Saturday Night Palsy Due to Spontaneous Upper Extremity Hematoma: An Extremely Rare Presentation of Alcoholic Cirrhosis

Case. Blast injuries to the upper extremity can be devastating and emotionally stressful injuries. We describe a case of a high-energy blast injury to an upper extremity from an explosive. The transfer of energy caused severe soft tissue/bony damage to the hand, but also led to associated Essex Lopresti and terrible triad injuries. The patient required emergent transradial amputation by hand surgery as well as definitive fixation by our orthopaedic team. Conclusion. We describe a unique salvage operation that established forearm pronosupination, elbow flexion, and proper prosthetic fitting. We feel that describing our technique could help others in treating this injury if encountered.

Download Full-text

Giant epidermal cyst of the arm: a rare presentation

BMJ Case Reports ◽

10.1136/bcr-2018-227615 ◽

2018 ◽

Vol 11 (1) ◽

pp. e227615

Author(s):

Shaan Patel ◽

Key Yan Tsoi ◽

George Joseph

Keyword(s):

Soft Tissue ◽

Upper Extremity ◽

Surgical Resection ◽

Soft Tissue Mass ◽

Epidermal Cyst ◽

Lateral Aspect ◽

Rare Presentation ◽

Tissue Mass ◽

Slow Growing

A giant epidermal cyst is a benign soft tissue mass commonly involving the trunk, hand and face. The authors report a rare presentation of a 69-year-old man who presented with a painful, slow-growing left arm mass for 30 years duration. Examination revealed a large, mobile, soft tissue mass of the lateral aspect of the left arm. MRI showed a large, cystic left arm soft tissue mass. The mass was excised and the diagnosis of a giant epidermal cyst was made based on imaging and histopathology after surgical resection. The mass measured 9.5 cm x 8 cm x 4 cm, which is the largest reported giant epidermal cyst of the upper extremity.

Download Full-text

Bleeding soft-tissue sarcoma: rare presentation of upper extremity sarcoma

The Internet Journal of Surgery ◽

10.5580/23aa ◽

2009 ◽

Vol 20 (2) ◽

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Upper Extremity ◽

Rare Presentation ◽

Extremity Sarcoma

Download Full-text

Congestive heart failure and upper extremity deep vein thrombosis: A rare presentation of a pheochromocytoma

Journal of Taibah University Medical Sciences ◽

10.1016/j.jtumed.2020.03.010 ◽

2020 ◽

Vol 15 (3) ◽

pp. 244-248

Author(s):

Eman M. Alfadhli

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Deep Vein Thrombosis ◽

Upper Extremity ◽

Rare Presentation ◽

Vein Thrombosis ◽

Deep Vein

Download Full-text

Mitochondrial Changes in Cholestasis

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100094553 ◽

1972 ◽

Vol 30 ◽

pp. 258-259

Author(s):

F. G. Zaki

Keyword(s):

Biliary Obstruction ◽

Alcoholic Cirrhosis ◽

Ultrastructural Changes ◽

List Type ◽

Common Occurrence ◽

Extrahepatic Cholestasis ◽

Mitochondrial Alteration ◽

Extrahepatic Biliary Obstruction ◽

Liver Biopsies ◽

Mitochondrial Anomalies

Alterations of liver cell mitochondria represent pathologic phenomenon of a fundamental nature. Mitochondrial anomalies have been often described in association with cholestasis. In attempt to determine whether a given pattern of mitochondrial alteration has any correlation with the cause of cholestasis, liver biopsies were examined from 38 patients showing :a. extrahepatic cholestasis due to complete or partial extrahepatic biliary obstruction (8 cases proven at operation)b. intrahepatic cholestasis due to drugs (9 cases), viral hepatitis (6 cases) and alcoholic cirrhosis (15 cases).Mitochondria exhibiting ultrastructural changes due to aging or to the ‘wear and teart’ processes were not considered. In this study, the only profound and most prominent mitochondrial deformation was reported on basis of their common occurrence in randomly examined sections.

Download Full-text

Combining Values

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2002.marapr01 ◽

2002 ◽

Vol 7 (2) ◽

pp. 1-4, 12 ◽

Cited By ~ 1

Author(s):

Christopher R. Brigham

Keyword(s):

Lower Extremity ◽

Upper Extremity ◽

Evaluation Method ◽

Proximal Phalanx ◽

Common Error ◽

The Third ◽

Whole Person ◽

Impairment Ratings ◽

Upper Extremity Impairment ◽

The Individual

Abstract To account for the effects of multiple impairments, evaluating physicians must provide a summary value that combines multiple impairments so the whole person impairment is equal to or less than the sum of all the individual impairment values. A common error is to add values that should be combined and typically results in an inflated rating. The Combined Values Chart in the AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition, includes instructions that guide physicians about combining impairment ratings. For example, impairment values within a region generally are combined and converted to a whole person permanent impairment before combination with the results from other regions (exceptions include certain impairments of the spine and extremities). When they combine three or more values, physicians should select and combine the two lowest values; this value is combined with the third value to yield the total value. Upper extremity impairment ratings are combined based on the principle that a second and each succeeding impairment applies not to the whole unit (eg, whole finger) but only to the part that remains (eg, proximal phalanx). Physicians who combine lower extremity impairments usually use only one evaluation method, but, if more than one method is used, the physician should use the Combined Values Chart.

Download Full-text

Impairment Tutorial: Functionally Limiting Upper Extremity Pain: Controversies in Impairment Rating

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2003.sepoct02 ◽

2003 ◽

Vol 8 (5) ◽

pp. 4-12

Author(s):

Lorne Direnfeld ◽

James Talmage ◽

Christopher Brigham

Keyword(s):

Upper Extremity ◽

Radicular Pain ◽

Illness Behavior ◽

Orthopedic Surgeon ◽

First Case ◽

Clinical Presentations ◽

Whole Person ◽

Physical Examinations ◽

Upper Extremity Impairment ◽

The Individual

Abstract This article was prompted by the submission of two challenging cases that exemplify the decision processes involved in using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). In both cases, the physical examinations were normal with no evidence of illness behavior, but, based on their histories and clinical presentations, the patients reported credible symptoms attributable to specific significant injuries. The dilemma for evaluators was whether to adhere to the AMA Guides, as written, or to attempt to rate impairment in these rare cases. In the first case, the evaluating neurologist used alternative approaches to define impairment based on the presence of thoracic outlet syndrome and upper extremity pain, as if there were a nerve injury. An orthopedic surgeon who evaluated the case did not base impairment on pain and used the upper extremity chapters in the AMA Guides. The impairment ratings determined using either the nervous system or upper extremity chapters of the AMA Guides resulted in almost the same rating (9% vs 8% upper extremity impairment), and either value converted to 5% whole person permanent impairment. In the second case, the neurologist evaluated the individual for neuropathic pain (9% WPI), and the orthopedic surgeon rated the patient as Diagnosis-related estimates Cervical Category II for nonverifiable radicular pain (5% to 8% WPI).

Download Full-text

Spinal Impairment Evaluation: Fifth Edition Changes

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2001.janfeb01 ◽

2001 ◽

Vol 6 (1) ◽

pp. 1-3

Author(s):

Robert H. Haralson

Keyword(s):

Spinal Cord ◽

Lower Extremity ◽

Range Of Motion ◽

Upper Extremity ◽

Spinal Cord Injuries ◽

Clinical Findings ◽

Fourth Edition ◽

Treatment Results ◽

Standard Terminology ◽

Made In

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, was published in November 2000 and contains major changes from its predecessor. In the Fourth Edition, all musculoskeletal evaluation and rating was described in a single chapter. In the Fifth Edition, this information has been divided into three separate chapters: Upper Extremity (13), Lower Extremity (14), and Spine (15). This article discusses changes in the spine chapter. The Models for rating spinal impairment now are called Methods. The AMA Guides, Fifth Edition, has reverted to standard terminology for spinal regions in the Diagnosis-related estimates (DRE) Method, and both it and the Range of Motion (ROM) Method now reference cervical, thoracic, and lumbar. Also, the language requiring the use of the DRE, rather than the ROM Method has been strengthened. The biggest change in the DRE Method is that evaluation should include the treatment results. Unfortunately, the Fourth Edition's philosophy regarding when and how to rate impairment using the DRE Model led to a number of problems, including the same rating of all patients with radiculopathy despite some true differences in outcomes. The term differentiator was abandoned and replaced with clinical findings. Significant changes were made in evaluation of patients with spinal cord injuries, and evaluators should become familiar with these and other changes in the Fifth Edition.

Download Full-text