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Assessment of upper extremity function either before or after surgical treatment has been a rapidly evolving field. A reproducible, accurate, and valid assessment tool provides the ability to compare surgical interventions, evalua...
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Assessment of upper extremity function either before or after surgical treatment has been a rapidly evolving field. A reproducible, accurate, and valid assessment tool provides the ability to compare surgical interventions, evaluate physical therapy regimens, and assess novel assistive and restorative technologies. The purpose of this article is to detail the various upper extremity assessment tools and introduce the concept of real-world data acquisition of upper extremity function. Copyright (C) 2019 by the American Society for Surgery of the Hand. All rights reserved.
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Purpose: The purpose of this study was to translate and cross-culturally adapt the UEFI into Modern Standard Arabic language and to examine its psychometric properties among patients with upper extremity musculoskeletal disorders....
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Purpose: The purpose of this study was to translate and cross-culturally adapt the UEFI into Modern Standard Arabic language and to examine its psychometric properties among patients with upper extremity musculoskeletal disorders. Materials and Methods: Translation and cross-cultural adaptation were done following Beaton’s guidelines. Internal consistency, test-retest reliability, measurement error and floor and ceiling effects for the Arabic UEFI were tested among 109 patients with upper extremity musculoskeletal disorders. Construct validity of the Arabic UEFI was also examined. Results: Translation and cross-cultural adaptation processes were generally smooth with no major issues. The Arabic UEFI was considered appropriate and comprehensible by the participants. Internal consistency for Arabic UEFI was adequate (Cronbach’s alpha = 0.96). Test-retest reliability for Arabic UEFI was excellent with ICC2 |—0.92. Measurement error was acceptable with a standard error of measurement of 5.5 and minimal detectable change of 12.8 points. Arabic UEFI shows no floor or ceiling effects. The results supported the majority of the construct validity predefined hypotheses (78%) supporting the construct validity of Arabic UEFI as a measure of upper extremity function. Conclusion: The Arabic UEFI is an appropriate, valid and reliable outcome measure for Arabic-speaking patients with upper extremity musculoskeletal disorders.
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Study DesignDescriptive cross-sectional survey study. IntroductionLimb salvage spares an extremity at risk for amputation after a major traumatic injury. Psychosocial recovery for individuals with lower extremity limb salvage has ...
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Study DesignDescriptive cross-sectional survey study. IntroductionLimb salvage spares an extremity at risk for amputation after a major traumatic injury. Psychosocial recovery for individuals with lower extremity limb salvage has been discussed in the literature. However, to date, psychosocial reactions for individuals with upper extremity (UE) limb salvage have not been examined. Purpose of the StudyTo determine which factors may influence psychosocial adaptation to UE limb salvage. MethodsParticipants (n?= 30; 28 males) were adults (mean, 30.13; range, 18-61) who sustained an UE limb salvage from a traumatic event. Adaptation was measured using a modified version of the Reactions to Impairment and Disability Inventory. ResultsA linear mixed-effects regression found that worse psychosocial adaptation was associated with having less than a college degree, being less than 6 months post-injury, being older than 23 years, and having more pain. Dominant hand injuries were found to influence poor adaptation on the denial Reactions to Impairment and Disability Inventory subscale only. DiscussionThe results of this study indicate that there is potential for nonadaptive reactions and psychological distress with certain variables in UE limb salvage. Therapists may use these results to anticipate which clients may be at risk for poor psychosocial outcomes. ConclusionsThis study indicates the need for early consideration to factors that affect psychological prognosis for the UE limb salvage population. However, future research is indicated to better understand the unique psychosocial challenges and needs of these individuals. Level of Evidence4.
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Coronavirus disease of 2019 (COVID-19), caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that emerged in Wuhan, was declared a pandemic by the World Health Organization. COVID-19 has many different cl...
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Coronavirus disease of 2019 (COVID-19), caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that emerged in Wuhan, was declared a pandemic by the World Health Organization. COVID-19 has many different clinical manifestations. One of them is arterial hypercoagulopathy. Although its mechanism is not fully explained, acute thrombosis and thromboembolism can be seen in patients. In this study, we present a case who was amputated due to the development of arterial thrombosis on the 10th day following infection with coronavirus, despite successful replantation after traumatic above-elbow amputation. After replantation on the seventh day, it was learned that the patient’s husband was positive for COVID-19 and had come to visit the patient. For this reason, we performed reverse transcription polymerase chain reaction (RT-PCR) to confirm the patient’s COVID-19 status. We found that the patient, who was asymptomatic, was positive by RT-PCR for COVID-19. On the 10th day after the operation, it was observed that the blood circulation of the replanted extremity was impaired, although it had been perfect until that day. Emergency embolectomy and vascular reanastomosis were planned for the patient. Although we generally observe thrombosis at an end-to-end anastomosis site, massive axillary arterial thrombosis was detected at the proximal end of the vascular anastomosis. Upon development of tachycardia, hypotension, and metabolic acidosis after embolectomy and vascular reanastomosis, the decision was made to amputate the replanted limb to reduce the risk of life-threatening complications. To our knowledge, this is the first such COVID-19-related complication on upper extremity replantation in the literature.
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A three-dimensional (3D) biomechanical model was developed to determine upper extremity kinematics and kinetics of persons walking with forearm crutches. Six-component load cells and strain gauges were installed in the crutches to...
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A three-dimensional (3D) biomechanical model was developed to determine upper extremity kinematics and kinetics of persons walking with forearm crutches. Six-component load cells and strain gauges were installed in the crutches to determine crutch forces. A six-camera VICON motion system was used to acquire coordinate data from 24 reflective markers attached to the upper extremities and crutches. Joint axes for the wrist, elbow, and glenohumeral joints were defined and joint forces and moments were determined using inverse dynamics. Accuracy of the crutch instrumentation was established by simultaneously collecting force data from a Kistler forceplate and each crutch during crutch-assisted gait with the respective crutch tip contacting the forceplate. In order to demonstrate the application of this biomechanical model, upper extremity weight bearing forces, joint motion, and stride characteristics were recorded from a subject with T-12 incomplete spinal cord injury (SCI), using a crutch-assisted reciprocal four-point gait pattern. The peak net joint forces and moments were greater for the right arm opposite the weaker left lower extremity. The largest joint forces were directed superiorly (Fz) and the asymmetrical pattern of crutch use was consistent with lower extremity strength differences. During left leg weight acceptance, increased right wrist extension motion and moment were recorded, which may contribute to wrist pathology.
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Free omental tissue transfer is a versatile reconstructive option for trunk, head and neck, and extremity reconstruction. Its utility is due to the length and caliber of the vascular pedicle and the malleability and surface area o...
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Free omental tissue transfer is a versatile reconstructive option for trunk, head and neck, and extremity reconstruction. Its utility is due to the length and caliber of the vascular pedicle and the malleability and surface area of the flap. We report our experience with omental free flap coverage of complex upper-extremity defects. A retrospective analysis of eight omental free-tissue transfers in seven patients with complex upper-extremity defects between 1999 and 2008 was performed. Indications, operative technique, and outcome were evaluated. Patient age ranged from 12 to 59 years with five male and two female patients. Indications included tissue defects due to crush-degloving injuries, pitbull mauling, or necrotizing soft tissue infection. All patients had prior operations including: revascularization, debridement, tendon repair, skin grafts, and/or fixation of associated fractures. One patient sustained severe bilateral crush-degloving injuries requiring free omental hemiflap coverage of both hands. The mean defect size was 291 cm2 with all patients achieving complete wound coverage. No flap loss or major complications were noted. Laparoscopic-assisted omental free flap harvest was performed in conjunction with the general surgery team in three cases. Mean follow-up was 2 years. The omental free flap is a valuable, often overlooked reconstructive option. The long vascular pedicle and large amount of pliable, well-vascularized tissue allow the flap to be aggressively contoured to meet the needs of complex three-dimensional defects. In addition, laparoscopic-assisted harvest may aid with flap dissection and may result in reduced donor-site morbidity.
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Objective. The use of the prone position to treat patients with COVID-19 pneumonia who are critically ill and mechanically ventilated is well documented. This case series reports the location, severity, and prevalence of focal per...
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Objective. The use of the prone position to treat patients with COVID-19 pneumonia who are critically ill and mechanically ventilated is well documented. This case series reports the location, severity, and prevalence of focal peripheral nerve injuries involving the upper limb identified in an acute COVID-19 rehabilitation setting. The purpose of this study was to report observations and to explore the challenges in assessing these patients. Methods. Participants were patients with suspected peripheral nerve injuries following discharge from COVID-19 critical care who were referred to the peripheral nerve injury multidisciplinary team. Data were collected retrospectively on what peripheral neuropathies were observed, with reference to relevant investigation findings and proning history. Results. During the first wave of the COVID-19 pandemic in the United Kingdom, 256 patients were admitted to COVID-19 critical care of Queen Elizabeth Hospital, Birmingham, United Kingdom. From March to June 2020, a total of 114 patients required prone ventilation. In this subgroup, a total of 15 patients were identified with clinical findings of peripheral nerve injuries within the upper limb. In total, 30 anatomical nerve injuries were recorded. The most commonly affected nerve was the ulnar nerve (12/30) followed by the cords of the brachial plexus (10/30). Neuropathic pain and muscle wasting were identified, signifying a high-grade nerve injury. Conclusion. Peripheral nerve injuries can be associated with prone positioning on intensive care units, although other mechanisms, such as those of a neuroinflammatory nature, cannot be excluded. Impact. Proning-related upper limb peripheral nerve injuries are not discussed widely in the literature and could be an area of further consideration when critical care units review their proning protocols. Physical therapists treating these patients play a key part in the management of this group of patients by optimizing the positioning of patients during proning, making early identification of peripheral nerve injuries, providing rehabilitation interventions, and referring to specialist services if necessary. Lay Summary. During the COVID-19 pandemic, patients who are very ill can be placed for long periods of time on their stomach to improve their chances of survival. The potential consequences of prolonged time in this position are weakness and pain in the arms due to potential nerve damage. There are some recommended treatments to take care of these problems.
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Vascular grafts, as either interpositional conduits or bypass grafts, can be used for revascularization procedures in the upper extremity. Vein grafts are more readily available and can be easier to harvest. Arterial grafts may pr...
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Vascular grafts, as either interpositional conduits or bypass grafts, can be used for revascularization procedures in the upper extremity. Vein grafts are more readily available and can be easier to harvest. Arterial grafts may provide superior patency rates compared with vein grafts. Arterial grafts can be located and harvested with consistent and reliable anatomy throughout the body.
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Objectives: To analyze work participation, work productivity, contributing factors, and physical work demands of individuals with upper limb absence (ULA).
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