary and/or tertiary intervention studies for neck/upper extremity conditions undertaken between 1999 and 2004 and to compare these results with those of previous reviews. Relevant studies were retrieved through the use of a systematic approach to literature searching and evaluated using a standardised tool. Evidence was then classified according to a “pattern of evidence” approach. Studies were categorised into subgroups depending on the type of intervention: mechanical exposure interventions; production systems/organisational culture interventions and modifier interventions. 31 intervention studies met the inclusion criteria. The findings provided evidence to support the use of some mechanical and modifier interventions as approaches for preventing and managing neck/upper extremity musculoskeletal conditions and fibromyalgia. Evidence to support the benefits of production systems/organisational culture interventions was found to be lacking. This review identified no single‐dimensional or multi‐dimensional strategy for intervention that was considered effective across occupational settings. There is limited information to support the establishment of evidence‐based guidelines applicable to a number of industrial sectors. PMID:16973739
Aponte-Tinao, Luis A.; Ayerza, Miguel A.; Muscolo, D. Luis; Farfalli, German L.
In comparison with the lower extremity, there is relatively paucity literature reporting survival and clinical results of allograft reconstructions after excision of a bone tumor of the upper extremity. We analyze the survival of allograft reconstructions in the upper extremity and analyze the final functional score according to anatomical site and type of reconstruction. A consecutive series of 70 allograft reconstruction in the upper limb with a mean followup of 5 years was analyzed, 38 osteoarticular allografts, 24 allograft-prosthetic composites, and 8 intercalary allografts. Kaplan-Meier survival analysis of the allografts was performed, with implant revision for any cause and amputation used as the end points. The function evaluation was performed using MSTS functional score. Sixteen patients (23%) had revision surgery for 5 factures, 2 infections, 5 allograft resorptions, and 2 local recurrences. Allograft survival at five years was 79% and 69% at ten years. In the group of patients treated with an osteoarticular allograft the articular surface survival was 90% at five years and 54% at ten years. The limb salvage rate was 98% at five and 10 years. We conclude that articular deterioration and fracture were the most frequent mode of failure in proximal humeral osteoarticular reconstructions and allograft resorption in elbow reconstructions. The best functional score was observed in the intercalary humeral allograft. PMID:23476115
Boocock, M G; McNair, P J; Larmer, P J; Armstrong, B; Collier, J; Simmonds, M; Garrett, N
Considered from medical, social or economic perspectives, the cost of musculoskeletal injuries experienced in the workplace is substantial, and there is a need to identify the most efficacious interventions for their effective prevention, management and rehabilitation. Previous reviews have highlighted the limited number of studies that focus on upper extremity intervention programmes. The aim of this study was to evaluate the findings of primary, secondary and/or tertiary intervention studies for neck/upper extremity conditions undertaken between 1999 and 2004 and to compare these results with those of previous reviews. Relevant studies were retrieved through the use of a systematic approach to literature searching and evaluated using a standardised tool. Evidence was then classified according to a "pattern of evidence" approach. Studies were categorised into subgroups depending on the type of intervention: mechanical exposure interventions; production systems/organisational culture interventions and modifier interventions. 31 intervention studies met the inclusion criteria. The findings provided evidence to support the use of some mechanical and modifier interventions as approaches for preventing and managing neck/upper extremity musculoskeletal conditions and fibromyalgia. Evidence to support the benefits of production systems/organisational culture interventions was found to be lacking. This review identified no single-dimensional or multi-dimensional strategy for intervention that was considered effective across occupational settings. There is limited information to support the establishment of evidence-based guidelines applicable to a number of industrial sectors.
de Araújo, Rodrigo Cappato; Rocha, Daniel Neves; Pitangui, Ana Carolina Rodarti; Pinotti, Marcos
The goal of this study was to assess the use of a dynamic orthosis on upper extremity function in chronic stroke patients. A case series approach was utilized, with provision of a training program (3x/week, 50 minutes/session for 8 weeks) and employment of a dynamic orthosis. Six volunteers with persistent hemiparesis due to a single, unilateral stroke performed task-oriented movements with the aid of a dynamic orthosis. Tests were administered before and after training. Functional capacity was assessed using the TEMPA (Test d'Évaluation des Membres Supérieurs de Personnes Âgées) test. The Wilcoxon test was used for pre-training and post-training comparisons of TEMPA scores. The volunteers showed significant improvement of upper extremity function in the performance of a bilateral task (p = 0.01) and three unilateral tasks (p = 0.04). This pilot study suggests that the dynamic orthosis associated with the performance of functional tasks can have positive outcomes regarding the improvement of functional capacity of upper extremity.
Villeneuve, Myriam; Lamontagne, Anouk
Music-supported therapy (MST) is an innovative approach that was shown to improve manual dexterity in acute stroke survivors. The feasibility of such intervention in chronic stroke survivors and its longer-term benefits, however, remain unknown. The objective of this pilot study was to estimate the short- and long-term effects of a 3-week piano training program on upper extremity function in persons with chronic stroke. A multiple pre-post sequential design was used, with measurements taken at baseline (week0, week3), prior to (week6) and after the intervention (week9), and at 3-week follow-up (week12). Three persons with stroke participated in the 3-week piano training program that combined structured piano lessons to home practice program. The songs, played on an electronic keyboard, involved all 5 digits of the affected hand and were displayed using a user-friendly MIDI program. After intervention, all the three participants showed improvements in their fine (nine hole peg test) and gross (box and block test) manual dexterity, as well as in the functional use of the upper extremity (Jebsen hand function test). Improvements were maintained at follow-up. These preliminary results support the feasibility of using an MST approach that combines structured lessons to home practice to improve upper extremity function in chronic stroke.
Background Schwannomas are the most common primary solitary tumor among peripheral nerve sheath tumors. The occurrence of transient or permanent neurological deficits after schwannoma resection is more common than previously recognized. Here, the neurological deficits before and after surgical resection of schwannomas in the upper extremities were examined. Methods The study included 43 upper-extremity schwannomas that were treated surgically between January 2000 and July 2013. The neurological status of each patient (such as pain, sensory disturbances, and motor disturbances) was evaluated preoperatively, immediately postoperatively, and at the final postoperative follow-up. Results Out of the 43 cases, 34 cases exhibited neurological symptoms before the operation, and in 31 of the 34 cases, neurological symptoms were either reduced or disappeared after the surgery. In 20 of the 43 cases, new neurological deficits that had not been observed preoperatively were noted immediately postoperatively; the newly acquired neurological deficits disappeared over time in 5 of the 20 cases. Significantly, more newly acquired neurological deficits remained in cases where the tumor was located in the upper arm and elbow than in cases where the tumor was located in the distal forearm. Conclusion New neurological deficits occurred after surgery in about half of the cases. This ratio was higher than expected, suggesting that schwannoma resection is not always a complication-free operation. Therefore, patients should be informed preoperatively about the possibility of neurological deficits. Furthermore, extreme care should be taken not to damage the affected and uninvolved nerves during surgery.
Han, Jay J.; Kurillo, Gregorij; Abresch, Richard T.; de Bie, Evan; Nicorici, Alina; Bajcsy, Ruzena
Introduction An innovative upper extremity 3D reachable workspace outcome measure acquired using Kinect sensor is applied towards Duchenne/Becker muscular dystrophy (DMD/BMD). The validity, sensitivity, and clinical meaningfulness of the novel outcome is examined. Methods Upper extremity function assessment (Brooke scale, NeuroQOL questionnaire) and Kinect-based reachable workspace analyses were conducted in 43 individuals with dystrophinopathy (30-DMD, 13-BMD; ages 7–60) and 46 controls (ages 6–68). Results The reachable workspace measure reliably captured a wide-range of upper extremity impairments encountered in both pediatric and adult, as well as ambulatory and non-ambulatory individuals with dystrophinopathy. Reduced reachable workspaces were noted for the dystrophinopathy cohort compared to controls, and they correlated with Brooke grades. Additionally, progressive reduction in reachable workspace directly correlated with worsening ability to perform activities of daily living, as self-reported on the NeuroQOL. Discussion This study demonstrates the utility and potential of the novel sensor-acquired reachable workspace outcome measure in dystrophinopathy. PMID:25597487
Seino, Satoshi; Yabushita, Noriko; Kim, Mi-ji; Nemoto, Miyuki; Jung, Songee; Osuka, Yosuke; Okubo, Yoshiro; Matsuo, Tomoaki; Tanaka, Kiyoji
Although usual gait speed (UGS) is considered an indicator of overall well-being, it is unclear whether upper extremity performance (UEP) measures provide a similar, additive contribution to functional status. We aimed to identify whether combining UEP measures can more accurately discriminate upper extremity functional limitation (UE limitation) and disability compared to UGS. We conducted a cross-sectional analysis on data from 322 community-dwelling older women, aged 65-96 years. Trained testers assessed UGS, and hand-grip strength (GRIP), functional reach (FR), back scratch, manipulating pegs (PEG), and moving beans with chopsticks as UEP measures. We assessed three functional statuses: UE limitation, activities of daily living (ADLs) and instrumental ADLs (IADLs) disabilities using self-reported questionnaires. Areas under the receiver operating characteristic curves (AUCs) were used to compare the discriminating power of UGS, with the individual and combined UEP measures for each status. Among UEP measures, only GRIP (AUC=0.68 for UE limitation, 0.81 for IADLs disability, and 0.84 for ADLs disability) could accurately discriminate each status as well as UGS (AUC=0.65, 0.83, and 0.91, respectively). Furthermore, UGS alone could discriminate UE limitation almost as well as the combination of GRIP, PEG, and FR (AUC=0.70). Combining other UEP measures did not help discriminate further. There were few advantages to combining UEP measures, and UGS or GRIP alone may suffice for assessing UE limitation and disability. However, the UGS should be the test of first choice, certainly more than GRIP, in routine assessment of functional limitation and disability, including UE limitation. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Ezendam, Daniëlle; Bongers, Raoul M; Jannink, Michiel J A
This review gives an overview of the current state of research regarding the effectiveness of mirror therapy in upper extremity function. A systematic literature search was performed to identify studies concerning mirror therapy in upper extremity. The included journal articles were reviewed according to a structured diagram and the methodological quality was assessed. Fifteen studies were identified and reviewed. Five different patient categories were studied: two studies focussed on mirror therapy after an amputation of the upper limb, five studies focussed on mirror therapy after stroke, five studies focussed on mirror therapy with complex regional pain syndrome type 1 (CRPS1) patients, one study on mirror therapy with complex regional pain syndrome type 2 (CRPS2) and two studies focussed on mirror therapy after hand surgery other than amputation. Most of the evidence for mirror therapy is from studies with weak methodological quality. The present review showed a trend that mirror therapy is effective in upper limb treatment of stroke patients and patients with CRPS, whereas the effectiveness in other patient groups has yet to be determined.
Wang, Jiang-Ning; Tong, Zhi-Hong; Zhang, Tie-Hui; Wang, Shou-Yu; Zhang, Hong-Quan; Zhao, Gui-Qing; Zhang, Feng
Salvage of the complex amputation of extremities, such as combined with devastating segmental injuries, extensive soft tissue defect, and multiple important organ injuries, continues to be a challenge for plastic surgeons. Temporary ectopic implantation of the amputated part to a healthy recipient site allows the patient to recover from critical combined injuries, radical debridements, and soft tissue repair. In this article, the authors report two cases of temporary ectopic implantation of complexly amputated forearms, followed by successful replantation to their anatomic positions at a second stage. The contralateral upper extremity is an acceptable recipient site for temporary ectopic implantation. In secondary replantation, a cross-arm flap can be designed to carry the vascular pedicle from the ectopic implantation recipient to improve blood supply to the replanted part when the second blood supply is established. The authors validated that temporary ectopic implantation of amputated parts provides an alternative procedure for the salvage of amputated extremities under special circumstances.
Douoguih, Wiemi A; Dolce, Donald L; Lincoln, Andrew E
Early cocking phase pitching mechanics may affect risk of upper extremity injury requiring surgery in professional baseball players. To assess the occurrence of inverted-W arm positioning and early trunk rotation in Major League Baseball (MLB) pitchers and to determine whether this throwing position is associated with upper extremity injury requiring surgery. Cross-sectional study; Level of evidence, 3. For 250 MLB pitchers in the 2010 season, 15 to 20 pitches from the start and end of an outing were reviewed using slow-motion game video for presence of an inverted-W position and early trunk rotation. Previous or current incidence of upper extremity injury requiring surgery for each player was determined using the MLB injury database, minor league injury records, available collegiate data, and publicly available online injury databases. Upper extremity surgery associated with an injury was considered to result from pitching. Consensus between investigators was achieved for 99% of players for inverted-W positioning (248 players) and in 97% of players for early trunk rotation (243 players) for videos reviewed independently. Rate of surgery with and without inverted-W position was 28 of 93 (30%) and 42 of 155 (27%), respectively. Rate of surgery with and without early trunk rotation was 37 of 111 (33%) and 30 of 132 (23%), respectively. Using a Cox proportional hazards model for risk analysis using the measured number of innings pitched at time of surgery as an approximate index of exposure and adjusting for age and fastball speed at time of surgery, early trunk rotation was associated with significantly increased risk of shoulder and/or elbow surgery with hazard ratio estimate of 1.69 (95% CI, 1.02-2.80). Presence of the inverted-W position was not associated with significantly increased risk (hazard ratio, 1.30; 95% CI, 0.79-2.14). The inverted-W throwing position was not associated with significantly greater risk of upper extremity injury requiring surgery in MLB
Overbeek, Celeste L; Nota, Sjoerd P F T; Jayakumar, Prakash; Hageman, Michiel G; Ring, David
To assess disability more efficiently with less burden on the patient, the National Institutes of Health has developed the Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function-an instrument based on item response theory and using computer adaptive testing (CAT). Initially, upper and lower extremity disabilities were not separated and we were curious if the PROMIS Physical Function CAT could measure upper extremity disability and the Quick Disability of Arm, Shoulder and Hand (QuickDASH). We aimed to find correlation between the PROMIS Physical Function and the QuickDASH questionnaires in patients with upper extremity illness. Secondarily, we addressed whether the PROMIS Physical Function and QuickDASH correlate with the PROMIS Depression CAT and PROMIS Pain Interference CAT instruments. Finally, we assessed factors associated with QuickDASH and PROMIS Physical Function in multivariable analysis. A cohort of 93 outpatients with upper extremity illnesses completed the QuickDASH and three PROMIS CAT questionnaires: Physical Function, Pain Interference, and Depression. Pain intensity was measured with an 11-point ordinal measure (0-10 numeric rating scale). Correlation between PROMIS Physical Function and the QuickDASH was assessed. Factors that correlated with the PROMIS Physical Function and QuickDASH were assessed in multivariable regression analysis after initial bivariate analysis. There was a moderate correlation between the PROMIS Physical Function and the QuickDASH questionnaire (r=-0.55, p<0.001). Greater disability as measured with the PROMIS and QuickDASH correlated most strongly with PROMIS Depression (r=-0.35, p<0.001 and r=0.34, p<0.001 respectively) and Pain Interference (r=-0.51, p<0.001 and r=0.74, p<0.001 respectively). The factors accounting for the variability in PROMIS scores are comparable to those for the QuickDASH except that the PROMIS Physical Function is influenced by other pain conditions while the QuickDASH is
Douoguih, Wiemi A.; Dolce, Donald L.; Lincoln, Andrew E.
Background: Early cocking phase pitching mechanics may affect risk of upper extremity injury requiring surgery in professional baseball players. Purpose: To assess the occurrence of inverted-W arm positioning and early trunk rotation in Major League Baseball (MLB) pitchers and to determine whether this throwing position is associated with upper extremity injury requiring surgery. Study Design: Cross-sectional study; Level of evidence, 3. Methods: For 250 MLB pitchers in the 2010 season, 15 to 20 pitches from the start and end of an outing were reviewed using slow-motion game video for presence of an inverted-W position and early trunk rotation. Previous or current incidence of upper extremity injury requiring surgery for each player was determined using the MLB injury database, minor league injury records, available collegiate data, and publicly available online injury databases. Upper extremity surgery associated with an injury was considered to result from pitching. Results: Consensus between investigators was achieved for 99% of players for inverted-W positioning (248 players) and in 97% of players for early trunk rotation (243 players) for videos reviewed independently. Rate of surgery with and without inverted-W position was 28 of 93 (30%) and 42 of 155 (27%), respectively. Rate of surgery with and without early trunk rotation was 37 of 111 (33%) and 30 of 132 (23%), respectively. Using a Cox proportional hazards model for risk analysis using the measured number of innings pitched at time of surgery as an approximate index of exposure and adjusting for age and fastball speed at time of surgery, early trunk rotation was associated with significantly increased risk of shoulder and/or elbow surgery with hazard ratio estimate of 1.69 (95% CI, 1.02-2.80). Presence of the inverted-W position was not associated with significantly increased risk (hazard ratio, 1.30; 95% CI, 0.79-2.14). Conclusion: The inverted-W throwing position was not associated with significantly
Lutz, A F; Immerzeel, W W; Kraaijenbrink, P D A; Shrestha, A B; Bierkens, M F P
The Indus basin heavily depends on its upstream mountainous part for the downstream supply of water while downstream demands are high. Since downstream demands will likely continue to increase, accurate hydrological projections for the future supply are important. We use an ensemble of statistically downscaled CMIP5 General Circulation Model outputs for RCP4.5 and RCP8.5 to force a cryospheric-hydrological model and generate transient hydrological projections for the entire 21st century for the upper Indus basin. Three methodological advances are introduced: (i) A new precipitation dataset that corrects for the underestimation of high-altitude precipitation is used. (ii) The model is calibrated using data on river runoff, snow cover and geodetic glacier mass balance. (iii) An advanced statistical downscaling technique is used that accounts for changes in precipitation extremes. The analysis of the results focuses on changes in sources of runoff, seasonality and hydrological extremes. We conclude that the future of the upper Indus basin's water availability is highly uncertain in the long run, mainly due to the large spread in the future precipitation projections. Despite large uncertainties in the future climate and long-term water availability, basin-wide patterns and trends of seasonal shifts in water availability are consistent across climate change scenarios. Most prominent is the attenuation of the annual hydrograph and shift from summer peak flow towards the other seasons for most ensemble members. In addition there are distinct spatial patterns in the response that relate to monsoon influence and the importance of meltwater. Analysis of future hydrological extremes reveals that increases in intensity and frequency of extreme discharges are very likely for most of the upper Indus basin and most ensemble members.
Immerzeel, W. W.; Kraaijenbrink, P. D. A.; Shrestha, A. B.; Bierkens, M. F. P.
The Indus basin heavily depends on its upstream mountainous part for the downstream supply of water while downstream demands are high. Since downstream demands will likely continue to increase, accurate hydrological projections for the future supply are important. We use an ensemble of statistically downscaled CMIP5 General Circulation Model outputs for RCP4.5 and RCP8.5 to force a cryospheric-hydrological model and generate transient hydrological projections for the entire 21st century for the upper Indus basin. Three methodological advances are introduced: (i) A new precipitation dataset that corrects for the underestimation of high-altitude precipitation is used. (ii) The model is calibrated using data on river runoff, snow cover and geodetic glacier mass balance. (iii) An advanced statistical downscaling technique is used that accounts for changes in precipitation extremes. The analysis of the results focuses on changes in sources of runoff, seasonality and hydrological extremes. We conclude that the future of the upper Indus basin’s water availability is highly uncertain in the long run, mainly due to the large spread in the future precipitation projections. Despite large uncertainties in the future climate and long-term water availability, basin-wide patterns and trends of seasonal shifts in water availability are consistent across climate change scenarios. Most prominent is the attenuation of the annual hydrograph and shift from summer peak flow towards the other seasons for most ensemble members. In addition there are distinct spatial patterns in the response that relate to monsoon influence and the importance of meltwater. Analysis of future hydrological extremes reveals that increases in intensity and frequency of extreme discharges are very likely for most of the upper Indus basin and most ensemble members. PMID:27828994
Fontes, Patrícia Lemos Bueno; Cruz, Thalita Karla Flores; Souto, Deisiane Oliveira; Moura, Ricardo; Haase, Vitor Geraldi
Clinical observations indicate that many children with hemiplegic cerebral palsy refrain from using or disregard the affected upper limb. The aim of the present study is to investigate deficits in different body representations (body schema, body structural description, and body image) in children with hemiplegic cerebral palsy (HCP) compared to typically-developing (TD) children. Three groups of children participated in this study: 42 TD children (aged 5.17-10.91 years), 23 children with right HCP (aged 5.83-10.92 years), and 22 children with left HCP (aged 5.67-10.90 years). The results demonstrate generalized deficits in all three body representations in children with HCP, and do not offer evidence for an effect of hemiplegia laterality.
Galanakos, Spyridon P; Bot, Arjan G J; Zoubos, Aristides B; Soucacos, Panayotis N
Upper extremity trauma and resulting disability is a stressful event and can affect a patient's personality. Several studies have shown that this injury type has serious psychological and/or social consequences. We systematically reviewed the evidence on the consequences of disability after a complex trauma (combination of soft tissue, osseous, vascular, and nerve involvement) of the upper extremity. We tried to find out the potential crucial factors that could determine the final hand function. In addition, we considered the challenges that need to be addressed to eliminate the adverse or negative effects that arise from upper limb trauma. In the literature, there is a growing interest to study changes in patients' quality of life and return to work. Psychological morbidity is an important part of patients' perceived general health. These issues could play an important role in the final functional outcome of the therapy. An early identification and treatment of trauma-related distress in patients may prevent progression of psychological pathology and mitigate negative effects on general health status. It may be important to evaluate the amount of psychological distress when caring for patients with hand injuries.
Objective: To investigate the safety and efficacy of a novel arm sleeve composed of a conventional arm sleeve extending to a wider area of the body. Materials and Methods: Five subjects with post-mastectomy upper extremity lymphedema, who had already been using their own arm sleeve, used a brand-new conventional arm sleeve for 2 weeks, followed by a novel arm sleeve for 2 weeks. The adverse events, arm-related symptoms, interface pressures, and subcutaneous fluid distributions observed by magnetic resonance imaging (MRI) were assessed. Results: The use of the novel arm sleeve resulted in a graduated compression extending to the shoulder (forearm, 21.8 ± 3.7 mmHg; upper arm, 15.2 ± 3.3 mmHg; shoulder, 8.8 ± 3.1 mmHg). By eliminating the wring seen in the conventional arm sleeve, the disturbed proximal diffusion of the subcutaneous fluid and venous occlusion were successfully avoided, as confirmed by MRI. No adverse event or worsening of arm-related symptoms was reported. Conclusion: The novel arm sleeve seemed to provide graduated compression to a wider area, allowing improved subcutaneous fluid and venous drainage without any adverse events. Therefore, the novel arm sleeve may be recommended as a compression therapy option for upper extremity lymphedema. PMID:24995057
Huang, Felix C; Patton, James L
With stroke survivors (n=30) as the test population, we investigated how upper extremity training with negative viscosity affects coordination in unassisted conditions. Using a planar force-feedback device, subjects performed exploratory movements within an environment that simulated 1) negative viscosity added to elbow and shoulder joints 2) augmented inertia to the upper and lower arm combined with negative viscosity, or 3) a null force field (control). After training, we evaluated each subject's ability to perform circular movements in the null field. Negative viscosity training resulted in greater within-day reductions in error compared with the combined field training. Negative viscosity promoted greater distributions of accelerations during free exploration, especially in the sagittal axis, while combined field training diminished overall activity. Both force field training groups exhibited next day retention, while this was not observed for the control group. The improvement in performance suggests that greater range of kinematic experiences contribute to learning, even despite novel force field environments. These findings provide support for the use of movement amplifying environments for upper extremity rehabilitation, allowing greater access to training while maintaining user engagement. © 2011 IEEE
Giuffre, Jennifer L; Bishop, Allen T; Spinner, Robert J; Shin, Alexander Y
After reading this article, the participant should be able to: 1. Identify the prerequisite conditions to perform a tendon or a nerve transfer. 2. Detail some of the current nerve and tendon transfer options in upper extremity peripheral nerve injuries. 3. Understand the advantages and disadvantages of tendon and nerve transfers used in isolation and in combination. 4. Appreciate the controversies that surround the nerve/tendon transfers. 5. Realize the treatment outcomes of peripheral nerve injuries. Traditional treatment of a Sunderland fourth- or fifth-degree peripheral nerve injury has been direct neurorrhaphy, nerve grafting, or tendon transfers. With increasing knowledge of nerve pathophysiology, additional treatment options such as nerve transfers have become increasingly popular. With an array of choices for treating peripheral nerve injuries, there is debate as to whether tendon transfers and/or nerve transfers should be performed to restore upper extremity function. Often, tendon and nerve transfers are used in combination as opposed to one in isolation to obtain the most normal functioning extremity without unacceptable donor deficits. The authors tend to prefer reconstructive techniques that have proven long-term efficacy to restore function. Nerve transfers are becoming more common practice, with excellent results; however, the authors are wary of using nerve transfers that sacrifice possible secondary tendon reconstruction should the nerve transfer fail.
JL, Veronica; Parasuraman, S.; Khan, M. K. A. Ahamed; Jeba DSingh, Kingsly
There have been many studies indicating that control system of rehabilitative robot plays an important role in determining the outcome of the therapy process. Existing works have done the prediction of feedback signal in the controller based on the kinematics parameters and EMG readings of upper limb's skeletal system. Kinematics and kinetics based control signal system is developed by reading the output of the sensors such as position sensor, orientation sensor and F/T (Force/Torque) sensor and there readings are to be compared with the preceding measurement to decide on the amount of assistive force. There are also other works that incorporated the kinematics parameters to calculate the kinetics parameters via formulation and pre-defined assumptions. Nevertheless, these types of control signals analyze the movement of the upper limb only based on the movement of the upper joints. They do not anticipate the possibility of muscle plasticity. The focus of the paper is to make use of the kinematics parameters and EMG readings of skeletal system to predict the individual torque of upper extremity's joints. The surface EMG signals are fed into different mathematical models so that these data can be trained through Genetic Algorithm (GA) to find the best correlation between EMG signals and torques acting on the upper limb's joints. The estimated torque attained from the mathematical models is called simulated output. The simulated output will then be compared with the actual individual joint which is calculated based on the real time kinematics parameters of the upper movement of the skeleton when the muscle cells are activated. The findings from this contribution are extended into the development of the active control signal based controller for rehabilitation robot.
Menéndez, Cammie Chaumont; Amick, Benjamin C.; Chang, Che-Hsu (Joe); Dennerlein, Jack T.; Harrist, Ronald B.; Jenkins, Mark; Robertson, Michelle; Katz, Jeffrey N.
Objective The study examines temporal variations in upper-extremity musculoskeletal symptoms throughout the day, over a week and throughout the semester. Methods 30 undergraduates were followed in a repeated measures study throughout a semester. Upper extremity musculoskeletal symptoms data were collected on handheld computers randomly throughout the day for seven days over three data collection periods. Multilevel statistical models evaluated associations between time-related predictors and symptoms. Results In adjusted models, pain reported at baseline was associated with increased odds of experiencing both any symptoms (OR = 15.64; 90% CI 7.22–33.88) and moderate or greater symptoms (OR = 16.44; 90% CI 4.57–29.99). Any symptoms were less likely to be reported if responses occurred at 58–76 days (OR = 0.66; 90% CI 0.49–0.86), 77–90 days (OR = 0.29; 90% CI 0.20–0.42) and 91–117 days (OR = 0.54; 90% CI 0.39–0.75) into the semester compared to 35–57 days. Similarly, responding after midnight was associated with greater odds of reporting moderate or greater symptoms (OR = 21.33; 90% CI 6.49–65.97). There was no association observed for day of week and symptoms. Conclusion This pilot work suggests upper extremity musculoskeletal symptoms exhibit temporal variations related to time of day and days into semester. Understanding the natural history of musculoskeletal symptoms and disorders is needed when designing epidemiologic research and/or intervention studies using symptom outcome measures. PMID:20075517
Wood, Krista Coleman; Lathan, Corinna E.; Kaufman, Kenton R.
External feedback of performance is an important component of therapy, especially for children with impairments due to cerebral palsy because they lack intrinsic experience of “good movements” to compare effort and determine performance outcomes. A robotic therapy system was developed to provide feedback for specific upper extremity movements (gestures) which are therapeutically desirable. The purpose of this study was to compare changes in forearm supination/pronation or wrist extension/flexion motion following conventional therapy and gestural robotic feedback therapy intervention. Six subjects with cerebral palsy (ages 5–18, GMFCS level IV—three subjects, level III—one subject, and level I—two subjects) participated in a blinded crossover design study of conventional and robotic feedback therapy targeting either forearm supination or wrist extension. Functional upper extremity motion at baseline and following conventional and robotic feedback therapy interventions were obtained using a motion capture system by personnel blinded to the intervention order. All activities were approved by IRB. Use of the robotic feedback system did result in slightly increased movement in the targeted gesture without change in un-targeted motions. Data also suggest a decrease in both agonist and antagonist motion following conventional therapy intervention. Results suggest improved motion when robotic feedback therapy intervention precedes conventional therapy intervention. Robotic feedback therapy is no different than conventional therapy to improve supination or wrist extension function in upper extremity impairments of children with cerebral palsy when changes were considered as aggregate data. In this very small group of diverse patients, individual subject results suggested that intervention order could be responsible for obscuring differences due to intervention type. Outcomes from several individual subjects suggest that results could be different given a more
Background Few prospective cohort studies of distal upper extremity musculoskeletal disorders have been performed. Past studies have provided somewhat conflicting evidence for occupational risk factors and have largely reported data without adjustments for many personal and psychosocial factors. Methods/design A multi-center prospective cohort study was incepted to quantify risk factors for distal upper extremity musculoskeletal disorders and potentially develop improved methods for analyzing jobs. Disorders to analyze included carpal tunnel syndrome, lateral epicondylalgia, medial epicondylalgia, trigger digit, deQuervain’s stenosing tenosynovitis and other tendinoses. Workers have thus far been enrolled from 17 different employment settings in 3 diverse US states and performed widely varying work. At baseline, workers undergo laptop administered questionnaires, structured interviews, two standardized physical examinations and nerve conduction studies to ascertain demographic, medical history, psychosocial factors and current musculoskeletal disorders. All workers’ jobs are individually measured for physical factors and are videotaped. Workers are followed monthly for the development of musculoskeletal disorders. Repeat nerve conduction studies are performed for those with symptoms of tingling and numbness in the prior six months. Changes in jobs necessitate re-measure and re-videotaping of job physical factors. Case definitions have been established. Point prevalence of carpal tunnel syndrome is a combination of paraesthesias in at least two median nerve-served digits plus an abnormal nerve conduction study at baseline. The lifetime cumulative incidence of carpal tunnel syndrome will also include those with a past history of carpal tunnel syndrome. Incident cases will exclude those with either a past history or prevalent cases at baseline. Statistical methods planned include survival analyses and logistic regression. Discussion A prospective cohort study of
Alavi, Seyedeh Shohreh; Makarem, Jalil; Abbasi, Mahya; Rahimi, Azin; Mehrdad, Ramin
Musculoskeletal Disorders (MSDs) can lead to potential adverse consequences for individuals and their organizations, and in various research, its relationship to physical and mental health of workforce has been studied. The purpose of this study was to determine the prevalence of MSDs of upper extremities among office workers and its association with mental health status. In this cross sectional study, 1488 out of 1630 office workers completed the Standardized Nordic Musculoskeletal Disorders Ques-tionnaire and General Health Questionnaire (GHQ-28) (response rate = 91.3%). Upper extremity MSDs were reported in 410 (27.5%) office workers, including 269 (18.1%) shoulder, 79 (5.3%) elbow and 207 (13.9%) hand/wrist symptoms. Based on GHQ-28, 254 (17.1%) participants were found to be at risk of developing a psychiatric disorder that were observed in 26.7% of workers with MSDs symptoms. Shoulder (p < 0.001), elbow (p < 0.001) and hand/wrist (p < 0.001) MSDs were associated with poor mental health. Among the four GHQ-28 subscales (somatic symptoms, anxiety/insomnia, social dysfunction, and depression), anxiety/insomnia was strongly correlated with shoulders (P < 0.001), elbows (P = 0.002), and hands/wrists (P < 0.001) symptoms. Office workers with upper extremity MSDs were more likely to be experiencing mental distress. This indicates a need for greater emphasis on preventive programs at workplace to support their psychological well-being.
Miyake, Yuki; Kobayashi, Ryuji; Kelepecz, Dolly; Nakajima, Masaaki
The purpose of this study was to investigate the influence of core exercises on upper extremity function relative to skilled motor behavior and postural sway. We examined the effects of core exercises on the skilled motor behavior and postural sway of 40 healthy students who were assigned randomly to the core exercise group or the control group. Independent variable is extent of exposure to core exercise and dependent variables are skilled motor behavior and postural sway. A Purdue pegboard which measures skilled motor behavior and a stabilometer which measures postural sway were used to evaluate the influence of core exercises. Pre-intervention and post-intervention skilled motor behavior and postural sway were compared between the core exercise group and control group using the Wilcoxon rank sum test; a significance level of α = 0.05 was considered statistically significant. Also, we investigated the application of core exercises in a clinical setting for one patient with cerebral vascular disease. The post intervention skilled motor behavior (p = 0.04) and postural sway, LNG (p = 0.05), LNG/TIME (p = 0.04) and X LNG (p = 0.02) were significantly higher in the core exercise group than control group. In the case report, there were good results; function of the upper extremity improved after doing the exercises. There were positive changes in some daily living activities. Core exercises are likely to enhance trunk stabilization to improve upper extremity function. It is possible for core exercises to be adapted for patients. Copyright © 2012 Elsevier Ltd. All rights reserved.
Hageman, Michiel G J S; Briet, Jan Paul; Oosterhoff, Thijs C H; Bot, Arjan G; Ring, David; Vranceanu, Ana-Maria
Cognitive flexibility - the ability to restructure one's knowledge, incorporate new facts, widen perspective, and adapt to the demands of new and unexpected conditions - can help one adapt to illness. The aim of this study was to assess the relationship between cognitive flexibility and hand and upper extremity specific disability in patients presenting to a hand surgeon. Secondarily, we determined predictors of cognitive flexibility and pain. Eighty-nine consecutive outpatients completed the Cognitive flexibility questionnaire (CFS), Short Health Anxiety Inventory-5 (SHAI-5), Pain Self-Efficacy Questionnaire (PSEQ), Disabilities of Arm, Shoulder and Hand, short form (QuickDASH), and Patient Health Questionnaire for Depression-2 (PHQ-2) in a cross-sectional study. CFS did not correlate with disability or pain intensity. Disability correlated with PSEQ (r = -0.66, p < 0.01), PHQ-2 (r = 0.38, p = <0.01), and SHAI-5 (r = 0.33, p < 0.01). Pain intensity correlated with PSEQ (r = -0.51 p < 0.01) and PHQ-2 (r = 0.41 p < 0.01). There was a small correlation between the CFS and PSEQ (r = 0.25, p = 0.02). The best multivariable models for QuickDASH and pain intensity included PSEQ and PHQ and explained 35 % and 28 % of the variability respectively. Upper extremity specific disability and pain intensity are limited more by self-efficacy than cognitive flexibility. Interventions to improve self-efficacy might help patients with upper extremity illness.
Miyaguchi, Kazuyoshi; Demura, Shinichi
A gender difference in ability using the stretch-shortening cycle (SSC ability) in the upper extremities has not been studied in detail. This study aimed to devise an index to evaluate SSC ability during powerful elbow flexion and to examine its gender differences. Thirty-three men athletes (19.9 +/- 1.0 years) and 21 women athletes (20.6 +/- 1.2 years) with mastered SSC movements participated in this study. They pulled a 20% load of maximal voluntary contraction (MVC) by elbow flexion as quickly as possible with the dominant upper extremity from the following two preliminary conditions: a static relaxed muscle state (SR condition) and using a countermovement (SSC condition). The muscle power was measured accurately by a power measurement device, which adopted the weight loading method. The peak power under both conditions showed significantly higher values in men than in women. In both genders, the peak power showed significantly lower values in the SSC condition than in the SR condition (p < 0.05). The potentiation of using the SSC was not found in the peak power test. However, the initial power showed significantly higher values under the SSC condition (men: 37.2 +/- 6.4 W; women: 17.4 +/- 5.1 W) than in the SR condition (men: 18.3 +/- 4.3 W; women: 11.2 +/- 3.1 W). Hence, assuming a difference between initial muscle power outputs of the SR and SSC conditions as a difference in SSC ability, an SSC index was devised to evaluate the above ability. The SSC index showed significantly higher values in men (50.1 +/- 12.4) than in women (32.1 +/- 23.2). However, the individual difference of SSC ability was very large in women. The ability of women to use SSC in the upper extremities may be inferior to that of men.
Objective To determine the effects of combining robot-assisted game training with conventional upper extremity rehabilitation training (RCT) on motor and daily functions in comparison with conventional upper extremity rehabilitation training (OCT) in stroke patients. Methods Subjects were eligible if they were able to perform the robot-assisted game training and were divided randomly into a RCT and an OCT group. The RCT group performed one daily session of 30 minutes of robot-assisted game training with a rehabilitation robot, plus one daily session of 30 minutes of conventional rehabilitation training, 5 days a week for 2 weeks. The OCT group performed two daily sessions of 30 minutes of conventional rehabilitation training. The effects of training were measured by a Manual Function Test (MFT), Manual Muscle Test (MMT), Korean version of the Modified Barthel Index (K-MBI) and a questionnaire about satisfaction with training. These measurements were taken before and after the 2-week training. Results Both groups contained 25 subjects. After training, both groups showed significant improvements in motor and daily functions measured by MFT, MMT, and K-MBI compared to the baseline. Both groups demonstrated similar training effects, except motor power of wrist flexion. Patients in the RCT group were more satisfied than those in the OCT group. Conclusion There were no significant differences in changes in most of the motor and daily functions between the two types of training. However, patients in the RCT group were more satisfied than those in the OCT group. Therefore, RCT could be a useful upper extremity rehabilitation training method. PMID:28971037
Pehlivan, Ali Utku; Rose, Chad; O'Malley, Marcia K
Rehabilitation of the distal joints of the upper extremities is crucial to restore the ability to perform activities of daily living to patients with neurological lesions resulting from stroke or spinal cord injury. Robotic rehabilitation has been identified as a promising new solution, however, much of the existing technology in this field is focused on the more proximal joints of the upper arm. A recently presented device, the RiceWrist-S, focuses on the rehabilitation of the forearm and wrist, and has undergone a few important design changes. This paper first addresses the design improvements achieved in the recent design iteration, and then presents the system characterization of the new device. We show that the RiceWrist-S has capabilities beyond other existing devices, and exhibits favorable system characteristics as a rehabilitation device, in particular torque output, range of motion, closed loop position performance, and high spatial resolution.
Cejna, Manfred; Salomonowitz, Erich; Wohlschlager, Helmut; Zwrtek, Karin; Boeck, Rudolf; Zwrtek, Ronald
Purpose: Retrospective analysis of the results of rt-PA thrombolysis in the treatment of acute thromboembolic occlusion of the upper limb.Methods: Of 55 patients with demonstrated acute embolic arterial occlusion, rt-PA thrombolysis was performed on 40 occlusions in 38 patients (23 women with a mean age of 62 years, range 32-85 years; 15 men with a mean age of 65 years, range 32-92 years) according to the following design: 6 mg rt-PA/hr for 30 min, 3 mg rt-PA/hr for the next 30 min, 1 mg rt-PA/hr for 7 hr, and 0.4 mg rt-PA/hr until the end of lysis. Onset of symptoms varied from 1 to 14 days. Included were three isolated upper-arm occlusions, nine combined brachial and forearm occlusions, and 28 forearm and hand artery occlusions.Results: The overall success rate was 55%. The lysis results for isolated upper arm, combined brachial and forearm occlusions, and forearm and hand artery occlusions were 100%, 66%, and 46%, respectively. In eight patients surgical embolectomy had to be performed after failed thrombolysis. No amputation was required in the follow-up period. No lethal complications occurred.Conclusions: Interventional rt-PA treatment of proximal upper-extremity arterial occlusions may be performed with comparable success rates to surgical embolectomy and without severe complications. For distal occlusions the results are inferior to the success rates obtained with surgery.
Alemdaroğlu, Ipek; Karaduman, Ayşe; Yilmaz, Öznur Tunca; Topaloğlu, Haluk
We investigated and compared the effects of 2 different types of upper extremity exercise training on upper extremity function, strength, endurance, and ambulation in patients with early-stage Duchenne muscular dystrophy (DMD). The study group (n = 12) exercised with an arm ergometer under the supervision of a physiotherapist, whereas the control group (n = 12) underwent a strengthening range-of-motion (ROM) exercise program under the supervision of their families at home for 8 weeks. Upper extremity functional performance, strength, endurance, and ambulatory status were assessed before and after the training. Ambulation scores, endurance, and arm functions, as well as proximal muscle strength, were improved after the training in the study group (P < 0.05). These results demonstrate that upper extremity training with an arm ergometer is more effective in preserving and improving the functional level of early-stage DMD patients compared to ROM exercises alone. © 2014 Wiley Periodicals, Inc.
Cavadas, Pedro C
Soft-tissue complications in the replantation wound, either septic or non-septic, are the main cause of failure in major extremity replantations. In the presence of necrosis or infection, vascular errosion or thrombosis readily develops and can lead to limb loss. Very aggressive surgical treatment has been recommended to salvage the replanted limb in these highly unstable clinical situations. Over a 10-year period, 423 amputated parts were replanted, 56 of which were replants proximal to the wrist. The experience of the author in treating 11 cases of critical soft-tissue necrosis (four septic and seven non-septic) after major replantation of the upper extremity with aggressive debridement and flap coverage, is reported. All flaps and limbs survived.
Feuerstein, Michael; Nicholas, Rena A; Huang, Grant D; Haufler, Amy J; Pransky, Glenn; Robertson, Michele
Workstyle or the behavioral, cognitive, and physiological response that can occur in some individuals to increases in work demands has been proposed to help explain the link between ergonomic and psychosocial factors in the exacerbation of work-related upper extremity symptoms. Currently, there is no measure of this construct, hindering research on its potential link to work related upper extremity problems in the workplace. The present study describes the development and psychometric properties of a measure of workstyle. Questionnaire items reflecting dimensions of workstyle as per the original conceptualization were generated primarily through focus groups with office workers and separate groups held with occupational physicians, physical therapists, occupational health psychologists, and experts in ergonomics, behavioral science, and human factors. Items created through this process were then administered to 282 symptomatic and asymptomatic office workers. Measures of job stress, ergonomic risk, upper extremity symptoms, and functional limitations were also obtained. The workstyle questionnaire was divided into two broad dimensions: Characteristic responses to work and Response to increased work demands. The scale development process as indicated by factor analysis yielded subscales that are theoretically consistent with the workstyle construct. These subscales include: working through pain, social reactivity at work, limited workplace support, deadlines/pressure, self imposed work pace/workload, breaks, mood, pain/tension, autonomic response, and numbness tingling. The internal consistency of these subscales varied from 0.61 to 0.91, n = 282 while the test-retest (3 weeks) reliability for the various subscales ranged from r = 0.68 to 0.89, n = 143. A total workstyle score was computed that excluded the pain/tension and numbness/tingling subscales to avoid circular reasoning in terms of the measure's relationship to outcomes of pain and functional limitations
Liu, K-W; Lin, V C-H; Chang, I-W
Clear cell adenocarcinoma (CCA) in the urinary tract is a rare neoplasm morphologically identical to the Müllerian counterpart. Clear cell adenocarcinoma is extremely rare in the upper urinary tract. We present a case with CCA of the renal pelvis. Microscopically, the tumor exhibited exophytic growth with predominantly tubulocystic structures, as well as solid and papillary patterns. The neoplastic cells were cuboidal with clear to pale eosinophilic cytoplasm and abundant intracellular and extracellular eosinophilic hyaline globules. By immunohistochemically, the tumor was labeled by cytokeratins and hepatocyte nuclear factor-1β. The patient was still alive without evidence of recurrence in the follow-up period of nineteen months after diagnosis.
Roberson, D. J.; Fernjallah, M.; Barr, R. E.; Gonzalez, R. V.
A back propagation neural network has been employed to precondition the electromyographic signal (EMG) that drives a computational model of the human upper extremity. This model is used to determine the complex relationship between EMG and muscle activation, and generates an optimal muscle activation scheme that simulates the actual activation. While the experimental and model predicted results of the ballistic muscle movement are very similar, the activation function between the start and the finish is not. This neural network preconditions the signal in an attempt to more closely model the actual activation function over the entire course of the muscle movement.
Menendez, Mariano E; Eberlin, Kyle R; Mudgal, Chaitanya S; Ring, David
Although upper-extremity disability has been shown to correlate highly with various psychosocial aspects of illness (e.g., self-efficacy, depression, kinesiophobia, and pain catastrophizing), the role of language in musculoskeletal health status is less certain. In an English-speaking outpatient hand surgery office setting, we sought to determine (1) whether a patient's primary native language (English or Spanish) is an independent predictor of upper-extremity disability and (2) whether there are any differences in the contribution of measures of psychological distress to disability between native English- and Spanish-speaking patients. A total of 122 patients (61 native English speakers and 61 Spanish speakers) presenting to an orthopaedic hand clinic completed sociodemographic information and three Patient-Reported Outcomes Measurement Information System (PROMIS)-based computerized adaptive testing questionnaires: PROMIS Pain Interference, PROMIS Depression, and PROMIS Upper-Extremity Physical Function. Bivariate and multivariable linear regression modeling were performed. Spanish-speaking patients reported greater upper-extremity disability, pain interference, and symptoms of depression than English-speaking patients. After adjusting for sociodemographic covariates and measures of psychological distress using multivariable regression modeling, the patient's primary language was not retained as an independent predictor of disability. PROMIS Depression showed a medium correlation (r = -0.35; p < 0.001) with disability in English-speaking patients, while the correlation was large (r = -0.52; p < 0.001) in Spanish-speaking patients. PROMIS Pain Interference had a large correlation with disability in both patient cohorts (Spanish-speaking: r = -0.66; p < 0.001; English-speaking: r = -0.77; p < 0.001). The length of time since immigration to the USA did not correlate with disability among Spanish speakers. Primary language has less
Togawa, S; Yamami, N; Nakayama, H; Mano, Y; Ikegami, K; Ozeki, S
The Mangled Extremity Severity Score (MESS) may be used to decide whether to perform amputation in patients with injuries involving a limb. A score of 7 points or higher indicates the need for amputation. We have treated three patients with a MESS of 7 points or higher, in two of which the injured limb was salvaged. This scoring system was originally devised to assess injuries to the lower limb. However, a MESS of 7 points as a justification for amputation does not appear appropriate when assessing injuries to the major vessels in the upper limb.
Wilson, James D; Alred, Steven C
The evidence regarding the value of prophylactic anticoagulation to prevent peripherally inserted central catheter-related upper extremity venous thrombosis (PRUEVT) is inconsistent. The authors reviewed 3 years of data, identifying all cases of PRUEVT at a facility in Texas, and individually matched each for risk factors with 2 controls. Not being on any form of anticoagulant or antiplatelet agent was associated with a modestly increased risk of PRUEVT (odds ratio 1.93, P = .036, 95% confidence interval, 1.025-3.602). Each approach to thrombosis prevention showed a trend toward a protective effect, but none reached statistical significance individually.
Gutowski, Christina J; Ilyas, Asif M
Osteoporosis continues to be a major health condition plaguing the aging population. The major manifestation of osteoporosis, the development of fragility fractures, is a burden both clinically and economically on patients and the nation's health care system, with up to half of all American women sustaining a fragility fracture in their older years. The high frequency of injuries to the distal radius and proximal humerus should lead upper extremity surgeons to take pause and recognize the magnitude of impact these fractures have on their patient population. Recommended interventions span a spectrum of aggressiveness and have various financial implications.
Yagihashi, T.; Hatori, K.; Ishii, K.; Torii, C.; Momoshima, S.; Takahashi, T.; Kosaki, K.
CHARGE syndrome is an autosomal dominant congenital anomaly syndrome, and the causative gene is CHD7. We report a patient with a CHD7 mutation who presented with juvenile muscular atrophy of a unilateral upper extremity, a presumably heterogeneous condition that is also known as Hirayama disease. This association has not been previously described. Weakness and atrophy of the hands should be carefully examined in patients with CHARGE syndrome, since Hirayama disease might be a possible complication in adolescent patients with this syndrome. PMID:21046013
Moore, Amy M.; Wagner, I. Janelle; Fox, Ida K.
Peripheral nerve injuries are common in the setting of complex upper extremity trauma. Early identification of nerve injuries and intervention is critical for maximizing return of function. In this review, the principles of nerve injury, patient evaluation, and surgical management are discussed. An evidence-based approach to nerve reconstruction is reviewed, including the benefits and limitations of direct repair and nerve gap reconstruction with the use of autografts, processed nerve allografts, and conduits. Further, the principles and indications of commonly used nerve transfers in proximal nerve injuries are also addressed. PMID:25685102
Benotmane, A; Faraoun, K; Mohammedi, F; Benkhelifa, T; Amani, M E
To study the clinical characteristics of a group of patients with diabetes and established upper extremity infections and to determine the causative factors of hand infections. Prospective study of diabetic patients referred in to our service with infections of the upper extremity from January 1992 to December 2001. Twenty-six diabetic patients with an infection of the upper extremity were studied (17 F, 9 M). The admission rate equalled 0.7%. Twenty-one patients (80.8%) presented a Type 2 diabetes and 5 a Type 1 diabetes (19.2%). The diagnosis age of diabetes was 44.6 +/- 13.8 Years (range: 16-62). The average age at the occurrence of the lesion was 52.5 +/- 15.1 Years (range: 21-73). The average duration of diabetes was 8.3 +/- 5.9 Years (range: 0-22). Diabetes was, in all the cases, poorly controlled because of an inadequate hypoglycaemic treatment and/or bad compliance. The patients had a high prevalence of peripheral neuropathy (n=17; 65.4%). The delays in presentation to the doctor and those related to hospitalization were respectively 9.1 +/- 10.0 days (n=23) and 16.8 +/- 12.1 days. The hospitalization length reached 33.6 +/- 22.6 days (range: 7-93). The final results, 6 Months after hospitalization, were as follows: the death rate reached 19.2% (n=5); 23.1% of the patients (n=6) had a minor amputation; for 53.8% of the patients (n=14), the lesions healed without any amputation. One patient left hospital against medical advice. Eleven out of 20 patients (55%), amputated or not, were left with deformities and a subjective dysfunction of the affected limb. Infections of the upper extremity in diabetic patients constitute an uncommon but serious complication. They seem to be more frequent in housewives. They result in a high morbIdity. Prevention of these infections should be based on patients' education (compliance with diabetes treatment, hand care, prompt visit to the doctor) and General Practitioners' training for an adequate treatment and/or a rap
Ghareeb, Paul A; Neustein, Thomas M; Fang, Robert C; Payne, Diane E
Assessment of tissue perfusion can be a challenge for the hand surgeon. Indocyanine green (ICG) angiography has been shown to be a valuable adjunct to physical examination and clinical judgment when there is a concern for tissue perfusion. The use of this technology has risen sharply in recent years in reconstructive surgery. Applications of ICG angiography have been developed throughout the field of surgery, including breast surgery, free tissue transfer, bowel surgery, neurosurgery, and lymphatic reconstruction. In this study, we discuss the novel applications of ICG angiography within the field of upper extremity surgery, and provide specific case examples of its successful use.
Haefeli, Mathias; Calcagni, Maurizio
Spastic hemiplegia and cerebral palsy often lead to typical deformities of the upper extremity. Muscle- and joint-contractures may be painful and aesthetically unappealing and may interfere with function and hygiene. Within the first weeks after the cerebral incidence the vital threat is dominating and the exact amount of neurologic impairment is not assessable. During this period, conservative treatment should counteract the development of contractures. After spontaneous neurologic recovery, surgical options should be taken into account. When choosing surgical procedures, factors as volitional motor control, sensibility and cognition must be taken into account besides the morphologic changes. This is best achieved in a multidisciplinary setting of neurologists, rehabilitation specialists, physiotherapists and surgeons.
Manning, Kathryn Y; Menon, Ravi S; Gorter, Jan Willem; Mesterman, Ronit; Campbell, Craig; Switzer, Lauren; Fehlings, Darcy
Using resting state functional magnetic resonance imaging (MRI), we aim to understand the neurologic basis of improved function in children with hemiplegic cerebral palsy treated with constraint-induced movement therapy. Eleven children including 4 untreated comparison subjects diagnosed with hemiplegic cerebral palsy were recruited from 3 clinical centers. MRI and clinical data were gathered at baseline and 1 month for both groups, and 6 months later for the case group only. After constraint therapy, the sensorimotor resting state network became more bilateral, with balanced contributions from each hemisphere, which was sustained 6 months later. Sensorimotor resting state network reorganization after therapy was correlated with a change in the Quality of Upper Extremity Skills Test score at 1 month (r = 0.79, P = .06), and Canadian Occupational Performance Measure scores at 6 months (r = 0.82, P = .05). This clinically correlated resting state network reorganization provides further evidence of the neuroplastic mechanisms underlying constraint-induced movement therapy. © The Author(s) 2015.
Tedesco Triccas, L; Burridge, J H; Hughes, A M; Pickering, R M; Desikan, M; Rothwell, J C; Verheyden, G
To systematically review the methodology in particular treatment options and outcomes and the effect of multiple sessions of transcranial direct current stimulation (tDCS) with rehabilitation programmes for upper extremity recovery post stroke. A search was conducted for randomised controlled trials involving tDCS and rehabilitation for the upper extremity in stroke. Quality of included studies was analysed using the Modified Downs and Black form. The extent of, and effect of variation in treatment parameters such as anodal, cathodal and bi-hemispheric tDCS on upper extremity outcome measures of impairment and activity were analysed using meta-analysis. Nine studies (371 participants with acute, sub-acute and chronic stroke) were included. Different methodologies of tDCS and upper extremity intervention, outcome measures and timing of assessments were identified. Real tDCS combined with rehabilitation had a small non-significant effect of +0.11 (p=0.44) and +0.24 (p=0.11) on upper extremity impairments and activities at post-intervention respectively. Various tDCS methods have been used in stroke rehabilitation. The evidence so far is not statistically significant, but is suggestive of, at best, a small beneficial effect on upper extremity impairment. Future research should focus on which patients and rehabilitation programmes are likely to respond to different tDCS regimes. Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.
Li, Zhanling; Li, Zhanjie; Li, Chengcheng
Probability modeling of hydrological extremes is one of the major research areas in hydrological science. Most basins in humid and semi-humid south and east of China are concerned for probability modeling analysis of high flow extremes. While, for the inland river basin which occupies about 35% of the country area, there is a limited presence of such studies partly due to the limited data availability and a relatively low mean annual flow. The objective of this study is to carry out probability modeling of high flow extremes in the upper reach of Heihe River basin, the second largest inland river basin in China, by using the peak over threshold (POT) method and Generalized Pareto Distribution (GPD), in which the selection of threshold and inherent assumptions for POT series are elaborated in details. For comparison, other widely used probability distributions including generalized extreme value (GEV), Lognormal, Log-logistic and Gamma are employed as well. Maximum likelihood estimate is used for parameter estimations. Daily flow data at Yingluoxia station from 1978 to 2008 are used. Results show that, synthesizing the approaches of mean excess plot, stability features of model parameters, return level plot and the inherent independence assumption of POT series, an optimum threshold of 340m3/s is finally determined for high flow extremes in Yingluoxia watershed. The resulting POT series is proved to be stationary and independent based on Mann-Kendall test, Pettitt test and autocorrelation test. In terms of Kolmogorov-Smirnov test, Anderson-Darling test and several graphical diagnostics such as quantile and cumulative density function plots, GPD provides the best fit to high flow extremes in the study area. The estimated high flows for long return periods demonstrate that, as the return period increasing, the return level estimates are probably more uncertain. The frequency of high flow extremes exhibits a very slight but not significant decreasing trend from 1978 to
Kim, Eunjoo; Kim, KyeongMi
[Purpose] This study investigated the effects of purposeful action observation on upper extremity kinematic patterns in individuals with hemiplegia. [Subjects and Methods] Twelve patients were recruited in accordance with the inclusion criteria. The experimental group (n=6) was trained with a purposeful action observation program. The control group (n=6) was trained with only purposeful action without action observation. The programs were performed 30 min/session, 5 times per week for 30 sessions in 6 weeks of training. Upper extremity kinematic patterns were measured by a 3-dimensional motion analysis system before and after training, and the results were analyzed. [Results] The experimental group and the control group showed improvements in average velocity, trajectory ratio, and movement degree, but no statistically significant differences were observed between the groups. The experimental group showed statistically significant improvements in average velocity, trajectory ratio after the intervention. The experimental group also showed an improvement in movement degree, but the post-intervention difference was not significant. [Conclusion] The results of this study show that purposeful action observation training program improved the average velocity and trajectory ratio of stroke patients. Further research should enroll more subjects divided into more specific groups for treatment. PMID:26180326
Wagner, Joanne M.; Dromerick, Alexander W.; Sahrmann, Shirley A.; Lang, Catherine E.
Objective To investigate upper extremity muscle activation and recovery during the first few months after stroke. Methods Subjects with hemiparesis following stroke were studied performing a reaching task at an acute time point (mean = 9 days post-stroke) and then again at a subacute time point (mean = 109 days post-stroke). We recorded kinematics and electromyographic activity of 6 upper extremity muscles. Results At the acute time point, the hemiparetic group had delayed muscle onsets, lower modulation ratios, and higher relative levels of muscle activation (%MVIC) during reaching than controls. From the acute to the subacute time points, improvements were noted in all three variables. By the subacute phase, muscle onsets were similar to controls, while modulation ratios remained lower than controls and %MVIC showed a trend toward being greater in the hemiparetic group. Changes in muscle activation were differentially related to changes in reaching performance. Conclusions Our data show that improvements in muscle timing and decreases in the relative level of volitional activation may underlie improved reaching performance in the early months after stroke. Significance Given that stroke is one of the leading causes of persistent physical disability, it is important to understand how the ability to activate muscles changes during the early phases of recovery after injury. PMID:17097340
Dale, Ann Marie; Strickland, Jaime; Gardner, Bethany; Symanzik, Juergen; Evanoff, Bradley Allen
Assessment of workplace physical exposures by self-reported questionnaires has logistical advantages in population studies, but is subject to exposure misclassification. This study measured agreement between eight self-reported and observer-rated physical exposures to the hands and wrists, and evaluated predictors of intermethod agreement. Workers (n = 341) from three occupational categories (clerical/technical, construction, and service) completed self-administered questionnaires and worksite assessments. Analyses compared self-reported and observed ratings using a weighted kappa coefficient. Personal and psychosocial factors, presence of upper extremity symptoms, andjob type were evaluated as predictors of agreement. Weighted kappa values were substantial for lifting (0.67) and holding vibrating tools (0.61), moderate for forceful grip (0.58), and fair to poor for all other exposures. Upper extremity symptoms did not predict greater disagreement between self-reported and observed exposures. Occupational category was the only significant predictor of inter-method agreement. Self-reported exposures may provide a useful estimate of some work exposures for population studies.
El-Bestar, Sohair Fouad; El-Mitwalli, Ashraf Abdel-Moniem; Khashaba, Eman Omar
This study was to determine the prevalence and work-related risk factors of neck-upper extremity musculoskeletal disorders (MSDs) among video display terminal (VDT) users. A comparative cross-sectional study was conducted; there were 60 VDT users and 35 controls. The participants filled in a structured questionnaire, had electrophysiological tests and an X-ray of the neck. The prevalence of MSDs was higher (28.3%) among VDTs users compared to controls (14.3%) with no statistically significant difference. The prevalence of cervical disorders with or without radiculopathy (18.3%) was the most common disorder followed by carpal tunnel syndrome (6.6%). The mean (SD) age of MSD cases (51 ± 7.2 years) was statistically significantly higher than of the controls (42.8 ± 9). Physical exposure to prolonged static posture (OR: 6.9; 95% CI: 0.83-57.9), awkward posture (OR: 5.5; 95% CI: 0.6-46.4) and repetitive movements (OR: 5.5; 95% CI: 0.65-46.4) increased risk of MSDs with a statistically significant difference for static posture only (p < .05). VDT users experienced more job dissatisfaction, work-overload and limited social support from supervisors and colleagues. VDT use did not increase the risk of neck-upper extremity MSDs. The risk increased with older age and static posture.
Waersted, Morten; Hanvold, Therese N; Veiersted, Kaj Bo
This review examines the evidence for an association between computer work and neck and upper extremity disorders (except carpal tunnel syndrome). A systematic critical review of studies of computer work and musculoskeletal disorders verified by a physical examination was performed. A total of 22 studies (26 articles) fulfilled the inclusion criteria. Results show limited evidence for a causal relationship between computer work per se, computer mouse and keyboard time related to a diagnosis of wrist tendonitis, and for an association between computer mouse time and forearm disorders. Limited evidence was also found for a causal relationship between computer work per se and computer mouse time related to tension neck syndrome, but the evidence for keyboard time was insufficient. Insufficient evidence was found for an association between other musculoskeletal diagnoses of the neck and upper extremities, including shoulder tendonitis and epicondylitis, and any aspect of computer work. There is limited epidemiological evidence for an association between aspects of computer work and some of the clinical diagnoses studied. None of the evidence was considered as moderate or strong and there is a need for more and better documentation.
Background This review examines the evidence for an association between computer work and neck and upper extremity disorders (except carpal tunnel syndrome). Methods A systematic critical review of studies of computer work and musculoskeletal disorders verified by a physical examination was performed. Results A total of 22 studies (26 articles) fulfilled the inclusion criteria. Results show limited evidence for a causal relationship between computer work per se, computer mouse and keyboard time related to a diagnosis of wrist tendonitis, and for an association between computer mouse time and forearm disorders. Limited evidence was also found for a causal relationship between computer work per se and computer mouse time related to tension neck syndrome, but the evidence for keyboard time was insufficient. Insufficient evidence was found for an association between other musculoskeletal diagnoses of the neck and upper extremities, including shoulder tendonitis and epicondylitis, and any aspect of computer work. Conclusions There is limited epidemiological evidence for an association between aspects of computer work and some of the clinical diagnoses studied. None of the evidence was considered as moderate or strong and there is a need for more and better documentation. PMID:20429925
Fritz, Jan; Efron, David T; Fishman, Elliot K
Successful management of upper extremity arterial injury requires fast and accurate diagnosis. The rate of limb preservation depends on the location, severity, and time of ischemia. Indications for diagnostic imaging depend on the mechanism and type of injury, clinical signs, cardiovascular stability, and clinical suspicion. Because of ease of access, speed, and high accuracy for this diagnosis, multidetector computed tomographic (MDCT) angiography is often used as the first line imaging modality. MDCT systems with 64 slice configuration and more afford high temporal and spatial high-resolution, isotropic data acquisition and integration with whole-body trauma MDCT protocols. The use of individual injection timing protocols ensures high diagnostic image quality. Several strategies are available to reduce radiation exposure. Direct MDCT angiography findings of arterial injuries include active extravasation, luminal narrowing, lack of luminal contrast opacification, filling defect, arteriovenous fistula, and pseudoaneurysm. Important descriptors are location and length of defect, degree of luminal narrowing, and presence of distal arterial supply reconstitution. Proximal arterial injuries include the subclavian, axillary, and brachial arteries. Distal arterial injuries include the ulnar and radial arteries, as well as the palmar arterial arches. Concomitant venous injury, musculoskeletal injury, and nerve damage are common. In this exhibit, we outline the role of MDCT angiography in the diagnosis and management of upper extremity arterial injury, discuss strategies for MDCT angiography acquisition and concepts of data visualization, and illustrate various types of injuries.
Both, M; Aries, P M; Müller‐Hülsbeck, S; Jahnke, T; Schäfer, P J; Gross, W L; Heller, M; Reuter, M
Objectives To evaluate the outcome of balloon angioplasty in the arteries of the upper extremities in patients with giant‐cell arteritis (GCA) and stenosing extracranial involvement. Methods Percutaneous transluminal angioplasty (PTA) for symptomatic upper limb artery stenoses (n = 29) and occlusions (n = 1) resistant to medical treatment was carried out in 10 patients (all women, mean age 65 years) with GCA. Vascular lesions were located in the subclavian (n = 4), axillary (n = 10) and brachial (n = 16) arteries. Interventional treatment was accompanied by immunosuppressive drugs in all patients. Follow‐up included clinical and serological examination, magnetic resonance angiography and colour duplex ultrasound. Results Initial technical success of angioplasty was achieved in the case of all vascular lesions. In five patients, marked recurrent stenoses (vascular territories; n = 10/30) were found during follow‐up (mean 24 months). The cumulative primary patency rate was 65.2%. All recurrent lesions developed in the territories of the initial long‐segment stenoses. Repeated PTA (vascular territories, n = 8; patients, n = 5) provided a cumulative secondary patency rate of 82.6% and a cumulative tertiary patency rate of 89.7%. Conclusions Despite a tendency to restenoses, balloon angioplasty of the upper‐extremity artery, in combination with immunosuppressive treatment, is an efficient method for the treatment of extracranial GCA. PMID:16464985
Idzikowski, J R; Janes, P C; Abbott, P J
A survey of snowboarding injuries was conducted over 10 seasons (1988 to 1998). A questionnaire evaluating 20 variables was used to collect data from 47 medical facilities near Colorado ski resorts. A total of 7430 snowboarding-related injuries were seen. A control group consisted of 3107 noninjured snowboarders. Most of those injured were 30 years of age or younger; 74% of injuries occurred in men and 26% in women; 39% of injured snowboarders were beginners and 61% were intermediate or experts. Men rode at more advanced levels than women. Injured snowboarders were more likely than noninjured snowboarders to be beginners. There were 3645 (49.06% of total) upper extremity injuries; 56.43% were fractures, 26.78% sprains, and 9.66% dislocations. The most common site of injury was the wrist (21.6% of all snowboarding injuries). Wrist fractures (except to the scaphoid) and sprains were more common in beginners, women, and younger age groups. Intermediate and expert men were more likely to sustain hand, elbow, and shoulder injuries, as well as more severe injuries. Falling was the predominant mechanism of upper extremity injuries. Snowboarders who wore protective wrist guards were half as likely to sustain wrist injuries as those who did not wear guards.
Talaei-Khoei, Mojtaba; Fischerauer, Stefan F; Jha, Ragini; Ring, David; Chen, Neal; Vranceanu, Ana-Maria
Pain intensity and symptoms of depression are correlated and individually associated with decreased physical function. We compared two explanatory mediation models; one with depression as mediator of the association of pain intensity with physical function and the other one with pain intensity as the mediator of the effect of depression on physical function. In a cross-sectional study, 102 patients with upper extremity musculoskeletal illness completed measures of pain intensity, PROMIS depression CAT, PROMIS physical function-upper extremity CAT and demographics. We determined that pain intensity and symptoms of depression were partial mediators of their respective and independent effects on physical function. While depression had a larger standardized mediation effect and a bigger kappa-squared (κ (2)) effect size compared to pain intensity, the actual proportion of variance in physical function that could be explained by the mediated effects (i.e., R (2) mediation effect size) was equal in both models suggesting that the two mediation models have equal ability to explain variations in physical function. The bidirectional mediation effect suggests a reinforcement mechanism, in which, pain intensity and symptoms of depression reciprocally influence their negative impacts on physical function among patients with musculoskeletal illness.
Brattwall, Metha; Jildenstål, Pether; Warrén Stomberg, Margareta; Jakobsson, Jan G.
Upper extremity blocks are useful as both sole anaesthesia and/or a supplement to general anaesthesia and they further provide effective postoperative analgesia, reducing the need for opioid analgesics. There is without doubt a renewed interest among anaesthesiologists in the interscalene, supraclavicular, infraclavicular, and axillary plexus blocks with the increasing use of ultrasound guidance. The ultrasound-guided technique visualising the needle tip and solution injected reduces the risk of side effects, accidental intravascular injection, and possibly also trauma to surrounding tissues. The ultrasound technique has also reduced the volume needed in order to gain effective block. Still, single-shot plexus block, although it produces effective anaesthesia, has a limited duration of postoperative analgesia and a number of adjuncts have been tested in order to prolong analgesia duration. The addition of steroids, midazolam, clonidine, dexmedetomidine, and buprenorphine has been studied, all being off-label when administered by perineural injection, and the potential neurotoxicity needs further study. The use of perineural catheters is an effective option to improve and prolong the postoperative analgesic effect. Upper extremity plexus blocks have an obvious place as a sole anaesthetic technique or as a powerful complement to general anaesthesia, reducing the need for analgesics and hypnotics intraoperatively, and provide effective early postoperative pain relief. Continuous perineural infusion is an effective option to prolong the effects and improve postoperative quality. PMID:27239291
Alavi, Seyedeh Shohreh; Abbasi, Mahya; Mehrdad, Ramin
Background The identification of the risk factors for musculoskeletal disorders (MSDs) is the first step in designing effective preventive interventions. Objectives To investigate the association between individual, organizational, physical, and psychological factors and upper extremity MSDs (i.e., shoulder, elbow and hand/wrist). Materials and Methods In this cross-sectional study, the study population was comprised of office workers from Qom Province, Iran. Of the 1630 Iranian office workers who were selected via a random multistage cluster sampling method, 1488 completed a comprehensive data collection form designed to investigate the individual, organizational, physical, and psychological factors related to MSDs (response rate: 91.3%). Results The predictors of shoulder MSDs in the past 12 months were uncomfortable sitting posture (β = 0.42, P = 0.04), limited rest breaks (β=0.73, P = 0.012), and no access to adjustable desks (β = 0.43, P = 0.018). Working on a computer for more than five hours (β = 0.61, P = 0.004) and an uncomfortable sitting posture (β = 0.79, P = 0.001) predicted hand/wrist symptoms. Conclusions Various risk factors in the workplace may contribute to MSDs in different upper extremities. Preventive interventions should hence include ergonomic and office equipment modifications. PMID:28182176
Kegel, Gary; Marshall, Astrid; Barron, O Alton; Catalano, Louis W; Glickel, Steven Z; Kuhn, Margaret
A survey regarding upper-extremity steroid injection practices was distributed to all active members of the American Society for Surgery of the Hand (ASSH) and American Shoulder and Elbow Surgeons (ASES) using SurveyMonkey. Response rates for the ASSH and ASES were 26% and 24%, respectively. The potency-adjusted dose of steroid injected for common hand and wrist injections ranged from 0.375 to 133.33 mg and for shoulder injections ranged from 0.375 to 250 mg. These ranges span 356-fold and 667-fold differences, respectively. Potency-adjusted doses differed significantly between steroid types for all injections evaluated in this study. American Society for Surgery of the Hand members gave significantly smaller doses of steroid for the glenohumeral and acromioclavicular joints than ASES members. Only 9% of respondents based injection practice on a scientific reference. Sixteen percent of ASSH and 31% of ASES respondents reported no specific rationale for their steroid injection practice; 78% of ASSH and 52% of ASES respondents attributed their rationale to some kind of instruction from their mentors or colleagues. Upper-extremity surgeons demonstrate substantial variability in their practice of steroid injections, with up to a 667-fold range in steroid dose. Experienced clinical opinion is the principal rationale for these injection practices; little rationale is based on formal scientific evidence.
England, J. F., Jr.; Godaire, J. E.; Klinger, R. E.; Bauer, T. R.; Julien, P. Y.
The Upper Arkansas River basin has experienced notable large floods, including the event of 2-6 June 1921 that devastated the city of Pueblo, Colorado. We investigated flood and paleoflood hydrology at strategic sites to determine the frequency and geographic extent of extreme floods within the basin for a dam safety application. Streamgage, historical, and paleoflood data were utilized to develop frequency curves at sites near Salida, Cotopaxi, Parkdale, and Pueblo. Soil/stratigraphic descriptions, radiocarbon dating, and hydraulic modeling were used to estimate paleoflood nonexceedance bounds at the four sites, which ranged from 400 to 2200 YBP for late Holocene surfaces to late Pleistocene surfaces near Cotopaxi. Peak-flow data are from lower-magnitude snowmelt runoff in May and June in the upper basin and from high-magnitude rainfall runoff from June to August in the lower basin. Flood frequency curves reflect this transition near Parkdale from snowmelt to extreme rainfall-runoff. For similar return periods, paleoflood peak discharges increase from about 480 m 3/s upstream at Loma Linda to about 4250 m 3/s downstream near Pueblo. This increase is attributed to the larger rainfall component derived from lower elevations between Loma Linda and Pueblo. Return periods for design floods at Pueblo Dam exceeded 10,000 years based on paleoflood frequency curve extrapolations.
Futatsuka, M; Inaoka, N; Ueno, T
The validity of function tests on the upper extremities as prognostic tools in vibration syndrome was evaluated over a sequence of observation periods. The subjects examined were 672 forest workers using chain saws who had had some complaints and who had shown abnormal findings in the function tests. The function tests consisted of peripheral circulatory and sensory tests, including cold provocation and motor tests of functional capacity in the upper extremities. From the results of testing, 23 variables were selected and examined by multivariate analysis. The four principal components were extracted by principal component analysis, and the factor score of the peripheral circulatory disturbances component was found to be highly correlated with the severity of VWF (Vibration-induced White Finger). The course of VWF and the nail compression test had high standard regression coefficients with the severity of vibration syndrome. The course of finger numbness, pinching power, pain threshold, skin temperature and X-ray findings in the elbow joints had high discriminant function values for the evaluation of the severity of vibration syndrome.
Cramer, Anne Catherine Miller; McLean, Anna Warszawa; Ahari, Jalil
A healthy female presented with upper extremity (UE) swelling of several days duration. Admission laboratories were normal except for an elevated D-dimer. An UE ultrasound with Doppler revealed a thrombus in the right subclavian vein. A subsequent chest CT angiogram further characterised the subclavian vein thrombus and also identified a pulmonary embolus. A thorough history and laboratory evaluation showed that her only risk factors were long-time contraceptive pills and a recent cycle of ovarian hyperstimulation (OH) 7 weeks prior to presentation. Anticoagulation treatment was started and the patient's remaining outpatient work-up was negative for all other hereditary causes. A complete anatomic work-up showed bilateral thoracic outlet syndrome (TOS). A review of the literature on the occurrence of upper extremity deep venous thrombosis suggests that these usually occur in the presence of a predisposing factor, including catheters, indwelling devices and active malignancies. OH has been shown to precipitate venous thromboembolism events; however, the diagnosis of bilateral TOS as a predisposing risk factor has not been described in a patient who had recently undergone recent OH and in one who was not actively pregnant. 2016 BMJ Publishing Group Ltd.
Nessler, J. A.; Silvas, M.; Carpenter, S.; Newcomer, S. C.
Surfers often wear wetsuits while paddling in the ocean. This neoprene covering may be beneficial to upper extremity movement by helping to improve proprioceptive acuity, or it may be detrimental by providing increased resistance. The purpose of this study was to evaluate the effects of wearing a wetsuit on muscle activation, upper extremity motion, heart rate, and oxygen consumption during simulated surfboard paddling in the laboratory. Twelve male, recreational surfers performed two paddling trials at a constant workload on a swim bench ergometer both with and without a wetsuit. Kinematic data and EMG were acquired from the right arm via motion capture, and oxygen consumption and heart rate were recorded with a metabolic cart and heart rate monitor. Wearing a wetsuit had no significant effect on oxygen consumption or heart rate. A significant increase in EMG activation was observed for the middle deltoid but not for any of the other shoulder muscle evaluated. Finally, approximate entropy and estimates of the maximum Lyapunov exponent increased significantly for vertical trajectory of the right wrist (i.e. stroke height) when a wetsuit was worn. These results suggest that a 2mm wetsuit has little effect on the energy cost of paddling at lower workloads but does affect arm motion. These changes may be the result of enhanced proprioceptive acuity due to mechanical compression from the wetsuit. PMID:26551321
Wilson, David J; Scully, William F; Rawlings, John M
Ultrasound machines are creating more refined pictures and becoming more user-friendly and readily accessible. As a result, ultrasound is being increasingly used for therapeutic purposes. One example involves the use of ultrasound guidance in musculoskeletal interventional procedures, such as joint injections, tendon sheath injections, and peripheral nerve blocks. Technical considerations and therapeutic results have been described for multiple locations about the upper extremities, with varying levels of success. The implementation of ultrasound-guided injections in the orthopedist's clinic has therapeutic, financial, and provider role implications. Given these potential benefits, orthopedic providers, both in practice and residency, would benefit from increased exposure and education in ultrasound use. Ultrasound provides the benefit of real-time, dynamic imaging without the radiation exposure of fluoroscopy, and ultrasound-guided injections can be performed in the office, as opposed to the operating room, which is frequently required when using fluoroscopy. A basic knowledge of the principles and terms used in ultrasound is required. With these simple principles, a practitioner can review techniques for specific areas of the musculoskeletal system and begin using ultrasound to guide injections. Many locations for diagnostic and/or therapeutic injections in the upper extremities have improved accuracy and benefit with the use of ultrasound vs blind techniques, although a few have not been shown to have a significant difference in the literature. The educational and professional implications can be significant, but these potential benefits need to be carefully weighed against costs by each orthopedic practice. Copyright 2015, SLACK Incorporated.
Werner, Robert A; Franzblau, Alfred; Gell, Nancy; Hartigan, Anne G; Ebersole, Marissa; Armstrong, Thomas J
This study followed 279 auto assembly workers over 1 year to identify which factors influenced whether a worker would visit the plant medical department because of an upper-extremity musculoskeletal problem. Incident cases were defined as involving workers who had not gone to the plant medical department in the preceding 6 months and then subsequently visited the medical department with a work-related musculoskeletal disorder that was potentially due to repetitive work activity (acute fractures or lacerations were excluded). There were 45 cases identified during the study period. Based on Cox regression analysis, significant predictors for visiting a medical department included exceeding the threshold limit value for hand activity and peak force, a history of diabetes, a current diagnosis of carpal tunnel syndrome, elbow tendonitis, and age under 40 years. The results of this study are consistent with those of other prospective studies that showed that both ergonomic and past medical history are risk factors for an upper-extremity musculoskeletal disorder and suggests that there is a healthy worker or survivor effect among older workers.
Schneider, Jeffrey C; Ozsecen, Muzaffer Y; Muraoka, Nicholas K; Mancinelli, Chiara; Della Croce, Ugo; Ryan, Colleen M; Bonato, Paolo
Burn contractures are common and difficult to treat. Measuring continuous joint motion would inform the assessment of contracture interventions; however, it is not standard clinical practice. This study examines use of an interactive gaming system to measure continuous joint motion data. To assess the usability of an exoskeleton-based interactive gaming system in the rehabilitation of upper extremity burn contractures. Feasibility study. Eight subjects with a history of burn injury and upper extremity contractures were recruited from the outpatient clinic of a regional inpatient rehabilitation facility. Subjects used an exoskeleton-based interactive gaming system to play 4 different video games. Continuous joint motion data were collected at the shoulder and elbow during game play. Visual analog scale for engagement, difficulty and comfort. Angular range of motion by subject, joint, and game. The study population had an age of 43 ± 16 (mean ± standard deviation) years and total body surface area burned range of 10%-90%. Subjects reported satisfactory levels of enjoyment, comfort, and difficulty. Continuous joint motion data demonstrated variable characteristics by subject, plane of motion, and game. This study demonstrates the feasibility of use of an exoskeleton-based interactive gaming system in the burn population. Future studies are needed that examine the efficacy of tailoring interactive video games to the specific joint impairments of burn survivors. Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
Massie, Crystal L; Du, Yue; Conroy, Susan S; Krebs, H Igo; Wittenberg, George F; Bever, Christopher T; Whitall, Jill
Robots designed for rehabilitation of the upper extremity after stroke facilitate high rates of repetition during practice of movements and record precise kinematic data, providing a method to investigate motor recovery profiles over time. To determine how motor recovery profiles during robotic interventions provide insight into improving clinical gains. A convenience sample (n = 22), from a larger randomized control trial, was taken of chronic stroke participants completing 12 sessions of arm therapy. One group received 60 minutes of robotic therapy (Robot only) and the other group received 45 minutes on the robot plus 15 minutes of translation-to-task practice (Robot + TTT). Movement time was assessed using the robot without powered assistance. Analyses (ANOVA, random coefficient modeling [RCM] with 2-term exponential function) were completed to investigate changes across the intervention, between sessions, and within a session. Significant improvement (P < .05) in movement time across the intervention (pre vs post) was similar between the groups but there were group differences for changes between and within sessions (P < .05). The 2-term exponential function revealed a fast and slow component of learning that described performance across consecutive blocks. The RCM identified individuals who were above or below the marginal model. The expanded analyses indicated that changes across time can occur in different ways but achieve similar goals and may be influenced by individual factors such as initial movement time. These findings will guide decisions regarding treatment planning based on rates of motor relearning during upper extremity stroke robotic interventions. © The Author(s) 2015.
Douglass, Nathan; Yao, Jeffrey
A plethora of screw designs and sizes are available from multiple companies for use in upper extremity surgery. Knowing the dimensions of screws is critical in the treatment of bone of varying dimensions for fractures, osteotomies, or arthrodeses. Although many screws are named by their major thread diameter, this is not always true. Because of this confusing nomenclature and vast number of options, we sought to review the most commonly used screws and codify their dimensions into a readily available article and reference chart. This article highlights the basic dimensions of commonly used headless screws, stand-alone lag screws, non-locking and locking screws for plating, and biocomposite screws. Commonly described treatments using these screws include fixation of elbow, wrist, carpal, metacarpal, and phalangeal fractures and osteotomies, as well as arthrodeses of upper extremity joints. This article and its tables are by no means exhaustive of all commercially available implants. The focus is on the most commonly used implants in the United States as of 2014.
Nagura, Issei; Kanatani, Takako; Sumi, Masatoshi; Inui, Atsuyuki; Mifune, Yutaka; Kokubu, Takeshi; Kurosaka, Masahiro
Some patients showed unusual responses to the immobilization without any objective findings with casts in upper extremities. We hypothesized their that intolerance with excessive anxiety to casts is due to claustrophobia triggered by cast immobilization. The aim of this study is to analyze the relevance of cast immobilization to the feeling of claustrophobia and discover how to handle them. There were nine patients who showed the caustrophobic symptoms with their casts. They were assesed whether they were aware of their claustrophobis themselves. Further we investigated the alternative immobilization to casts. Seven out of nine cases that were aware of their claustrophobic tendencies either were given removable splints initially or had the casts converted to removable splints when they exhibited symptoms. The two patients who were unaware of their latent claustrophobic tendencies were identified when they showed similar claustrophobic symptoms to the previous patients soon after short arm cast application. We replaced the casts with removable splints. This resolved the issue in all cases. We should be aware of the claustrophobia if patients showed unusual responses to the immobilization without any objective findings with casts in upper extremities, where removal splint is practical alternative to cast to continue the treatment successfully.
Nagura, Issei; Kanatani, Takako; Sumi, Masatoshi; Inui, Atsuyuki; Mifune, Yutaka; Kokubu, Takeshi; Kurosaka, Masahiro
Introduction. Some patients showed unusual responses to the immobilization without any objective findings with casts in upper extremities. We hypothesized their that intolerance with excessive anxiety to casts is due to claustrophobia triggered by cast immobilization. The aim of this study is to analyze the relevance of cast immobilization to the feeling of claustrophobia and discover how to handle them. Methods. There were nine patients who showed the caustrophobic symptoms with their casts. They were assesed whether they were aware of their claustrophobis themselves. Further we investigated the alternative immobilization to casts. Results. Seven out of nine cases that were aware of their claustrophobic tendencies either were given removable splints initially or had the casts converted to removable splints when they exhibited symptoms. The two patients who were unaware of their latent claustrophobic tendencies were identified when they showed similar claustrophobic symptoms to the previous patients soon after short arm cast application. We replaced the casts with removable splints. This resolved the issue in all cases. Conclusions. We should be aware of the claustrophobia if patients showed unusual responses to the immobilization without any objective findings with casts in upper extremities, where removal splint is practical alternative to cast to continue the treatment successfully. PMID:25379544
Jeong, In Cheol; Finkelstein, Joseph
Upper extremity exercise training has been shown to improve clinical outcomes in different chronic health conditions. Arm-operated bicycles are frequently used to facilitate upper extremity training however effective use of these devices at patient homes is hampered by lack of remote connectivity with clinical rehabilitation team, inability to monitor exercise progress in real time using simple graphical representation, and absence of an alert system which would prevent exertion levels exceeding those approved by the clinical rehabilitation team. We developed an interactive biking exercise (iBikE) platform aimed at addressing these limitations. The platform uses a miniature wireless 3-axis accelerometer mounted on a patient wrist that transmits the cycling acceleration data to a laptop. The laptop screen presents an exercise dashboard to the patient in real time allowing easy graphical visualization of exercise progress and presentation of exercise parameters in relation to prescribed targets. The iBikE platform is programmed to alert the patient when exercise intensity exceeds the levels recommended by the patient care provider. The iBikE platform has been tested in 7 healthy volunteers (age range: 26-50 years) and shown to reliably reflect exercise progress and to generate alerts at pre-setup levels. Implementation of remote connectivity with patient rehabilitation team is warranted for future extension and evaluation efforts.
Lucado, Ann M; Kolber, Morey J; Cheng, M Samuel; Echternach, John L
Descriptive, cross-sectional. To compare static strength characteristics of the upper extremity musculature in female recreational tennis players with lateral epicondylalgia to those of nonsymptomatic tennis players and a control group of women who did not play tennis. There is a paucity of research describing the relationship between lateral epicondylalgia and strength characteristics of the upper extremity musculature, despite the functional relationship between the shoulder, elbow, and wrist. Sixty-three women were recruited into 3 groups (n = 21 per group): symptomatic tennis players (STP) with lateral epicondylalgia, nonsymptomatic tennis players, and controls. Data collection was performed during a single session, during which the strength of selected muscle groups of the dominant upper extremity was measured using a combination of force transducers. Strength ratios of selected muscle groups were then calculated. The STP group reported median pain level of 3/10 on a numeric pain rating scale and a symptom duration of 16 weeks. The STP group had weaker lower trapezius strength (mean difference, -9.0 N; 95% confidence interval [CI]: -13.5, -4.4) and wrist extensor strength (-12.7 N; 95% CI: -24.4, -1.1), and a higher shoulder internal/external rotation strength ratio (0.19; 95% CI: 0.02, 0.35) and upper/lower trapezius strength ratio (1.32; 95% CI: 0.41, 2.23), compared to those of the nonsymptomatic group. Compared to the control group, the STP group demonstrated a significantly higher shoulder internal/external rotation strength ratio (0.21; 95% CI: 0.04, 0.38) and wrist flexion/extension strength ratio (0.14; 95% CI: 0.01, 0.27). In this group of recreational female tennis players, significant differences in strength and strength ratio characteristics were identified. Although the design of the study precludes establishing a cause-and-effect relationship, the results suggest further study and treatment of the muscle groups of interest.
Winstein, Carolee J.; Wolf, Steven L.; Dromerick, Alexander W.; Lane, Christianne J.; Nelsen, Monica A.; Lewthwaite, Rebecca; Cen, Steven Yong; Azen, Stanley P.
IMPORTANCE Clinical trials suggest that higher doses of task-oriented training are superior to current clinical practice for patients with stroke with upper extremity motor deficits. OBJECTIVE To compare the efficacy of a structured, task-oriented motor training program vs usual and customary occupational therapy (UCC) during stroke rehabilitation. DESIGN, SETTING, AND PARTICIPANTS Phase 3, pragmatic, single-blind randomized trial among 361 participants with moderate motor impairment recruited from 7 US hospitals over 44 months, treated in the outpatient setting from June 2009 to March 2014. INTERVENTIONS Structured, task-oriented upper extremity training (Accelerated Skill Acquisition Program[ASAP]; n = 119); dose-equivalent occupational therapy (DEUCC; n = 120); or monitoring-only occupational therapy (UCC; n = 122). The DEUCC group was prescribed 30 one-hour sessions over 10 weeks; the UCC group was only monitored, without specification of dose. MAIN OUTCOMES AND MEASURES The primary outcome was 12-month change in log-transformed Wolf Motor Function Test time score (WMFT, consisting of a mean of 15 timed arm movements and hand dexterity tasks). Secondary outcomes were change in WMFT time score (minimal clinically important difference [MCID] = 19 seconds) and proportion of patients improving ≥25 points on the Stroke Impact Scale (SIS) hand function score (MCID = 17.8 points). RESULTS Among the 361 randomized patients (mean age, 60.7 years; 56% men; 42% African American; mean time since stroke onset, 46 days), 304 (84%) completed the 12-month primary outcome assessment; in intention-to-treat analysis, mean group change scores (log WMFT, baseline to 12 months) were, for the ASAP group, 2.2 to 1.4 (difference, 0.82); DEUCC group, 2.0 to 1.2 (difference, 0.84); and UCC group, 2.1 to 1.4 (difference, 0.75), with no significant between-group differences (ASAP vs DEUCC:0.14; 95% CI, −0.05 to 0.33; P = .16; ASAP vs UCC: −0.01; 95% CI, −0.22 to 0.21; P = .94; and
Lee, Dong-Rour; Kim, Laurentius Jongsoon
[Purpose] The purpose of this study was to examine the reliability and validity of the Closed Kinetic Chain Upper Extremity Stability (CKCUES) test. [Subjects and Methods] A sample of 40 subjects (20 males, 20 females) with and without pain in the upper limbs was recruited. The subjects were tested twice, three days apart to assess the reliability of the CKCUES test. The CKCUES test was performed four times, and the average was calculated using the data of the last 3 tests. In order to test the validity of the CKCUES test, peak torque of internal/external shoulder rotation was measured using an isokinetic dynamometer, and maximum grip strength was measured using a hand dynamometer, and their Pearson correlation coefficients with the average values of the CKCUES test were calculated. [Results] The reliability of the CKCUES test was very high (ICC=0.97). The correlations between the CKCUES test and maximum grip strength (r=0.78-0.79), and the peak torque of internal/external shoulder rotation (r=0.87-0.94) were high indicating its validity. [Conclusion] The reliability and validity of the CKCUES test were high. The CKCUES test is expected to be used for clinical tests on upper limb stability at low price.
Barrero, L H; Pulido, J A; Berrio, S; Monroy, M; Quintana, L A; Ceballos, C; Hoehne-Hueckstaedt, U; Ellegast, R
We report the prevalence of symptoms of common upper-limb disorders and describe comprehensively mechanical workloads in a sample of workers of the Colombian flower industry. One hundred fifty eight workers from eight flower manufacturers were assessed. Assessments included Borg self-reported exertion and working practices, medical examinations, video-based observations and kinematic and surface muscular activity assessments of upper-limb. Point prevalence of signs and symptoms of CTS, epicondylitis, and De Quervain's disease was 32.9%, 15.2%, and 13.3%, respectively. All tasks are executed on average in wrist extension, ulnar deviation, and high elbow flexion. Average median muscle activity across tasks ranged between 3.6% and 27.3%. Forearm muscles were mainly active. The occurrence of signs and symptoms of upper-extremity musculoskeletal disorders was high among the sample. The classification and cutting task showed the highest mechanical demands. Interventions in this working population are required and should be directed to allow for muscular rest on regular basis. Copyright © 2012 Wiley Periodicals, Inc.
Kraaijpoel, Noémie; van Es, Nick; Porreca, Ettore; Büller, Harry R; Di Nisio, Marcello
Upper extremity deep vein thrombosis (UEDVT) accounts for 4% to 10% of all cases of deep vein thrombosis. UEDVT may present with localized pain, erythema, and swelling of the arm, but may also be detected incidentally by diagnostic imaging tests performed for other reasons. Prompt and accurate diagnosis is crucial to prevent pulmonary embolism and long-term complications as the post-thrombotic syndrome of the arm. Unlike the diagnostic management of deep vein thrombosis (DVT) of the lower extremities, which is well established, the work-up of patients with clinically suspected UEDVT remains uncertain with limited evidence from studies of small size and poor methodological quality. Currently, only one prospective study evaluated the use of an algorithm, similar to the one used for DVT of the lower extremities, for the diagnostic workup of clinically suspected UEDVT. The algorithm combined clinical probability assessment, D-dimer testing and ultrasonography and appeared to safely and effectively exclude UEDVT. However, before recommending its use in routine clinical practice, external validation of this strategy and improvements of the efficiency are needed, especially in high-risk subgroups in whom the performance of the algorithm appeared to be suboptimal, such as hospitalized or cancer patients. In this review, we critically assess the accuracy and efficacy of current diagnostic tools and provide clinical guidance for the diagnostic management of clinically suspected UEDVT. Copyright © 2017 Elsevier Ltd. All rights reserved.
Fradet, Laetitia; Liefhold, Beate; Rettig, Oliver; Bruckner, Thomas; Akbar, Michael; Wolf, Sebastian I
Instrumented gait analysis is widely accepted as an objective assessment of lower-extremity function. Conversely, upper-extremity function suffers from lack of objective evaluation. The present paper aims at proposing a protocol to be used to clinically and objectively evaluate upper-extremity function whatever the pathological joint. Secondly, it aims at better understanding the consequences on upper-extremity function and the compensation mechanisms induced by elbow contracture. Elbow contracture was simulated in this study by using a brace. Twelve healthy subjects followed an instrumented 3D movement analysis while performing 11 daily life movements. The movements were performed with 3 different elbow contracture conditions, simulated by wearing an adjustable elbow brace. The proposed protocol was successful in creating a wide range of motion at all the upper-extremity joints. The activity-related range of motion and the mean range of motion computed on the whole set of daily life movements were effective in evaluating the severity of elbow contracture. The lack of elbow flexion was compensated by trunk flexion, hand flexion and radial deviation, and combined movement of shoulder flexion, abduction, and humeral internal rotation. Deficit in elbow extension was mainly compensated by the use of trunk flexion. A protocol could be proposed for the objective evaluation of upper-extremity function. Its application to elbow contracture suggests that loss of elbow flexion affects more movements than loss of elbow extension.
Houwink, Annemieke; Aarts, Pauline B. M.; Geurts, Alexander C. H.; Steenbergen, Bert
A common problem in children with hemiplegic cerebral palsy (CP) is the asymmetrical development of arm and hand capacity caused by the lack of use of the affected upper limb, or developmental disregard. In this paper, we provide a neuropsychological model that relates developmental disregard to attentional processes and motor learning. From this…
Houwink, Annemieke; Aarts, Pauline B. M.; Geurts, Alexander C. H.; Steenbergen, Bert
A common problem in children with hemiplegic cerebral palsy (CP) is the asymmetrical development of arm and hand capacity caused by the lack of use of the affected upper limb, or developmental disregard. In this paper, we provide a neuropsychological model that relates developmental disregard to attentional processes and motor learning. From this…
Rozenfeld, Michael; Peleg, Kobi; Givon, Adi; Kessel, Boris
When treating patients with stab injuries of the torso, clinicians often lack timely information about the degree and nature of internal organ damage. An externally observable sign significantly associated with characteristics of torso injuries may therefore be useful for practitioners. One such potential sign is the presence of wounds to the hands, sometimes sustained during victims' attempt to defend themselves during the violent altercation. Thus, the primary aim of this study was to evaluate the association between presence of upper extremity wounds and the severity of the thoracic and intra-abdominal injuries due to stabbing. This study was carried out retrospectively using data on 8714 patients with stabbing-related injuries from 19 trauma centers that participated in the Israeli National Trauma Registry (INTR) between January 1st1997 and December 31st 2013. Patients with wounds of upper extremities in addition to torso injuries (UE group) were compared to other patients with torso injuries (TO group) in terms of demographics, injury characteristics and clinical outcome. The compared groups were found to be homogeneous in terms of age and systolic blood pressure; the number of sustained torso injuries was also identical. The UE group comprised a slightly greater percentage of females, however both groups were predominantly male. Patients with upper extremity injuries had a lower proportion of internal organ damage (36% vs. 38.5%) and lower mortality (0.9% vs. 2%). The higher mortality of patients without upper extremity wounds remained significantly different even when adjusted by other epidemiological parameters (OR 2.46, 95% CI 1.33-5.08).The number of sustained upper extremity injuries was positively associated with deeper penetration of the torso by the stabbing instrument. Patients with stabbing-related upper extremity wounds had a significant survival advantage over patients without such injuries. However, a greater number of sustained upper extremity
Das De, Soumen; Vranceanu, Ana-Maria; Ring, David C
Upper-extremity-specific disability correlates with mood and coping strategies. The aim of this study was to determine if two psychological factors, kinesiophobia (fear of movement) and perceived partner support, contribute significantly to variation in upper-extremity-specific disability in a model that included factors known to contribute to variation such as depression, pain anxiety, and catastrophic thinking. We performed an observational cross-sectional study of 319 patients who each had one of the following conditions: trigger finger (n = 94), carpal tunnel syndrome (n = 29), trapeziometacarpal arthrosis (n = 33), Dupuytren contracture (n = 31), de Quervain syndrome (n = 28), wrist ganglion cyst (n = 32), lateral epicondylosis (n = 41), and a fracture of the distal part of the radius treated nonoperatively six weeks previously (n = 31). Each patient completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and questionnaires measuring symptoms of depression, pain anxiety, catastrophic thinking, kinesiophobia, and perceived level of support from a partner or significant other. Stepwise multiple linear regression was used to determine significant independent predictors of the DASH score. Men had significantly lower (better) DASH scores than women (21 versus 31; p < 0.01). DASH scores also differed significantly by diagnosis (p < 0.01), marital status (p = 0.047), and employment status (p < 0.01). The DASH score correlated significantly with depressive symptoms (p < 0.01), catastrophic thinking (p < 0.01), kinesiophobia (p < 0.01), and pain anxiety (p < 0.01) but not with perceived partner support. The best multivariable model of factors associated with greater arm-specific disability (according to the DASH score) included sex, diagnosis, employment status, catastrophic thinking, and kinesiophobia and accounted for 55% of the variation. In this sample, kinesiophobia and catastrophic thinking were the most important predictors of upper-extremity
Pransky, G; Benjamin, K; Himmelstein, J; Mundt, K; Morgan, W; Feuerstein, M; Koyamatsu, K; Hill-Fotouhi, C
The purpose of this study was to describe the demographic, vocational, medical, workplace, and psychosocial characteristics of patients treated for work-related upper-extremity disorders, to document treatment patterns in a community-practice setting, and to determine which of these factors predicts subsequent employment and functional status outcomes. A questionnaire was administered by mail or telephone to 112 patients seen at the University of Massachusetts Occupational Upper Extremities Disorders Clinic and included measures of disease-specific functional status, pain, reactions to pain, employer-employee relations, and number and type of interventions used to treat the disorder. Results were compared with baseline data obtained, on average, 16 months prior to follow-up. Of the original cohort (n = 124), 112 participated in the prospective study. Although most patients reported improvement in pain severity, fear of pain, life situation, and functional status, there was little change in employment status. Patients' self-reported intentions of return to work at baseline did not predict work status at follow-up. In general, those who were employed at baseline remained employed, had a greater reduction in symptom severity over time, and were significantly more likely to report improvement in their problem than those who were unemployed. The efficacy of various interventions was examined by type, mix, and intensity (number of different interventions undergone by the patient). No positive relationship was found between these measures and employment status, self-reported change in the problem, or self-reported improvement in functional status. Significant negative relationships were found between surgery, psychotherapeutic interventions, and outcomes. This was likely to have occurred because of a selection bias toward the more chronic and severely disabled patients for these treatments. However, the relative ineffectiveness of such intensive interventions as surgery
Background Repetitive task practice is argued to drive neural plasticity following stroke. However, current evidence reveals that hemiparetic weakness impairs the capacity to perform, and practice, movements appropriately. Here we investigated how power training (i.e., high-intensity, dynamic resistance training) affects recovery of upper-extremity motor function post-stroke. We hypothesized that power training, as a component of upper-extremity rehabilitation, would promote greater functional gains than functional task practice without deleterious consequences. Method Nineteen chronic hemiparetic individuals were studied using a crossover design. All participants received both functional task practice (FTP) and HYBRID (combined FTP and power training) in random order. Blinded evaluations performed at baseline, following each intervention block and 6-months post-intervention included: Wolf Motor Function Test (WMFT-FAS, Primary Outcome), upper-extremity Fugl-Meyer Motor Assessment, Ashworth Scale, and Functional Independence Measure. Neuromechanical function was evaluated using isometric and dynamic joint torques and concurrent agonist EMG. Biceps stretch reflex responses were evaluated using passive elbow stretches ranging from 60 to 180º/s and determining: EMG onset position threshold, burst duration, burst intensity and passive torque at each speed. Results Primary outcome: Improvements in WMFT-FAS were significantly greater following HYBRID vs. FTP (p = .049), regardless of treatment order. These functional improvements were retained 6-months post-intervention (p = .03). Secondary outcomes: A greater proportion of participants achieved minimally important differences (MID) following HYBRID vs. FTP (p = .03). MIDs were retained 6-months post-intervention. Ashworth scores were unchanged (p > .05). Increased maximal isometric joint torque, agonist EMG and peak power were significantly greater following HYBRID vs. FTP (p < .05) and effects were
Hakim, Renée M; Tunis, Brandon G; Ross, Michael D
The focus of research using technological innovations such as robotic devices has been on interventions to improve upper extremity function in neurologic populations, particularly patients with stroke. There is a growing body of evidence describing rehabilitation programs using various types of supportive/assistive and/or resistive robotic and virtual reality-enhanced devices to improve outcomes for patients with neurologic disorders. The most promising approaches are task-oriented, based on current concepts of motor control/learning and practice-induced neuroplasticity. Based on this evidence, we describe application and feasibility of virtual reality-enhanced robotics integrated with current concepts in orthopaedic rehabilitation shifting from an impairment-based focus to inclusion of more intense, task-specific training for patients with upper extremity disorders, specifically emphasizing the wrist and hand. The purpose of this paper is to describe virtual reality-enhanced rehabilitation robotic devices, review evidence of application in patients with upper extremity deficits related to neurologic disorders, and suggest how this technology and task-oriented rehabilitation approach can also benefit patients with orthopaedic disorders of the wrist and hand. We will also discuss areas for further research and development using a task-oriented approach and a commercially available haptic robotic device to focus on training of grasp and manipulation tasks. Implications for Rehabilitation There is a growing body of evidence describing rehabilitation programs using various types of supportive/assistive and/or resistive robotic and virtual reality-enhanced devices to improve outcomes for patients with neurologic disorders. The most promising approaches using rehabilitation robotics are task-oriented, based on current concepts of motor control/learning and practice-induced neuroplasticity. Based on the evidence in neurologic populations, virtual reality-enhanced robotics
Background Techniques for the skeletal attachment of amputation-prostheses have been developed over recent decades. This type of attachment has only been performed on a small number of patients. It poses various potential advantages compared to conventional treatment with a socket, but is also associated with an increased risk of bone or implant-bone interface fracture in the case of a fall. We therefore investigated the bending stiffness and ultimate bending moment of such devices implanted in human and synthetic bones. Methods Eight human specimens and 16 synthetic models of the proximal femora were implanted with lower extremity prostheses and eight human specimens and six synthetic humeri were implanted with upper extremity prostheses. They were dissected according to typical amputation levels and underwent loading in a material testing machine in a four-point bending setup. Bending stiffness, ultimate bending moment and fracture modes were determined in a load to failure experiment. Additionally, axial pull-out was performed on eight synthetic specimens of the lower extremity. Results Maximum bending moment of the synthetic femora was 160.6±27.5 Nm, the flexural rigidity of the synthetic femora was 189.0±22.6 Nm2. Maximum bending moment of the human femora was 100.4±38.5 Nm, and the flexural rigidity was 137.8±29.4 Nm2. The maximum bending moment of the six synthetic humeri was 104.9±19.0 Nm, and the flexural rigidity was 63.7±3.6 Nm2. For the human humeri the maximum bending moment was 36.7±11.0 Nm, and the flexural rigidity at was 43.7±10.5 Nm2. The maximum pull-out force for the eight synthetic femora was 3571±919 N. Conclusion Significant differences were found between human and synthetic specimens of the lower and upper extremity regarding maximum bending moment, bending displacement and flexural rigidity. The results of this study are relevant with respect to previous finding regarding the load at the interfaces of osseointegrated prosthesis
Slodicka, R; Lautenbach, M; Eisenschenk, A
The operative treatment of hand and upper extremity trauma with injury of main vessels becomes a daily standard work in trauma and microsurgical replantation centers. The techniques of vessel and soft tissue reconstruction are well known. The outcome of the replantation depends on various factors. Main influences are the intraoperative status of the vessel wall and the unobstructed flow in the vessel after the operation. Another factor for successful replantation is the homeostasis of the patient. It can be influenced by many drugs which are applied according to a replantation schema. Aim of this therapy is the correction of the rheologic properties of a patient. In a patient group of 25 treated with Prostaglandin E1 (Prostavasin) we observed better wound healing with a 80% rate of successful replantation and microvascular vessel reconstruction.
Keene, David J
This case report summarises the presentation of a 28-year-old female with signs and symptoms characteristic of thoracic outlet syndrome, but who was later found to have an effort-induced Upper Extremity Deep Vein Thrombosis (UEDVT), otherwise known as Paget-Schroetter syndrome. Effort-induced UEDVT is rare, but the similarity between the signs and symptoms of thoracic outlet syndrome and this type of thrombosis can result in patients with this condition presenting to musculoskeletal therapists. The key features of the case are described, followed by an overview of UEDVT and the importance of recognising this condition in musculoskeletal therapy practice. The role of therapists in referring for early medical diagnostics is key to ensuring management of the thrombosis is instigated early, therefore reducing the risk of life threatening consequences such as pulmonary embolism.
Waddell, Kimberly J.; Birkenmeier, Rebecca L.; Moore, Jennifer L.; Hornby, T. George
OBJECTIVE. We investigated the feasibility of delivering an individualized, progressive, high-repetition upper-extremity (UE) task-specific training protocol for people with stroke in the inpatient rehabilitation setting. METHOD. Fifteen patients with UE paresis participated in this study. Task-specific UE training was scheduled for 60 min/day, 4 days/wk, during occupational therapy for the duration of a participant’s inpatient stay. During each session, participants were challenged to complete ≥300 repetitions of various tasks. RESULTS. Participants averaged 289 repetitions/session, spending 47 of 60 min in active training. Participants improved on impairment and activity level outcome measures. CONCLUSION. People with stroke in an inpatient setting can achieve hundreds of repetitions of task-specific training in 1-hr sessions. As expected, all participants improved on functional outcome measures. Future studies are needed to determine whether this high-repetition training program results in better outcomes than current UE interventions. PMID:25005508
Aune, T K; Ettema, G; Vereijken, B
The authors' aim was to compare spatial and temporal accuracy in proximal versus distal joints in upper extremities. Given the morphological differences in corticospinal and corticomotoneuronal projections for proximal and distal muscles, they hypothesized that bilateral asymmetry would be larger for distal than for proximal joints. Twelve participants performed isolated flexion-extension movements with the shoulders and index fingers. Angular range of motion of finger and shoulder movements was kept constant. The results showed significant bilateral asymmetry for both proximal and distal joints for both spatial and temporal accuracy. More importantly, bilateral asymmetry was significantly larger for the index fingers than for the shoulders for both spatial and temporal variables, as hypothesized. These results at the behavioral level pave the way for further studies that combine direct measures of neural activation with behavioral measures to further illuminate the potential link between bilateral communication and laterality effects in motor performance.
Cooney, W P
Upper extremity syndromes caused by a single stress or by repetitive microtrauma occur in a variety of sports. The throwing motion, long-distance swimming, bowling, golf, gymnastics, basketball, volleyball, and field events can repetitively stress the hand, wrist, elbow, and shoulder. The biomechanical evaluation of racquet handling, throwing, and swimming motions has progressed considerably, and the future looks promising for better identification and prevention of sports injuries due to stress. These insights will help the physician more adequately understand and treat athletic injuries. As for the present, we must recognize athletic injuries for what they are--debilitating single or repetitive trauma to active persons who want a rapid return to their sport. The goal of both the injured athlete and the treating physician must be 100% recovery; compromise in treatment is not warranted. To achieve the best results, the physician should emphasize to the athlete, coach, and parent that healing is a matter of time.
Brewer, Bambi R; McDowell, Sharon K; Worthen-Chaudhari, Lise C
Although the use of robotic devices to address neuromuscular rehabilitative goals represents a promising technological advance in medical care, the large number of systems being developed and varying levels of clinical study of the devices make it difficult to follow and interpret the results in this new field. This article is a review of the current state-of-the-art in robotic applications in poststroke therapy for the upper extremity, written specifically to help clinicians determine the differences between various systems. We concentrate primarily on systems that have been tested clinically. Robotic systems are grouped by rehabilitation application (e.g., gross motor movement, bilateral training, etc.), and, where possible, the neurorehabilitation strategies employed by each system are described. We close with a discussion of the benefits and concerns of using robotics in rehabilitation and an indication of challenges that must be addressed for therapeutic robots to be applied practically in the clinic.
Fromm, B; Rupp, R; Gerner, H J
We report on the first experience with the Freehand system in German-speaking countries, an implantable neuroprosthesis developed for the functional electrical stimulation of the upper extremity. Indications for its use are neurological deficits of the cervical spinal cord with active mobility of the shoulder and elbow flexion in tetraplegics, ideally in C5/6 tetraplegics. A further precondition for the implantation of this system is an intact reflex arc of the muscles that are to be stimulated, i.e. of the forearm and hand. Central defects such as hemiparesis, cerebral palsies or athetoid disorders or peripheral nerve palsies (e.g. brachial plexus lesions) are no good indications for the implantation of the Freehand system. We report on patient selection criteria, preoperative percutaneous electrical stimulation, the surgical procedure itself with optional active tendon transpositions, the intensive postoperative rehabilitation program until the patient is able to use the system independently and the life-long after-care.
This report, part 2 of a two-part case report on the clinical use of neuromuscular electrical stimulation (NMES) for children with cerebral palsy, documents the functional changes that occurred with the application of NMES to the upper extremity of two children, 1.6 and 6.7 years of age, with hemiplegia due to cerebral palsy. The NMES was used as an adjunct to a dynamic-systems, task-oriented physical therapy program. The youngest child showed immediate improvement in the ability to crawl and use both hands together. The older child demonstrated increased sensory awareness and use of the nonfunctional hand. Preliminary findings suggest that NMES may be a useful physical therapy tool for enhancing muscle strength increasing sensory awareness, and assisting motor learning and coordination.
Balcı, Nilay Comuk; Dogru, Esra; Aytar, Aydan; Gokmen, Ozge; Depreli, Ozde
[Purpose] The aim of this study was to compare the unaffected upper extremity of patients with hemiparesis with that of healthy subjects in terms of function, pain, and tactile sense. [Subjects and Methods] Upper extremity evaluation parameters of 20 patients with hemiparesis were compared with an age-matched control group of 20 healthy subjects. A shorter version of the Disability of Arm and Shoulder Questionnaire, Upper Extremity Functional Index, and Simple Shoulder Test were used to evaluate the upper extremity functionality. The Visual Analog Scale was used to measure pain severity at rest, at night, and during activity. Tactile sensation levels were assessed by Semmes-Weinstein monofilaments at four palmar areas. [Results] A statistically significant difference was found in the upper extremity functionality between the groups. Pain severity at rest was significantly higher in the hemiparetic group. There was no significant difference in night and activity pain severities or tactile sensation levels between the groups. [Conclusion] According to our results, the unaffected side of patients with hemiparesis differs in functionality and pain at rest compared with that of healthy persons. Studies with larger sample size and various evaluation tests are needed to further investigate the unaffected side of patients with hemiparesis. PMID:27512250
Han, Ji Won; Kim, Young Mi
The abdominal muscles, upper extremities, and diaphragm work in synergy to maintain trunk stability during breathing. This study aimed to investigate the effects of a breathing technique combined with dynamic upper extremity exercise on the pulmonary function of healthy adults. Forty male participants in their 20s were recruited and randomly divided into two groups of 20 participants each: the experimental group performed a dynamic upper extremity exercise with breathing, and the control group only performed the breathing exercise. The experimental duration was 4 weeks, and both groups performed each training three times per a week. We performed pulmonary function test. Forced vital capacity increased significantly in both groups after the training period, but it was not significantly different between the two groups. Similarly, the forced expiratory volume at one second was not significantly different after training, but was significantly different between the two groups. In contrast, the peak expiratory flow did not show any significant within-group or between-group difference. Consequently, we came up with result that breathing exercise with dynamic upper extremity exercise improves pulmonary function. Our findings indicate that the breathing and dynamic upper extremity exercise described here should be considered in patients who require breathing therapy, since it seems to have beneficial effects on pulmonary function.
Luria, Shai; Rivkin, Gurion; Avitzour, Malka; Liebergall, Meir; Mintz, Yoav; Mosheiff, Ram
Explosion injuries to the upper extremity have specific clinical characteristics that differ from injuries due to other mechanisms. To evaluate the upper extremity injury pattern of attacks on civilian targets, comparing bomb explosion injuries to gunshot injuries and their functional recovery using standard outcome measures. Of 157 patients admitted to the hospital between 2000 and 2004, 72 (46%) sustained explosion injuries and 85 (54%) gunshot injuries. The trauma registry files were reviewed and the patients completed the DASH Questionnaire (Disabilities of Arm, Shoulder and Hand) and SF-12 (Short Form-12) after a minimum period of 1 year. Of the 157 patients, 72 (46%) had blast injuries and 85 (54%) had shooting injuries. The blast casualties had higher Injury Severity Scores (47% vs. 22% with a score of > 16, P = 0.02) and higher percent of patients treated in intensive care units (47% vs. 28%, P = 0.02). Although the Abbreviated Injury Scale score of the upper extremity injury was similar in the two groups, the blast casualties were found to have more bilateral and complex soft tissue injuries and were treated surgically more often. No difference was found in the SF-12 or DASH scores between the groups at follow up. The casualties with upper extremity blast injuries were more severely injured and sustained more bilateral and complex soft tissue injuries to the upper extremity. However, the rating of the local injury to the isolated limb is similar, as was the subjective functional recovery.
Quinn, Lori; Busse, Monica; Dal Bello-Haas, Vanina
Parkinson Disease (PD) and Huntington Disease (HD) are degenerative neurological diseases, which can result in impairments and activity limitations affecting the upper extremities from early in the disease process. The progressive nature of these diseases poses unique challenges for therapists aiming to effectively maximize physical functioning and minimize participation restrictions in these patient groups. Research is underway in both diseases to develop effective disease-modifying agents and pharmacological interventions, as well as mobility-focused rehabilitation protocols. Rehabilitation, and in particular task-specific interventions, has the potential to influence the upper extremity functional abilities of patients with these degenerative conditions. However to date, investigations of interventions specifically addressing upper extremity function have been limited in both PD, and in particular HD. In this paper, we provide an update of the known pathological features of PD and HD as they relate to upper extremity function. We further review the available literature on the use of outcome measures, and the clinical management of upper extremity function in both conditions. Due to the currently limited evidence base in both diseases, we recommend utilization of a clinical management framework specific for degenerative conditions that can serve as a guideline for disease management. Copyright © 2013. Published by Elsevier Inc.
Blume, Kathrin R; Dietrich, Caroline; Huonker, Ralph; Götz, Theresa; Sens, Elisabeth; Friedel, Reinhard; Hofmann, Gunther O; Miltner, Wolfgang H R; Weiss, Thomas
With the development of microsurgical techniques, replantation has become a feasible alternative to stump treatment after the amputation of an extremity. It is known that amputation often induces phantom limb pain and cortical reorganization within the corresponding somatosensory areas. However, whether replantation reduces the risk of comparable persisting pain phenomena as well as reorganization of the primary somatosensory cortex is still widely unknown. Therefore, the present study aimed to investigate the potential development of persistent pain and cortical reorganization of the hand and lip areas within the sensory cortex by means of magnetoencephalographic dipole analyses after replantation of a traumatically amputated upper limb proximal to the radiocarpal joint. Cortical reorganization was investigated in 13 patients with limb replantation using air puff stimulation of the phalanges of both thumbs and both corners of the lower lip. Displacement of the centre of gravity of lip and thumb representations and increased cortical activity were found in the limb and face areas of the primary somatosensory cortex contralateral to the replanted arm when compared to the ipsilateral hemisphere. Thus, cortical reorganization in the primary somatosensory cortex also occurs after replantation of the upper extremity. Patients' reports of pain in the replanted body part were negatively correlated with the amount of cortical reorganization, i.e. the more pain the patients reported, the less reorganization of the subjects' hand representation within the primary somatosensory cortex was observed. Longitudinal studies in patients after macroreplantation are necessary to assess whether the observed reorganization in the primary somatosensory cortex is a result of changes within the representation of the replanted arm and/or neighbouring representations and to assess the relationship between the development of persistent pain and reorganization.
Punnett, L; Gold, J; Katz, J N; Gore, R; Wegman, D H
To estimate the one year cumulative incidence and persistence of upper extremity (UE) soft tissue disorders, in a fixed cohort of automotive manufacturing workers, and to quantify their associations with ergonomic exposures. At baseline and at follow up, cases of UE musculoskeletal disorders were determined by interviewer administered questionnaire and standardised physical examination of the upper extremities. The interview obtained new data on psychosocial strain and updated the medical and work histories. An index of exposure to ergonomic stressors, obtained at baseline interview, was the primary independent variable. Cumulative incidence and persistence of UE disorders (defined both by symptoms and by physical examination plus symptoms) were analysed in relation to baseline ergonomic exposures, adjusting for other covariates. The incidence of new disorders was modelled using multivariate proportional hazards regression among workers who were not cases in the first year and the prevalence on both occasions was modelled by repeated measures analysis. A total of 820 workers (69% of eligible cohort members) was examined. Follow up varied slightly by department group but not by baseline exposure level or other characteristics. Among the non-cases at baseline, the cumulative incidence of UE disorders was 14% by symptoms and 12% by symptoms plus examination findings. These rates increased with index of physical exposures primarily among subjects who had the same jobs at follow up as at baseline. Increased exposure during follow up increased risk of incidence. The persistence of UE disorders from baseline to follow up examination was nearly 60% and somewhat associated with baseline exposure score. These longitudinal results confirm the previous cross sectional associations of UE musculoskeletal disorders with exposure to combined ergonomic stressors. The exposure-response relation was similar for incident cases defined by symptoms alone and those confirmed by physical
Gold, Judith E; Hallman, David M; Hellström, Fredrik; Björklund, Martin; Crenshaw, Albert G; Djupsjobacka, Mats; Heiden, Marina; Mathiassen, Svend Erik; Piligian, George; Barbe, Mary F
This study systematically summarizes biochemical biomarker research in non-traumatic musculoskeletal disorders (MSD). Two research questions guided the review: (i) Are there biochemical markers associated with neck and upper-extremity MSD? and (ii) Are there biochemical markers associated with the severity of neck and upper-extremity MSD? A literature search was conducted in PubMed and SCOPUS, and 87 studies met primary inclusion criteria. Following a quality screen, data were extracted from 44 articles of sufficient quality. Most of the 87 studies were cross-sectional and utilized convenience samples of patients as both cases and controls. A response rate was explicitly stated in only 11 (13%) studies. Less than half of the studies controlled for potential confounding through restriction or in the analysis. Most sufficient-quality studies were conducted in older populations (mean age in one or more analysis group >50 years). In sufficient-quality articles, 82% demonstrated at least one statistically significant association between the MSD and biomarker(s) studied. Evidence suggested that: (i) the collagen-repair marker TIMP-1 is decreased in fibro proliferative disorders, (ii) 5-HT (serotonin) is increased in trapezius myalgia, and (iii) triglycerides are increased in a variety of MSD. Only 5 studies showed an association between a biochemical marker and MSD severity. While some MSD biomarkers were identified, limitations in the articles examined included possible selection bias, confounding, spectrum effect (potentially heterogeneous biomarker associations in populations according to symptom severity or duration), and insufficient attention to comorbid conditions. A list of recommendations for future studies is provided.
Yin, Chan Wai; Sien, Ng Yee; Ying, Low Ai; Chung, Stephanie Fook-Chong Man; Tan May Leng, Dawn
To investigate the effect of virtual reality (VR) rehabilitation on upper extremity motor performance of patients with early stroke. Pilot randomized controlled trial. Rehabilitation wards. Twenty three adults with stroke (mean age (SD) = 58.35 (13.45) years and mean time since stroke (SD) = 16.30 (7.44) days). Participants were randomly assigned to VR group (n=11) or control group (n=12). VR group received nine 30 minutes upper extremity VR therapy in standing (five weekdays in two weeks) plus conventional therapy, which included physical and occupational therapy. Control group received only conventional therapy, which was comparable to total training time received by VR group (mean training hours (SD):VR = 17.07 (2.86); control = 15.50 (2.79)). The main outcome measure was the Fugl-Meyer Assessment (FMA). Secondary outcomes included Action Research Arm Test, Motor Activity Log and Functional Independence Measure. Results were taken at baseline, post intervention and 1-month post intervention. Participants' feedback and adverse effects were recorded. All participants improved in FMA scores (mean change (SD) = 11.65 (8.56), P<.001). These effects were sustained at one month after intervention (mean (SD) change from baseline = 18.67 (13.26), P<.001). All other outcome measures showed similar patterns. There were no significant differences in improvement between both groups. Majority of the participants found VR training useful and enjoyable, with no serious adverse effects reported. Although additional VR training was not superior to conventional therapy alone, this study demonstrates the feasibility of VR training in early stroke. © The Author(s) 2014.
Briet, Jan Paul; Hageman, Michiel G J S; Overbeek, Celeste L; Mudgal, Chaitanya; Ring, David C; Vranceanu, Ana-Maria
The degree to which patients' expectations are met during an office visit consistently correlates with patients' satisfaction, whereas the relationship between previsit expectations and satisfaction varies. The aim of this pilot study was to preliminarily assess the relationship of psychosocial factors, pain intensity, and magnitude of disability to previsit expectations, met expectations, and satisfaction with medical care in patients with hand and upper extremity conditions in a surgical outpatient clinic. A cohort of 85 outpatients with upper extremity illnesses indicated their previsit expectations (Patients Intention Questionnaire), degree to which these expectations were met (Expectations Met Questionnaire), level of depressive symptoms (Patient Health Questionnaire-2), confidence about the ability to achieve one's goals in spite of pain (Pain Self-Efficacy Questionnaire), pain intensity (Numerical Rating Scale for pain), disability (Disabilities of the Arm Shoulder and Hand, short version; QuickDASH), and satisfaction with the medical visit (Medical Interview Satisfaction Scale). Higher previsit expectations were associated with more depressive symptoms, lower pain self-efficacy, higher pain intensity, and fewer years of education. Patients in the low and moderate met expectations categories had significantly more symptoms of depression, fewer years of education, and more pain compared to those in the high-met expectations category. Fewer years of education and higher pain intensity predicted higher previsit expectations and explained 19% of variance. Psychosocial factors affect both previsit expectations and met expectations during an outpatient visit to a hand surgeon. Met expectations, but not previsit expectations, affect satisfaction. Prognostic, level II. Copyright © 2016 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.
van Huizum, Martine A; Hoornweg, Marije J; de Ruiter, Noor; Oudenhoven, Erik; Hage, J Joris; Veeger, Dirk Jan
Dissection of the latissimus dorsi (LD) flap may have a distinct impact on upper extremity function and strength. To date, insufficient differentiation has been made between loss of muscular strength and shoulder function by dissection of the LD muscle per se and loss of function resulting from all excisional surgery, radiation therapy, and reconstructive procedures at the donor site and the recipient site that may have been combined near the shoulder region. This study determines the long-term effect of the LD breast reconstruction on the strength profiles of the upper extremity by measuring the isometric torque strength both in seven synergistic- and two contra-movement directions. The Biodex System 3 Pro (Biodex Medical Systems, New York, NY) was used in 12 patients at a mean of 3.5 years after surgery, and in 20 matched controls. Because loss of LD muscle may not result in significant impairment of activities of daily live (ADL) even in cases where objective measurements are decreased, this study simultaneously assessed the subjective function by use of the standardised Disability of Arm, Shoulder and Hand (DASH) questionnaire. This study observed a significant long-term loss of 8.8 Nm or 19% LD torque strength in synergistic movement directions after transplantation of the LD muscle. This loss correlated significantly with an increase of the mean DASH score among the patients. Because no significant loss of contra-movement torque strength was observed, it was concluded that the loss of synergistic torque strength appears to result from the loss of LD function per se.
Choi, Kup-Sze; Chan, Tak-Yin
To investigate the feasibility of using tablet device as user interface for students with upper extremity disabilities to input mathematics efficiently into computer. A touch-input system using tablet device as user interface was proposed to assist these students to write mathematics. User-switchable and context-specific keyboard layouts were designed to streamline the input process. The system could be integrated with conventional computer systems only with minor software setup. A two-week pre-post test study involving five participants was conducted to evaluate the performance of the system and collect user feedback. The mathematics input efficiency of the participants was found to improve during the experiment sessions. In particular, their performance in entering trigonometric expressions by using the touch-input system was significantly better than that by using conventional mathematics editing software with keyboard and mouse. The participants rated the touch-input system positively and were confident that they could operate at ease with more practice. The proposed touch-input system provides a convenient way for the students with hand impairment to write mathematics and has the potential to facilitate their mathematics learning. Implications for Rehabilitation Students with upper extremity disabilities often face barriers to learning mathematics which is largely based on handwriting. Conventional computer user interfaces are inefficient for them to input mathematics into computer. A touch-input system with context-specific and user-switchable keyboard layouts was designed to improve the efficiency of mathematics input. Experimental results and user feedback suggested that the system has the potential to facilitate mathematics learning for the students.
Punnett, L; Gold, J; Katz, J; Gore, R; Wegman, D
Aims: To estimate the one year cumulative incidence and persistence of upper extremity (UE) soft tissue disorders, in a fixed cohort of automotive manufacturing workers, and to quantify their associations with ergonomic exposures. Methods: At baseline and at follow up, cases of UE musculoskeletal disorders were determined by interviewer administered questionnaire and standardised physical examination of the upper extremities. The interview obtained new data on psychosocial strain and updated the medical and work histories. An index of exposure to ergonomic stressors, obtained at baseline interview, was the primary independent variable. Cumulative incidence and persistence of UE disorders (defined both by symptoms and by physical examination plus symptoms) were analysed in relation to baseline ergonomic exposures, adjusting for other covariates. The incidence of new disorders was modelled using multivariate proportional hazards regression among workers who were not cases in the first year and the prevalence on both occasions was modelled by repeated measures analysis. Results: A total of 820 workers (69% of eligible cohort members) was examined. Follow up varied slightly by department group but not by baseline exposure level or other characteristics. Among the non-cases at baseline, the cumulative incidence of UE disorders was 14% by symptoms and 12% by symptoms plus examination findings. These rates increased with index of physical exposures primarily among subjects who had the same jobs at follow up as at baseline. Increased exposure during follow up increased risk of incidence. The persistence of UE disorders from baseline to follow up examination was nearly 60% and somewhat associated with baseline exposure score. Conclusions: These longitudinal results confirm the previous cross sectional associations of UE musculoskeletal disorders with exposure to combined ergonomic stressors. The exposure-response relation was similar for incident cases defined by symptoms
Rowe, Veronica T; Winstein, Carolee J; Wolf, Steven L; Woodbury, Michelle L
To investigate the measurement properties of the Functional Test of the Hemiparetic Upper Extremity (FTHUE) and examine how its score may or may not inform design of a rehabilitation program. The FTHUE was recently used in the Interdisciplinary Comprehensive Arm Rehabilitation Evaluation randomized controlled trial. This circumstance provided the opportunity to examine the psychometric properties of the FTHUE as it pertains to contemporary poststroke rehabilitation and recovery models. Outpatient rehabilitation clinic. Participants (N=109; mean age, 61.2±13.5y; mean days poststroke, 46±20.3) with resultant hemiparesis in the upper extremity. Not applicable. Dimensionality was examined with confirmatory factor analysis (CFA), and person and item measures were derived with Rasch item response analysis. Therapists' notes were also reviewed. The CFA results support unidimensionality, and 16 of 17 items fit the Rasch model. The Rasch person separation (2.17) and item separation (4.50) indices, ability strata (3.22), person reliability (.82), and item reliability (.95) indicate good measurement properties. Item difficulties ranked from -6.46 to 3.43 logits; however, there was a substantial ceiling effect of person measures. Post hoc examination of therapists' written observations indicated that the scoring criteria are not sensitive to the movement strategy used for task completion. The FTHUE's item difficulty hierarchy indicated that scores adequately distinguished the ability to perform simple versus complex motor movements of functional tasks. However, the FTHUE scoring method did not allow inclusion of the type of movement strategy used to accomplish task items. Therefore, we suggest modifications to the FTHUE that would allow it to be used for collaborative treatment planning and align well with more contemporary perspectives on treatment theory. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
Talaei-Khoei, Mojtaba; Nemati-Rezvani, Hora; Fischerauer, Stefan F; Ring, David; Chen, Neal; Vranceanu, Ana-Maria
The Gross process model of emotion regulation holds that emotion-eliciting situations (e.g. musculoskeletal illness) can be strategically regulated to determine the final emotional and behavioral response. Also, there is some evidence that innate emotional traits may predispose an individual to a particular regulating coping style. We enrolled 107 patients with upper extremity musculoskeletal illness in this cross-sectional study. They completed self-report measures of positive and negative affect, emotion regulation strategies (cognitive reappraisal and expressive suppression), upper extremity physical function, pain intensity, and demographics. We used Preacher and Hayes' bootstrapping approach to process analysis to infer the direct effect of positive and negative affect on physical function as well as their indirect effects through activation of emotion regulation strategies. Negative affect was associated with decreased physical function. The association was partly mediated by expressive suppression (b (SE)=-.10 (.05), 95% BCa CI [-.21, -.02]). Positive affect was associated with increased physical function. Cognitive reappraisal partially mediated this association (b (SE)=.11 (.05), 95% BCa CI [.03, .24]). After controlling for pain intensity, the ratio of the mediated effect to total effect grew even larger in controlled model comparing to uncontrolled model (33% vs. 26% for expressive suppression and 32% vs. 30% for cognitive reappraisal). The relationships between affect, emotion regulation strategies and physical function appear to be more dependent on the emotional response to an orthopedic condition rather than the intensity of the nociceptive stimulation of the pain. Findings support integration of emotion regulation training in skill-based psychotherapy in this population to mitigate the effect of negative affect and enhance the influence of positive affect on physical function. Copyright © 2017 Elsevier Inc. All rights reserved.
Kraft, George H; Amtmann, Dagmar; Bennett, Susan E; Finlayson, Marcia; Sutliff, Matthew H; Tullman, Mark; Sidovar, Matthew; Rabinowicz, Adrian L
Upper extremity (UE) dysfunction may be present in up to ~80% of individuals with multiple sclerosis (MS), although its importance may be under-recognized relative to walking impairment, which is the hallmark symptom of MS. Upper extremity dysfunction affects independence and can impact the ability to use walking aids. Under-recognition of UE dysfunction may result in part from limited availability of performance-based and patient self-report measures that are validated for use in MS and that can be readily incorporated into clinical practice for screening and regularly scheduled assessments. In addition to the 9-Hole Peg Test, which is part of the Multiple Sclerosis Functional Composite, there are several performance-based measures that are generally used in the rehabilitation setting. These measures include the Box and Block Test, the Action Research Arm Test, the Test d'Evaluation de la performance des Membres Supérieurs des Personnes Agées, and the Jebsen-Taylor Test of Hand Function. Several of these measures were developed for use in stroke, although in contrast to stroke, which is characterized by unilateral dysfunction, UE impairment in MS is generally bilateral, and should be assessed as such. Similarly, patient-reported UE measures are available, including Disabilities of the Arm, Shoulder, and Hand (DASH) and its shorter version, QuickDASH, the Manual Ability Measure, and ABILHAND, although none has been psychometrically validated for MS. Recently, item response theory was used to develop a Neuro-QOL (Quality of Life) UE measure and a Patient-Reported Outcomes Measurement Information System UE measure; neither of these have demonstrated sensitivity to change, limiting their use for longitudinal assessment. Consequently, although work is still needed to develop and validate performance-based and patient-reported measures of UE function that are suitable for use in daily MS clinical practice, currently available UE measures can be recommended for
Finn, Sacha B; Perry, Briana N; Clasing, Jay E; Walters, Lisa S; Jarzombek, Sandra L; Curran, Sean; Rouhanian, Minoo; Keszler, Mary S; Hussey-Andersen, Lindsay K; Weeks, Sharon R; Pasquina, Paul F; Tsao, Jack W
Phantom limb pain (PLP) is prevalent in patients post-amputation and is difficult to treat. We assessed the efficacy of mirror therapy in relieving PLP in unilateral, upper extremity male amputees. Fifteen participants from Walter Reed and Brooke Army Medical Centers were randomly assigned to one of two groups: mirror therapy (n = 9) or control (n = 6, covered mirror or mental visualization therapy). Participants were asked to perform 15 min of their assigned therapy daily for 5 days/week for 4 weeks. The primary outcome was pain as measured using a 100-mm Visual Analog Scale. Subjects in the mirror therapy group had a significant decrease in pain scores, from a mean of 44.1 (SD = 17.0) to 27.5 (SD = 17.2) mm (p = 0.002). In addition, there was a significant decrease in daily time experiencing pain, from a mean of 1,022 (SD = 673) to 448 (SD = 565) minutes (p = 0.003). By contrast, the control group had neither diminished pain (p = 0.65) nor decreased overall time experiencing pain (p = 0.49). A pain decrement response seen by the 10th treatment session was predictive of final efficacy. These results confirm that mirror therapy is an effective therapy for PLP in unilateral, upper extremity male amputees, reducing both severity and duration of daily episodes. NCT0030144 ClinicalTrials.gov.
Fox, Ida K; Davidge, Kristen M; Novak, Christine B; Hoben, Gwendolyn; Kahn, Lorna C; Juknis, Neringa; Ruvinskaya, Rimma; Mackinnon, Susan E
Cervical spinal cord injury can result in profound loss of upper extremity function. Recent interest in the use of nerve transfers to restore volitional control is an exciting development in the care of these complex patients. In this article, the authors review preliminary results of nerve transfers in spinal cord injury. Review of the literature and the authors' cases series of 13 operations in nine spinal cord injury nerve transfer recipients was performed. Representative cases were reviewed to explore critical concepts and preliminary outcomes. The nerve transfers used expendable donors (e.g., teres minor, deltoid, supinator, and brachialis) innervated above the level of the spinal cord injury to restore volitional control of missing function such as elbow extension, wrist extension, and/or hand function (posterior interosseous nerve or anterior interosseous nerve/finger flexors reinnervated). Results from the literature and the authors' patients (after a mean postsurgical follow-up of 12 months) indicate gains in function as assessed by both manual muscle testing and patients' self-reported outcomes measures. Nerve transfers can provide an alternative and consistent means of reestablishing volitional control of upper extremity function in people with cervical level spinal cord injury. Early outcomes provide evidence of substantial improvements in self-reported function despite relatively subtle objective gains in isolated muscle strength. Further work to investigate the optimal timing and combination of nerve transfer operations, the combination of these with traditional treatments (tendon transfer and functional electrical stimulation), and measurement of outcomes is imperative for determining the precise role of these operations. Therapeutic, IV.
Makhni, Eric C; Meadows, Molly; Hamamoto, Jason T; Higgins, John D; Romeo, Anthony A; Verma, Nikhil N
Patient reported outcomes (PROs) serve an integral role in clinical research by helping to determine the impact of clinical care as experienced by the patient. With recent initiatives in health care policy and pay for performance, outcome reporting is now recognized as a policy-driven requirement in addition to a clinical research tool. For outcome measures to satisfy these regulatory requirements and provide value in understanding disease outcomes, they must be responsive and efficient. Recent research has uncovered certain concerns regarding traditional PROs in patients with upper extremity disability and injury. These include lack of consensus regarding selection of PROs for a given diagnoses, inconsistent techniques of administration of the same PROs, and the administrative burden to patients and providers of completing these forms. To address these limitations, emphasis has been placed on streamlining the outcomes reporting process, and, as a result, the National Institutes of Health (NIH) created the Patient Reported Outcomes Measurement Information System (PROMIS). PROMIS forms were created to comprehensively and efficiently measure outcomes across multiple disease states, including orthopedics. These tools exist in computer adaptive testing and short forms with the intention of more efficiently measuring outcomes compared with legacy PROs. The goals of this review are to highlight the main components of PROMIS reporting tools and identify recent use of the scores in the upper extremity literature. The review will also highlight the research and health policy potentials and limitations of implementing PROMIS into everyday orthopedic practice. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
Imamoğlu, Nail; Karadibak, Didem; Ergin, Gülbin; Yavuzşen, Tuğba
The aim of this study was to evaluate the effects of education on the upper extremity functions of patients with lymphedema (LE) after breast cancer treatments. Thirty-eight patients with LE after breast cancer treatments participated in the study. The patients were separated into two groups. Group 1 (n = 19) was educated about the causes and symptoms of LE and the methods for minimizing complications from LE, such as skin care, changes that must be made in daily life activities, exercises, and protective clothing. Group 2 (n = 19) was treated through standard means (surgical, chemotherapy, radiotherapy). A universal goniometer was used to assess the range of motion of the upper extremity of the patients. The Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) and the Shoulder Pain and Disability Index (SPADI) were used to assess shoulder function. The measures were carried out once by the same physiotherapist. The chi-square and Mann-Whitney U tests were used to analyze the data. Group 1, educated about LE, performed better than the other group in shoulder flexion range. When shoulder abduction, internal-external rotation, and elbow flexion motions were compared by using the DASH and SPADI, no significant difference was observed between the groups (p > 0.05). However, when shoulder function was compared, Group 1 was better. There was no significant difference between the groups when the severity of LE was compared. This study underscores the need to develop and implement strategies for LE prevention and education for all breast cancer patients.
Kasarskis, E J; Berryman, S; English, T; Nyland, J; Vanderleest, J G; Schneider, A; Berger, R; McClain, C
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.
Hardwick, Dustin; Bryden, Anne; Kubec, Gina; Kilgore, Kevin
To examine the prevalence of joint contractures in the upper limb and association with voluntary strength, innervation status, functional status, and demographics in a convenience sample of individuals with cervical spinal cord injury to inform future prospective studies. Cross-sectional convenience sampled pilot study. Department of Veterans Affairs Research Laboratory. Thirty-eight participants with cervical level spinal cord injury. Not applicable. Contractures were measured with goniometric passive range of motion. Every joint in the upper extremity was evaluated bilaterally. Muscle strength was measured with manual muscle testing. Innervation status was determined clinically with surface electrical stimulation. Functional independence was measured with the Spinal Cord Independence Measure III (SCIM-III). Every participant tested had multiple joints with contractures and, on average, participants were unable to achieve the normative values of passive movement in 52% of the joints tested. Contractures were most common in the shoulder and hand. There was a weak negative relationship between percentage of contractures and time post-injury and a moderate positive relationship between percentage of contractures and age. There was a strong negative correlation between SCIM-III score and percentage of contractures. Joint contractures were noted in over half of the joints tested. These joint contractures were associated with decreased functional ability as measured by the SCIM-III. This highlights the need the need for detailed evaluation of the arm and hand early after injury as well as continued monitoring of joint characteristics throughout the life course of the individual with tetraplegia.
Schnorenberg, Alyssa J.; Slavens, Brooke A.; Wang, Mei; Vogel, Lawrence; Smith, Peter; Harris, Gerald F.
Pediatric manual wheelchair users (MWU) require high joint demands on their upper extremity (UE) during wheelchair mobility, leading them to be at risk of developing pain and pathology. Studies have examined UE biomechanics during wheelchair mobility in the adult population; however, current methods for evaluating UE joint dynamics of pediatric MWU are limited. An inverse dynamics model is proposed to characterize three-dimensional UE joint kinematics and kinetics during pediatric wheelchair mobility using a SmartWheel instrumented handrim system. The bilateral model comprises thorax, clavicle, scapula, upper arm, forearm, and hand segments and includes the sternoclavicular, acromioclavicular, glenohumeral, elbow and wrist joints. A single 17 year-old male with a C7 spinal cord injury (SCI) was evaluated while propelling his wheelchair across a 15-meter walkway. The subject exhibited wrist extension angles up to 60°, large elbow ranges of motion and peak glenohumeral joint forces up to 10% body weight. Statistically significant asymmetry of the wrist, elbow, glenohumeral and acromioclavicular joints was detected by the model. As demonstrated, the custom bilateral UE pediatric model may provide considerable quantitative insight into UE joint dynamics to improve wheelchair prescription, training, rehabilitation and long-term care of children with orthopaedic disabilities. Further research is warranted to evaluate pediatric wheelchair mobility in a larger population of children with SCI to investigate correlations to pain, function and transitional changes to adulthood. PMID:24309622
Schnorenberg, Alyssa J; Slavens, Brooke A; Wang, Mei; Vogel, Lawrence C; Smith, Peter A; Harris, Gerald F
Pediatric manual wheelchair users (MWU) require high joint demands on their upper extremity (UE) during wheelchair mobility, leading them to be at risk of developing pain and pathology. Studies have examined UE biomechanics during wheelchair mobility in the adult population; however, current methods for evaluating UE joint dynamics of pediatric MWU are limited. An inverse dynamics model is proposed to characterize three-dimensional UE joint kinematics and kinetics during pediatric wheelchair mobility using a SmartWheel instrumented handrim system. The bilateral model comprises thorax, clavicle, scapula, upper arm, forearm, and hand segments and includes the sternoclavicular, acromioclavicular, glenohumeral, elbow and wrist joints. A single 17 year-old male with a C7 spinal cord injury (SCI) was evaluated while propelling his wheelchair across a 15-meter walkway. The subject exhibited wrist extension angles up to 60°, large elbow ranges of motion and peak glenohumeral joint forces up to 10% body weight. Statistically significant asymmetry of the wrist, elbow, glenohumeral and acromioclavicular joints was detected by the model. As demonstrated, the custom bilateral UE pediatric model may provide considerable quantitative insight into UE joint dynamics to improve wheelchair prescription, training, rehabilitation and long-term care of children with orthopedic disabilities. Further research is warranted to evaluate pediatric wheelchair mobility in a larger population of children with SCI to investigate correlations to pain, function and transitional changes to adulthood.
Wirth, Valerie J.; Van Lunen, Bonnie L.; Mistry, Dilaawar; Saliba, Ethan; McCue, Frank C.
Objective: To examine the effect of 15 minutes of upper and lower extremity exercise on raising intramuscular temperature in the triceps surae to 39 ° C to 45 ° C (the therapeutic range). Design and Setting: Intramuscular temperature was measured 5 cm deep in the triceps surae using a 23-gauge thermistor needle microprobe connected to a monitor. Each subject was tested under 3 conditions: 15 minutes of rest, 15 minutes of jogging on a treadmill, and 15 minutes of handpedaling an upper-body ergometer. Exercise bouts were performed at 70% of each subject's maximum heart rate. Subjects: Six males, either sedentary or recreational athletes (age = 21.3 ± 2.9 years; ht = 176.8 ± 6.0 cm; wt = 72.7 ± 11.6 kg; resting heart rate = 57.8 ± 6.74 bpm; target heart rate = 156.5 ± 3.0 bpm), volunteered to participate in this experiment. Measurements: Intramuscular temperature was measured at a depth of 5 cm before and after each test condition. Results: Data analyses consisted of analyses of variance with repeated measures and a Tukey post hoc test (P < .05). The results showed a significant temperature increase over baseline after exercise on the treadmill (2.2 ° C ± 0.63 ° C); however, it did not yield temperature increases ≥ 39 ° C. No significant temperature change occurred after exercise on the upper-body ergometer (-0.45 ° C ± 0.80 ° C). Conclusions: Active exercise increased intramuscular temperature in working muscles but did not affect intramuscular temperature in nonworking muscles. In addition, 15 minutes of jogging on a treadmill at 70% of maximum heart rate was not sufficient to raise intramuscular temperature to 39 ° C to 45 ° C. ImagesFigure 1.Figure 2. PMID:16558512
Janssen, Mariska M H P; Hendriks, Jan C M; Geurts, Alexander C H; de Groot, Imelda J M
Preserving upper extremity (UE) function in patients with Duchenne muscular dystrophy (DMD) is extremely important as it is related to independence and quality of life. For clinical decision making, knowledge of variables associated with UE function is necessary. This knowledge is, however, limited. Therefore, this study aims to gain more insight into the variables associated with UE function in DMD. Data from an international web-based questionnaire on UE function, obtained from 213 DMD patients, were used. Six dependent variables regarding UE function were used in multivariable linear regression analyses. In addition, 26 independent variables regarding patient characteristics, medication, therapy, supportive aids, pain, stiffness and participation were used. Twelve independent variables showed a significant relation to UE function. Variables with a negative relation to UE function were: later disease stage, occurrence of scoliosis, higher age, use of UE splints, more frequent stiffness complaints, more limitations due to stiffness, more frequent elbow pain, and having physical therapy. A positive relation with UE function was seen for going to school or work, use of corticosteroids, higher BMI, and higher age at diagnosis. These variables explained 56-81 % of the variation of the different measures of UE function. Knowledge of variables associated with UE function is very important in the clinical management of DMD patients. The results of this study suggest that corticosteroid use and participation in school and work related activities are positively related to UE function in DMD patients, as well as reducing pain and stiffness and preventing scoliosis.
Landy, David C.; Norton, Robert A.; Barkin, Jodie A.; Henriques, Stephen; Owens, Patrick; Miki, Roberto A.
Background Though pedestrian versus motor vehicle (PVMV) accidents are a common cause of trauma admission and subsequent orthopaedic consult, the prevalence of upper extremity fracture (UEF) in such events and its association with lower extremity injury (LEI) is unknown. We sought to describe UEF in PVMV accident patients at the time of orthopaedic consult. Methods A retrospective chart review was conducted for all pedestrian hit by motor vehicle cases for which an orthopaedic consult was performed at Jackson Memorial Hospital between July 2006 and January 2008. Fractures were recorded by location along with relevant clinical information. Logistic regression was used to calculate odds ratios (O.R.) and 95% confidence intervals (C.I.) for variables associated with UEF. Results 336 cases were identified and reviewed. LEI was the most frequent injury type (67% of cases). UEF was also common, found in 25% of cases (humerus 11%, ulna 7%, radius 6%, hand 4%, and wrist 2%). Tibia or fibula fracture, femur fracture, and spine fracture were negatively associated with UEF in univariate analyses and after controlling for other associated factors. Conclusions In PVMV accident populations, UEF is a frequent injury often seen in the absence of any LEI. These findings emphasize the importance of carefully screening all PVMV accident patients for UEF and may call into question the usefulness of currently discussed injury pattern. PMID:21045980
Bales, Joshua G; Meals, Roy
In the orthopedic patient, the diagnosis of a compression neuropathy may be straightforward. However, various medical comorbidities can obscure this diagnosis. It is paramount for the practicing orthopedic surgeon to have an appreciation for the medical pathology of common axonal neuropathies to properly diagnose, treat, and refer a patient with altered sensation in the upper extremity. The prevalence of diabetes in the United States is 10%, and roughly 20% of diabetic patients have peripheral neuropathy. In addition to diabetes, 32% of heavy alcohol users present with polyneuropathy. With advancements in the treatment of human immunodeficiency virus/acquired immunodeficiency syndrome clinicians may see the long-term effects of the virus manifested as axonal neuropathies and extreme allodynia. In some regions of the world, Hansen's disease usurps diabetes as the most common cause of polyneuropathy. Based on patient demographics and social habits, Lyme disease, multiple sclerosis, and syphilis can all manifest as polyneuropathies. Understanding the common medical causes of neuropathy will aid the orthopedic surgeon in differentiating simple compression neuropathies from diseases mimicking or confounding them.
Dong, C.; Bougher, S. W.; Ma, Y.; Toth, G.; Lee, Y.; Nagy, A. F.; Tenishev, V.; Pawlowski, D. J.; Combi, M. R.
The investigation of ion escape fluxes from Mars, resulting from the solar wind interaction with its upper atmosphere/ionosphere, is important due to its potential impact on the long-term evolution of Mars atmosphere (e.g., loss of water) over its history. In the present work, we adopt the 3-D Mars cold neutral atmosphere profiles (0 ~ 300 km) from the newly developed and validated Mars Global Ionosphere Thermosphere Model (M-GITM) and the 3-D hot oxygen profiles (100 km ~ 5 RM) from the exosphere Monte Carlo model Adaptive Mesh Particle Simulator (AMPS). We apply these 3-D model output fields into the 3-D BATS-R-US Mars multi-fluid MHD (MF-MHD) model (100 km ~ 20 RM) that can simulate the interplay between Mars upper atmosphere and solar wind by considering the dynamics of individual ion species. The multi-fluid MHD model solves separate continuity, momentum and energy equations for each ion species (H+, O+, O2+, CO2+). The M-GITM model together with the AMPS exosphere model take into account the effects of solar cycle and seasonal variations on both cold and hot neutral atmospheres. This feature allows us to investigate the corresponding effects on the Mars upper atmosphere ion escape by using a one-way coupling approach, i.e., both the M-GITM and AMPS model output fields are used as the input for the multi-fluid MHD model and the M-GITM is used as input into the AMPS exosphere model. In this study, we present M-GITM, AMPS, and MF-MHD calculations (1-way coupled) for 2.5 GYA conditions and/or extreme solar conditions for present day Mars (high solar wind velocities, high solar wind dynamic pressure, and high solar irradiance conditions, etc.). Present day extreme conditions may result in MF-MHD outputs that are similar to 2.5 GYA cases. The crustal field orientations are also considered in this study. By comparing estimates of past ion escape rates with the current ion loss rates to be returned by the MAVEN spacecraft (2013-2016), we can better constrain the
Fochtmann, A; Binder, H; Rettl, G; Starlinger, J; Aszmann, O; Sarahrudi, K; Hajdu, S
Third degree open fractures and traumatic sub-/total amputations of the upper extremity represent severe injuries and are associated with a high rate of functional impairment of the affected extremity. More than 20 years ago, the Mangled Extremity Severity Score (MESS) was introduced to predict amputation following severe lower extremity trauma. However, there have been few studies evaluating MESS in connection with the mangled upper limb. A retrospective medical chart review was performed of all patients diagnosed with the aforementioned fractures of the upper extremity treated at the Department of trauma surgery (level I trauma center) and the Clinical division of plastic and reconstructive surgery at the general hospital of Vienna between 1994 and 2014. Fifty-four out of 606 patients (9%) suffered from a total of 61 third degree open fractures or traumatic sub-/total amputations of the upper extremity (Gustilo-Anderson, type IIIA, n=30; Gustilo-Anderson, type IIIB, n=15; Gustilo-Anderson, type IIIC, n=9; traumatic sub-/total amputations, n=7). Thirty-seven out of 54 patients (69%) suffered fractures of the forearm, 10/54 (19%) patients of the humerus and 7/54 (13%) patients of the forearm and the humerus. The median MESS and Injury Severity Score (ISS) for all patients was 5 (range: 3-10) and 9 (range: 4-50), respectively. Seventeen out of 54 patients (31%) were diagnosed with a MESS≥7. Twenty-one out of 54 patients (39%) suffered severe vascular injuries and 22/54 (41%) patients suffered injuries of neural structures. Throughout the therapy process, 6/54 (11%) patients died. Definite limb salvage was achieved in 45 (94%) of the 48 survivors, of whom 9/45 (20%) subjects had a MESS≥7. It became apparent that definite limb salvage could be achieved in the mangled upper extremity regardless of MESS. It should be noted that in the current study, limb functionality was not assessed. However, without a standardized scoring system, there might be
Kalichman, Leonid; Frenkel-Toledo, Silvi; Vered, Elisha; Sender, Iris; Galinka, Tal; Alperovitch-Najenson, Deborah; Ratmansky, Motti; Treger, Iuly
The aim of our single-group pre-post design pilot study was to evaluate the short-term effect of kinesio taping (KT) application on pain and motor ability of hemiplegic shoulder pain (HSP) patients. Eleven poststroke patients with HSP hospitalized in the Department of Neurology C, Loewenstein Rehabilitation Hospital, Raanana, Israel, received a KT application in addition to their usual rehabilitation protocol. KT, consisting of one to three strips according to a predefined algorithm, was applied to the painful shoulder region. A 10 cm Visual Analog Scale of shoulder pain at rest and at arm movement, active and passive pain-free abduction range of motion, Box & Blocks, and Fugl-Meyer upper extremity motor assessment were performed before treatment and 24 h after wearing the KT. After applying the KT, there was no significant change in any variables. Short-term KT application, used in our study, produced no change in shoulder pain, range of motion, or ability of upper limb in HSP patients. Additional studies should evaluate the effect of long-term application and different types of KT applications on HSP.
Bleyenheuft, Yannick; Ebner-Karestinos, Daniela; Surana, Bhavini; Paradis, Julie; Sidiropoulos, Alexis; Renders, Anne; Friel, Kathleen M; Brandao, Marina; Rameckers, Eugene; Gordon, Andrew M
An approach that simultaneously engages both the upper and lower extremities, hand-arm bimanual intensive therapy including lower extremity (HABIT-ILE), has recently demonstrated improvements in upper and lower extremities in children with unilateral cerebral palsy (CP). It is not known whether children with bilateral CP would benefit from this approach. The aim of this study was to examine the efficacy of HABIT-ILE in children with bilateral CP. A quasi-randomized trial design was used, whereby 20 participants (age 6-15y, Gross Motor Function Classification System levels II-IV, Manual Ability Classification System levels I-III) were assigned to a treatment (HABIT-ILE) or a comparison group in the order in which they were enrolled. Children in the HABIT-ILE group were assessed before and after 84 hours of intervention over 13 days, as well as at 3 months' follow-up. Children in the comparison group were assessed at the same time points. Children in both groups were assessed using the Gross Motor Function Measure (GMFM-66) and ABILHAND-Kids (primary measures), and six secondary measures. A group×test session interaction indicated significant improvements in the HABIT-ILE group as assessed by the GMFM-66, lower-extremity performance (6-Minute Walk Test; Pediatric Balance Scale), functional upper-extremity abilities (ABILHAND-Kids/Pediatric Evaluation of Disability Inventory), and the dexterity of the less affected upper extremity. HABIT-ILE is efficacious for improving both upper- and lower-extremity function in children with bilateral CP. © 2017 Mac Keith Press.
Madaric, Juraj; Klepanec, Andrej; Mistrik, Martin; Altaner, Cestmir; Vulev, Ivan
Induction of therapeutic angiogenesis by autologous bone marrow mononuclear cell transplantation has been identified as a potential new option in patients with advanced lower-limb ischemia. There is little evidence of the benefit of intra-arterial cell application in upper-limb critical ischemia. We describe a patient with upper-extremity critical limb ischemia with digital gangrene resulting from hypothenar hammer syndrome successfully treated by intra-arterial autologous bone marrow mononuclear cell transplantation.
Yeldan, Ipek; Huseyınsınoglu, Burcu Ersoz; Akıncı, Buket; Tarakcı, Ela; Baybas, Sevim; Ozdıncler, Arzu Razak
[Purpose] The aim of the study was to evaluate the effects of a very early mirror therapy program on functional improvement of the upper extremity in acute stroke patients. [Subjects] Eight stroke patients who were treated in an acute neurology unit were included in the study. [Methods] The patients were assigned alternatively to either the mirror therapy group receiving mirror therapy and neurodevelopmental treatment or the neurodevelopmental treatment only group. The primary outcome measures were the upper extremity motor subscale of the Fugl-Meyer Assessment, Motricity Index upper extremity score, and the Stroke Upper Limb Capacity Scale. Somatosensory assessment with the Ayres Southern California Sensory Integration Test, and the Barthel Index were used as secondary outcome measures. [Results] No statistically significant improvements were found for any measures in either group after the treatment. In terms of minimally clinically important differences, there were improvements in Fugl-Meyer Assessment and Barthel Index in both mirror therapy and neurodevelopmental treatment groups. [Conclusion] The results of this pilot study revealed that very early mirror therapy has no additional effect on functional improvement of upper extremity function in acute stroke patients. Multicenter trials are needed to determine the results of early application of mirror therapy in stroke rehabilitation.
Yeldan, Ipek; Huseyınsınoglu, Burcu Ersoz; Akıncı, Buket; Tarakcı, Ela; Baybas, Sevim; Ozdıncler, Arzu Razak
[Purpose] The aim of the study was to evaluate the effects of a very early mirror therapy program on functional improvement of the upper extremity in acute stroke patients. [Subjects] Eight stroke patients who were treated in an acute neurology unit were included in the study. [Methods] The patients were assigned alternatively to either the mirror therapy group receiving mirror therapy and neurodevelopmental treatment or the neurodevelopmental treatment only group. The primary outcome measures were the upper extremity motor subscale of the Fugl-Meyer Assessment, Motricity Index upper extremity score, and the Stroke Upper Limb Capacity Scale. Somatosensory assessment with the Ayres Southern California Sensory Integration Test, and the Barthel Index were used as secondary outcome measures. [Results] No statistically significant improvements were found for any measures in either group after the treatment. In terms of minimally clinically important differences, there were improvements in Fugl-Meyer Assessment and Barthel Index in both mirror therapy and neurodevelopmental treatment groups. [Conclusion] The results of this pilot study revealed that very early mirror therapy has no additional effect on functional improvement of upper extremity function in acute stroke patients. Multicenter trials are needed to determine the results of early application of mirror therapy in stroke rehabilitation. PMID:26696729
Basu, Anna Purna; Pearse, Janice; Kelly, Susan; Wisher, Vicki; Kisler, Jill
Children with hemiplegic cerebral palsy often have marked hand involvement with excessive thumb adduction and flexion and limited active wrist extension from infancy. Post-lesional aberrant plasticity can lead to progressive abnormalities of the developing motor system. Disturbances of somatosensory and visual function and developmental disregard contribute to difficulties with hand use. Progressive soft tissue and bony changes may occur, leading to contractures, which further limit function in a vicious cycle. Early intervention might help to break this cycle, however, the precise nature and appropriateness of the intervention must be carefully considered. Traditional approaches to the hemiplegic upper limb include medications and botulinum toxin injections to manage abnormalities of tone, and surgical interventions. Therapist input, including provision of orthoses, remains a mainstay although many therapies have not been well evaluated. There has been a recent increase in interventions for the hemiplegic upper limb, mostly aimed outside the period of infancy. These include trials of constraint-induced movement therapy (CIMT) and bimanual therapy as well as the use of virtual reality and robot-assisted therapy. In future, non-invasive brain stimulation may be combined with therapy. Interventions under investigation in the infant age group include modified CIMT and action observation therapy. A further approach which may be suited to the infant with thumb-in-palm deformity, but which requires evaluation, is the use of elastic taping. Enhanced cutaneous feedback through mechanical stimulation to the skin provided by the tape during movement has been postulated to modulate ongoing muscle activity. If effective, this would represent a low-cost, safe, widely applicable early intervention. PMID:25610423
Escamilla, Rafael F; Andrews, James R
Understanding when and how much shoulder muscles are active during upper extremity sports is helpful to physicians, therapists, trainers and coaches in providing appropriate treatment, training and rehabilitation protocols to these athletes. This review focuses on shoulder muscle activity (rotator cuff, deltoids, pectoralis major, latissimus dorsi, triceps and biceps brachii, and scapular muscles) during the baseball pitch, the American football throw, the windmill softball pitch, the volleyball serve and spike, the tennis serve and volley, baseball hitting, and the golf swing. Because shoulder electromyography (EMG) data are far more extensive for overhead throwing activities compared with non-throwing upper extremity sports, much of this review focuses on shoulder EMG during the overhead throwing motion. Throughout this review shoulder kinematic and kinetic data (when available) are integrated with shoulder EMG data to help better understand why certain muscles are active during different phases of an activity, what type of muscle action (eccentric or concentric) occurs, and to provide insight into the shoulder injury mechanism. Kinematic, kinetic and EMG data have been reported extensively during overhead throwing, such as baseball pitching and football passing. Because shoulder forces, torques and muscle activity are generally greatest during the arm cocking and arm deceleration phases of overhead throwing, it is believed that most shoulder injuries occur during these phases. During overhead throwing, high rotator cuff muscle activity is generated to help resist the high shoulder distractive forces approximately 80-120% bodyweight during the arm cocking and deceleration phases. During arm cocking, peak rotator cuff activity is 49-99% of a maximum voluntary isometric contraction (MVIC) in baseball pitching and 41-67% MVIC in football throwing. During arm deceleration, peak rotator cuff activity is 37-84% MVIC in baseball pitching and 86-95% MVIC in football
Ribeiro, J; Figueiredo, P; Sousa, A; Monteiro, J; Pelarigo, J; Vilas-Boas, J P; Toussaint, H M; Fernandes, R F
Our purpose was to characterize the oxygen uptake ([Formula: see text]) kinetics, assess the energy systems contributions and determine the energy cost when swimming front crawl at extreme intensity. Complementarily, we compared swimming full body with upper body only. Seventeen swimmers performed a 100 m maximal front crawl in two conditions: once swimming with full body and other using only the upper propulsive segments. The [Formula: see text] was continuously measured using a telemetric portable gas analyser (connected to a respiratory snorkel), and the capillary blood samples for lactate concentration analysis were collected. A sudden increase in [Formula: see text] in the beginning of exercise, which continuously rose until the end of the bout (time: 63.82 ± 3.38 s; [Formula: see text]: 56.07 ± 5.19 ml min(-1) kg(-1); [Formula: see text] amplitude: 41.88 ± 4.74 ml min(-1) kg(-1); time constant: 12.73 ± 3.09 s), was observed. Aerobic, anaerobic lactic and alactic pathways were estimated and accounted for 43.4, 33.1 and 23.5 % of energy contribution and 1.16 ± 0.10 kJ m(-1) was the energy cost. Complementarily, the absence of lower limbs lead to a longer time to cover 100 m (71.96 ± 5.13 s), slower [Formula: see text] kinetics, lower aerobic and anaerobic (lactic and alactic) energy production and lower energy cost. Despite the short duration of the event, the aerobic energy contribution covers about 50 % of total metabolic energy liberation, highlighting that both aerobic and anaerobic energy processes should be developed to improve the 100 m swimming performance. Lower limbs action provided an important contribution in the energy availability in working muscles being advised its full use in this short duration and very high-intensity event.
Pitangui, Ana C.R.; Nascimento, Vinícius Y.S.; da Silva, Hítalo A.; dos Passos, Muana H.P.; de Araújo, Rodrigo C.
Background The Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) has been proposed as an option to assess upper limb function and stability; however, there are few studies that support the use of this test in adolescents. Purpose The purpose of the present study was to investigate the intersession reliability and agreement of three CKCUEST scores in adolescents and establish clinimetric values for this test. Study Design Test-retest reliability Methods Twenty-five healthy adolescents of both sexes were evaluated. The subjects performed two CKCUEST with an interval of one week between the tests. An intraclass correlation coefficient (ICC3,3) two-way mixed model with a 95% interval of confidence was utilized to determine intersession reliability. A Bland-Altman graph was plotted to analyze the agreement between assessments. The presence of systematic error was evaluated by a one-sample t test. The difference between the evaluation and reevaluation was observed using a paired-sample t test. The level of significance was set at 0.05. Standard error of measurements and minimum detectable changes were calculated. Results The intersession reliability of the average touches score, normalized score, and power score were 0.68, 0.68 and 0.87, the standard error of measurement were 2.17, 1.35 and 6.49, and the minimal detectable change was 6.01, 3.74 and 17.98, respectively. The presence of systematic error (p < 0.014), the significant difference between the measurements (p < 0.05), and the analysis of the Bland-Altman graph infer that CKCUEST is a discordant test with moderate to excellent reliability when used with adolescents. Conclusion The CKCUEST is a measurement with moderate to excellent reliability for adolescents. Level of Evidence 2b PMID:28217423
Solomito, Matthew J; Garibay, Erin J; Woods, Jessica R; Õunpuu, Sylvia; Nissen, Carl W
The incidence of upper extremity injuries in baseball pitchers is increasing. Over the past decade there has been a great deal of research attempting to elucidate the cause of these injuries, focusing mainly on the mechanics of the pitching arm with no examination of other key segments, such as the trunk. This is surprising, as coaches will often comment on trunk position in an effort to improve pitching outcomes. To determine the association between contralateral trunk lean and ball velocity and the moments about the elbow and glenohumeral joint. Descriptive laboratory study. A total of 99 pitchers were recruited for this study and underwent a pitching analysis using 3-dimensional motion analysis techniques. A random intercept mixed-effects regression model was used to determine if statistically significant associations existed between contralateral trunk lean (away from the pitching arm side) and ball velocity, as well as the elbow varus moment and glenohumeral internal rotation moment. The results demonstrated that the greatest contralateral trunk lean occurs around the time of the peak elbow varus moment. Statistically significant associations were found between contralateral trunk lean and increased ball velocity (P=.003) indicating that for every 10° increase in contralateral lean, ball velocity increased 0.5 m/s. Results also indicated that for every 10° increase in contralateral lean, elbow varus moments increased by 3.7 N·m and glenohumeral internal rotation moments increased by 2.5 N·m (P<.001 for both). Study findings indicate that the positioning of the trunk plays a substantial role in pitching performance and pitcher injury potential. This work helps to demonstrate the importance of proper trunk mechanics in pitching and highlights the need for future research to understand the contribution of the trunk to pitching mechanics. Pitching coaches and trainers can use the results of this study to stress the importance of proper trunk mechanics in
DUMA, STEFAN M.; SCHREIBER, PHIL H.; McMASTER, JOHN D.; CRANDALL, JEFF R.; BASS, CAMERON R.; PILKEY, WALTER D.
This paper presents the dynamic injury tolerances for the female humerus and forearm derived from dynamic 3-point bending tests using 22 female cadaver upper extremities. Twelve female humeri were tested at an average strain rate of 3.7±1.3%/s. The strain rates were chosen to be representative of those observed during upper extremity interaction with frontal and side airbags. The average moment to failure when mass scaled for the 5th centile female was 128±19 Nm. Using data from the in situ strain gauges during the drop tests and geometric properties obtained from pretest CT scans, an average dynamic elastic modulus for the female humerus was found to be 24.4±3.9 GPa. The injury tolerance for the forearm was determined from 10 female forearms tested at an average strain rate of 3.94±2.0%/s. Using 3 matched forearm pairs, it was determined that the forearm is 21% stronger in the supinated position (92±5 Nm) versus the pronated position (75±7 Nm). Two distinct fracture patterns were seen for the pronated and supinated groups. In the supinated position the average difference in fracture time between the radius and ulna was a negligible 0.4±0.3 ms. However, the pronated tests yielded an average difference in fracture time of 3.6±1.2 ms, with the ulna breaking before the radius in every test. This trend implies that in the pronated position, the ulna and radius are loaded independently, while in the supinated position the ulna and radius are loaded together as a combined structure. To produce a conservative injury criterion, a total of 7 female forearms were tested in the pronated position, which resulted in the forearm injury criterion of 58±12 Nm when scaled for the 5th centile female. It is anticipated that these data will provide injury reference values for the female forearm during driver air bag loading, and the female humerus during side air bag loading. PMID:10386782
Hoozemans, M J M; Knelange, E B; Frings-Dresen, M H W; Veeger, H E J; Kuijer, P P F M
Systematically review observational studies concerning the question whether workers that perform pushing/pulling activities have an increased risk for upper extremity symptoms as compared to workers that perform no pushing/pulling activities. A search in MEDLINE via PubMed and EMBASE was performed with work-related search terms combined with push/pushing/pull/pulling. Studies had to examine exposure to pushing/pulling in relation to upper extremity symptoms. Two authors performed the literature selection and assessment of the risk of bias in the studies independently. A best evidence synthesis was used to draw conclusions in terms of strong, moderate or conflicting/insufficient evidence. The search resulted in 4764 studies. Seven studies were included, with three of them of low risk of bias, in total including 8279 participants. A positive significant relationship with upper extremity symptoms was observed in all four prospective cohort studies with effect sizes varying between 1.5 and 4.9. Two out of the three remaining studies also reported a positive association with upper extremity symptoms. In addition, significant positive associations with neck/shoulder symptoms were found in two prospective cohort studies with effect sizes of 1.5 and 1.6, and with shoulder symptoms in one of two cross-sectional studies with an effect size of 2.1. There is strong evidence that pushing/pulling is related to upper extremity symptoms, specifically for shoulder symptoms. There is insufficient or conflicting evidence that pushing/pulling is related to (combinations of) upper arm, elbow, forearm, wrist or hand symptoms.
Khosronejad, Ali; Le, Trung; DeWall, Petra; Bartelt, Nicole; Woldeamlak, Solomon; Yang, Xiaolei; Sotiropoulos, Fotis
We present data-driven numerical simulations of extreme flooding in a large-scale river coupling coherent-structure resolving hydrodynamics with bed morphodynamics under live-bed conditions. The study area is a ∼ 3.2 km long and ∼ 300 m wide reach of the Upper Mississippi River, near Minneapolis MN, which contains several natural islands and man-made hydraulic structures. We employ the large-eddy simulation (LES) and bed-morphodynamic modules of the Virtual Flow Simulator (VFS-Rivers) model, a recently developed in-house code, to investigate the flow and bed evolution of the river during a 100-year flood event. The coupling of the two modules is carried out via a fluid-structure interaction approach using a nested domain approach to enhance the resolution of bridge scour predictions. We integrate data from airborne Light Detection and Ranging (LiDAR), sub-aqueous sonar apparatus on-board a boat and in-situ laser scanners to construct a digital elevation model of the river bathymetry and surrounding flood plain, including islands and bridge piers. A field campaign under base-flow condition is also carried out to collect mean flow measurements via Acoustic Doppler Current Profiler (ADCP) to validate the hydrodynamic module of the VFS-Rivers model. Our simulation results for the bed evolution of the river under the 100-year flood reveal complex sediment transport dynamics near the bridge piers consisting of both scour and refilling events due to the continuous passage of sand dunes. We find that the scour depth near the bridge piers can reach to a maximum of ∼ 9 m. The data-driven simulation strategy we present in this work exemplifies a practical simulation-based-engineering-approach to investigate the resilience of infrastructures to extreme flood events in intricate field-scale riverine systems.
Oliver, Gretchen D; Plummer, Hillary A; Keeley, David W
Fast-pitch softball has become an increasingly popular sport for female athletes. There has been little research examining the windmill softball pitch in the literature. The purpose of this study was to describe the muscle activation patterns of 3 upper extremity muscles (biceps, triceps, and rhomboids [scapular stabilizers]) and 2 lower extremity muscles (gluteus maximus and medius) during the 5 phases of the windmill softball pitch. Data describing muscle activation were collected on 7 postpubescent softball pitchers (age 17.7 ± 2.6 years; height 169 ± 5.4 cm; mass 69.1 ± 5.4 kg). Surface electromyographic data were collected using a Myopac Jr 10-channel amplifier (RUN Technologies Scientific Systems, Laguna Hills, CA, USA) synchronized with The MotionMonitor™ motion capture system (Innovative Sports Training Inc, Chicago IL, USA) and presented as a percent of maximum voluntary isometric contraction. Gluteus maximus activity reached (196.3% maximum voluntary isometric contraction [MVIC]), whereas gluteus medius activity was consistent during the single leg support of phase 3 (101.2% MVIC). Biceps brachii activity was greatest during phase 4 of the pitching motion. Triceps brachii activation was consistently >150% MVIC throughout the entire pitching motion, whereas the scapular stabilizers were most active during phase 2 (170.1% MVIC). The results of this study indicate the extent to which muscles are activated during the windmill softball pitch, and this knowledge can lead to the development of proper preventative and rehabilitative muscle strengthening programs. In addition, clinicians will be able to incorporate strengthening exercises that mimic the timing of maximal muscle activation most used during the windmill pitching phases.
Rohafza, Maryam; Fluet, Gerard G; Qiu, Qinyin; Adamovich, Sergei
Timed measures of standardized functional tasks are commonly used to measure treatment effects in persons with upper extremity (UE) paresis due to stroke. The effectiveness of their ability to measure motor recovery has come into question because of their inability to distinguish between motor recovery and compensations. This paper presents three linear regression models generated from twelve kinematic measures collected during the performance of a two phase reach/grasp and transport /release activity as performed by 21 persons with upper extremity hemiparesis due to chronic stroke. One of these models demonstrated a statistically significant correlation with the subjects' scores on the Wolf Motor Function Test (WMFT), a battery of fifteen standardized upper extremity functional activities. The second and third models demonstrated a statistically significant correlation with the subjects' WMFT change scores elicited by a two week intensive upper extremity motor rehabilitation intervention. The high correlation suggests that models of kinematic measurements can be used to predict neurologic improvement and the effectiveness of treatment.
Ringenbach, Shannon D. R; Albert, Andrew R.; Chen, Chih-Chia; Alberts, Jay L.
The aim of this study was to examine the effectiveness of 2 modes of exercise on cognitive and upper extremity movement functioning in adolescents with Down syndrome (DS). Nine participants randomly completed 3 interventions over 3 consecutive weeks. The interventions were: (a) voluntary cycling (VC), in which participants cycled at their…
Imaiso, Y; Taniwaki, T; Yamada, T; Kira, J; Kobayashi, T
We report a 54-year-old man with vitamin B12 deficiency myelopathy limited to the upper extremity region. He was well until October, 1995, when he had an onset of exertional dyspnea and general fatigue. Then he noted tingling sensation in bilateral upper extremities in March, 1996. He had undergone total gastrectomy due to gastric ulcer 15 years ago. Neurological examination revealed superficial and vibratory sensory loss in the upper extremities distal to elbows, and pseudoathetoid movement of the left fingers. Otherwise neurological examination was unremarkable. Laboratory examination revealed macrocytic anemia, and low serum vitamin B12. However, serum folate was within the normal range. In SEP studies, median nerve stimulation evoked peripheral N9 and N13 potentials, but not cortical N20 one. Posterior tibial nerve stimulation elicited normal responses. MEP, VEP, needle EMG, and nerve conduction studies gave normal findings. T2-weighted MRI showed high signal intensity lesions at the C1-Th1 level in the posterior column, especially in the cuneate fascicles. The gracile fascicles were spared. This is a very rare case of myelopathy due to vitamin B12 deficiency presenting only sensory disturbances in both upper extremities. The lesions limited in the cuneate fascicle were confirmed by electrophysiological, and neuroradiological examinations.
Ringenbach, Shannon D. R; Albert, Andrew R.; Chen, Chih-Chia; Alberts, Jay L.
The aim of this study was to examine the effectiveness of 2 modes of exercise on cognitive and upper extremity movement functioning in adolescents with Down syndrome (DS). Nine participants randomly completed 3 interventions over 3 consecutive weeks. The interventions were: (a) voluntary cycling (VC), in which participants cycled at their…
Chan, Y W; Kay, R; Schwartz, M S
Single fibre electromyography (SFEMG) was performed on six young Chinese males with distal spinal muscular atrophy of the upper extremities. Abnormal SFEMG findings of increased fibre density, jitter and blocking were recorded over both arms and legs in all patients, suggesting a more generalised disturbance than would appear clinically. Images PMID:2019844
Park, Jin-Young; Chang, Moonyoung; Kim, Kyeong-Mi; Kim, Hee-Jung
The purpose of this study was to examine the effects of mirror therapy on upper-extremity function and activities of daily living in chronic stroke patients. [Subjects and Methods] Fifteen subjects were each assigned to a mirror therapy group and a sham therapy group. The Fugl-Meyer Motor Function Assessment and the Box and Block Test were performed to compare paretic upper-extremity function and hand coordination abilities. The functional independence measurement was conducted to compare abilities to perform activities of daily living. [Results] Paretic upper-extremity function and hand coordination abilities were significantly different between the mirror therapy and sham therapy groups. Intervention in the mirror therapy group was more effective than in the sham therapy group for improving the ability to perform activities of daily living. Self-care showed statistically significant differences between the two groups. [Conclusion] Mirror therapy is effective in improving paretic upper-extremity function and activities of daily living in chronic stroke patients. PMID:26180297
Park, Jin-Young; Chang, Moonyoung; Kim, Kyeong-Mi; Kim, Hee-Jung
The purpose of this study was to examine the effects of mirror therapy on upper-extremity function and activities of daily living in chronic stroke patients. [Subjects and Methods] Fifteen subjects were each assigned to a mirror therapy group and a sham therapy group. The Fugl-Meyer Motor Function Assessment and the Box and Block Test were performed to compare paretic upper-extremity function and hand coordination abilities. The functional independence measurement was conducted to compare abilities to perform activities of daily living. [Results] Paretic upper-extremity function and hand coordination abilities were significantly different between the mirror therapy and sham therapy groups. Intervention in the mirror therapy group was more effective than in the sham therapy group for improving the ability to perform activities of daily living. Self-care showed statistically significant differences between the two groups. [Conclusion] Mirror therapy is effective in improving paretic upper-extremity function and activities of daily living in chronic stroke patients.
Yoon, Jisun; Chun, Min Ho; Lee, Sook Joung; Kim, Bo Ryun
The aim of this study was to evaluate the benefit of virtual reality-based rehabilitation on upper-extremity function in patients with brain tumor. Patients with upper-extremity dysfunction were divided into age-matched and tumor type-matched two groups. The intervention group performed the virtual reality program 30 mins per session for 9 sessions and conventional occupational therapy 30 mins per session for 6 sessions for 3 wks, whereas the control group received conventional occupational therapy alone 30 mins per session for 15 sessions for 3 wks. The Box and Block test, the Manual Function test, and the Fugl-Meyer scale were used to evaluate upper-extremity function. The Korean version of the Modified Barthel Index was used to assess activities of daily living. Forty patients completed the study (20 for each group). Each group exhibited significant posttreatment improvements in the Box and Block test, Manual Function test, Fugl-Meyer scale, and Korean version of the Modified Barthel Index scores. The Box and Block test, the Fugl-Meyer scale, and the Manual Function test showed greater improvements in shoulder/elbow/forearm function in the intervention group and hand function in the control group. Virtual reality-based rehabilitation combined with conventional occupational therapy may be more effective than conventional occupational therapy, especially for proximal upper-extremity function in patients with brain tumor. Further studies considering hand function, such as use of virtual reality programs that targeting hand use, are required.
Morino, Akira; Shida, Masahiro; Tanaka, Masashi; Sato, Kimihiro; Seko, Toshiaki; Ito, Shunsuke; Ogawa, Shunichi; Yokoi, Yuka; Takahashi, Naoaki
[Purpose] The aim of the present study was to examine, in patients requiring prolonged mechanical ventilation, if the response of tidal volume during manually assisted breathing is dependent upon both upper extremity muscle tone and the pressure intensity of manually assisted breathing. [Subjects] We recruited 13 patients on prolonged mechanical ventilation, and assessed their upper extremity muscle tone using the modified Ashworth scale (MAS). The subjects were assigned to either the low MAS group (MAS≤2, n=7) or the high MAS group (MAS≥3, n=6). [Methods] The manually assisted breathing technique was applied at a pressure of 2 kgf and 4 kgf. A split-plot ANOVA was performed to compare the tidal volume of each pressure during manually assisted breathing between the low and the high MAS groups. [Results] Statistical analysis showed there were main effects of the upper extremity muscle tone and the pressure intensity of the manually assisted breathing technique. There was no interaction between these factors. [Conclusion] Our findings reveal that the tidal volume during the manually assisted breathing technique for patients with prolonged mechanical ventilation depends upon the patient’s upper extremity muscle tone and the pressure intensity. PMID:26357431
Gordon, Andrew M.
Impaired hand function is among the most functionally disabling symptoms of unilateral cerebral palsy. Evidence-based treatment approaches are generally lacking. However, recent approaches providing intensive upper extremity training appear promising. In this review, we first describe two such approaches, constraint-induced movement therapy (CIMT)…
Thorley, Megan; Lannin, Natasha; Cusick, Anne; Novak, Iona; Boyd, Roslyn
Aim: To investigate reliability of the Quality of Upper Extremity Skills Test (QUEST) scores for children with cerebral palsy (CP) aged 2-12 years. Method: Thirty-one QUESTs from 24 children with CP were rated once by two raters and twice by one rater. Internal consistency of total scores, inter- and intra-rater reliability findings for total,…
Moon, Young-Eun; Kim, Sang-Hyun
The aim of this study was to compare the effects of ethyl chloride and placebo sprays for reducing pain induced by needle electromyography and changes in parameters of the motor unit action potential during needle electromyography of the upper extremity. Sixty patients were randomized into the ethyl chloride or placebo spray groups. In both groups, spray was applied just before needle electromyography of the flexor carpi radialis, and a visual analog scale to evaluate the pain of needle electromyography and a five-point Likert scale for patient satisfaction and preference for reexamination were compared between the two groups. Then, changes in the amplitude, phases, turns, and duration of the motor unit action potential during needle electromyography of the biceps brachii were compared before and after spraying in each group. The visual analog scale was significantly lower, and patient satisfaction and preference for reexamination were significantly higher in the ethyl chloride spray group. Among the parameters of the motor unit action potential, there were no significant changes except for an increased duration after spraying with ethyl chloride. Ethyl chloride spray can effectively reduce pain, but it must be used with caution because it may affect parameters of the motor unit action potential during needle electromyography.
Davis, J T; Limpisvasti, Orr; Fluhme, Derrick; Mohr, Karen J; Yocum, Lewis A; Elattrache, Neal S; Jobe, Frank W
Increased pitch counts have been linked to increased complaints of shoulder and elbow pain in youth baseball pitchers. Improper pitching mechanics have not been shown to adversely affect the upper extremity in youth pitchers. The correct performance of 5 biomechanical pitching parameters correlates with lower humeral internal rotation torque and elbow valgus load, as well as higher pitching efficiency, in youth and adolescent pitchers. Descriptive laboratory study. In sum, 169 baseball pitchers (aged 9-18) were analyzed using a quantitative motion analysis system and a high-speed video while throwing fastballs. The correct performance of 5 common pitching parameters was compared with each pitcher's age, humeral internal rotation torque, elbow valgus load, and calculated pitching efficiency. Motion analysis correlated with video analysis for all 5 parameters (P < .05). Youth pitchers (aged 9-13) performing 3 or more parameters correctly showed lower humeral internal rotation torque, lower elbow valgus load, and higher pitching efficiency (P < .05). Youth pitchers with better pitching mechanics generate lower humeral internal rotation torque, lower elbow valgus load, and more efficiency than do those with improper mechanics. Proper pitching mechanics may help prevent shoulder and elbow injuries in youth pitchers. The parameters described in this study may be used to improve the pitching mechanics of youth pitchers and possibly reduce shoulder and elbow pain in youth baseball pitchers.
Cho, Erina; Chen, Richard; Merhi, Lukas-Karim; Xiao, Zhen; Pousett, Brittany; Menon, Carlo
Advancement in assistive technology has led to the commercial availability of multi-dexterous robotic prostheses for the upper extremity. The relatively low performance of the currently used techniques to detect the intention of the user to control such advanced robotic prostheses, however, limits their use. This article explores the use of force myography (FMG) as a potential alternative to the well-established surface electromyography. Specifically, the use of FMG to control different grips of a commercially available robotic hand, Bebionic3, is investigated. Four male transradially amputated subjects participated in the study, and a protocol was developed to assess the prediction accuracy of 11 grips. Different combinations of grips were examined, ranging from 6 up to 11 grips. The results indicate that it is possible to classify six primary grips important in activities of daily living using FMG with an accuracy of above 70% in the residual limb. Additional strategies to increase classification accuracy, such as using the available modes on the Bebionic3, allowed results to improve up to 88.83 and 89.00% for opposed thumb and non-opposed thumb modes, respectively. PMID:27014682
Covill, Laura G; Petersen, Shannon M
Upper extremity (UE) neurodynamic tests are used to examine neural tissue in patients with neuro-musculoskeletal disorders. Although comparisons between involved and uninvolved limbs are made clinically, minimal data exist reflecting the normal variation between sides. The purpose of this study was to determine if within-subject differences exist between limbs in the UE component of neurodynamic tests of the median, radial, and ulnar nerves. Sixty-one healthy subjects were examined. Difference between limbs for the median nerve-biased test was significant (right=16.4° ± 11.4°, left=20.1° ± 13.7°; p=0.045). There was no significant difference between limbs for the radial or ulnar nerve-biased tests. Correlation between limbs was poor for all tests (median r(2) =0.14; radial r(2) =0.20; ulnar r(2) =0.13). Lower-bound scores were calculated to determine the amount of difference needed to consider asymmetry beyond measurement error; the scores for each neurodynamic test were as follows: median 27°, radial 20°, and ulnar 21°. The results of this study show that between-limb values have low correlation and that it may be normal for an individual to have range of motion differences between limbs with neurodynamic tests.
Shikako-Thomas, Keiko; Fehlings, Darcy; Germain, Manon; Gordon, Andrew M; Maynard, Doug; Majnemer, Annette
Intensive upper extremity training (IUET) has demonstrated efficacy in clinical and functioning outcomes in children with hemiplegia. However, implementation in the clinical context requires novel service models and knowledge translation. To map implementation of IUET in Canada, to identify factors associated with the implementation and best practices for implementation. Mixed-methods design; descriptive statistics, chi-square tests. Individual phone interviews and focus groups with purposeful sampling. Thematic analysis; telephone surveys with managers of 31 pediatric rehabilitation centers across Canada. Four focus groups across Canada and one in the Netherlands. Implementation of IUET group interventions is limited in Canada (7/31). Barriers included beliefs and values related to evidence-based practice, opportunities for continuing education, researchers-clinicians partnerships, access to scientific literature, and the presence of a champion. Pressure from parents and media presenting IUET as a novel and effective therapy, support and flexibility of families, having the critical mass of clients and a managerial willingness to accommodate new ideas and restructure service provision were some facilitators. Uptake of the evidence requires many steps described in the knowledge translation cycle. Factors identified in the study could be considered in most clinical settings to facilitate the uptake of research evidence for IUET.
Blaivas, Michael; Stefanidis, Konstantinos; Nanas, Serafim; Poularas, John; Wachtel, Mitchell; Cohen, Rubin; Karakitsos, Dimitrios
Background-Aim. Upper extremity deep vein thrombosis (UEDVT) is an increasingly recognized problem in the critically ill. We sought to identify the prevalence of and risk factors for UEDVT, and to characterize sonographically detected thrombi in the critical care setting. Patients and Methods. Three hundred and twenty patients receiving a subclavian or internal jugular central venous catheter (CVC) were included. When an UEDVT was detected, therapeutic anticoagulation was started. Additionally, a standardized ultrasound scan was performed to detect the extent of the thrombus. Images were interpreted offline by two independent readers. Results. Thirty-six (11.25%) patients had UEDVT and a complete scan was performed. One (2.7%) of these patients died, and 2 had pulmonary embolism (5.5%). Risk factors associated with UEDVT were presence of CVC [(odds ratio (OR) 2.716, P = 0.007)], malignancy (OR 1.483, P = 0.036), total parenteral nutrition (OR 1.399, P = 0.035), hypercoagulable state (OR 1.284, P = 0.045), and obesity (OR 1.191, P = 0.049). Eight thrombi were chronic, and 28 were acute. We describe a new sonographic sign which characterized acute thrombosis: a double hyperechoic line at the interface between the thrombus and the venous wall; but its clinical significance remains to be defined. Conclusion. Presence of CVC was a strong predictor for the development of UEDVT in a cohort of critical care patients; however, the rate of subsequent PE and related mortality was low. PMID:22655181
Keenan, M A
Spasticity that interferes with upper extremity function is common in adults following stroke, brain injury, or anoxia. During the period of neurologic recovery definitive surgical procedures are avoided. Techniques to temporarily reduce spasticity include the implantation of a MicroPort reservoir and catheter for repeated branchial plexus blocks and phenol nerve blocks, which provide longer lasting relief of noxious muscle tone. Percutaneous blocks of the musculocutaneous and recurrent median nerves and motor point blocks of the pectoralis major, the brachioradialis, and forearm flexor muscles are easily performed at bedside. The motor branch of the ulnar nerve can be injected surgically with phenol to diminish intrinsic spasticity. When neurologic recovery has plateaued, hand placement can be improved in many patients following proximal release of the brachioradialis muscle and lengthening of the biceps and branchialis tendons. Hand function is enhanced by fractional lengthening of spastic wrist and finger flexors. Intrinsic spasticity must be addressed at the same time by phenol block or intrinic release. When extensor function is lacking, a tenodesis of the wrist extensors is helpful. The thumb-in-palm deformity requires proximal release of the thenar muscles as well as lengthening of the flexor pollicis longus. Contracture releases in the nonfunctional arm improve hygiene and ease care.
Adams, Richard J.; Lichter, Matthew D.; Krepkovich, Eileen T.; Ellington, Allison; White, Marga; Diamond, Paul T.
A study was conducted to investigate the criterion validity of measures of upper extremity (UE) motor function derived during practice of virtual activities of daily living (ADLs). Fourteen hemiparetic stroke patients employed a Virtual Occupational Therapy Assistant (VOTA), consisting of a high-fidelity virtual world and a Kinect™ sensor, in four sessions of approximately one hour in duration. An Unscented Kalman Filter-based human motion tracking algorithm estimated UE joint kinematics in real-time during performance of virtual ADL activities, enabling both animation of the user’s avatar and automated generation of metrics related to speed and smoothness of motion. These metrics, aggregated over discrete sub-task elements during performance of virtual ADLs, were compared to scores from an established assessment of UE motor performance, the Wolf Motor Function Test (WMFT). Spearman’s rank correlation analysis indicates a moderate correlation between VOTA-derived metrics and the time-based WMFT assessments, supporting the criterion validity of VOTA measures as a means of tracking patient progress during an UE rehabilitation program that includes practice of virtual ADLs. PMID:25265612
Nikolov, Krasimir V.; Baleva, Marta P.; Savov, Alexey S.
The levels of antibodies to cardiolipin and β2-glycoprotein I and polymorphic variants G1691A of Factor V (factor V Leiden, FVL) and G20210A of prothrombin gene (G20210A) were studied in 16 patients with upper-extremity deep vein thrombosis (UEDVT). Most of patients with this syndrome have elevated values of these antibodies. Two of these patients are heterozygous carriers for G20210A and 1 – for FVL. Three patients with UEDVT and systemic lupus erythematosus (SLE) are positive for ANA and two others (one of them with Raynaud syndrome) have border line titre 1: 80 for ANA. All 3 patients with SLE are women and the interval between the development of the UEDVT and the onset of SLE was 1-4 years. We would like to suggest that: 1) UEDVT could be the first clinical symptom of Antiphospholipid syndrome, and 2) UEDVT may be the first clinical manifestation of SLE preceding the development of the systemic autoimmune disease by several years. PMID:26648774
Laudner, Kevin; Selkow, Noelle; Burke, Nick; Meister, Keith
Because of the tremendous forces produced and the repetitive nature of baseball, players have shown various shoulder adaptations in strength and range of motion. However, no research has identified whether alterations occur in the blood flow to the dominant arm among competitive baseball players. Twenty professional baseball pitchers and 16 position players participated. Measurements were taken on day 1 of 2 consecutive spring training seasons. Diagnostic ultrasound was used to measure blood flow of the throwing arm brachial artery. These measurements were taken in a standing position with the test arm resting at the participant's side and again with the test arm in a provocative shoulder position. Separate 1-way analyses of variance were conducted to compare blood flow between seasons (P < .05). In a resting position, the blood flow of the pitchers did not change from 1 year to the next (P = .48). However, blood flow of the pitchers in the provocative position significantly decreased after the first year (P = .009). The position players did not have any significant changes in blood flow for either arm position (P > .11). In a provocative shoulder position, the blood flow of pitchers significantly decreased after 1 competitive baseball season. These results indicate that after a competitive season, the blood flow to the upper extremity of pitchers may be compromised. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
Feuerstein, Michael; Nicholas, Rena A; Huang, Grant D; Dimberg, Lennart; Ali, Danielle; Rogers, Heather
In practice the secondary prevention of work-related upper extremity (WRUE) symptoms generally targets biomechanical risk factors. Psychosocial risk factors have also been shown to play an important role in the development of WRUE symptom severity and future disability. The addition of a stress management component to biomechanically focused interventions may result in greater improvements in WRUE symptoms and functional limitations than intervening in the biomechanical risk factors alone. Seventy office workers with WRUE symptoms were randomly assigned to an ergonomics intervention group (assessment and modification of work station and stretching exercises) or a combined ergonomic and job stress intervention group (ergonomic intervention plus two 1-h workshops on the identification and management of workplace stress). Baseline, 3- and 12-month follow-up measures of observed ergonomic risks and self-reported ergonomic risks, job stress, pain, symptoms, functional limitation, and general physical and mental health were obtained from all participants. While both groups experienced significant decreases in pain, symptoms, and functional limitation from baseline to three months with improvements continuing to 12 months post baseline, no significant differences between groups were observed for any outcome measures. Findings indicate that the additional two-session job stress management component did not significantly enhance the short- or long-term improvements brought about by the ergonomic intervention alone.
Werner, Robert A; Franzblau, Alfred; Gell, Nancy; Ulin, Sheryl S; Armstrong, Thomas J
Upper extremity tendonitis (UET) associated with work activity is common but the true incidence and risk factors can best be determined by a prospective cohort study. This study followed a cohort of 501 active workers for an average of 5.4 years. Incident cases were defined as workers who were asymptomatic at baseline testing and had no prior history of UET and went on to be diagnosed with an UET during the follow-up period or at the follow-up evaluation. The incident cases were compared to the subset of the cohort who also had no history of an UET and did not develop tendonitis during the study. The cumulative incidence in this cohort was 24.3% or 4.5% annually. The factors found to have the highest predictive value for identifying a person who is likely to develop an UET in the near future included age over 40, a BMI over 30, a complaint at baseline of a shoulder or neck discomfort, a history of CTS and a job with a higher shoulder posture rating. The risk profile identifies both ergonomic and personal health factors as risks and both categories of factors may be amenable to prevention strategies.
Bain, E Eugene; Meehan, Shane A; Hale, Elizabeth K
Necrobiotic xanthogranuloma (NXG) is an uncommon granulomatous disorder of unknown pathogenesis that often presents with yellowish plaques in a periorbital distribution. While a majority of cases are associated with an underlying paraproteinemia of the IgG kappa type, a much smaller number are found to be associated with an underlying multiple myeloma. We present a case of a 78-year-old male with an isolated lesion of NXG on his right upper extremity. Following his diagnosis of NXG, further investigation for underlying systemic disorders with serum immunofixation revealed a monoclonal IgG kappa immunoglobulin with an M-spike of 1.2 g/dL. A PET-CT demonstrated bone destruction in the left proximal fifth rib, left scapula, the anterior lumbar I (L1) vertebrae, the left lumbar III (L3) vertebrae posterior elements and possibly left sacrum. A bone marrow biopsy revealed 18 % plasma cells. With these findings he was diagnosed with stage I multiple myeloma. Though clinically unimpressive and atypical in location for NXG, early biopsy and diagnosis of this solitary lesion led to the discovery of his hematopoietic disorder.
Galanakos, Spyridon P; Zoubos, Aristides B; Mourouzis, Iordanis; Ignatiadis, Ioannis; Bot, Arjan G J; Soucacos, Panayotis N
So far, predictive models with individualized estimates of prognosis for patients with peripheral nerve injuries are lacking. Our group has previously shown the prognostic value of a standardized scoring system by examining the functional outcome after acute, sharp complete laceration and repair of median and/or ulnar nerves at various levels in the forearm. In the present study, we further explore the potential mathematical model in order to devise an effective prognostic scoring system. We retrospectively collected medical record data of 73 cases with a peripheral nerve injury in the upper extremity in order to estimate which patients would return to work, and what time was necessary to return to the pre-injury work. Postoperative assessment followed the protocol described by Rosén and Lundborg. We found that return to pre-injury work can be predicted with high sensitivity (100%) and specificity (95%) using the total numerical score of the Rosén and Lundborg protocol at the third follow-up interval (TS3) as well as the difference between the TS3 and the total score at second follow-up interval (TS2). In addition, the factors age and type of injured nerve (median, ulnar, or combined) can determine the time of return to work based on a mathematical model. This prognostic protocol can be a useful tool to provide information about the functional and social prospects of the patients with these types of injuries.
BARBE, Mary F.; JAIN, Nisha X.; MASSICOTTE, Vicky S.; POPOFF, Steven N.; BARR-GILLESPIE, Ann E.
We evaluated the effectiveness of ergonomic workload reduction of switching rats from a high repetition high force (HRHF) lever pulling task to a reduced force and reach rate task for preventing task-induced osteopenic changes in distal forelimb bones. Distal radius and ulna trabecular structure was examined in young adult rats performing one of three handle-pulling tasks for 12 wk: 1) HRHF, 2) low repetition low force (LRLF); or 3) HRHF for 4 wk and than LRLF thereafter (HRHF-to-LRLF). Results were compared to age-matched controls rats. Distal forelimb bones of 12-wk HRHF rats showed increased trabecular resorption and decreased volume, as control rats. HRHF-to-LRLF rats had similar trabecular bone quality as control rats; and decreased bone resorption (decreased trabecular bone volume and serum CTX1), increased bone formation (increased mineral apposition, bone formation rate, and serum osteocalcin), and decreased osteoclasts and inflammatory cytokines, than HRHF rats. Thus, an ergonomic intervention of HRHF-to-LRLF prevented loss of trabecular bone volume occurring with prolonged performance of a repetitive upper extremity task. These findings support the idea of reduced workload as an effective approach to management of work-related musculoskeletal disorders, and begin to define reach rate and load level boundaries for such interventions. PMID:25739896
Stein, R B; Walley, M
Upper extremity amputees were tested on a standardized series of tasks using a myoelectric hand, a conventional prosthesis (cable-controlled hook), and their normal hand (unilateral amputees only). They answered also a questionnaire on activities of daily living (ADL) and provided other prosthetic information. Amputees who had been fitted only with a conventional prosthesis, and used their prosthesis regularly, tended to wear the prosthesis more hours per day (14 hours) than amputees fitted with a myoelectric hand (9.6 hours), some of whom continued to use a conventional prosthesis for some jobs. However, the amputees with myoelectric prostheses had a greater functional range of motion (ROM) than those with a conventional prosthesis, and many regular wearers of a myoelectric prosthesis had long since rejected a conventional prosthesis. Amputees took about 2.5 times as long to complete the tasks tested with a conventional prosthesis and about five times as long with a myoelectric prosthesis than with their normal hand. Despite the slower function, more than 60% of below-elbow (B-E) amputees accepted the myoelectric prosthesis in preference to a conventional prosthesis, which they had all been fitted with previously. Others preferred to continue using a conventional prosthesis to which they had become accustomed (13%) or no prosthesis (26%). The combination of function, ROM, and cosmetic appearance of a myoelectri