Rehabilitation of the replanted upper extremity

A concise protocol for the rehabilitation of the upper extremity after replantation is presented with special emphasis in the early mobilization of the hand.     

Epithelioid sarcoma of the upper extremity

Three cases of epithelioid sarcoma of the upper extremity are presented. Information regarding 112 previously published cases is reviewed. It is concluded that epithelioid sarcoma must be included in the differential diagnosis of soft-tissue tumors of the extremities. Moreover, the diagnosis of epithelioid sarcoma demands prompt and aggressive surgical intervention. Irradiation therapy and chemotherapy have not been proven to be of value in the management of epithelioid sarcoma.     

The radial forearm flap for reconstruction of the upper extremity

The radial forearm flap, owing to its good-caliber arteries of long length and equally well distributed venous system, has proved very reliable. It has not only earned its place and recognition in reconstructive hand surgery, but also has emerged as a workhorse for the microvascular surgeon. We have used 14 radial forearm flaps for upper extremity reconstruction, and we present herein our experience. The technique of extracorporeal tissue transfer, which has been published elsewhere, was used in two patients and is detailed. Four representative patients are presented.     

Mycobacterium marinum infections of the upper extremity

A significant number of patients infected with Mycobacterium marinum have been treated at the Curtis National Hand Center in Baltimore, Maryland. The purpose of this study was to review the authors' experience with M. marinum infections of the upper extremity. Twenty-nine patients were identified and their charts were reviewed for all factors related to diagnosis and treatment. The most common presenting symptoms were swelling (n = 25) and pain (n = 14). Only 69 percent of patients could correlate their injury with aquatic activities. The mean time from injury to diagnosis was 5.2 months. Acid-fast bacilli stains were positive in only 22 percent of specimens. The mean number of procedures was 1.75, with the majority being tenosynovectomy. The mean duration of antibiotic therapy was 6 months. Clinical history, pathological evaluation, and a high clinical suspicion can lead to early diagnosis and introduction of antibiotics. The authors' patients were successfully treated with 6 months of antibiotic therapy and early surgical intervention.     

A questionnaire technique for assessing the stress at work

Subjective perception of the stress at work is a phenomenon reflecting the experience-mediated relationship between the sum of objective conditions of work and the sum of individual's traits available to cope with demands of the work environment. This relationship is mirrored in the function of the whole organism and can be described using the formula S = f (E, D), where S = the state of the organism, E = exposure (i.e. the sum of all stressors the organism is exposed to), and D = disposition (i.e. the sum of traits the organism has available to cope with these stressors). Based on these theoretical considerations, a questionnaire has been developed as a tool for assessing the work stress in different groups of occupations. This "Work Stress Assessment" (WSA) questionnaire was used in a group of 4800 female employees from various branches of the printing industry. Of a total of 160 questionnaire items, 98 items were selected and used to assess the workload in these employees, using a 5-point rating scale of evaluation. The responses were processed statistically, separately for 3531 blue-collar and 1269 white-collar respondents. The use of the factor analysis method revealed that the two groups of jobs had 16 factors in common, 3 factors were specific for blue-collar and 2 factors for white-collar jobs. Judged by factor components, the responses of subjects were well structured and the perceived stress at work turned out to well reflect the reality of conditions of work, which confirms the construct validity of this methodical approach based on the subjective perception of occupational stress. High coefficients of consistency (0.959 for blue-collar and 0.946 for white-collar occupations) point to the reliability of this questionnaire technique. Thus, the WSA questionnaire appears to suitably complement the other methodical approaches aimed at assessing the stress at work in different groups of occupations.     

Treatment of congenital upper extremity problems

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Describe the terminology and classification of congenital hand anomalies. 2. Describe the incidence and embryogenesis of some common congenital hand anomalies. 3. Discuss the general principles and goals for treatment of congenital hand anomalies. 4. Describe the management of five of the more common congenital hand anomalies (syndactyly, short digits, thumb duplication, hypoplastic thumb, and radial dysplasia). SUMMARY: Congenital hand anomalies can cause substantial emotional and functional problems. This article reviews the etiology, classification, and management of some of the more common hand anomalies. A general approach to the patient and the goals of treatment are reviewed, as is the approach to five specific congenital hand anomalies: syndactyly, short digits, thumb duplication, hypoplastic thumb, and radial dysplasia.     

Composite in situ vein bypass for upper extremity revascularization

Chronic upper extremity arterial insufficiency is rare. Consequently, major reports specifically limited to the topic are scarce, and the clinical experience is small. In addition, symptomatology, diagnostic criteria, and guidelines for surgical management remain ill-defined. In the lower extremities, however, in situ vein bypass has been attempted for nearly three decades. This technique offers many advantages over traditional revascularization methods. Although the procedure has become popular for the lower extremity, no report of its use in the upper extremity is found in the literature. We report what may be the first case in which in situ bypass was used in the upper extremity for a threatened limb secondary to diabetic occlusive vascular disease complicated by a previous shunt used for hemodialysis. Revascularization of the upper extremity using the in situ vein bypass technique may offer a new alternative to traditional methods of revascularization.     

An upper extremity kinematic model for evaluation of hemiparetic stroke

Quantification of rehabilitation progress is necessary for accurately assessing clinical treatments. A three-dimension (3D) upper extremity (UE) kinematic model was developed to obtain joint angles of the trunk, shoulder and elbow using a Vicon motion analysis system. Strict evaluation confirmed the system's accuracy and precision. As an example of application, the model was used to evaluate the upper extremity movement of eight hemiparetic stroke patients with spasticity, while completing a set of reaching tasks. Main outcome measures include kinematic variables of movement time, range of motion, peak angular velocity, and percentage of reach where peak velocity occurs. The model computed motion patterns in the affected and unaffected arms. The unaffected arm showed a larger range of motion and higher angular velocity than the affected arm. Frequency analysis (power spectrum) demonstrated lower frequency content for elbow angle and angular velocity in the affected limb when compared to the unaffected limb. The model can accurately quantify UE arm motion, which may aid in the assessment and planning of stroke rehabilitation, and help to shorten recovery time.     

Effects of a passive upper extremity exoskeleton for overhead tasks

Overhead work is a major cause of upper extremity work-related musculoskeletal disorders (WMSD). In this paper, the potential effects of a Passive Upper-Limb Exoskeleton (PULE) were evaluated in the tasks of overhead works. This proposed PULE has a higher degree of freedom and does not impede the user's upper limb movements. Fifteen male volunteers participated in the study by performing the repeated overhead bolt installation tasks. The electromyographic (EMG) values of anterior deltoid (AD), mid deltoid (MD), descending trapezius (TR), and triceps (TB) of the left and right arms of the participants were measured at three different overhead task heights with Intervention (with/without the PULE). Moreover, the rankings of perceived discomfort (RPD) obtained on the neck, shoulders, upper arms, forearms, upper back, waists, and legs were rated for each participant. The preliminary experiment results show that the initial nEMG of right anterior deltoid (AD) decreased by 38.5%, median nEMG values decreased by 45.1%, and total RPD decreased by 52.4%. The use of the PULE could bring the benefits of less upper extremity muscle contraction and lower RPD compared to the non-use, which may potentially reduce or slow down the level of upper extremity WMSD across the overhead work.     

Pathophysiology of upper extremity muscle disorders.

A review of the literature on the pathophysiology of upper extremity muscle disorders (UEMDs) was performed. An overview is given of clinical findings and hypotheses on the pathogenesis of UEMDs. The literature indicates that disorders of muscle cells and limitations of the local circulation underlie UEMDs. However, these disorders identified do not necessarily lead to symptoms. The following mechanisms have been proposed in the literature: (1) selective recruitment and overloading of type I (Cinderella) motor units; (2) intra-cellular Ca(2+) accumulation; (3) impaired blood flow; (3b) reperfusion injury; (3.3c) blood vessel-nociceptor interaction; (4a) myofascial force transmission; (4b) intramuscular shear forces; (5) trigger points; (6) impaired heat shock response. The results of the review indicate that there are multiple possible mechanisms, but none of the hypotheses forms a complete explanation and is sufficiently supported by empirical data. Overall, the literature indicates that: (1) sustained muscle activity, especially of type I motor units, may be a primary cause of UEMDs; (2) in UEMDs skeletal muscle may show changes in morphology, blood flow, and muscle activity; (3) accumulation of Ca(2+) in the sarcoplasm may be the cause of muscle cell damage; (4) it seems plausible that suboptimal blood flow plays a role in pathogenesis of UEMDs; (5) since the presence of fiber disorders is not a sufficient condition for the development of UEMSDs additional mechanisms, such as sensitization, are assumed to play a role.