scholarly journals Fulminant Hemorrhagic Bullae of the Upper Extremities Arising in the Setting of IV Placement During Severe COVID-19 Infection: Observations From a Major Consultative Practice

2021 ◽  
Vol 108 (1) ◽  
Author(s):  
Elena Kurland
Keyword(s):  
Upper Extremities ◽  
Hemorrhagic Bullae

Rating Spinal Nerve Extremity Impairment Using the Sixth Edition

2009 ◽  
Vol 14 (4) ◽  
pp. 1-6
Author(s):  
Christopher R. Brigham
Keyword(s):  
Nerve Root ◽  
Spinal Nerve ◽  
Upper Extremities ◽  
Motor Deficits ◽  
Nerve Injuries ◽  
Sixth Edition ◽  
Federal Employee ◽  
Nerve Root Injury ◽  
Root Injury ◽  
Rating Process

Abstract The AMAGuides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, does not provide a separate mechanism for rating spinal nerve injuries as extremity impairment; radiculopathy was reflected in the spinal rating process in Chapter 17, The Spine and Pelvis. Certain jurisdictions, such as the Federal Employee Compensation Act (FECA), rate nerve root injury as impairment involving the extremities rather than as part of the spine. This article presents an approach to rate spinal nerve impairments consistent with the AMA Guides, Sixth Edition, methodology. This approach should be used only when a jurisdiction requires ratings for extremities and precludes rating for the spine. A table in this article compares sensory and motor deficits according to the AMA Guides, Sixth and Fifth Editions; evaluators should be aware of changes between editions in methodology used to assign the final impairment. The authors present two tables regarding spinal nerve impairment: one for the upper extremities and one for the lower extremities. Both tables were developed using the methodology defined in the sixth edition. Using these tables and the process defined in the AMA Guides, Sixth Edition, evaluators can rate spinal nerve impairments for jurisdictions that do not permit rating for the spine and require rating for radiculopathy as an extremity impairment.

Peripheral Nerve and Brachial Plexus Impairment, AMA Guides, Sixth Edition

2017 ◽  
Vol 22 (2) ◽  
pp. 3-5
Author(s):  
James B. Talmage ◽  
Jay Blaisdell
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Complex Regional Pain Syndrome ◽  
Lower Extremities ◽  
Pain Syndrome ◽  
Upper Extremities ◽  
Motor Deficits ◽  
Type I ◽  
Sixth Edition ◽  
Nerve Entrapments

Abstract Physicians use a variety of methodologies within the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, to rate nerve injuries depending on the type of injury and location of the nerve. Traumatic injuries that cause impairment to the peripheral or brachial plexus nerves are rated using Section 15.4e, Peripheral Nerve and Brachial Plexus Impairment, for upper extremities and Section 16.4c, Peripheral Nerve Rating Process, for lower extremities. Verifiable nerve lesions that incite the symptoms of complex regional pain syndrome, type II (similar to the former concept of causalgia), also are rated in these sections. Nerve entrapments, which are not isolated traumatic events, are rated using the methodology in Section 15.4f, Entrapment Neuropathy. Type I complex regional pain syndrome is rated using Section 15.5, Complex Regional Pain Syndrome for upper extremities or Section 16.5, Complex Regional Pain Syndrome for lower extremities. The method for grading the sensory and motor deficits is analogous to the method described in previous editions of AMA Guides. Rating the permanent impairment of the peripheral nerves or brachial plexus is similar to the methodology used in the diagnosis-based impairment scheme with the exceptions that the physical examination grade modifier is never used to adjust the default rating and the names of individual nerves or plexus trunks, as opposed to the names of diagnoses, appear in the far left column of the rating grids.

The Care of Burned Upper Extremities

1986 ◽  
Vol 13 (1) ◽  
pp. 107-118 ◽  
Author(s):  
Norman S. Levine ◽  
Robert T. Buchanan
Keyword(s):  
Upper Extremities

Ultrasound features of peripheral angiodistonic syndrome of the upper extremities in vibration disease

2020 ◽  
Vol 60 (11) ◽  
pp. 815-817
Author(s):  
Nadezhda I. Kuprina ◽  
Ekaterina V. Ulanovskaya ◽  
Olga A. Kochetova
Keyword(s):  
Blood Flow ◽  
Heart Defects ◽  
Peripheral Resistance ◽  
Resistance Index ◽  
Ulnar Artery ◽  
Upper Extremities ◽  
Disease Stage ◽  
Peripheral Blood Flow ◽  
Pronounced Increase ◽  
Vibration Disease

Introduction. Vibration disease (VD) is an example of the most common pathology due to the systematic exposure of the worker to intense vibration with sufficient work experience, the main manifestation of which is peripheral angiodystonic syndrome. The aim of study was to learn the features of peripheral blood flow in the arteries of the forearm in vibration disease using the ultrasound method. Materials and methods. The radial and ulnar arteries in patients with vibration disease were examined by ultrasound in B- and PW-mode. These materials present the results of an ultrasound assessment of the speed indicators of the main arteries of the forearm in vibration disease stages 1 and 2. The selection criteria for patients in the study ware the presence of pronounced clinical manifestations of angiodystonic syndrome in vibration disease, confirmed by instrumental research methods and data on the sanitary and hygienic characteristics of working conditions, the absence of cardiovascular chronic diseases (ischemic heart disease, heart defects, rhythm and conduction disturbances), rheumatic, oncological, infectious diseases, osteo-traumatic changes in the upper extremities. Results. The groups of patients with the established diagnosis of vibration disease of 1 and 2 degrees were studied. With vibration disease stage 1 a decrease in the pulse velocity of blood flow was observed in isolation on the ulnar artery and an increase in peripheral resistance (pulsation index and resistance index) in the radial and ulnar arteries symmetrically on both upper extremities. The second stage of vibration disease differed from the first by a more significant decrease in speed indicators both on the ulnar and radial arteries on both sides, symmetrically in combination with a more pronounced increase in peripheral resistance indicators on both main arteries of the forearm (pulsation index and resistance index). The revealed changes were determined with the same frequency in men and women. Conclusions. A significant decrease in speed indicators on the ulnar artery and an increase in peripheral resistance indicators are detected already at the initial stages of vibration disease. Thus, the method of ultrasound examination of the main arteries of the middle caliber of the upper extremities is currently the only available and objective method for examining the vascular system in vibration disease.

Survey on the Prevalence of Carpal Tunnel Syndrome in Simple Repetitive Workers Who Use Upper Extremities

2001 ◽  
Vol 13 (3) ◽  
pp. 209 ◽  
Author(s):  
Ji Eun Son ◽  
Tae Woon Jang ◽  
Yoon Kou Kim ◽  
Young Seoub Hong ◽  
Kap Yeol Jung ◽  
...  
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Upper Extremities ◽  
Tunnel Syndrome

A Retrospective Study to Evaluate the Efficacy of a Plasma Energy System (Renuvion) in the Management of Skin Laxity to Improve Tightening at the Time of Standard Liposuction of the Arms

2021 ◽  
pp. 074880682110310
Author(s):  
Angelo Cuzalina ◽  
Pasquale G. Tolomeo
Keyword(s):  
Upper Extremity ◽  
Control Site ◽  
Clinical Staff ◽  
Upper Extremities ◽  
Final Visit ◽  
Recipient Site ◽  
Skin Laxity ◽  
Plasma Energy ◽  
Treatment Site ◽  
And Control

The aim of this study was to determine the efficacy of cool atmospheric plasma (Renuvion/J-plasma) in promoting skin tightening and soft tissue contouring following liposuction of the upper extremities. The study was a retrospective review of upper extremity liposuction with associated Renuvion therapy performed by the same surgeon. Patients were made aware of Renuvion therapy to assist with skin laxity and offered adjunctive treatment following liposuction. While a majority of patients elected to have Renuvion therapy performed bilaterally, a small subset of patients elected for unilateral treatment. This subset of patients pursued delayed treatment on the control side. The inclusion criteria for the study included patients with moderate fat excess of the upper extremity with associated mild to moderate cutaneous laxity. Exclusion criteria for the study included severe medical comorbidities, body mass index greater than 35 kg/m2 and those below the age of 30. The study included 5 female patients between the ages of 46 to 52. The method of treatment was liposuction of the bilateral upper extremities with removal of equal proportions of fat. The recipient site for Renuvion treatment was randomly selected by the study coordinator; the surgeon and clinical staff remained blinded to the selection. Following treatment, the patients were evaluated at 1 week, 6 weeks, and 6 months postoperatively to assess surgical outcomes subjectively. The surgeon and clinical staff were unblinded at the final visit. Patients were evaluated based on subjective criteria and photographic evaluation at each postoperative visit. At the 1-week visit, no significant differences were noted in all subjects. At the 6-week visit, two patients demonstrated improved results to the treatment site when compared with the control site. At the 6-month visit, four out of the five patients demonstrated a significant improvement in contour and laxity at the treatment site when compared with the control site. One patient demonstrated equal results on both treatment and control sites with no major abnormalities. Following the final evaluation, the patients underwent a secondary procedure to the control site with Renuvion to obtain similar results as the recipient site. One patient demonstrated equal results on both test and control sites with no major abnormalities. The use of plasma energy via Renuvion in conjunction with liposuction has demonstrated esthetic results with proposed long-term benefits. The plasma energy device, as an adjuvant therapy, may be beneficial in cases where liposuction alone may not address tissue laxity concerns. Additional studies with a larger sample size, objective criteria, and extended follow-ups are necessary to statistically analyze the results and determine its significance.

scholarly journals Identifying and Evaluating Vocation-Related Neuro-Musculoskeletal Deficiencies in Professional Musicians: A Review

2021 ◽  
Vol 11 (5) ◽  
pp. 2035
Author(s):  
Joseph Mizrahi
Keyword(s):  
Myofascial Pain ◽  
Tennis Elbow ◽  
Traumatic Injury ◽  
Lateral Epicondylitis ◽  
Upper Extremities ◽  
Upper Body ◽  
Professional Musicians ◽  
Shoulder Muscles ◽  
Repetitive Movements ◽  
Tunnel Syndrome

A combination of factors exposes musicians to neuro-musculoskeletal disorders, which lead to pain and damage. These involve overuse due to long playing hours, containing repetitive movements under stressful conditions, usually performed in an unnatural posture. Although the evoked disorders are usually non-traumatic, they may often lead to prolonged or even permanent damage. For instance, in upper string players, these include bursitis and tendinopathies of the shoulder muscles, tendonitis of the rotator cuff, injury at the tendon sheaths, medial or lateral epicondylitis (also known as tennis elbow), myofascial pain, and wrist tendonitis (also known as carpal tunnel syndrome, or De Quervein’s syndrome). In cases of intensive performance, a traumatic injury may result, requiring drastic means of intervention such as surgery. It should be pointed out that the upper body and upper extremities are the most commonly affected sites of playing musicians. This review provides a description of the playing-related motor disorders in performing musicians, and of the methodologies used to identify and evaluate these disorders, particularly for violinists and other upper string players.

scholarly journals Gastrointestinal involvement and its association with the risk for nephritis in IgA vasculitis

2021 ◽  
Vol 13 ◽  
pp. 1759720X2110248
Author(s):  
Mario Sestan ◽  
Nastasia Kifer ◽  
Marijan Frkovic ◽  
Matej Sapina ◽  
Sasa Srsen ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Odds Ratio ◽  
Biochemical Parameters ◽  
Upper Extremities ◽  
Iga Vasculitis ◽  
Older Children ◽  
Multivariate Logistic Regression ◽  
Gastrointestinal Involvement ◽  
Chronic Complications ◽  
Gi Symptoms

Background: We analysed clinical and biochemical parameters in predicting severe gastrointestinal (GI) manifestations in childhood IgA vasculitis (IgAV) and the risk of developing renal complications. Methods: A national multicentric retrospective study included children with IgAV reviewed in five Croatian University Centres for paediatric rheumatology in the period 2009–2019. Results: Out of 611 children, 281 (45.99%) had at least one GI manifestation, while 42 of 281 (14.95%) had the most severe GI manifestations. Using logistic regression several clinical risk factors for the severe GI manifestations were identified: generalized rash [odds ratio (OR) 2.09 (95% confidence interval (CI) 1.09–4.01)], rash extended on upper extremities (OR 2.77 (95% CI 1.43–5.34)] or face [OR 3.69 (95% CI 1.42–9.43)] and nephritis (IgAVN) [OR 4.35 (95% CI 2.23–8.50)], as well as lower values of prothrombin time (OR 0.05 (95% CI 0.01–0.62)], fibrinogen [OR 0.45 (95% CI 0.29–0.70)] and IgM [OR 0.10 (95% I 0.03–0.35)]] among the laboratory parameters. Patients with severe GI involvement more frequently had relapse of the disease [OR 2.14 (CI 1.04–4.39)] and recurrent rash [OR 2.61 (CI 1.27–5.38)]. Multivariate logistic regression found that the combination of age, GI symptoms at the beginning of IgAV and severity of GI symptoms were statistically significant predictors of IgAVN. Patients in whom IgAV has started with GI symptoms [OR 6.60 (95% CI 1.67–26.06)], older children [OR 1.22 (95% CI 1.02–1.46)] with severe GI form of IgAV (OR 5.90 (95% CI 1.12–31.15)] were particularly high-risk for developing IgAVN. Conclusion: We detected a group of older children with the onset of GI symptoms before other IgAV symptoms and severe GI form of the IgAV, with significantly higher risk for acute and chronic complications of IgAV.

scholarly journals POS0574 RELATIONSHIP BETWEEN INVOLVED JOINT FOR REGION AND MODIFIED HEALTH ASSESSMENT QUESTIONNAIRE SCORE IN JAPANESE PATIENT WITH RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 521.2-521
Author(s):  
I. Yoshii
Keyword(s):  
Health Assessment Questionnaire ◽  
Global Assessment ◽  
Disease Duration ◽  
Health Assessment ◽  
Lower Extremities ◽  
Upper Extremities ◽  
Whole Body ◽  
Large Joint ◽  
Small Joint ◽  
Assessment Questionnaire

Objectives:Rheumatoid arthritis (RA) is a chronic inflammatory disease that involves various joints in whole body. For evaluation of daily life activities (ADL), modified Health Assessment Questionnaire (mHAQ) is usually used. This index configures eight ADL functions these are separated by predominant extremities. This study aimed to evaluate how involved joint affect ADL predominantly in real world setting.Methods:A total of 24,450 times of consultation with RA patient were visited in the institute. Here, patient with RA was interviewed every another visit, and involved joint in whole body, pain score with visual analog scale (PS-VAS), and mHAQ were recorded. Involved joints were divided by four regions in accordance with joint size and part; small joint in upper extremities (US), large joint in upper extremities (UL), small joint in lower extremities (LS), and large joint in lower extremities (LL). mHAQ was also separately evaluated in accordance with predominant regions; upper extremities predominant mHAQ (mHAQ_UE), and lower extremities predominant mHAQ (mHAQ_LE). Adding to these parameters, as an index for disease activity monitoring, components of the simplified disease activity index score (SDAI) was also recorded. Relationship between mHAQ for each predominant extremities, and these parameters and sex, age, disease duration of RA, anti-cyclic citrullinated polypeptide antibodies (ACPA), rheumatoid factor (RF), and Sharp/van der Heijde score (SHS), were statistically evaluated using linear regression analysis.Results:mHAQ_UE significantly correlated with age, ACPA and RF titre, SHS, tenderness joint count (TJC), patient’s global assessment (PGA), evaluator’s global assessment (EGA), C-reactive protein (CRP), US, UL, LL, and PS-vas, whereas mHAQ-LE significantly correlated with all parameters that demonstrated significant correlation with mHAQ-UE and disease duration. mHAQ also correlated with all parameters those that demonstrated significant correlation with mHAQ-LE. Interestingly, all of mHAQ-UE, mHAQ-LE, and mHAQ did not correlated significantly with swollen joint count (SJC) and LS.Conclusion:mHAQ is influenced by various factors, however, SJC and involvement of small joint in lower extremities did not affect mHAQ.Disclosure of Interests:None declared

561 Bilateral Upper Extremity Amputation After High Voltage Electrical Injury: A Case Report

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S130-S131
Author(s):  
Andrew Khalifa ◽  
Anzar Sarfraz ◽  
Jacob B Avraham ◽  
Ronnie Archie ◽  
Matthew Kaminsky ◽  
...  
Keyword(s):  
Case Report ◽  
High Voltage ◽  
Troponin I ◽  
Low Voltage ◽  
Foley Catheter ◽  
The United States ◽  
Upper Extremities ◽  
Full Thickness ◽  
Electrical Injuries

Abstract Introduction Electrical injuries represent 0.4–3.2% of admissions to burn units and are responsible for >500 deaths per year in the United States. Approximately half occur in the workplace and are the fourth leading cause of work-related-traumatic death. The extent of injury can be drastically underestimated by total body surface area percentage (TBSA). Along with cutaneous burns, high voltage electrical injuries can lead to necrosis of muscle, bone, nervous tissue, and blood vessels. Aggressive management allows for patient survival, but at significant cost. Newer technologic advances help improve functional outcomes. Methods This case-report was conducted via retrospective chart review of the case presented. Results A 43-year-old male sustained a HVEI (>10, 000 V) after contacting an active wire while working as a linesman for an electric company. He presented after less than 15-minute transport from an outside hospital with full thickness burns and auto-amputation to all fingers on both hands and the distal third of the left hand (Images 1 and 2). There were full thickness circumferential burns to the entire left and right upper extremities with contractures, with the burns extending into the axilla, and chest wall musculature. The patient had 4th degree burns and a large wound to the left shoulder with posterior extension to the scapula, flank and back with approximately 25% TBSA (Image 3). Compartments were tense in both upper extremities. Patient was sedated and intubated to protect the airway and placed on mechanical ventilation. A femoral central line was then placed, and the patient was given pain control, continued fluid resuscitation, and blood products. Dark red colored urine from a foley catheter that was immediately identified as rhabdomyolysis induced myoglobinuria. Labs drawn demonstrated elevated troponin I, CK >40,000. BUN 18, creatinine 1.0, K+ 5.2 and phosphate 5.6. Decision was made immediately for operative intervention with emergent amputation of both upper extremities in the light of rhabdomyolysis secondary to tissue necrosis and oliguria. During the patient’s hospital course, he underwent multiple operations for further debridement with vacuum-assisted closure therapy and skin grafting of sites, as well as targeted muscle reinnervation (TMR) 6 months later at an outside hospital. Conclusions Although HVEI only account for a small percentage of burn admissions, they are associated with greater morbidity than low-voltage injuries. Patients with HVEI often incur multiple injuries, more surgical procedures, have higher rates of complications, and more long term psychological and rehabilitative difficulties. Despite the need for amputation in some of these critically ill patients, options exist that allow for them to obtain long term functional success.

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