Superior Limb Research Articles

Impaired Femoral Vascular Compliance and Endothelial Dysfunction in 30 Healthy Male Soccer Players: Competitive Sports and Local Detrimental Effects.

Background:Despite beneficial effects of physical activity on cardiovascular risk, discordant data on elite athletes (high atherosclerotic damage in activity comprising strenuous exertion) and retired sportsmen are reported in the literature.Hypothesis:We hypothesize that long-lasting daily physical activity could affect the morphology and function of the carotid and femoral vessel walls differently, as assessed in elite male athletes aged 20 to 30 years compared with age- and sex-matched healthy controls.Study Design:Retrospective case-control study.Level of Evidence:Level 3.Methods:Sixty male subjects (30 athletes and 30 controls) underwent medical examination for ankle brachial index, augmentation index (AIX) and AIX corrected for heart rate (AIXr), peripheral arterial tonometry (PAT), and intima media thickness and pulse wave velocity assay at common carotid (carotid–intima media thickness [c-IMT], carotid–pulse wave velocity [c-PWv]) and femoral arteries (femoral–intima media thickness [f-IMT], femoral–pulse wave velocity [f-PWv]) assessed by ultrasonography using Doppler ultrasound.Results:Athletes showed a significantly lower heart rate (HR) at rest and a better lipid profile than controls. In athletes, c-PWv (5.87 ± 0.80 vs 6.62 ± 1.02 m/s, P = 0.001) and f-PWv (8.96 ± 1.29 vs 7.89 ± 1.39, P = 0.002) were, respectively, significantly lower and higher than values found in controls; accordingly, carotid AIX (4.03 ± 6.21 vs 7.81 ± 5.21, P = 0.003) and femoral AIX (8.56 ± 10.21 vs 6.09 ± 7.95, P = 0.042) were lower and higher than control values, even after correction for heart rate (P = 0.03). On the other hand, IMT values were significantly higher in controls than in athletes (c-IMT, P < 0.0001; f-IMT, P < 0.0001). A positive significant correlation between HR and c-IMT and f-IMT (r = 0.527, P < 0.001 and r = 0.539, P < 0.0001, respectively) and between HR and c-PWv (r = 0.410, P = 0.01) was found when controls and athletes were considered as a whole group. Soccer players showed lower PAT values in comparison with controls (P = 0.002).Conclusion:Elite sports positively affect c-IMT, f-IMT, and carotid PWv and AIX but not femoral PWv, AIX, AIXr, or PAT.Clinical Relevance:Physical activity affects vascular beds in elite athletes differentially, depending on the rate of superior or inferior limb involvement in different sports. In soccer players, physical activity has a protective effect on carotid and femoral vessel walls but worsens femoral arterial and endothelial function. These findings highlight how different results can be shown on carotid and femoral districts, when these vascular districts are differently stressed during sport activity.

Extracorporeal Shock Waves in the Treatment of Equinovarus Foot in a Duchenne Patient: A Case Report

Background: Duchenne muscular dystrophy (DMD) is characterized by a progressive muscular weakness, with loss of independent ambulation. When the disease results in the complete loss of ambulation, one of the purposes of treatment during the latest phase is to prevent or reduce complications such as foot deformities. A 20-year-old DMD patient had a complete loss of muscular strength in the inferior and superior limbs and a severe bilateral clubfoot deformity. Active movements were not possible, while passive motion was very limited in dorsiflexion and pronation, inversion and eversion, with stronger limitation on the right foot.

Swimming, physical activity and health: a historical perspective

Swimming, which is the coordinated and harmonic movement of the human body inside a liquid medium by means of the combined action of the superior and inferior limbs, is a physical activity which is diffused throughout the whole world and it is practiced by healthy and non-healthy subjects. Swimming is one of the physical activities with less contraindications and, with limited exceptions, can be suggested to individuals of both sexes and of every age range, including the most advanced. Swimming requires energy both for the floating process and for the anterograde progression, with a different and variable osteo-arthro-muscular involvement according to the different styles. The energetic requirement is about four times that for running, with an overall efficiency inferior to 10%; the energetic cost of swimming in the female subject is approximately two thirds of that in the male subject. The moderate aerobic training typical of swimming is useful for diabetic and hypertensive individuals, for people with painful conditions of rachis, as also for obese and orthopaedic patients. Motor activity inside the water reduces the risk of muscular-tendinous lesions and, without loading the joints in excess, requires the harmonic activation of the whole human musculature. Swimming is an activity requiring multiple abilities, ranging from a sense of equilibrium to that of rhythm, from reaction speed to velocity, from joint mobility to resistance. The structured interest for swimming in the perspective of human health from the beginning of civilization, as described in this contribution, underlines the relevance attributed to this activity in the course of human history.

Designing Functional Clothes for Persons with Locomotor Disabilities

Abstract The life quality improvement issue is a problem of national and international interest. This acquires total different values when it is to refer to a series of disadvantaged categories, that is the persons with locomotor disabilities. It is an inevitable social responsibility to create equal opportunities for disabled people, to prevent any intentional or unintentional discrimination that they face and apply positive discrimination if necessary to improve their living standards and to let them have an equal share from social development as productive individuals of society. A disability is any kind of restriction or inability to accomplish a certain activity, which belongs to the interval considered as “normal” for a human being. Disabilities are characterized by deficiencies or excesses in the activity or behaviour that is normally expected from a person; they can be temporary or permanent, reversible or irreversible, progressive or regressive. The physical disabilities that require the use of wheelchairs imply the manufacturing of special clothing products that meet certain needs at a functional and/or therapeutic level. The study presents the main aspects involved in designing and developing textile products for this category of users. Therefore, the apparel that is specially designed for persons with disabilities has to: allow more freedom and independence when is being worn, correspond to the aesthetic point of view, offer psychological benefits and help to socially integrate the individual who wears it. In addition, clothes should not hinder the individual’s mobility and must allow the use of the chest and of the superior limbs to the maximum, they must be durable, have a low level of electrostatic charge, be absorbent and comfortable, present the so-called “rehabilitation functions”, and last but not least, be beneficial for the wearer both from a physical and psychological point of view.

Intraoperative Photodynamic Surgery (iPDS) with Acridine Orange for Musculoskeletal Sarcomas

We recently established the new limb salvage modality of acridine orange (AO) therapy (AOT), in an attempt to develop minimally invasive limb salvage surgery with minimal damage of normal tissues and a low risk of local recurrence. The treatment modality consists of intraoperative photodynamic surgery (iPDS) and photodynamic therapy (iPDT), followed by postoperative radiodynamic therapy (RDT) using AO for patients with high-grade malignant musculoskeletal sarcomas. Clinical results have shown that the treatment is associated with a low risk of local recurrence, the risk being almost the same as that following conventional wide resection, and yields superior limb function as compared to that obtained after wide resection. In this review, we present the detailed mechanism of selective accumulation of AO in sarcomas, which is related to the acidic environment and lysosomal acidity of the tumor cells induced by cancer-specific glycolysis not involving the define tricarboxylic acid (TCA) cycle (Warburg's effect). We also describe the clinical uses of AOT and the procedure for intraoperative photodynamic surgery (iPDS) using local administration of AO.

The lower border of the zygomatic arch could be a better landmark for the middle fossa dura: Cadaveric dissection study

BackgroundDural injury and CSF otorrhea is a serious complication during mastoidectomy especially in low level dura. ObjectivesAim of the study is to determine a reliable landmark for the middle fossa dura to minimize risk of dural injury and CSF otorrhea during mastoidectomy. By answering the question which is considered as a more fixed landmark for the dura; the supramastoid crest or the lower border of the zygomatic arch? MethodsA cadaveric study was done on 204 temporal bone specimens in the temporal bone lab at the Ain Shams University Specialized Hospital.A correlation between the level of the supramastoid crest and the level of the zygomatic arch was done.A correlation between the level of the dura and the level of the supramastoid crest in the area of mastoid antrum was done.A correlation between the level of the dura and the level of the zygomatic arch was done. ResultsIn 20.6% of specimens, the dura lies at a lower level than the level of the supramastoid crest but in 2.9% of specimens the dura lies at a lower level than the lower border of the zygomatic arch. ConclusionIt is better to consider the lower border of the zygomatic arch as a reliable landmark of the middle fossa dura in the area of the antrum than to consider the supramastoid crest as a landmark for the dura. It is better to consider imaginary line directed posteriorly from the lower border of the zygomatic arch as a superior limb of the Macewen triangle.

AB0986 Electromyography and Biochemistry Characterization of Patients with Pain and Muscle Weakness - Extended Cohort

BackgroundMuscle damage, often manifested as muscle weakness and, rarely as muscle pain is common in rheumatic diseases. These include idiopathic inflammatory myopathies (IIM), and myopathy seen in other rheumatic diseases,...

Takayasu’s arteritis in pregnancy – a case report

We present a case report of pregnant woman with Takayasu's arteritis diagnosed in childhood. The treatment was modified owing to the fact that the patient wished to get pregnant and she conceived spontaneously within the first year after that. Vasculitis activity was low during pregnancy Hypertension was treated with methyldopa and metoprolol. After the confirmation of pregnancy daily administration of prednizone and enoxaparin (at a dose of 5 mg and 40 mg, respectively) has been started. In the third trimester of pregnancy the values of blood pressure increased. The patient required higher doses of antihypertensive drugs. Proteinuria appeared in the daily urine collection. The values of liver enzymes have increased. Elective cesarean section was performed at 37 weeks of gestation due to narrow oscillations revealed by CTG and weaker fetal movements reported by the mother A male infant (weight 2840 g, Apgar 10) was born. The mother and the child were discharged on day 5 of the postpartum. Treatment with steroids, antihypertensive drugs, thyroxine and enoxaparin was continued. Hypertension and preeclampsia are the most dangerous complications in pregnant women with Takayasu's disease. They can affect the health status of the mother and the child. Maternal blood pressure should be controlled very accurately on the two superior limbs. Vaginal delivery of the baby is preferred. Cesarean section is indicated when the values of the maternal blood pressure are elevated in the second part of vaginal delivery

Long Insular Artery Infarction: Characteristics of a Previously Unrecognized Entity

The infarctions arising in the long insular arteries of the M2 segment have been poorly described in the past. The purpose of this study was to investigate the incidence, clinical characteristics, and pathogenesis of long insular artery infarcts. Patients with acute isolated infarcts in territories of the long insular arteries and lenticulostriate arteries were retrospectively reviewed. The long insular artery territory was defined as the area above the lenticulostriate artery territory at the level of centrum semiovale. On the coronal section, it lies between the tip of the anterior horn and the top of the superior limb of the insular cleft. Clinical features and prevalence of embolic sources were compared between the 2 groups. Of 356 consecutive patients with acute ischemic stroke, 8 (2.2%) had a long insular artery infarct (long insular artery group) and 50 (14.0%) had a lenticulostriate artery infarct (lenticulostriate artery group). There were no differences in age, sex, prevalence of risk factors, neurologic deficit, or incidence of lacunar syndromes between these groups. Abrupt onset was more common in the long insular artery than in the lenticulostriate artery group (P = .004). The prevalence of embolic high-risk sources (eg, atrial fibrillation) was not significantly different between these groups, but the combined prevalence of all embolic sources, including moderate-risk sources, was significantly higher in the long insular artery group (P = .048). Isolated infarction caused by long insular artery occlusion is not rare. Abrupt onset is more common for long insular artery infarction, and this finding could be attributed to the higher incidence of an embolic etiology as the pathogenesis of infarction.

Reconstruction of sarcoma defects following pre-operative radiation: Free tissue transfer is safe and reliable

Neoadjuvant radiotherapy followed by surgical resection and soft tissue reconstruction provides the best possibility of achieving superior limb function in soft tissue sarcomas. The aim of this study was to report our experience of free flap microsurgical reconstruction of recently irradiated soft tissue sarcoma defects. A retrospective study of microsurgical outcome in consecutively treated extremity and trunk sarcoma patients undergoing free tissue transfer between 2007 and 2012 was conducted from a prospectively collected database. Outcomes in pre-operatively irradiated patients were compared with non-irradiated patients. Demographic data, operative details, limb salvage rate, post-operative including microsurgical complications, and long-term limb function (Toronto Extremity Salvage score, TESS; Musculoskeletal Tumour Society Rating Scale, MSTS) were recorded and analysed for differences between the two study groups. Forty-six patients underwent 46 free flaps (pre-irradiated n = 32, non-irradiated n = 14) over the study period. Microvascular complications (intra-operative revision, flap re-exploration, flap loss) were uncommon and similar between the two groups (4/32 and 2/14 respectively, p > 0.05). Recipient site wound healing complications (i.e. not flap related) occurred more frequently in pre-irradiated patients (16 events) compared with the control group (2 events, p = 0.03). There was no significant difference in limb salvage rate, or TESS/MSTS functional outcome scores between the two patient groups. Free tissue transfer is safe and effective in patients undergoing surgical resection and reconstruction following neoadjuvant radiotherapy.

Throwing Motion Control of the Springed Pendubot

This brief describes a control strategy for the throwing motion of an underactuated two-link planar robot called the Pendubot. The springed Pendubot is built based on the concept of unstable zero dynamics, and our investigation uses it as a dynamic model of superior limbs to imitate human throwing motion. In the proposed control strategy, the zero dynamics is intentionally destabilized when a ball held by the end-effector is constrained on a geometric path in a vertical plane, using output zeroing control for the deviation between the ball and geometric path. The unstable zero dynamics drives the ball along the geometric path to achieve fast and accurate throw in a desired direction. The unstable zero dynamics is analytically derived to guarantee the dynamic acceleration of the ball along the geometric path. Numerical simulations and experimental results confirm the effectiveness of the proposed control strategy.

Pterygium Masking Bifid Medial Rectus Insertion and Strabismic Amblyopia

Figure 1: Peroperative clinical picture of anomalous bifi d medial rectus; Figure 2: : The two separate limbs, made prominent by inserting separate muscle hooks, defi ne a broad, thick superior limb and a thin, narrow inferior limb; Figure 3: Exotropia of 30 PD noted on cover testing and PBCT on post-operative visit; Figure 4: Final preoperative result after pterygium excision and AL-CAT; Figure 5: Postoperative appearance with excised pterygium and evident strabismus.

Footprint of the Lateral Ligament Complex of the Ankle

We describe the topographic anatomy of the lateral ligament complex of the ankle using 3-dimensional (3D) computed tomography (CT) imaging. Dissection of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) was performed on 8 unpaired fresh-frozen cadaver feet. Ligaments were sharply dissected from bone, and the footprint was outlined with radio-opaque paint. The specimen underwent a 0.625-mm slice CT scan of the ankle with 3D reconstructions. Software was used to determine the surface area of the ligament footprint as well as measure the distance from the peroneal tubercle to the center of the CFL footprint. Data are presented as mean ± standard error. Six specimens had a bifid ATFL. Seven ankles had a bifid ATFL footprint on the talus. All specimens had intact CFL fibers. The intact superior and inferior limbs of the ATFL measured 19.7 ± 1.2 mm and 16.7 ± 1.1 mm. The CFL measured 24.8 ± 2.4 mm. The area of the footprints of the superior ATFL and inferior ATFL on the talus measured 1.5 ± 0.26 cm(2) and 0.90 ± 0.07 cm(2). The CFL and ATFL origins on the fibula were continuous and measured 3.48 ± 0.39 cm(2). The CFL insertion on the calcaneus measured 2.68 ± 0.20 cm(2). The CFL was found 27.1 ± 1.0 mm posterior and superior from the peroneal tubercle. In presumably uninjured specimens, both the ATFL and its footprint on the talus were bifid. The CFL and ATFL origins have a single confluent footprint on the anterior border of the distal fibula. The CFL footprint on the calcaneus is almost 3 cm posterior and superior to the peroneal tubercle. This study may assist surgeons in anatomically reconstructing the lateral ligament complex of the ankle.

The human hippocampus observed by scanning electron microscopy (SEM): The dentate gyrus is made of an array of the neuronal lamellae.

Scanning electron microscopy (SEM) was employed to clarify the three dimensional structure of the human hippocampus.The polymorphic layer was L-shaped in coronal histological sections. The superior limb and lateral two thirds of the inferior limb formed a continuous plate. This plate consisted of L-shaped bars that were fused side by side with borders that were, although incompletely, demarcated by the stratum granulosum. The medial one third of the inferior limb was independent part of these L-shaped bars and took part in formation of the dentes. There were 40 to 50 dentes, and each had segmental blood vessels. Thus, the polymorphic layer was organized on a segmental plan, 40- 50 in number, arrayed along the antero-posterior axis.CA4 was surrounded by the L-shaped polymorphic layer and also had the superior and inferior crura. The medial end of the inferior crus was enveloped by the medial one third of the polymorphic tissue and was completely independent from its neighbors. Therefore, CA4, too, may be segmentally constructed following the same plan as the bars of the polymorphic layer. These observations suggest that, first, three major components of the hippocampus, the stratum granulosum, polymorphic layer, and CA4, are constructed based on the same lamellar unit in the dentate gyrus, and, second, the individual lamellae appear as distinct bars in the medial one third, but form a plate in the lateral two thirds of these structures. There were 7 to 12 pyramidal hillocks, organized of the central process and its covering, in the subiculum. Pyramidal cells showed clear polarity in the hillock; the cell apex oriented to the central process and the base to the periphery. The axon emitted from the cell base and formed the alveus. Pyramidal hillocks caused slight waves of the stratum pyramidale on the lateral border of the hippocampus but did not affect the superior surface. Functional aspects of the segmental arrangement of neuronal units along the antero-posterior axis and their medio-lateral diversity were discussed in terms of the three-synapse pathway in the hippocampus.

Pancaost syndrome related to hydatid cyst

Pancoast syndrome remains a rare presentation of pulmonary diseases. Even in endemic area of echinococcosis, lung's hydatid cyst is seldomly revealed by this syndrome. We report a case of a 38 year old male patient who presented to our department with neck and left superior limb pain associated with palmar muscle atrophy and Horner's syndrome. Radiological investigations suggested the diagnosis of hydatid cyst of the left lung apex which was confirmed by surgical excision and pathological examination of the lesion. This case highlights an uncommon etiology of Pancoast syndrome which might mislead physicians in their practice.

Tetraplegia or paraplegia with brachial diparesis? What is the most appropriate designation for the motor deficit in patients with lower cervical spinal cord injury?

The authors seek to clarify the nomenclature used to describe cervical spinal cord injuries, particularly the use of the terms "tetraplegia", "quadriplegia", "quadriparesis", "tetraparesis", "incomplete quadriplegia" or "incomplete tetraplegia" when applied to patients with lower cervical cord injuries. A review of the origin of the terms and nomenclature used currently to describe the neurological status of patients with SCI in the literature was performed. The terms "tetraplegia", "quadriplegia", "quadriparesis", "tetraparesis", "incomplete quadriplegia" or "incomplete tetraplegia" have been used very often to describe patients with complete lower cervical SCI despite the fact that the clinical scenario is all the same for most of these patients. Most of these patients have total loss of the motor voluntary movements of their lower trunk and inferior limbs, and partial impairment of movement of their superior limbs, preserving many motor functions of the proximal muscles of their arms (superior limbs). A potentially better descriptive term may be "paraplegia with brachial diparesis". In using the most appropriate terminology, the patients with lower cervical SCI currently referred as presenting with "tetraplegia", "quadriplegia", "quadriparesis", "tetraparesis", "incomplete quadriplegia" or "incomplete tetraplegia", might be better described as having "paraplegia with brachial diparesis".

Motor cortex stimulation in refractory pelvic and perineal pain: Report of two successful cases

In some patients, with refractory chronic pelvic and perineal pain, pain and quality of life are barely alleviated despite optimal medical treatment, infiltrations and surgical release of the pudendal nerve. The management of these patients is complex, especially after failure of neuromodulation techniques (spinal cord stimulation. S3 nerve root stimulation and direct stimulation of the pudendal nerve). We report the first two cases illustrating the value of motor cortex stimulation (MCS), in this new indication. The history, decision-making process, intraoperative findings and results of this technique are presented. The perineal cortical area was identified by intraoperative motor evoked potentials in the external anal sphincter, confirming its location in the primary motor cortex between the inferior and superior limb positions. As predictive value of repetitive transcranial magnetic stimulation (rTMS) in the identification of responders to MCS for pain is now established, we performed pre-operative rTMS sessions for both patients. The first patient was a 74-years-old woman who reported an 11-year history of left lateral perineal pain. The second patient was a 45-year-old woman who reported a 4-year history of perineal pain following hysterectomy with ovariectomy. After respectively 40 months and 19 months of follow up, both patients reported an improvement of pain ranging from 40 to 50%. Time to onset of pain on sitting was markedly improved from a few minutes to 90 minutes, and largely contributing to improvement of activities of daily living and of quality of life. These two first cases suggest that motor cortex stimulation constitutes a new treatment for refractory pelvic and perineal pain, and should be considered after failure of conventional neuromodulation techniques, especially spinal cord stimulation.

Mapping of Transverse and Sigmoid Sinus Junction: Application in Vertical Extension of Suboccipital Craniotomy

Introduction: There is paucity of data regarding the surface landmarks and the vertical course of the sigmoid sinus. Moreover, the junction between transverse and sigmoid sinus is gradual, with transitional dural zone seen over superior and inferior limb and not at a focal point. Earlier studies have addressed the distances between various bone landmarks and the junction but not the “angle.” We have used the technique of mapping the sinus and defining the “GENU” of the transverse sigmoid junction so that it can aid the vertical extension of suboccipital craniotomy.

Вплив функціонального стану м’язової системи пальців руки людини на динаміку їх рухової активності

Basic features of the motion activity dynamics of II–V fingers of human superior limbs are analyzed. The frequency-force dependence of arm fingers bending at change of the functional state of their muscular system is quantitatively estimated. Qualitative similarity in dynamics of changes of mechanography features under the influence of external (work of contralateral muscles) and internal (fatigue, blood supply disturbance) factors is determined. Mean power of finger muscular system is maximal when n. medianus and n. ulnaris are stimulated with force not less then two rheobases and stimuli width are not less then 4 ms with finger applied weight of 20–40 g.

Giant Epidermal Cyst of the Periorbital Area

Epidermal cysts of periorbit and intraorbit are common problems to ophthalmologists, but giant periorbital epidermal cyst is exceedingly rare. Only a few cases have been reported previously. A 62-year-old woman presented with a large right periorbital area mass that resulted in right upper lid complete ptosis and severe gaze limitation in all directions. Visual acuity of right eye was finger count (20/2000). Computed tomography and magnetic resonance imaging revealed a bone-destroying mass involving the lateral side of the right superior orbital limb. Complete surgical removal was performed through skin incision. The superior-lateral orbital limb was reconstructed with bone cement and Leibinger plate. Pathologic examination revealed a giant epidermal cyst (9.8×5.2×4.0 cm) of the periorbital area. After surgery, there was near-complete resolution of ptosis and gaze limitation. In addition, marked elevation of visual acuity was observed (20/125 on best-corrected visual acuity).