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Introduction: For comminuted and displaced fractures of the radial head open reduction and internal fixation (ORIF) is recommended nowadays as the treatment of choice. Due to the development of locking plates the possibilities of ORIF in complex fracture types were extended. The purpose of this retrospective survey therefore was to review the preliminary subjective and objective results in patients treated by anatomically preshaped locked plating. A reliable fracture healing for these recently introduced plating devices was hypothesized.Materials and Methods: Subjective and objective criteria included patient's satisfaction, pain rating on a visual analogue scale (VAS) and active range of motion (ROM) compared to the contralateral armside. Functional scoring included the Morrey elbow performance score (MEPS), the QuickDASH and the elbow self-assessment score (ESAS). Furthermore, follow-up radiographs were reviewed.Results: Between 2011 and 2014 a total of 24 patients were managed with ORIF using anatomically preshaped low-profile locking plates. All patients had suffered from comminuted radial head fractures (type III-IV according to Mason classification). Twenty of 24 patients returned for follow-up examination after a mean of 30 months (range 18-53 months). Patients' satisfaction was rated as highly satisfied in 17 cases and satisfied in 3 cases. An unrestricted ROM for extension-flexion arc and pronation-supination arc was rated in 10 cases. Minor ROM deficiencies with a 5° limited extension compared to the contralateral side was evaluated in 6 cases. Only four patients were rated with and extension and supination deficiency of 10°, one of whom with an additional pronation deficiency of 10°. The calculated MEPS was Ø 98 ± 4 (range 85-100), and the QuickDASH was Ø 3 ± 6 (range 0-21). The ESAS was completed by 18 patients with a mean of Ø 96.54 ± 2.95 (range 94-100) indicating a non-restricted elbow function.Conclusions: The treatment of comminuted radial head fractures using anatomically preshaped locking radial head plates represents a reliable and safe surgical approach, leading to good to excellent functional results. Being aware of the importance of the radial head for elbow stability, open reduction and internal fixation should be preferred prior to radial head resection or replacement in complex radial head fractures. Further trials with a higher number of patients are needed to confirm the advantages of preshaped radial head plates. [ABSTRACT FROM AUTHOR]

Although typical corticobasal syndrome (CBS) presents with asymmetric upper limb symptoms, the prevalence and clinical characteristics of patients with symptoms beginning in other sites are unknown. From January 1997 through April 2016, consecutive patients with CBS who fulfilled the modified Cambridge criteria were recruited. Their medical records were reviewed to determine the body part, where the initial symptoms developed and the clinical characteristics. A total of 24 patients [13 female participants, median age at onset: 64 (IQR 60-74) years, and median duration between onset and evaluation: 38 (17-53) months] met the criteria. The initial symptom involved the unilateral upper limb in 14 cases (58%), unilateral lower limb in five (21%), gait in four (17%), and visual field in one (4%). Over a median of 59 (IQR 40-68) months of follow-up, the duration between the onset and the time for need of assistance in walking was significantly shorter in the patients with lower limb (p = 0.018 with log-rank test) or gait (p = 0.025) onset than in those with upper limb onset. About a half of the CBS patients initially complained of symptoms other than the upper limb. The most common area of origin of the initial symptom after the upper limb was the lower limb followed by gait. Such patients need assistance in walking earlier than those with upper limb-onset CBS. Patients with lower limb- or gait-onset CBS are not rare and may have unfavorable outcome. [ABSTRACT FROM AUTHOR]

Impaired manual dexterity is a frequently reported disability in people with multiple sclerosis (MS) and is increasingly prevalent with worsening disease. While various tests and patient-reported outcome measures are available, the Nine-Hole Peg Test (NHPT) is considered as a gold standard measure of manual dexterity and most frequently used in MS research and clinical practice. The MS Outcome Assessments Consortium (MSOAC) includes representatives from advocacy organizations, Food and Drug Administration (FDA), European Medicines Agency (EMA), National Institute of Neurological Disorders and Stroke (NINDS), academic institutions, and industry partners along with persons living with MS. Among the MSOAC goals are acceptance and qualification by regulators of performance outcomes that are highly reliable and valid, practical, cost-effective, and meaningful to persons with MS. A critical step for these neuroperformance metrics is elucidation of clinically relevant benchmarks, well-defined degrees of disability, and gradients of change that are deemed clinically meaningful. This article addresses the NHPT, the proposed MSOAC measure for upper extremity function. We find that the NHPT is reliable within and between test sessions, discriminates between healthy subjects and MS patients with different levels of upper limb impairment, and shows high convergent validity with other manual dexterity as well as more comprehensive upper limb measures. Ecological validity is established by its relation to perceived upper limb use in daily life and perceived difficulty in performing activities of daily living. The NHPT is responsive to deterioration in longitudinal studies, and research suggests that a 20% change in test score is commonly used to define clinically meaningful worsening, a definition that needs further validation in all stages of the disease. [ABSTRACT FROM AUTHOR]

Background: Nonoperative treatment has historically been considered the standard for fractures of the shaft of the humerus. Minimally invasive bridge-plate osteosynthesis for isolated humeral shaft fractures has been proven to be a safe technique, with good and reproducible results. This study was designed to compare clinical and radiographic outcomes between patients who had been treated with bridge plate osteosynthesis and those who had been managed nonoperatively with a functional brace.Methods: A prospective randomized trial was designed and included 110 patients allocated to 1 of 2 groups: surgery with a bridge plate or nonoperative treatment with a functional brace. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score at 6 months. The score on the Short Form-36 (SF-36) life-quality questionnaire, complications of treatment, Constant-Murley score for the shoulder, pain level, and radiographic results were assessed as secondary outcomes. Participants were assessed at 2 weeks; 1, 2, and 6 months; and 1 year after the interventions.Results: The mean DASH score of the bridge plate group was statistically superior to that of the functional brace group (mean scores, 10.9 and 16.9, respectively; p = 0.046) only at 6 months. The bridge plate group also had a significantly more favorable nonunion rate (0% versus 15%) and less mean residual angular displacement seen on the anteroposterior radiograph (2.0° versus 10.5°) (both p < 0.05). No difference between the groups was detected with regard to the SF-36 score, pain level, Constant-Murley score, or angular displacement seen on the lateral radiograph.Conclusions: This trial demonstrates that, compared with functional bracing, surgical treatment with a bridge plate has a statistically significant advantage, of uncertain clinical benefit, with respect to self-reported outcome (DASH score) at 6 months, nonunion rate, and residual deformity in the coronal plane as seen on radiographs.Level Of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

A low origin of the radial artery is a rare anatomical variation, with the incidence estimated at 0.2 %. This report presents a previously unrecorded case of an unusual distal origin of the radial artery, co-occurring with a double recurrent radial artery. The radial artery arose under the pronator teres muscle, 76 mm below the intercondylar line of the humerus. After emerging from under the tendon of the pronator teres muscle, the radial artery took a typical course and terminated in the deep palmar arch. Additionally, the double radial recurrent artery branched directly off the brachial artery, near the level of the radial neck. A well-developed muscular branch of the first radial recurrent artery ran beneath the brachioradialis muscle and supplied the brachioradialis, extensor carpi radialis longus and brevis, as well as supinator muscles. The second (accessory) radial recurrent artery took origin from the posterior aspect of the brachial artery, ran deep to the distal tendon of the biceps brachii muscle and terminated by joining the articular network of elbow. According to recent theories, the plexiform appearance of the arteries at early stages of upper limb development allows for formation of alternative pathways of blood flow, which may give rise to variations in the definitive arterial pattern. [ABSTRACT FROM AUTHOR]

Background: Upper limb paresis is one of the most frequent and persistent impairments following stroke. Only 12-34% of stroke patients achieve full recovery of upper limb functioning, which seems to be required to habitually use the affected arm in daily tasks. Although the recovery of upper limb functioning is most pronounced during the first 4 weeks post stroke, there are few studies investigating the effect of rehabilitation during this critical time window. The purpose of this trial is to determine the effect of electrical somatosensory stimulation (ESS) initiated in the acute stroke phase on the recovery of upper limb functioning in a nonselected sample of stroke patients.Methods/design: A sample of 102 patients with upper limb paresis of varying degrees of severity is assigned to either the intervention or the control group using stratified random sampling. The intervention group receives ESS plus usual rehabilitation and the control group receives sham ESS plus usual rehabilitation. The intervention is applied as 1 h of ESS/sham ESS daily, followed by motor training of the affected upper limb. The ESS/sham ESS treatment is initiated within 7 days from stroke onset and it is delivered during hospitalization, but no longer than 4 weeks post stroke. The primary outcome is hand dexterity assessed by the Box and Block Test; secondary outcomes are the Fugl-Meyer Assessment, hand grip strength, pinch strength, perceptual threshold of touch, degree of pain, and modified Rankin Scale score. Outcome measurements are conducted at baseline, post intervention and at 6-month follow-up.Discussion: Because of the wide inclusion criteria, we believe that the results can be generalized to the larger population of patients with a first-ever stroke who present with an upper limb paresis of varying severity. On the other hand, the sample size (n = 102) may preclude subgroup analyses in such a heterogeneous sample. The sham ESS treatment totals a mere 2% of the active ESS treatment delivered to the intervention group per ESS session, and we consider that this dose is too small to induce a treatment effect.Trial Registration: ClinicalTrials.gov, NCT02250365 . Registered on 18 September 2014. [ABSTRACT FROM AUTHOR]

Background: Poland syndrome (PS) is a rare congenital anomaly associated with absent or hypoplastic pectoralis major muscle and a wide spectrum of ipsilateral thoracic and upper extremity deformities. Hidradenitis suppurativa (HS) is a recurrent inflammatory follicular disease that commonly affects the apocrine-bearing skin and involves follicular occlusion and hyperkeratosis. Case Report: We report a case of a 46-year-old male with a history of chronic recurrent hidradenitis suppurativa who was incidentally found to have a simple type of Poland syndrome with incidental hypoplasia of ipsilateral gluteal muscles. Conclusions: Not only can PS present with HS, which we describe for the first time, but it is also associated with a wide variability of symptoms such as previously unknown co-existence of gluteal muscles hypoplasia [ABSTRACT FROM AUTHOR]

Purpose: The biomechanical adaptations in front crawl and backstroke swimming, as influenced by the implementation of a concurrent teaching programme were analysed. Methods: Sixteen participants (19.75 ± 1.13 years) underwent a 30 weeks intervention characterized by an increasing complexity to accomplish motor skills in the following order: (i) lower limbs propulsion; (ii) lower limbs propulsion synchronized with breathing cycle; (iii) lower limbs propulsion synchronized with one upper limb action; (iv) lower limbs propulsion synchronized with both breathing cycle and one upper limb action; (v) full swimming stroke; (vi) motor trajectory of the arms stroke. Performance and biomechanics were measured at front crawl and backstroke during three time points throughout the programme. Results: There were improvements in performance over time at front crawl (21.49 s to 19.99 s, p < 0.01) and backstroke (27.15 s to 24.60 s, p = 0.01). Significant improvements were found for velocity at front crawl (1.13 m/s to 1.22 m/s, p < 0.01) and backstroke (0.92 m/s to 1.00 m/s, p < 0.01). Stroke frequency increased at backstroke (0.64 to 0.73 Hz, p = 0.01), while the intra-cyclic variation of the velocity decreased at front crawl (0.13 to 0.12%, p = 0.02). There was also a moderate-high inter-subject variability in response to the programme. Conclusions: These findings prove that a programme of 30 weeks teaching concurrently front crawl and backstroke is effective to promote similar biomechanical adaptations in low-tier swimmers. However, each subject shows an individual response to better adapt the biomechanical actions and to reach a higher level of expertise. [ABSTRACT FROM AUTHOR]

Background Digital analysis of writing and drawing has become a valuable research and clinical tool for the study of upper limb motor dysfunction in patients with essential tremor, Parkinson’s disease, dystonia, and related disorders. We developed a validated method of computerized spiral analysis of hand-drawn Archimedean spirals that provides insight into movement dynamics beyond subjective visual assessment using a Wacom graphics tablet. While the Wacom tablet method provides robust data, more widely available mobile technology platforms exist. New method We introduce a novel adaptation of the Wacom-based method for the collection of hand-drawn kinematic data using an Apple iPad. This iPad-based system is stand-alone, easy-to-use, can capture drawing data with either a finger or capacitive stylus, is precise, and potentially ubiquitous. Results The iPad-based system acquires position and time data that is fully compatible with our original spiral analysis program. All of the important indices including degree of severity, speed, presence of tremor, tremor amplitude, tremor frequency, variability of pressure, and tightness are calculated from the digital spiral data, which the application is able to transmit. Comparison with existing method While the iPad method is limited by current touch screen technology, it does collect data with acceptable congruence compared to the current Wacom-based method while providing the advantages of accessibility and ease of use. Conclusions The iPad is capable of capturing precise digital spiral data for analysis of motor dysfunction while also providing a convenient, easy-to-use modality in clinics and potentially at home. [ABSTRACT FROM AUTHOR]

Purpose: Playing the string instrument predisposes musicians to musculoskeletal problems in the upper extremity and trunk which usually affects more than one anatomical region. These musculoskeletal problems could result in difficulty in performing activities of daily living and playing a musical instrument. The aim of this study was to evaluate disability associated with musculoskeletal problems of string instrumentalists in South Africa by using the quick Disability of the Arms, Shoulder and Hands (DASH) and the Neck Disability Index (NDI) as measuring tools. Materials and methods: String instrumentalists from both amateur and professional orchestras were recruited via an electronic and a paper based survey to participate in the study by completing a self-administered questionnaire. The prevalence of musculoskeletal problems affecting performance was 56.6% and the trunk and shoulders were mainly affected. The overall disability scores of the QuickDASH and the NDI were 12.9 ± 13.2 and 11.5 ± 9.8 respectively. Symptomatic individuals had higher disability scores, 13.9 ± 13.8 (QuickDASH) and 15.0 ± 10.5 (NDI). Conclusion: The presence of musculoskeletal problems in one or more anatomic regions results in activity limitation and participation restriction of activities of daily living and it also impedes performance, therefore, it is important to evaluate the biomechanical structures involved in playing in order to proffer injury prevention strategies directly focussed on the basic components of performance. [ABSTRACT FROM AUTHOR]

We present the case of a 38-year-old right-hand-dominant female with a longstanding extensive high flow arteriovenous malformation (AVM) affecting the left hand and forearm. The patient's main complaints were altered sensation in the left hand and difficulty with co-ordination. Clinical examination revealed reduced global sensibility in the hand and evidence of a vascular steal phenomenon resulting in a cold thumb and small finger without trophic changes. Subsequent nerve conduction studies identified peripheral neuropathy affecting the median, ulnar and radial nerves. There was no evidence of entrapment neuropathy and the findings were attributed to nerve ischemia as a result of the steal phenomenon. This case represents an unusual complication of an AVM of the upper limb which has not been reported previously to our knowledge. Patients with complex AVMs presenting with atypical peripheral neuropathies should be assessed for the possibility of steal phenomenon. Level of Evidence: Level V, risk/prognostic study. [ABSTRACT FROM AUTHOR]

Purpose:To examine subjective health-related quality of life (HRQoL) in adults with congenital unilateral upper limb deficiency (UULD) in Norway and to explore the associations between demographic and clinical factors and HRQoL. Method:Cross-sectional study comparing HRQoL, measured by SF-36, among adults with UULD and an age- and gender-matched control group from the Norwegian general population (NGP). Results:Seventy-seven respondents, median age 42 years (range: 20–82); 71% were women. Most had left-sided (61%), below elbow (53%), transverse (73%) deficiency. Compared to the NGP, the UULD group reported reduced HRQoL on all SF-36 subscales except for the role emotional (RE) scale (p=0.321), mental health (MH) (p=0.055) and mental component summary (MCS) (p=0.064). The greatest difference was on the bodily pain (BP) scale (point difference of 20.0). Multiple linear regression models showed significant association between several physical- and mental SF-36 subscales and occupational status, occurrence of comorbidity and chronic pain. Conclusions:Persons with UULD reported reduced HRQoL on most SF-36 subscales, mostly in the physical health domain. Employment status, occurrence of comorbidity and chronic pain seem to have a negative impact on the HRQoL. Measures that can reduce pain and loss of function should be given particular attention in UULD rehabilitation.Implications for RehabilitationPersons with congenital unilateral upper limb deficiency (UULD) who experience pain and discomfort should seek professional help for evaluating their everyday coping strategies.Professionals who meet persons with UULD should examine anomalies, comorbidity, pain and employment status before choosing advices and actions.Individually adapted grip-improving devices, environments, physical exercise and pain management programs should be implemented early to reduce pain, loss of function and decreased HRQoL.A multidisciplinary approach is often necessary when counseling persons with UULD. [ABSTRACT FROM PUBLISHER]

Sound inverse dynamics modeling is lacking in aquatic locomotion research because of the difficulty in measuring hydrodynamic forces in dynamic conditions. Here we report the successful implementation and validation of an innovative methodology crossing new computational fluid dynamics and inverse dynamics techniques to quantify upper limb joint forces and moments while moving in water. Upper limb kinematics of seven male swimmers sculling while ballasted with 4 kg was recorded through underwater motion capture. Together with body scans, segment inertial properties, and hydrodynamic resistances computed from a unique dynamic mesh algorithm capable to handle large body deformations, these data were fed into an inverse dynamics model to solve for joint kinetics. Simulation validity was assessed by comparing the impulse produced by the arms, calculated by integrating vertical forces over a stroke period, to the net theoretical impulse of buoyancy and ballast forces. A resulting gap of 1.2±3.5% provided confidence in the results. Upper limb joint load was within 5% of swimmer׳s body weight, which tends to supports the use of low-load aquatic exercises to reduce joint stress. We expect this significant methodological improvement to pave the way towards deeper insights into the mechanics of aquatic movement and the establishment of practice guidelines in rehabilitation, fitness or swimming performance. [ABSTRACT FROM AUTHOR]

The power of the two-experimental arm trial depends on three choices: (1) when one arm is dropped (if at all); (2) the final testing procedure, assuming no dropping; and (3) the sampling ratio for the three arms. Multiple-arm designs require critical values which were calculated using Mathematica. Power calculations were exact based on probabilities from binomial distributions. The "drop the loser" strategy is optimal for the primary endpoint. The equal sized two treated arm trial gives reasonable power for the primary as well as good power to select the best treated arm. The best power was provided by the 3:3:4 sampling, but it was only marginally better. [ABSTRACT FROM AUTHOR]

Background The Holt-Oram syndrome ( HOS) is an autosomal dominant disorder affecting 1/100.000 live births. It is defined by upper limb anomalies and congenital heart defects with variable severity. We describe a dramatic phenotype of a male, 15-month-old patient being investigated for strict diagnostic criteria of HOS. Methods and results Genetic analysis revealed a so far unpublished TBX5 mutation, which occurs de novo in the patient with healthy parents. TBX5 belongs to the large family of T-box transcription factors playing major roles in morphogenesis and cell-type specification. The mutation located in the DNA-binding domain at position 920 (C→A) leads to an amino acid change at position 85 (proline → threonine). Three-dimensional analysis of the protein structure predicted a cis to trans change in the respective peptide bond, thereby probably provoking major conformational and functional alterations of the protein. The p.Pro85Thr mutation showed a dramatically reduced activation (97%) of the NPPA promoter in luciferase assays and failed to induce NPPA expression in HEK 293 cells compared to wild-type TBX5 protein. The mutation did not interfere with the nuclear localization of the protein. Conclusion These results suggest that the dramatic functional alteration of the p.Pro85Thr mutation leads to the distinctive phenotype of the patient. [ABSTRACT FROM AUTHOR]

Congenital and developmental malformations of the upper extremity are uncommon and their diagnosis can challenge radiologists. Many complex classification systems exist, the latest of which accounts for the complex embryology and pathogenetic mechanisms that govern the formation of these anomalies. Using appropriate descriptors allows for more specific diagnosis and improved consultation with referring pediatricians and surgeons, helping to guide medical and surgical interventions and, if indicated, further investigation for associated abnormalities and underlying syndromes. We review the imaging characteristics of upper limb malformations to help pediatric radiologists better understand the classification and workup necessary in these cases. [ABSTRACT FROM AUTHOR]

The main purpose of this study was to determine the clinical, electrophysiological and thermal effects of radial extracorporeal shock wave (rESW) stimulation on upper limb muscles affected by spasticity in patients with chronic stroke. Patients included in the study were randomly assigned into the following two groups: 30 patients stimulated with active rESW (A); and 30 patients stimulated with placebo rESW (B). All patients were analyzed using the Modified Ashworth Scale (MAS) to test the spasticity levels of the elbow (E), radio carpal (RC) and fingers (FF) joints; surface electromyography (sEMG) was performed for the resting bioelectrical activity registration of the flexor carpi radialis (FCR) and flexor carpi ulnaris (FCU) muscles; and infrared thermal imaging (IRT) was used to assess the temperature distributions of the carpal flexor muscles (CFM). All assessments were performed at baseline (t0), immediately after rESW (t1) as well as 1 and 24 h following its finalization (t2 and t3). Patients treated with active rESW showed a statistically significant reduction in the MAS score for the RC joint at t1 and for the FF joints at t1, t2 and t3 (p < 0.05). A significant decrease in sEMG activity was observed in the FCR and FCU muscles at t1, t2 and t3 (p < 0.05); significant increases in the mean and maximum values of the IRT detection was observed using inter-group comparisons in t2 and t3 (p < 0.05). No significant alterations were observed in patients after placebo rESW stimulation (p > 0.05). Applications of rESW demonstrating positive effects at reducing the level of spastic hypertonia of the upper limb muscles in patients with chronic stroke. ESW treatments should be considered as a potential anti-spastic effect to regulate vasculature. [ABSTRACT FROM AUTHOR]

Holt-Oram Syndrome is an autosomal dominant condition with complete penetrance and which involves upper limb skeletal and cardiac abnormalities. The latter can be structural defects or involve the conduction system. This report details the occurrence of left ventricular non-compaction in multiple family members with Holt-Oram Syndrome. It is recommended that patients with the Holt-Oram Syndrome be considered for comprehensive cardiac evaluation to exclude non-compaction cardiomyopathy as this may have significant prognostic implications. [ABSTRACT FROM AUTHOR]

Background: Arthroplasty is a proven treatment option for glenohumeral osteoarthritis. Common indications include primary or posttraumatic osteoarthritis, avascular necrosis of the humeral head, rotator cuff tear arthropathy and rheumatoid osteoarthritis. Arthroplasty is rarely performed among patients with glenohumeral dysmelia. An overuse of the upper limb in patients with thalidomide-induced phocomelia and people with similar congenital deformities like dysmelia results in premature wear of the shoulder joint. This study aims to evaluate our experience with cases of glenohumeral osteoarthritis caused by dysmelia and treated with arthroplasty. To date, few reports on the outcome of shoulder arthroplasty exist on this particular patient group.Case Presentation: We included four dysmelic patients (five shoulders) with substantial glenoid dysplasia in a prospective database after approval by the local ethics committee. Once conservative treatment options had been exhausted, the patients were treated with shoulder arthroplasty and assessed clinically and radiographically before and after surgery. The mean patient age at the time of surgery was 50.4 years. The minimum follow-up time was 24 months (24-91 months). All patients experienced a considerable improvement of range of motion (ROM) and a relief of pain. No intra- or postoperative complications appeared.Conclusion: Patients with dysmelia have acceptable short and mid-term results with resurfacing hemiarthroplasty. It is an effective although somewhat complicated method to relieve pain and improve movement. Long-term performance of arthroplasty in patients with dysmelia remains to be seen, particularly with regard to the remaining problem of the altered and often deficient glenoid. [ABSTRACT FROM AUTHOR]

Background: Phocomelia is an extremely rare congenital malformation that emerged as one extreme of a range of defects resulting from in utero exposure to thalidomide. Individuals with thalidomide embryopathy (TE) have reported developing symptoms suggestive of peripheral nervous system dysfunction in the mal-developed limbs in later life. Methods: Case control study comparing TE subjects with upper limb anomalies and neuropathic symptoms with healthy controls using standard neurophysiological testing. Other causes of a peripheral neuropathy were excluded prior to assessment. Results: Clinical examination of 17 subjects with TE (aged 50.4±1.3 [mean±standard deviation] years, 10 females) and 17 controls (37.9±9.0 years; 8 females) demonstrated features of upper limb compressive neuropathy in three-quarters of subjects. Additionally there were examination findings suggestive of mild sensory neuropathy in the lower limbs (n = 1), L5 radiculopathic sensory impairment (n = 1) and cervical myelopathy (n = 1). In TE there were electrophysiological changes consistent with a median large fibre neuropathic abnormality (mean compound muscle action potential difference -6.3 mV ([-9.3, -3.3], p = 0.0002) ([95% CI], p-value)) and reduced sympathetic skin response amplitudes (-0.8 mV ([-1.5, -0.2], p = 0.0089)) in the affected upper limbs. In the lower limbs there was evidence of sural nerve dysfunction (sensory nerve action potential -5.8 μV ([-10.7, -0.8], p = 0.0232)) and impaired warm perception thresholds (+3.0°C ([0.6, 5.4], p = 0.0169)). Conclusions: We found a range of clinical features relevant to individuals with TE beyond upper limb compressive neuropathies supporting the need for a detailed neurological examination to exclude other treatable pathologies. The electrophysiological evidence of large and small fibre axonal nerve dysfunction in symptomatic and asymptomatic limbs may be a result of the original insult and merits further investigation. [ABSTRACT FROM AUTHOR]

Thirty-six year-old female patient was admitted to the hospital with the complaints of increasing numbness in left arm and leg, headache and vomitting for one month. In her physical examination, 1/5 strength loss in left arm and leg and disestesy were detected. In the computerized tomography (CT) an intracranial tumor was showed in right parietal lob and in the magnetic resonance imaging (MRI) hypointense was found in T1 weighed section and a tumor lesion causing hyperintense, lobule contured, located extraaxially, putting pressure on neural tissue, contrasted homogenously and leading to oedema effect on neural tissue in right parietal lob was detected in T2 weighed section. The lesion was totally excised with dura. Histopathologic diagnosis was reported as inflammatory myofibroblastic tumor. In the postoperative first month control, left hemiparesis was disappeared, however disestesy was continuing. [ABSTRACT FROM AUTHOR]

Background: Aberrant reinnervation after brachial plexus injuries may produce cocontractions between diaphragm and upper limb muscles. This syndrome is known as 'Breathing Arm'. Methods: In the current study among 138 brachial plexopathy patients we retrospectively investigated the electrophysiological studies of 20 patients with severe brachial plexus injuries who had breathing arm or breathing hand. Results: One of 20 patients had breathing hand additionally. One (5 %) patient had only upper trunk injury, 9 (45 %) patients had upper and middle trunk where 10 (50 %) had injury to all portions of brachial plexus. Conclusion: Recognition and documentation of breathing arm may help to define the localization and severity of brachial plexus lesion, and consequently aids selection of the appropriate treatment. [ABSTRACT FROM AUTHOR]

Elastic intramedullary nailing (ESIN) has been proposed as an alternative minimal-invasive method for the operative management of mid-shaft fractures of the clavicle. However, a relevant complication rate has been reported in previous cohorts. The present retrospective single-centre study aimed to analyse the complications following ESIN in adult patients with clavicular mid-shaft fractures (Allman type I) and their impact on functional and patient-perceived outcome measures. Results were compared to a control group receiving locking plate osteosynthesis. The clinical course and outcome of operatively managed patients with clavicular mid-shaft fractures were retrospectively analysed. Patients were assigned to group A (ESIN) and group B (plate fixation). Radiological, functional (Constant Murley Shoulder Outcome Score (CS), the Disabilities of the Arm, Shoulder and Hand (DASH) Score, the Oxford Shoulder Score (OSS)), and patient perceived aesthetic and clinical outcome were measured. A total of 47 (33 male, 14 female) operatively managed patients with a mean age of 26.7 ± 14.9 years and a follow up time of 38.1 ± 19.4 months were analysed. 36 patients were treated by ESIN (Group A), whereas 11 patients received open reduction and internal plate fixation (Group B). Patients were operatively treated with a mean delay of 7.4 ± 9.3 days (group A: 6.6 ± 8.7 days, group B: 10.2 ± 11.1 days, p=0.326) between trauma and the surgical index procedure. There were no significant differences in the functional (CS: p=0.338, DASH: p=0.247, OSS: p=0.434) and patient-perceived (p=0.346) outcome measures between both groups. Surgical complications were noted in 14 patients (group A: 12, group B: 2) and non-union in 4 patients (group A: 3, group B: 1). There was no correlation between the recorded complications as assessed by the Clavien and Dindo classification and the functional as well as the patient-perceived outcome measures. Despite a relevant incidence rate of surgical complications, ESIN provides good to excellent functional and patient-perceived results in the treatment of clavicular mid-shaft fractures. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 16-year-old boy who was taken to the emergency room (ER) with redness, pain, and swelling of his upper right arm. The boy is a quarterback of his high school football team but was healthy and active with no medical history before the admission. He was then diagnosed with Paget-Schroetter syndrome (PSS) which is defined as natural thrombus in the axillary and subclavian veins which occurs due to a tough upper-extremity activity.

Background: There has been a recent interest in the development of body-machine interfaces which allow individuals with motor impairments to control assistive devices using body movements.Methods: In this case study, we report findings in the context of the development of such an interface for a 10-year old child with congenital absence of upper and lower limbs. The interface consisted of 4 wireless inertial measurement units (IMUs), which we used to map movements of the upper body to the position of a cursor on a screen. We examined the learning of a task in which the child had to move the cursor to specified targets on the screen as quickly as possible. In addition, we also determined the robustness of the interface by evaluating the child's performance in two different body postures.Results: We found that the child was not only able to learn the task rapidly, but also showed superior performance when compared to typically developing children in the same age range. Moreover, task performance was comparable for the two different body postures, suggesting that the child was able to control the device in different postures without the need for interface recalibration.Conclusions: These results clearly establish the viability and robustness of the proposed non-invasive body-machine interface for pediatric populations with severe motor limitations. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to assess the safety and tolerability of Kinesio Taping (KT) in patients with arm lymphedema.Method: Medical device clinical study in women with arm lymphedema. Kinesio Tex Gold bandage was applied by the KT technique. Assessments and interviews were carried out both at the beginning and 4 days after intervention. Skin disorders, reported tolerance and modification of limb volume and function after intervention were assessed. Changes in limb volume and functionality before and after intervention were compared by the Student's t test and the Wilcoxon Signed-Rank test, considering significant p value <0.05.Results: Twenty-four women were studied. After intervention, no patient had cutaneous lesions, vesicle or limb hyperthermia, and 4.2% presented skin peeling and redness. Most patients reported no change in social life and that they felt safer in the daily activity and were very pleased with the treatment. The patients presented improvement of upper limb functionality after intervention (p < 0.001). No difference of limb volume was found after intervention (p = 0.639).Conclusions: Kinesio Tex Gold bandage by the KT technique proved to be safe and tolerable in patients with lymphedema, with improved functionality and no change of the affected limb volume. [ABSTRACT FROM AUTHOR]

Cervical spinal cord injury (SCI) in humans typically damages both sides of the spinal cord, resulting in asymmetric functional impairments in the arms. Despite this well-accepted notion and the growing emphasis on the use of bimanual training strategies, how movement of one arm affects the motion of the contralateral arm after SCI remains unknown. Using kinematics and multichannel electromyographic (EMG) recordings we studied unilateral and bilateral reach-to-grasp movements to a small and a large cylinder in individuals with asymmetric arm impairments due to cervical SCI and age-matched control subjects. We found that the stronger arm of SCI subjects showed movement durations longer than control subjects during bilateral compared with unilateral trials. Specifically, movement duration was prolonged when opening and closing the hand when reaching for a large and a small object, respectively, accompanied by deficient activation of finger flexor and extensor muscles. In subjects with SCI interlimb coordination was reduced compared with control subjects, and individuals with lesser coordination between hands were those who showed prolonged times to open the hand. Although the weaker arm showed movement durations during bilateral compared with unilateral trials that were proportional to controls, the stronger arm was excessively delayed during bilateral reaching. Altogether, our findings demonstrate that during bilateral reach-to-grasp movements the more impaired arm has detrimental effects on hand opening and closing of the less impaired arm and that they are related, at least in part, to deficient control of EMG activity of hand muscles. We suggest that hand opening might provide a time to drive bimanual coordination adjustments after human SCI. [ABSTRACT FROM AUTHOR]

Arm movement control takes advantage of multiple inputs, including those originating from the contralateral arm. In the mirror paradigm, it has been suggested that control of the unseen arm, hidden by the mirror, is facilitated by the reflection of the other, moving arm. Although proprioceptive feedback originating from the moving arm, (the image of which is reflected in the mirror), is always coupled with visual feedback in the mirror paradigm, the former has received little attention. We recently showed that the involuntary arm movement following a sustained, isometric contraction, known as the “floating arm” or “Kohnstamm phenomenon”, was adjusted to the passive-motorized displacement of the other arm. However, provision of mirror feedback, that is, the reflection in the mirror of the passively moved arm, did not add to this coupling effect. Therefore, the interlimb coupling in the mirror paradigm may to a large extent have a proprioceptive origin rather than a visual origin. The objective of the present study was to decouple mirror feedback and proprioceptive feedback from the reflected, moving arm and evaluate their respective contributions to interlimb coupling in the mirror paradigm. First (in Experiment 1, under eyes-closed conditions), we found that masking the proprioceptive afferents of the passively moved arm (by co-vibrating the antagonistic biceps and triceps muscles) suppressed the interlimb coupling between involuntary displacement of one arm and passive displacement of the other. Next (in Experiment 2), we masked proprioceptive afferents of the passively moved arm and specifically evaluated mirror feedback. We found that interlimb coupling through mirror feedback (though significant) was weaker than interlimb coupling through proprioceptive feedback. Overall, the present results show that in the mirror paradigm, proprioceptive feedback is stronger and more consistent than visual-mirror feedback in terms of the impact on interlimb coupling. [ABSTRACT FROM AUTHOR]

Background: There has been limited research on upper limb dysfunction in people with multiple sclerosis (PwMS). Objective: The objective of this paper is to study unilateral and bilateral upper limb dysfunction at different International Classification of Functioning (ICF) levels according to overall disability in PwMS. Methods: A total of 105 PwMS (16 with EDSS<4 (mild); 17 with EDSS 4–5.5 (moderate); 37 with EDSS 6–6.5 (severe); 35 with EDSS>6.5 (severe non-ambulant)) were recruited from two rehabilitation centers and assessed in a cross-sectional study. Results: The whole sample showed a diminished sensory function (median (first/third interquartile)) score of 3 (2/3) on the Monofilament Test and a reduced strength 91 (76/100) points on the Motricity Index (Body-Function level). Sensory dysfunction did not increase with higher EDSS while strength decreased from 100 (86/100) in the mild subgroups to 91 (80/100) points in the severe subgroup. All showed diminished dexterity, scoring 0.28 peg/s (0.17/0.35) on the Nine-Hole Peg Test (NHPT) (activity level). Score was better for the mild (0.38 (0.35/0.46)) peg/s compared to the severe subgroup (0.28 (0.17/0.35)). Sixty-eight percent, 44% and 75% of PwMS showed bilateral disorders in sensation, strength and dexterity, respectively. The Community Integration Questionnaire (participation level) showed a 35% reduction in home activities, even among PwMS with EDSS<4. Conclusion: This study showed uni-/bilateral upper limb abnormalities at all ICF levels increasing with the overall disability. [ABSTRACT FROM AUTHOR]

Objective: The nature of changes in brain activation related to good recovery of arm function after stroke is still unclear. While the notion that this is a reflection of neuronal plasticity has gained much support, confounding by compensatory strategies cannot be ruled out. We address this issue by comparing brain activity in recovered patients 6 months after stroke with healthy controls. Methods: We included 20 patients with upper limb paresis due to ischemic stroke and 15 controls. We measured brain activation during a finger flexion-extension task with functional MRI, and the relationship between brain activation and hand function. Patients exhibited various levels of recovery, but all were able to perform the task. Results: Comparison between patients and controls with voxel-wise whole-brain analysis failed to reveal significant differences in brain activation. Equally, a region of interest analysis constrained to the motor network to optimize statistical power, failed to yield any differences. Finally, no significant relationship between brain activation and hand function was found in patients. Patients and controls performed scanner task equally well. Conclusion: Brain activation and behavioral performance during finger flexion-extensions in (moderately) well recovered patients seems normal. The absence of significant differences in brain activity even in patients with a residual impairment may suggest that infarcts do not necessarily induce reorganization of motor function. While brain activity could be abnormal with higher task demands, this may also introduce performance confounds. It is thus still uncertain to what extent capacity for true neuronal repair after stroke exists. [ABSTRACT FROM AUTHOR]

The Oberg, Manske and Tonkin (OMT) Classification of congenital anomalies of the hand and upper limb uses dysmorphological terminology, placing conditions in one of three groups: Malformations, Deformations and Dysplasias. The main group, Malformations, is further subdivided according to whether the whole of the limb is affected or the hand plate alone, and whether the primary insult involves one of the three axes of limb development and patterning or is non-axial. The common surgical diagnoses, such as thumb duplication and thumb hypoplasia, are then placed within this framework. Recently the International Federation of Societies for Surgery of the Hand Scientific Committee for Congenital Conditions approved the OMT Classification as a timely and appropriate replacement of the previously accepted Swanson Classification. This review charts the development of and modifications to the OMT Classification and its current status. [ABSTRACT FROM AUTHOR]

The link between schizophrenia and anomalies in the distal upper limb is well documented. Preliminary studies have identified a number of biometric parameters of the hand by which schizophrenics can be distinguished from matched controls. The current study seeks to determine whether patients with schizophrenia can be singled out from a disparate group of other mental disorders by using the same parameters. We studied three groups, totaling 134 men: 51 diagnosed with schizophrenia, 29 with anxiety and mood disorders, and 54 comprising a control group. Seven parameters were studied: the proximal interphalangeal joint, the eponychia of the middle and ring digits, two dermatoglyphic features, and two constitutional factors. Examiners evaluated the parameters based on photographs and prints. An initial Mann Whitney comparison showed no significant difference between the control group and those identified with anxiety and mood disorders. We therefore accounted for them as a single group. In a discriminant analysis, an overall accuracy of 78.4% was established with a sensitivity of 80.4% (schizophrenics identified correctly) and a specificity of 77.1% (controls identified correctly). These results suggest that the biometric parameters employed may be useful in identifying patients with schizophrenia from a disparate group of other mental disorders. [ABSTRACT FROM AUTHOR]

Plexiform neurofibroma is generally accepted as a component of neurofibromatosis type 1. It is frequently seen on the head and neck regions, and extremity involvement is rare. In this report, a case of giant plexiform neurofibroma located on the upper extremity and anterior chest wall is presented. Level of Evidence: Level V, therapeutic study. [ABSTRACT FROM AUTHOR]

Standard upper-limb motor function impairment assessments, such as the Fugl-Meyer Assessment (FMA), are a critical aspect of rehabilitation after neurological disorders. These assessments typically take a long time (about 30 min for the FMA) for a clinician to perform on a patient, which is a severe burden in a clinical environment. In this paper, we propose a framework for automating upper-limb motor assessments that uses low-cost sensors to collect movement data. The sensor data is then processed through a machine learning algorithm to determine a score for a patient's upper-limb functionality. To demonstrate the feasibility of the proposed approach, we implemented a system based on the proposed framework that can automate most of the FMA. Our experiment shows that the system provides similar FMA scores to clinician scores, and reduces the time spent evaluating each patient by 82%. Moreover, the proposed framework can be used to implement customized tests or tests specified in other existing standard assessment methods. [ABSTRACT FROM AUTHOR]

Background: The aim was to assess the validity and reliability of the Persian version of shortened disabilities of the arm, shoulder, and hand (Quick-DASH) questionnaire in patients with upper extremity conditions. Methods: We administered the Persian version of Quick-DASH to 202 patients with upper extremity conditions, of which 71 patients randomly returned after 3 days to respond to the questionnaire for the 2nd time. In order to test the construct validity of the questionnaire, patients responded to the Michigan Hand Outcome Questionnaire (MHOQ) and Short Form 36 Health Survey (SF-36) as well. Internal consistency was tested using the Cronbach's alpha, and test-retest reliability was measured using intra-class correlation coefficient (ICC). Results: Cronbach's alpha was 0.90. ICC was 0.89. Convergent validity was confirmed, as the Spearman correlation between the Quick-DASH and MHOQ was 0.67 and ranged from 0.24 to 0.56 between the subscales of the SF-36 and Quick-DASH. Conclusions: Observation of excellent internal consistency, good to excellent test-retest reliability, and moderate to strong construct validity confirms the validity and reliability of the Persian version of Quick-DASH for evaluating the magnitude and level of disability in upper extremity conditions. [ABSTRACT FROM AUTHOR]

Obesity reduces the efficiency of postural and movement control mechanisms. However, the effects of obesity on a functional motor task and postural control in standing and seated position have not been closely quantified among children. The aim of this study is to examine the effects of obesity on the execution of aiming tasks performed in standing and seated conditions in children. Twelve healthy weight children and eleven obese children aged between 8 and 11 years pointed to a target in standing and seated position. The difficulty of the aiming task was varied by using 2 target sizes (1.0 cm and 5.0 cm width; pointing to the smaller target size needs a more precise movement and constitutes a more difficult task). Hand movement time (MT) and its phases were measured to quantify the aiming task. Mean speed of the center of pressure displacement (COP speed) was calculated to assess postural stability during the movement. Obese children had significantly higher MTs compared to healthy-weight children in seated and standing conditions explained by greater durations of deceleration phase when aiming. Concerning the COP speed during the movement, obese children showed significantly higher values when standing compared to healthy-weight children. This was also observed in the seated position. In conclusion, obesity adds a postural constraint during an aiming task in both seated and standing conditions and requires obese children to take more time to correct their movements due to a greater postural instability of the body when pointing to a target with the upper-limb. [ABSTRACT FROM AUTHOR]

In clinical settings, traditional stroke rehabilitation evaluation methods are subjectively scored by occupational therapists, and the assessment results vary individually. To address this issue, this study aims to develop a stroke rehabilitation assessment system by using inertial measurement units. The inertial signals from the upper extremities were acquired, from which three quantitative indicators were extracted to reflect rehabilitation performance during stroke patients' movement examination, i.e., shoulder flexion. Both healthy adults and stroke patients were recruited to correlate the proposed quantitative evaluation indices and traditional rehab assessment scales. Especially, as a unique feature of the study the weight for each of three evaluation indicators was estimated by the least squares method. The quantitative results demonstrate the proposed method accurately reflects patients' recovery from pre-rehabilitation, and confirm the feasibility of applying inertial signals to evaluate rehab performance through feature extraction. The implemented assessment scheme appears to have the potential to overcome some shortcomings of traditional assessment methods and indicates rehab performance correctly. [ABSTRACT FROM AUTHOR]

Upper arm deformities secondary to weight loss or senile elastosis have led to an increased demand for aesthetic contouring procedures. We conducted this study to objectively assess if, in Teimourian low-grade upper arm remodelling, one session of laser-assisted lypolisis (LAL) could result in full patient satisfaction. Between 2011 and 2013, 45 patients were treated for unsightly fat arm Teimourian grade I (15 patients), grade IIa (15 patients) and grade IIb (15 patients) with one session of LAL. The laser used in this study was a 1470-nm diode laser (Alma Lasers, Cesarea, Israel) with the following parameters: continuous mode, 15 W power and transmission through a 600-μm optical fibre. Previous mathematical modelling suggested that 0.1 kJ was required in order to destroy 1 ml of fat. Treatment parameters and adverse effects were recorded.The arm circumference and skin pinch measurements were assessed pre and postoperatively. Patients were asked to file a satisfaction questionnaire. Pain during the anaesthesia and discomfort after the procedure were minimal. Complications included prolonged oedema in 11 patients. The average arm circumference decreased by 4.9 ± 0.4 cm in the right arm ( p < 0.01) and 4.7 ± 0.5 cm in the left arm ( p < 0.01) in grade I patients, 5.5 ± 0.6 cm in the right arm ( p < 0.01) and 5.2 ± 0.5 cm in the left arm ( p < 0.01) in grade IIa patients and 5.4 ± 0.5 cm in the right arm ( p < 0.01) and 5.3 ± 0.5 cm in the left arm ( p < 0.01) in grade IIB patients. The skin tightening effect was confirmed by the reduction of the skin calliper measurements in all three groups. Overall mean opinion of treatment was high for both patients and investigators. Of the 45 patients, all but one would recommend this treatment. A single session of LAL in upper arm remodelling for Teimourian grades I to IIb is a safe and reproducible technique. The procedure allows reduction in the amount of adipose deposits while providing full skin tightening. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to analyse sports participation of individuals with upper limb deficiency (ULD) and associated factors. Methods Individuals with ULD originating from the Netherlands were invited, via their attending physiatrist or prosthetist, to answer a digital or paper questionnaire. The questionnaire consisted of 34 items related to personal characteristics, type of deficiency and participation in sports. Results Of the 175 respondents, 57% participated in sports for at least 60 min/week (athletes). Results of logistic regression analyses indicated that the presence of an additional health problem hindering sports participation (β=-1.31, p<0.001) and a more proximal onset of the limb deficiency (β=0.76, p=0.022) had a negative influence on sports participation. For individuals with an acquired ULD, a medium education level (β=0 0.77, p=0.108) and participation in sports before their amputation (β=1.11, p=0.007) had a positive influence on sports participation. The desire to stay healthy and the pleasure derived from sports participation represented the main reasons for participation in sports according to athletes. The presence of an additional medical problem and a lack of motivation were reasons for non-athletes to not participate in sports. Conclusions The majority of individuals with ULD participate in sports regularly. The presence of an additional medical problem, as well as the level of ULD, educational level and participation in sports before amputation, was related to participation in sports. [ABSTRACT FROM AUTHOR]

MRI of the peripheral nerves continues to grow technologically and in clinical use. This article reviews the technological aspects and basic interpretation of high-resolution MR imaging of the upper extremity nerves. These techniques work with 1.5-, or preferably 3-T, scanners regardless of vendors. The article also includes selected pitfalls in the interpretation of upper extremity nerve MRI. [ABSTRACT FROM AUTHOR]

Radial longitudinal deficiencies are characterized by radial deviation of the wrist, a short and bowed forearm and a non-functional or absent thumb. The deformity is caused by varying degrees of underdevelopment and malformation including hypoplasia of the bones, joints, muscles, tendons, ligaments, nerves and vessels. This study describes our results from centralization in 8 limbs with Bayne type III-IV radial longitudinal deficiencies. We reviewed 8 limbs from 6 patients with a centralization performed between 2002 and 2010. The median patient age at the time of the operation was 2.75 years (range 2-14 years). The sex ratio was 4 male and 2 female. All patients underwent centralization. One patient had an additional 6.5 cm elongation of the ulna bone by means of a circular external fixator (CEF). The median follow-up time from centralization was 4,5 years (range 2-10 years). The result was considered to be excellent in 4 cases, good in 3 cases and fair in 1 case. Radial deviations regenerated in all cases. During follow-up, a radial deviation of 15 degrees developed in one patient; this deviation did not require surgical correction. Hand and wrist movements were within acceptable levels. Movement and function of the wrist and forearm can be obtained through centralization of the wrist and ulnar elongation when necessary. A cosmetically pleasant appearance can be ensured. [ABSTRACT FROM AUTHOR]

Background : To assess disability more efficiently with less burden on the patient, the National Institutes of Health has developed the Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function-an instrument based on item response theory and using computer adaptive testing (CAT). Initially, upper and lower extremity disabilities were not separated and we were curious if the PROMIS Physical Function CAT could measure upper extremity disability and the Quick Disability of Arm, Shoulder and Hand (QuickDASH). Questions/purposes: We aimed to find correlation between the PROMIS Physical Function and the QuickDASH questionnaires in patients with upper extremity illness. Secondarily, we addressed whether the PROMIS Physical Function and QuickDASH correlate with the PROMIS Depression CAT and PROMIS Pain Interference CAT instruments. Finally, we assessed factors associated with QuickDASH and PROMIS Physical Function in multivariable analysis. Methods: A cohort of 93 outpatients with upper extremity illnesses completed the QuickDASH and three PROMIS CAT questionnaires: Physical Function, Pain Interference, and Depression. Pain intensity was measured with an 11-point ordinal measure (0-10 numeric rating scale). Correlation between PROMIS Physical Function and the QuickDASH was assessed. Factors that correlated with the PROMIS Physical Function and QuickDASH were assessed in multivariable regression analysis after initial bivariate analysis. Results: There was a moderate correlation between the PROMIS Physical Function and the QuickDASH questionnaire (r = −0.55, p < 0.001). Greater disability as measured with the PROMIS and QuickDASH correlated most strongly with PROMIS Depression (r = −0.35, p < 0.001 and r = 0.34, p < 0.001 respectively) and Pain Interference (r = −0.51, p < 0.001 and r = 0.74, p < 0.001 respectively). The factors accounting for the variability in PROMIS scores are comparable to those for the QuickDASH except that the PROMIS Physical Function is influenced by other pain conditions while the QuickDASH is not. Conclusions: The PROMIS Physical Function instrument may be used as an upper extremity disability measure, as it correlates with the QuickDASH questionnaire, and both instruments are influenced most strongly by the degree to which pain interferes with achieving goals. Level of Evidence: Level III, diagnostic study. See the Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

The experiment was designed to determine participants' ability to coordinate a bimanual multifrequency pattern of isometric forces using homologous or non-homologous muscles. Lissajous feedback was provided to reduce perceptual and attentional constraints. The primary purpose was to determine whether the activation of homologous and non-homologous muscles resulted in different patterns of distortions in the left limb forces that are related to the forces produced by the right limb. The task was to rhythmically produce a 1:2 pattern of isometric forces by exerting isometric forces on the left side force transducer with the left arm that was coordinated with the pattern of isometric forces produced on the right side force transducer with the right arm. The results indicated that participants were able to 'tune-in' a 1:2 coordination patterns using homologous (triceps muscles of the left and right limbs) and using non-homologous muscles (biceps left limb and triceps right limb) when provided Lissajous feedback. However, distinct but consistent and identifiable distortions in the left limb force traces were observed for both the homologous and non-homologous tasks. For the homologous task, the interference occurred in the left limb when the right limb was initiating and releasing force. For the non-homologous task, the interference in the left limb force occurred only when the right limb was releasing force. In both conditions, the interference appeared to continue from the point of force initiation and/or release to peak force velocity. The overall results are consistent with the notion that neural crosstalk manifests differently during the coordination of the limbs depending upon whether homologous or non-homologous muscles are activated. [ABSTRACT FROM AUTHOR]

This study examined how force tremor and muscle activity are altered between limbs when a visual target is removed for one limb during bilateral index finger abduction. Isometric index finger abduction force was examined in healthy adults (23 ± 4 years) when both index fingers abducted simultaneously. Abduction forces ranged from 5 to 20 % maximum voluntary contraction, and these target forces were displayed on a PC monitor in front of the subject. Force tremor and first dorsal interosseous (FDI) activity were first collected while subjects viewed visual targets for both index fingers and then when the visual target was removed for the non-dominant index finger. Subjects successfully matched the force amplitudes generated for both limbs regardless of visual condition. When the visual target was removed for one limb, force tremor increased in this limb ( p < 0.01). Different power spectral profiles were evident for each FDI EMG when targets were available for both limbs ( p < 0.05); however, when one target was removed, the pattern of FDI EMG for the limb without a visual target closely reflected FDI EMG for the limb which had the visual target. The CNS actively modulates muscle activity in each limb to perform visually guided isometric contractions. Given that the goal was to match force output with both limbs, the requirements of the task must be established from the limb that had a visual target, and a copy of those motor commands appears to have been sent to the FDI of the limb without a visual target. [ABSTRACT FROM AUTHOR]

Voluntary movements induce postural perturbations, which are counteracted by anticipatory postural adjustments (APAs) that preserve body equilibrium. Little is known about the neural structures generating APAs, but several studies suggested a role of sensory-motor areas, basal ganglia, supplementary motor area and thalamus. However, the role of the cerebellum still remains an open question. The aim of this present paper is to shed further light on the role of cerebellum in APAs organization. Thus, APAs that stabilize the arm when the index finger is briskly flexed were recorded in 13 ataxic subjects (seven sporadic cases, four dominant ataxia type III and two autosomal recessive), presenting a slowly progressive cerebellar syndrome with four-limb dysmetria, and compared with those obtained in 13 healthy subjects. The pattern of postural activity was similar in the two groups [excitation in triceps and inhibition in biceps and anterior deltoid (AD)], but apparent modifications in timing were observed in all ataxic subjects in which, on average, triceps brachii excitation lagged the onset of the prime mover flexor digitorum superficialis by about 27 ms and biceps and AD inhibition were almost synchronous to it. Instead, in normal subjects, triceps onset was synchronous to the prime mover and biceps and AD anticipated it by about 40 ms. The observed disruption of the intra-limb APA organization confirms that the cerebellum is involved in APA control and, considering cerebellar subjects as a model of dysmetria, also supports the view that a proper APA chain may play a crucial role in refining movement metria. [ABSTRACT FROM AUTHOR]

Background Intention tremor and dysmetria are leading causes of upper extremity disability in Multiple Sclerosis (MS). The development of effective therapies to reduce tremor and dysmetria is hampered by insufficient understanding of how the distributed, multi-focal lesions associated with MS impact sensorimotor control in the brain. Here we describe a systems-level approach to characterizing sensorimotor control and use this approach to examine how sensory and motor processes are differentially impacted by MS. Methods Eight subjects with MS and eight age- and gender-matched healthy control subjects performed visually-guided flexion/extension tasks about the elbow to characterize a sensory feedback control model that includes three sensory feedback pathways (one for vision, another for proprioception and a third providing an internal prediction of the sensory consequences of action). The model allows us to characterize impairments in sensory feedback control that contributed to each MS subject's tremor. Results Models derived from MS subject performance differed from those obtained for control subjects in two ways. First, subjects with MS exhibited markedly increased visual feedback delays, which were uncompensated by internal adaptive mechanisms; stabilization performance in individuals with the longest delays differed most from control subject performance. Second, subjects with MS exhibited misestimates of arm dynamics in a way that was correlated with tremor power. Subject-specific models accurately predicted kinematic performance in a reach and hold task for neurologically-intact control subjects while simulated performance of MS patients had shorter movement intervals and larger endpoint errors than actual subject responses. This difference between simulated and actual performance is consistent with a strategic compensatory trade-off of movement speed for endpoint accuracy. Conclusions Our results suggest that tremor and dysmetria may be caused by limitations in the brain's ability to adapt sensory feedback mechanisms to compensate for increases in visual information processing time, as well as by errors in compensatory adaptations of internal estimates of arm dynamics. [ABSTRACT FROM AUTHOR]

In patients with unilateral upper limb paralysis from strokes and other brain lesions, strategies for functional recovery may eventually include brain-machine interfaces (BMIs) using control signals from residual sensorimotor systems in the damaged hemisphere. When voluntary movements of the contralateral limb are not possible due to brain pathology, initial training of such a BMI may require use of the unaffected ipsilateral limb. We conducted an offline investigation of the feasibility of decoding ipsilateral upper limb movements from electrocorticographic (ECoG) recordings in three patients with different lesions of sensorimotor systems associated with upper limb control. We found that the first principal component (PC) of unconstrained, naturalistic reaching movements of the upper limb could be decoded from ipsilateral ECoG using a linear model. ECoG signal features yielding the best decoding accuracy were different across subjects. Performance saturated with very few input features. Decoding performances of 0.77, 0.73, and 0.66 (median Pearson's r between the predicted and actual first PC of movement using nine signal features) were achieved in the three subjects. The performance achieved here with small numbers of electrodes and computationally simple decoding algorithms suggests that it may be possible to control a BMI using ECoG recorded from damaged sensorimotor brain systems. [ABSTRACT FROM AUTHOR]

Background Holt-Oram syndrome (HOS) is an autosomal dominant disorder characterised by upper limb anomalies and congenital heart defects. We present epidemiological and clinical aspects of HOS patients using data from EUROCAT (European Surveillance of Congenital Anomalies) registries. Methods The study was based on data collected during 1990-2011 by 34 registries. The registries are population-based and use multiple sources of information to collect data on all types of birth using standardized definitions, methodology and coding. Diagnostic criteria for inclusion in the study were the presence of radial ray abnormalities and congenital heart disease (CHD), or the presence of either radial ray anomaly or CHD, with family history of HOS. Results A total of 73 cases of HOS were identified, including 11 (15.1%) TOPFA and 62 (84.9%) LB. Out of 73 HOS cases, 30.8% (20/65) were suspected prenatally, 55.4% (36/65) at birth, 10.7% (7/65) in the first week of life, and 3.1% (2/65) in the first year of life. The prenatal detection rate was 39.2% (20/51), with no significant change over the study period. In 55% (11/20) of prenatally detected cases, parents decided to terminate pregnancy. Thumb anomalies were reported in all cases. Agenesis/hypoplasia of radius was present in 49.2% (30/61), ulnar aplasia/hypoplasia in 24.6% (15/61) and humerus hypoplasia/phocomelia in 42.6% (26/61) of patients. Congenital heart defects (CHD) were recorded in 78.7% (48/61) of patients. Isolated septal defects were present in 54.2 (26/48), while 25% (12/48) of patients had complex/severe CHD. The mean prevalence of HOS diagnosed prenatally or in the early years of life in European registries was 0.7 per 100,000 births or 1:135,615 births. Conclusions HOS is a rare genetic condition showing regional variation in its prevalence. It is often missed prenatally, in spite of the existence of major structural anomalies. When discovered, parents in 45% (9/20) of cases opt for the continuation of pregnancy. Although a quarter of patients have severe CHD, the overall first week survival is very good, which is important information for counselling purposes. [ABSTRACT FROM AUTHOR]