BACKGROUND Eighty percent of stroke patients develop upper limb dysfunction,especially hand dysfunction,which has a very slow recovery,resulting in economic burden to families and society.AIM To investigate the impact...BACKGROUND Eighty percent of stroke patients develop upper limb dysfunction,especially hand dysfunction,which has a very slow recovery,resulting in economic burden to families and society.AIM To investigate the impact of task-oriented training based on acupuncture therapy on upper extremity function in patients with early stroke.METHODS Patients with early stroke hemiplegia who visited our hospital between January 2021 and October 2022 were divided into a control group and an observation group,each with 50 cases.The control group underwent head acupuncture plus routine upper limb rehabilitation training(acupuncture therapy).In addition to acupuncture and rehabilitation,the observation group underwent upper limb task-oriented training(30 min).Each group underwent treatment 5 d/wk for 4 wk.Upper extremity function was assessed in both groups using the Fugl-Meyer Assessment-Upper Extremity(FMA-UE),Wolf Motor Function Rating Scale(WMFT),modified Barthel Index(MBI),and Canadian Occupational Performance Measure(COPM).Quality of life was evaluated using the Short-Form 36-Item Health Survey(SF-36).Clinical efficacy of the interventions was also evaluated.RESULTS Before intervention,no significant differences were observed in the FMA-UE,MBI,and WMFT scores between the two groups(P>0.05).After intervention,the FMA-UE,WMFT,MBI,COPM-Functional Mobility and Satisfaction,and SF-36 scores increased in both groups(P<0.05),with even higher scores in the observation group(P<0.05).The observation group also obtained a higher total effective rate than the control group(P<0.05).CONCLUSION Task-oriented training based on acupuncture rehabilitation significantly enhanced upper extremity mobility,quality of life,and clinical efficacy in patients with early stroke.展开更多
[Objectives]To investigate the evidence-based effect of virtual reality-based mirror therapy system(VR-MT)on upper extremity function among stroke patients.[Methods]A systematic electronic searching of the Medline,Pub...[Objectives]To investigate the evidence-based effect of virtual reality-based mirror therapy system(VR-MT)on upper extremity function among stroke patients.[Methods]A systematic electronic searching of the Medline,PubMed,Web of Science and CNKI was initially performed up to June 10,2024.The risk of bias of the included studies was evaluated using RevMan 5.4 software based on the Cochrane Handbook for Systematic Reviews.The random-effects model or fixed-effects models was employed to estimate the standardized mean difference(SMD).The subgroup analyses were conducted exploring theVR-MT type(immersive or non-immersive)and comparing with MT or control group.[Results]In total 8 studies with a total of 273 stroke patients were included in this review.The pooled analysis of these trials showed a statistically significant enhancement inFMA-UE scores(6 studies,SMD=0.72,[95%CI 0.37 to 1.06];P<0.0001,I^(2)=31%)and Box and Block Test(BBT)(3 studies,SMD=0.49,[95%C/0.05 to 0.93];P=0.03,I^(2)=0%),rather than Manual Function Test(MFT)scores(3 studies,SMD=0.38,[95%CI-0.09 to 0.84];P=0.11,I^(2)=0%)following the application of reality-based mirror therapy.Additionally,the subgroup analysis results indicated that immersive VR-MT can significantly improve FMA-UE(5studies,SMD=0.73,[95%CI 0.24 to 1.23];P=0.004,I^(2)=43%).In contrast,the overall effect of non-immersive VR-MT was non-significant(2 studies,SMD=0.33,[95%CI-0.69 to 1.34];P=0.53,I^(2)=72%).[Conclusions]In this systematic review and meta-analysis,our findings indicate that immersiveVR-MT has the potential to improve upper extremity function among stroke patients.展开更多
[Objectives]To conduct a comprehensive examination of the evidence-based impact of repetitive transcranial magnetic stimulation(rTMS)on upper extremity functionality in patients with acute stroke.[Methods]A rigorous a...[Objectives]To conduct a comprehensive examination of the evidence-based impact of repetitive transcranial magnetic stimulation(rTMS)on upper extremity functionality in patients with acute stroke.[Methods]A rigorous and systematic electronic search was conducted across the Medline,PubMed,and Web of Science databases,encompassing literature up to July 1,2024.To ensure the reliability of the in-cluded studies,an assessment of their risk of bias was conducted using RevMan 5.4 software,in accordance with the rigorous standards out-lined in the Cochrane Handbook for Systematic Revieus.Subsequently,we employed either the random-effects model or the fixed-effects model,depending on the heterogeneity of the data,to estimate the standardized mean difference(SMD)in outcomes,utilizing Stata 18.0 software for statistical analysis.[Results]Our review encompassed a total of five studies,involving 252 patients with acute stroke.The pooled analysis of these studies revealed a statistically significant improvement in Fugl-Meyer Assessment of the Upper Extremity(FMA-UE)scores among pa-tients who received rTMS therapy(SMD=2.71,95%CI:0.85 to 4.56;P<0.0001),albeit with considerable heterogeneity(I^(2)=97.65%)across the trials.[Conclusions]The results of this systematic review and meta-analysis underscore the promising potential of rTMS in enhancing upper extremity function in patients who have experienced an acute stroke.These findings provide compelling evidence for the therapeutic benefits of rTMS in this patient population.展开更多
BACKGROUND Vascular injuries of the upper extremities are considered relatively rare injuries affecting mostly the young population.They often are complex injuries accompanied by other musculoskeletal trauma or trauma...BACKGROUND Vascular injuries of the upper extremities are considered relatively rare injuries affecting mostly the young population.They often are complex injuries accompanied by other musculoskeletal trauma or trauma in other anatomic locations.Their management is challenging since they can lead to disabilities with major socioeconomic effects.AIM To analyze data about the mechanism of injury,the management algorithm and functional outcomes of vascular injuries of the upper extremity.METHODS One hundred and fifteen patients(96 males and 19 females)with arterial injuries of the upper extremity treated in a tertiary trauma center from January 2003 to December 2022 was conducted.Mean patients’age was 33.7 years and the mean follow up time was 7.4 years.Patients with Mangled Extremity Severity Score≥7 and Injury Severity Score≥20,previous upper limb surgery or major trauma and any neuromuscular or psychiatric disease were excluded,from the study.RESULTS A penetrating trauma was the most common cause of injury.The radial artery was the artery injured in most of the cases(37.4%)followed by the ulnar(29.5%),the brachial(12.1%)and the axillary(6%).A simultaneous injury of both of the forearm’s arteries was in 15.6%of the cases.In 93%of the cases there were other concomitant musculoskeletal injuries of the extremity.Tendon lacerations were the most common,followed by nerve injuries.The postoperative functional scores(full Disabilities of the Arm,Shoulder,and Hand and VAS)had very satisfactory values.CONCLUSION Although vascular injuries of the upper extremity are rare,they may occur in the context of major combined musculoskeletal trauma.Although a multidisciplinary approach is essential to optimize outcome,the ability of trained hand surgeons to repair all injuries in combined vascular and musculoskeletal upper extremity trauma,excluding isolated vascular injuries,ensures shorter operative times and better functional outcomes.展开更多
Background: Upper limb amputations are one of the unpleasant war injuries that armed forces are exposed to frequently. The present study aimed to assess the musculoskeletal and peripheral nervous systems in Iraq-Iran ...Background: Upper limb amputations are one of the unpleasant war injuries that armed forces are exposed to frequently. The present study aimed to assess the musculoskeletal and peripheral nervous systems in Iraq-Iran war veterans with bilateral upper extremity amputation.Methods: The study consisted of taking a history and clinical examinations including demographic data, presence and location of pain, level of amputation, passive and active ranges of movement of the joints across the upper and lower extremities and spine, manual palpation, neurological examination, blood circulation pulses and issues related to a prosthetic limb. In this study, 103 Iranian bilateral upper extremity amputees(206 amputations) from the IranIraq war were evaluated, and a detailed questionnaire was also administered.Results: The most common level of amputation was the finger or wrist level(108, 52.4%). Based on clinical examination, we found high frequencies of limited active and passive joint range of movement across the scapula, shoulder, elbow, wrist and metacarpophalangeal, interphalangeal and thumb joints. Based on muscle strength testing, we found varying degrees of weakness across the upper limbs. Musculoskeletal disorders included epicondylitis(65, 31.6%), rotator cuff injury(24, 11.7%), bicipital tendonitis(69, 33.5%), shoulder drop(42, 20.4%) and muscle atrophy(19, 9.2%). Peripheral nerve disorders included carpal tunnel syndrome in 13(6.3%) and unilateral brachial plexus injury in 1(1%). Fifty-three(51.5%) were diagnosed with facet joint syndrome at the level of the cervical spine(the most frequent site). Using a prosthesis was reported by 65(63.1%), both left and right sides. The back was the most common site of pain(71.8%).Conclusion: The high prevalence of neuro-musculoskeletal disorders among bilateral upper extremity amputees indicates that they need regular rehabilitation care.展开更多
Upper extremity deep vein thrombosis(UEDVT)is less common than lower extremity DVT but is a cause of significant morbidity and mortality in intensive care unit patients.Increasing cancer incidence,prolonged life expec...Upper extremity deep vein thrombosis(UEDVT)is less common than lower extremity DVT but is a cause of significant morbidity and mortality in intensive care unit patients.Increasing cancer incidence,prolonged life expectancy and increasing use of intravascular catheters and devices has led to an increased incidence of UEDVT.It is also associated with high rates of complications like pulmonary embolism,post-thrombotic syndrome and recurrent thrombosis.Clinical prediction scores and D-dimer may not be as useful in identifying UEDVT;hence,a high suspicion index is required for diagnosis.Doppler ultrasound is commonly employed for diagnosis,but other tests like computed tomography and magnetic resonance imaging venography may also be required in some patients.Contrast venography is rarely used in patients with clinical and ultrasound findings discrepancies.Anticoagulant therapy alone is sufficient in most patients,and thrombolysis and surgical decompression is seldom indicated.The outcome depends on the cause and underlying comorbidities.展开更多
Statement of the Problem: Upper limb hemiparesis is a common impairment underlying disability after Stroke. Transfer of treatment to daily functioning remains a question for traditional approaches used in treatment of...Statement of the Problem: Upper limb hemiparesis is a common impairment underlying disability after Stroke. Transfer of treatment to daily functioning remains a question for traditional approaches used in treatment of upper extremity hemiparesis. Approaches based on Motor Learning principles may facilitate the transfer of treatment to activities of daily living. Methodology: Forty one subjects with chronic stroke, attending department of occupational therapy, National Institute for the Orthopaedically Handicapped, Kolkata, West Bengal, India participated in a single blinded randomized pre-test and post-test control group training study. Subjects were randomized over three intervention groups receiving modified Constraint Induced Movement Therapy (n = 13), Bilateral Arm training (n = 14), and an equally intensive conventional treatment program (n = 14). Subjects in the bilateral arm training group participated in bilateral symmetrical activities, where as subjects in constraint induced movement therapy group performed functional activities with the affected arm only and conventional group received conventional Occupational Therapy. Each group received intensive training for 1 hour/day, 5 days/week, for 8 weeks. Pre-treatment and post-treatment measures included the Fugl-Meyer measurement of physical performance (FMA- upper extremity section), action research arm test, motor activity log. Assessments were administered by a rater blinded to group assignment. Result: Both m-CIMT (p = 0.01) and bilateral arm training (p = 0.01) group showed statistically significant improvement in upper extremity functioning on Action Research Arm Test score in comparison to the conventional therapy group (p = 0.33). The bilateral arm training group had significantly greater improvement in upper arm function (Proximal Fugl-Meyer Assessment score, p = 0.001);while the constraint induced movement therapy group had greater improvement of hand functions (Distal Fugl-Meyer Assessment score, p = 0.001. There is an improvement seen in Quality of movement in the Conventional Therapy group. (p = 0.001). Conclusion: Both the treatment techniques can be used for upper extremity management in patients with chronic stroke. Bilateral arm training may be used to improve upper arm function and m-CIMT may be used to improve hand functions, while the group that received modified constraint induced movement therapy had greater improvement.展开更多
Introduction: Upper extremity impairment is one of the common complications following a stroke. There are numerous rehabilitation strategies to address this problem. However, patients with moderate to severe upper lim...Introduction: Upper extremity impairment is one of the common complications following a stroke. There are numerous rehabilitation strategies to address this problem. However, patients with moderate to severe upper limb disabilities respond differently to the same rehabilitation protocol. Apart from each patient’s unique characteristics, there are specific brain reorganizing patterns that affect the post-rehabilitation response rate. Functional magnetic resonance imaging (fMRI) determines brain activation area and connectivity patterns and has been utilized in the neurorehabilitation field. Material and Methods: Six stroke patients who suffered from moderate to severe upper extremity dysfunction were enrolled in this pilot study. Upper extremity function tests including the Fugl-Meyer assessment test for upper extremity (FMA-UE), and Wolf Motor Function Test (WMFT) were utilized before and after completing an intensive rehabilitation. The intensive rehabilitation program was conducted one hour a day for five days per week for four weeks. Moreover, fMRI was applied before initiating rehabilitation. The regions of interest were those associated with movement, including Brodmann areas (BA) BA1-BA6. Results: Six stroke patients in the sub-acute to chronic phase and ages ranging between 33 - 75 years were enrolled. All patients showed an improvement in upper limb function after four weeks of rehabilitation. Patient number one (Pt1) had the most improvement in FMA-UE, while patient number four (Pt4) recovered the most measured by WMFT. Pt1 demonstrated increased activity in all contralesional regions, whereas Pt4 had only increased activity in ipsilesional areas. Furthermore, patients with greater activation in the ipsilesional BA6 (Pt1, Pt4, Pt5, and Pt6) had better responses to the rehabilitation therapy. Conclusion: Patients with greater activation in the baseline fMRI, particularly ipsilesional BA6, had a better response to the intensive rehabilitation therapy. However, the patients with the most severe hand dysfunction showed lesser improvement despite the same brain activity as others in the initial fMRI.展开更多
Objective:To evaluate clinical efficacy by traditional Chinese combined with western therapy to treat upper extremity edema after breast cancer surgery.The clinical efficacy was described by the effective rate and the...Objective:To evaluate clinical efficacy by traditional Chinese combined with western therapy to treat upper extremity edema after breast cancer surgery.The clinical efficacy was described by the effective rate and the change of peripheral diameter of the affected limb.Methods:National Knowledge Internet(CNKI),Wan Fang Digital Journals(Wan Fang),VIP Chinese periodical service platform(VIP),Chinese biomedical literature service system(CBM),PubMed and EMBASE were searched on computer.And clinical randomized controlled trials(RCT)of the treatment of upper extremity edema after breast cancer surgery with integration of Chinese and western treatment were selected.The time was from January 2011 to May 2020.Upper extremity edema after breast cancer surgery was the first key word and the second was traditional Chinese combined with western therapy.Note Express was used to screen and extract literature.Bias risks of all the literature included in the study were evaluated and analyzed by RevMan5.3 software.Results:10 randomized controlled clinical tests,644 patients in conformity to the inclusion criteria,9 for the observation of curative effectiveness,5 of changes in limb circumference.322 cases were included in the observation group and the same number of cases in the control group,all of which were in Chinese.The results expressed that the curative effect in the observation group was 91.1%,and it was higher than the curative effect in the control group treated by single western treatment obviously,and it was only 68.9%[95%CI(1.22,1.44),Z=6.55,P<0.00001].The peripheral diameter shrinking degree of the affected limb in the observation group was also clearly higher than that in the control group which was healed by simple western treatment[95%CI(-0.98,-0.64),Z=9.40,P<0.00001].Conclusion:Traditional Chinese combined with western therapy treating upper extremity edema after the surgery of breast cancer had a notable clinical effect,which treated the disease and effectively lessened the peripheral diameter of the affected limb.The method was worthy of clinical application.However,owing to the low quality of the included documents,further discussion and learning were still needed.展开更多
Objective To discuss the etiology,course of diseases and prognosis of symmetry peripheral entrapment enuropathies of upper extremity. Methods The etiology, clinical scale and resluts of 14 cases were analyzed betwen 1...Objective To discuss the etiology,course of diseases and prognosis of symmetry peripheral entrapment enuropathies of upper extremity. Methods The etiology, clinical scale and resluts of 14 cases were analyzed betwen 1999 and April 2002. Results In the bilateral tunnel syndrome, the excellent and good rate was 60% at the original side and 80% at the contralateral side occurred later. In the bilateral carpal tunnel syndrome, the excellent and good rate was 67% at the original side and 89% at the contralateral side occurred later. Conclusion The main etiological factor of the bilateral cubital tunnel syndrome was the elbow eversion deformity. The lesions of synovium contributed mainly to the symmetry carpal tunnel syndrome. The symmetry peripheral entrapment neuropathies of upper extremity should be operated on as soon as possible when diagnosis had been made for enhancement of treatment outcome. 5 refs,2 tabs.展开更多
Objective To investigate the clinical features and magnetic resonance imaging (MRI) findings of patients with Hirayama disease simply presenting proximal upper extremity muscular atrophy. Methods Three patients with H...Objective To investigate the clinical features and magnetic resonance imaging (MRI) findings of patients with Hirayama disease simply presenting proximal upper extremity muscular atrophy. Methods Three patients with Hirayama disease simply展开更多
Background Little is known regarding risk factors specific to pedialric upper extremity firearm injuries.The purpose of this study is to evaluate pediatric patients treated for these injuries to identify at-risk popul...Background Little is known regarding risk factors specific to pedialric upper extremity firearm injuries.The purpose of this study is to evaluate pediatric patients treated for these injuries to identify at-risk populations and recurring mechanisms of injury.Methods A 20-year retrospective review was conducted.Patients 17 years of age and younger,with upper extremity injuries related to a firearm,were included.Analysis involved Fisher's exact and Chi-square tests.Results One hundred and eighty patients were included.The mean age was 12.04±4.3 years.Most included patients were male(85%).Interestingly,females were more frequently victims of assault(P=0.03),and males were more frequently injured due to accidental discharge(P<0.001).The most affected race/ethnicity was White-not Hispanic or Latino(48%).The hand was the most frequent location injured(31%)and was more likely to be accidental than proximal injuries(P=0.003).Air rifes were the most common firearm type used(56%).Pistols were implicated in 47(26%)cases,rifles in 17(9%),and.shotguns in 10(6%).Ninety-nine(55%)patients had procedures in the operating room.The most frequent procedure was foreign body removal(55%).Conclusions Risk factors such as male sex,W hite-not Hispanic or Latino race/ethnicity,and adolescent age were attributed to increased risk for injury.Male sex was associated with increased risk of injury by accidental discharge and female sex with intentional assault.Air rifles were the most common firearm type overall,although female sex was associated with increased risk for injury by powder weapon.展开更多
Objectives:This study aimed to explore the effects of the“FuekFone(F.F.)home-based program”on the upper limb and cognitive function of ischemic stroke patients after discharge.Methods:A single group pre-and post-tes...Objectives:This study aimed to explore the effects of the“FuekFone(F.F.)home-based program”on the upper limb and cognitive function of ischemic stroke patients after discharge.Methods:A single group pre-and post-test design was conducted.A total of 40 patients with recovery after ischemic stroke were recruited from two university hospitals in Thailand.The study was conducted between June 2022 and January 2023.Participants underwent a six-week“F.F.home-based program,”which combined an upper limb and cognitive function rehabilitation device with Android games,including stationary barrel,adventure walk,adventure stroll,sliding barrel,sauce squeeze,and cut objects.Each game has different difficulty levels.Patients can perform corresponding exercises through the games according to their conditions under the guidance of medical staff.The patients played for 24 min per time,4 min each game,three days a week.The second week,let the patients play games for 30 min per time,5 min each game,3 days a week.Then,in the 3e6 weeks,let the patients play games for 1 h per time,10 min each game,5 days a week.At the pre-and post-intervention,the Thai version of the National Institutes of Health Stroke Scale(NIHSS),the Motor Assessment Scale,and the Montreal Cognitive Assessment(MoCA score)were administered to patients at discharge and at 2,4,and 6 weeksafter discharge,and the results were compared.Results:All participants completed this program.Participants had statistically improved upper limb function(upper arm function score,hand movements score,advanced hand activities score,total Motor Assessment Scale score)and MoCA score at 2,4,and 6 weeks after discharge(P<0.001).In the comparison of upper limb function and cognitive function at each of the study times,we found statistically improved upper limb function(upper arm function score,hand movements score,advanced hand activities score,total Motor Assessment Scale score)and MoCA score at 4,and 6 weeks after discharge when compared to after discharge and 2 weeks after discharge,respectively(P<0.05).Conclusions:Continuing care of patients post-stroke after discharge from hospital,such as F.F.homebased program should be applied at home to enhance upper limb and cognitive function.展开更多
Vascularized lymph node transfers(VLNT)are useful options for the surgical treatment of lymphedema.Conventional VLNT does not include the reconstruction of physiological lymphatic outflow,which may pose a risk of post...Vascularized lymph node transfers(VLNT)are useful options for the surgical treatment of lymphedema.Conventional VLNT does not include the reconstruction of physiological lymphatic outflow,which may pose a risk of postoperative lymphatic vessel obstruction and lymph node sclerosis.We report a case of lymph flow bypass reconstruction using a superficial circumflex Iliac artery perforator(SCIP)flap,including VLNT with efferent lymphatico-lymphatic anastomosis.A 63-year-old female with severe right upper extremity lymphedema after mastectomy was reconstructed using a SCIP free flap,which included a vascularized lymph node elevated from the left groin area and transferred to the right axilla area.The SCIP vessels were anastomosed to the medial intercostal artery perforator vessels and the efferent lymphatic vessel from the vascularized lymph node was anastomosed to the internal mammary lymphatic vessels using supermicrosurgical technique.Indocyanine green lymphography showed the reconstructed lymphatic flow from the right hand to the right internal mammary lymphatics through the transferred flap.Postoperatively,lymphedema improved and there was no lymphedema at the donor site with a 2-year follow-up.Lymphatic flow bypass reconstruction using VLNT with efferent lymphatico-lymphatic anastomosis may provide a useful option for the treatment of severe lymphedema.展开更多
Nerve transfers for peripheral nerve injuries have become increasingly popular over the past two decades.While techniques for ulnar nerve repair have been well-documented,more recent techniques for median and radial n...Nerve transfers for peripheral nerve injuries have become increasingly popular over the past two decades.While techniques for ulnar nerve repair have been well-documented,more recent techniques for median and radial nerve branch reinnervation are still being explored.This review describes the outcomes of common and emerging techniques for reinnervation of the distal branches of the median and radial nerves.展开更多
Soft tissue tumors in the hand have a broad differential diagnosis. Included in the list of differential diagnoses for these tumors are Schwannomas, which are benign tumors within the peripheral nervous system [1]. Sc...Soft tissue tumors in the hand have a broad differential diagnosis. Included in the list of differential diagnoses for these tumors are Schwannomas, which are benign tumors within the peripheral nervous system [1]. Schwannomas are uncommon within the upper extremity, and they are exceedingly rare within the hand and wrist [1]. We describe a case of an 80-year-old female presented with a soft tissue mass within her right thumb. She underwent excisional biopsy of the mass, and pathology showed features consistent with schwannoma. She had resolution of her symptoms thereafter. We discuss the differential diagnosis for soft-tissue tumors in this location. When assessing patients with soft tissue tumors of the hand and wrist, it is important for the treating provider to maintain a broad differential diagnosis in order to facilitate appropriate management of these lesions.展开更多
Introduction: Anthrax is a zoonotic disease caused by Bacillus anthracis spores. Cutaneous form is the most common and the least fatal form of the disease, however the disease is uncommon in Europe and U.S. and the re...Introduction: Anthrax is a zoonotic disease caused by Bacillus anthracis spores. Cutaneous form is the most common and the least fatal form of the disease, however the disease is uncommon in Europe and U.S. and the reports in the literature are mostly case reports for upper extremity. Case Series: 7 patients, who were treated between 1999 and 2015 in our clinic with the diagnosis of cutaneous anthrax in their upper extremity, were included to our study. 3 patients applied directly to plastic surgery, others were consulted from the infectious disease clinics. Reconstructions were done with skin grafts or secondarily. Discussion: Anthrax causes cutaneous, gastrointestinal and inhalation forms of the disease. Despite being very rare in Europe and US, in Turkey there are many reported anthrax cases. However, cutaneous anthrax of upper extremity is reported rarely in the literature. Painless papule and vesicles are well defined as clinical findings. In anthrax, the excision of skin lesions or biopsies is contraindicated because of the risk of systemic spread. Conclusion: Despite cutaneous anthrax of the hand and upper extremity is very rare, the diagnosis is easy because of the typical presentation and history. Once the definitive diagnosis is set, the treatment is effortless with the antibiotherapy and first steps of the reconstruction ladder.展开更多
Objective:To evaluate and analyze the influencing factors of upper limb lymphedema after breast cancer surgery,and to study effective nursing intervention measures.Methods:500 cases of early breast cancer patients fro...Objective:To evaluate and analyze the influencing factors of upper limb lymphedema after breast cancer surgery,and to study effective nursing intervention measures.Methods:500 cases of early breast cancer patients from October 2017 to December 2020 were selected,all patients underwent surgical intervention,retrospectively analyzed the basic clinical data of patients,and statistically analyzed the influencing factors of upper limb lymphedema.All patients with upper extremity lymphedema received high-quality nursing intervention,and the specific nursing effect was analyzed.Results:Logistic regression analysis showed that the risk factors of upper limb lymphedema after breast cancer surgery included hypertension,postoperative upper limb functional exercise,delayed healing of incision,radiotherapy and so on.After nursing intervention,the patients*12*5 elbow 10cm,elbow 10cm,wrist size value and VAS score were better than those before nursing(P<0.05).The quality of life score of patients after nursing intervention was significantly better than that before nursing(P<0.05).Conclusion:Hypertension,postoperative upper limb functional exercise,delayed healing of incision,radiotherapy and other factors can induce upper limb lymphedema after breast cancer surgery.Effective nursing intervention can alleviate the condition of patients with upper limb lymphedema and improve their quality of life,which is worthy of comprehensive promotion.展开更多
BACKGROUND: In the natural evolution of cerebrovascular disease, unconscious use of affected extremity during drug treatment and daily life can improve the function of affected upper extremity partially, but it is ver...BACKGROUND: In the natural evolution of cerebrovascular disease, unconscious use of affected extremity during drug treatment and daily life can improve the function of affected upper extremity partially, but it is very slow and also accompanied by the formation of abnormal mode. Therefore, functional training should be emphasized in recovering the motor function of extremity. OBJECTIVE: To observe the effects of combination of motor relearning program and Bobath method on motor function of upper extremity of patients with stroke. DESIGN: Comparison of therapeutic effects taking stroke patients as observation subjects. SETTING: Department of Neurology, General Hospital of Beijing Jingmei Group. PARTICIPANTS: Totally 120 stroke patients, including 60 males and 60 females, averaged (59±3) years, who hospitalized in the Department of Neurology, General Hospital of Beijing Jingmei Group between January 2005 and June 2006 were recruited. The involved patients met the following criteria: Stroke attack within 2 weeks; diagnosis criteria of cerebral hemorrhage or infarction made in the 4th National Cerebrovascular Disease Conference; confirmed by skull CT or MRI; Informed consents of therapeutic regimen were obtained. The patients were assigned into 2 groups according to their wills: rehabilitation group and control group, with 30 males and 30 females in each group. Patients in rehabilitation group averaged (59±2)years old, and those in the control group averaged (58±2)years old. METHODS: ① Patients in two groups received routine treatment in the Department of Neurology. When the vital signs of patients in the rehabilitation group were stable, individualized treatment was conducted by combined application of motor relearning program and Bobath method. Meanwhile, training of activity of daily living was performed according to the disease condition changes of patients at different phases, including the nursing and instruction of body posture, the maintenance of good extremity position, bed exercise, bedside sit up and sitting position balance, sit up exercise, dynamic and static balance exercise, walking exercise, active training and passive training. The strength, time and speed of training were increased gradually according to their physical abilities. Patients were trained 45 to 60 minutes once, 5 times a week, within 2 weeks. ② Evaluation criteria of therapeutic effect: The motor function of upper extremity was evaluated by Fugl-Meyer method on the day of beginning and end of treatment. Higher points indicated better function of upper extremity. ③ t test and paired t test were used for comparing the difference of intergroup and intragroup measurement data, respectively. MAIN OUTCOME MEASURES: Changes in Fugl-Meyer scoring of two groups before and after treatment. RESULTS: Totally 120 stroke patients participated in the final analysis. Before treatment, Fugl-Meyer scoring was close between rehabilitation group and control group [(14.47±2.38),(14.16±2.39) points, P > 0.05]; Fugl-Meyer scoring of rehabilitation group after treatment was significantly higher than that before treatment and that of control group[(37.93±2.67),(18.36±2.43) points, t =11.053, 5.408, P < 0.01]; There were no significant differences in Fugl-Meyer scoring between before treatment in the control group and control group (P > 0.05). CONCLUSION: Combined application of motor relearning program and Bobath method can significantly improve the motor function of upper extremity of patients with stroke.展开更多
The objective of this paper is to quantify the local stabilities of the neck and upper extremities （right/left shoulders and right/left elbows）, and investigate differences between linear and nonlinear measurements ...The objective of this paper is to quantify the local stabilities of the neck and upper extremities （right/left shoulders and right/left elbows）, and investigate differences between linear and nonlinear measurements of the associated joint motions and differences in the local stability between the upper and lower extremities. This attempt involves the calculation of a nonlinear parameter, Lyapunov Exponent （LE）, and a linear parameter, Range of Motion （ROM）, during treadmill walking in conj unction with a large population of healthy subjects. Joint motions of subjects were captured using a three-dimensional motion-capture system. Then mathematical chaos theory and the Rosenstein algorithm were employed to calculate LE of joints as the extent of logarithmic divergence between the neighboring state-space trajectories of flexion-extension angles. LEs computed over twenty males and twenty females were 0.037~0.023 for the neck, 0.043＋0.021 for the right shoulder, 0.045i0.030 for the left shoulder, 0.032i0.021 for the right elbow, and 0.034~0.026 for the left elbow. Although statistically significant difference in the ROM was observed between all pairs of the neck and upper extremity joints, differences in the LE between all pairs of the joints as well as between males and females were not statistically significant. Between the upper and lower extremities, LEs of the neck, shoulder, and elbow were significantly smaller than those of the hip （-0.064） and the knee （-0,062）. These results indicate that a statistical difference in the local stability between the upper extremity joints is not significant. However, the different result between the ROM and LE gives a strong rationale for applying both linear and nonlinear tools together to the evaluation of joint movement. The LEs of the joints calculated from a large population of healthy subjects could provide normative values for the associated joints and can be used to evaluate the recovery progress of patients with joint related diseases.展开更多
文摘BACKGROUND Eighty percent of stroke patients develop upper limb dysfunction,especially hand dysfunction,which has a very slow recovery,resulting in economic burden to families and society.AIM To investigate the impact of task-oriented training based on acupuncture therapy on upper extremity function in patients with early stroke.METHODS Patients with early stroke hemiplegia who visited our hospital between January 2021 and October 2022 were divided into a control group and an observation group,each with 50 cases.The control group underwent head acupuncture plus routine upper limb rehabilitation training(acupuncture therapy).In addition to acupuncture and rehabilitation,the observation group underwent upper limb task-oriented training(30 min).Each group underwent treatment 5 d/wk for 4 wk.Upper extremity function was assessed in both groups using the Fugl-Meyer Assessment-Upper Extremity(FMA-UE),Wolf Motor Function Rating Scale(WMFT),modified Barthel Index(MBI),and Canadian Occupational Performance Measure(COPM).Quality of life was evaluated using the Short-Form 36-Item Health Survey(SF-36).Clinical efficacy of the interventions was also evaluated.RESULTS Before intervention,no significant differences were observed in the FMA-UE,MBI,and WMFT scores between the two groups(P>0.05).After intervention,the FMA-UE,WMFT,MBI,COPM-Functional Mobility and Satisfaction,and SF-36 scores increased in both groups(P<0.05),with even higher scores in the observation group(P<0.05).The observation group also obtained a higher total effective rate than the control group(P<0.05).CONCLUSION Task-oriented training based on acupuncture rehabilitation significantly enhanced upper extremity mobility,quality of life,and clinical efficacy in patients with early stroke.
文摘[Objectives]To investigate the evidence-based effect of virtual reality-based mirror therapy system(VR-MT)on upper extremity function among stroke patients.[Methods]A systematic electronic searching of the Medline,PubMed,Web of Science and CNKI was initially performed up to June 10,2024.The risk of bias of the included studies was evaluated using RevMan 5.4 software based on the Cochrane Handbook for Systematic Reviews.The random-effects model or fixed-effects models was employed to estimate the standardized mean difference(SMD).The subgroup analyses were conducted exploring theVR-MT type(immersive or non-immersive)and comparing with MT or control group.[Results]In total 8 studies with a total of 273 stroke patients were included in this review.The pooled analysis of these trials showed a statistically significant enhancement inFMA-UE scores(6 studies,SMD=0.72,[95%CI 0.37 to 1.06];P<0.0001,I^(2)=31%)and Box and Block Test(BBT)(3 studies,SMD=0.49,[95%C/0.05 to 0.93];P=0.03,I^(2)=0%),rather than Manual Function Test(MFT)scores(3 studies,SMD=0.38,[95%CI-0.09 to 0.84];P=0.11,I^(2)=0%)following the application of reality-based mirror therapy.Additionally,the subgroup analysis results indicated that immersive VR-MT can significantly improve FMA-UE(5studies,SMD=0.73,[95%CI 0.24 to 1.23];P=0.004,I^(2)=43%).In contrast,the overall effect of non-immersive VR-MT was non-significant(2 studies,SMD=0.33,[95%CI-0.69 to 1.34];P=0.53,I^(2)=72%).[Conclusions]In this systematic review and meta-analysis,our findings indicate that immersiveVR-MT has the potential to improve upper extremity function among stroke patients.
文摘[Objectives]To conduct a comprehensive examination of the evidence-based impact of repetitive transcranial magnetic stimulation(rTMS)on upper extremity functionality in patients with acute stroke.[Methods]A rigorous and systematic electronic search was conducted across the Medline,PubMed,and Web of Science databases,encompassing literature up to July 1,2024.To ensure the reliability of the in-cluded studies,an assessment of their risk of bias was conducted using RevMan 5.4 software,in accordance with the rigorous standards out-lined in the Cochrane Handbook for Systematic Revieus.Subsequently,we employed either the random-effects model or the fixed-effects model,depending on the heterogeneity of the data,to estimate the standardized mean difference(SMD)in outcomes,utilizing Stata 18.0 software for statistical analysis.[Results]Our review encompassed a total of five studies,involving 252 patients with acute stroke.The pooled analysis of these studies revealed a statistically significant improvement in Fugl-Meyer Assessment of the Upper Extremity(FMA-UE)scores among pa-tients who received rTMS therapy(SMD=2.71,95%CI:0.85 to 4.56;P<0.0001),albeit with considerable heterogeneity(I^(2)=97.65%)across the trials.[Conclusions]The results of this systematic review and meta-analysis underscore the promising potential of rTMS in enhancing upper extremity function in patients who have experienced an acute stroke.These findings provide compelling evidence for the therapeutic benefits of rTMS in this patient population.
文摘BACKGROUND Vascular injuries of the upper extremities are considered relatively rare injuries affecting mostly the young population.They often are complex injuries accompanied by other musculoskeletal trauma or trauma in other anatomic locations.Their management is challenging since they can lead to disabilities with major socioeconomic effects.AIM To analyze data about the mechanism of injury,the management algorithm and functional outcomes of vascular injuries of the upper extremity.METHODS One hundred and fifteen patients(96 males and 19 females)with arterial injuries of the upper extremity treated in a tertiary trauma center from January 2003 to December 2022 was conducted.Mean patients’age was 33.7 years and the mean follow up time was 7.4 years.Patients with Mangled Extremity Severity Score≥7 and Injury Severity Score≥20,previous upper limb surgery or major trauma and any neuromuscular or psychiatric disease were excluded,from the study.RESULTS A penetrating trauma was the most common cause of injury.The radial artery was the artery injured in most of the cases(37.4%)followed by the ulnar(29.5%),the brachial(12.1%)and the axillary(6%).A simultaneous injury of both of the forearm’s arteries was in 15.6%of the cases.In 93%of the cases there were other concomitant musculoskeletal injuries of the extremity.Tendon lacerations were the most common,followed by nerve injuries.The postoperative functional scores(full Disabilities of the Arm,Shoulder,and Hand and VAS)had very satisfactory values.CONCLUSION Although vascular injuries of the upper extremity are rare,they may occur in the context of major combined musculoskeletal trauma.Although a multidisciplinary approach is essential to optimize outcome,the ability of trained hand surgeons to repair all injuries in combined vascular and musculoskeletal upper extremity trauma,excluding isolated vascular injuries,ensures shorter operative times and better functional outcomes.
基金the Veterans and Martyrs Affair Foundation (VMAF)Janbazan Medical and Engineering Research Center (JMERC)
文摘Background: Upper limb amputations are one of the unpleasant war injuries that armed forces are exposed to frequently. The present study aimed to assess the musculoskeletal and peripheral nervous systems in Iraq-Iran war veterans with bilateral upper extremity amputation.Methods: The study consisted of taking a history and clinical examinations including demographic data, presence and location of pain, level of amputation, passive and active ranges of movement of the joints across the upper and lower extremities and spine, manual palpation, neurological examination, blood circulation pulses and issues related to a prosthetic limb. In this study, 103 Iranian bilateral upper extremity amputees(206 amputations) from the IranIraq war were evaluated, and a detailed questionnaire was also administered.Results: The most common level of amputation was the finger or wrist level(108, 52.4%). Based on clinical examination, we found high frequencies of limited active and passive joint range of movement across the scapula, shoulder, elbow, wrist and metacarpophalangeal, interphalangeal and thumb joints. Based on muscle strength testing, we found varying degrees of weakness across the upper limbs. Musculoskeletal disorders included epicondylitis(65, 31.6%), rotator cuff injury(24, 11.7%), bicipital tendonitis(69, 33.5%), shoulder drop(42, 20.4%) and muscle atrophy(19, 9.2%). Peripheral nerve disorders included carpal tunnel syndrome in 13(6.3%) and unilateral brachial plexus injury in 1(1%). Fifty-three(51.5%) were diagnosed with facet joint syndrome at the level of the cervical spine(the most frequent site). Using a prosthesis was reported by 65(63.1%), both left and right sides. The back was the most common site of pain(71.8%).Conclusion: The high prevalence of neuro-musculoskeletal disorders among bilateral upper extremity amputees indicates that they need regular rehabilitation care.
文摘Upper extremity deep vein thrombosis(UEDVT)is less common than lower extremity DVT but is a cause of significant morbidity and mortality in intensive care unit patients.Increasing cancer incidence,prolonged life expectancy and increasing use of intravascular catheters and devices has led to an increased incidence of UEDVT.It is also associated with high rates of complications like pulmonary embolism,post-thrombotic syndrome and recurrent thrombosis.Clinical prediction scores and D-dimer may not be as useful in identifying UEDVT;hence,a high suspicion index is required for diagnosis.Doppler ultrasound is commonly employed for diagnosis,but other tests like computed tomography and magnetic resonance imaging venography may also be required in some patients.Contrast venography is rarely used in patients with clinical and ultrasound findings discrepancies.Anticoagulant therapy alone is sufficient in most patients,and thrombolysis and surgical decompression is seldom indicated.The outcome depends on the cause and underlying comorbidities.
文摘Statement of the Problem: Upper limb hemiparesis is a common impairment underlying disability after Stroke. Transfer of treatment to daily functioning remains a question for traditional approaches used in treatment of upper extremity hemiparesis. Approaches based on Motor Learning principles may facilitate the transfer of treatment to activities of daily living. Methodology: Forty one subjects with chronic stroke, attending department of occupational therapy, National Institute for the Orthopaedically Handicapped, Kolkata, West Bengal, India participated in a single blinded randomized pre-test and post-test control group training study. Subjects were randomized over three intervention groups receiving modified Constraint Induced Movement Therapy (n = 13), Bilateral Arm training (n = 14), and an equally intensive conventional treatment program (n = 14). Subjects in the bilateral arm training group participated in bilateral symmetrical activities, where as subjects in constraint induced movement therapy group performed functional activities with the affected arm only and conventional group received conventional Occupational Therapy. Each group received intensive training for 1 hour/day, 5 days/week, for 8 weeks. Pre-treatment and post-treatment measures included the Fugl-Meyer measurement of physical performance (FMA- upper extremity section), action research arm test, motor activity log. Assessments were administered by a rater blinded to group assignment. Result: Both m-CIMT (p = 0.01) and bilateral arm training (p = 0.01) group showed statistically significant improvement in upper extremity functioning on Action Research Arm Test score in comparison to the conventional therapy group (p = 0.33). The bilateral arm training group had significantly greater improvement in upper arm function (Proximal Fugl-Meyer Assessment score, p = 0.001);while the constraint induced movement therapy group had greater improvement of hand functions (Distal Fugl-Meyer Assessment score, p = 0.001. There is an improvement seen in Quality of movement in the Conventional Therapy group. (p = 0.001). Conclusion: Both the treatment techniques can be used for upper extremity management in patients with chronic stroke. Bilateral arm training may be used to improve upper arm function and m-CIMT may be used to improve hand functions, while the group that received modified constraint induced movement therapy had greater improvement.
文摘Introduction: Upper extremity impairment is one of the common complications following a stroke. There are numerous rehabilitation strategies to address this problem. However, patients with moderate to severe upper limb disabilities respond differently to the same rehabilitation protocol. Apart from each patient’s unique characteristics, there are specific brain reorganizing patterns that affect the post-rehabilitation response rate. Functional magnetic resonance imaging (fMRI) determines brain activation area and connectivity patterns and has been utilized in the neurorehabilitation field. Material and Methods: Six stroke patients who suffered from moderate to severe upper extremity dysfunction were enrolled in this pilot study. Upper extremity function tests including the Fugl-Meyer assessment test for upper extremity (FMA-UE), and Wolf Motor Function Test (WMFT) were utilized before and after completing an intensive rehabilitation. The intensive rehabilitation program was conducted one hour a day for five days per week for four weeks. Moreover, fMRI was applied before initiating rehabilitation. The regions of interest were those associated with movement, including Brodmann areas (BA) BA1-BA6. Results: Six stroke patients in the sub-acute to chronic phase and ages ranging between 33 - 75 years were enrolled. All patients showed an improvement in upper limb function after four weeks of rehabilitation. Patient number one (Pt1) had the most improvement in FMA-UE, while patient number four (Pt4) recovered the most measured by WMFT. Pt1 demonstrated increased activity in all contralesional regions, whereas Pt4 had only increased activity in ipsilesional areas. Furthermore, patients with greater activation in the ipsilesional BA6 (Pt1, Pt4, Pt5, and Pt6) had better responses to the rehabilitation therapy. Conclusion: Patients with greater activation in the baseline fMRI, particularly ipsilesional BA6, had a better response to the intensive rehabilitation therapy. However, the patients with the most severe hand dysfunction showed lesser improvement despite the same brain activity as others in the initial fMRI.
基金General project of national natural science foundation(No.81573989,81403408)Project for national talent inheritors of traditional Chinese medicine[No.(2019)36]Project for leading talent of hygiene and health of Shandong province[No.(2020)3]。
文摘Objective:To evaluate clinical efficacy by traditional Chinese combined with western therapy to treat upper extremity edema after breast cancer surgery.The clinical efficacy was described by the effective rate and the change of peripheral diameter of the affected limb.Methods:National Knowledge Internet(CNKI),Wan Fang Digital Journals(Wan Fang),VIP Chinese periodical service platform(VIP),Chinese biomedical literature service system(CBM),PubMed and EMBASE were searched on computer.And clinical randomized controlled trials(RCT)of the treatment of upper extremity edema after breast cancer surgery with integration of Chinese and western treatment were selected.The time was from January 2011 to May 2020.Upper extremity edema after breast cancer surgery was the first key word and the second was traditional Chinese combined with western therapy.Note Express was used to screen and extract literature.Bias risks of all the literature included in the study were evaluated and analyzed by RevMan5.3 software.Results:10 randomized controlled clinical tests,644 patients in conformity to the inclusion criteria,9 for the observation of curative effectiveness,5 of changes in limb circumference.322 cases were included in the observation group and the same number of cases in the control group,all of which were in Chinese.The results expressed that the curative effect in the observation group was 91.1%,and it was higher than the curative effect in the control group treated by single western treatment obviously,and it was only 68.9%[95%CI(1.22,1.44),Z=6.55,P<0.00001].The peripheral diameter shrinking degree of the affected limb in the observation group was also clearly higher than that in the control group which was healed by simple western treatment[95%CI(-0.98,-0.64),Z=9.40,P<0.00001].Conclusion:Traditional Chinese combined with western therapy treating upper extremity edema after the surgery of breast cancer had a notable clinical effect,which treated the disease and effectively lessened the peripheral diameter of the affected limb.The method was worthy of clinical application.However,owing to the low quality of the included documents,further discussion and learning were still needed.
文摘Objective To discuss the etiology,course of diseases and prognosis of symmetry peripheral entrapment enuropathies of upper extremity. Methods The etiology, clinical scale and resluts of 14 cases were analyzed betwen 1999 and April 2002. Results In the bilateral tunnel syndrome, the excellent and good rate was 60% at the original side and 80% at the contralateral side occurred later. In the bilateral carpal tunnel syndrome, the excellent and good rate was 67% at the original side and 89% at the contralateral side occurred later. Conclusion The main etiological factor of the bilateral cubital tunnel syndrome was the elbow eversion deformity. The lesions of synovium contributed mainly to the symmetry carpal tunnel syndrome. The symmetry peripheral entrapment neuropathies of upper extremity should be operated on as soon as possible when diagnosis had been made for enhancement of treatment outcome. 5 refs,2 tabs.
文摘Objective To investigate the clinical features and magnetic resonance imaging (MRI) findings of patients with Hirayama disease simply presenting proximal upper extremity muscular atrophy. Methods Three patients with Hirayama disease simply
文摘Background Little is known regarding risk factors specific to pedialric upper extremity firearm injuries.The purpose of this study is to evaluate pediatric patients treated for these injuries to identify at-risk populations and recurring mechanisms of injury.Methods A 20-year retrospective review was conducted.Patients 17 years of age and younger,with upper extremity injuries related to a firearm,were included.Analysis involved Fisher's exact and Chi-square tests.Results One hundred and eighty patients were included.The mean age was 12.04±4.3 years.Most included patients were male(85%).Interestingly,females were more frequently victims of assault(P=0.03),and males were more frequently injured due to accidental discharge(P<0.001).The most affected race/ethnicity was White-not Hispanic or Latino(48%).The hand was the most frequent location injured(31%)and was more likely to be accidental than proximal injuries(P=0.003).Air rifes were the most common firearm type used(56%).Pistols were implicated in 47(26%)cases,rifles in 17(9%),and.shotguns in 10(6%).Ninety-nine(55%)patients had procedures in the operating room.The most frequent procedure was foreign body removal(55%).Conclusions Risk factors such as male sex,W hite-not Hispanic or Latino race/ethnicity,and adolescent age were attributed to increased risk for injury.Male sex was associated with increased risk of injury by accidental discharge and female sex with intentional assault.Air rifles were the most common firearm type overall,although female sex was associated with increased risk for injury by powder weapon.
文摘Objectives:This study aimed to explore the effects of the“FuekFone(F.F.)home-based program”on the upper limb and cognitive function of ischemic stroke patients after discharge.Methods:A single group pre-and post-test design was conducted.A total of 40 patients with recovery after ischemic stroke were recruited from two university hospitals in Thailand.The study was conducted between June 2022 and January 2023.Participants underwent a six-week“F.F.home-based program,”which combined an upper limb and cognitive function rehabilitation device with Android games,including stationary barrel,adventure walk,adventure stroll,sliding barrel,sauce squeeze,and cut objects.Each game has different difficulty levels.Patients can perform corresponding exercises through the games according to their conditions under the guidance of medical staff.The patients played for 24 min per time,4 min each game,three days a week.The second week,let the patients play games for 30 min per time,5 min each game,3 days a week.Then,in the 3e6 weeks,let the patients play games for 1 h per time,10 min each game,5 days a week.At the pre-and post-intervention,the Thai version of the National Institutes of Health Stroke Scale(NIHSS),the Motor Assessment Scale,and the Montreal Cognitive Assessment(MoCA score)were administered to patients at discharge and at 2,4,and 6 weeksafter discharge,and the results were compared.Results:All participants completed this program.Participants had statistically improved upper limb function(upper arm function score,hand movements score,advanced hand activities score,total Motor Assessment Scale score)and MoCA score at 2,4,and 6 weeks after discharge(P<0.001).In the comparison of upper limb function and cognitive function at each of the study times,we found statistically improved upper limb function(upper arm function score,hand movements score,advanced hand activities score,total Motor Assessment Scale score)and MoCA score at 4,and 6 weeks after discharge when compared to after discharge and 2 weeks after discharge,respectively(P<0.05).Conclusions:Continuing care of patients post-stroke after discharge from hospital,such as F.F.homebased program should be applied at home to enhance upper limb and cognitive function.
文摘Vascularized lymph node transfers(VLNT)are useful options for the surgical treatment of lymphedema.Conventional VLNT does not include the reconstruction of physiological lymphatic outflow,which may pose a risk of postoperative lymphatic vessel obstruction and lymph node sclerosis.We report a case of lymph flow bypass reconstruction using a superficial circumflex Iliac artery perforator(SCIP)flap,including VLNT with efferent lymphatico-lymphatic anastomosis.A 63-year-old female with severe right upper extremity lymphedema after mastectomy was reconstructed using a SCIP free flap,which included a vascularized lymph node elevated from the left groin area and transferred to the right axilla area.The SCIP vessels were anastomosed to the medial intercostal artery perforator vessels and the efferent lymphatic vessel from the vascularized lymph node was anastomosed to the internal mammary lymphatic vessels using supermicrosurgical technique.Indocyanine green lymphography showed the reconstructed lymphatic flow from the right hand to the right internal mammary lymphatics through the transferred flap.Postoperatively,lymphedema improved and there was no lymphedema at the donor site with a 2-year follow-up.Lymphatic flow bypass reconstruction using VLNT with efferent lymphatico-lymphatic anastomosis may provide a useful option for the treatment of severe lymphedema.
文摘Nerve transfers for peripheral nerve injuries have become increasingly popular over the past two decades.While techniques for ulnar nerve repair have been well-documented,more recent techniques for median and radial nerve branch reinnervation are still being explored.This review describes the outcomes of common and emerging techniques for reinnervation of the distal branches of the median and radial nerves.
文摘Soft tissue tumors in the hand have a broad differential diagnosis. Included in the list of differential diagnoses for these tumors are Schwannomas, which are benign tumors within the peripheral nervous system [1]. Schwannomas are uncommon within the upper extremity, and they are exceedingly rare within the hand and wrist [1]. We describe a case of an 80-year-old female presented with a soft tissue mass within her right thumb. She underwent excisional biopsy of the mass, and pathology showed features consistent with schwannoma. She had resolution of her symptoms thereafter. We discuss the differential diagnosis for soft-tissue tumors in this location. When assessing patients with soft tissue tumors of the hand and wrist, it is important for the treating provider to maintain a broad differential diagnosis in order to facilitate appropriate management of these lesions.
文摘Introduction: Anthrax is a zoonotic disease caused by Bacillus anthracis spores. Cutaneous form is the most common and the least fatal form of the disease, however the disease is uncommon in Europe and U.S. and the reports in the literature are mostly case reports for upper extremity. Case Series: 7 patients, who were treated between 1999 and 2015 in our clinic with the diagnosis of cutaneous anthrax in their upper extremity, were included to our study. 3 patients applied directly to plastic surgery, others were consulted from the infectious disease clinics. Reconstructions were done with skin grafts or secondarily. Discussion: Anthrax causes cutaneous, gastrointestinal and inhalation forms of the disease. Despite being very rare in Europe and US, in Turkey there are many reported anthrax cases. However, cutaneous anthrax of upper extremity is reported rarely in the literature. Painless papule and vesicles are well defined as clinical findings. In anthrax, the excision of skin lesions or biopsies is contraindicated because of the risk of systemic spread. Conclusion: Despite cutaneous anthrax of the hand and upper extremity is very rare, the diagnosis is easy because of the typical presentation and history. Once the definitive diagnosis is set, the treatment is effortless with the antibiotherapy and first steps of the reconstruction ladder.
文摘Objective:To evaluate and analyze the influencing factors of upper limb lymphedema after breast cancer surgery,and to study effective nursing intervention measures.Methods:500 cases of early breast cancer patients from October 2017 to December 2020 were selected,all patients underwent surgical intervention,retrospectively analyzed the basic clinical data of patients,and statistically analyzed the influencing factors of upper limb lymphedema.All patients with upper extremity lymphedema received high-quality nursing intervention,and the specific nursing effect was analyzed.Results:Logistic regression analysis showed that the risk factors of upper limb lymphedema after breast cancer surgery included hypertension,postoperative upper limb functional exercise,delayed healing of incision,radiotherapy and so on.After nursing intervention,the patients*12*5 elbow 10cm,elbow 10cm,wrist size value and VAS score were better than those before nursing(P<0.05).The quality of life score of patients after nursing intervention was significantly better than that before nursing(P<0.05).Conclusion:Hypertension,postoperative upper limb functional exercise,delayed healing of incision,radiotherapy and other factors can induce upper limb lymphedema after breast cancer surgery.Effective nursing intervention can alleviate the condition of patients with upper limb lymphedema and improve their quality of life,which is worthy of comprehensive promotion.
文摘BACKGROUND: In the natural evolution of cerebrovascular disease, unconscious use of affected extremity during drug treatment and daily life can improve the function of affected upper extremity partially, but it is very slow and also accompanied by the formation of abnormal mode. Therefore, functional training should be emphasized in recovering the motor function of extremity. OBJECTIVE: To observe the effects of combination of motor relearning program and Bobath method on motor function of upper extremity of patients with stroke. DESIGN: Comparison of therapeutic effects taking stroke patients as observation subjects. SETTING: Department of Neurology, General Hospital of Beijing Jingmei Group. PARTICIPANTS: Totally 120 stroke patients, including 60 males and 60 females, averaged (59±3) years, who hospitalized in the Department of Neurology, General Hospital of Beijing Jingmei Group between January 2005 and June 2006 were recruited. The involved patients met the following criteria: Stroke attack within 2 weeks; diagnosis criteria of cerebral hemorrhage or infarction made in the 4th National Cerebrovascular Disease Conference; confirmed by skull CT or MRI; Informed consents of therapeutic regimen were obtained. The patients were assigned into 2 groups according to their wills: rehabilitation group and control group, with 30 males and 30 females in each group. Patients in rehabilitation group averaged (59±2)years old, and those in the control group averaged (58±2)years old. METHODS: ① Patients in two groups received routine treatment in the Department of Neurology. When the vital signs of patients in the rehabilitation group were stable, individualized treatment was conducted by combined application of motor relearning program and Bobath method. Meanwhile, training of activity of daily living was performed according to the disease condition changes of patients at different phases, including the nursing and instruction of body posture, the maintenance of good extremity position, bed exercise, bedside sit up and sitting position balance, sit up exercise, dynamic and static balance exercise, walking exercise, active training and passive training. The strength, time and speed of training were increased gradually according to their physical abilities. Patients were trained 45 to 60 minutes once, 5 times a week, within 2 weeks. ② Evaluation criteria of therapeutic effect: The motor function of upper extremity was evaluated by Fugl-Meyer method on the day of beginning and end of treatment. Higher points indicated better function of upper extremity. ③ t test and paired t test were used for comparing the difference of intergroup and intragroup measurement data, respectively. MAIN OUTCOME MEASURES: Changes in Fugl-Meyer scoring of two groups before and after treatment. RESULTS: Totally 120 stroke patients participated in the final analysis. Before treatment, Fugl-Meyer scoring was close between rehabilitation group and control group [(14.47±2.38),(14.16±2.39) points, P > 0.05]; Fugl-Meyer scoring of rehabilitation group after treatment was significantly higher than that before treatment and that of control group[(37.93±2.67),(18.36±2.43) points, t =11.053, 5.408, P < 0.01]; There were no significant differences in Fugl-Meyer scoring between before treatment in the control group and control group (P > 0.05). CONCLUSION: Combined application of motor relearning program and Bobath method can significantly improve the motor function of upper extremity of patients with stroke.
文摘The objective of this paper is to quantify the local stabilities of the neck and upper extremities （right/left shoulders and right/left elbows）, and investigate differences between linear and nonlinear measurements of the associated joint motions and differences in the local stability between the upper and lower extremities. This attempt involves the calculation of a nonlinear parameter, Lyapunov Exponent （LE）, and a linear parameter, Range of Motion （ROM）, during treadmill walking in conj unction with a large population of healthy subjects. Joint motions of subjects were captured using a three-dimensional motion-capture system. Then mathematical chaos theory and the Rosenstein algorithm were employed to calculate LE of joints as the extent of logarithmic divergence between the neighboring state-space trajectories of flexion-extension angles. LEs computed over twenty males and twenty females were 0.037~0.023 for the neck, 0.043＋0.021 for the right shoulder, 0.045i0.030 for the left shoulder, 0.032i0.021 for the right elbow, and 0.034~0.026 for the left elbow. Although statistically significant difference in the ROM was observed between all pairs of the neck and upper extremity joints, differences in the LE between all pairs of the joints as well as between males and females were not statistically significant. Between the upper and lower extremities, LEs of the neck, shoulder, and elbow were significantly smaller than those of the hip （-0.064） and the knee （-0,062）. These results indicate that a statistical difference in the local stability between the upper extremity joints is not significant. However, the different result between the ROM and LE gives a strong rationale for applying both linear and nonlinear tools together to the evaluation of joint movement. The LEs of the joints calculated from a large population of healthy subjects could provide normative values for the associated joints and can be used to evaluate the recovery progress of patients with joint related diseases.
