Elbow Level Research Articles

A rare case with atypical findings: schwannoma of the radial nerve

A 53-year-old male complained of weakness in the dorsum of the 5-4-3rd fingers of the right hand. The musculus extensor digitorum communis was heavy and the musculus extensor indices proprius was light involved in the needle electroneuromyography study. Radial nerve ultrasonography showed a mass(schwannoma) which located on the radial nerve course after the lateral epicondyle at the elbow level. In conclusion, we should consider radial nerve schwannoma in patients with radial nerve injury and when there is an atypical involvement of the muscles innervated by the radial nerve, we should utilize ultrasonography for evaluation.

Role of Radiation Therapy in Management of Isolated Myeloid Sarcoma: Report of a Case and Review of the Literature

Myeloid sarcoma is an infrequent extramedullary tumor originating from immature myeloid cells and is associated with acute non-lymphocytic leukemia or myelodysplastic syndrome. Recent years have seen advancements in the survival rates of leukemia patients, primarily attributed to a deeper comprehension of the genetic underpinnings of the disease and the development of more effective combinations of chemotherapy and targeted therapies. Notably, the ability to achieve lasting control over systemic disease within the blood and bone marrow has markedly contributed to improved survival rates. However, the emergence of extramedullary relapses can present challenging therapeutic situations, where radiation therapy emerges as a crucial intervention. In light of these considerations, we report the case of a 67-year-old patient, with a history of acute leukemia treated in 2019 in remission and who presents an extramedullary blast localization at the level of the left elbow treated locally by radiotherapy and we have conducted a comprehensive literature review aimed at evaluating the potential role of radiotherapy in managing this rare manifestation of leukemia.

Reverse end-to-side technique (RETS) – supercharge and babysitting effect in median and ulnar nerve injuries. Case studies and surgical technique

High nerve damage at the shoulder or elbow is associated with a long regeneration period for effectorsmuscles located within the hand, leading to their irreversible atrophy and permanent dysfunction. Advanced microsurgical reconstructive techniques, such as end-to-side (ETS ) sutures, reverse end-to-side (RETS ) reconstruction (so-called supercharge/babysitting procedure), or nerve transfers within the hand, shorten the interval and thus the recovery time or provide continuous stimulation of the effector before the regeneration of the native axons of the nerve. The paper aims to present the authors’ results after treatment of a high injury of the ulnar and median nerves with additional RETS performed based on the results of three clinical cases. Two patients No 1 and 2 had a high ulnar nerve injury at the elbow level due to a distal humerus fracture. Nerve neurolysis was performed at the level of the primary lesion, followed by a reverse end-to-side transfer of the anterior interosseous nerve to the deep motor branch of the ulnar nerve. The patient No 3 with damage to the median nerve due to a fracture of the shaft of the radius. Neurolysis of the preserved part of the nerve, resection of the neuroma, and direct suture of the damaged part of the nerve were performed, as well as a simultaneous RETS transfer of the anterior interosseous nerve to the thenar motor branch of the median nerve. All presented patients had significant signs of improvement, with full to partial motor recovery of the nerves supported by supercharge/babysitting RETS technique. It is valuable, especially in borderline cases when the decision is between neurolysis/repair alone or nerve transfer is difficult to take and not clearly defined.

Effectiveness of ultrasound-guided perineural hydro-dissection with 5% dextrose for pronator teres syndrome: a case series

Pronator teres syndrome (PTS) is s a proximal compressive neuropathy of the median nerve at the elbow level by the pronator teres muscle leading to pain and numbness in the area of the nerve distribution. Conservative treatment may be effective in 50-70% of cases with extremity rest and non-steroidal anti-inflammatory drugs, corticosteroids, and surgical decompression. Dextrose perineural hydro-dissection under ultrasound guidance is an interventional therapeutic option in cases of peripheral neuropathy due to nerve entrapment. This is a serial case study investigating the efficacy of dextrose perineural hydro-dissection for long-term pain relief in PTS. A numeric rating scale (NRS) and Quick-DASH (Quick-Disability of the Arm, Shoulder and Hand) were used to evaluate pre- and post-treatment states with ultrasound-guided 5% dextrose hydro-dissection therapy. All patients experienced satisfactory resolution on evaluation twelve months after treatment. In long-term evaluation, dextrose perineural hydro-dissection exhibits good clinical and functional outcomes for patients with PTS.
 Abbreviations: CTS - carpal tunnel syndrome; HD - hydro-dissection; NRS - numeric rating scale; PTS - Pronator teres syndrome; Quick-DASH - Quick-Disability of the Arm, Shoulder and Hand
 Key words: Pronator Syndrome; Pain; Perineural Hydro-Dissection; Median Neuropathy
 Citation: Tua Siahaan YM. Effectiveness of ultrasound-guided perineural hydro-dissection with 5% dextrose for pronator teres syndrome: a case series. Anaesth. pain intensive care 2023;27(5):607−613; DOI:
 10.35975/apic.v27i5.2318
 Received: July 11, 2023; Reviewed: August 27, 2023; Accepted: August 27, 2023

Origin and Distribution of the Brachial Plexus in Two Procyonids (Procyon cancrivorus and Nasua nasua, Carnivora).

Procyon cancrivorus and Nasua nasua are two procyonids with different evolutionary adaptations to use their thoracic limbs. Therefore, this study aimed to characterize the differences in the brachial plexus between both species. Five P. cancrivorus and five N. nasua cadavers were used to perform this investigation with the permission of the bioethics committee and environmental license. Gross dissections were performed on the cervical, pectoral, and thoracic limb regions to find the origin and distribution of the brachial plexus. The brachial plexus of both species originated in a variant manner from C5-T1, C5-T2, C6-T1, or C6-T2. All brachial plexus nerves were observed and, interestingly, the musculocutaneous sent a communicating branch to the median nerve medially to the axillary artery, forming an ansa axillaris in both species. An ansa pectoralis was also observed medially to the axillary artery. Additionally, in P. cancrivorus, the musculocutaneous nerve innervates the pronator teres and flexor carpi radialis muscles and communicates with the median nerve at the elbow level to continue as a common trunk at the antebrachium. The brachial plexus has differences between both procyonids, although in both species, it could conserve a primitive arrangement present within the infraorder Arctoidea.

Efficacy of Butorphanol and Tramadol as an Adjuvant to Levobupivacaine for Postoperative Analgesia in Brachial Plexus Block – A Randomized Double-Blind Study

Background: Supraclavicular brachial plexus block has evolved as a safe alternative to general anaesthesia with good postoperative analgesia. In an attempt to hasten the onset of block and increase the duration of postoperative analgesia, various adjuvant drugs are used along with local anesthetic agents. Aim: The present study was undertaken to assess the analgesic efficacy of butorphanol (2mg) and tramadol (100 mg) as an adjuvant to levobupivacaine in supraclavicular brachial plexus block during perioperative period. Study Design: This was a prospective, randomized, double blind study done on 100 adult patients of ASA I-III aged between 18-65 years and scheduled for various upper limb surgeries below the level of elbow. Materials and Methodology: Patients were allocated by computer generated random draw into two groups of 50 each and were administered the study drugs under ultrasonographic guidance. Both groups received 22ml of the study drug (Group B 20 ml 0.5% levobupivacaine + Butorphanol 2mg and Group T 0.5% levobupivacaine + Tramadol 100 mg). Patients were assessed for duration of postoperative analgesia, onset & duration of sensory as well as motor blockade and occurrence of any side effects. Results: Duration of postoperative analgesia was significantly elevated in group B (683±88.58 min), as compared to group T (483.2±45.24 min.) with p<0.001. Onset of sensory and motor blockade was comparable among both groups (p>0.05). Duration of sensory and motor block in group B was significantly longer compared to group T (p<0.001). Hemodynamics were stable and side effects were minimal in both the groups. Conclusion: Butorphanol 2mg when added to 20ml 0.5% levobupivacaine in brachial plexus block, significantly prolongs the duration of postoperative analgesia, sensory and motor block as compared to addition of 100 mg tramadol, with minimal side effects and hemodynamic changes. However, these adjuvants shorten the onset times of sensory and motor block to a similar extent. Keywords: Brachial plexus block, Levobupivacaine, Butorphanol, Tramadol, Analgesia.

Study Regarding the Upper Limb Range of Motion After Breast Cancer Surgery

"Introduction: Mastectomy surgery in association with local radiotherapy and chemotherapy generates side effects such as: lymphedema, decreased range of motion, chronic pain, cardiotoxicity, neuropathy, premature menopause, infertility, anxiety, depression, fatigue. Decreased range of motion is the most disabling side effect of the treatment. Aerobic and resistive exercises can prevent lymphedema and improve the range of motion of the upper limb on the side of mastectomy. Objective: The purpose of the present study is to verify the effectiveness of an individualized kinetic program, applied to improve the upper limb range of motion after breast cancer surgery. Methods: In this study, 5 subjects (females, aged between 49 and 67) with right radical mastectomy and axillary lympho-dissection were included. They performed a kinetic program twice a week for 6 months and we evaluated the range motion at the level of the upper limb. Results: All the movements performed in upper limb (flexion, extension, abduction, adduction, internal and external rotation) improved, suggesting that the kinetic program is efficient. The average of the flexion movement increased by 35°, from 126° to 161°. The values obtained for the extension movement show an increase of the average by 14.6°. The abduction movement improved from 120° to 170°. At the elbow level, the flexion increased by 24.4° and the extension decreased by 6°. At the wrist level, the flexion increased by 37.4° and the extension increased from 41.8° to 78°. Conclusions: After applying the therapeutic program, the final physical assessments highlights that the range of motion increased in the upper limb. Keywords: breast cancer, range of motion, mastectomy. "

Place of injuries of elbow joint in the structure of primary permanent disability among Ukrainian population

Despite the rapid development of orthopedics consequences of elbow injuries have a significant proportion of unsatisfactory treatment results until now. Owing to comprehend the sources of disability doctors could determine drawbacks of treatment and regulate rehabilitation program for patients with elbow injuries better. The purpose of the study was to investigate the structure of primary permanent disability due to elbow injuries among the Ukrainian population. The study was made on annual reports of Regional centers of medical and social expertise and the Center of medical and social expertise of the city of Kiev for 2018. During the reporting period a disability group due to upper extremity injuries was established totally for 1 211 patients in age over 18 years, among them 195 people had consequences of elbow traumas. That caused an intensive prevalence rate of 6.22 cases per 1 million of adults. Male patients (70.8%) and patients in working age (94.9%) prevailed among people with disability. 10.8% of patients were determined as people with disability without a revision period after the primary examination on medical and social expertise commission. The causes of primary permanent disability were domestic injuries (90.8%), occupational injuries (5.0%), injures during military service and battle injuries (2.1%) and disability since the childhood (2.1%). Structure according to disability groups showed the next distribution: 90.3% – the 3rd group, 9.2% – the 2nd group and 0.5% – the 1st group. Consequences of elbow injuries which led to primary permanent disability were caused by bone fractures (61.5%), elbow contractures and elbow ankyloses (19.0%), injuries of an ulnar nerve (8.7%), traumatic amputation at the elbow level (6.2%), forearm dislocations (3.1%), open wounds of elbow (1.0%), elbow ligaments ruptures (0.5%). Patients registered as disabled with a revision period during the first examination on commission had sufficient rehabilitation potential for restoration of elbow joint function and one of the upper limb in total.

ADDITION OF LOCAL CRYOTHERAPY FOR TREATMENT OF POST-MASTECTOMY LYMPHEDEMA

Worldwide, lymphedema can present as a significant health issue. Left untreated, it can have long-term medical and psychological consequences for patients. Cryotherapy is a new physical therapy modality used for many purposes including reduction of pain, inflammation, and edema. It is thought to decrease interstitial fluid volume through many mechanisms. Therefore, it is reasonable to think that cryotherapy might have a positive effect in treatment of lymphedema. The goal of this study was to investigate how local cryotherapy in combination with standard therapy affects patient outcomes. Forty post-mastectomy female patients aged 40-60 years old with lymphedema were referred to the outpatient clinics of the Faculty of Physical Therapy at South Valley University for medical treatment and follow-up by the vascular surgery department. Patients were randomly divided into two groups of equal size. Traditional physical therapy programs (manual lymphatic drainage, pneumatic compression, bandaging, breathing exercises, circulatory exercises, shoulder mobilizations, and ROM exercises) were combined with pulsed local cryotherapy three times per week for 12 weeks in Group (A). For 12 weeks, Group (B) received only traditional physical therapy three times per week. Patients were evaluated using circumferential measurement with tape at the wrist, below the elbow, and above the elbow level, as well as ultrasonography to assess skin thickness before the start of physical therapy, 6 weeks later, and at the end of the treatment (after 12 weeks). Results indicate that cryotherapy is an effective adjunct modality for the treatment of secondary lymphedema and should be added to physical therapy protocols for lymphedema rehabilitation.

Elbow-Height Handle and Staggered Stance Exhibited Greatest Force in Pushing and Pulling: A Study among Malaysian Adults

Introduction: Pushing and pulling activities are common in daily life and industrial workplaces. These activities are potentially contributing to muscle fatigue in the back and shoulder if not managed ergonomically. Therefore, this study aimed to quantify the maximum strength of Malaysian adults in horizontal symmetrical two-handed pushing and pulling with different handle heights and stances. Methods: Forty-seven participants of 24 males and 23 females were recruited in pushing and pulling experiments. The participants were assistant engineers and postgraduate students of a technical university. The dependent variable was the magnitude of push/ pull force. The independent variables consisted of action, handle height and stances. The experimental design was set for 2 actions, 3 handle heights and 2 stances, yielding 12 variables combinations. Results: Key findings of this study revealed that combination of pull action, handle height at elbow level and staggered stance exhibited greatest force. On the contrary, combination of push action, handle height at knuckle level and parallel stance resulted in lowest force. In pushing test, both male and female participants obtained greatest force of 233.3 N and 121.7 N, respectively, when the handle height was at elbow level and staggered stance. Similarly, in pulling test, males and females obtained highest force of 242.9 N and 152.4 N, respectively. Conclusion: This study concluded that handle height at elbow level and staggered stance exhibited greatest force in pushing and pulling activities. This study provides information to individuals who involved in pushing and pulling tasks with least force exertion to minimize muscle fatigue in the back and shoulder. Future studies should consider the following recommendations: 1) Participants of study should involve manufacturing industry workers. 2) To study the effect of pushing and pulling tasks on muscle activity.

A Three months Electrodiagnostic Follow-Up of Patients Suspected of having Ulnar Nerve Involvement at Elbow Level with Normal Conventional Electrodiagnostic Study at First Evaluation.

Compression of ulnar nerve at the elbow is the second most common peripheral neuropathy of the upper extremity. Due to the lack of the gold diagnostic standard for ulnar nerve involvement at elbow level (UNE) and the lack of sufficient study in this field, we decided to evaluate patients with symptoms of this disease who have normal conventional electrodiagnostic study (EDX) in first evaluation. In this cross-sectional study, 18 persons were selected from patients who were referred to the clinic of Physical Medicine and Rehabilitation. If conventional EDX was normal, compound nerve action potential (CNAP) test (peak latency and amplitude) was carried out. Patients with normal conventional EDX but abnormal ulnar CNAP included to our study. After 3 months, if they had not been treated for ulnar neuropathy, they were reexamined by conventional EDX plus ulnar CNAP measurement. In total, 18 patients (11 females, 7 males) aged 28-58 years old (mean = 40.11) were analyzed in this study. After 3 months, 14 patients (77.8%) demonstrated parameter changes consistent with UNE in conventional EDX. Based on the results of this study, ulnar CNAP has diagnostic value in patients with symptoms of UNE who have normal routine EDX. Therefore, ulnar CNAP should be taken into account for early diagnosis of ulnar neuropathy when routine electrodiagnostic tests are normal.

Riscos ergonômicos e sintomas musculoesqueléticos em técnicos administrativos do Instituto Federal Catarinense durante o teletrabalho na pandemia da COVID-19

ABSTRACT This study aimed to evaluate musculoskeletal symptoms and ergonomic risks in telework environments of administrative technicians at the Instituto Federal Catarinense. In total, 142 administrative technicians who answered an online questionnaire about sociodemographic information, task performance, work environment, and musculoskeletal pain participated in the study. Data were analyzed by binary logistic regression separately for each outcome, using pain in the neck, right shoulder and low back pain as dependent variables. The prevalence of pain among administrative technicians was 92.7% and the most frequent regions were the neck, lumbar spine, and right shoulder. Mental overload (stress), inadequate worktable, monitor and work chair, lack of guidance on ergonomic risks and adaptations in the work environment were the main ergonomic risks. An association was observed between neck pain and administrative technicians who were mentally overloaded, did not practice any physical activity, did not have the table at elbow level, had neither forearms support nor used a mouse (but a touchpad instead); and right shoulder pain in administrative technicians who had no forearm support and used a touchpad. Also, low back pain was associated with mentally overloaded women who did not have footrest, table at the elbow level, or a chair with lumbar support and upholstery. The institution should provide adequate equipment and furniture and training the employees on the ergonomic risks at work.

A rare occurrence of ganglion cysts on the posterolateral aspect of the elbow without neurological manifestations: a case series and review of the literature

ABSTRACT BACKGROUND: The occurrence of ganglion cysts around the elbow is rare, and the occurrence of these lesions without any symptoms of compression to the nearby structures is even rarer. Most published cases of elbow ganglions have reported patients with symptoms relating to compression of the radial nerve, or branches thereof secondary to anteriorly located cysts. We present two cases of ganglions occurring on the posterolateral aspect of the elbow with no pressure symptoms to the radial nerve CASE SERIES: The first case is a 33-year-old male, with a seven-month history of a spontaneous, slow-growing mass on the posterolateral aspect of his left elbow. The second case is a 38-year-old female, with a 12-month history of a spontaneous mass on the posterolateral aspect of her left elbow. In both cases, the reason for presentation was the unsightly elbow with an enlarging mass. The lesions were painless and both patients were neurologically intact with no restriction on range of motion of the joint. Both patients underwent excision of the mass for aesthetic reasons DISCUSSION: Patients with elbow ganglions usually have cysts located anterior to the radiocapitellar joint and almost invariably present with an associated motor, or less commonly, a sensory deficit of the radial nerve. Various treatment modalities have been reported; however, the vast majority undergo open surgical excision due to their association with progressive neurological symptoms. This usually leads to resolution of symptoms, and recurrence is rare CONCLUSION: The clinical presentation of the two patients reported in this case series seems to be far less frequent than patients presenting with a neuropathy of the radial nerve due to an anteriorly located elbow ganglion. It cannot, however, be excluded that there is an underreporting of asymptomatic elbow ganglions. According to our review of the English literature, this is only the third report of an asymptomatic elbow ganglion in the lateral compartment of the elbow Level of evidence: Level 5 Keywords: elbow, ganglion, cyst

Functional Assessment of 3D Printed Prosthesis in Children with Congenital Hand Differences-A Prospective Observational Study

Background: Children with congenital differences who require prosthesis, have special needs due to their growth and psychosocial factors. Cosmetic or body-powered prosthesis provides basic functional needs but poses a financial burden on the family. Prostheses with advanced functions need to be deferred until adulthood. 3D printed prosthesis is a novel alternative being cost-effective for children. Since limited literature is available on the functionality of 3D printed prosthesis and none in the South Asian population, this study was done to assess its utility in congenital hand amputations. Methods: Fourteen children with congenital hand amputations were selected for a prospective observational study. Unilateral below Elbow test (UBET), Box and Block test and ABILHAND questionnaire were used for assessment with and without prosthesis after six months. Results: Eleven patients completed the follow-up. Box and Block test improved from a mean score of 24 to 35 with the prosthesis implying an improvement in manual gross dexterity (p -0.049). UBET (p -0.002) and ABILHAND questionnaire (p < 0.001) showed a decrease in score with the use of a prosthesis which suggested a lack of lateral and tripod pinch in the current design of a prosthesis. Patients with below elbow prosthesis performed better. Conclusions: 3D printed prostheses are an excellent option for use as a transitional prosthesis as they are inexpensive, serves to improve needs with respect to grasping activities at both wrist and elbow level amputation and customizable according to patients' need and limb deficiency and replaceable as the child grows with age. Current designs are useful with respect to grasping activities.

Post-Operative Assessment of Ulnar Nerve Tension Using Shear-Wave Elastography.

Background: Ulnar nerve compression at the elbow level is the second-most common entrapment neuropathy. The aim of this study was to use shear-wave elastography for the quantification of ulnar nerve elasticity in patients after ulnar nerve decompression with anterior transposition and in the contralateral non-operative side. Method: Eleven patients with confirmed diagnosis and ulnar nerve decompression with anterior transposition were included and examinations were performed on an AixplorerTM ultrasound system (Supersonic Imagine, Aix-en-Provence, France). Results: We observed significant differences at 0-degree (p < 0.001), 45-degree (p < 0.05), 90-degree (p < 0.01) and 120-degree (p < 0.001) elbow flexion in the shear elastic modulus of the ulnar nerve in the operative and non-operative sides. There were no statistically significant differences between the elasticity values of the ulnar nerve after transposition at 0-degree elbow flexion and in the non-operative side at 120-degree elbow flexion (p = 0.39), or in the ulnar nerve after transposition at 120-degree elbow flexion and in the non-operative side at 0-degree elbow flexion (p = 0.09). Conclusion: Shear-wave elastography has the potential to be used postoperatively as a method for assessing nerve tension noninvasively by the estimation of mechanical properties, such as the shear elastic modulus.

MO659INITIAL EXPERIENCE OF PERCUTANEOUS ARTERIOVENOUS FISTULA CREATION

Abstract Background Arteriovenous fistulas (AVFs) for hemodialysis are inconstantly used primarily due to problems with maturation and early thrombosis. An endovascular approach -without open surgery- for fistula creation offers another option for establishing a reliable vascular access. By this procedure, a arteriovenous fistula is created in the area of the cubital fossa in the deep vascular system, either between the ulnar artery and the accompanying vein or the radial artery and radial vein and uses the perforating vein at the level of the elbow to transfer blood to the superficial network of the arm. Aim To evaluate the safety, success and maturation rates of percutaneous arteriovenous fistula creation. Materials and Methods From February 2018 to June 2020 (28 months), 30 percutaneous arteriovenous fistulas (pAVF) using the WavelinQ device were created in 30 patients (male: 100%) with end stage kidney disease. Outcome measures were safety, defined as adverse events occurring within the first month of creation, success, defined as the ability to create an anastomosis between the vessels of interest and maturation rates, defined as the ability to perform at least one successful dialysis with the AVF. Secondary outcome measures included procedural complications, secondary procedures, time to cannulation, and AVF survival. Results All cases were performed as day procedures. 23 out of 30 patients (70%) were already on hemodialysis carrying a permanent central venous catheter. Main comorbidities were hypertension (21/30; 70%), diabetes (15/30; 50%) while 11/30 (30.5%) were smokers. Success was 100% (30/30). Mean follow-up was 547 days (range: 14-1071 days). In one case a pseudoaneurysm of the brachial artery was created immediately after sheath removal and in another case, an aneurysm of the AVF anastomosis was observed 17 days post-procedure and AVF was legated with a covered stent placed in the arterial part. In all, 26/30 AVFs (86.6%) were successfully cannulated. Mean time to cannulation was 61.3 days. Another one failed after maturation during the follow-up period. In total, 15 interventions were needed to achieve maturation (15/26; 0.58 procedures per AVF). 5 maintenance endovascular interventions were performed during the follow-up period (5/26; 19.2%). Mean time from cannulation to the end of follow up was 566.2 days (range: 135-1041 days). Conclusion Current analysis suggests that percutaneous AVF creation is safe, successfully performed with high maturation rates. Large scale prospective studies are needed to validate results.

English

BACKGROUND To improve the quality of block (sensory and motor characteristics), postoperative pain management and reduce large doses of local anaesthetics, various adjuvants are used with local anaesthetic agents. We have evaluated dexmedetomidine as an adjuvant to 0.5 % ropivacaine in supraclavicular brachial plexus block in terms of onset and duration of sensory and motor block &amp; duration of postoperative analgesia. METHODS This is a prospective randomised comparative study. 60 patients who were admitted for elective surgeries of the lower arm, at the level of elbow, forearm &amp; hand were enrolled. They were divided in to two groups of 30 patients each as follows - group RD: supraclavicular brachial plexus block given with 30 mL of 0.5 % ropivacaine + 1 mL (100 μg) of dexmedetomidine. Group RC: supraclavicular brachial plexus block given with 30 mL of 0.5 % ropivacaine + 1 mL of normal saline. Various parameters like onset times and durations of sensory and motor block, duration of analgesia, total analgesic needed, and side-effects were recorded for each patient. RESULTS The time of onset of sensory and motor block was significantly early in dexmedetomidine group than in control group. The duration of sensory and motor block was significantly prolonged in group RD as compared to group RC. The duration of sensory block was 724.18 + 73.26 min in group RD (GD) and 582.16 + 93.12 min. in group RC (GC). The duration of analgesia was significantly prolonged in group RD. CONCLUSIONS Addition of dexmedetomidine as an adjuvant to ropivacaine is associated with early onset of sensory and motor block. The duration of sensory and motor block was prolonged. The duration of analgesia was prolonged and patients required less rescue analgesia. The use of dexmedetomidine was associated with reversible bradycardia and sedation score was less KEYWORDS Ropivacaine, Dexmedetomidine, Adjuvant, Supraclavicular Brachial Plexus Block

Changes in Musculoskeletal Discomfort and Postural Alignment According to the Height of the Worktable When VDT Activities were Performed by Patients in a Wheelchair with C6 and T6 Spinal Cord Injuries

Purpose: This purpose of the study was to identify the effects of computer worktable heights on musculoskeletal changes in the neck and upper extremities and postural alignment in patients with C6 and T6 level spinal cord injuries. Materials and Methods: The participants in the present study were patients diagnosed with AIS A. The level of the worktable was set 5 cm below the elbow, at elbow level, and 5 cm above elbow level. Subjective musculoskeletal discomfort (Borg-RPE) was measured at the end of the experiment. To compare the side posture for the wheelchair axle, patients with C6 and the T6 injuries were selected to measure the angle of the centerline for the axle, the tip of the chin, and the postural change for the tragus of the ear. Results: First, in the patient with C6 injuries, the Borg-RPE scores decreased when the worktable height was 5 cm above the elbow, whereas, in the patient with T6 injuries, the Borg-RPE scores decreased when the worktable height was decreased. Second, in the patient with C6 injuries, the chin tip and tragus of the ear were close to the center of the wheelchair when the height of the worktable was 5 cm above the elbow in the lateral position. In the patient with T6 injuries, there was no difference in lateral posture according to the height of the worktable. Conclusion: To reduce musculoskeletal system discomfort in patients during video display terminal (VDT) work, it is necessary to set the worktable height higher than the elbow standard for patients with C6 injuries and lower than elbow height for patients with T6 injuries. In the case of posture change, in the patient with C6 injuries, the higher the worktable height, the more the neck and head changed from forward flexion to a neutral posture.

Angioaccess for hemodialysis in kidney transplantation

Cardiovascular complications represent the main cause of morbidity and mortality in patients with chronic renal disease, so the objective of this article is to demonstrate the influence of the patency of the arteriovenous fistula on echocardiographic variables measured in the left heart. For this, a multivariate study, longitudinal, prospective and controlled study of independent groups after an intervention that included 39 patients who had their angioaccess closed (study group) and 42 who were not exposed to surgery (control group). Both groups exhibited functional kidney transplantation. The main results emerge when comparing the prevalence between the study group and the control group, the average age; 45.6 and 44.1 years, the male sex, 24 (60%) and 23 (53.5%) and the white skin color; 33 (82.5%) and 32 (74.4%). The most frequent etiology of the original nephropathy was hypertensive vascular nephropathy; 12 (30%) vs 14 (32.6%). Among the clinical manifestations, remission of palpitations and dyspnea on exertion were evidenced in the study group. With regard to blood pressure, for the systolic it ranged from 123 ±13.4 to 120.5 ±9.2 vs. 125.6 ±8.4 to 128 ±8.3 mmHg (p= 0.000), while the diastolic varied from; 76.8 ±7.5 to 76.3 ±6.2 vs. 78.6 ±4.9 to 82.4 ±3.9 mmHg (p= 0.000). The hematocrit had equivalent values; 0.43 ±0.06 and 0.45 ±0.06 vs 0.42 ±0.05 and 0.42 ±0.06 l/l (p= 0.035) and the serum creatinine showed decrease in the operated patients from; 106.8 ±26.2 to 99.8 ±23.9 μMol/l vs 114 ±27.8 to 120.3 ±31 μMol/l (p= 0.002). The echocardiographic variables measured comparatively according to the location of the angioaccesses at the left elbow level; diameter of the left ventricle: 3.12 ±4.08 vs 1.48 ±3.46 mms (p=0.001), ejection fraction of the left ventricle: 2.99 ±5.47 vs -1.98 ±6.23 % (p=0.018) and the telediasolic volume: -23 ±33.41 vs 10.86 ±36.87 ml (p=0.006). The contralateral elbow revealed; for the left ventricular ejection fraction: 3.32 ±3.42 vs -2.18 ±4.78 % (p=0.037) and for cardiac output: -1.29 ±0.88 vs -0.26 ±0.86 l/min (0.020). The conclusions show that the our study has shown that closing the angioaccess to patients with functioning renal transplants with respect to those not operated, contributes to the regression of morphological and hemodynamic alterations observed by transthoracic echocardiography in the left heart at the different locations of the vascular accesses.

Contribution of Imaging to the Diagnosis of Non-Traumatic Tendinopathies of the Thoracic Limb in a Resource-Constrained Country

Introduction: Tendinopathy of the thoracic limb (TMT) is frequent, and is responsible for an important socio-professional handicap. Medical imaging, in particular, ultrasound has a major role in contributing to the diagnosis. As the use of ultrasound is recent in osteoarticular pathology, especially in Africa, we proposed to determine the contribution of imaging in the diagnosis of tendinopathy of the thoracic limbs in a country with limited resources. Patients and Method: A descriptive and analytical cross-sectional study of patients with tendinopathy of the thoracic limb who consulted the rheumatology department of the CNHU-HKM of Cotonou from August 6, 2019 to October 6, 2019. We evaluated the concordance of thoracic limb tendinopathy between imaging (radiography and ultrasound) and the clinic on the one hand and then between radiography and ultrasound on the other hand. The analysis of the collected data was carried out with the Epi-info software version 7.2.1.0. Then the concordance was evaluated by the kappa coefficient. Results: Fifty- two (52) patients with 104 joints were evaluated. The average age was 54.92 ± 3.40 years. Clinically, rotator cuff tendinopathy was the most frequent abarticular pathology (45.19%). The clinical-ultrasound agreement was strong (k = 0.7527) for the shoulders, very strong (k = 0.9360) for the elbows and moderate for the wrists (k = 0.6695). The clinical-radiographic agreement was weak (k = 0.2316) at the shoulder level and very weak (k = 0.2087) at the elbow level. The radio-ultrasound agreement was very low in the shoulders (k = 0.1522), elbows (k = 0.1859) and wrists (k = 0.0001). Conclusion: The contribution of imaging in the diagnosis of TMT remains certain even in a country with limited resources like ours. Ultrasound is a reliable examination for the diagnosis of non-traumatic tendinopathy of the thoracic limb with a good clinical-ultra- sound concordance and a weak radio-clinical and radio-ultrasound concordance.