Arm injuries

Many sports are associated with a variety of peripheral nervous system (PNS) injuries specific to that sport. A systematic review of sport-specific PNS injuries has not been attempted previously, and will assist in the understanding of morbidities and mortality associated with particular sporting activities, either professional or amateur. A systematic review of the literature using PubMed (1965-2003) was performed examining all known sports and a range of possible PNS injuries attributable to that sport. Numerous sporting activities (53) were found to have associated PNS injuries. The sports most commonly reported with injuries were football, hockey, soccer, baseball and winter activities. There are a number of sporting activities with injuries unique to the individual sport. This review should be of assistance for the neurologist, neurosurgeon, orthopaedic surgeon, physiatrist, sports medicine doctor, athletic trainer and general physician in contact with athletes possessing neuro...

The Metropolitan Police figures suggest an increase in the incidence of injuries related to gun crime. We conducted a retrospective analysis of extremity gunshot injuries over a five-year period. Our aim is to report on our (1) incidence, (2) complications and (3) experience in ...

Objective. Patient cooperation and satisfaction with home exercise programs are important for successful outcomes of intervention. This study investigated factors from three models to predict increased compliance and satisfaction with home exercise programs: the Model of Human Occupation (MOHO), including the volition subsystem (interests), habituation subsystem (roles), and performance subsystem (reported physical capacity); the Health Belief Model (HBM), including perceived barriers, benefits, self-efficacy, and severity; and the Health Locus of Control (HLOC). Method. Sixty-two outpatients at an orthopedic upper-extremity rehabilitation facility completed a battery of questionnaires and self-report instruments, including a health belief survey to assess HBM factors, the Multidimensional Health Locus of Control Scale, the Modified Activity Profile to assess the performance subsystem of the MOHO, a demographic questionnaire (including roles), a report of home exercise, and a satisf...

Temporary intravascular shunts (TIVS) are synthetic intraluminal conduits that maintain arterial and/or venous blood flow. This technique can be used for: 1) replantation; 2) open extremity fractures with extensive soft tissue and arterial injuries; or 3) damage control (extremity/truncal). The literature defining TIVS is composed exclusively of small case series (primarily penetrating injuries). Our goal was to identify the injured population who actually undergoes TIVS using the National Trauma Data Bank (2001 to 2005). TIVS were placed in 395 patients (mean Injury Severity Score = 26; initial hemodynamic instability = 24%; mean based deficit = -7.2; mortality = 14%). Blunt mechanisms caused 64 per cent (251 of 395) of cases. Penetrating injuries were primarily gunshot wounds (97%). Concurrent severe extremity fractures and/or soft tissue defects were present in 185 (74%) blunt-injured patients. Only six of 111 centers performing TIVS used this technique five or more times. Only t...

BACKGROUND Explosion injuries to the upper extremity have specific clinical characteristics that differ from injuries due to other mechanisms. OBJECTIVES To evaluate the upper extremity injury pattern of attacks on civilian targets, comparing bomb explosion injuries to gunshot injuries and their functional recovery using standard outcome measures. METHODS Of 157 patients admitted to the hospital between 2000 and 2004, 72 (46%) sustained explosion injuries and 85 (54%) gunshot injuries. The trauma registry files were reviewed and the patients completed the DASH Questionnaire (Disabilities of Arm, Shoulder and Hand) and SF-12 (Short Form-12) after a minimum period of 1 year. RESULTS Of the 157 patients, 72 (46%) had blast injuries and 85 (54%) had shooting injuries. The blast casualties had higher Injury Severity Scores (47% vs. 22% with a score of > 16, P = 0.02) and higher percent of patients treated in intensive care units (47% vs. 28%, P = 0.02). Although the Abbreviated Injury...

This article describes the background and study design of the PROMO study (Prospective Research on Musculoskeletal disorders in Office workers). Few longitudinal studies have been performed to investigate the risk factors responsible for the incidence of hand, arm, shoulder and neck symptoms among office workers, given the observation that a large group of office workers might be at risk worldwide. Therefore, the PROMO study was designed. The main aim is to quantify the contribution of exposure to occupational computer use to the incidence of hand, arm, shoulder and neck symptoms. The results of this study might lead to more effective and/or cost-efficient preventive interventions among office workers. A prospective cohort study is conducted, with a follow-up of 24 months. In total, 1821 participants filled out the first questionnaire (response rate of 74%). Data on exposure and outcome is collected using web-based self-reports. Outcome assessment takes place every three months duri...

BackgroundThe accuracy of the physical examination for tears of the long head of the biceps remains controversial.PurposeThe goals were 1) to characterize the occurrence of partial tears of the long head of the biceps tendon in a group of consecutive patients, and 2) to analyze the diagnostic value of various clinical tests for pathologic lesions of the proximal biceps tendon.Study DesignCohort study (diagnosis); Level of evidence, 2.MethodsOf 847 consecutive patients who underwent arthroscopic procedures for a variety of shoulder conditions, 40 were found at the time of arthroscopy to have partial biceps tendon tears. The average age of these 24 men and 16 women was 59 years (range, 18-83). Preoperative physical examinations had included 9 commonly used tests for shoulder examination. Statistical analysis included sensitivity, specificity, negative predictive value, positive predictive value, and likelihood ratios for these tests.ResultsThe prevalence rate of partial tears was 5% (...

To date, no civilian studies have demonstrated that pre-hospital (PH) tourniquets improve survival. We hypothesized that late, trauma center (TC) tourniquet use would increase death from hemorrhagic shock compared to early (PH) placement. All patients arriving to a Level 1, urban TC between October 2008 and January 2016 with a tourniquet placed before (T-PH) or after arrival to the TC (T-TC) were evaluated. Cases were assigned the following designations: indicated (absolute indication [vascular injury requiring repair/ligation, operation within 2 hours for extremity injury, or traumatic amputation] or relative indication [major musculoskeletal/soft tissue injury requiring operation 2-8 hours after arrival, documented large blood loss]) or non-indicated. Outcomes were death from hemorrhagic shock, physiology upon arrival to the TC, and massive transfusion requirements. After univariate analysis, logistic regression was carried out to assess independent predictors of death from hemorrhagic shock. A total of 306 patients received 326 tourniquets for injuries to 157 upper and 147 lower extremities. Two hundred eighty-one (92%) had an indication for placement. Seventy percent of patients had a blunt mechanism of injury. T-TC patients arrived with a lower systolic blood pressure (SBP, 101 [86, 123] vs. 125 [100, 145] mm Hg, p < 0.001), received more transfusions in the first hour of arrival (55% vs. 34%, p = 0.02), and had a greater mortality from hemorrhagic shock (14% vs. 3.0%, p = 0.01). When controlling for year of admission, mechanism of injury and shock upon arrival (SBP ≤90 mm Hg or HR ≥120 bpm or base deficit ≤ 4) indicated T-TC had a 4.5-fold increased odds of death compared to T-PH (OR 4.5, 95% CI 1.23-16.4, p = 0.02). Waiting until TC arrival to control hemorrhage with a tourniquet was associated with worsened blood pressure and increased transfusion within the first hour of arrival. In routine civilian trauma patients, delaying to T-TC was associated with 4.5-fold increased odds of mortality from hemorrhagic shock. Level IV.

Background and Purpose —The fat embolism syndrome (FES) is characterized by the simultaneous occurrence of pulmonary and neurological symptoms as well as skin and mucosal petechiae in the setting of long-bone fractures or their surgical repair. Its pathophysiology is poorly understood, and effective treatments are lacking. We present 5 patients with long-bone fractures in whom in vivo microembolism was detected by transcranial Doppler. Methods —Five patients with long-bone fractures were monitored with transcranial Doppler for microembolic signals (MESs) after trauma. Two patients also had intraoperative monitoring. A TC-2020 instrument equipped with MES detection software was used. Detected signals were saved for subsequent review. Selected signals satisfied criteria defined previously and were categorized as large or small. Results —Cerebral microembolism was detected in all 5 patients and was transient, resolving within 4 days of injury. Intraoperative monitoring revealed an incr...

Background Upper extremity injuries account for a large proportion of attendances to the Emergency Department. The aim of this study was to assess population-based trends in the incidence of upper extremity injuries in the Dutch population between 1986 and 2008, and to give a detailed overview of the associated health care costs. Methods Age-standardized incidence rates of upper extremity injuries were calculated for each year between 1986 and 2008. The average number of people in each of the 5-year age classes for each year of the study was calculated and used as the standard (reference) population. Injury cases were extracted from the National Injury Surveillance System (non-hospitalized patients) and the National Medical Registration (hospitalized patients). An incidence-based cost model was applied in order to estimate associated direct health care costs in 2007. Results The overall age-adjusted incidence of upper extremity injuries increased from 970 to 1,098 per 100,000 person...

This study used NHTSA NASS/CDS data to examine whether advancing age was associated with a higher incidence and severity of front airbag-related upper extremity injury (UEI). Using a retrospective cohort design we analyzed weighted data from 1998-2007 for. The study population consisted of lap/shoulder belted people over 16 years of age who were driving passenger vehicles with model years 1998-2003 and were involved in a frontal crash where their front airbag deployed. Drivers who were ejected, involved in a vehicle rollover, or accompanied by a passenger sitting directly behind them were omitted. The exposure variable was age and the outcome variables were UEI incidence and severity. Associations were adjusted for gender, seat track position, vehicle type, vehicle weight, intrusion, and delta-v. Logistic regressions were performed using SAS survey procedures to account for the complex survey design. Overall, 42% of drivers sustained an UEI. Advancing age was associated with a highe...

BACKGROUND Post-burn contractures severely deteriorate life quality. We aimed to present our treatment protocols for post-burn sequelae and the contractures that cause functional limitations. METHODS Seventy-seven cases with post-burn contracture were treated in our clinic. Post-burn contractures occurring after a burn injury affected the upper extremity, face and neck in 60, 17 and 6 cases, respectively. Skin grafts, local flaps such as advancement flaps, Z-plasties, K-plasties, regional flaps such as posterior interosseous flap, tissue expanded flaps, and free flaps were used according to the severity of the contractures. RESULTS In one patient with type II axillary contraction, recurrence was seen. Full range of motion was achieved in the 3.6-year follow-up period in elbow contractures. Eight of 71 phalangeal joint contractures recurred. Two patients underwent reoperation for neck contracture recurrences. CONCLUSION Excellent results were seen with prefabricated flaps, which were...

Peripheral nerve injuries are commonly seen as a result of domestic, industrial, or military trauma. Sharp objects usually cause these nerve injuries. When assessing these injuries, it is important to evaluate each nerves' motor and sensory function. One must be cognizant of associated injuries such as fractures, vascular damage, and musculotendinous lacerations. The time since the injury, level of injury, and age of the patient are important prognosticators impacting the return of function. Intraoperatively, one must assess the vascularity of the soft tissue bed and the nerve itself, the nerve gap, conduction, and the topography of the fascicles to insure proper orientation. Application of the principles of nerve repair (magnification, minimal tension, meticulous soft tissue handling, experienced surgeon and staff) can enhance the chances for a successful result. Additionally, to maximize functional recovery following peripheral nerve repair, a carefully planned program of post...