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1.
Braz. j. anesth ; 73(6): 736-743, Nov.Dec. 2023. tab, graf
Article in English | LILACS | ID: biblio-1520386

ABSTRACT

Abstract Background: Brachial plexus block (BPB) has been accepted as a reliable alternative for general anesthesia in upper limb surgeries. Adding adjuvant drugs like dexmedetomidine and sufentanil has been shown to have clinical and pharmacologic advantages. In this randomized parallel clinical trial, we aim to compare the effects of these two adjuvants for bupivacaine in BPB. Methods: In this double-blinded study, by using computer-assisted block randomization, 40 patients ranged from 20 to 65 years old and scheduled for elective upper limb surgeries were assigned to two equal study groups (n = 20), receiving 1 mL of 5 μg.mL-1 sufentanil (group S) or 1 mL of 100 μg.mL-1 dexmedetomidine (group D) in adjunction to 30 mL of 0.5% bupivacaine for supraclavicular BPB under the guidance of ultrasonography. Characteristics of local anesthesia and postoperative analgesia were evaluated (n = 40). Results: The duration of blocks significantly improved in group S (sensory: estimated median difference (EMD) [95%CI] = 100.0 [70.0~130.0], p < 0.001; motor: EMD [95%CI] = 120.0 [100.0~130.0], p < 0.001). Group S also had significantly longer postoperative analgesia and lower opioid consumption within 24 hours after the surgery (EMD [95%CI] = 4.0 [3.0~7.0], p < 0.001; EMD [95%CI] = -5.0 [-5.0~-5.0], p < 0.001; respectively). None of the patients showed adverse effects concerning vital signs, nausea, or vomiting. Conclusion: Our study showed that during ultrasound-guided supraclavicular BPB, sufentanil is a fairly better choice than dexmedetomidine as an adjuvant for bupivacaine and can provide preferable sensory and motor blocks. No significant side effects were seen in either of the study groups.


Subject(s)
Humans , Adolescent , Adult , Middle Aged , Aged , Dexmedetomidine/therapeutic use , Brachial Plexus Block , Bupivacaine , Sufentanil , Upper Extremity/surgery , Anesthetics, Local
3.
Int. j. morphol ; 41(2): 548-554, abr. 2023. ilus
Article in Spanish | LILACS | ID: biblio-1440318

ABSTRACT

Los avances en el área de la salud, con el desarrollo de nuevos procedimientos diagnósticos y quirúrgicos, requieren un conocimiento cada vez más preciso de la anatomía humana. La difusión de la disposición variable de la anatomía resulta primordial no sólo en el campo de la especialización o el postgrado, sino por sobre todo, en el pregrado, desde donde se formarán los especialistas que luego desarrollarán esas nuevas prácticas clínicas y quirúrgicas que requerirán una sólida formación anatómica. Es por esto que la aplicación correcta de técnicas anatómicas en las muestras anatómicas es fundamental para que esta enseñanza en el pregrado pueda desarrollarse de manera eficiente, teniendo la plastinación un rol fundamental en este sentido. El objetivo de este trabajo consistió en dar a conocer el hallazgo de variaciones anatómicas arteriales en los miembros superiores de una muestra humana sometida al proceso de plastinación para fomentar, por un lado, la importancia del conocimiento anatómico en el pregrado, el postgrado y las especialidades, como así también la relevancia de la preservación a largo plazo de material biológico para la difusión continua de la anatomía.


SUMMARY: Advances in the area of health with the development of new diagnostic and surgical procedures require an increasingly precise knowledge of human anatomy. The diffusion of the variable arrangement of anatomy is essential not only in the field of specialization or postgraduate, but above all, in the undergraduate, from where the specialists will be trained who will later develop these new clinical and surgical practices that will require a solid anatomical background. This is why the correct application of anatomical techniques in anatomical samples is essential for this undergraduate teaching to be developed efficiently, plastination having a fundamental role in this regard. The aim of this work was to report the discovery of anatomical variations in the upper limbs of a human sample subjected to the plastination process to promote, on one hand, the importance of anatomical knowledge in undergraduate, postgraduate and specialties, as well as the relevance of long- term preservation of biological material for the continued dissemination of anatomy.


Subject(s)
Humans , Ulnar Artery/anatomy & histology , Radial Artery/anatomy & histology , Upper Extremity/blood supply , Anatomic Variation , Plastination
4.
Int. j. morphol ; 41(2): 555-568, abr. 2023. ilus, tab
Article in English | LILACS | ID: biblio-1440323

ABSTRACT

SUMMARY: Upper limb nerve variations may be related to the absence of a nerve, an interconnection between two nerves or a variant course. The purpose of this review is to screen the existing literature on upper limb nerve variations that may alter the neurologic diagnostic process. A scoping review was performed following PRISMA for Scoping Reviews guidelines. Initially, 1331 articles were identified by searching Pubmed and Web of Science until the 22nd of October 2022. After screening, reading, and additional searching 50 articles were included in this review. Variations were divided into two categories: 1) variations causing a different innervation pattern involving sensory, motor, or both types of fibers, and 2) variations causing or related to compression syndromes. Two-thirds of the included articles were cadaver studies. Nine articles were diagnostic studies on symptomatic or healthy individuals involving medical imaging and/or surgery. Nerve variations that may cause a different innervation pattern concern most frequently their interconnection. The connection between the median and musculocutaneous nerve in the upper limb and the connection between the median and ulnar nerve in the forearm (Martin-Gruber) or hand (Riche-Cannieu) may be present in half of the population. Injury to these connections may cause compound peripheral neuropathies a result of variant sensory and motor branching patterns. Muscular, vascular, or combined anomalies in the forearm were reported as causes of entrapment neuropathies. These nerve variations may mimic classical entrapment syndromes such as carpal tunnel syndrome or compression at ulnar canal (Guyon's canal). Knowledge of frequent nerve variations in the arm may be important during the diagnostic process and examination. Variant innervation patterns may explain non-classical clinical signs and/or symptoms during provocative tests. Classical nerve compression syndromes in the arm may warrant for differential diagnosis, especially in the case of persistent or recurrent symptoms.


Las variaciones nerviosas del miembro superior pueden estar relacionadas con la ausencia de un nervio, una interconexión entre dos nervios o un curso variante. El objetivo de esta revisión fue examinar la literatura existente sobre las variaciones de los nervios de los miembros superiores que pueden alterar el proceso de diagnóstico neurológico. Se realizó una revisión de alcance siguiendo las pautas de PRISMA para revisiones de alcance. Inicialmente, se identificaron 1331 artículos mediante la búsqueda en Pubmed y Web of Science hasta el 22 de octubre de 2022. Después de la selección, la lectura y la búsqueda adicional, se incluyeron 50 artículos en esta revisión. Las variaciones se dividieron en dos categorías: 1) variaciones que causan un patrón de inervación diferente que involucra fibras sensoriales, motoras o de ambos tipos, y 2) variaciones que causan o están relacionadas con síndromes de compresión. Dos tercios de los artículos incluidos eran estudios de cadáveres. Nueve artículos fueron estudios de diagnóstico en individuos sintomáticos o sanos que involucraron imágenes médicas y/o cirugía. Las variaciones nerviosas que pueden causar un patrón de inervación diferente se refieren con mayor frecuencia a su interconexión. La conexión entre el nervio mediano y musculocutáneo en el miembro superior y la conexión entre el nervio mediano y ulnar en el antebrazo (Martin-Gruber) o la mano (Riche-Cannieu) puede estar presente en la mitad de la población. La lesión de estas conexiones puede causar neuropatías periféricas compuestas como resultado de patrones de ramificación variantes sensitivos y motores. Se informaron anomalías musculares, vasculares o combinadas en el antebrazo como causas de neuropatías por atrapamiento. Estas variaciones nerviosas pueden imitar los síndromes de atrapamiento clásicos, como el síndrome del túnel carpiano o la compresión en el canal ulnar. El conocimiento de las variaciones nerviosas frecuentes en el brazo puede ser importante durante el proceso de diagnóstico y examen. Los patrones de inervación variantes pueden explicar los signos y/o síntomas clínicos no clásicos durante las pruebas de provocación. Los síndromes clásicos de compresión nerviosa en el brazo pueden justificar el diagnóstico diferencial, especialmente en el caso de síntomas persistentes o recurrentes.


Subject(s)
Humans , Peripheral Nerves/anatomy & histology , Upper Extremity/innervation , Anatomic Variation
5.
Chinese Critical Care Medicine ; (12): 757-758, 2023.
Article in Chinese | WPRIM | ID: wpr-982668

ABSTRACT

Patients in the intensive care unit (ICU) often need to have various catheters placed on their bodies due to their severe condition. In order to prevent the occurrence of unplanned extubation, patients' hands should be restrained appropriately. The current restraint gloves used in clinical practice have problems such as improper restraint, easy falling off of oxygen saturation monitoring probes, and pressure injury of hands. Therefore, department of critical care medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine designed a wrist restraint glove suitable for restless patients, and obtained the national utility model patent (ZL 2020 2 1612453.7). The device is composed of restraint gloves and restraint rings, which can not only restrain patients, but also continuously monitor the changes of blood oxygen saturation in patients with restfulness. This device is convenient to use, low cost, comfortable to wear, and can prevent the occurrence of device-related pressure injuries, which is suitable for clinical application.


Subject(s)
Humans , Wrist , Intensive Care Units , Critical Care , Hand , Upper Extremity , Restraint, Physical
6.
Chinese journal of integrative medicine ; (12): 534-539, 2023.
Article in English | WPRIM | ID: wpr-982288

ABSTRACT

OBJECTIVE@#To observe the clinical efficacy of transcutaneous electrical acupoint stimulation (TEAS) combined with warm acupuncture in treating breast cancer associated with upper limb lymphedema (BCRL).@*METHODS@#This was a retrospective cohort study using a paired control design. Fifty-two BCRL patients were assigned to the control group (27 cases) and the treatment group (25 cases). The patients in the control group were treated with lymphedema comprehensive detumescence treatment (CDT) for 4 weeks, including systematic therapy composed of manual lymphatic drainage, compression bandage, skincare, and functional exercise. The patients in the treatment group were treated with TEAS combined with warm acupuncture based on the control group methods. Each treatment lasted for 30 min and was applied twice a week for 4 weeks. The arm circumference (AC) of different positions of the affected limb and the degree of swelling of the affected limb were evaluated before the first treatment and after the last treatment. The clinical efficacy was evaluated according to the degree of edema before and after treatment. All adverse events during treatment were recorded.@*RESULTS@#The patients' AC and the swelling feeling of the affected limb in the treatment group and the control group were both reduced compared with those before treatment. Compared with the control group, AC of the wrist joint transverse stria, the midpoint between the wrist joint transverse stria and the elbow joint transverse stria in the treatment group were significantly reduced (P<0.05). The decrease in AC diameter at the midpoint between the elbow joint transverse stria and the axillary transverse stria was the most significant (P<0.01). The swelling degree of the affected limbs in the treatment group was significantly lower than before treatment, and was significantly lower compared with the control group after treatment (P<0.01). The total effective rate was 72% in the treatment group, significantly higher than that in the control group (55.56%, P<0.05). No serious adverse events occured in either group.@*CONCLUSIONS@#TEAS combined with warm acupuncture can effectively reduce AC and swelling feeling of the affected limb in patients with BCRL. The effect is better than that of CDT therapy alone. (Registration No. ChiCTR2200062075).


Subject(s)
Humans , Female , Breast Neoplasms/therapy , Acupuncture Points , Retrospective Studies , Lymphedema/complications , Acupuncture Therapy/adverse effects , Upper Extremity , Treatment Outcome
7.
Chinese Journal of Traumatology ; (6): 217-222, 2023.
Article in English | WPRIM | ID: wpr-981931

ABSTRACT

PURPOSE@#The present study aimed to treat fractures of the distal end of the radius in children with Robert Jones (RJ) bandage. The objective was to compare this treatment modality with the cast regarding the frequency of the complication occurrence, child comfortability, and family satisfaction.@*METHODS@#The study was a randomized controlled non-inferiority clinical trial including children with recent (less than 5 days) fractures at the distal end of the radius OTA/AO 23-A2, which is usually treated conservatively. Those with open fractures, pathological fracture, severely displaced fracture that needs reduction or multiple injuries were excluded. The participants were divided randomly into 2 groups according to the treatment modalities. Group 1 was treated by plaster of Paris cast (the control group), and Group 2 by modified RJ bandage (the trial group). The difference between the 2 groups was found by the Chi-squared test. The difference was considered statistically significant when the p value was less than 0.05.@*RESULTS@#There were 150 children (aged 2 - 12 years, any gender) included in the study, 75 in each group. The complications occured in 5 (3.3%) cases only, pressure sores of 3 cases in Group 1 and fracture displacement of 2 cases in Group 2. There was no statistically significant difference in the rate of complication occurrence between both modalities of treatment (p = 0.649). Children treated by RJ bandages were more comfortable than those treated by the cast (97.3% vs. 73.3%, p < 0.001) with a statistically significant difference between them. Contrary to that, the families were more satisfied with the cast than RJ bandage (88.0% vs. 81.3%), but without a statistically significant difference (p = 0.257).@*CONCLUSION@#RJ bandage is a non-inferior alternative to the cast for the treatment of fractures at the distal end of the radius that can be treated conservatively in children.


Subject(s)
Humans , Child , Radius Fractures/therapy , Wrist Fractures , Fracture Fixation , Bandages , Upper Extremity , Casts, Surgical
8.
China Journal of Orthopaedics and Traumatology ; (12): 591-596, 2023.
Article in Chinese | WPRIM | ID: wpr-981739

ABSTRACT

The shoulder joint is the most flexible joint in the body with the largest range of motion, and the movement pattern is more complex. Accurate capture of three-dimensional motion data of the shoulder joint is crucial for biomechanical evaluation. Optical motion capture systems offer a non-invasive and radiation-free method to capture shoulder joint motion data during complex movements, enabling further biomechanical analysis of the shoulder joint. This review provides a comprehensive overview of optical motion capture technology in the context of shoulder joint movement, including measurement principles, data processing methods to reduce artifacts from skin and soft tissues, factors influencing measurement results, and applications in shoulder joint disorders.


Subject(s)
Humans , Shoulder , Motion Capture , Biomechanical Phenomena , Upper Extremity , Shoulder Joint , Movement , Range of Motion, Articular
9.
Article in Portuguese | LILACS, CONASS, ColecionaSUS, SES-GO | ID: biblio-1442371

ABSTRACT

O envelhecimento é um processo de modificações corporais progressivo, que promove alterações morfofisiológicas e dificulta a realização de tarefas funcionais, podendo ocasionar aumento de lesões e influencia diretamente na qualidade de vida. Objetivo: Avaliar a funcionalidade e qualidade de vida dos idosos em reabilitação de membros superiores. Métodos: Estudo transversal e descritivo envolvendo idosos em reabilitação de membros superiores. Para realização da coleta dos dados foram aplicados três questionários na forma de entrevista, um questionário socioeconômico clínico elaborado pelos autores, o questionário Disabilities of the arm, shoulder and hand (DASH) e o questionário Item Short Form Health Survey (SF-12). Resultados: A amostra foi composta por 30 idosos, com média de idade de 69,53 ± 6.62 anos, predominantemente do sexo feminino (66,7%), ensino superior completo (46,7%), trabalhadores autônomos (46,7%), com renda mensal de 5 ou mais salário-mínimo. (53,3%). Quanto a qualidade de vida do questionário SF-12 obtivemos 40,53% no componente físico (PCS), 52,74% componente mental (MCS). Quanto a funcionalidade do questionário DASH o score de 40,68% classifica como incapacidade leve. Conclusão: Os idosos em reabilitação de membros superiores apresentaram melhor qualidade de vida no componente mental e incapacidade leve nos membros superiores


Aging is a process of progressive body changes, which promotes morphophysiological changes and makes it difficult to perform functional tasks, leading to an increase in injuries and directly influencing the quality of life. Objective: To evaluate the functionality and quality of life of elderly people undergoing rehabilitation of upper limbs. Methods: Cross-sectional and descriptive study involving elderly people undergoing upper limb rehabilitation. To perform the data collection, three questionnaires were applied in the form of an interview. The first was a socioeconomic clinical questionnaire prepared by the authors. Then, the "arm, shoulder, and hand" (DASH) impairments. Last but not least was the Item Short Form Health Survey (SF-12). Results: The sample consisted of 30 elderly people, with a mean age of 69.53 ± 6.62 years, predominantly female (66.7%), complete higher education (46.7%), self-employed (46.7 %), with a monthly income of 5 or more minimum wages. (53.3%). As for the quality of life of the SF-12 questionnaire, we obtained 40.53% in the physical component (PCS) and 52.74% in the mental part (MCS). As for the functionality of the DASH questionnaire, the score of 40.68% classifies it as a mild disability. Conclusion: The elderly undergoing rehabilitation of upper limbs had a better quality of life in the mental component and mild disability in the upper limbs.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Quality of Life , Wounds and Injuries/rehabilitation , Aged , Upper Extremity
11.
Med. lab ; 27(1): 25-32, 2023. ilus
Article in Spanish | LILACS | ID: biblio-1412746

ABSTRACT

Las lesiones metastásicas representan hasta un 3 % de los tumores malignos de la glándula tiroides. La mayoría de los casos se originan de tumores de células renales y de pulmón. El abordaje diagnóstico implica una alta sospecha clínica en pacientes con primarios conocidos, sin embargo, puede ser la manifestación inicial de una enfermedad maligna extensa no diagnosticada hasta en un 20 % a 40 % de los pacientes. La biopsia por aguja fina ha demostrado buen rendimiento para el diagnóstico de los nódulos metastásicos. El pronóstico y la opción del tratamiento quirúrgico dependen del control local del primario y del estado de la enfermedad sistémica asociada, por lo tanto, debe ser individualizado. Por lo general, hasta un 80 % de los pacientes con compromiso de la tiroides tienen enfermedad metastásica multiorgánica, y la intención del tratamiento quirúrgico es con fines paliativos para prevenir las complicaciones derivadas de la extensión local de la enfermedad a las estructuras del tracto aerodigestivo superior en el cuello. Se presenta a continuación, una serie de seis casos de pacientes con lesiones metastásicas a glándula tiroides con primarios en riñón, mama y de melanomas


Metastatic lesions represent up to 3% of malignant tumors of the thyroid gland. Most cases originate from lung and renal cell tumors. The diagnostic approach implies a high clinical suspicion in patients with known primaries, however, it can be the initial manifestation of an extensive undiagnosed malignant disease in up to 20% to 40% of patients. Fine-needle biopsy has shown good performance for the diagnosis of metastatic nodules. The prognosis and the option of surgical treatment depend on the local control of the primary condition and the state of the associated systemic disease, therefore it must be individualized. In general, up to 80% of patients with thyroid involvement have multi-organ metastatic disease and surgical treatment is intended to be palliative to prevent complications resulting from local extension of the disease to structures of the upper aerodigestive tract in the neck. A case series of six patients with metastatic lesions to the thyroid gland with primaries in the kidney, breast and melanomas is presented below


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Thyroid Neoplasms/secondary , Breast Neoplasms/pathology , Facial Neoplasms/pathology , Carcinoma, Renal Cell/pathology , Carcinoma, Ductal, Breast/pathology , Upper Extremity/pathology , Kidney Neoplasms/pathology , Melanoma/pathology
12.
Chinese Journal of Traumatology ; (6): 77-82, 2023.
Article in English | WPRIM | ID: wpr-970979

ABSTRACT

PURPOSE@#Upper limb disorders are one of the most common and important types of occupational injuries. Besides, identifying the factors influencing return to work following these injuries is essential to reduce the dimensions of the problem. In this study, we investigated the return to work and associated factors following occupational injuries leading to upper limb impairment.@*METHODS@#In this retrospective cohort study, the rate of return to work and associated factors were assessed in 256 workers with work-related upper limb injury referred to a teaching hospital from March 2011 to December 2018. The inclusion criterion was a history of occupational injury resulting in upper limb impairment, and exclusion criteria included the presence of simultaneous impairment in other organs, congenital or non-occupational limb defects as well as patients with incomplete information in their medical records. Individuals' records, including age at the time of injury, gender, date of injury, marital status, education, level of amputation and injury, whole person impairment (WPI) and physiotherapy (prescribed by the physician) were reviewed. The WPI was calculated to assess the extent of the injury. All analyzes were performed by SPSS version 25.0.@*RESULT@#The rate of return to work was 54.3%, in which 51.8% for the same job and 48.2% for a new job. The main factors associated with non-return to work were more days off work (p = 0.001), higher injury severity (p = 0.001), and dominant hand injury (p = 0.034).@*CONCLUSION@#The number of days off work, the WPI, and dominant hand injury are the most important determinant in returning to work. In addition, increased job satisfaction and support from co-workers and employers are work-related factors that can lead to an increased return to work.


Subject(s)
Humans , Occupational Injuries/etiology , Retrospective Studies , Upper Extremity/injuries , Hand Injuries
13.
Chinese Journal of Traumatology ; (6): 60-62, 2023.
Article in English | WPRIM | ID: wpr-970976

ABSTRACT

Post-burn contractures are common entities seen in developing countries. There are multiple reasons for the development of contractures, most are preventable. In extensive contractures, a strategic plan is necessary to release all contractures and yet not antagonize post-operative positions. It is also necessary to be cost-effective and minimize the number of surgeries needed. Conventionally the release sequence in extensive burn contractures is proximal to distal. In this case report, we discuss an unusual sequence where we released distal contractures before the proximal to achieve optimum results. A 3-year-old child with post-burn contracture of hand, wrist, elbow, and axilla was treated in 2 stages, with the release of wrist contracture and cover with pedicled abdominal flap in the first stage and division of pedicled flap with the release of axilla and elbow contracture in the second stage. Thus, the release of all contractures was achieved without antagonizing post-operative positions and minimized the number of surgeries. A case-based approach may be crucial in making a strategic surgical plan to minimize the rehabilitation phase, rather than following known dictums.


Subject(s)
Humans , Child, Preschool , Surgical Flaps/surgery , Upper Extremity , Plastic Surgery Procedures , Skin Transplantation , Contracture/surgery
14.
Rev. venez. cir. ortop. traumatol ; 54(2): 96-103, dic. 2022. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1516775

ABSTRACT

El objetivo de esta investigación es evaluar la utilidad de la Técnica de WALANT en cirugías ambulatorias de mano en pacientes post Covid-19 en el Hospital General del Sur "Dr. Pedro Iturbe", Maracaibo, Estado Zulia, durante el periodo de julio del 2020 a octubre del 2021. Se realizó un estudio pre-experimental, longitudinal y prospectivo. El muestreo fue probabilístico al azar simple. Se aplicó un análisis estadístico de tipo descriptivo. Se incluyeron 50 pacientes con edad promedio de 37,02+/- 14,1(18-64) años, 52% de sexo femenino y 48% masculino. De ocupación 46% comerciante y obrero. Ama de casa y oficinista 44%, otros 10%. Con diagnóstico de dedo en gatillo 20%, síndrome del túnel carpiano 24%. Con la técnica se realizaron procedimientos quirúrgicos tipo neuroadhesiolisis del nervio mediano 24%, exéresis 22%. Tiempo quirúrgico de 5 a 10 minutos de duración en 56,9% de los casos. Se encontró punta de EVA: preoperatorio 56% de 7-10 ptos, Intraoperatorio 64% 0 ptos y postoperatorio 66% 0 ptos. Analgesia de rescate 92%. 88% sin complicaciones. La estancia Hospitalaria en 92% de los casos fue 1 hora. Reintegro a sus actividades 90%. Tiempo de reintegro en 46% de los casos de 1-5 días. 86% de los pacientes se sintieron satisfechos. En conclusión, la Técnica de WALANT en pacientes post Covid-19 es de gran utilidad para la realización de cirugías ambulatorias de bajo riesgo de mano, presentó pocas complicaciones, el tiempo quirurgo fue corto, el reintegro a sus actividades fue rápido y la satisfacción del paciente fue buena(AU)


The objective of this study is to evaluate the usefulness of the WALANT Technique in ambulatory hand surgeries in post- Covid-19 patients at the Hospital General del Sur "Dr. Pedro Iturbe", Maracaibo, Estado Zulia, during the period from July 2020 to October 2021. A pre-experimental, longitudinal and prospective study was made. Sampling was simple random probabilistic. A descriptive statistical analysis was applied. 50 patients were included with an average age of 37,02+/-14,1(18-64) years, 52,0% female and 48,0% male. Occupation 46,0% merchant and worker. Housewife and office 44,0%, others 10,0%. With a diagnosis of trigger finger 20,0%, carpal tunnel syndrome 24,0%. With the technique, 24,0% median nerve neuroadhesiolysistype surgical procedures were performed, 22,0% exeresis. Surgical time from 5 to 10 minutes in 56,9% of cases. A VAS tip was found: preoperative 56,0% 7-10 points, intraoperative 64,0% 0 points and postoperative 66,0% 0 points. Rescue analgesia 92,0%. 88,0% without complications. Hospital stay in 92,0% of cases was 1 hour. Refund to their activities 90,0%. Refund time in 46,0% of cases from 1-5 days. 86,0% of the patients felt satisfied. In conclusion, the WALANT Technique in post-COVID-19 patients is very useful for performing low-risk outpatient hand surgeries, it presented few complications, the surgical time was short, the return to their activities was fast and the satisfaction of the patient. patient was good(AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Ambulatory Surgical Procedures , COVID-19 , Hand/surgery , Anesthesia, Local , Comorbidity , Upper Extremity , Patient Care , Hypertension , Lidocaine/administration & dosage
15.
Rev. bras. ciênc. mov ; 30(1): [1-21], jan.-mar. 2022. tab, ilus
Article in Portuguese | LILACS | ID: biblio-1378089

ABSTRACT

As epicondilalgias medial e lateral são as causas mais frequentes de sintomas dolorosos nos membros superiores. Observa-se um aumento no número de publicações sobre os efeitos do treino da musculatura escapular no manejo clínico das epicondilalgias, porém desconhecemos uma revisão sistemática que avalie os efeitos do treinamento resistido nos músculos escapulares nessa condição. Objetivo: revisar sistematicamente os efeitos do treinamento resistido nos músculos escapulares nas epicondilalgias. Metodologia: foi realizada uma busca científica (SciELO, PubMed, LILASCS, PEDro) de estudos clínicos controlados sobre os efeitos do treinamento resistido nos músculos escapulares nas epicondilalgias publicados até maio 2021. A escala de PEDro foi aplicada para avaliação da qualidade metodológica. Resultados: foram encontrados 266 artigos e 3 foram incluídos na revisão sistemática. Os estudos inclusos enfatizaram o treinamento dos músculos trapézio médio, trapézio inferior e serrátil anterior associados a reabilitação convencional. Através da análise individual dos estudos observa-se efeitos positivos do treino escapular na dor, na função (Patient Rated Tennis Elbow Evaluation Questionnaire ­ PRTEE) e na força de preensão manual em indivíduos com epicondilalgias lateral. A metanálise revela que adicionar exercícios escapulares a fisioterapia convencional reduz a dor (EVA 0-10) em 1.23 (95% IC, 2,00-0,47, p=0,002, I2=47%, p para heterogeidade = 0.17) e aumenta a função (PRTEE 0-100) em 5.47 (95% IC, 10,00-0,93, p=0,02, I2=0%, p para heterogeidade = 0.84) na epicondilalgias lateral. A média de pontuação da escala PEDro foi de 6,33/10. Conclusão: o treinamento resistido dos músculos escapulares associados a reabilitação reduzem dor e aumentam função em indivíduos com epicondilalgia lateral. Sugere-se a realização de mais estudos com melhor qualidade metodológica para avaliar a importância do fortalecimento dos músculos escapulares em indivíduos com epicondilalgias. (AU)


Medial and lateral epicondylalgia are the most requente causes of painful symptoms in the upper limbs. There is na increase in the number of publications on the effects of scapular muscle training in the clinical management of epicondylalgia, but we do not know of a systematic review that assesses the effects of resistance training on scapular muscles in this condition. The aim of the study was to systematically review the effects of resistance training on scapular muscles in epicondylalgia. A scientific search (SciELO, PubMed, LILASCS, PEDro) of controlled clinical studies on the effects of resistance training for the scapular muscles in epicondylagias published until May 2021 was performed. The PEDro scale was applied to assess the methodological quality. 266 articles were found and 3 were included in the systematic review. The included studies emphasized the training of the middle trapezius, lower trapezius and serratus anterior muscles associated with conventional rehabilitation. Through the individual analysis of the studies, positive effects of scapula training on pain, function Patient Rated Tennis Elbow Evaluation Questionnaire ­ PRTEE) and handgrip strength were observed in individuals with lateral epicondylalgia. The meta-analysis reveals that adding scapular exercises to conventional physical therapy reduces pain (VAS 0-10) by 1.23 (95% CI, 2.00-0.47, p=0.002, I2=47%, p for heterogeneity = 0.17) and increases function (PRETEE 0-100) by 5.47 (95% CI, 10.00- 0.93, p=0.02 I2=0%, p for heterogeneity = 0.84) in lateral epicondylalgia. The average score of the studies on the PEDro scal e was 6.33 out 10. In conclusion, resistance training of scapular muscles associated with rehabilitation reduces pain the increases function in individuals with lateral apicondylalgia. It is suggested that more studies be carried out with better methodological quality to assess the importance of strengthening the scapular muscles in individuals with epicondylalgia. (AU)


Subject(s)
Humans , Scapula , Resistance Training , Muscles , Pain , Tennis Elbow , Physical Therapy Modalities , Upper Extremity , Trapezium Bone , Superficial Back Muscles
16.
Rev. bras. ciênc. mov ; 30(1): [1-16], jan.-mar. 2022. tab, ilus
Article in English | LILACS | ID: biblio-1373151

ABSTRACT

Objective. was to assess flexibility in women with breast cancer who underwent concurrent training (aerobic+resistance) (CT) more static stretching. Methods. This was a controlled pilot study, with 31 women (age 30 to 59) under breast cancer treatment, 14 women were allocated to a training group (TG) who underwent CT more static stretching, concomitant to hospital treatment and 17 women for the control group (CG) who only underwent hospital treatment. The CT more static stretching was performed in 12 weeks with 5 sessions per week, three sessions (aerobic+resistance) and two sessions (stretching exercises) on alternate days. The flexibility of the shoulder was measured by means of the 360º Sanny pendulum goniometer and the flexibility of the lower limbs was assessed through the sit-and-reach test. Data were analyzed using repeated measures ANOVA Test and Bonferroni Post-hoc using SPSS 21 software, with α of 5%. Results. The TG presented increased flexibility in the horizontal abduction of the right shoulder (p=0.001) and in the lower limbs (p<0.001), but the CG showed a reduction in the horizontal abduction of the right shoulder (p=0.003). The effect size for horizontal abduction of the right shoulder was medium (p=0.508) and for the lower limbs was large (p=0.839). Conclusion. CT more static stretching may be a therapeutic intervention to increase flexibility of upper and lower limbs in women with breast cancer. (AU)


Objetivo. Avaliar a flexibilidade em mulheres com câncer de mama que realizaram treinamento concorrente (aeróbio + resistência) (TC) mais alongamento estático. Métodos. Este foi um estudo piloto controlado, com 31 mulheres (de 30 a 59 anos) em tratamento para câncer de mama, 14 mulheres foram alocadas em um grupo de treinamento (GT) que realizaram TC mais alongamento estático, concomitante a tratamento hospitalar e 17 mulheres para o grupo de controle (GC) que somente realizaram tratamento hospitalar. O TC mais alongamento estático foram realizados em 12 semanas com 5 sessões semanais, três sessões (aeróbia + resistência) e duas sessões (exercícios de alongamento) em dias alternados. A flexibilidade do ombro foi medida por meio do goniômetro de pêndulo 360º Sanny e a flexibilidade de membros inferiores foi avaliada por meio do teste de sentar e alcançar. Os dados foram analisados usando o Teste ANOVA de medidas repetidas e Post-hoc de Bonferroni no software SPSS 21, com α de 5%. Resultados. O GT apresentou aumento da flexibilidade na abdução horizontal do ombro direito (p=0,001) e nos membros inferiores (p<0,001), mas o GC apresentou redução da abdução horizontal do ombro direito (p=0,003). O tamanho do efeito para abdução horizontal do ombro direito foi médio (p=0,508) e para membros inferiores foi grande (p=0,839). Conclusão. O TC mais alongamento estático podem ser uma intervenção terapêutica para aumentar a flexibilidade de membros superiores e inferiores em mulheres com câncer de mama. (AU)


Subject(s)
Humans , Female , Adult , Middle Aged , Shoulder , Breast Neoplasms , Exercise , Pliability , Muscle Stretching Exercises , Therapeutics , Women , Cardiovascular System , Lower Extremity , Upper Extremity , Hospitals
17.
Rev. bras. ciênc. mov ; 30(1): [1-16], jan.-mar. 2022. tab
Article in English | LILACS | ID: biblio-1373683

ABSTRACT

Cervical disorders and the shortening of the pectoralis minor are advocated to play an important role in patients with subacromial pain syndrome, despite the absence of evidence. This study aimed to compare the deep cervical flexor muscle function and the shortening of the pectoralis minor between patients with subacromial pain syndrome and controls. Secondarily, this study aimed to analyze the relationship of clinical tests with pain and disability among patients. This is a case-control study with 32 patients with subacromial pain syndrome [mean age: 33 ± 6.9 years; sex: 22 (65.6%) men; right dominance: 31 (96.9%)] and 32 controls matched for age, sex, handedness, and affected side. Participants filled the Numerical Pain Rating Scale, the Shoulder Pain and Disability Index; and performed the clinical tests which were compared between patients and controls. Pectoralis minor length of the patient's group (median = 9.0) was similar to the controls (median = 9.7) (U = 421.5; p = 0.22). The deep neck muscle function presented no statistical difference between patients and controls (χ2 = 4.319; p = 0.504). There was no statistically significant correlation between clinical tests and patient self-reported measures. Therefore, deep cervical flexor muscle and the pectoralis minor muscle were not impaired in patients with subacromial pain syndrome and did not show a relationship with self-reported measures.


Distúrbios cervicais e o encurtamento do músculo peitoral menor são apontados como tendo um papel importante em pacientes com síndrome da dor subacromial, apesar da ausência de evidências. Este estudo teve como objetivo comparar a função dos músculos flexores cervicais profundos e o encurtamento do músculo peitoral menor entre pacientes com síndrome da dor subacromial e controles. Secundariamente, este estudo objetivou analisar a relação dos testes clínicos com a dor e incapacidade entre os pacientes com síndrome da dor subacromial. Trata-se de um estudo caso-controle com 32 pacientes com síndrome da dor subacromial [idade: 33 ± 6,9 anos; sexo: 22 (65,6%) homens; dominância direita: 31 (96,9%)] e 32 controles pareados por idade, sexo, lateralidade e lado afetado. Os participantes preencheram a Numerical Pain Rating Scale, o Shoulder Pain and Disability Index, realizaram os testes clínicos e os resultados dos pacientes e controles foram comparados. O comprimento do músculo peitoral menor no grupo de pacientes (mediana = 9,0) foi semelhante ao grupo controle (mediana = 9,7) (U = 421,5; p = 0,22). A função do músculo flexor cervical profundo não apresentou diferença estatística entre pacientes e controles (χ2 = 4,319; p = 0,504). Não houve correlação estatisticamente significativa entre os testes clínicos e as medidas relatadas pelos pacientes. Portanto, o músculo flexor cervical profundo e o músculo peitoral menor não foram prejudicados em pacientes com síndrome da dor subacromial e não mostraram relação com medidas autorreferidas.


Subject(s)
Humans , Male , Adult , Neck Pain , Shoulder Pain , Diagnosis , Pectoralis Muscles , Wounds and Injuries , Shoulder Impingement Syndrome , Upper Extremity , Test Taking Skills , Chronic Pain
18.
Chinese Journal of Medical Instrumentation ; (6): 42-46, 2022.
Article in Chinese | WPRIM | ID: wpr-928855

ABSTRACT

Based on the biomechanical mechanism of human upper limb, the disadvantages of traditional rehabilitation training and the current status of upper limb rehabilitation robot, a six degree of freedom, flexible adjustment, wearable upper limb rehabilitation exoskeleton design scheme is proposed. Firstly, the mechanics of each joint of the upper limb is analyzed, and the virtual prototype design of the whole mechanical structure of the upper limb rehabilitation wearable exoskeleton is carried out by using CATIA three-dimensional software. The tooth transmission of the forearm and the upper arm single row four point contact ball bearing with internal/external rotation and the shoulder flexible passive adjustment mechanism (viscoelastic damper) are innovatively designed. Then, the joints of the upper limb rehabilitation exoskeleton are analyzed, theoretical analysis and calculation of the driving torque, the selection of the motor and gearbox of each driving joint are carried out. Finally, the whole finite element analysis of the upper limb exoskeleton is carried out. The research and experimental results showed that the design scheme of the upper limb exoskeleton assist structure is highly feasible, which can help the patients with upper limb paralysis and motor dysfunction self-rehabilitation.


Subject(s)
Humans , Biomechanical Phenomena , Exoskeleton Device , Robotics , Stroke Rehabilitation , Torque , Upper Extremity , Wearable Electronic Devices
19.
J. vasc. bras ; 21: e20210130, 2022. graf
Article in Portuguese | LILACS | ID: biblio-1365073

ABSTRACT

Resumo Contexto A maior sobrevida dos doentes dialíticos somada à incapacidade de obtenção de órgãos suficientes para atender a demanda, bem como à dificuldade de acesso aos serviços de saúde, levou ao aumento da fila para transplante e ao prolongamento do tempo de utilização do acesso venoso central para hemodiálise. A etiologia mais comum de estenose de veia central é o acesso venoso central prolongado, pelas lesões intimais decorrentes da presença do cateter. Objetivos Avaliar resultados de angioplastia para tratamento de doença oclusiva venosa central com fístula arteriovenosa periférica funcionante. Métodos Estudo tipo coorte retrospectivo com revisão de prontuários de 47 doentes com lesões estenóticas ou oclusivas. A avaliação dos doentes foi realizada em 30 dias, 6 meses e 1 ano após a recanalização ou correção da estenose com ATP ou ATP/aplicação de stent. Resultados Lesões estenóticas foram encontradas em 25 doentes (53%), e oclusões, em 22 (47%) doentes. A angioplastia percutânea transluminal (ATP) com stent foi utilizada em 64% dos doentes, e angioplastia isolada com balão, em 36% deles. A análise de resultados clínicos mostrou elevada taxa de melhora clínica precoce (30 dias) em 82% dos doentes (intervalo de confiança [IC] 71-93%). Após 1 ano de seguimento, a taxa de perviedade primária foi de 57%, e a taxa de perviedade primária assistida foi de 72% (IC 57-84%). Conclusão O tratamento endovascular das estenoses ou oclusões de veia central sugere melhora clínica dos sintomas e taxas adequadas de perviedade no período de 1 ano, apesar da limitação no tamanho amostral.


Abstract Background The increased survival of dialysis patients and the inability to obtain sufficient organs to meet demand for transplantation, compounded by poor access to health services, have caused the transplant waiting lists to grow, extending the time spent using central venous accesses for hemodialysis. The most common etiology of central vein stenosis is prolonged central venous access, due to intimal injuries caused by the presence of the catheter. Objectives To assess the results of angioplasty to treat central vein occlusion in patients with functioning peripheral arteriovenous fistulas. Methods Retrospective cohort study with review of medical records from 47 patients with stenotic or occlusive lesions. Patients were assessed at 30 days, 6 months, and 1 year after recanalization or correction of stenosis with transluminal percutaneous angioplasty (TPA) or TPA/stenting. Results Stenotic lesions were detected in 25 patients (53%) and occlusions were found in 22 (47%) patients. TPA with stenting was used in 64% of patients and balloon angioplasty in isolation was used in 36%. Analysis of clinical results showed a high rate of early clinical improvement (30 days), seen in 82% of patients (confidence interval [CI] 71-93%). After 1 year of follow-up, the primary patency rate was 57% and the assisted primary patency rate was 72% (CI 57-84%). Conclusions Endovascular treatment of central vein stenosis or occlusions suggests clinical improvement of symptoms and adequate rates of patency at 1 year, notwithstanding the limited sample size.


Subject(s)
Humans , Male , Female , Middle Aged , Arterial Occlusive Diseases/therapy , Arteriovenous Fistula/therapy , Angioplasty/methods , Constriction, Pathologic/therapy , Retrospective Studies , Outcome Assessment, Health Care , Upper Extremity
20.
Coluna/Columna ; 21(4): e262464, 2022. tab, il
Article in English | LILACS | ID: biblio-1404410

ABSTRACT

ABSTRACT Objectives: Evaluate the surgical treatment of scoliotic curvature effects and sagittal radiographic parameters of the spine and upper limbs after surgical treatment with direct vertebral rotation (DVR) associated with type 1 osteotomy in adolescents with idiopathic scoliosis (AIS). Material and Methods: 41 patients with AIS were evaluated and compared before and after surgery. Scoliosis was confirmed by a radiographic of the spine. The radiographic parameters evaluated were: Cobb angles (proximal and distal thoracic), segmental kyphosis (T5-T12), total kyphosis (T1-T12), cervical lordosis (C2-C7), distance from the center of gravity of the skull to C7 (Cervical VAS), measurement of T1 slope (T1), neck slope, IT slope (AP), angle of the upper chest opening and plumb line C7-S1 (SVA C7-S1). Statistical analysis compared the pre- and post-surgical effects of sagittal cervical and shoulder parameters. Results: After the surgical procedure, significant reductions were observed for the following parameters of spine measurement: proximal and distal thoracic Cobb angle, with a correction of 68% of the main thoracic curve. The measurements of the inclination of the T1 profile and the inclination of the neck also improve after surgery. Regarding the shoulders, there was a reduction in T1 AP slope and intercoracoid angle after surgery. The other radiographic parameters did not show significant differences. Conclusion: Surgical treatment with direct vertebral rotation (DVR) associated with type 1 osteotomy promoted better sagittal radiographic parameters of the thoracic Cobb angles, T1 inclination of the cervical spine, neck inclination, and better shoulder symmetry. Level of Evidence II; Prospective study.


RESUMO Objetivos: Avaliar o efeito do tratamento cirúrgico da curvatura escoliótica, dos parâmetros radiográficos sagitais da coluna e membros superiores após tratamento cirúrgico com rotação vertebral direta (DVR) associada a osteotomia tipo 1 de adolescentes com escoliose idiopática (AIS). Material e Métodos: 41 pacientes com AIS foram avaliados e comparados pré e pós-cirurgia. A escoliose foi confirmada por exame de radiografia da coluna. Os parâmetros radiográficos avaliados foram: ângulos de Cobb (torácico proximal e distal), cifose segmentar (T5-T12), cifose total (T1-T12), lordose cervical (C2-C7), distância do centro de gravidade do crânio até C7 (SVA cervical), medida da inclinação de T1 (T1), inclinação do pescoço, inclinação de TI (AP), ângulo da abertura superior do tórax e linha de prumo C7-S1 (SVA C7-S1). Análise estatística comparando o efeito pré e pós-cirúrgico dos parâmetros sagitais da cervical e ombro. Resultados: Após procedimento cirúrgico observou-se reduções significativas para os seguintes parâmetros de medida da coluna: ângulo de Cobb torácico proximal e distal, com correção de 68% da curva torácica principal. As medidas da inclinação de T1 perfil e da inclinação do pescoço também melhoraram após cirurgia. Com relação aos ombros houve uma redução da inclinação de T1 AP e do ângulo intercoracóideo após cirurgia. Os demais parâmetros radiográficos não apresentaram diferenças significantes. Conclusão: O tratamento cirúrgico com rotação vertebral direta (DVR) associada a osteotomia tipo 1 promoveu melhoria nos parâmetros radiográficos sagitais dos ângulos de Cobb torácica, inclinação de T1 da coluna cervical, inclinação do pescoço e uma melhor simetria dos ombros. Nível de evidência II; Estudo prospectivo.


RESUMEN Objetivos: Evaluar el efecto del tratamiento quirúrgico de la curvatura escoliótica, parámetros radiográficos sagitales de columna y miembros superiores después del tratamiento quirúrgico con rotación vertebral directa (DVR) asociada a osteotomía tipo 1 en adolescentes con escoliosis idiopática (AIS). Material y métodos: Se evaluaron 41 AIS antes y después de la cirugía. La escoliosis se confirmó un examen radiográfico. Los parámetros evaluados fueron: ángulos de Cobb (torácico proximal y distal), cifosis segmentaria (T5-T12), cifosis total (T1-T12), lordosis cervical (C2-C7), distancia del centro de gravedad del cráneo a C7 (VAS cervical), medición de la pendiente T1 (T1), la pendiente del cuello, la pendiente IT (AP), el ángulo de la abertura superior del pecho y la plomada C7-S1 (SVA C7-S1). El análisis estadístico fue para comparar el efecto pre y posquirúrgico. Resultados: Después de cirugía, se observaron reducciones significativas para los siguientes parámetros de medición de la columna: ángulo de Cobb torácico proximal y distal, con corrección del 68% de la curva torácica principal. Las medidas de la inclinación del perfil T1 y la inclinación del cuello también mejoraron después de la cirugía. En cuanto a los hombros, hubo una reducción de la pendiente T1 AP y del ángulo intercoracoideo después de la cirugía. Los demás parámetros radiográficos no mostraron diferencias significativas. Conclusión: El tratamiento quirúrgico con rotación vertebral directa (DVR) asociado a la osteotomía tipo 1 promovió mejores parámetros radiográficos sagitales de los ángulos de Cobb torácicos, inclinación T1 de la columna cervical, inclinación del cuello y mejor simetría del hombro. Nivel de Evidencia II; Estudio prospectivo.


Subject(s)
Humans , Osteotomy , Scoliosis , General Surgery , Upper Extremity
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