Upper Extremity In Patients Research Articles

Neurodynamic evaluation and nerve conduction studies in patients with forward head posture.

Forward head posture (FHP) is one of the most frequently seen problems. The aim of this study was to evaluate the neurodynamic tests and peripheral nerve conductions of upper extremity in patients with FHP. The study population included 100 patients with upper extremity and neck problems and 34 healthy individuals as a control group. Craniovertebral angle measurement was used to determine forward head posture. Stretch tests for radial, ulnar and median nerves were performed. Nerve conductions of bilateral median, radial, ulnar and medial antebrachial cutaneous (MAC) nerves were examined in all patients included in the study. The most significant nerve conduction differences in moderate-to-severe FHP patients were a decrease in the sensory nerve action potential (SNAP) and compound muscle action potential (CMAP) amplitudes of median nerves, a decrease in the SNAP amplitude of ulnar nerves, a delay in the F response latency of ulnar nerves and prolongation in the SNAP latency of the MAC nerve. FHP makes patients more prone to peripheral entrapments.

COMBINATION OF HYPNOSIS THERAPY AND RANGE OF MOTION EXERCISE ON UPPER-EXTREMITY MUSCLE STRENGTH IN PATIENTS WITH NON-HEMORRAGHIC STROKE

Background: Range of Motion (ROM) exercise has been identified in the literature that it has an effect in improving muscle strength, especially in patients with stroke. However, little is known about the effect of ROM exercise combined with hypnosis therapy.
 Objective: To determine the effect of combination of hypnosis therapy and ROM exercise on upper extremity muscle strength in patients with non-hemorrhagic.
 Methods: This study employed a quasi-experiment with pretest-posttest control group design. Thirty-two samples were selected using simple random sampling, which 16 randomly assigned in the experiment and control group. Muscle strength was measured using muscle strength scale. Hypnosis Deepening test was used to measure the level of hypnosis depth. Paired t-test and Independent t-test were used for data analysis.
 Results: The mean value of muscle strength in the experiment group was 3.50 and the mean value in the control group was 2.62. Independent sample t-test obtained p-value = 0.012, indicated that there was a statistically significant difference in the mean of muscle strength of upper extremity in the experiment and control group. Paired t-test obtained p-value = 0.000, which indicated that there was significant difference between the average of muscle strength value before and after treatment
 Conclusion: The combination of hypnosis therapy and ROM exercise has a significant effect in increasing muscle strength of upper extremity in patients with stroke non-hemorrhagic.

Mirror therapy for motor function of the upper extremity in patients with stroke: A meta-analysis.

To evaluate the mean treatment effect of mirror therapy on motor function of the upper extremity in patients with stroke. Electronic databases, including the Cochrane Library, PubMed, MEDLINE, Embase and CNKSystematic, were searched for relevant studies published in English between 1 January 2007 and 22 June 2017. Randomized controlled trials and pilot randomized controlled trials that compared mirror therapy/mirror box therapy with other rehabilitation approaches were selected. Two authors independently evaluated the searched studies based on the inclusion/exclusion criteria and appraised the quality of included studies according to the criteria of the updated version 5.1.0 of the Cochrane Handbook for Systematic Review of Interventions. Eleven trials, with a total of 347 patients, were included in the meta-analysis. A moderate effect of mirror therapy (standardized mean difference 0.51, 95% confidence interval (CI) 0.29, 0.73) on motor function of the upper extremity was found. However, a high degree of heterogeneity (χ2 = 25.65, p = 0.004; I2 = 61%) was observed. The heterogeneity decreased a great deal (χ2 = 6.26, p = 0.62; I2 = 0%) after 2 trials were excluded though sensitivity analysis. Although the included studies had high heterogeneity, meta-analysis provided some evidence that mirror therapy may significantly improve motor function of the upper limb in patients with stroke. Further well-designed studies are needed.

High-Output Cardiac Failure and Coronary Steal With an Arteriovenous Fistula

Creation of an arteriovenous access for hemodialysis can provoke a sequence of events that significantly affects cardiovascular hemodynamics. We present a 78-year-old man with end-stage renal disease and concomitant coronary artery disease previously requiring coronary artery bypass grafting including a left internal mammary graft to the left anterior descending artery, ischemic cardiomyopathy with left ventricular systolic dysfunction, and severe aortic stenosis who developed hypotension unresponsiveto medical therapy after recent angioplasty of his ipsilateral arteriovenous fistula for high-grade outflow stenosis. This case highlights the long-term effects of dialysis access on the cardiovascular system, with special emphasis on complications such as high-output cardiac failure and coronary artery steal syndrome. Banding of the arteriovenous fistula provided symptomatic relief with a decrease in cardiac output. Avoidance of arteriovenous access creation on the ipsilateral upper extremity in patients with a left internal mammary artery bypass graft may prevent coronary artery steal syndrome.

The presentation and management of hypertension in a large cohort of Takayasu arteritis

The objective of this study was to explore the presentation and management of hypertension secondary to Takayasu arteritis (TA) in a large cohort, single center in China. We retrospectively analyzed 381 TA patients with hypertension hospitalized in Fuwai hospital between Jan. 2004 and Feb. 2014. Diagnosis of hypertension was according to clinic blood pressure or the central blood pressure measured during angiography. Renal artery stenosis was the most common cause (264, 69.3%), followed by the thoracic descending aorta stenosis (98, 25.7%), abdominal aorta stenosis (78, 20.5%), and severe aortic regurgitation (45, 11.8%). More than two kinds of pathologies were found in 98 (25.7%) patients. The mean age of hypertension onset was 25.0 ± 14.3years. The mean blood pressure of upper extremity in patients without bilateral subclavian artery stenosis (321, 84.3%) was 176.0 ± 29.4mmHg/97.2 ± 23.0mmHg, while in 60 (15.7%) patients with bilateral subclavian artery stenosis, the mean central blood pressure was 192.7 ± 30.8mmHg/102.4 ± 121.1mmHg. A total of 305 were followed for 38.4 ± 36.7months, and the rate of blood pressure control, improvement, and failure was 50.8, 41.0, and 8.2%, respectively. Immunosuppressive therapy (OR 2.402, 95% confidence interval 1.253-4.603, P = 0.008) and the pathogenesis of hypertension (P = 0.010) were associated with prognosis of hypertension. The pathogenesis of hypertension due to TA is very complex and multifactorial. Renal artery stenosis is most frequently observed, followed by stenosis of the thoracic descending aorta, abdominal aorta, and severe aortic regurgitation. Immunosuppressive therapy and identifying the pathogenesis of hypertension is of great importance in patients with TA.

Neuronal Plasticity after Repetitive Transcranial Magnetic Stimulation in Patients with Central Cord Syndrome

To delineate the effect of high frequency repetitive transcranial magnetic stimulation (rTMS) on the recovery of upper extremity in patients with central cord syndrome (CCS).

Usefulness of repetitive transcranial magnetic stimulation for the recovery of central cord syndrome

Objectives Repetitive transcranial magnetic stimulation (rTMS) can modulate neuronal circuits and also enhance spinal cord plasticity. Our aim of this study was to delineate the effect of rTMS on the functional recovery of upper extremity in patients with incomplete spinal cord injury, especially central cord syndrome (CCS), and detect the changes of spinal cord tracts crossing the lesion by diffusion tensor imaging (DTI). Method Fourteen patients with CCS, which level of injury was between C4 to C6, were performed rTMS with high frequency (20Hz) over the unilateral motor cortex for 5 days as well as the conventional occupational therapy. The non-treated side of each subject was used as control. We assessed the neurological status using International Standard for Neurological Classification of Spinal Cord Injury (ISNCSCI), and functional status of upper extremities using the Jebsen hand function and O'conner finger dexterity tests twice; before treatment, and 1 month after treatment. DTI was performed on the injured cervical spinal cord, obtained fractional anisotrophy (FA), apparent diffusion coefficient (ADC) at each level, and calculate imaginary spinal cord tracts of each subject. Results The neurological status of the upper extremity motor score in the treated side using ISNCSCI was improved in all subjects otherwise only 10 of 14 subjects (71.4%) showed some improvements of non-treated side at 1 month after treatment. The functional status including the writing score of Jebsen hand function test were also significantly improved more in treated side in comparison with non-treated side at 1 month. The FA values and the number of imaginary spinal cord tracts of treated side at the injured level were also increased more than those of non-treated side in the same subjects. Any side effects such as seizure, severe headache, nausea or vision problem was not observed during rTMS treatment and follow-up period. Conclusions The high frequency rTMS was effective to improve the neurological and functional status of CCS patients and might increase the spinal cord plasticity without any serious side effects.

Upper Extremity Medial Arterial Calcification and Peripheral Artery Disease in Asymptomatic Patients With Chronic Kidney Disease in Predialysis Stage.

Two types of peripheral artery disease (PAD) in asymptomatic patients with chronic kidney disease (CKD) can be detected by the use of duplex Doppler: medial arterial calcification (MAC) and occlusive PAD. The aim of this pilot study is to evaluate different types of subclinical PAD in upper extremities of patients with CKD. The prevalence of upper extremity MAC and occlusive PAD was investigated in 41 asymptomatic patients with CKD and 18 controls with normal kidney function, using duplex Doppler ultrasound, according to the vascular laboratory protocol. A mild-to-severe MAC was significantly more prevalent in patients with CKD compared to the control group ( P = .015), mostly in radial arteries (RAs; P = .002 and P = .016, respectively). The prevalence of occlusive PAD was not significantly different between the 2 groups ( P = .381). Patients in the CKD group were younger, nonsmokers, and more often had hypertension ( P = .038, P = .038, and P = .034, respectively). A duplex ultrasound screening for upper extremity subclinical PAD in patients with CKD in a predialysis stage may identify patients with mild-to-severe MAC which is important in surgery of hemodialysis access.

Inhibition of Parkinsonian tremor with cutaneous afferent evoked by transcutaneous electrical nerve stimulation

BackgroundRecent study suggests that tremor signals are transmitted by way of multi-synaptic corticospinal pathway. Neurophysiological studies have also demonstrated that cutaneous afferents exert potent inhibition to descending motor commands by way of spinal interneurons. We hypothesize in this study that cutaneous afferents could also affect the transmission of tremor signals, thus, inhibit tremor in patients with PD.MethodsWe tested this hypothesis by activating cutaneous afferents in the dorsal hand skin innervated by superficial radial nerve using transcutaneous electrical nerve stimulation (TENS). Eight patients with PD having tremor dominant symptom were recruited to participate in this study using a consistent experimental protocol for tremor inhibition. Resting tremor and electromyogram (EMG) of muscles in the upper extremity of these subjects with PD were recorded, while surface stimulation was applied to the dorsal skin of the hand. Fifteen seconds of data were recorded for 5 s prior to, during and post stimulation. Power spectrum densities (PSDs) of tremor and EMG signals were computed for each data segment. The peak values of PSDs in three data segments were compared to detect evidence of tremor inhibition.ResultsAt stimulation intensity from 1.5 to 1.75 times of radiating sensation threshold, apparent suppressions of tremor at wrist, forearm and upper arm and in the EMGs were observed immediately at the onset of stimulation. After termination of stimulation, tremor and rhythmic EMG bursts reemerged gradually. Statistical analysis of peak spectral amplitudes showed a significant difference in joint tremors and EMGs during and prior to stimulation in all 8 subjects with PD. The average percentage of suppression was 61.56% in tremor across all joints of all subjects, and 47.97% in EMG of all muscles. The suppression appeared to occur mainly in distal joints and muscles. There was a slight, but inconsistent effect on tremor frequency in the 8 patients with PD tested.ConclusionsOur results provide direct evidence that tremor in the upper extremity of patients with PD can be inhibited to a large extent with evoked cutaneous reflexes via surface stimulation of the dorsal hand skin area innervated by the superficial radial nerve.

EMU: A transparent 3D robotic manipulandum for upper-limb rehabilitation.

This paper introduces the EMU, a three-dimensional robotic manipulandum for rehabilitation of the upper extremity for patients with neurological injury. The device has been designed to be highly transparent, have a large workspace, and allow the use of the hand for interaction with real-world objects to provide additional contextual cues during exercises. The transparency is achieved through the use of a capstan transmission for the drive joints; a hybrid serial parallel kinematics minimising moving inertia; and lightweight materials. An experimental protocol is reported here which demonstrates the transparency through a comparison to out-of-robot movements, and with an existing rehabilitation robotic device. Additionally, an adjustable gravity compensation method is constructed, which minimises the torque required at the shoulder to carry the subject's arm. These characteristics allow the EMU to serve as a multi-purpose platform for the further development of novel robot assisted rehabilitation strategies.

No Difference Between Noxious and Innocuous Thermal Stimulation on Motor Recovery of Upper Extremity in Patients With Acute Stroke: A Randomized Controlled Trial With 6-Month Follow-up

BackgroundThermal stimulation (TS) has been developed and incorporated into stroke rehabilitation. However, whether noxious and innocuous TS induce the same effects on motor function recovery after stroke is still unknown. A comparative study of different temperature combination regimens is needed. ObjectiveTo compare the short- and long-term effectiveness between noxious and innocuous TS on motor recovery of upper extremity in patients with acute stroke. DesignRandomized, controlled trial with concealed allocation, intention-to-treat analysis and blinded outcome assessors. SettingA university hospital rehabilitation department in Taiwan. ParticipantsA total of 79 patients with acute ischemic stroke were recruited. The majority had moderate to severe motor impairment of the upper extremity (UE). InterventionIn addition to traditional rehabilitation, the experimental group (n = 39) underwent noxious TS (heat pain 46-47°C/cold pain 7-8°C), and the control group (n = 40) received innocuous TS (heat 40-41°C/cold 20-21°C). TS intervention was applied for 30 minutes once per day and for a total of 20-24 times during hospital stay. A custom-made TS instrument, comprising 2 thermal stimulators and their respective thermal pads constructed in a closed-loop system, was used. OutcomesThe Fugl-Meyer upper extremity score (the primary outcome), Action Research Arm Test, Motricity Index, Barthel Index, and modified Ashworth scale (the secondary outcomes) were administered by a blinded assessor at baseline, post–12th TS, post-intervention, 1-month, and 6-month follow-ups. ResultsNo significant differences between groups were found on the primary outcome at postintervention and follow-up assessments. At 1-month follow-up, the innocuous group showed a small effect (partial η2 = 0.02) that was greater than that of the noxious group, but that effect was eliminated at 6 months. Both groups presented significant within-group improvements over time (both P < .001). ConclusionsCombining noxious TS with traditional rehabilitation did not yield better short-term or long-term results than combining innocuous TS with traditional rehabilitation on UE functional recovery for individuals with acute stroke. Level of EvidenceII

Contralateral peripheral neurotization for a hemiplegic hindlimb after central neurological injury.

OBJECTIVE Contralateral peripheral neurotization surgery has been successfully applied to rescue motor function of the hemiplegic upper extremity in patients with central neurological injury (CNI). It may contribute to strengthened neural pathways between the contralesional cortex and paretic limbs. However, the effect of this surgery in the lower extremities remains unknown. In the present study the authors explored the effectiveness and safety of contralateral peripheral neurotization in treating a hemiplegic lower extremity following CNI in adult rats. METHODS Controlled cortical impact (CCI) was performed on the hindlimb motor cortex of 36 adult Sprague-Dawley rats to create severe unilateral traumatic brain injury models. These CCI rats were randomly divided into 3 groups. At 1 month post-CCI, the experimental group (Group 1, 12 rats) underwent contralateral L-6 to L-6 transfer, 1 control group (Group 2, 12 rats) underwent bilateral L-6 nerve transection, and another control group (Group 3, 12 rats) underwent an L-6 laminectomy without injuring the L-6 nerves. Bilateral L-6 nerve transection rats without CCI (Group 4, 12 rats) and naïve rats (Group 5, 12 rats) were used as 2 additional control groups. Beam and ladder rung walking tests and CatWalk gait analysis were performed in each rat at baseline and at 0.5, 1, 2, 4, 6, 8, and 10 months to detect the skilled walking functions and gait parameters of both hindlimbs. Histological and electromyography studies were used at the final followup to verify establishment of the traumatic brain injury model and regeneration of the L6-L6 neural pathway. RESULTS In behavioral tests, comparable motor injury in the paretic hindlimbs was observed after CCI in Groups 1-3. Group 1 started to show significantly lower slip and error rates in the beam and ladder rung walking tests than Groups 2 and 3 at 6 months post-CCI (p < 0.05). In the CatWalk analysis, Group 1 also showed a higher mean intensity and swing speed after 8 months post-CCI and a longer stride length after 6 months post-CCI than Groups 2 and 3 (p < 0.05). Transection of L-6 resulted in transient skilled walking impairment in the intact hindlimbs in Groups 1 and 2 (compared with Group 3) and in the bilateral hindlimbs in Group 4 (compared with Group 5). All recovered to baseline level within 2 months. Histological study of the rat brains verified comparable injured volumes among Groups 1-3 at final examinations, and electromyography and toluidine blue staining indicated successful regeneration of the L6-L6 neural pathways in Group 1. CONCLUSIONS Contralateral L-6 neurotization could be a promising and safe surgical approach for improving motor recovery of the hemiplegic hindlimb after unilateral CNI in adult rats. Further investigations are needed before extrapolating the present conclusions to humans.

Hybrid Assistive Neuromuscular Dynamic Stimulation Therapy: A New Strategy for Improving Upper Extremity Function in Patients with Hemiparesis following Stroke.

Hybrid Assistive Neuromuscular Dynamic Stimulation (HANDS) therapy is one of the neurorehabilitation therapeutic approaches that facilitates the use of the paretic upper extremity (UE) in daily life by combining closed-loop electromyography- (EMG-) controlled neuromuscular electrical stimulation (NMES) with a wrist-hand splint. This closed-loop EMG-controlled NMES can change its stimulation intensity in direct proportion to the changes in voluntary generated EMG amplitudes recorded with surface electrodes placed on the target muscle. The stimulation was applied to the paretic finger extensors. Patients wore a wrist-hand splint and carried a portable stimulator in an arm holder for 8 hours during the daytime. The system was active for 8 hours, and patients were instructed to use their paretic hand as much as possible. HANDS therapy was conducted for 3 weeks. The patients were also instructed to practice bimanual activities in their daily lives. Paretic upper extremity motor function improved after 3 weeks of HANDS therapy. Functional improvement of upper extremity motor function and spasticity with HANDS therapy is based on the disinhibition of the affected hemisphere and modulation of reciprocal inhibition. HANDS therapy may offer a promising option for the management of the paretic UE in patients with stroke.

Results of thumb-in-palm deformity surgery combined with arthrodesis of the wrist in cerebral palsy children with severe deformities

Introduction Thumb-in-palm adduction and wrist flexion contractures are the most frequently encountered deformities of the upper extremity in patients with severe spastic paralysis. When deformities are severe, ease of personal care, skin hygiene, hand function and appearance are adversely affected. Several surgical options have been described for thumb-in-palm deformity. The aim of this study was to assess the results of the thumb-in-palm deformity surgery combined with arthrodesis of the wrist in CP children with severe deformity. Material and methods Eleven patients operated for severe spastic contracture of the hand and the wrist were evaluated. Wrist arthrodesis was realized in all cases. Radiographs were performed to analyze the union rate and the flexion deformity. According to the thumb-in-palm deformity, 6 lengthening, 1 adductor release, 2 tenodesis and 2 arthrodesis were realized. The patients were subjectively evaluated using the Disability Assessment scale (DAS) and a visual analog scale assessing appearance, function, hygiene, ease of daily care, pain and overall satisfaction. Results The average age of patients and follow-up was respectively 18 years at the time of surgery and 28 months. The mean radiographic flexion deformity significantly improved from 77° preoperatively to 4° of dorsal angulation postoperatively. The DAS improved significantly from a preoperative mean of 9.2 to a postoperative mean of 4.5. Visual analog scale demonstrated improvements in different conditions. The functional house score improved but the thumb-in-palm deformity was more pronounced in 6 patients after the surgery and two patients required a second surgery. Discussion The thumb-in-palm is a true obstacle to use of the hand in patients with severe spastic paralysis. When the deformity of the thumb is important, the soft tissues surgery may be inadequate and the arthrodesis of the thumb in a functional position is a good option. Conclusion The treatment of thumb-in-palm deformity is difficult in severe CP children. The thumb and wrist disorders have to be treated in one stage with a surgical plan established to improved the function needed in patients with severe contracture.

Are interlimb interactions disturbed in patients with Parkinson’s disease? A study under unloading conditions

During natural human locomotion neural connections characteristic for the control of quadrupedal walking are activated. The degree of interaction between the neural networks generating rhythmic movements of the upper and lower extremities, depends on the tonic state of each of these networks, adjustable by motor command in the brain. The distortion of such command in patients with Parkinson's disease (PD) may lead to disturbance of interlimb interactions. In conditions of arms and legs unloading in 17 patients with PD and 16 healthy subjects investigated the effect of limb movement of one girdle on the parameters of motor activity of the limbs of the other girdle in their combined cyclic movements. In patients the weakening of influences of active or passive arm movements, and active movements of the distal parts of the arms on voluntary leg movements was shown, while in healthy subjects the effect of arm movements on the parameters of voluntary movements was significant. The effect of arm movements on the possibility of involuntary activation of air- stepping by vibratory stimulation of the leg muscles in patients was absent, while in healthy subjects the motor activity of the arms increased the opportunity of involuntary rhythm activation. The differences in the influence of leg movements to the rhythmic movement of the upper extremities in patients and healthy subjects were revealed. The medication exhibited interlimb interaction, but it was insufficient for normalization of the state of neural networks in patients. It is concluded that in patients with PD, neural networks generating stepping rhythm are in a state of heightened tonic activity. This does not allow not only activating involuntary rhythmic movements, but also showing facilitation effect with arms to legs.

Use of hyperspectral imaging to assess endothelial dysfunction in peripheral arterial disease

Hyperspectral imaging (HSI) is a technology that with limited training can noninvasively measure oxygenated hemoglobin (oxyHb) and deoxygenated hemoglobin concentrations in the skin to create an oxygenation map. This pilot study determined whether HSI could be used to demonstrate vascular dysfunction in the upper extremity of patients with peripheral artery disease (PAD) and coronary artery disease (CAD). This prospective study included 93 consecutive, consented patients presenting to the vascular clinic, with and without diagnosed arterial disease, and healthy volunteers. Patients underwent HSI at the upper arm, forearm, and palm before and after cuff occlusion (50mm Hg above systolic) for 5minutes. Medical records of enrolled patients were reviewed for demographic data, medications, surgical history, and other pertinent information. Significant changes occurred with oxyHb, with minimal to no effects on deoxygenated hemoglobin. The highest values of oxyHb were detected in the upper arm, followed by the forearm and hand. The absolute and percentage change in oxyHb measured in the upper arm and forearm was significantly reduced in controls aged >40years compared with controls aged<40years. Significant differences were noted in the upper arm oxyHb absolute change in response to cuff occlusion comparing PAD or CAD (n= 47) vs the older control cohort (P= .028). When the 23 patients with PAD only were separated out, the upper arm oxyHb response to cuff occlusion is even more significantly impaired (P< .01) compared with controls. Our study suggests the ability of HSI to assess the presence of PAD or CAD based on systemic vascular dysfunction at sites remote from the clinically diseased vascular bed. This could enable early screening and tracking of arterial disease patients before the development of clinically advanced disease.

Nerve injuries of the upper extremity associated with vascular trauma—surgical treatment and outcome

Peripheral nerve injuries are often associated with injuries of adjacent tissue. As a result of anatomic proximity between nerves and vascular structures, there is a high chance of combined injuries of these structures (23%). The aim of our study is to describe and analyze associated nerve and vascular injuries of the upper extremity in patients treated at the Clinic of Neurosurgery in Belgrade over a 10-year period. This study included 83 patients that received surgical treatment at the Clinic of Neurosurgery in Belgrade after having been diagnosed with upper extremity nerve injury. The study included all patients that satisfied these criteria over a period of 10years. The patients with associated vascular injuries, 36 of them, were considered our study group, while 47 patients without associated vascular injuries were considered our control group. Finally, we compared treatment outcome between these groups. The final outcome evaluation was performed 2years after surgical treatment. In our study group, 84.8% surgical nerve repair was successful (fair, good, and excellent outcome), while in the control group (patients without vascular injury), surgical nerve repair was successful in 87.9%. The overall satisfactory neurological outcome (M3-M5) was present in 86.6% of nerve repairs. Our study shows that there is no significant difference between the treatment outcome in patients with associated nerve and vascular injuries and patients with isolated nerve injuries if they are diagnosed in time and treated appropriately. Successful treatment can only be accomplished through a multidisciplinary approach undertaken by a highly qualified medical team.

Differences in active range of motion measurements in the upper extremity of patients with writer's cramp compared with healthy controls

Study DesignExploratory case-control study. IntroductionWriter's cramp (WC) is a type of focal hand dystonia. The central nervous system plays a role in its pathophysiology, but abnormalities in the affected musculoskeletal components may also be relevant. Purpose of the StudyWe compared the active range of motion (ROM) in patients with WC and healthy volunteers (HVs) and correlated the findings with disease duration and severity. MethodsAffected limb joints were measured with goniometers. Patients were assessed at least 3 months after their last botulinum toxin (botulinum neurotoxin) injection, and strength was clinically normal. t tests were used to compare the ROMs of WC with matched HVs. The Spearman correlation coefficient assessed the relationship of active ROMs to the disease duration and handwriting subscore of the Dystonia Disability Scale. ResultsROMs of D1 metacarpophalangeal (MCP) joint extension as well as D2 and D5 MCP flexion were significantly smaller in WC, and distal interphalangeal joint extension in D3 and D5 was significantly greater compared with HVs. There were negative correlations between D2 MCP flexion and disease duration and with Dystonia Disability Scale. DiscussionAbnormalities in ROMs in WC were found. Severity and disease duration correlated with reduced D2 MCP flexion. This may be related to intrinsic biomechanical abnormalities, co-contraction of muscles, or a combination of subclinical weakness and atrophy from repeated botulinum neurotoxin injections. ConclusionsHand biomechanical properties should not be ignored in the pathophysiology of WC. Level of Evidence2c.

Charcot’s neuroarthropathy of the hand in a patient with diabetes mellitus

Charcot’s neuroarthropathy (CNA) is a destructive disease associated with a reduced proprioceptive sensation. Diabetes mellitus (DM) is one of the most common etiological factor for CNA which typically affects ankles and small joints of feet. Neuroarthropathy seen in upper extremity in patients with DM is a rare clinical condition.In this report, we presented a case of CNA with hand involvement who had type-II DM. Neuroarthropathy was rapidly progressed and destructive changes were observed in right hand joints after a minor trauma in current case.Charcot’s neuroarthropathy may rarely occur in the joints of hand in patients with DM. Early diagnosis of CNA is important in order to protect joints and avoid further disability.

Effect of Resistance Exercise Intensity on the Strength and Lymphedema of Upper Extremity in Patients with Breast Cancer

Purpose: The purpose of this study was to determine the effects of high and low resistance exercise using an elastic band on the strength and lymphedema of upper extremity in patients with breast cancer. Methods: Seventeen female patients with breast cancer related lymphedema were randomly allocated...