Factors influencing arm and axillary symptoms after treatment for node negative breast carcinoma.
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BACKGROUND: The purpose of the current study was to identify the factors that contribute to postoperative arm symptoms following breast conserving surgery in a well-defined cohort of node negative breast carcinoma patients. METHODS: A convenience sample of 370 women >/= 50 years of age with node negative breast carcinoma who were participants in a randomized controlled trial designed to assess the need for breast radiation in addition to tamoxifen were surveyed. Axillary dissection was optional for patients 65 years or older and who were clinically node negative. RESULTS: A total of 65.1% (241/370) of women had ipsilateral shoulder or arm symptoms. Multivariate analysis revealed that axillary dissection, breast radiation, and younger age (odds ratio = 11.2, 1.65, and 3.8 respectively) were significantly (P < 0.05) associated with increased ipsilateral shoulder or arm symptoms. Treatment with axillary dissection and breast radiation were significant factors (P < 0.02) associated with the self-reporting of arm swelling (odds ratio = 4.4 and 2.0, respectively). Patients 70 years old or greater reported significantly fewer arm symptoms (odds ratio = 0.26, P < 0.05) after axillary dissection. CONCLUSIONS: Arm symptoms were present in about 80% of patients who underwent breast conserving surgery, axillary dissection, and breast radiation in the current study. These symptoms were significantly associated with the use of axillary dissection, breast radiation, and younger age. Older patients experienced fewer arm symptoms after standard treatment for node negative breast carcinoma, and thus older age should not be a contraindication to axillary dissection. (+info)
An analysis of muscular load and performance in using a pen-tablet system.
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The present paper aims to investigate two characteristics; task performance and muscular load during skill process for the pen-tablet input system with the mouse input system on the PC in order to determine the comprehensive usability for the pen-tablet system. Two computer tasks were designed for the study: task SL and task PT. Task SL was a repetitive computer-drawing including typical mouse motions such as clicking and drag-dropping. Task PT was a polygon tracing task requiring fine-controlled movements with the input device. Surface electromyography (EMG) and performance data were measured during the task. When the pen-tablet was being used, low amplitudes of EMGs for the biceps brachii, the flexor digitorum superficialis, and the extensor digitorum were found, whereas no EMG difference for the trapezius was found for both tasks. On the first day, the performance with the mouse was much higher than the performance with the pen-tablet in terms of error rates and the number of completed trials. However, the performance with the pen-tablet exceeded the performance with the mouse from the second day on, and the subjects performed better with the pen-tablet than with the mouse. Current results imply that the skill process for the pen-tablet system was very short and the subjects felt comfortable to use the new system from the beginning. (+info)
A myoelectric model for thoracic spinal motion dynamics during clinical rotation tests: Part 1. Ipsilateral regional motor performance.
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Osteopathic physicians may use regional diagnostic rotation tests of the spine during physical examinations for patient evaluations. Clinical judgments of these responses relate to symmetry as a criterion for mobility. This first part of a two-part study reports the authors' investigation of regional ipsilateral myoelectric activity during responses to active and passive shoulder and trunk rotations on the left- and right-side muscles with subjects seated. Results indicate symmetry existed in both active and passively induced regional rotation tests. Further, the distribution (profile) of ipsilateral myoelectric activity in the thorax reflected a bell-shaped activity curve that peaked at thoracic levels 6 and 7. This profile element demonstrates remarkable similarity between volitional and physician-induced rotation motions. These myoelectric data justify symmetry and profile as tangible standards for making clinical judgments of regional responses to spinal rotation diagnostic tests. (+info)
Clinical analysis of cervical radiculopathy causing deltoid paralysis.
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In general, deltoid paralysis develops in patients with cervical disc herniation (CDH) or cervical spondylotic radiculopathy (CSR) at the level of C4/5, resulting in compression of the C5 nerve root. Therefore, little attention has been paid to CDH or CSR at other levels as the possible cause of deltoid paralysis. In addition, the surgical outcomes for deltoid paralysis have not been fully described. Fourteen patients with single-level CDH or CSR, who had undergone anterior cervical decompression and fusion for deltoid paralysis, were included in this study. The severity of deltoid paralysis was classified into five grades according to manual motor power test, and the severity of radiculopathy was recorded on a visual analog scale (zero to ten points). The degree of improvement in both the severity of deltoid paralysis and radiculopathy following surgery was evaluated. Of 14 patients, one had C3/4 CDH, four had C4/5 CDH, three had C4/5 CSR, one had C5/6 CDH, and five had C5/6 CSR. Both deltoid paralysis and radiculopathy improved significantly with surgery (2.57+/-0.51 grades vs 4.14+/-0.66, P=0.001, and 7.64+/-1.65 points vs 3.21+/-0.58, P=0.001, respectively). In conclusion, the current study demonstrates that deltoid paralysis can develop due to CDH or CSR not only C4/5, but also at the levels of C3/4 and C5/6, and that surgical decompression significantly improves the degree of deltoid paralysis due to cervical radiculopathy. (+info)
A myoelectric model for thoracic spinal motion dynamics during clinical rotation tests: Part 2. Bilateral segmental motor behaviors.
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In part 2 of their report, the authors continue to evaluate myoelectric data obtained from spinal motion dynamics involved in clinical rotation tests. They add to the ipsilateral regional analysis of motor performance as previously presented and analyze the total bilateral myoelectric activity gathered concurrently at individual thoracic vertebral segments during simultaneous rotation left and right motion tests. The authors' hypothetical consideration concerns the nature of composite behaviors at these vertebral segments during active and passive motions and the role that postural dynamics play in movement function. They consider these concepts in the context of the study's experimental design and also within the broader concept of the osteopathic musculoskeletal examination. Results revealed pronounced similarity in individual spinal electromyographic patterns whether motions were volitional or physician induced. Analysis demonstrates the bell-shaped myoelectric behavior pattern originally reported in part 1. The authors also discuss a functional model for this myoelectric activity involving a helical spinal motor pattern with a focal area of transition that is dynamic in response to postural and motion demands. (+info)
The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire: longitudinal construct validity and measuring self-rated health change after surgery.
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BACKGROUND: The disabilities of the arm, shoulder and hand (DASH) questionnaire is a self-administered region-specific outcome instrument developed as a measure of self-rated upper-extremity disability and symptoms. The DASH consists mainly of a 30-item disability/symptom scale, scored 0 (no disability) to 100. The main purpose of this study was to assess the longitudinal construct validity of the DASH among patients undergoing surgery. The second purpose was to quantify self-rated treatment effectiveness after surgery. METHODS: The longitudinal construct validity of the DASH was evaluated in 109 patients having surgical treatment for a variety of upper-extremity conditions, by assessing preoperative-to-postoperative (6-21 months) change in DASH score and calculating the effect size and standardized response mean. The magnitude of score change was also analyzed in relation to patients' responses to an item regarding self-perceived change in the status of the arm after surgery. Performance of the DASH as a measure of treatment effectiveness was assessed after surgery for subacromial impingement and carpal tunnel syndrome by calculating the effect size and standardized response mean. RESULTS: Among the 109 patients, the mean (SD) DASH score preoperatively was 35 (22) and postoperatively 24 (23) and the mean score change was 15 (13). The effect size was 0.7 and the standardized response mean 1.2.The mean change (95% confidence interval) in DASH score for the patients reporting the status of the arm as "much better" or "much worse" after surgery was 19 (15-23) and for those reporting it as "somewhat better" or "somewhat worse" was 10 (7-14) (p = 0.01). In measuring effectiveness of arthroscopic acromioplasty the effect size was 0.9 and standardized response mean 0.5; for carpal tunnel surgery the effect size was 0.7 and standardized response mean 1.0. CONCLUSION: The DASH can detect and differentiate small and large changes of disability over time after surgery in patients with upper-extremity musculoskeletal disorders. A 10-point difference in mean DASH score may be considered as a minimal important change. The DASH can show treatment effectiveness after surgery for subacromial impingement and carpal tunnel syndrome. The effect size and standardized response mean may yield substantially differing results. (+info)
Brachial plexus examination and localization using ultrasound and electrical stimulation: a volunteer study.
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BACKGROUND: Current techniques of brachial plexus block are "blind," and nerve localization can be frustrating and time consuming. Previous studies on ultrasound-assisted brachial plexus blocks are mostly performed with scanning probes of 10 MHz or less. The authors tested the usefulness of a state-of-the-art, high-resolution ultrasound probe (up to 12 MHz) in identifying the brachial plexus in five locations of the upper extremity and in guiding needle advancement to target before nerve stimulation. METHODS: In this prospective observational study, 15 volunteers underwent brachial plexus examination using an L12-L5 MHz probe and a Philips-ATL 5000 ultrasound unit in the interscalene, supraclavicular, infraclavicular, axillary, and midhumeral regions. Thereafter, an insulated block needle was advanced under direct ultrasound guidance to target nerves before confirmation by electrical nerve stimulation in five volunteers in each of the interscalene, supraclavicular, and axillary regions. The quality of brachial plexus images, anatomic variations, and the technique of needle advancement for nerve localization were recorded. RESULTS: The brachial plexus components were successfully identified in the transverse view as round to oval hypoechoic structures with small internal punctuate echos in all regions examined except the infraclavicular area (visualized in 27% of the cases). The authors' technique of advancing the needle in-line with the ultrasound beam allowed moment-by-moment observation of the needle shaft and tip movement at the time of nerve localization. Hypoechoic structures were stimulated electrically and confirmed to be nerves. CONCLUSIONS: These preliminary data show that the high-resolution L12-L5 probe provides good quality brachial plexus ultrasound images in the superficial locations i.e., the interscalene, supraclavicular, axillary, and midhumeral regions. The needle technique described here for ultrasound-assisted nerve localization provides real-time guidance and is potentially valuable for brachial plexus blocks. (+info)
Evaluation of the lateral modified approach for continuous interscalene block after shoulder surgery.
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BACKGROUND: Continuous interscalene block is the technique of choice for postoperative pain relief treatment after shoulder surgery. The authors prospectively evaluated the modified lateral approach for the performance of the interscalene catheter block and monitored 700 patients for clinical efficacy and complications during the first 6 months after placement of the catheter. METHODS: A total of 700 adults scheduled to undergo elective shoulder surgery performed with an interscalene brachial plexus block through an interscalene catheter were included in this study. The interscalene brachial plexus block procedure was standardized for all patients. Difficulties in placement of the catheter, clinical efficacy of anesthesia and analgesia, patient satisfaction, and acute and chronic complications were recorded. Patients were observed daily for 5 days for any complications and were evaluated at 1, 3, and 6 months after surgery. Persistence of neurologic complication was investigated by electroneuromyography. RESULTS: A total of 700 adults completed the study. Easy placement of the catheter (one attempt) was achieved in 86% of the patients. Resistance to thread the catheter was encountered in 6%; no major complications were observed during injection of the initial bolus. The success rate for anesthesia was 97%. Postoperative analgesia was efficient in 99%. The concentration and the rate of infusion of ropivacaine had to be increased in 31 patients (6%). In five patients (0.7%), signs of local infection around the puncture point were noted; in one patient (0.1%), a collection of pus was surgically drained. Patient satisfaction was 9.6 on a scale of 0-10. Minor neurologic complications (paresthesias, dysesthesias, pain not related to surgery) were observed in 2.4%, 0.3%, and 0% at 1, 3, and 6 months, respectively. At 1 month, three sulcus ulnaris syndromes, one carpal tunnel syndrome, and one complex regional pain syndrome were diagnosed. Two patients (0.2%) had sensory-motor deficit, which necessitated 19 and 28 weeks to recover. Electromyography was suggestive of partial axonotmesis. CONCLUSION: The lateral modified approach provides good conditions for placement of the interscalene catheter. Anesthesia and analgesia performed through the catheter are efficient. The rates of infection and neurologic complications are low, and patient satisfaction is high. (+info)