Covid-19 Brachial plexopathy: a case report

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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GAMBARAN KEKUATAN OTOT PADA LANSIA DI BPLU SENJA CERAH PANIKI BAWAH

Jurnal e-Biomedik ◽

10.35790/ebm.3.1.2015.6618 ◽

2015 ◽

Vol 3 (1) ◽

Author(s):

Prisilia M. Pinontoan ◽

Sylvia R. Marunduh ◽

Herlina I. S. Wungouw

Keyword(s):

Muscle Strength ◽

Elderly Women ◽

Elbow Flexion ◽

Knee Extension ◽

Shoulder Abduction ◽

Elderly Men ◽

Cross Sectional ◽

Purposive Sampling ◽

Shoulder Flexion ◽

Cross Sectional Design

Abstract: The aim of this study was to find out the profile of muscle strength on elderly at BPLU Senja Cerah Paniki Bawah. This was a descriptive study with cross sectional design. There were 26 respondents who met the inclusion criteria, consisted of 10 elderly men and 16 elderly women. Respondents were selected by using purposive sampling method. The measurements of the muscle strength were done by using 1 RM method while doing elbow flexion, elbow extension, shoulder flexion, shoulder extension, shoulder abduction, knee flexion, knee extension and dorsoflexion. Data were analyzed manually and computerized then presented in tabular form. The result shows that the average muscle strength in elderly men were greater than women and the average muscle strength of respondents that were included in the age group 60-79 years old were greater than those in 80-99 years.Keywords: muscle strength, elderly.1 RMAbstrak: Tujuan dari penelitian ini yaitu untuk mengetahui gambaran kekuatan otot pada Lansia di BPLU Senja Cerah Paniki Bawah. Penelitian ini merupakan peneliltian deskriptif dengan rancangan potong lintang. Responden yang memenuhi kriteria inklusi terdiri dari 26 orang yang terdiri dari 10 orang laki-laki dan 16 orang perempuan. Sampel dipilih menggunakan cara purposive sampling. Kekuatan otot pada lansia diukur dengan menggunakan metode 1 RM yang diukur pada gerakan fleksi siku, ekstensi siku, fleksi bahu, ekstensi bahu, abduksi bahu, fleksi lutut, ekstensi lutut serta dorsofleksi. Data yang sudah didapatkan kemudian dikumpul dan diolah secara manual dan komputerisasi serta disajikan dalam bentuk tabel. Hasil penelitian menunjukkan rerata kekuatan otot responden laki-laki lebih besar dibanding perempuan dan rerata kekuatan responden yang termasuk dalam kelompok umur 60-79 tahun lebih besar dibanding kelompok umur 80-99 tahun.Kata kunci: kekuatan otot, lansia, 1 RM.

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Clinical-enabled aspects after Neurotoxoplasmosis in a patient with immunosuppression: a case report

10.5327/1516-3180.432 ◽

2021 ◽

Author(s):

Adrielle Galanti ◽

Verônia Corrêa César Rodrigues ◽

Daniela Maria Ribeiro Vaz ◽

Ana Paula Oliveira Borges

Keyword(s):

Case Report ◽

Motor Coordination ◽

Clinical Investigation ◽

Functional Independence ◽

Berg Balance Scale ◽

Fine Motor ◽

Cross Sectional ◽

Right Cerebral Hemisphere ◽

The Right ◽

Immunodeficiency Syndrome

Background: Neurotoxoplasmosis is an opportunistic infection caused by the protozoan Toxoplasma Gondii, frequent in patients with Acquired Immunodeficiency Syndrome who become immunosuppressed by the presence of the disease. It can be presented by one or more brain abscesses, encephalitis or ventriculitis. Objectives: case report of a volunteer after neurological sequelae of neurotoxoplasmosis in order to highlight the relevant findings for a neurofunctional rehabilitation. Design and setting: This is an observational, cross-sectional case report type study conducted at the Clínica Escola de Fisioterapia of the University of Franca (UNIFRAN), with CEP approval (CAAE 83164918.2.0000.5495). Methods: Female patient, 53 years old. In the physiotherapy sector, neurological evaluation of the components was performed: sensitivity, movement, tone, reflexes, motor coordination, balance and gait. Balance and gait were assessed using the Berg Balance Scale, the Standing and Walking Test and the Dynamic Walking Index. Results: After clinical investigation, neurological toxoplasmosis infection was found in the right cerebral hemisphere. The physiotherapeutic evaluation showed the presence of left hemiparesis, the presence of spastic hypertonia, patellar and achilles hyperreflexia, the absence of fine motor skills and the presence of a reaping gait. The BSE result was 32 points, the TUG was 10.3 seconds and IMD was 20 points. Conclusion: The compromises found have an impact on the functionality of the volunteer. This study emphasizes the valorization of neurofunctional physiotherapeutic semiology for a treatment proposal that promotes greater functional independence.

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

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.289 ◽

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.

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

The American Journal of Sports Medicine ◽

10.1177/0363546516688657 ◽

2017 ◽

Vol 45 (6) ◽

pp. 1413-1419 ◽

Cited By ~ 17

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.

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Nerve Transfer for Elbow Flexion in Radiation-Induced Brachial Plexopathy: A Case Report

Hand ◽

10.1007/s11552-008-9136-9 ◽

2008 ◽

Vol 4 (2) ◽

pp. 123-128 ◽

Cited By ~ 12

Author(s):

Thomas H. Tung ◽

Daniel Z. Liu ◽

Susan E. Mackinnon

Keyword(s):

Case Report ◽

Nerve Transfer ◽

Elbow Flexion ◽

Brachial Plexopathy ◽

Radiation Induced

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Clinical Dilemma and the Role of Cone-Beam Computed Tomography in the Diagnosis of an Unusual Presentation of Central Odontogenic Tumor—A Case Report

Indian Journal of Radiology and Imaging ◽

10.1055/s-0041-1736401 ◽

2021 ◽

Vol 31 (03) ◽

pp. 782-788

Author(s):

Mouttoukichenin Surenthar ◽

Subramanian Vasudevan Srinivasan ◽

Vannathan Kumaran Jimsha ◽

Ramanathan Vineeth

Keyword(s):

Computed Tomography ◽

Case Report ◽

Cone Beam Computed Tomography ◽

Unusual Presentation ◽

Odontogenic Tumor ◽

Cone Beam ◽

Diagnostic Challenge ◽

Cross Sectional ◽

Clinical Dilemma ◽

The Right

AbstractCone beam computed tomography (CBCT) provides a detailed analysis of the dentition and of cortical and medullary bone free of superimposition inherent in radiographs, which are effortlessly plausible, easily available, and relatively inexpensive when compared with other cross-sectional imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI). This article presents a case report of a 23-year-old male patient with a complaint of a mass in the right side lower back tooth region for the past 2 and a half months, which had the unusual presentation of prominent exophytic growth masking the central odontogenic tumor, wherein the diagnostic performances of CBCT in unveiling the diagnostic challenge that led to the clinical dilemma is emphasized. Routine radiographs such as orthopantomogram, mandibular occlusal view were taken along with CBCT, which accentuated the precise diagnosis in this case. The lesion was surgically enucleated with curettage and extraction of the involved teeth. CBCT unveiled the classic multilocularity of ameloblastoma, which routine imaging failed to display. CBCT played a pivotal role in counteracting the diagnostic challenges faced and also in distinguishing it from a cystic lesion that was initially deceived by routine two-dimensional radiographs.

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Secondary abdominal appendicular pregnancy: Case report

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1408484r ◽

2014 ◽

Vol 142 (7-8) ◽

pp. 484-487

Author(s):

Mico Rosso ◽

Sinisa Sijanovic ◽

Zlatko Topolovec ◽

Domagoj Vidosavljevic ◽

Robert Selthofer ◽

...

Keyword(s):

Case Report ◽

Ectopic Pregnancy ◽

Point Of View ◽

Reproductive Age ◽

Gynecology And Obstetrics ◽

Secondary Implantation ◽

Pouch Of Douglas ◽

Histopathologic Analysis ◽

Ectopic Pregnancies ◽

The Right

Introduction. The case report describes a 29-year-old nulliparous woman that was admitted at the Department of Gynecology and Obstetrics of the Clinical Hospital Osijek complaining of mild abdominal pain without vaginal discharge. Case Outline. The patient?s menstrual cycle was irregular, from 30-45 days. An ultrasound examination showed suspicion of an ectopic pregnancy with a ?HCG level of 1358 IU/L. Due to the presence of liquid in the pouch of Douglas the patient underwent emergency laparoscopy, which showed the presence of tumor mass between the right Fallopian tube and the appendix. These two structures associated with adhesions corresponded to secondary implantation after spontaneous tubal abortion which was confirmed by histopathologic analysis. Conclusion. Laparoscopy has emerged as the ?gold standard? in the diagnosis and treatment of ectopic pregnancy, in this case the secondary abdominal pregnancy. From the diagnostic point of view, all women of reproductive age should be considered pregnant until proven otherwise, also keeping in mind that ectopic pregnancies can have different locations and many clinical features.

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Granular cell tumor of the breast: Case report

Mastology ◽

10.29289/259453942020v30s1090 ◽

2020 ◽

Vol 30 (Suppl 1) ◽

Author(s):

Juliana da Costa Souza ◽

Juliana Ferreira de Lima ◽

Aline Bortolotto Di Pace ◽

Sandro Luiz Sayão Prior ◽

Luiz Henrique Gebrim

Keyword(s):

Case Report ◽

Black Women ◽

Granular Cell Tumor ◽

Neuron Specific Enolase ◽

Granular Cell ◽

Cell Tumor ◽

Ultrasound Guided ◽

Cross Sectional ◽

Imaging Characteristics ◽

The Right

Introduction: Granular cell tumor (GCT) is rare, usually benign, with less than a 2% chance of malignancy. It is usually located in the tongue, and affects the breast in only 6% of the reported cases, with incidence of 1:1000 cases of breast carcinoma. Its origin is related to the Schwann cells. It presents itself as a firm, painless, moveable mass, smaller than 3 cm. It can affect men and women in several age groups, and is more frequent among black women, from the 4th to the 6th decades of life. The image mimics malignant lesions. Mammography shows: dense, circumscribed, sometimes spiculated nodules, without associated microcalcifications. The ultrasound showed: solid, hypoechoic, heterogeneous, round, irregular nodule, with irregular halo in some cases. Histologically, there are large, polygonal cells, with eosinophilic, granular cytoplasm displayed in blades or trabeculae, with benign, atypical and malignant variants. Positive immunohistochemical (IHC) for markers such as: S00 protein, vimentin, neuron-specific enolase, CD-57, CF-68, inhibin alpha, SOX-10, calretinin, PGP9.5, Gap43. The treatment is the excision of the lesion with margins, with low risk of recurrence. Objective: To describe a case of GCT in Hospital Pérola Byington in January/2019. Method: Cross-sectional, descriptive case report obtained through a medical chart review. Results: S.R.P, 56-year old female, white patient, assisted in January, 2019, complaining of a nodule in the right breast for three months. She denies comorbidities, is not aware of family history of cancer. G1P1N, menacme from the age of 13 to 53, denies hormone therapies. At the first examination: nodule measuring 2.5x2.5cm, in the right SLQ, retracting the nipple; right axilla (RA) showing palpable lymph node. Mammography shows a nodule in the right breast (RB), with irregular shape, partially defined borders, measuring 3.8 cm, located in SLQ(B4)-. An ultrasound guided nodule core biopsy at 10hMD, measuring 2.24x1.52x1.97, RA without findings. Biopsy suggests GCT (without IHC). The choice was to perform an ultrasound guided mammotome with IHC, confirming the GCT (positive for S-100, CD-68, enolase and vimentin), submitted to sectorectomy for the excision of the residual lesion. Conclusions: GCT is rare, benign, in most cases; however, when clinical, epidemiological and imaging characteristics suggest cancer, it is necessary to make an anatomopathological confirmation with IHC and excision of the lesion.

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Comparison of Shoulder and Elbow Range of Motion and Arm Muscle Strength in Humerus Fractured Patients Treated with Operative and Non-operative at Dr. Soebandi Hospital

Journal of Agromedicine and Medical Sciences ◽

10.19184/ams.v1i1.1698 ◽

1970 ◽

Vol 1 (1) ◽

pp. 25

Author(s):

Dedy Chandra Hariyono ◽

Muhamad Hasan ◽

Rony Prasetyo

Keyword(s):

Muscle Strength ◽

Range Of Motion ◽

Operative Treatment ◽

Elbow Flexion ◽

Humerus Fracture ◽

Shoulder Abduction ◽

Cross Sectional ◽

Shoulder Flexion ◽

Significant Difference ◽

Cross Sectional Design

Humerus fracture is a disruption of normal architecture in humerus bone . This study was conducted to identify The Range Of Motion (ROM), muscle strength of arm and analyze the comparison of the ROM and muscle strength on humerus fracture patients between operative and non-operative treatment. This research used non-experimental study with cross-sectional design. Observed variables were Range of Motion and muscle strength each measured by goniometer and muscle strength scale, respectively. Comparing to these circumstances, there were significant difference in shoulder abduction, shoulder flexion, shoulder extension, elbow extension and elbow flexion between operative treatment patients and non-operative treatment patients at dr. Soebandi Hospital Jember. Keywords : humerus fracture, range of motion, muscle strength.

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MUSCLE CONTRACTION DURING MANEUVERING STEERING WHEEL USING SURFACE ELECTROMYOGRAPYHY

Malaysian Journal of Public Health Medicine ◽

10.37268/mjphm/vol.20/no.special1/art.698 ◽

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.

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