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Wrist Examination: A Focused Approach
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
The elbow is flexed and the forearm supinated. The examiner palpates the radial and ulnar pulses and places their thumbs on them with the rest of the hand supporting the wrist. The patient then opens and closes their hand multiple times making a fist. The radial and ulnar arteries are then compressed under the examiner's thumbs simultaneously. The examiner then releases one artery. The normal colour of the hand and figures should return in a few seconds. This is repeated with the release of the other artery. Any delay or difference may indicate an artery obstruction, and a difference also indicates which artery dominates blood supply to the hand. In 80% of individuals this is the ulnar artery (Photos 9.19 and 9.20).
Shoulder dystocia
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Randall C. Floyd, James S. Smeltzer
The most effective maneuver is delivery of the posterior arm (3,5,9,11,12). The main risks are vaginal lacerations and fetal humeral fracture. The latter risk can be minimized in the following way (Fig. 3): The operator’s hand is extended further into the uterus to find the humerus attached to the posterior shoulder. The humerus is brought to the front along the side of the fetus. The elbow is flexed so that the forearm is brought across the body. The forearm is firmly grasped by the operator’s entire hand and pulled out in a reverse Pinard sequence. The delivery of the arm causes the posterior shoulder to enter the pelvis. The anterior shoulder should now be easily deliverable under the pubis. Otherwise, an identical maneuver is performed on the anterior arm, except that the traction on the forearm is more toward the mother’s posterior (42) (Fig. 3C,D). This sequence of advance of the shoulders—the posterior one into the pelvis, the anterior one under the pubis, and the posterior one out of the pelvis—is exactly that of a normal delivery. The only difference is that this advance is accomplished by sequential delivery of the arms.
Musculoskeletal and Soft-Tissue Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Tennis elbow causes pain over the lateral epicondyle of the humerus from a partial tear of the extensor origin of the forearm muscles used in repetitive movements (e.g. using a screwdriver or playing tennis).
Successful treatment of acute worsening complex regional pain syndrome in affected dominant right-hand from secondary pathology of new onset third and fourth digit trigger finger
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
A 65 year old right-hand dominant male with a past medical history significant for diabetes, lupus, arrhythmia on life-long anticoagulation, and extensive cervical to lumbar spinal fusion surgeries presented with acute onset right distal arm CRPS type 1 diagnosed by Budapest Criteria [3]. Patient-reported severe pain in the right forearm and hand not following a dermatomal pattern that occurred about 1 month after undergoing right carpal tunnel release surgery. Physical exam findings revealed sensory changes of allodynia over the right palm, palmar wrist, and portions of the dorsal hand and hyperalgesia over the distal right forearm; vasomotor changes of cooler right distal fingers, erythema of the hand, bluish discoloration of the wrist; sudomotor changes of right-hand swelling and excessive palmar sweating; and motor/trophic changes of right-hand grip strength weakness, loss of finger flexion range of motion to 90 degrees, limited right wrist flexion to a few degrees, and shiny skin changes without nail changes.
High elasticity of the flexor carpi ulnaris and pronator teres muscles is associated with medial elbow injuries in youth baseball players
Published in The Physician and Sportsmedicine, 2022
Akira Saito, Kyoji Okada, Kazuyuki Shibata, Hiromichi Sato, Tetsuaki Kamada
Although various theories regarding the contributing factors to medial elbow injuries in youth baseball players have been proposed, repetitive elbow valgus stresses during throwing has been previously demonstrated as contributing to these types of elbow injuries [3,5,6]. The forearm flexor-pronator muscles as well as the ulnar collateral ligament (UCL) contributes to elbow joint stability against valgus force during throwing [7–9]. Muscle elasticity is known to increase according to repeated muscle contraction and high external load [10–12]. A previous study reported that youth baseball players with medial elbow injuries had high elasticity in the pronator teres (PT) [13]. However, the relationships between the elasticities of the other forearm muscles and medial elbow injuries in youth baseball players are unknown. In cadaveric biomechanical studies, several authors have reported that the flexor digitorum superficialis (FDS) or flexor carpi ulnaris (FCU) were the major contributors to elbow valgus stability [7,8,14]. Accordingly, youth baseball players with medial elbow injuries may have high elasticities in these forearm muscles on account of repetitive elbow valgus stress. Moreover, a previous study indicated that the muscle elasticity increased with pain [15]. It is likely that youth baseball players with elbow pain have higher elasticity of the forearm muscles than those without elbow pain.
Preoperative Simulation and Three-Dimensional Model for the Operative Treatment of Forearm Double Fracture: A Randomized Controlled Clinical Trial
Published in Journal of Investigative Surgery, 2022
Yin Zhang, Junchao Luo, Li Cao, Shuijun Zhang, Yu Tong, Qing Bi, Qiong Zhang
Forearm double fracture is a commonly encountered condition in orthopedics, and inappropriate treatment can lead to significant loss of forearm function. Notably, the elbow rotation function plays a pivotal role in the dexterity of the hand [1]. In addition, displacement, malunion, and nonunion are frequent complications associated with double fractures of the forearm. Most double fractures are fixed with plates and screws to achieve good functional recovery of the forearm [2]. However, surgical planning for complex double fractures of the forearm is dependent on the imaging technique used and experience of the surgeon. Although, three-dimensional (3D) computed tomography (CT) shows the positional relationship of fracture fragments, preoperative planning is still limited due to the 2D-display on imaging. Therefore, this not only makes it difficult for inexperienced doctor to achieve perfect anatomical reduction of fracture fragments, but also leads to longer operation time, more bleeding (For tourniquet, we release it 15 minutes after the operative time reaches 90 minutes, so longer operative time may increase the intraoperative bleeding), and intraoperative fluoroscopy [3].