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Peripheral Nerve Examination
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Nikhil Agrawal, Chaitanya Mudgal
More distally in the forearm, the ulnar side of the wrist should be examined and observed. A Tinel's sign here can be evidence of ulnar nerve compression in the canal. This is also a common site for a pseudoaneurysm of the ulnar artery from repetitive mechanical trauma in the area, termed “hypothenar hammer syndrome.” The vascular enlargement manifests first as vascular compromise of the ulnar hand but can also exert a mass effect on the ulnar nerve [9]. Other masses present within the canal, such as a ganglion can cause a similar mass effect on the nerve.
Upper Extremity Arterial Occlusive Disease
Published in Sachinder Singh Hans, Alexander D Shepard, Mitchell R Weaver, Paul G Bove, Graham W Long, Endovascular and Open Vascular Reconstruction, 2017
Upper extremity critical ischemia may develop from a host of pathologic conditions that involve the axillary artery and beyond,1 including: embolism from a cardiac source; blunt or penetrating trauma; and in situ thrombosis following arterial cannulation. High-volume hemodialysis arteriovenous fistulae or grafts may siphon significant arterial flow from the hand, inducing an ischemic steal syndrome. Less frequently, arterial pathology is due to repetitive extrinsic trauma to the axillary artery in highperformance baseball pitchers and to the ulnar artery in workers who use the heel of their hands as a “hammer” (hypothenar hammer syndrome) (Figure31.1). A proximal arterial aneurysm or an ulcerative plaque may also present as a source of distal embolization. Radiation and giant-cell arteritis, while uncommon, can result in diffuse stenosis of the axillobrachial axis.
Acute physiological and functional effects of repetitive shocks on the hand–arm system: a pilot study on healthy subjects
Published in International Journal of Occupational Safety and Ergonomics, 2023
Jonathan Witte, Alexandra Corominas, Benjamin Ernst, Uwe Kaulbars, Robert Wendlandt, Hans Lindell, Elke Ochsmann
Differences of ΔT between the exposed hand and the non-exposed hand could be demonstrated for the shock exposures, as opposed to the random vibration signal. This could be due to a central vasoconstrictor response mediated through the sympathetic system and/or local vasoactive substances which is observed with HAV [51–55]. Repetitive shocks of the same rms magnitude express much higher peak acceleration values that possibly additionally impact on the ipsilateral hand–arm system, e.g., wall shear stress on the endothelium [56] or microtraumas known from the aetiology of hypothenar hammer syndrome [57]. Last, it remains controversial whether skin temperature measurements can effectively depict acute vascular effects [58,59], the more so as thermography did not reach high levels of sensitivity or specificity for diagnosing HAVS [60]. Nonetheless, Thompson and Griffin [61] and Mirbod et al. [62] were able to correlate plethysmographic blood flow measurements with skin temperatures, concluding that these two parameters described the same vascular mechanism. With this, infrared thermography should be considered for use in occupational health prevention in the future, provided that confounders like room temperature or previous physical activity are well controlled.
Development and evaluation of RAMP I – a practitioner’s tool for screening of musculoskeletal disorder risk factors in manual handling
Published in International Journal of Occupational Safety and Ergonomics, 2019
Carl Mikael Lind, Mikael Forsman, Linda Maria Rose
Daily use of the hand as an impact tool has been related to hypothenar hammer syndrome [79], while shocks and impacts have been related to vascular and neurological UEMSDs [60]. Hand impacts occurring for an equivalent of about >100 times during an 8-h workday have been considered a WMSD risk factor [80]. Therefore, hand impacts of about >100 times/workday was used as the assessment criterion.