Extremity Disorders Research Articles

Congenital and Pediatric Upper Extremity Disorders

Congenital and Pediatric Upper Extremity Disorders

Cheiroarthropathy: A Common Disorder in Patients in the T1D Exchange

Diabetic cheiroarthropathy is a long-term complication of diabetes that causes significant morbidity and can impair functional abilities. It has not been well studied in individuals with type 1 diabetes (T1D). The T1D Exchange registry provided an opportunity to assess the frequency of cheiroarthropathy and related characteristics. An internet-based survey was sent to 6,199 registry participants ≥18 years old, with 1,911 (31%) responding (62% female, 90% non-Hispanic White, mean age 40 years, median diabetes duration 20 years, mean glycated hemoglobin [HbA1c] 7.7% [61 mmol/mol]). A total of 586 (31%) adults reported a diagnosis of ≥1 upper extremity disorder: 293 (15%) reported frozen shoulder, 293 (15%) trigger finger, 261 (14%) carpal tunnel, and 92 (5%) Dupuytren contracture, with 281 (15%) reporting ≥2 disorders. Those with upper extremity joint disorders were more likely older ( P<.001) and had longer duration of diabetes ( P<.001) than those without. HbA1c levels at the time of survey completion were 7.6% in participants with cheiroarthropathy versus 7.8% (62 mmol/mol) in participants without cheiroarthropathy. Cheiroarthropathy is common in adults with T1D. Additional research is needed to understand the pathogenesis and risk factors for this disorder. Standards of care for early recognition and treatment of diabetic cheiroarthropathy are also needed, particularly for adults with long-term diabetes. Improved awareness of cheiroarthropathy signs and symptoms of is needed so that patients can be identified and seek treatment before the condition causes disability. BMI = body mass index; CGM = continuous glucose monitor; DCCT/EDIC = Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications; HbA1C = glycated hemoglobin; T1D = type 1 diabetes; T2D = type 2 diabetes.

Evaluation of ergonomic working conditions among standing sewing machine operators in Sri Lanka

BackgroundStanding Sewing Machine Operators (SSMOs) are engaged in highly repetitive operations, and work while standing during their entire working hours. This leads to discomforts and Musculoskeletal Disorders (MSDs). However, there is a dearth of research in SSMOs’ working conditions.Objective: Aim of the study is to evaluate the prevalence of MSDs and related ergonomic risk factors among SSMOs in the Sri Lankan textile industry.Methods: The sample included 552 female sewing machine operators. Data were collected through self-reported questionnaires which included demographic, job-related factors and Cornell Musculoskeletal Discomfort Questionnaire [CMDQ], along with the application of validated ergonomic tools (Rapid Entire Body Assessment [REBA] and Strain Index [SI]) to assess the ergonomic risks amongst them. The inter-rater reliability test ensured the reliability among observers. An individual regression model was developed for each body parts to assess the associated risk factors.Results: The highest occurrence of musculoskeletal symptoms were in knee, foot, thigh, lower leg and lower back of SSMOs. REBA grand score (4–11) indicated that workers’ postures were at medium, high and very high risk levels necessitating evaluation to change. Moreover, SI indicated medium and high risk of upper extremity disorders. Finally, regression models revealed associated risk factors with musculoskeletal symptoms among various body parts including age, Body Mass Index (BMI), marital status, SSMO experience, job satisfaction, job stress, daily walking distance to the boarding place/factory, interest in job rotation and satisfaction with the design of sewing machine.Conclusion: The findings highlighted that the prevalence of discomfort and MSDs in the lower limbs were higher than in the upper limbs among SSMOs. The findings revealed the working conditions of SSMO and emphasised the need for ergonomic interventions to minimise the MSDs among them. Relevance to industryThe findings highlighted ergonomic risks among SSMOs and associated risk factors which will help managers and researchers better understand the working conditions of SSMOs. The identified risk factors could be considered during the implementation of standing sewing operation layouts and during the selection and allocation of new employees.

Postural Disorders of the Lower Extremities in Children of the Younger School Age

Postural Disorders of the Lower Extremities in Children of the Younger School Age

Novel mutation of SCN9A gene in a family with Paroxysmal Extreme Pain Disorder (PEPD): Considerations of paediatric interest

Introduction: Paroxysmal Extreme Pain Disorder (PEPD) is a rare autosomal dominant disease, caused by mutations in the SCN9A gene, which encodes the NaV1.7 voltage-gated sodium channel alpha subunit. Symptoms generally begin in early infancy with episodes of excruciating, burning and spreading pain in the lower part of the body, typically in the anorectal area, which can last from seconds to hours. Case description: We describe the case of a 5-year-old male with PEPD and a novel heterozygous mutation c.5825c>T (p. Thr1942ile) in the SCN9A gene. This is a novel mutation that has not previously been reported. Discussion: According to the available information, the clinical significance of the variant c.5825c>T (p. Thr1942ile) is unknown. However, its presence in the patient and in others affected family members, reinforces its possible pathogenicity and is suggestive of mutation segregation with the disease in this family. Conclusion: We consider that it is a family case of interest to the pediatrician, for allowing: 1) To be able to intuit it by the clinic early and 2) To be able to confirm it by means of the corresponding genetic study.

Prevalence and Compatibility of Chronic Venous Disorders of Lower Extremities, Restless Legs Syndrome,Anxiety and Depressive Conditions Among Employees of Enterprises in the Moscow Region

Prevalence and Compatibility of Chronic Venous Disorders of Lower Extremities, Restless Legs Syndrome,Anxiety and Depressive Conditions Among Employees of Enterprises in the Moscow Region

The World after Ebola: An Overview of Ebola Complications, Vaccine Development, Lessons Learned, Financial Losses, and Disease Preparedness.

The 2014-2016 Ebola outbreak in West Africa was the largest of its kind with 11,000 deaths and approximately 28,637 affected cases. The aim of the study was to analyze the global situation after the Ebola outbreak including Ebola complications, vaccine development, lessons learned, financial losses, and disease preparedness. We searched in PubMed, Google, and Google Scholar by using keywords Ebola virus, Ebola vaccine development and Ebola virus transmission, the world after Ebola, financial losses by Ebola outbreak, and disease preparedness. Ebola virus disease is a complex disorder associated with gastrointestinal, hepatic, renal, respiratory, cardiovascular, and neurological complications. Ebola virus persisted in the semen of male infected patients for 470 to 565 days, and the chances of viral transmission by sexual contacts remained high even after patient recovery. There are several reports of extreme socioneuropsychological disorders in Ebola survivors and Ebola healthcare workers. There is no Food and Drug Administration-approved drug or vaccine for Ebola. Many research groups are working to develop a vaccine against Ebola by using different biotechnology techniques. Some vaccine candidates, including replicating vesicular stomatitis virus and Chimpanzee adenovirus-3, have entered phase III clinical trials and are expected to receive clinical licensing in coming years. The West African Ebola epidemic caused a financial loss of $6 billion in Africa and an additional global economic loss of more than $12 billion. After the Ebola epidemic, four global commissions were established for disease preparedness. A proposition was also forwarded to the World Health Organization for the establishment of the Centre for Emergency Preparedness and Response for the disease management. The devastating Ebola epidemic opened the window for disease preparedness to face any future disease epidemic.

Pattern of muscle contraction in different postures among Malaysia pineapple plantation workers

Lower extremity disorders is associated with prolonged and awkward postures such as kneeling, squatting and stooping. Current study aims to examine the risk factors of awkward postures among pineapple plantation workers in Malaysia by using Ovako Working Posture Analysis System (OWAS). The postural analysis output from OWAS is then compared and validated by using Surface Electromyography (sEMG). There are 103 pineapple plantation workers participated in this study with an average working experience of 1 to 3 years. Based on OWAS findings, it shows for an overall distribution, planting, manual weeding and harvesting are the tasks fell under Action Category (AC) 3 which indicating distinctly harmful and (AC) 4 which indicating extremely harmful. The readings of muscle activity during selected postures show that erector spinae and multifidus muscle are actively contracted during kneeling, squatting and stooping posture. The results from this study signify that long exposure to these postures can increase the likelihood of having WMSDs such as back pain and lower limb injuries among pineapple plantation workers. This study suggests that ergonomic intervention such as mechanization of tools and equipments should be implemented in order to eliminate or reduce poor postures. In case of incapability for any mechanization, adequate and effective training should be provided for the workers as they can apply the knowledge through their job.

Binding Affinity and Function of the Extremely Disordered Protein Complex Containing Human Linker Histone H1.0 and Its Chaperone ProTα.

It was recently reported that human linker histone H1.0 and its chaperone prothymosin-α (ProTα) form an extremely disordered 1:1 complex with an ultrahigh affinity (equilibrium dissociation constant KD of ∼2 × 10-12 M) measured using a single-molecule Förster resonance energy transfer method. It was hypothesized that the ultrahigh affinity and extreme disorder may be required for the chaperone function of ProTα, in which it displaces the linker histone from condensed chromatin. Here, we measure the binding affinity for the ProTα-H1.0 complex using isothermal titration calorimetry and report a KD value of (4.6 ± 0.5) × 10-7 M. In addition, we show that ProTα facilitates the formation of the H1.0-nucleosome complex in vitro. The results of our study contrast with those of the previous report and provide new insights into the chaperone function of ProTα. Possible causes for the observed discrepancy in binding affinity are discussed.

Determining functional activity profiles in patients with upper extremity disorders: is there effect modification by hand-grip strength?

PurposeThe purposes of this study were to investigate the effect of hand-grip strength (HGS) on the Disabilities of the Arm, Shoulder, and Hand (DASH) score in women with upper extremity musculoskeletal disorders (UEMDs) living in rural communities and examine whether upper extremity diseases affected upper extremity functional activity in each group (normal/low HGS) and whether grip strength (GS) was an effect modifier in upper extremity functional activity.MethodsA total of 239 women older than 60 years who had completed a medical workup for epicondylitis, rotator cuff tears, and/or hand osteoarthritis were included in the final study. Functional activity was assessed by DASH, and muscle strength was measured by GS. Low HGS was defined according to the Asian Working Group for Sarcopenia (HGS <18 kg in women). Pearson correlation analysis was performed to evaluate the relationship between HGS and the DASH score. A multiple regression analysis was performed after defining DASH as a dependent variable and dividing subjects into two groups (low HGS and normal HGS). Statistical analyses were performed using SPSS Statistics V.24.ResultsHGS in the participants correlated with the DASH score (r=−0.320, P<0.001). In the low HGS group, waist circumference (B=−0.526, P=0.010) and the DASH score were significantly correlated. In addition, DASH scores were statistically significantly increased as the number of upper extremity diseases increased to 2 (B=11.592, P=0.016) and 3 (B=15.716, P=0.001). The DASH score in the normal HGS group was correlated with the Patient Health Questionnaire-2 score (β=2.680, P<0.001) after adjusting covariates.ConclusionWe found that HGS in UEMD patients affected health-related quality of life as measured by the DASH. Maintaining hand muscle strength may improve patient functional activity in age-related UEMDs.

Patient Experiences of Participating in Mind–Body Interventions in an Outpatient Rehabilitation Setting

Abstract Date Presented 4/20/2018 This study explored the experiences of eight patients with upper extremity disorders who participated in mind–body interventions in outpatient rehabilitation. Using a qualitative descriptive method, four themes emerged, alluding to multiple benefits of holistic practice. Primary Author and Speaker: Sandy Takata Contributing Authors: Shawn C. Roll

Shoulder tendon characteristics in disabled swimmers in high functional classes – Preliminary report

ObjectiveTo characterize disabled swimmers in comparison to an able-bodied swimmers for (1) supraspinatus tendon thickness, (2) subacromial space and (3) occupation ratio. DesignCross-Sectional Study. SettingResearch laboratory. ParticipantsDisabled swimmers with upper (DSw-Upper) (n = 8) and lower (DSw-Lower) (n = 7) extremity disorders. The DSw-Upper were classified in sports class S7-S8, while DSw-Lower in S9-S10. The control group had 15 able-bodied swimmers. Main outcome measuresUltrasound images of (1) supraspinatus tendon in short axis and long axis, (2) subacromial space, and (3) occupation ratio. ResultsA thicker supraspinatus tendon in short axis was observed in DSw-Upper versus C-Sw (p = 0.012) and DSw-Upper versus DSw-Lower (p = 0.018); and in long axis for DSw-Upper versus CSw (p = 0.0001), and DSw-Upper versus DSw-Lower (p = 0.002). There was a greater occupation ratio in DSw-Upper versus DSw-Lower in short axis (p = 0.013) and long axis (p = 0.035). ConclusionsThe present study showed a thicker supraspinatus tendon and greater occupation ratio with the tendon occupying more of the subacromial space that may predispose upper extremity disabled swimmers to tendon disorders such as subacromial impingement syndrome. Ultrasound examination can be used to assess shoulder tendon characteristics and the relationship to the subacromial space, to determine potential for injury and training load monitoring.

Charge-Induced Disorder Controls the Thermal Conductivity of Entropy-Stabilized Oxides.

Manipulating a crystalline material's configurational entropy through the introduction of unique atomic species can produce novel materials with desirable mechanical and electrical properties. From a thermal transport perspective, large differences between elemental properties such as mass and interatomic force can reduce the rate at which phonons carry heat and thus reduce the thermal conductivity. Recent advances in materials synthesis are enabling the fabrication of entropy-stabilized ceramics, opening the door for understanding the implications of extreme disorder on thermal transport. Measuring the structural, mechanical, and thermal properties of single-crystal entropy-stabilized oxides, it is shown that local ionic charge disorder can effectively reduce thermal conductivity without compromising mechanical stiffness. These materials demonstrate similar thermal conductivities to their amorphous counterparts, in agreement with the theoretical minimum limit, resulting in this class of material possessing the highest ratio of elastic modulus to thermal conductivity of any isotropic crystal.

Electronic transport and phonon properties of maximally disordered alloys: From binaries to high-entropy alloys

Abstract

Noninvasive quantitative assessment of microcirculatory disorders of the upper extremities with 2D fluorescence optical imaging.

Quantitative Imaging of microcirculatory disorders is challenging. To investigate the feasibility of 2D Fluorescence Optical Imaging (FOI) for characterization and quantification of microcirculatory disorders in peripheral arterial occlusive disease (PAOD) of the upper extremity. 9 patients with various clinical presentations of PAOD of the upper extremity were included. Quantitative analysis of both hands was performed by assessing the fluorescence intensity of Indocyanine Green (ICG) dynamically over a time period of 360 seconds. Analysis of the signal intensity within multiple regions of both hands was calculated and time-dependent perfusion curves for each region of interest were plotted over time. Compared to the healthy, vascular non-impaired segments, pathological segments with an impaired tissue perfusion were identified through a decreased rate of early tissue enhancement (p = 0.02) and increased signal intensity of the optical perfusion agent per second (p < 0.001). The affected segments showed a decreased maximum signal intensity and a prolonged interval to reach the maximum signal intensity (time to peak). 2D FOI allows quantitative assessment of the peripheral microcirculation in various vascular pathophysiologies and is able to detect the impaired tissue perfusion in patients with vascular disorders of the upper extremity.

TLR4-MyD88 pathway promotes the imbalanced activation of NLRP3/NLRP6 via caspase-8 stimulation after alkali burn injury

Alkali burn (AB) is one of the most serious ocular traumas in the world, characterized by extreme ocular surface disorders, critical secondary dry eye and irreversible vision loss. The exact mechanisms involved are unknown. Innate immunity, including the involvement of Toll-like receptors (TLRs) and NOD-like receptors (NLRs), is believed to participate in the pathogenesis of the epithelia, but the exact mechanisms by which TLRs transduce signals to NLRs and downstream molecules to initiate innate immunity remain poorly defined. In this present study, we used murine models of AB and AB concomitant desiccating stress (DS) to investigate the potential functions and mechanisms of TLR4 in regulating NLRP3 and NLRP6 during AB injury and secondary dry eye. We demonstrated that AB injury induced activation of the TLR4-MyD88 pathway, leading to imbalanced NLRP3 and NLRP6 via the activation of caspase-8 signaling. DS worsened ocular surface disorders post-AB injury by magnifying this phenomenon. Caspase-8 signaling promoted NLRP3 upregulation via the nuclear factor (NF)-κB pathway, while NLRP6 suppressed NF-κB activation. Our findings also revealed that TLR4-MyD88 knockout can alleviate AB-induced or DS-worsened ocular surface disorders, shedding light on the potential therapeutic strategies in the future for AB injury. Taken together, our findings demonstrate that AB promotes the TLR4-MyD88-caspase-8 axis to cause imbalanced NLRP3/NLRP6, and DS exacerbates ocular surface damage via magnifying this imbalance.

A personalized self-management and intensive spa therapy intervention for musculoskeletal disorders of the upper extremities contributes to reduce disability: A randomized controlled trial

Musculoskeletal disorders (MSDs) constitute a major occupational health problem in the working population. MSDs manifest as localized pain or functional difficulty in one or more anatomical areas, such as the cervical spine, shoulder, elbow, hand, and wrist. Although physical exercise is widely recommended, few studies with a good level of evidence have enabled us to base a complete, well-constructed intervention on exercise that can be offered as secondary prevention in these disorders. A prospective, multicenter, comparative, randomized study using Zelen's design. This study falls under active prevention of MSDs of the upper extremities. Participants are workers aged between 18 and 65 years, with any type of job or workstation, with or without a history of sick leave. The primary aim is to show the superiority at 3 months of a combination of spa therapy, exercise, and self-management workshops for 6 days over self-management workshops in terms of employee functional capacity in personal and professional daily life (QUICK DASH scale). We included 148 patients, 73 assigned to the intervention group and 75 to the control group. At 3 months, the total score of functional disability assessed by QUICK DASH decreased in both groups. This reduction was higher in the intervention group (−10.04 ± 15.83) versus control group (−5.57 ± 13.45). We noticed a non-significant decrease for QUICK DASH total score ( P = 0.10). However, the field specifically assessing disabilities in physical activities; QUICK DASH sport; had significantly decreased in the intervention group (−14.58 ± 21.49) versus control group (−6.72 ± 19.04) ( P = 0.02). The originality of this intervention lies, in its short, intensive format, which is compatible with remaining in work; and in its multidisciplinary approach. This trial demonstrates the benefits of a short course of spa therapy combined with a personalized self-management program on the functional capacity in their daily life.

Associated Joint Pain with Controlled Ankle Movement (CAM) Walker Boot Wear

Category: Ankle Introduction/Purpose: A controlled ankle movement (CAM) walker boot is often prescribed for patients with a lower extremity injury or disorder. CAM boot wear, however, may cause gait alterations and leg-length discrepancy, which are commonly associated with joint pain. This study evaluates the location, frequency and duration of secondary site pain relating to immobilization in a CAM walker boot. Methods: Patients wearing a CAM walker boot for treatment of a foot or ankle injury were prospectively enrolled and evaluated for new or worsened secondary site pain. Surveys at four time points were completed to evaluate the presence of secondary site pain, its severity, and its impact on overall function. Results: The final study population included 46 patients (mean age 49 years). At transition out of the boot (mean, 4.2 weeks), 31 patients (67%) reported secondary site pain either new or worse than baseline with an average of 1.6 secondary pain sites. The secondary sites most susceptible to pain were the lower back, contralateral hip, and ipsilateral knee. A majority (84%) of these pains began within the first two weeks of boot wear. Secondary site pain was less common after transition out of the boot: 18 patients (39%) at 1 month, 15 patients (33%) at 3 months. The mean VAS for secondary site pains at transition out of boot was 51.2. Statistical significance was found correlating secondary site pain and a history of chronic pain (P=.04). Conclusion: Secondary site pain after CAM walker boot wear was common. The frequency and severity of pain lessened with time after transition out of the boot. Yet, one-third of patients still had new or worsened secondary site pain three months after cessation of boot wear.

Lesiones musculoesqueléticas de extremidades superiores en trabajadores de una fábrica de cartón

Objetivo: Determinar la relación entre trastornos musculoesqueléticos de extremidades superiores y las actividades laborales realizadas por trabajadores de líneas de impresión de cajas de cartón.Métodos: Estudio correlacional y transversal. Población de estudio 50 trabajadores de líneas de impresión de cajas de cartón. Se utilizó el cuestionario nórdico de Kuorinka, historia clínica, maniobras y signos específicos de extremidad superior, análisis ergonómico del puesto de trabajo y método RULA.Resultados: Los resultados del cuestionario nórdico muestran en primer lugar sintomatología en muñecas con un 58%. Las maniobras y signos clínicos específicos con mayor frecuencia reportados como positivos fueron Jobe, Gerber, Phalen, Finkelstein y Flick. El método RULA arrojó un nivel riesgo 4 de 4 en todos los puestos con actuación de cambios urgentes en las tareas.Conclusiones: Las actividades laborales que realizan en la línea de impresión de cajas de cartón están relacionadas con la sintomatología y generación de lesiones muscuoloesqueléticas en extremidades superiores en la población de estudio.

Selected clinical syndromes of genetic variability in pain sensation

Pain sensation is variable both in animals and humans. Factors that influence the threshold and intensity of pain include race, ethnic origin, sex, material standard of living, stress exposure, environmental conditions and genetic factors. Methods used to identify potential gene variants responsible for the development of pain syndromes include identification of mutation or single nucleotide polymorphism (SNP), analysis of genetic variability in twins, and recently, genome wide association study (GWAS). Pain sensation disorders are the result of a single mutation, as in Biemond syndrome (congenital analgesia), erythromelalgia and paroxysmal extreme pain disorder, or polygenic mutations, as in fibromyalgia and migraine. Sensation of pain starts when the stimulus acts through chemical mediators to activate nerve endings. The signal is then transduced through neurons and spinal pathways to the brain. This process involves synaptic neurotransmitters, membrane receptors, neuromodulators and cell structures that ultimately affect the intensity of pain. The objective of this paper is to present selected clinical syndromes of genetically determined pain sensation disorders and the use of genetic diagnostics in explaining their cause.