Late Revascularization on Upper Extremity: Case Series

BACKGROUND: Video games can be used to motivate repetitive movements in paediatric rehabilitation. Most upper limb videogaming therapies do not however include haptic feedback which can limit their impact. OBJECTIVE: To explore the effectiveness of interactive computer play with haptic feedback for improving arm function in children with cerebral palsy (CP). METHODS: Eleven children with hemiplegic CP attended 12 therapist-guided sessions in which they used a gaming station composed of the Novint Falcon, custom-built handles, physical supports for the child’s arm, games, and an application to manage and calibrate therapeutic settings. Outcome measures included Quality of Upper Extremity Skills Test (QUEST) and Canadian Occupational Performance Measure (COPM). The study protocol is registered on clinicaltrials.gov (NCT04298411). RESULTS: Participants completed a mean of 3858 wrist extensions and 6665 elbow/shoulder movements during the therapist-guided sessions. Clinically important improvements were observed on the dissociated and grasp dimensions on the QUEST and the performance and satisfaction scales of the COPM (all p< 0.05). CONCLUSION: This study suggests that computer play with haptic feedback could be a useful and playful option to help improve the hand/arm capacities of children with CP and warrants further study. The opportunities and challenges of using low-cost, mainstream gaming software and hardware for therapeutic applications are discussed.

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Discussion: Characteristics of Upper Extremity Recovery in Acute Flaccid Myelitis: A Case Series

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000007696 ◽

2021 ◽

Vol 147 (3) ◽

pp. 656-658

Author(s):

Kevin J. Zuo ◽

Kristen M. Davidge

Keyword(s):

Upper Extremity ◽

Case Series ◽

Acute Flaccid Myelitis

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Assessment of 30-Day Adverse Events in Single-Event, Multilevel Upper Extremity Surgery in Adult Patients with Upper Motor Neuron Syndrome

Hand ◽

10.1177/1558944720975151 ◽

2020 ◽

pp. 155894472097515

Author(s):

Raahil Patel ◽

Peter C. Rhee

Keyword(s):

Adverse Events ◽

Motor Neuron ◽

Upper Extremity ◽

Intraoperative Complications ◽

Hospital Readmissions ◽

Case Series ◽

Adult Patients ◽

Minimal Risk ◽

Single Event ◽

Cord Injury

Background: Upper motor neuron (UMN) syndrome consists of muscle spasticity, weakness, and dyssynergy due to a brain or spinal cord injury. The purpose of this study is to describe the perioperative adverse events for adult patients undergoing single-event, multilevel upper extremity surgery (SEMLS) due to UMN syndrome. Methods: A retrospective case series was performed for 12 consecutive adult patients who underwent SEMLS to correct upper extremity dysfunction or deformity secondary to UMN syndrome. The evaluation consisted of primary outcome measures to identify readmission rates and classify adverse events that occurred within 30 days after surgery. Results: All 12 patients were functionally dependent with 50% (n = 6) men and 50% (n = 6) women at a mean age of 43.6 years (range: 21-73) with a mean of 5.92 (range: 0-16) comorbid diagnoses at the time of surgery. There were no intraoperative complications, hospital readmissions, or deaths among the 12 patients. Five patients experienced 5 minor postoperative complications that consisted of cast- or orthosis-related skin breakdown remote from the incision (n = 3), incidental surgical site hematoma that required no surveillance or intervention (n = 1), and contact dermatitis attributed to the surgical dressing that resolved with topical corticosteroids (n = 1). Conclusions: With an appropriate multidisciplinary approach, there is minimal risk for developing perioperative and 30-day postoperative adverse events for adults undergoing SEMLS to correct upper extremity deformities secondary to UMN syndrome. Level of Evidence: IV

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Thrombolytic Salvage of the Frostbitten Upper Extremity: A Systematic Review

Hand ◽

10.1177/1558944720940065 ◽

2020 ◽

pp. 155894472094006

Author(s):

James Drinane ◽

Adee J. Heiman ◽

Joseph A. Ricci ◽

Ashit Patel

Keyword(s):

Systematic Review ◽

Thrombolytic Therapy ◽

Upper Extremity ◽

Animal Studies ◽

English Language ◽

Case Series ◽

Current Data ◽

Ischemic Tissue ◽

Promising Treatment ◽

Salvage Rate

Background Vascular thrombosis secondary to frostbite can lead to ischemic tissue damage in severe cases. Threatened extremities may be salvaged with thrombolytics to restore perfusion; however, current data are limited to single institution case series. The authors performed a systematic review to determine the efficacy of thrombolytic therapy in treating upper extremity frostbite. Methods PubMed, EBSCO, and Google Scholar were queried using the keywords “thrombolytics,” “frostbite,” “fibrinolytics,” and “tPA.” Exclusion criteria were failure to delineate anatomic parts injured, failure to report number of limbs salvaged, animal studies, and non-English language publications. Thrombolytic therapy was defined as intraarterial (IA) or intravenous (IV) administration of tissue plasminogen activator (tPA), alteplase, urokinase, streptokinase, or any tPA derivative. Results A total of 42 studies were identified, with 13 satisfying inclusion criteria. Eight studies reported catheter-directed IA thrombolysis, four reported systemic IV administration, and 1 reported both methods. A total of 157 patients received thrombolytics. In all, 73 upper extremity digits were treated by IA route and 136 digits were treated by IV route. Overall upper extremity digit salvage rate was 59%. There was a significantly higher salvage rate in digits treated by the IA route compared to the IV route. Conclusions Thrombolytics, particularly when administered by the intra-arterial route, are emerging as a promising treatment of severe frostbite of the upper extremity, increasing digit salvage rates.

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The Serially-Operated Essex-Lopresti Injury: Long-Term Outcomes in a Retrospective Cohort

Journal of Hand and Microsurgery ◽

10.1055/s-0039-3401380 ◽

2020 ◽

Vol 12 (01) ◽

pp. 47-55

Author(s):

Svenna H. W. L. Verhiel ◽

Sezai Özkan ◽

Christopher G. Langhammer ◽

Neal C. Chen

Keyword(s):

Upper Extremity ◽

Radial Head ◽

Rating Scale ◽

Case Series ◽

Outcome Evaluation ◽

Pain Severity ◽

Measurement Information ◽

Radial Head Arthroplasty ◽

Patient Reported ◽

Essex Lopresti

Abstract Objective The main aim of this article is to report 10-year outcomes after Essex-Lopresti injury (ELI). Study Design Retrospective case series. Two level I trauma centers and one associated community hospital from 2003 to 2016. Patients Sixteen patients who sustained an ELI and were treated at one of our three regional hospitals. Intervention Initially, 4 patients (25%) were treated nonoperatively by immobilization and 12 patients (75%) were treated operatively. Proximal surgery included radial head open reduction and internal fixation (ORIF), radial head arthroplasty, radial head excision and forearm ORIF, and wound debridement. Ten patients (63%) were acutely identified with longitudinal forearm instability. Of these, four patients had the distal radioulnar joint pinned. In the other six patients, the forearm was immobilized. Overall, 16 patients underwent a total of 32 revision surgeries. Main Outcome Measure Performance of Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS UE) Physical score, Numeric Rating Scale (NRS) score for pain-severity, and NRS score for satisfaction of overall outcome. Results Follow-up for outcome evaluation was available for 10 patients, at a median of 10 (interquartile range [IQR]: 8.0–12) years after date of injury. The median PROMIS UE Physical score was 36 (IQR: 33–38). Median NRS score for pain-severity on average was 5 (IQR: 0–6). The median NRS score for satisfaction of overall outcome was 7 (IQR: 5–8). Conclusion Patients who sustain an ELI generally have substantial deficits of upper extremity function as measured by PROMIS UE. Early radial head arthroplasty may be beneficial, but further study in a larger cohort is needed. Outcomes of nonoperative treatment and operative treatment were similar and suggest that current surgical treatments are incomplete.

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Complete Abolition of Opioid Prescribing in an Upper Extremity Surgical Practice

Hand ◽

10.1177/1558944720966713 ◽

2020 ◽

pp. 155894472096671

Author(s):

Mark Henry

Keyword(s):

Soft Tissue ◽

Upper Extremity ◽

Pain Control ◽

Case Series ◽

Similar Efficacy ◽

Wound Management ◽

Elbow Fracture ◽

Level Of Evidence ◽

Hand Fracture ◽

Fracture Bone

Background Prescription opioids threaten potential addiction, diversion, and death. Nonopioid regimens have demonstrated similar efficacy for select upper extremity postoperative patients. Methods After adopting a practice policy completely abolishing opioid prescriptions, data were collected on all consecutive surgical cases for the next 6 months, without exclusion. There were 800 cases, 61% male and 39% female, with a mean age of 45. Seventy patients (9%) reported already using prescription medications employed in multimodality regimens; no instruction was given to alter consumption. Patients were divided into 5 groups based on the type of surgery: elective soft tissue (24%), trauma wound management (19%), soft tissue structural repairs (9%), hand fracture/bone procedures (34%), and wrist to elbow fracture/bone procedures (14%). Each group was compared directly to each other group with a 2-tailed t-test, P < .05. Results Patients reported achieving pain control without the need for further medication assistance by a mean of postoperative day 2.7. Times to pain control by group were as follows: 1.5, 3.1, 2.7, 2.9, and 3.6 days respectively. Mean postoperative daily pain scores (using a 10-point visual analog scale) for days 1 to 5 were as follows: 2.8, 2.1, 1.5, 1.0, and 0.6, respectively, with a sum of 8.0. During the 6-month tracking period, the practice only received 4 calls from patients with questions about pain control (0.5% of cases). Conclusions Patients achieved good immediate pain control without opioids and reported rapidly declining pain levels over the next several days to the point of no longer requiring medication. Type of Study/Level of Evidence Prospective cohort case series, therapeutic; Level IV.

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