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Abstract Objective To identify the location of the Riché-Cannieu anastomosis (RCA) in relation to the Cardinal Kaplan Line (KCL) and the Y line. Methods A total of 20 hands of 10 recently-deceased adult male cadavers aged between 27 and 66 years were dissected for the investigation of the relationship of the most distal point of the RCA with the KCL and with the Y line, drawn from the axis of the third metacarpal head, following the longitudinal axis of the hand. Results In 20 limbs, the most distal point of the nerve communication was positioned distally in relation to the KCL. The Y line was positioned on the radial side in relation to the most distal point of the RCA in 14 limbs, and it was positioned on the ulnar side in relation to the Y line in 6 limbs. The crossing between the KCL and the Y line occurred proximal to the RCA in 18 limbs; in 1 hand, it was positioned distal to the intersection between these lines; and in another hand, the KCL was positioned exactly on the RCA. Conclusion Knowledge of these anatomical relationships can prevent damage to nerve branches and thus also prevent paralysis of intrinsic muscles in surgical procedures in the palm of the hand.
Resumo Objetivo Identificar a localização da anastomose de Riché-Cannieu (ARC) em relação à linha cardinal de Kaplan (LCK) e à linha Y. Métodos Ao todo, 20 mãos de 10 cadáveres adultos do sexo masculino com idades entre 27 e 66 anos, recentemente falecidos, foram dissecadas para a investigação da relação do ponto mais distal da ARC com a LCK e a linha Y traçada a partir do eixo da cabeça do terceiro metacarpo seguindo o eixo longitudinal da mão. Resultados Nos 20 membros, o ponto mais distal da comunicação nervosa era distal à LCK. A linha Y estava no lado radial em relação ao ponto mais distal da ARC em 14 membros, e no lado ulnar em relação à linha Y em 6 membros. O cruzamento entre a LCK e a linha Y foi proximal à ARC em 18 membros; em 1 mão, era distal à intersecção entre essas linhas e, em outra mão, a LCK estava exatamente na ARC. Conclusão O conhecimento dessas relações anatômicas pode prevenir danos aos ramos nervosos e, assim, também prevenir a paralisia dos músculos intrínsecos em procedimentos cirúrgicos na palma da mão.
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Este relato de caso aborda o curso clínico de um envenenamento botrópico ocorrido no município de Jarinu, SP, no ano de 2021. O paciente necessitou de fasciotomia em membro superior após síndrome compartimental aguda com enxertia dermoepidérmica em um segundo momento cirúrgico. No pós-operatório tardio, o paciente evoluiu com retração, necessitando de reabordagem cirúrgica com correção de retração de membro superior esquerdo. Discute-se a gravidade do acidente ofídico, efeitos do veneno nos tecidos, complicações, síndrome compartimental aguda, indicação e técnica da fasciotomia descompressiva com base na literatura.
This case study examines the clinical course of a Bothrops snakebite poisoning that occurred in Jarinu, São Paulo, Brazil, in 2021. The patient required a fasciotomy in the upper limb due to acute compartment syndrome, followed by a second surgical procedure involving dermo-epidermal grafting. In the late postoperative period, the patient experienced retraction, leading to a subsequent surgical intervention to correct the retraction in the left upper limb. The severity of the snakebite accident, the effects of venom on tissues, complications, acute compartment syndrome, as well as the indications and techniques for decompressive fasciotomy, are discussed based on the available literature.
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Objective@#To systematically evaluate the effect of mini basketball on children s upper limb strength in China, and to provide basis for the development of kindergarten mini basketball and the improvement of children s upper limb strength performance.@*Methods@#CNKI, Wanfang Data, VIP, PubMed, and Web of Science databases were searched from the establishment of the database to July 26, 2023. The PICOST model was used for literature screening, and 13 literature with a total of 20 studies were finally included. The Cochrane System Evaluation Criteria was used for literature quality evaluation. Review Manager 5.4 and Stata 17 were used for statistical analysis and publication bias test.@*Results@#A total of 939 children were included in 20 studies, including 470 in the experimental group and 469 in the control group. Meta analysis showed that mini basketball had an extremely significant effect on the improvement of children s upper limb strength ( SMD=0.83, 95%CI=0.53-1.13, Z=5.40, P < 0.01 ). The results of subgroup analysis showed that there was no significant gender difference in the improvement of children s upper limb strength by mini basketball ( P >0.05), mini basketball exercise with an intervention time of less than or equal to 30 minutes ( SMD=0.49, 95%CI=0.29-0.70, Z=4.70, P <0.01) and an exercise cycle of more than 12 weeks ( SMD=1.25, 95%CI=0.54-1.96, Z= 3.45 , P<0.01) can achieve a better intervention effect on the upper limb strength of children. Meta regression results showed that the exercise intervention time was the main source of heterogeneity ( t=2.71, 95%CI= 1.38-22.93, P <0.05). Egger s test showed that the publication bias of the included studies was not statistically significant ( t=0.78, P >0.05).@*Conclusions@#Mini basketball training can improve the upper limb strength of children, but there is no significant gender difference. The upper limb strength is affected by the restriction of intervention time and exercise cycle. Schools can appropriately add small basketball in physical education classes to improve children s upper limb strength.
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Objective：Studies on upper extremity functional interventions for patients with spinal cord infarction are limited, and the effectiveness of the interventions for upper limb paresis in such patients have not been elucidated. This case report describes evidence-based spinal cord injury interventions that improved upper extremity function in a patient with spinal cord infarction.Methods：A man in his 60s presented with mild right hemiplegia because of right anterior spinal artery infarction in the C5 medullary segment. Upon admission, the patient had an American Spinal Injury Association Impairment Scale of D, lacked cognitive impairment, and demonstrated independence indoors with ambulation. The intervention included a combination of robotic therapy and electrical stimulation, adherence-enhancing behavioral strategies (Transfer Package), and typical occupational therapy. We recorded the following upper extremity functional scores：①Active Range of Motion of the shoulder, ②Passive Range of Motion of the shoulder, ③Manual Muscle Test, ④Grip strength, ⑤Pinch strength, ⑥Action Research Arm Test, ⑦Simple Test for Evaluating Hand Function, and ⑧Motor Activity Log.Results：After intervention therapy for 39 days, upper extremity function and the degree and quality of arm use in daily activities improved.Conclusion：These results suggest that evidence-based interventions for spinal cord injury could improve upper extremity function and the degree and quality of arm use in daily activities in patients with cervical spinal cord infarcti.
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Objective:To investigate the clinical efficacy of repetitive transcranial magnetic stimulation (rTMS) versus functional electrical stimulation (FES) in the treatment of post-stroke complex regional pain syndrome. Methods:The randomized controlled study included 60 patients with post-stroke complex regional pain syndrome who received treatment at the Wenzhou TCM Hospital of Zhejiang Chinese Medical University from July 2021 to February 2023. These patients were divided into an rTMS group ( n = 30) and an FES group ( n = 30) using a random number table method. Patients in the rTMS group were treated with rTMS, while those in the FES group were treated with FES. All treatments were performed once daily for 8 consecutive weeks. The clinical efficacy, total active movement score of the fingers, Fugl-Meyer assessment scale score, Activity of Daily Living score, modified Barthel Index score, shoulder joint range of motion, and safety were compared between the two groups. Results:The total response rate in the FES group was 86.7% (26/30), which was significantly higher than 83.3% (25/30) in the rTMS group ( Z = 0.09, P = 0.93). After treatment, there were no significant differences between the two groups in terms of total active movement score of the fingers and Fugl-Meyer assessment scale score ( P = 0.244, 0.262). No significant differences were found between the two groups in MBI score and ADL score (both P > 0.05). There was also no significant difference in shoulder joint range of motion between the two groups ( P > 0.05). Conclusion:Both rTMS and FES are highly effective for post-stroke complex regional pain syndrome. They can improve upper limb function, enhance daily living abilities, and remodel neurological functions of the brain.
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Objective To systematically review whether mirror therapy(MT)intervention can effectively improve upper extremity motor function and activities of daily living(ADL)in stroke patients;whether its improvement is affected by pa-tients'age and disease course;and whether MT's influencing factors,such as intervention period,time,and fre-quency,have a dosage effect on upper extremity motor function and ADL. Methods Seven databases were searched,including Embase,Web of Science,PubMed,Cochrane Library,Wanfang data,VIP and CNKI from establishment to April,2023,and randomized controlled trials of MT for upper extremity motor function and ADL in stroke patients were screened.Quality assessment was performed using Physiothera-py Evidence Database(PEDro).Meta-analysis was performed using RevMan 5.4.1,and network meta-analysis was performed using R software,reticulated meta-analysis tables and cumulative probability tables were drawn for ranked comparisons,and funnel plots were drawn to test for publication bias of the outcome indicators using Stata 17.0 software.GRADE was used to evaluate the quality of evidence for the outcome indicators. Results A total of 13 papers(532 patients)were included.The PEDro score ranged from 6 to 8.Most of the literature did not report the blinding completely or did not implement allocation concealment,which might have some limita-tions.MT could improve the scores of Fugl-Meyer Assessment-Upper Extremities(n = 466,MD = 6.05,95%CI 3.44～8.66,P<0.001),Barthel index(n = 230,MD = 9.95,95%CI 6.23～13.68,P<0.001)and Functional Inde-pendence Measure(n = 147,MD = 4.17,95%CI 2.61～5.72,P<0.001)in stroke patients.Network meta-analysis showed that MT was more effective in upper limb motor function intervention for stroke patients aged 40 to 59 years with a disease course less than three months;and an intervention period less than four weeks,single inter-vention time less than 30 minutes,intervention duration daily more than 30 minutes and intervention twice daily might optimize the effects on upper limb motor function. Conclusion MT is effective on upper limb motor function and ADL in stroke patients,and the effect on upper limb mo-tor function is affected by the age and disease course of the patients,as well as the period,time and frequency of intervention.
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Objective To explore the effect of robotic training under position limitation on upper limb of patients with shoulder sub-luxation after stroke. Methods From March to December,2023,sixty patients with shoulder subluxation after stroke in the First Affiliated Hospital of Bengbu Medical University were randomized into conventional group(n = 20),robot group(n = 20)and position-limited group(n = 20).All the groups accepted conventional rehabilitation,while the robot group underwent robot training and the position-limited group underwent robot training under position limitation,for four weeks.Before and after treatment,Fugl-Meyer Assessment-Upper Extremities(FMA-UE)and modified Bar-thel Index(MBI)were used for evaluation,surface electromyography(sEMG)was used to measure the average electromyography(AEMG)and root mean square(RMS)of posterior deltoid fasciculus and supraspinatus during contraction,and musculoskeletal ultrasonography was used to determine the distance of acromion-greater tuber-osity(AGT)of the affected side. Results After treatment,FMA-UE score,MBI score,AEMG,RMS and the distance of AGT improved in all the groups(|t|>10.850,P<0.001),and all the indexes were optimal in the position-limited group(F>42.031,P<0.001). Conclusion Robotic training for upper limb under postural limitation can further improve upper limb function and sub-luxation status,activities of daily living,and peri-shoulder muscle in patients with shoulder subluxation after stroke.
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SUMMARY OBJECTIVE: The objective of this study was to investigate the relationship between upper limb kinetics and perceived fatigability in elderly individuals during an upper limb position sustained isometric task. METHODS: A total of 31 elderly participants, 16 men (72.94±4.49 years) and 15 women (72.27±6.05 years), performed a upper limb position sustained isometric task. Upper-limb acceleration was measured using an inertial measurement unit. Perceived fatigability was measured using the Borg CR10 scale. RESULTS: Higher mean acceleration in the x-axis throughout the activity was associated with higher final perceived fatigability scores. Moderate correlations were observed between perceived fatigability variation and mean acceleration cutoffs in all axes during the second half of the activity. In women, significant correlations were found between all perceived fatigability cutoffs and mean acceleration in the y- and x-axes. However, in men, the relationships between perceived fatigability variation and mean acceleration were more extensive and stronger. CONCLUSION: The acceleration pattern of the upper limb is linked to perceived fatigability scores and variation, with differences between sexes. Monitoring upper limb acceleration using a single inertial measurement unit can be a useful and straightforward method for identifying individuals who may be at risk of experiencing high perceived fatigability or task failure.
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Abstract Introduction COVID-19 can cause persistent symptoms even in mild cases, such as fatigue and dyspnea, which can reduce functional capacity and make it difficult to perform activities of daily living. Objective To compare functional capacity using the pegboard and ring test and the six-minute walk test responses in post-COVID-19 patients according to the ventilatory support used. Methods Cross-sectional study including 40 adults of both sexes after SARS-CoV2 infection between June 2020 and June 2021, with assessment of functional capacity using the pegboard and ring test (upper limbs) and the six-minute walk (lower limbs). Those who reported comprehension deficit or neuromuscular disease were excluded. All participants were evaluated between 15 and 90 days after the onset of symptoms, diagnosed by nasal swab and classified according to the ventilatory support used during the infection. Results The mean age of the participants (n = 40) was 54.30 (±12.76) years, with BMI 28.39 (±4.70) kg/m2 and pulmonary involvement in 51.49 (±17.47)%. A total of 37 participants were hospitalized with a stay of 14.33 (±15.44) days, and 30% were previously immunized, while 7.5% reached the predicted distance covered. The average achieved was 46.44% (398.63 ± 130.58 m) in the distance covered and 39.31% (237.58 ± 85.51) in the movement of rings. Participants who had invasive mechanical ventilation (n = 10) had the worst functional capacity in both tests 265.85 ± 125.11 m and 181.00 ± 90.03 rings, compared to 472.94 ± 88.02 m and 273.25 ± 66.09 rings in non-invasive ventilation (n = 8), 410.32 ± 90.39 m and 257.68 ± 62.84 rings in oxygen therapy (n = 19), 569.00 ± 79.50 m and 203.00 ± 169.00 rings when there was no hospitalization (n = 3). Conclusion Participants who required invasive mechanical ventilation had worse functional capacity, 46% of what was expected in the walk test and 39% of what was expected in the pegboard and ring test.
Resumo Introdução A COVID-19 pode causar sintomas per-sistentes mesmo nos casos leves, como fadiga e dispneia, que podem reduzir a capacidade funcional e a realização das atividades de vida diária. Objetivo Comparar a avaliação da capacidade funcional a partir do teste da argola e caminhada dos 6 minutos pós-COVID-19 con-forme o suporte ventilatório utilizado. Métodos: Estudo transversal com 40 adultos, de ambos os sexos, pós-infecção por SARS-CoV2 entre julho/2020 e julho 2021, com avaliação da capacidade funcional pelos testes da argola (membros superiores) e caminhada (membros inferiores) de 6 minutos. Todos os participantes foram avaliados entre 15 e 90 dias do princípio dos sintomas, diagnosticados por swab nasal, e classificados conforme o suporte ventilatório utilizado durante a infecção. Resultados A média de idade dos participantes (n = 40) foi 54,30 (±12,76) anos, índice de massa corporal 28,39 (±4,70) kg/m2 e acometimento pulmonar em vidro fosco 51,49 (±17,47)%. Trinta e sete participantes foram hospitalizados com permanência de 14,33 (±15,44) dias, 30% previamente imunizados; 7,5% atingiram o predito da distância percorrida. A média alcançada foi de 46,44% (398,63 ± 130,58 m) na distância percorrida e 39,31% (237,58 ± 85,51) em movimento de argolas. Os participantes que utilizaram ventilação mecânica invasiva (n = 10) apresentaram pior capacidade funcional em ambos os testes: 265,85 ± 125,11 m e 181,00 ± 90,03 argolas comparado a 472,94 ± 88,02 m e 273,25 ± 66,09 argolas em ventilação não invasiva (n = 8), 410,32 ± 90,39m e 257,68 ± 62,84 argolas em oxigenoterapia (n = 19), 569,00 ± 79,50 m e 203,00 ± 169,00 argolas sem internação (n = 3). Conclusão Os participantes que necessitaram de ventilação mecânica invasiva apresen-taram pior capacidade funcional, com 46% do esperado no teste de caminhada e 39% no teste de argola de 6 minutos.
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ABSTRACT BACKGROUND: Congenital Anomalies of the Upper Limb (CAUL) are a group of structural or functional abnormalities that develop during intrauterine life and can lead to limb dysfunction. OBJECTIVES: To analyze the prevalence of congenital anomalies of the upper limbs in Brazil and assess maternal and neonatal variables. DESIGN AND SETTING: A cross-sectional, descriptive study was conducted on congenital upper limb malformations among live births across Brazil. METHODS: The study spanned from 2010 to 2019. Data were sourced from the Department of Informatics of the Unified Health System (DATASUS) and the Live Birth Information System (SINASC) portal. Analyses focused on the information reported in field 41 of the Live Birth Declaration Form entered into the computerized system. RESULTS: The most common anomaly in Brazil was supernumerary fingers, classified as ICD-Q69.0, affecting 11,708 children, with a prevalence of 4.02 per 10,000 live births. Mothers aged over 40 years had a 36% higher prevalence of having children with CAUL than mothers under 40 years old (OR = 1.36; 95% CI 1.19-1.56). Newborns weighing ≥ 2,499 g were 2.64 times more likely to have CAUL compared to those weighing ≥ 2,500 g (OR = 2.64; 95% CI 2.55-2.73). CONCLUSION: There was an observed increase in the reporting of CAUL cases over the decade studied. This trend serves as an alert for health agencies, as understanding the prevalence of CAUL and its associated factors is crucial for preventive medicine.
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Abstract Background Parkinson's disease (PD) may progressively reduce the upper limb's functionality. Currently, there is no standardized upper limb functional capacity assessment in PD in the rehabilitation field. Objective To identify specific outcome measurements to assess upper limbs in PD and access functional capacity. Methods We systematically reviewed and analyzed the literature in English published from August/2012 to August/2022 according to PRISMA. The following keywords were used in our search: "upper limbs" OR "upper extremity" and "Parkinson's disease." Two researchers searched independently, including studies accordingly to our inclusion and exclusion criteria. Registered at PROSPERO CRD42021254486. Results We found 797 studies, and 50 were included in this review (n = 2.239 participants in H&Y stage 1-4). The most common upper limbs outcome measures found in the studies were: (i) UPDRS-III and MDS-UPDRS to assess the severity and progression of PD motor symptoms (tremor, bradykinesia, and rigidity) (ii) Nine Hole Peg Test and Purdue Pegboard Test to assess manual dexterity; (iii) Spiral test and Funnel test to provoke and assess freezing of upper limbs; (iv) Technology assessment such as wearables sensors, apps, and other device were also found. Conclusion We found evidence to support upper limb impairments assessments in PD. However, there is still a large shortage of specific tests to assess the functional capacity of the upper limbs. The upper limbs' functional capacity is insufficiently investigated during the clinical and rehabilitation examination due to a lack of specific outcome measures to assess functionality.
Resumo Antecedentes A doença de Parkinson (DP) reduz progressivamente a funcionalidade do membro superior. Não existe uma avaliação padronizada da capacidade funcional do membro superior na DP na área da reabilitação. Objetivo Identificar medidas de resultados específicos para avaliar membros superiores na DP e avaliar capacidade funcional. Métodos Revisamos e analisamos sistematicamente a literatura publicada de agosto/2012 a agosto/2022 de acordo com PRISMA. Usamos as seguintes palavras-chave "membros superiores" OU "extremidade superior" e "doença de Parkinson." Dois pesquisadores fizeram a busca de forma independente, incluindo estudos de acordo com os critérios de inclusão e exclusão. Registro PROSPERO CRD42021254486. Resultados Encontramos 797 estudos, 50 foram incluídos no estudo(n = 2.239 participantes no estágio 1-4 de H&Y). As medidas de resultados de membros superiores mais comuns encontradas foram: (i) UPDRS-III e MDS-UPDRS, para avaliar a gravidade e a progressão dos sintomas motores da DP (tremor, bradicinesia, e rigidez); (ii) Nine Hole Peg Test e Purdue Pegboard Test para avaliar a destreza manual; (iii) Teste da Espiral e Teste do Funil para provocar e avaliar o congelamento de membros superiores; (iv) Avaliação de tecnologia, como sensores vestíveis, aplicativos e outros dispositivos também foram encontrados. Conclusão Encontramos evidências para dar suporte para as avaliações de deficiências de membros superiores na DP. No entanto, ainda há grande escassez de testes específicos para avaliar a capacidade funcional dos membros superiores. A capacidade funcional dos membros superior é insuficientemente investigada durante o exame clínico e de reabilitação devido à falta de medidas de resultados específicos para avaliar a funcionalidade.
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SUMMARY OBJECTIVE: This study aimed to investigate the effects of upper extremity home exercises on grip strength, range of motion, activity performance, and functionality in individuals with systemic sclerosis and to compare with patient education. METHODS: A total of 46 individuals with systemic sclerosis (55.52±11.54 years) were included. Individuals were randomly assigned into intervention (n=23) and control (n=23) groups. Dynamometer, goniometer, Canadian Occupational Performance Measurement, Disabilities of the Arm, Shoulder, and Hand, Score for Assessment and Quantification of Chronic Rheumatic Affections of the Hands, and Duruoz Hand Index were used for evaluation. RESULTS: Post-treatment, in terms of delta (Δ) values, hand grip and pinch strengths (p: 0.000-0.016), active (p: 0.000-0.032) and passive (p: 0.000-0.043) total range of motions, Canadian Occupational Performance Measurement performance and satisfaction, Disabilities of the Arm, Shoulder, Score for Assessment and Quantification of Chronic Rheumatic Affections of the Hands, and Duruoz Hand Index (p: 0.000) were in favor of the intervention group. CONCLUSION: Upper extremity home exercises increase grip strength, range of motion, activity performance, and functionality in patients with systemic sclerosis. We recommend that rehabilitation programs include not only hand exercises but also upper extremity exercises.
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ABSTRACT BACKGROUND AND OBJECTIVES: With the necessity to assess musculoskeletal complaints caused by computer use, The Maastricht Upper Extremity Questionnaire (MUEQ) was created, which aims to assess musculoskeletal complaints of the upper limbs, shoulder complex and cervical spine in computer users. However, there is currently no comprehensive summary in the scientific literature on the psychometric properties of the MUEQ. The objective of this study was to conduct a synthesis of all available scientific evidence that has analyzed the psychometric properties of the MUEQ. CONTENTS: This study followed the PRISMA recommendations. The bibliographic search was carried out in the following databases: MEDLINE (via VHL), Embase, LILACS (via VHL), Pubmed, PsycINFO, Scielo, Academic Search Premier, CINAHL, Rehabilitation & Sports Medicine Source, MEDLINE Complete, Web of Science CENTRAL, Scopus and SPORTDiscus. Studies that addressed the psychometric properties of the MUEQ were included, as long as they were original articles of research carried out with human beings and indexed in the databases used. The studies were selected in two phases, with two independent reviewers. A total of 6 articles were included in the analysis. The evidence based on internal structure showed acceptable results. The reliability indexes ranged from α=0.52 to α=0.84, and ICC/composite reliability > 0.70 in the analyzed studies, classified as "good" and "excellent," respectively. CONCLUSION: In general, this research found a lack of detail on the process of content validity and evidence related to external variables and the description of the sample. These problems extended to the evidence based on the internal structure and reliability of the MUEQ, which did not reach levels considered acceptable to ensure its adequacy and accuracy.
RESUMO JUSTIFICATIVA E OBJETIVOS: Com a necessidade de avaliar as queixas musculoesqueléticas ocasionadas pelo uso de computadores, foi criado o The Maastricht Upper Extremity Questionnaire (MUEQ), cujo objetivo foi avaliar as queixas musculoesqueléticas relativas aos membros superiores, ao complexo do ombro e à cervical em usuários de computadores. No entanto, atualmente não existe uma sumarização abrangente, na literatura científica, sobre as propriedades psicométricas do MUEQ. O objetivo deste estudo foi realizar uma síntese de evidências científicas disponíveis que analisaram as propriedades psicométricas do MUEQ. CONTEÚDO: Este estudo seguiu as recomendações do PRISMA. A busca bibliográfica foi realizada nas bases de dados Medline (via BVS), Embase, LILACS (via BVS), Pubmed, PsycINFO, Scielo, Academic Search Premier, CINAHL, Rehabilitation & Sports Medicine Source, MEDLINE Complete, Web of Science CENTRAL, Scopus e SPORTDiscus. Foram incluídos estudos que abordaram as propriedades psicométricas do MUEQ, desde que fossem artigos originais de pesquisas desenvolvidas com seres humanos e indexados nas bases utilizadas. A seleção dos estudos ocorreu em duas fases, com dois revisores independentes. Foram incluídos 6 artigos/publicações na análise. A evidência baseada na estrutura interna apresentou resultados aceitáveis. Os índices de fidedignidade variaram de α=0,52 a α=0,84 e ICC/confiabilidade composta foram maiores que 0,70 nos estudos selecionados, classificados como "bom" e "excelente", respectivamente. CONCLUSÃO: De um modo geral, esta pesquisa constatou a falta de detalhamento sobre o processo de validade de conteúdo e de evidências relacionados a variáveis externas e à descrição da amostra. Esses problemas se estenderam à evidência baseada na estrutura interna e à confiabilidade do MUEQ, que não alcançaram níveis considerados aceitáveis para garantir sua adequação e precisão.
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Resumen: Introducción: los aneurismas son dilataciones vasculares localizadas y permanentes de una arteria; en los pseudoaneurismas, las capas normales del vaso sanguíneo son reemplazadas por tejido fibroso. Debido a su baja incidencia, así como el desafío diagnóstico y terapéutico que representan; nuestro objetivo es presentar el caso clínico de un pseudoaneurisma de una arteria digital de la mano y realizar una revisión sistemática sobre dicha patología. Material y métodos: búsqueda bibliográfica en Medline, utilizando los términos «arteria digital¼ y «aneurisma¼. Se incorporaron estudios de patología de dilatación vascular que afecte la mano y los dedos. Se excluyeron trabajos con patología de afección proximal de la mano. Presentación de caso: paciente femenino de 79 años de edad, que posterior a herida cortante de quinto dedo de mano izquierda, desarrolla tumoración necrótica de rápido crecimiento. Contaba con ecografía y angiografía que sugerían hematoma. Se decidió manejo quirúrgico, durante el cual se observó que la tumoración involucraba arteria digital colateral cubital del quinto dedo. Se resecó lesión y segmento arterial involucrado. Cursó postquirúrgico sin complicaciones. Se confirmó el diagnóstico histopatológico de pseudoaneurisma de la lesión. Discusión: la etiología traumática es la causa más frecuente de los aneurismas digitales. Los factores de riesgo para los pseudoaneurismas incluyen lesiones penetrantes y alteraciones de la cascada de coagulación, como en el caso presentado. Conclusión: el pseudoaneurisma de una arteria digital es una patología rara y con gran variabilidad de manejo terapéutico. La resección quirúrgica de la lesión con la reconstrucción del flujo vascular, es el tratamiento recomendado.
Abstract: Introduction: aneurysms are focal and permanent dilations of an artery; in pseudoaneurysms, the normal layers of the blood vessel are replaced by fibrous tissue. Due to their low incidence, as well as the diagnostic and therapeutic challenge they represent; our objective is to present the clinical case of a pseudoaneurysm of a digital artery of the hand and to carry out a systematic review of this pathology. Material and methods: literature search in Medline, using the terms "digital artery" and "aneurysm." Studies of vascular dilation pathology affecting the hand and fingers were incorporated. Studies with pathology of proximal involvement of the hand were excluded. Case presentation: a 79-year-old female patient who, after a sharp force trauma to the fifth finger of the left hand, develops a rapidly growing necrotic tumor. She had ultrasound and angiography that suggested hematoma. Surgical management was decided, during which it was observed that the tumor involved ulnar collateral digital artery of the fifth finger. The lesion and the arterial segment involved were resected. Post-surgical course without complications. The histopathological diagnosis of pseudoaneurysm of the lesion was confirmed. Discussion: traumatic etiology is the most frequent cause of digital aneurysms. Risk factors for pseudoaneurysms include sharp force trauma and alterations of the coagulation pathways, as in the case presented. Conclusion: the pseudoaneurysm of a digital artery is a rare pathology with great variability of therapeutic management. Surgical resection of the lesion with vascular flow reconstruction is the recommended treatment.
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Background: Electrical burn injuries are still amongst the highest accident-related morbidities. Aim: To assess the demographic profile as well as to study outcomes of early fasciotomy in salvage acute electrical burns involving upper limbs. Materials and Methods: The present study was a prospective case series study conducted in Department of Plastic and Reconstructive Surgery at Gandhi Medical College and Hospital, Secunderabad, from January 2020 to January 2022. Total 20 study subjects were evaluated. Electrical burn injury was assessed at the time of admission. Data was analyzed by using coGuide software, V.1.01. Results: In the study population, 55% belonged to age group of 30 years. Male predominance with 75% compared to female. Accidents 40% were major cause of injury. In majority, 65% of the cases fasciotomies were done within 48 hrs of electrical burn injuries. Conclusion: The results of the study concluded that younger generation is more prone to electrical burn injuries and males were majorly affected. Unsafe work areas and accidents are main reasons for injuries. High voltage affected the study population compared to low voltage. Amputations were required in fingers and below elbow. Early fasciotomy, repeated debridement's, definitive skin cover (SSG/flap) have helped in reducing the morbidity and improving the quality of life of the patient.
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Introduction: Because of the the complex physiopathology of spasticity, it is distinguished as one of the most significant positive clinical signs of upper motor neuron syndrome, constituting a clinical feature that has great impact in the neurorehabilitation setting. Thus, the current study aimed to determine the prevalence, onset, evolution, and prediction of spasticity after a stroke. Materials and Methods: A correlational, longitudinal design was used. A total of 136 patients were evaluated at the following times: 10 days (T1), 3 months (T2), and 12 months (T3) poststroke. The initial evaluation included sociodemographic and clinical data (T1). Muscle tone was measured (T1, T2, and T3) using the Modified Ashworth Scale. Results: The prevalence of poststroke spasticity in the elbow was 37.5 % at T1 and 57.4 % at T2 and T3. Among patients with motor damage, the onset of spasticity occurred at T1 in 44.7 %, between T1 and T2 in 23.7 %, and between T2 and T3 in 0.9 %. Significant predictors of the alteration in muscular tone for at least two of the evaluation times were ethnic self-classification, type, area, extent of stroke, and number of sessions. Conclusions: Spasticity onset occurs during the first 10 days after a stroke. More clinical than sociodemographic variables predicted spasticity.
Introducción: la espasticidad se destaca como uno de los signos clínicos positivos más significativos del síndrome de motoneurona superior, por su compleja fisiopatología, y constituye una característica clí- nica de gran impacto en el ámbito de la neurorrehabilitación. Por lo tanto, el objetivo fue determinar la prevalencia, el inicio, la evolución y la predicción de la espasticidad después de un accidente cerebro- vascular. Materiales y métodos: se utilizó un diseño longitudinal correlacional. Se evaluaron 136 pacientes: 10 días (T1), 3 meses (T2) y 12 meses (T3) pos-ACV. La evaluación incluyó datos sociodemográficos y clínicos (T1) y se midió el tono muscular (T1, T2 y T3) mediante la Escala de Ashworth Modificada. Resultados: la prevalencia en el codo fue del 37.5 % en T1, y del 57.4 % en T2 y T3. Entre los pacientes con daño motor, el inicio de la espasticidad ocurrió en T1 para el 44.7 % de ellos, entre T1 y T2 para el 23.7 % y entre T2 y T3 para el 0.9 %. La autoclasificación étnica, el tipo, el área, la extensión del ictus y el número de sesiones predijeron significativamente la alteración del tono muscular en al menos dos ocasiones. Conclusiones: el inicio de la espasticidad ocurre durante los 10 primeros días después de un ACV. Más variables clínicas que sociodemográficas predijeron espasticidad.
Introdução: a espasticidade destaca-se como um dos sinais clínicos positivos mais significativos da síndrome do neurônio motor superior, devido à sua fisiopatologia complexa, e constitui uma característica clínica de grande impacto no campo da neurorreabilitação. Portanto, nosso objetivo foi determinar a prevalência, início, evolução e predição da espasticidade após o acidente vascular cerebral. Materiais e métodos: foi utilizado um desenho correlacional longitudinal. Foram avaliados 136 pacientes: 10 dias (T1), 3 meses (T2) e 12 meses (T3) pós-AVC. A avaliação incluiu dados sociodemográficos e clínicos (T1) e o tônus muscular (T1, T2 e T3) foi medido por meio da Escala Modificada de Ashworth. Resultados: a prevalência no cotovelo foi de 37,5 % em T1 e 57,4 % em T2 e T3. Entre os pacientes com prejuízo motor, o início da espasticidade ocorreu em T1 em 44,7 % deles, entre T1 e T2 em 23,7 % e entre T2 e T3 em 0,9 % dos pacientes. A autoclassificação étnica, o tipo, a área, a extensão do AVC e o número de sessões predisseram significativamente as anormalidades do tônus muscular em pelo menos duas ocasiões. Conclusões: o início da espasticidade ocorre durante os primeiros 10 dias após o acidente vascular cerebral. Mais variáveis clínicas do que sociodemográficas previram a espasticidade
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Humansالملخص
Resumen: Introducción: en años recientes con el renacimiento de la anestesia regional a causa de los avances técnicos en equipamiento como el ultrasonido, estos han permitido llevar a cabo bloqueos de plexo braquial con varias técnicas de abordaje, alta eficacia de éxito y disminución de complicaciones. Objetivo: conocer la eficacia y seguridad del bloqueo de plexo braquial con ultrasonido, en anestesiólogos con especialidad en anestesia regional. Material y métodos: se realizó el estudio observacional, descriptivo y retrospectivo de la práctica clínica habitual en 283 pacientes de 0 a 15 años, programados para cirugía electiva de ortopedia y traumatología, de extremidad superior (húmero tercio distal, codo, antebrazo y mano), con manejo anestésico: sedación más bloqueo de plexo braquial con ultrasonido abordaje supraclavicular o infraclavicular. Durante dos años, de enero de 2018 a diciembre de 2019. Resultados: los bloqueos fueron realizados por 11 anestesiólogos con especialidad en anestesia regional. Se evaluó la eficacia con 99.65% de éxito. En cuanto a la seguridad no se registraron complicaciones. Conclusiones: el uso de ultrasonido en bloqueo de plexo braquial con abordaje supraclavicular e infraclavicular es una técnica con éxito alto y sin complicaciones; sin embargo, es necesario tener capacitación y experiencia.
Abstract: Introduction: in recent years with the revival of regional anesthesia due to technical advances in equipment such as ultrasound, have allowed to carry out brachial plexus blocks with several approach techniques with high efficiency of success and reduction of complications. Objective: to know the efficacy and safety of brachial plexus block with ultrasound, in anesthesiologists with a specialty in regional anesthesia. Material and methods: the observational, descriptive, retrospective study of the usual clinical practice was carried out in 283 patients from 0 to 15 years old, scheduled for elective orthopedic surgery and traumatology, of the upper extremity (distal third humerus, elbow, forearm and hand), with anesthetic management: sedation plus brachial plexus block with ultrasound supraclavicular or infraclavicular approach. For two years from January 2018 to December 2019. Results: the blocks were performed by 11 anesthesiologists specializing in regional anesthesia. Efficacy was evaluated with 99.65% success. In terms of safety, there were no complications. Conclusions: the use of ultrasound in brachial plexus block with supraclavicular and infraclavicular approach is a technique with high success and without complications however it is necessary to have training and experience.
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ObjectiveTo investigate the effect of combination of proprioceptive neuromuscular facilitation (PNF) rope training and repetitive transcranial magnetic stimulation (rTMS) on upper limb motor function of stroke patients with hemiplegia. MethodsFrom March, 2021 to February, 2022, 90 stroke inpatients with hemiplegia in the Department of Rehabilitation Medicine, the Second Affiliated Hospital of Guangxi Medical University were divided into control group (n = 30), rope group (n = 30) and combination group (n = 30) randomly. All the groups received routine rehabilitation, while the control group received routine PNF training, the rope group received PNF rope training, and the combination group received PNF rope training and rTMS, for four weeks. They were assessed with Functional Test for the Hemiplegic Upper Extremity-Hong Kong version (FTHUE-HK), Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and modified Barthel Index (MBI) before and after treatment. ResultsThe scores of FTHUE-HK, FMA-UE and MBI increased in all the three groups after treatment (t > 2.167, P < 0.05), and they were more in the combination group than in the rope group (P < 0.05), and in the rope group than in the control group (P < 0.05). ConclusionThe combination of PNF rope training and rTMS is more effective on motor function of upper limbs of stroke patients with hemiplegia than PNF training alone.
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Objective:To evaluate the short-term outcomes of modified reverse Sauvé-Kapandji technique in treating the congenital radioulnar synostosis.Methods:A retrospective analysis was performed on the data of 46 congenital radioulnar synostosis patients were treated with modified reverse Sauvé-Kapandji technique in Beijing Jishuitan Hospital from December 2018 to January 2020, including 38 males (45 sides), 8 females (9 sides), average age 6.6 (3.2, 8.1) years old. All the patients were classified as type III according to Cleary-Omer classification and were followed up for at least 1 year. All the patients were treated with same operation, in which 1.5 cm shaft was resected at the proximal radius, allogeneic graft tendon was used as interposition, and rotational osteotomy was performed in the middle of the ulnar shaft, with intramedullary needle or Kirschner wire fixation, depending on the intramedullary width of ulnar shaft. The radiological features were collected and recorded preoperatively and at the latest follow-up, together with the following evaluation indexes: modified Morrey tasks score, subjective function score, active forearm rotation range without compensation, active forearm rotation range with wrist joint compensation, and active forearm rotation range with wrist and shoulder joint compensation.Results:All patients were followed up for 14.6±3.4 months (range, 11.2-19.5 months). The uncompensated forearm rotation Angle was 0.0°±0.0° before surgery and 62.3°±23.7° after surgery. The forearm rotation angles before and after surgery with wrist compensatory surgery were 86.9°±29.4° and 133.2°±27.9°, respectively. The forearm rotation angles before and after surgery with wrist and shoulder joint compensatory surgery were 205.2°±42.7° and 245.2°±35.8°, respectively. There were statistically significant differences in the above indexes before and after surgery ( t=8.71, P<0.001; t=2.54, P=0.030; t=5.05, P<0.001). Ulnar union was observed in 31 patients (37 sides) after the operation, and the union duration was 6.1±2.3 months. There were 15 patients (17 sides) ulnar shafts faced with postoperative delayed union, the union duration was 8.4±1.6 months and were recovered after prolonging brace fixation and orthopedic shock wave treatment. The scores of subjective function and improved Morrey tasks of the 43 sides with good pseudo-joint were 12.1 (0.0, 20.8) and 0.7 (0.0, 1.0) points, respectively, which were improved compared with 33.9 (25.0, 41.6) and 3.2 (2.0, 4.0) points before surgery. The differences were statistically significant ( Z=-2.44, P=0.015; Z=-2.83, P=0.005). There were 11 forearms with postoperative pseudo-joint re-ankylosis, the average forearm rotation ranges without compensation was 11.4°±10.5°(range, 0°-30°), the average forearm rotation ranges with wrist compensation was 98.6°±15.9° (range, 80°-120°), the average forearm rotation ranges with wrist and shoulder compensation was 231.7°±16.9° (range, 210°-255°). The average subjective function scores was 26.7 (8.3, 39.6). The average modified Morrey tasks scores was 1.2 (0, 2), and there were no other postoperative complications. Conclusion:The reverse Sauvé-Kapandji technique showed a satisfying short-term outcome, and can be a new choice of treatment for type III congenital radioulnar synostosis.
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ObjectiveTo construct a framework of PICO for occupational therapy to improve upper extremity function in stroke patients based on World Health Organization Family of International Classifications (WHO-FICs), and to analyze the functional outcome of major occupational therapies to improve upper extremity in stroke. MethodsUsing the WHO-FICs framework, the databases such as Web of Science, PubMed, CNKI and SinoMed were searched for literature related to occupational therapy interventions for upper extremity function in stroke patients from the date of establishment to October, 2022, and the contents of the literature were extracted for a systematic review. ResultsTen randomized controlled trials from six countries were finally included, involving 382 participants (≥ 18 years old). The literatures were mainly from the fields of rehabilitation medicine, physics and rehabilitation medicine, neuroscience, bioengineering medicine, occupational therapy and other research fields, and were published mainly after 2013. The quality of the included literatures was evaluated using Physiotherapy Evidence Database (PEDro) scale with a mean score of 7.5. Based on the WHO-FICs framework, the types of diseases included intracerebral haemorrhage (8B00), cerebral ischemic stroke (8B11), subarachnoid hemorrhage (8B01), abnormality of tonus and reflex (MB47), and hemiplegia (MB53). The main dysfunctions of the upper extremity after stroke included mobility of joint functions (b710), stability of joint functions (b715), muscle power functions (b730), muscle tone functions (b735), motor reflex functions (b750), control of voluntary movement functions (b760), involuntary movement functions (b765). Activity and participation included activity of upper limb, such as lifting and carrying objects (d430), hand and arm use (d445), and fine hand use (d440); and the daily life activities and social participation, such as self-care (d510-d570), domestic life (d610-d660), major life areas (d810-d879), community, social and civic life (d910-d950). Therapeutic interventions on body functions included electrical stimulation of muscle functions (MU2.SC.BP), assistance and guidance of exercise for involuntary movement reaction (MV2.PG.ZZ); therapeutic interventions involving activity and participation were training in lifting and carrying (SIA.PH.ZZ), training in fine hand use (SIG.PH.ZZ), exercises of arm and hand use (SIJ.PH.ZZ), self care (SM1-SMH), household tasks (SO2-SOD), and playing games (SXD.PH.ZZ); 15 to 60 minutes a time, three to ten times a week, for three to eight weeks, in hospital or at home. The outcomes of the intervention were divided into three levels. At the body function level, patients had improved neuromotor conduction function, reflex function, casual motor control, coordination and speed, joint mobility, and grip strength. At the activity and participation level, there were enhancements in upper limb mobility and speed, fine hand function and speed, frequency and quality of upper limb activity participation, and the capacities of daily living and reduced difficulty in daily activity tasks. In terms of whole functioning, patients had acquired quality of life and well-being and acquainted a feeling of pleasure and accomplishment. ConclusionA PICO framework was constructed for occupational therapy based on WHO-FICs. The health conditions included intracerebral haemorrhage, cerebral ischemic stroke, subarachnoid hemorrhage, abnormality of tonus and reflex, and hemiplegia. Upper extremity motor dysfunction mainly included dysfunction of voluntary motor control, low or hyperactive motor reflexes, abnormalities in muscle tone, impaired muscle coordination, poor stability of joint activities, and reduced muscle strength, etc. Activity limitation and participation restriction were manifested as functioning in the fields of arm and hand activity participation, fine manual activity, and activities of daily living and social participation. Therapeutic interventions at body function level included brain-computer interface-based functional electrical stimulation and unimanual mirror therapy; therapeutic interventions at activity and participation level included action observation training, bimanual mirror therapy, task-oriented training, bilateral arm training and upper extremity robotics training. The health and functional benefits included the improvements in upper extremity motor function, upper extremity mobility and participation levels, activities of daily living and social participation, and quality of life and well-being.