79 Maximizing Safe Positioning of Upper Extremities After Axillary Burn Injuries to Prevent Contractures and Maintain Function

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S51-S51
Author(s):  
Connie Greiser ◽  
David Lorello ◽  
Eric Barto ◽  
S V Gartner ◽  
Dan Lyons ◽  
...  
Keyword(s):  
Healthy Subjects ◽  
Elbow Flexion ◽  
Primary Objective ◽  
Burn Injuries ◽  
Shoulder Abduction ◽  
Shoulder Injury ◽  
Shoulder Range Of Motion ◽  
History Of ◽  
The Right ◽  
Shoulder Range

Abstract Introduction Burns crossing over a joint can result in a contracture of that joint. Axillary burns and subsequent contractures are common and may impact negatively on burn survivor rehabilitation. Positioning of burned extremities at the most lengthened position is ideal for maintenance of function and contracture prevention, 90 degrees of abduction is the most accepted position for axillary burn injuries. However, many activities of daily living require shoulder range of motion (ROM) greater than 90 degrees. The primary objective of this study was to describe and examine the incidence of paresthesia, pain, and intolerance in healthy subjects when the shoulder was placed in a position of 90 degrees or greater of shoulder abduction. Methods The subject’s nondominant upper extremity (NDE) was randomly placed in a series three of positions, including: (1) 90 degrees shoulder abduction, 30 degrees horizontal adduction with elbow extension, forearm neutral; (2) 130 degrees shoulder abduction, 30 degrees horizontal adduction, 30 degrees elbow flexion, forearm neutral; (3) 150 degrees shoulder abduction, 30 degrees horizontal adduction, 30 degrees elbow flexion, forearm neutral. Each position was maintained for a maximum of 2 hours. Subjects experiencing subjective symptoms including paresthesia lasting longer than 1 minute, pain rated greater than 3/10, and/or intolerance 2/5 was removed from the position. All subjects received at least 30 minutes of rest between positions. Results A total of 25 subjects were enrolled, mean age was 25.8 years, the majority were female (60%) and 20% had a history of NDE shoulder injury. The right arm was the dominant extremity (DE) in 88% of subjects. There were no significant differences in ROM between the DE and NDE extremity with the exception of external shoulder rotation, 94.96⁰ vs 84.8⁰ (p=.0142). Average total splint time was 136 minutes with a range of 40 – 360 minutes. Only 1 subject successfully completed all 3 splinting periods. There were 75 individual splinting events over the 3 splinting periods, and 90% of the time the splinting was stopped early. The most common reason for stopping early was paresthesia (88%) followed by pain (7%). Conclusions The positions selected represent the routine and usual care at our burn center. Patients are routinely positioned from hours to days depending on patient need. This study demonstrated that healthy subjects were unable to tolerate positioning for even two hours. Applicability of Research to Practice Additional research is needed to determine optimal positioning for the shoulder joint.

639 Maximizing Safe Positioning of Upper Extremities after Axillary Burn Injuries to Prevent Contractures and Maintain Function

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S175-S176
Author(s):  
Connie Greiser ◽  
David Lorello ◽  
Dan Lyons ◽  
Karen J Richey ◽  
Derek Murray ◽  
...  
Keyword(s):  
Healthy Subjects ◽  
Elbow Flexion ◽  
Primary Objective ◽  
Burn Injuries ◽  
Shoulder Abduction ◽  
Shoulder Injury ◽  
Shoulder Range Of Motion ◽  
History Of ◽  
The Right ◽  
Shoulder Range

Abstract Introduction Burns crossing over a joint can result in a contracture of that joint. Axillary burns and subsequent contractures are common and may impact negatively on burn survivor rehabilitation. Positioning of burned extremities at the most lengthened position is ideal for maintenance of function and contracture prevention, 90 degrees of abduction is the most accepted position for axillary burn injuries. However, many activities of daily living require shoulder range of motion (ROM) greater than 90 degrees. The primary objective of this study was to describe and examine the incidence of paresthesia, pain, and intolerance in healthy subjects when the shoulder was placed in a position of 90 degrees or greater of shoulder abduction. Methods The subject’s nondominant upper extremity (NDE) was randomly placed in a series three of positions, including: (1) 90 degrees shoulder abduction, 30 degrees horizontal adduction with elbow extension, forearm neutral; (2) 130 degrees shoulder abduction, 30 degrees horizontal adduction, 30 degrees elbow flexion, forearm neutral; (3) 150 degrees shoulder abduction, 30 degrees horizontal adduction, 30 degrees elbow flexion, forearm neutral. Each position was maintained for a maximum of 2 hours. Subjects experiencing subjective symptoms including paresthesia lasting longer than 1 minute, pain rated greater than 3/10, and/or intolerance 2/5 was removed from the position. All subjects received at least 30 minutes of rest between positions. Results A total of 25 subjects were enrolled, mean age was 25.8 years, the majority were female (60%) and 20% had a history of NDE shoulder injury. The right arm was the dominant extremity (DE) in 88% of subjects. There were no significant differences in ROM between the DE and NDE extremity with the exception of external shoulder rotation, 94.96⁰ vs 84.8⁰ (p=.0142). Average total splint time was 136 minutes with a range of 40 – 360 minutes. Only 1 subject successfully completed all 3 splinting periods. There were 75 individual splinting events over the 3 splinting periods, and 90% of the time the splinting was stopped early. The most common reason for stopping early was paresthesia (88%) followed by pain (7%). Conclusions The positions selected represent the routine and usual care at our burn center. Patients are routinely positioned from hours to days depending on patient need. This study demonstrated that healthy subjects were unable to tolerate positioning for even two hours.

scholarly journals Effect of Pitching Consecutive Days in Youth Fast-Pitch Softball Tournaments on Objective Shoulder Strength and Subjective Shoulder Symptoms

2017 ◽  
Vol 45 (6) ◽  
pp. 1413-1419 ◽  
Author(s):  
S. Andrew Skillington ◽  
Robert H. Brophy ◽  
Rick W. Wright ◽  
Matthew V. Smith
Keyword(s):  
Shoulder Pain ◽  
External Rotation ◽  
Elbow Flexion ◽  
Strength Loss ◽  
Complete Recovery ◽  
Progressive Increase ◽  
Shoulder Abduction ◽  
Shoulder Injury ◽  
Level Of Evidence ◽  
Cross Sectional

Background: The windmill pitching motion has been associated with risk for shoulder injury. Because there are no pitching limits on youth fast-pitch softball pitchers, these athletes often pitch multiple games across consecutive days. Strength changes, fatigue levels, and shoulder pain that develop among female fast-pitch pitchers over the course of consecutive days of pitching have not been investigated. Hypothesis: Over the course of 2- and 3-day fast-pitch softball tournaments, pitchers will develop progressive objective weakness and increased subjective shoulder fatigue and pain without complete recovery between days. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Fourteen female fast-pitch softball pitchers between the ages of 14 and 18 years were evaluated for strength and fatigue changes across 2- and 3-day tournaments. At the beginning and end of each day of tournament play, pitchers were asked to quantify shoulder fatigue and shoulder pain levels of their dominant throwing arm using a 10-point visual analog scale (VAS). Shoulder abduction, flexion, external rotation, internal rotation, elbow flexion, and elbow extension strength measurements were gathered using a handheld dynamometer. Results: Over the course of an average single day of tournament participation, pitchers developed significant increases in VAS scores for shoulder fatigue (median, 2.0; 95% CI, 1.3-3.0) and pain (median, 1.3; 95% CI, 0.5-2.3) and significant strength loss in all tested motions. Pitchers also developed significant increases in VAS shoulder fatigue (median, 3.5; 95% CI, 1.5-5.5), VAS shoulder pain (median, 2.5; 95% CI, 1.0-4.5), and strength loss in all tested motions over the entire tournament. Shoulder pain, fatigue, and strength do not fully recover between days. The accumulation of subjective shoulder pain and fatigue over the course of tournament play were closely correlated. Conclusion: Among youth female fast-pitch softball pitchers, there is a progressive increase in shoulder fatigue, pain, and weakness over the course of 2- and 3-day tournaments without full recovery between consecutive days of pitching.

Ulnar Nerve Strain in Functional Elbow and Shoulder Motions

2019 ◽  
Vol 24 (03) ◽  
pp. 323-328
Author(s):  
Chaiyos Vinitpairot ◽  
Surut Jianmongkol ◽  
Tala Thammaroj ◽  
Settapon Wattanakamolchai
Keyword(s):  
Ulnar Nerve ◽  
High Strain ◽  
Cellular Phone ◽  
Elbow Flexion ◽  
Daily Activities ◽  
Shoulder Abduction ◽  
Average Strain ◽  
Fresh Frozen ◽  
History Of ◽  
Or History

Background: Shoulder and elbow motions can affect ulnar nerve strain. However, there is no evidence that links this kind of strain to specific activities. The purpose of this study was to examine ulnar nerve strain at the elbow resulting from normal daily activities. Methods: This study was conducted using thirty fresh frozen cadaveric elbows from subjects who had no deformities or history of previous upper extremity surgery. Strain was calculated based on nerve elongation. Ulnar nerve strain at the elbow from motion related to common daily activities was measured in both normal nerves and nerves in which gliding motion was restricted. The results of these measurement were then compared. Results: Activities related to extreme elbow and shoulder motions, such as cellular phone use, yielded an average strain of 6.3%. In addition, we found that nerve strain increased significantly in conditions in which gliding motion was restricted. Nerve strain due to motion associated with cellular phone use, for example, rose by 69.1%. Conclusions: Elbow flexion and shoulder abduction in daily activities are associated with increases in ulnar nerve strain, but this may not cause permanent damage to the nerve. After nerve gliding motion had been restricted, nerves that normally exhibited less strain often had even increased higher levels of strain than those nerves that normally exhibited high strain.

scholarly journals MUSCLE CONTRACTION DURING MANEUVERING STEERING WHEEL USING SURFACE ELECTROMYOGRAPYHY

2020 ◽  
Vol 20 (Special1) ◽  
pp. 216-222
Author(s):  
Darliana M ◽  
Baba MD ◽  
Dian DID ◽  
Ahmad RI
Keyword(s):  
Muscle Contraction ◽  
Biceps Brachii ◽  
Strong Relationship ◽  
Elbow Flexion ◽  
Objective Measurement ◽  
Steering Wheel ◽  
Shoulder Abduction ◽  
Road Accidents ◽  
Driving Posture ◽  
The Right

Driving posture is one of the factors that need to be emphasized in ensuring driver’s comfort and to avoid road accidents and injuries. Meanwhile, fatigue has a strong relationship with comfortable posture and it contributes 15.7% of the total road accidents in Malaysia. Fatigue can reduce driving concentration and performances, thus increases the risk of road accidents and injuries. In order to determine the driver’s comfort, this study had measured muscle contraction using the objective measurement for comfortable and optimum driving posture angles. The equipment used for conducting objective measurement on 14 respondents was sEMG. The researcher had used sEMG equipment to evaluate muscles activities at upper extremities, which comprises of Biceps Brachii (BB), Deltoid Anterior (DA) and Trapezious Upper (TU) that were involved during controlling the car steering. It involves three driving postures parameters according to the fixed elbow and shoulder angles. The results from this study showed the BB muscle increased positively when turning the steering wheel to the right within 3 to 6 times value increased. Meanwhile, DA and TU muscles experience a contraction in the opposite direction with steering wheel turning action, which shows higher right side DA and TU muscle contraction when the driver turn the steering to the left with around 80% decrease for DA and within 60% to 80% decrease value for TU. BB muscle also shows an increasing value of muscle contraction with higher elbow flexion, meanwhile DA and TU muscles contraction also show an increment in-line with greater shoulder abduction. The results showed that posture B with elbow angle at 36° and shoulder angle at 134° are the most comfortable driving postures, hence the lowest muscle contraction value of 15.67μV (BB), 19.31μV (DA) and 12.36μV (TU) compared to the other two measured postures. The results of muscle contraction from this study is capable of assisting researchers and car manufacturers to understand the relationship of steering maneuvering when developing more comfortable and suitable vehicle’s driver seat compartment.

scholarly journals Effects of Pilates Exercises on Shoulder Range of Motion, Pain, Mood, and Upper-Extremity Function in Women Living With Breast Cancer: A Pilot Study

2008 ◽  
Vol 88 (4) ◽  
pp. 494-510 ◽  
Author(s):  
Kim S Keays ◽  
Susan R Harris ◽  
Joseph M Lucyshyn ◽  
Donna L MacIntyre
Keyword(s):  
Breast Cancer ◽  
Range Of Motion ◽  
Upper Extremity ◽  
External Rotation ◽  
Exercise Program ◽  
Shoulder Abduction ◽  
Single Subject ◽  
Single Subject Research ◽  
Shoulder Range Of Motion ◽  
Shoulder Range

Background and Purpose The purpose of this study was to examine the effects of Pilates exercises on shoulder range of motion (ROM), pain, mood, and upper-extremity (UE) function in women who had been treated for breast cancer. Participants The participants were 4 women who had undergone axillary dissection and radiation therapy for stage I to IV breast cancer. Methods A nonconcurrent, multiple-baseline, single-subject research design was used to examine the effects of Pilates exercises on the 4 outcomes. Results Visual analyses of the data suggest a modest effect of the Pilates exercise program in improving shoulder abduction and external rotation ROM. Statistically significant improvement in shoulder internal and external rotation in the affected UE was shown for the one participant with pre-existing metastatic disease. The improving baselines seen for pain, mood, and UE function data made it impossible to assess the effects of Pilates exercises on those outcomes. No adverse events were experienced. Discussion and Conclusion Pilates exercises may be an effective and safe exercise option for women who are recovering from breast cancer treatments; however, further research is needed.

scholarly journals RELIABILITY AND VALIDITY OF THE HALO DIGITAL GONIOMETER FOR SHOULDER RANGE OF MOTION IN HEALTHY SUBJECTS

2018 ◽  
Vol 13 (4) ◽  
pp. 707-714 ◽  
Author(s):  
Sarah Correll ◽  
Jennifer Field ◽  
Heather Hutchinson ◽  
Gabby Mickevicius ◽  
Amber Fitzsimmons ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Healthy Subjects ◽  
Reliability And Validity ◽  
Shoulder Range Of Motion ◽  
Shoulder Range

scholarly journals Covid-19 Brachial plexopathy: a case report

2021 ◽  
Author(s):  
Antonio Edvan Camelo Filho ◽  
Diego Sant’Ana Sodré ◽  
Halisson Flamini Arantes ◽  
Carlos Otto Heise
Keyword(s):  
Case Report ◽  
Neuronal Damage ◽  
Elbow Flexion ◽  
Point Of View ◽  
Shoulder Abduction ◽  
Brachial Plexopathy ◽  
Cross Sectional ◽  
Electrophysiological Characterization ◽  
The Right

Context: The understanding of neuromuscular manifestations secondary to infection by SARS-CoV-2 is scarce. Peripheral neuropathies are a heterogeneous group of diseases affecting the peripheral nervous system, with a variable motor, sensitive and autonomic involvement. There are recent descriptions of atypical patterns of neuropathies after COVID-19. In this study we aim to report a brachial plexopathy secondary to COVID-19 with its clinical and electrophysiological characterization. We performed a cross-sectional, observational, descriptive, case report type, using medical record review. Case report: A 42 year-old female was hospitalized for 2 months due to severe respiratory syndrome due to COVID-19. She remained in the ICU for 20 days. During her stay in the ward she complained of weakness and pain in his right upper limb. Physical examination revealed weakness in the right shoulder abduction and elbow flexion. Nerve conduction studies demonstrated involvement of the upper trunk of the right brachial plexus. There was no report of trauma. Her BMI was 50 kg/m2. Conclusions: Recent studies bring atypical descriptions of focal neuropathies, multiple mononeuropathies and plexopathies, opening a new field of study in addition to the description of neuromuscular weakness following ICU stay after COVID-19. From an electrophysiological point of view, there is a recent interest in better characterization of patients with axonal neuropathies suggesting a possible vasculitic mechanism of neuronal damage after COVID-19. Further investigations are necessary to improve the characterization of this particular group, helping its diagnosis and early treatment to reduce complications and disabilities.

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