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This easy-to-follow 'cookbook' guides hand surgeons and radiologists through the process of diagnosis and treatment Mobile ultrasonography is revolutionizing the way hand surgery patients are managed. Ultrasound of the Hand and Upper Extremity: A Step-by-Step Guide is the first book on this field that is intended for practicing hand surgeons and the radiologists who work with them. A stepwise, practical guide specially designed for quick reference, with bullet-point text, informative figures, and detailed clinical examples, this book and its accompanying videos are ideal for the busy clinician. Edited by John R. Fowler and Nandkumar M. Rawool, with contributions by other experts with long experience in ultrasound techniques, this book features a reader-friendly chapter structure that describes the appropriate setup, anatomic landmarks, probe and patient positioning, comparative normal anatomy, relevant pathologic anatomy, and available injection techniques for 14 anatomic areas and conditions. Key Highlights * Full-color photographs to depict proper patient and probe positioning for optimal results * Expert advice on ultrasound machine settings for achieving the best images in various structures * Labeled ultrasound images of deformities and normal anatomy for comparative clinical use * Thirteen instructive videos highlight ultrasound techniques for a range of structures and pathologies This unique guidebook for upper limb ultrasound methods is the essential primary reference for all practicing hand surgeons and residents, as well as orthopedic surgeons, sports medicine specialists, and radiologists who must provide their patients with unrivaled care using state-of-the-art equipment and techniques.

Objectives. This study is aimed at exploring the feasibility of sonoelastography on muscle stiffness of spastic forearm and evaluating the improvement of functional performance in patients with poststroke spasticity (PSS) after receiving kinesiotaping (KT) and rehabilitation. Methods. According to the spastic levels (using modified Ashworth scale (MAS)) of the affected upper extremity, 59 patients with stroke were allocated into two groups, group A (MAS 0–1): 31 patients (14 men and 17 women; mean age: 60 years) and group B (MAS 1+–2): 28 patients (22 men and 6 women; mean age: 51 years). The Brunnstrom motor recovery stage at the wrist/distal parts in groups A and B was stage 3/3.5 and stage 2.75/3. We evaluated the Brunnstrom stage, spastic levels by MAS and modified Tardieu scale (MTS), and Fugl-Meyer Assessment for upper extremity (FMA-UE). We also evaluated the muscle spasticity of flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), and flexor digitorum superficialis (FDS) muscles using sonoelastography with shear wave velocity (SWV). We applied KT for 20 patients in group B, comparing the changes in sonoelastography and functional outcomes between KT and without KT interventions. Results. Both the MAS and MTS scales were moderately correlated with the SWV in forearm muscles on hemiplegic side (r=0.336–0.554) After KT intervention, the SWV in FCR decreased (p=0.028). Muscle spasticity was reduced (p<0.01), and distal part of the Brunnstrom stage and FMA-UE were increased (p=0.045 and p=0.001). In patients without KT intervention, only the MTS degree reduced (p=0.026). Conclusions. The SWV of sonoelastography could objectively assess the reduction of muscle stiffness of the affected forearms in patients with PSS after KT intervention. Advances in Knowledge. Sonoelastography could be a quantitative method to follow up for therapeutic effect of the spastic forearm.

Background This randomized double-blinded trial compared the effect of intravenous and perineural dexamethasone (8 mg) on the duration of motor block for ultrasound (US)-guided axillary brachial plexus block (AXB). Methods Patients undergoing upper limb surgery with US-guided AXB were randomly allocated to receive preservative-free dexamethasone (8 mg) via intravenous ( n  = 75) or perineural ( n  = 75) administration. The local anesthetic agent, 1% lidocaine −0.25% bupivacaine (30 mL) with epinephrine 5 µg·mL −1 , was identical in all subjects. Operators and patients were blinded to the nature of the intravenous and perineural injectate. A blinded observer assessed the block success rate (i.e., a minimal sensorimotor composite score of 14 out of 16 points at 30 min), block onset time, as well as the presence of surgical anesthesia. Postoperatively, the blinded observer contacted all patients with successful blocks to record the duration of motor block (primary outcome), sensory block, and postoperative analgesia. Results No intergroup differences were observed in terms of success rate, surgical anesthesia, and block onset time. Compared to intravenous administration, perineural dexamethasone provided longer mean (SD) durations for motor block [17.5 (4.6) hr vs 12.8 (4.5) hr; mean difference, 4.6 hr; 95% confidence interval [CI], −6.21 to −3.08; P  < 0.001], sensory block [17.7 (5.1) hr vs 13.7 (5.0) hr; mean difference, 4.0 hr; 95% CI, −5.77 to −2.27; P  < 0.001], and postoperative analgesia [21.1 (4.6) hr vs 17.1 (4.6) hr; mean difference, 4.0 hr; 95% CI, −5.70 to −2.30; P  < 0.001]. Conclusion Compared to intravenous dosing, perineural dexamethasone (8 mg) results in longer durations of sensorimotor block and postoperative analgesia for ultrasound-guided axillary block. This trial was registered at www.clinicaltrials.gov number, NCT02629835.

Background The current recommendations on resistance training involving older adults have reported an improvement of body composition variables. Despite this, there is a lack of knowledge on how elastic resistance training (ERT) affects the muscle mass in older adults population. The purpose of this study was to determine the effects of a short-term ERT on muscle mass of health and untrained older adults. Methods Forty older adults were randomized into two groups of 20 individuals each: Control Group (CG = 66.2 ± 6.6 years) and Training Group (TG = 69.1 ± 6.3 years). TG underwent an ERT twice a week during 8 weeks and control group did not receive any specific intervention. The primary outcome was the upper and lower limbs muscle mass, measured by Dual-energy x-ray absorptiometry. The secondary outcomes were knee isokinetic peak torque (PT) at 60°/s and 120°/s speeds and isometric handgrip strength. A 2×2 mixed model (group [TG and CG] × time [pre and post]) analysis of variance (ANOVA) was applied to determine the effect on primary and secondary outcomes. Results The results of the ANOVA showed no significant effects in group x time interaction for (1) upper limbs fat free mass (F [1.38] = 1.80, p  = 0.19, effect size [ES] = 0.1) and for (2) lower limbs fat free mass (F [1.38] = 0.03, p  = 0.88, ES = 0.02). Regarding muscle strength, the ANOVA showed no significant effects in group x time interaction for (3) PT at 60°/s (F [1.38] = 0.33, p  = 0.56, ES = 3.0), for (4) PT at 120°/s (F [1.38] = 0.80, p  = 0.38, ES = 4.1) and for handgrip strength (F [1.38] = 0.65, p  = 0.42-value, ES = 0.9). Analysis of PT in TG showed a significant change of 4.5 %, but only at 120°/s ( p  = 0.01) when comparing pre and post-training (time interaction). Conclusions Eight weeks of ERT did not show significant changes in muscle mass and strength of untrained older adults. Trial registration NCT02253615 (09/25/14)

To determine if the infraclavicular brachial plexus block can be applied with lower volume of local anesthetic. Randomised, double-blinded clinical trial. 60 patients aged 5–15years with ASA I–II who underwent emergent or elective arm, forearm or hand operations were included in the study. Patients were divided into two groups randomly; standard volume local anesthetic administered group (Group S, n=30) and low volume anesthetic administered group (Group L, n=30). Postoperative pain scores, sensory and motor block durations were noted. Pain scores (Wong-Baker Face Scale) were evaluated and the results were detected to be similar at all times (30min, 1, 2, 4, 8, 12, 24h). Durations of motor block were 168(±16) minutes and 268(±15) minutes in Group L and Group S respectively and the difference was statistically significant (p<0.001). Durations of sensory block were 385(±26) and 402(±39) in Group L and Group S respectively and no statistically significant difference was detected (p=0.064). Similar block success, postoperative sensory block durations and pain scores could be obtained during infraclavicular brachial plexus in pediatric patients with lower local anesthetic volumes. •Local anesthetic toxicity is an important complication for peripheral nerve blocks.•Ultrasound guidance can be useful to apply the nerve block with lower volume.•Block quality, success and pain scores are similar in both lower and standard volume.

Emergency physicians often treat patients who require procedural sedation for the management of upper extremity fractures, dislocations, and abscesses (upper extremity emergencies). Unfortunately, procedural sedation is associated with several rare but potentially serious adverse effects and requires continuous hemodynamic monitoring and several dedicated staff members. The purpose of this study was to determine the role of ultrasound-guided supraclavicular brachial plexus nerve blocks in the emergency department (ED) as an alternative to procedural sedation for the management of upper extremity emergencies. In a prospective trial, a convenience sample of ED patients with upper extremity emergencies that would normally require procedural sedation were assigned to receive either procedural sedation or an ultrasound-guided supraclavicular brachial plexus nerve block. Emergency department length of stay (ED LOS) was the primary outcome measure and was analyzed using a paired 2-tailed Student t test. A total of 12 subjects were enrolled. Average ED LOS for subjects receiving the brachial plexus nerve block was 106 minutes (95% confidence interval, 57-155 minutes). Average ED LOS for subjects receiving procedural sedation was 285 minutes (95% confidence interval, 228-343 minutes). The ED LOS was significantly shorter in the nerve block group ( P < .0005). Patient satisfaction was high in both groups, and no significant complications occurred in either group. In our population, ultrasound-guided brachial plexus nerve blocks resulted in shorter ED LOS compared to procedural sedation for patients with upper extremity fractures, dislocations, or abscesses.

Electroencephalography (EEG) signals have great impact on the development of assistive rehabilitation devices. These signals are used as a popular tool to investigate the functions and the behavior of the human motion in recent research. The study of EEG-based control of assistive devices is still in early stages. Although the EEG-based control of assistive devices has attracted a considerable level of attention over the last few years, few studies have been carried out to systematically review these studies, as a means of offering researchers and experts a comprehensive summary of the present, state-of-the-art EEG-based control techniques used for assistive technology. Therefore, this research has three main goals. The first aim is to systematically gather, summarize, evaluate and synthesize information regarding the accuracy and the value of previous research published in the literature between 2011 and 2018. The second goal is to extensively report on the holistic, experimental outcomes of this domain in relation to current research. It is systematically performed to provide a wealthy image and grounded evidence of the current state of research covering EEG-based control for assistive rehabilitation devices to all the experts and scientists. The third goal is to recognize the gap of knowledge that demands further investigation and to recommend directions for future research in this area.

Children with spastic cerebral palsy (CP) experience altered muscle tone due to biomechanical changes, traditionally assessed through clinical scales. Shear wave elastography (SWE) offers a non-invasive way to quantify these changes. This study aimed to compare SWE measurements in spastic CP and typically developing (TD) children and investigate influencing factors such as joint position, range of motion, demographics, physical condition and, in CP children, the characteristics of CP. It also examined correlations between SWE measurements and spasticity scales in CP children. SWE measured the elastic modulus (kPa) of biceps brachii (BB), pronator teres (PT), adductor longus (AL), lateral gastrocnemius (LG), and soleus (SOL) muscles at rest and during maximum passive stretching (MPS) in 34 spastic CP children (age: 3–17) and 44 TD children (age: 3–14). Significant differences (p < 0.05) in SWE were found between CP and TD children. CP children had lower values in upper limb muscles and higher values in lower limb muscles at rest, with the opposite pattern during MPS. The Ashworth and Tardieu scales were associated with the elastic modulus in lower limb muscles (AL, GL, and SOL) at rest in CP children. Differences in elastic modulus at rest and MPS between upper and lower limbs and in spastic CP and TD children showed no consistent links to spasticity scales, reflecting neurological dysregulation, muscle architecture, and joint structure involvement. These variations were linked to neurological dysregulation and muscle architecture, with joint structures also affecting. SWE may offer a more precise assessment of muscle spasticity, minimizing the impact of confounding joint structures.

Secondary lymphedema causes swelling in limbs due to lymph retention following lymph node dissection in cancer therapy. Initiation of treatment soon after appearance of edema is very important, but there is no method for early diagnosis of lymphedema. In this study, we compared the utility of four diagnostic imaging methods: magnetic resonance imaging (MRI), computed tomography (CT), lymphoscintigraphy, and Indocyanine Green (ICG) lymphography. Between April 2010 and November 2011, we examined 21 female patients (42 arms) with unilateral mild upper limb lymphedema using the four methods. The mean age of the patients was 60.4 years old (35-81 years old). Biopsies of skin and collecting lymphatic vessels were performed in 7 patients who underwent lymphaticovenous anastomosis. The specificity was 1 for all four methods. The sensitivity was 1 in ICG lymphography and MRI, 0.62 in lymphoscintigraphy, and 0.33 in CT. These results show that MRI and ICG lymphography are superior to lymphoscintigraphy or CT for diagnosis of lymphedema. In some cases, biopsy findings suggested abnormalities in skin and lymphatic vessels for which lymphoscintigraphy showed no abnormal findings. ICG lymphography showed a dermal backflow pattern in these cases. Our findings suggest the importance of dual diagnosis by examination of the lymphatic system using ICG lymphography and evaluation of edema in subcutaneous fat tissue using MRI.

This study aimed to compare the fascicular anatomy of upper limb nerves visualized using in situ high-resolution ultrasound (HRUS) with ex vivo imaging modalities, namely, magnetic resonance microscopy (MRM), histological cross-sections (HCS), and optical projection tomography (OPT). The median, ulnar, and superficial branch of radial nerve ( n  = 41) were visualized in 14 cadaveric upper limbs using 22-MHz HRUS. Subsequently, the nerves were excised, imaged with different microscopic techniques, and their morphometric properties were compared. HRUS accurately differentiated 51–74% of fascicles, while MRM detected 87–92% of fascicles when compared to the referential HCS. Among the compared modalities, HRUS demonstrated the smallest fascicular ratios and fascicular cross-sectional areas, but the largest nerve cross-sectional areas. The probability of a fascicle depicted on HRUS representing a cluster of multiple fascicles on the referential HCS increased with the fascicular size, with some differences observed between the larger median and ulnar nerves and the smaller radial nerves. Accordingly, HRUS fascicle differentiation necessitates cautious interpretation, as larger fascicles are more likely to represent clusters. Although HCS is considered the reference modality, alterations in nerve cross-sectional areas or roundness during sample processing should be acknowledged.