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Examination of Pediatric Elbow
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
Karthick Rangasamy, Nirmal Raj Gopinathan, Pebam Sudesh
Muscles around the elbow joint mostly cross the wrist joint and small joints of the hand as well. So, look for any muscle wasting and contracture in the forearm and hand. Brachial artery injury in SC humerus fracture or missed compartment syndrome may lead to Volkmann’s contracture.
Hands with Joint Swellings
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
In SLE similar changes may occur and this is called Jaccoud's arthropathy. Wrist joints are always affected. Swelling and limitation of the affected joints occurs and muscle wasting results as a consequence. Some patients with rheumatoid arthritis develop the carpal tunnel syndrome due to compression of the median nerve by the thickened and inflamed synovium. In hands severely affected by rheumatoid changes, the examiner will want you to have assessed the functional aspects of the hand, i.e. what can the patient usefully do with it? Hold a cup or spoon, etc. Physiotherapy, occupational therapy and joint replacements may be part of the discussion.
Musculoskeletal system
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Wrist arthrography is predominantly conducted following trauma involving the wrist joint. A large percentage of patients having a fracture through the distal radius will also have damage to the intercarpal and/or capsular ligaments [15]. In this instance, RCJ and/or MCJ injection sites will be used [13]. The same sites will be used to investigate a suspected non-union of an intra-articular carpal bone. Arthrography can also be used to evaluate cartilage damage, in which case a DRUJ site is used, and loose bodies in the degenerative wrist joint. There is also a therapeutic element to wrist arthrography in cases of adhesive capsulitis. The injection can be used to distend the joint capsule and to guide placement and introduction of corticosteroids.
Potential contributing factors to upper limb associated reactions in people with acquired brain injury: an exploratory study
Published in Disability and Rehabilitation, 2022
Michelle B. Kahn, Ross A. Clark, Benjamin F. Mentiplay, Kelly J. Bower, John Olver, Gavin Williams
Importantly, however, hypertonicity or spasticity presence is not indicative of AR causation as commonly, ARs occurred at specific joint axes, in the absence of these impairments. For example, 24% and 37% of people with elbow joint ARs did not have elbow flexor hypertonicity or spasticity, respectively. Conversely, hypertonicity and spasticity also occurred without joint axis-specific ARs, with 43% and 45% of participants with shoulder internal rotator hypertonicity and spasticity respectively, without an AR at this axis. Similar findings were identified for the wrist joint. Contracture rarely featured in this cohort, making it an unlikely contributor to gait-related ARs. These findings have implications for neurorehabilitation clinical practice, emphasising that whilst not a pre-requisite for ARs during walking, positive UMNS features should be prioritised for impairment-based assessment of people with ABI. Careful assessment is therefore required as not all individuals with ARs possess these factors and nor should it be assumed that all individuals with these impairments have ARs. Targeted pharmacological management (e.g., Botulinum Neurotoxin) should be reserved for those with confirmed positive UMNS features in the relevant muscles and a corresponding joint axis AR.
Twenty years’ follow-up of radiocarpal arthrodesis for rheumatoid wrists
Published in Modern Rheumatology, 2021
Ryo Okabayashi, Hajime Ishikawa, Asami Abe, Hiroshi Otani, Kei Funamura, Rika Kakutani, Satoshi Ito, Youichi Kurosawa, Shunsuke Sakai, Kiyoshi Nakazono, Motohiro Suzuki, Yukihiro Matsuyama, Akira Murasawa
The wrist is frequently involved in the course of RA, affecting up to 60% of patients within the first 2 years after the onset of the disease and more than 90% of patients after 10 years [25]. Wrist joint deterioration sometimes progresses despite aggressive medical treatment. Simmen and Huber stated that functional loss is much greater for the unstable form than the stable form because tendon imbalance across the unstable wrist joint causes the loss of power and hand deformity [26]. Total wrist arthrodesis using a Rush pin was first described in 1965 by Clayton [27] and was modified in 1971 by Mannerfelt [28] for a surgical method. Subsequently, Della Santa and Chamay reported cases in which RL arthrodesis prevented carpal dislocation of the unstable wrist with a mean follow-up period of 5 years [5]. RL arthrodesis is superior to total wrist arthrodesis in terms of the preserved wrist extension/flexion. Our report is a long-term series of wrists treated with RC arthrodesis with a minimum follow-up period of 20 years.
Loss of selective wrist muscle activation in post-stroke patients
Published in Disability and Rehabilitation, 2020
Hanneke van der Krogt, Ingrid Kouwijzer, Asbjørn Klomp, Carel G.M. Meskers, J. Hans Arendzen, Jurriaan H. de Groot
In this study, we describe selective muscle activation by comparing EMG-signals of wrist muscles during two isometric but antagonistic task conditions, using the normalized ratio of the EMG-signals per muscle group, also called Activation Ratio (AR) [28]. This method is methodologically advantageous because it describes the activation of both flexor and extensor muscles in relation to their expected agonistic and antagonistic function. AR may be applied to antagonist muscle pairs provided the axis of movement is controlled (limitation in degrees of freedom). Selective muscle activation around the wrist joint had our special interest because of its role in lasting impairment in arm-hand function after stroke, e.g., in the case of flexion deformity. Muscle-specific AR is assumed to assist in a better definition of clinical phenotypes in post-stroke patients. However, this method has not been evaluated in post-stroke patients yet. Our aim was to describe and validate this technique for quantification of selective muscle activation of wrist flexor and extensor muscles in a cohort of post-stroke patients. Patterns of selective muscle activation were compared to healthy volunteers and test-retest reliability was assessed.