Pain In Upper Extremity Research Articles

Seronegative Isaac Syndrome Presenting as Focal Limb Stiffness Responsive to Plasma Exchange Therapy (P8-8.015)

<h3>Objective:</h3> N/A <h3>Background:</h3> Isaac syndrome is an autoimmune disorder of peripheral nerve hyperexcitability characterized by neuromyotonia, myokymia, muscles stiffness, pseudomyotonia, and pseudotetany frequently accompanied by dysautonomia and neuropathic pain. Approximately 50% of cases are associated with antibodies against contactin-associated protein-like 2 (CASPR2) or less commonly leucine-rich glioma inactivated protein 1 (LGI1), both components of the voltage-gated potassium channel (VGKC) complex. Paraneoplastic, genetic, and toxic etiologies must be considered. Management includes membrane-stabilizing drugs as well as immunotherapy in more severe cases. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> A 50-year-old woman presented with one year of left neck, shoulder, and upper extremity pain and stiffness that began one month after an upper respiratory illness. Her exam was notable for anterocollis, left shoulder elevation, impaired left shoulder abduction beyond 35–40 degrees, tonically contracted left biceps, and marked tenderness to palpation of the affected muscles. Symptomatic management with diazepam, lorazepam, baclofen, mexiletine, and trihexyphenidyl was ineffective. EMG demonstrated widespread neuromyotonic discharges throughout the proximal greater than distal left upper extremity, cervical and thoracic paraspinals, and right deltoid. Laboratory studies including CASPR2, LGI1, VGKC, GAD-65, and amphiphysin antibodies were unremarkable. Comprehensive screening for occult malignancy was unrevealing. She received partial benefit from carbamazepine, levetiracetam, cyclobenzaprine, and onabotulinumtoxinA injections, but symptoms remained debilitating. She was treated with IVIg 1g/kg Q2 weeks for three months with symptom progression to the jaw and lower extremities. She was started on plasmapheresis QOD for ten days every four weeks with rapid improvement in symptoms. <h3>Conclusions:</h3> We report a case of seronegative Isaac syndrome initially presenting with focal limb stiffness and dystonic posturing that was exquisitely responsive to plasmapheresis. This case highlights the need to consider peripheral nerve hyperexcitability syndromes in patients presenting with focal limb stiffness or painful dystonia and provides additional support for plasmapheresis as an effective treatment option for patients with debilitating symptoms. <b>Disclosure:</b> Dr. Khalil has received personal compensation in the range of $0-$499 for serving as a Resident and Fellow Council Member with American Association of Neuromuscular &amp; Electrodiagnostic Medicine. Dr. Khalil has received personal compensation in the range of $0-$499 for serving as a MS Mentorship Forum Participant with Foundation of the Consortium of Multiple Sclerosis Centers. Dr. Bradshaw has nothing to disclose.

MRI negative Varicella zoster virus (VZV) plexopathy in a young man with history of malignancy (P2-4.001)

<h3>Objective:</h3> To emphasize the importance of including VZV plexopathy in differential diagnosis in young individuals and to prevent the delay in diagnosis and treatment <h3>Background:</h3> VZV-associated plexopathy in mainly patients over 60 years old. Post herpetic neuralgia is a well-known complication of Herpes Zoster (HZ), however segmental zoster paresis secondary to HZ was reported in 1–20% of the cases in literature. MRI findings may be positive in up to 70% of the patients. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> 43 years-old man with history of grade 2 left frontal oligodendroglioma which was treated with 2 partial resections, radiation and adjuvant procarbazine/lomustine presented with left upper extremity pain and developed a blistering rash in dermatomal pattern in left proximal upper extremity 2 weeks after the initial symptoms. He was diagnosed with shingles and treated with steroids and acyclovir with minimal improvement. 6 weeks after presentation, physical exam revealed left deltoid, supraspinatus and infraspinatus weakness with normal muscle stretch reflexes and decreased sensation on C5 dermatome. EMG revealed absent left lateral antebrachial cutaneous sensory nerve action potentials (SNAP) amplitude, and a small left radial SNAP amplitude compared to the right side. Evidence of ongoing denervation with reinnervation was seen in the left upper trunk supplied muscles. MRI of the brachial plexus was negative for any abnormalities. Patient was diagnosed with VZV-associated plexopathy, improved with pregabalin and physical therapy. <h3>Conclusions:</h3> Our patient was significantly younger than expected in HZ group. MRI usually shows T2 hyperintensities and thickening of the nerve roots in patients with VZV-associated plexopathy. However, the presentation, onset of symptoms, characteristics of the rash and clinical course was diagnostic of HZ, and the weakness pattern, supported by the EMG findings were diagnostic for VZV-associated plexopathy. <b>Disclosure:</b> Dr. Gul has nothing to disclose. Ms. Ahmed has nothing to disclose. Dr. McGraw has nothing to disclose. Dr. Alshiekh Nasany has nothing to disclose.

Outpatient Fully Endoscopic Cervical Unilateral Laminotomy for Bilateral Decompression with Virtual Postoperative Monitoring

Objective: Cervical endoscopic unilateral laminotomy for bilateral decompression (CE-ULBD) is a promising novel surgical approach. However, to date, there is a paucity of data regarding safety, efficacy, and functional outcomes following CE-ULBD.Methods: The aim of this study was to investigate the outcomes of outpatient CE-ULBD combined with postoperative smartphone-based continuous physiological monitoring and virtual follow-up. Results: We included a total of 23 patients in our study group. The mean age was 69.1±2.5 years. A significant postoperative reduction of the visual analogue scale for neck pain (4.1±0.6 pre- vs. 2.3±0.5 post-surgery; P&lt;0.0001) and upper extremity pain (2.6±0.6 vs. 1.1±0.3; P=0.0012) was reported alongside a significant improvement in the Neck Disability Index (18.6±2.5 vs. 9.1±2.5; p=0.032). Eleven patients were monitored with continuous physiological monitoring via a smartphone app (SPINEHealthie ). Those patients were more likely to be outpatients (p=0.0002) and less likely to have postoperative inpatient clinic utilization (p&lt;0.0001). Continuous physiological monitoring suggested a trend towards higher levels of function in patients following CE-ULBD. Conclusion: : Our early results suggest that outpatient CE-ULBD followed by virtual postoperative monitoring is a safe and efficient therapeutic intervention for symptomatic cervical spinal stenosis.

Paresthesia and Pain in Both Arms when Shampooing One’s Hair: Symptoms of Neurogenic Thoracic Outlet Syndrome

Neurogenic thoracic outlet syndrome (TOS) is a clinical diagnosis based on the reproduction of a patient’s symptoms with a provocation test (arm elevation) after excluding other conditions that might cause similar symptoms. Neurologic symptoms and signs can vary from mild paresthesia and numbness to intrinsic hand muscle atrophy. The main controversy in patients with neurogenic TOS involves neurologic-type complaints of paresthesia, numbness, and pain. However, there is no positive objective test to identify the cause. A 54-year-old female patient presented with numbness and radiating pain in her bilateral arms that occurred every time she bowed her head while shampooing. The patient had a history of two neck sprains due to slipping before the onset of symptoms. In addition to pain and numbness in both arms at arm elevation, pain in the suprascapular and occipital areas was also present. After excluding cervical nerve root lesions and other bone abnormalities, the patient's symptoms disappeared by brachial plexus decompression through a supraclavicular approach. It is difficult to diagnose neurogenic TOS with pain and paresthesia without muscle weakness in the upper extremities. If physicians do not consider the possibility of neurogenic TOS in patients with upper extremity paresthesia and pain, unnecessary multiple treatments may be performed, prolonging patients’ suffering. The exacerbation of pain and paresthesia in both arms and hands can occur immediately after the head is lowered during shampooing. This can be interpreted as a characteristic symptom of a constricted interscalene triangle and brachial plexus compression caused by hyperabduction of the arm.

The Utilization of Radiofrequency Techniques for Upper Extremity Pain Management

BACKGROUND: In the 1990s, radiofrequency ablation emerged as a novel therapeutic approach tool for pain alleviation that did not result in neurological harm. Radiofrequency techniques are emerging methods as a possible option for upper extremity pain management. Furthermore, joint pain can result from multiple etiologies, and the management can differ based on what joint is affected. With the various management methods available to treat joint pain, radiofrequency ablation could be an effective, minimally invasive, promising intervention. OBJECTIVES: This study aimed to review the current and historical uses of radiofrequency in upper extremity pain compared to other management methods and to address the utilization of radiofrequency in upper extremity pain management. STUDY DESIGN: This is a narrative review of relevant studies on using radiofrequency techniques in upper extremity pain management. METHODS: On June 26, 2022, Medline/PubMed, Google Scholar, ERIC, and the Cochrane Database of Systematic Reviews were searched for relevant literature documenting the use of radiofrequency techniques in treating upper extremity pain. The terms “radiofrequency,” “pain,” “upper extremity,” “shoulder,” “elbow,” and “wrist” were used, resulting in 61 studies fitting the inclusion criteria. A narrative review was then undertaken. RESULTS: Radiofrequency ablation and its techniques are among the contemporary medical procedures that could be cost-effective solutions for patients suffering from chronic and postoperative pain. Its utilization for shoulder-related pain has been frequently studied, as it showed significant improvement with a high satisfaction rate as a solo procedure. When compared to intraarticular corticosteroid injections or local anesthetics, it was found to be more effective than local anesthetics. Although it did not appear superior to intraarticular corticosteroid injections, it had the advantage of infrequent repeat treatment. By comparison, studies involving the elbow and wrist showed promising results but were not as thorough as studies on the shoulder. Therefore, considering the possible side effects and complications, caution is warranted. LIMITATIONS: The paucity of articles available on its application to the elbow and wrist joints. More articles are necessary for the generalizability of the results. CONCLUSION: Radiofrequency techniques are a promising, minimally invasive procedure for controlling upper extremity pain. More studies on the topic, especially on elbow and wrist pain, are warranted for the generalizability of the results. KEY WORDS: Radiofrequency, pain management, upper extremity, shoulder, elbow, wrist, corticosteroid injection, local anesthetics

Percutaneous thrombectomy of upper extremity and thoracic central veins using Inari ClotTriever System: Experience in 14 patients.

In the present report, we have described the technical and clinical outcomes of percutaneous thrombectomy in the deep veins of the upper extremity and thorax using the ClotTriever system (Inari Medical, Irvine, CA). Fourteen patients with symptomatic deep venous occlusive disease in the upper extremity deep veins and thoracic central veins who had undergone thrombectomy using the ClotTriever system between October 2020 and January 2022 were reviewed. The technical results, adverse events, imaging follow-up data, and clinical outcomes were recorded. Fourteen patients (seven men and seven women; mean age, 53.6± 13.3years) constituted the study cohort. Of the 14 patients, 9 (64.3%) had had DVT due to intravascular invasion or external compression from known malignancy, 2 (14.3%) had had infected thrombi and/or vegetation due to Staphylococcus aureus refractory to intravenous antibiotic therapy, and 3 (21.4%) had had a benign etiology for thrombus formation. The presenting symptoms included upper extremity and/or facial swelling (n= 14), upper extremity pain (n= 6), fever (n= 2), and dyspnea (n= 1). Thrombectomy with the ClotTriever system was successfully completed in all 14 patients. Seven patients (50.0%) had required additional venous stent reconstruction after thrombectomy to address the underlying stenosis. No major adverse events were noted. All the patients had experienced resolution of the presenting symptoms. For the management of symptomatic deep venous occlusive disease of the upper extremity deep veins and thoracic central veins, thrombectomy using the ClotTriever system was feasible with excellent technical and clinical success.

Stellate Ganglion Blockade for Corticobasal Syndrome Pain: A Case Report and Potential New Discovery.

Corticobasal syndrome (CBS) is a neurodegenerative condition characterized by cortical and extrapyramidal dysfunction. It can manifest as painful asymmetric rigidity, spasticity, and dystonia. Treatments include muscle relaxants, analgesics, chemodenervation, and physical therapy.1 Some patient's pain is not alleviated by current treatments, demonstrating the need for new effective treatments. We report what may be the first case of CBS pain treated with stellate ganglion blockade. Stellate ganglion block is used to treat sympathetically mediated pain and complex regional pain syndrome (CRPS) of the upper extremity. We present a 63-year-old female diagnosed with CBS. Six years prior, she developed clumsiness, cramping, and difficulty completing tasks involving the right hand. This progressed to severe right upper extremity rigidity after 2 years. She was evaluated by movement and behavioral neurologists. She exhibited right upper extremity akinesis and rigidity, right sided predominate bradykinesia and leg rigidity, deficits with attention, language and recall, and speech apraxia. Magnetic resonance imaging, positron emission tomography, and dopamine transporter scan revealed volume loss of the left frontal and anterior parietal lobes, hypometabolism in the left posterior frontal region and mid-cingulate regions, and decreased radiotracer binding in the bilateral putamen, greater on the left. Laboratory studies including a frontotemporal dementia panel were unremarkable. As her condition progressed, she began experiencing constant pain in the right upper extremity. It was described as 8 of 10 in severity and only improved with botulinum toxin injections. At best, her pain was 4 of 10 after chemodenervation. However, this benefit often diminished weeks before her next dose. Despite chemodenervation treatment, she continued to describe her pain as “bone-breaking” and “intense.” Her pain did not improve with baclofen, tizanidine, clonazepam, levodopa, fluoxetine, ibuprofen, naproxen, acetaminophen, cannabidiol, topical diclofenac, or physical therapy. She was referred to pain medicine and a sympathetic block was proposed as a palliative measure. A right stellate ganglion block was performed with a 5 mL mixture of 10 mg of dexamethasone and 0.5% bupivacaine with epinephrine 1:200,000. She experienced relief after the procedure and continued to endorse a 0/10 pain at 2.5, 4, and 7 weeks. However, she did not experience improvement in her rigidity, dystonia, or limb akinesia. There has been at least one prior case of a patient with CBS who developed CRPS. Both conditions are associated with bradykinesia, dystonia, immobility, and sensory abnormalities.2 Both exhibit loss of inhibitory input to the cortex, increased cortical excitability,1, 3 and thalamic degeneration.1, 4 CRPS and CBS share the same pain generating mechanism as central post-stroke pain. In each condition, there is sensory deafferentation and reduction in thalamic and sensory input to the cortex, which produces pain.5 There are limited studies on the mechanism of pain generation in CBS. In her case, we suspect it is a combination of both peripherally and centrally mediated processes. The exact explanation for why she benefited from the procedure remains unclear. Sympathetic blockade may be effective in treating CBS-related pain. CBS and CRPS share similar pathophysiologic and phenotypic features. More research is needed to better treat pain associated with CBS and other neurodegenerative disorders. (1) Research project: A. Conception, B. Organization, C. Execution; (2) Statistical Analysis: A. Design, B. Execution, C. Review and Critique; (3) Manuscript: A. Writing of the First Draft, B. Review and Critique. L.H.: 1A, 1B, 1C, 3A. R.F.: 1A, 1C, 3B. E.C.S.: 1C, 3B. Ethical Compliance Statement: The authors confirm that this case is exempt from Institutional Review Board review per University of Nebraska Medical Center policy. Informed consent was discussed verbally with the patient, and then informed consent was obtained in written form. All core elements of Health Insurance Portability and Accountability Act of 1996 (HIPPA) and the additional informed consent requirements of this journal was addressed, obtained, and documented in the patient consent form. The patient consent form can be available upon request. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this work is consistent with those guidelines. Funding Sources and Conflicts of Interest: No specific funding was received for this work. The authors declare that there are no conflicts of interest relevant to this work. Financial Disclosures for the Previous 12 Months: The authors declare that there are no additional disclosures to report.

Parsonage-Turner syndrome following monkeypox infection and vaccination.

Beginning in May 2022, monkeypox infection and vaccination rates dramatically increased due to a worldwide outbreak. This case highlights magnetic resonance (MR) neurography findings in an individual who developed Parsonage-Turner syndrome (PTS) 5 days after monkeypox symptom onset and 12 days after receiving the JYNNEOS vaccination. MR neurography of the patient's left suprascapular nerve demonstrated intrinsic hourglass-like constrictions, a characteristic finding of peripheral nerves involved in PTS. Other viral infections and vaccinations are well-documented triggers of PTS, an underrecognized peripheral neuropathy that is thought to be immune-mediated and results in severe upper extremity pain and weakness. The close temporal relationship between monkeypox infection and vaccination, and PTS onset, in this case, suggests a causal relationship and marks the first known report of peripheral neuropathy associated with monkeypox.

The trajectory of pain and pain intensity in the upper extremity after stroke over time: a prospective study in a rehabilitation population

Purpose To assess the presence of upper extremity pain after stroke over time and the course of its intensity in patients with persistent pain. Materials and methods Patients with stroke completed a question on the presence of upper extremity pain (yes/no) and rated its intensity with a visual analogue scale (0–10) at 3, 18, and 30 months after starting multidisciplinary rehabilitation. The presence of upper extremity pain and its intensity over time were analysed with Generalized Estimating Equations models and Linear Mixed Models, respectively. Results 678 patients were included. The proportions of patients reporting upper extremity pain were 41.8, 36.0, and 32.7% at 3, 18, and 30 months, respectively, with the decline in proportions reaching statistical significance (odds ratio 0.82, 95% confidence interval 0.74–0.92, p < 0.001). At all time points, in those reporting pain the median intensity was 5.0 (interquartile ranges (IQR) 4.0–7.0 at 3 and 3.0–6.0 at 18 and 30 months). In the 73 patients with persistent pain, there was no significant change in intensity over time. Conclusions The proportion of patients reporting upper extremity pain after stroke was considerable, despite a significant decrease in 2.5 years. In patients reporting persistent pain, the intensity did not change over time.

Single-Leg Squat and Reported Pain in Collegiate Softball Pitchers.

Single-leg squat (SLS) performance is related to altered mechanics related to injury during the windmill softball pitch; however, it is unknown if SLS kinematics differ between softball pitchers with and without upper extremity pain. The purpose of this study was to compare knee valgus, trunk rotation, trunk lateral flexion, and trunk flexion during an SLS in collegiate softball pitchers with and without self-reported upper extremity pain. It was hypothesized that those who reported upper extremity pain would show increased compensatory trunk and knee kinematics compared with those without pain. Controlled laboratory study. A total of 75 collegiate softball players (mean age, 20.4 ± 1.7 years; mean height, 173.3 ± 7.7 cm; mean weight, 79.1 ± 11.6 kg) participated and were placed in pain (n = 20) or no-pain (n = 55) groups. Participants performed an SLS once per side. Kinematic data were collected at 100 Hz using an electromagnetic tracking system. A 2 (pain vs no pain) × 2 (descent vs ascent) × 2 (drive leg vs stride leg) mixed-design multivariate analysis of variance with Wilks lambda distribution was used to determine differences in drive-leg and stride-leg lower body mechanics between the descent and ascent phases of the SLS between the pitchers in the current study with and without pain. There was no significant effect in the 3-way interaction between upper extremity pain, side, and phase (Λ = 0.960; F[4, 70] = 0.726; P = .577; η2 = 0.04). However, there were large effects for the phase × side interaction (Λ = 0.850; P = .021; η2 = 0.150). There was a main effect of phase (Λ = 0.283; P < .001; η2 = 0.717). Study findings indicated that SLS mechanics do not differ between collegiate softball pitchers with and without reported upper extremity pain. Drive-leg mechanics showed more stability in the SLS than stride-leg mechanics. Softball pitchers are at risk of upper extremity injury. It is important to identify mechanisms that may lead to pain in order to mitigate the risk of injury.

Comparison of Trunk and Pelvic Kinematics in Youth Baseball Pitchers With and Without Upper Extremity Pain: A Cross-Sectional Study.

Motion of the pelvis and trunk during baseball pitching is associated with increased upper extremity (UE) kinetics. Increased kinetics on the UE may lead to throwing-arm pain in youth pitchers. Limited biomechanical comparisons have been conducted on youth pitchers with and without throwing-arm pain to identify mechanical risk factors associated with pain. To examine trunk and pelvic kinematics in youth baseball pitchers with and without UE pain. Cross-sectional study; Level of evidence, 3. A total of 26 male youth baseball pitchers (mean age, 12.7 ± 1.5 years; mean height, 162.2 ± 12.9 cm; mean weight, 52.6 ± 13.1 kg) were recruited to participate. An electromagnetic tracking system was used to obtain kinematic data during the fastball pitch. Data from a health history questionnaire was examined. Participants who answered "yes" to experiencing pain and who selected a region on their UE as the pain location were placed into the UE pain group. Participants who responded "no" to experiencing pain were placed into the pain-free group. We compared between-group differences in trunk rotation, flexion, and lateral flexion; pelvic rotation, anteroposterior tilt, and lateral tilt; and hip-shoulder separation from peak knee height to ball release of the baseball pitch using 1-dimensional statistical parametric mapping with an alpha level set at .05. No statistically significant differences were observed between the UE pain and pain-free groups in the 7 trunk and pelvic kinematics analyzed from peak knee height to ball release (P > .05). Trunk and pelvic kinematics during the pitching motion did not differ between pain and pain-free groups of youth baseball pitchers.

Prevalence of upper extremity pain and disability in elite football, ice hockey and floorball players

In athletes, injuries and medical conditions affecting the upper extremities are quite common. However, there has been limited research on the occurrence of joint pain in the peripheral upper extremities among elite athletes. Thus, this study aimed to determine how prevalent upper limb pain and disability are among team sports players, particularly in football, ice hockey and floorball. We also aimed to compare the severity of pain and disability among these sports and assess the risk of developing upper limb pain in athletes. This cross-sectional study was conducted between June 2021 and September 2022, involving 388 male elite athletes from national-level sports clubs. The prevalence of shoulder pain and disability was determined using the Shoulder Pain and Disability Index (SPI). Assessment of elbow pain and disability was conducted using the Oxford Elbow Score (OES), while wrist pain and disability were evaluated through the Patient-Rated Wrist Evaluation (PRWE). Significant differences in total SPI, OES and PRWE scores were observed among all groups. Ice hockey players experienced the highest levels of shoulder and wrist pain. Compared to football and floorball players, ice-hockey players had a 2.13 times higher risk of shoulder pain, with a pain incidence of 40.8%. Ice hockey also had a 1.71 times higher risk of wrist pain than football, with a pain prevalence of 26.3%. Notably, floorball players exhibited the most pronounced elbow pain, with a 13.18-fold higher risk than football and ice-hockey players and a pain prevalence of 67.2%. The study findings suggest that ice hockey players experience the highest pain levels in their right limbs, whereas football players have the lowest pain levels, underscoring the importance of dedicating more attention to developing innovative, effective and advanced preventive programs for athletes.

Safety of Left Subclavian Artery Selective Coverage without Revascularization in Thoracic Endovascular Aortic Repair for Type B Aortic Dissections.

Whether to proceed left subclavian artery (LSA) revascularization in patients with LSA coverage due to insufficient proximal landing zone (PLZ) during thoracic endovascular aortic repair (TEVAR) remains controversial. A total of 903 patients who received TEVAR were retrospectively analyzed. LSA could be covered if the PLZ was less than 15 mm accompanied with 1) a dominant or balanced right vertebral artery, 2) a complete circle of Willis, and 3) a left vertebral artery with a diameter ≥3 mm and without severe stenosis. LSA selective coverage was necessary for 35.0% (316/903) of the patients to extend the PLZ. Patients presented with weakness, pain, cooling and discoloration of the left upper extremity (LUE), and pulselessness of the left brachial artery were more in the LSA-covered group. The ischemia of LUE occurred more often in patients with LSA covered completely than in those with LSA covered partially. Functional arm status showed no significant difference in the arm, shoulder, and hand questionnaire scores at 12 months postoperative between the LSA-covered group and LSA-uncovered group, or between the LSA-covered completely group and LSA-covered partially group. It was safe to cover the LSA origin without revascularization if the PLZ was less than 15 mm accompanied with careful evaluation (description in method).

국내 자동차 및 모터사이클 수리업 근로자의 연령별 작업 유해요인 노출 정도, 건강 문제에 관한 비교 연구

Objective: In this study, the working environment, exposure to hazardous factors, and health problems of automobile and motorcycle repair workers are analyzed according to age group.BRBRBackground: Due to the nature of the automobile and motorcycle repair industry, a worker performs several processes and tasks, so the workers are exposed to various hazardous factors. In addition, the proportion of the elderly in the industry is increasing. Therefore, comparative analysis according to age is required for worker characteristics, exposure to working environment hazardous factors, satisfaction with working conditions, and health problems of workers in the industry.BRBRMethod: In this study, a total of 393 workers in the automobile and motorcycle repair industry were extracted from the 6th Korean working conditions survey. 47 people were in their 20s and younger, 58 people were in their 30s, 125 people were in their 40s, and 163 people were in their 50s and over. In the survey items, worker characteristics and health-related characteristics were analyzed.BRBRResults: There was a statistically significant differences in years of service, salary, and working hours per week by age. The proportion of complaining any musculoskeletal pain was the highest at 45.5%, followed by upper extremity pain (40.2%), fatigue (29.3%), back pain (27.0%), and lower extremity pain (17.0%). There was no statistically significant difference in the degree of exposure to hazardous factors during work by age, but the overall health status was found to be worse with increasing age. The proportion of complaints of health problems were high in those over 50 years of age.BRBRConclusion: It is necessary to prepare and implement countermeasures against fatigue and musculoskeletal disorders in elderly workers. In addition, preventive measures and efforts and support to improve working conditions are required to minimize the cumulative exposure of workers to hazardous factors. BRBRApplication: The study is considered to be meaningful as basic data for improving working conditions in the automobile and motorcycle repair industry.

Venous Thoracic Outlet Syndrome Combined with Brachial Neuritis Caused by Lymphadenopathy after Vaccination for Coronavirus Disease 2019: A Case Report

Thoracic outlet syndrome (TOS) occurs due to compression of the neurovascular bundle exiting the thoracic outlet, through which the brachial plexus and subclavian vessels pass. Here, we report a case of venous TOS combined with brachial neuritis, which was caused by axillary lymphadenopathy after the first dose of the BNT162b2 vaccine against coronavirus disease 2019 (COVID-19). A 17-year-old female patient presented with left upper extremity swelling and pain after inoculation with the BNT162b2 vaccine in the left deltoid muscle. Contrast-enhanced brachial plexus magnetic resonance imaging revealed severe swelling of the left axillary and subclavian lymph nodes, which lie immediately above the subclavian vein. An electrodiagnostic study revealed left brachial plexopathy, mainly involving the lower trunk with mixed demyelinating and axonal injury. The patient received intravenous steroid pulse therapy and oral steroid therapy. A follow-up examination showed complete recovery of muscle strength and function, pain, and swelling in the left upper extremity within 3 months after vaccination against COVID-19.

Prognostic factors associated with improvements in patient-reported outcomes in idiopathic adhesive capsulitis

The purpose of this study was to identify prognostic factors that are associated with improvements in patient-reported outcomes measures (PROMs) related to upper extremity function and pain in those suffering from idiopathic adhesive capsulitis. All patients treated conservatively for primary idiopathic adhesive capsulitis were identified from our institutional database between 2019 and 2021. Exclusion criteria included any patients treated surgically, follow-up less than one year, or incomplete survey results. PROMs including Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Computer Adaptive Test Version 2.0 (P-UE), Pain Interference (P-Interference), Pain Intensity (P-Intensity), and visual analog scale (VAS) pain scores. They were obtained at initial consultation and at one year to assess patient-perceived impact of their condition. Multiple linear and multivariable logistic regressions were performed to identify factors associated with improvement in patient-perceived pain and shoulder function using final PROM scores and difference in PROM scores from initial consultation. An independent t-test was used to compare baseline and one-year minimum follow-up PROMs. Odds ratios and their 95% confidence intervals were calculated for each factor; a P value of < .05 was considered statistically significant. A total of 56 patients (40 females and 16 males) were enrolled in the study with an average age of 54.7±7.7 years. A significant improvement (P<.001) was demonstrated at one-year minimum outcomes for P-UE, P-Interference, P-Intensity, and VAS scores. With respect to comorbid conditions, hypothyroidism [P-UE (β: 9.57, P=.006)] was associated with greater improvements in PROMs, while hyperlipidemia [P-UE (β:-4.13, P=.01) and P-Intensity (β: 2.40, P=.02)] and anxiety [P-UE (β:-4.13, P=.03)] were associated with poorer reported changes in PROMs. Female sex [P-UE (β: 4.03, P=.007) and P-Interference (β:-2.65, P=.04)] and employment in manual labor professions [P-Interference (β:-3.07, P=.01), P-Intensity (β:-2.92, P=.006), and VAS (β:-0.66, P=.03)] were associated with significantly better patient-perceived outcomes. Hispanic heritage was associated with higher reported changes of P-Intensity (β: 8.45, P=.004) and VAS (β: 2.65, P=.002). Patient-perceived improvements in PROMIS score during the natural history of adhesive capsulitis are likely multifactorial, with anxiety, hyperlipidemia, increased body mass index, and Hispanic heritage associated with reduced improvement in PROMIS scores.

Association of use of different type of manual therapy approach with upper extremity pain in manual therapists of Lahore”

This study was conducted to assess the upper limb pain in manual physiotherapists by using different manual therapy techniques.There was no such type of study in Pakistan and also there was less literature found on this study internationally.It was a cross sectional study . Data was collected from the manual physiotherapists of Lahore from different clinical settings. The data collection was done by using Non probability convenient sampling technique. The Sample size was 126, calculated from (“Raosoft” software). The questionnaire used to assess pain was the Standard Nordic musculoskeletal questionnaire. For the statistical analysis, SPSS 20 software was used to find the association of use of a different type of manual therapy approach with upper extremity pain in the manual therapist. The mean age of physiotherapists was 34.6 (SD = 5.996). Out of 126, male physiotherapist 66 and 60 were female. Mostly Physiotherapists who were included in this study had working experience of more than 5 years and practicing more than 3 hours a day had upper limb pain. Physiotherapists using manual therapy techniques Kalterborn technique had more pain in the neck, shoulder, elbow,wrist and hand than physiotherapists using Mulligan and Maitland. There was no association of any technique used by physiotherapists with shoulder, elbow, wrist/hand and neck pain (p&gt;0.05). This study concluded that physiotherapists using Kalternborn technique reported more upper limb pain than therapists using the maitland and mulligan techniques. There was no association of any technique used by hysiotherapists with shoulder, elbow, wrist/hand and neck pain.

Description of physical activity in children with juvenile idiopathic arthritis using accelerometry

ObjectivesJuvenile idiopathic arthritis (JIA) can lead to functional impotence and reduced physical activity (PA) in patients. The objective of this study was to monitor the daily PA of children aged 6–18 years with JIA using accelerometry based on disease activity and individual abilities, and to compare this with age recommendations. MethodsPatients volunteering for the study wore an accelerometer for 7 consecutive days; data were evaluated using a wGT3X ActiGraph™. The 2010 World Health Organization (WHO) recommendations were used for comparison. ResultsWe collected accelerometry data for 24 patients of the University Hospital Center (UHC) of Besançon. Only two patients did not reach the recommendations of moderate-to-vigorous PA (MVPA). Time spent in MVPA was negatively correlated with age, BMI, number of joints with active arthritis, JADAS score, and visual analogue pain assessment (VAPA). Patients with active disease, those with upper extremity pain, and female patients had significantly lower PA scores. ConclusionsAlmost all of the patients of the UHC of Besançon who accepted the study reached the WHO recommendations. Having an active disease, having painful upper limbs, or being a girl is associated with decreased PA.

Outcomes following Free Fibula Physeal Transfer for Pediatric Proximal Humerus Reconstruction: An International Multi-Institutional Study.

Vascularized fibula epiphyseal flap was first described in 1998 for proximal humeral reconstruction in children/infants. The authors aim to review their international, multi-institutional, long-term outcomes. An international, multi-institutional review (2004 to 2020) was conducted of patients younger than 18 years undergoing free vascularized fibula epiphyseal transfer for proximal humeral reconstruction. Donor- and recipient-site complications, pain, and final ambulatory status were reviewed. Growth of the transferred bone was assessed under the guidance of a pediatric musculoskeletal radiologist. Twenty-seven patients were included with a median age of 7 years (range, 2 to 13 years). Average follow-up was 120 ± 87.4 months. There were two flap failures (7.4%). Recipient-site complications included fracture [ n = 11 (40.7%)], avascular necrosis of the fibula head [ n = 1 (3.7%)], fibular head avulsion [ n = 1 (3.7%)], infection [ n = 1 (3.7%)], and hardware failure [ n = 1 (3.7%)]. Operative fixation was necessary in one patient with a fracture. The case of infection necessitated fibula explantation 2 years postoperatively, and ultimately, prosthetic reconstruction. Sixteen patients developed peroneal nerve palsy (59.3%): 13 of these cases resolved within 1 year (81% recovery), and three were permanent (11.1%). One patient (3.7%) complained of upper extremity pain. Longitudinal growth was confirmed in all but three cases [ n = 24 (88.9%)] at an average rate of 0.83 ± 0.25 cm/year. The vascularized fibula epiphysis for proximal humerus reconstruction in children preserves the potential for future growth and an articular surface for motion. Peroneal nerve palsy is common following harvest, although this is often transient. Future efforts should be geared toward reducing postoperative morbidity. Therapeutic, IV.

Glenohumeral Instability and Arm Pain in Overhead Throwing Athletes: A Correlational Study.

The overhead activity of throwing a baseball is arguably the most demanding athletic endeavor placed on the glenohumeral (GH) joint. Previous studies illustrate that 75-80% of baseball players will experience some degree of upper extremity (UE) pain. GH instability is thought to play a role. The purpose of this study was to investigate the relationship between GH joint hypermobility and instability with measures of arm pain and performance in overhead throwing athletes. Actively competing baseball pitchers were recruited and evaluated once with the anterior-posterior Load and Shift examination procedure, the Kerlan-Jobe Orthopedic Clinic Shoulder and Elbow Questionnaire (KJOC), and the Functional Arm Scale for Throwers (FAST). Multivariate analysis was performed to identify correlation between severe GH capsular laxity (GH instability), mild capsular laxity (GH hypermobility), no capsular laxity (GH normal), and presence of shoulder pain when pitching. Cross-sectional Study. Forty-five pitchers were evaluated, 62.2% of throwing shoulders were classified normal stability, 26.7% were classified hypermobile, and 11.1% were classified unstable. Average KJOC scores for pitchers with the three mobility categories were 66.1 (normal), 59.7 (hypermobile), and 45.0 (unstable). Average FAST scores among the pitchers were 19.9 (normal), 34.2 (hypermobile), and 32.2 (unstable). Pitchers with GH instability and GH hypermobility demonstrated increased arm pain compared to athletes with normal GH joints; KJOC scores of 3.2, 5.5, and 7.4 (p = 0.0007), respectively. Pitchers with GH instability and hypermobility demonstrated significantly increased ratings of arm pain compared to pitchers with no capsular laxity. 3b.