Risk factors associated with self‐reported symptoms of digital ischemia in elite male volleyball players in the Netherlands

One in every four elite male volleyball players in the Netherlands reported blue or pale digits in the dominant hand. Little is known about risk factors. To assess whether personal‐, sports‐, and work‐related risk factors are associated with these symptoms in these volleyball players, a survey was performed among elite male volleyball players in the Dutch national top league and in the Dutch beach volleyball team. The questionnaire assessed the presence of symptoms and risk factors. Binary logistic regression was performed to calculate odds ratios (ORs). A total of 99 of the 107 athletes participated – a response rate of 93%. Two sports‐related risk factors were associated with symptoms of blue or pale digits: 18–30 years playing volleyball [OR = 6.70; 95% confidence interval (CI) 1.12–29.54] and often/always performing weight training to increase dominant limb strength (OR = 2.70; 95% CI 1.05–6.92). No significant other sports‐, personal‐, or work‐related risk factors were found. Playing volleyball for more than 17 years and often/always performing weight training to increase dominant limb strength were independently associated with an increased risk on ischemia‐related complaints of the dominant hand in elite male volleyball players.     

Inadvertent intra-arterial drug injections: the role of angiographic and clinical findings

Purpose: To evaluate the angiographic findings of patients who have inadvertently injected oral formulations of drugs into an upper extremity artery.

Material and Methods: The radiology files for the previous 4 years were analyzed retrospectively. Seven patients were referred from the Emergency Department for angiography and possible thrombolysis during that time period.

Results: The worst clinical results were found among the patients whose angiographic examinations showed absent flow. Two patients who were treated with local thrombolysis had no better results compared to the other five patients.

Conclusion: Findings of delayed flow and absent flow in angiography should lead to intensified conservative treatment, especially among patients who have clinical findings of delayed capillary refilling or/and impaired muscular strength.     

Chronic exertional compartment syndrome of the forearm

Chronic exertional compartment syndrome (CECS) is an overuse injury characterized by increased intracompartmental pressure during exercise. CECS has been described in the foot, thigh, and trunk, but 95% of cases occur in the lower leg. Interestingly, CECS may also affect the upper extremities and has been best described in the forearms. Unfortunately, due to the rarity of this condition, there is no consensus regarding its diagnosis and treatment. This review seeks to discuss the prevalence, etiology, diagnosis, and treatment of CECS of the forearms, which has been described in the literature.     

儿童上气道咳嗽综合征74例临床分析

目的探讨儿童上气道咳嗽综合征的临床特点和治疗方案。方法对74例UACS患儿的症状、体征、影像学检查及综合治疗方法进行分析。结果 74例中慢性鼻窦炎26例(35%),变应性鼻部疾病20例(27%),小儿特有的腺样体和/或腭扁桃体肥大15例(20%),慢性鼻炎13例(18%),均以慢性咳嗽为主诉。经过积极的抗炎与抗变态反应治疗以及必要的手术治疗,咳嗽消失63例,咳嗽明显减轻9例。结论 儿童UACS以咳嗽为主要临床特点,表现或不表现出鼻部、咽部疾病特点,是儿童慢性咳嗽较常见的原因,详细询问病史,合理检查,可减少误诊。     

Case Report: Upper Extremity Deep Venous Thrombosis in a 19-Year-Old Baseball Player

Abstract

This report describes a case of a collegiate baseball player who presented with 3 weeks of worsening right shoulder pain and mild swelling and faint discoloration of the right arm and hand. He was found to have a nonocclusive clot in his brachial vein and was treated with anticoagulants. This was his second lifetime thrombosis. A hematologic workup revealed no evidence of a hereditary origin, and thrombosis was believed to be related to recent exertion (baseball throwing). Upper extremity deep vein thromboses are extremely uncommon. However, because they can have potentially life-threatening consequences, deep vein thromboses must be on the differential for any athlete who presents with increased pain, swelling, or discoloration of an extremity.     

Musculoskeletal extremity injuries in a cohort of schoolchildren aged 6–12: A 2.5‐year prospective study

The objectives of this prospective school cohort study were to describe the epidemiology of diagnosed musculoskeletal extremity injuries and to estimate the injury incidence rates in relation to different settings, different body regions and injury types. In all, 1259 schoolchildren, aged 6–12, were surveyed weekly during 2.5 years using a new method of automated mobile phone text messaging asking questions on the presence of any musculoskeletal problems. All injuries were clinically diagnosed. Physical activity was measured from text messaging and accelerometers. A total number of 1229 injuries were diagnosed; 180 injuries in the upper extremity and 1049 in the lower extremity, with an overall rate of 1.59 injuries per 1000 physical activity units [95% confidence interval (CI) 1.50–1.68]. Upper extremities accounted for a rate of 0.23 (95% CI 0.20–0.27) and lower extremities accounted for 1.36 (95% CI 1.27–1.44). This study has added a wide overall perspective to the area concerning incidence and incidence rates of musculoskeletal extremity injuries in schoolchildren aged 6–12 years, including severe and less severe, traumatic, and overuse injuries. The understanding of injury epidemiology in children is fundamental to the acknowledgement and insurance of the appropriate prevention and treatment.     

Epidemiology of fishing related upper extremity injuries presenting to the emergency department in the United States

Objective: Fishing injuries commonly affect the hands. The goal of this study was to quantify the incidence of fishing-related upper extremity injuries that present to emergency departments in the United States.

Methods: We examined the reported cases of fishing-related upper extremity injuries in the National Electronic Injury Surveillance System database. Analysis was performed based on age, sex and the type of injury reported.

Results: The national incidence of fishing-related upper extremity injuries was 119.6 per 1 million person-years in 2014. The most common anatomic site for injury was the finger (63.3%), followed by the hand (20.3%). The most common type of injury in the upper extremity was the presence of a foreign body (70.4%). The incidence of fishing-related upper extremity injuries in males was 200 per 1 million person-years, which was significantly higher than the incidence in females (41 per 1 million person-years).

Conclusion: The incidence of fishing-related upper extremity injuries that present to the Emergency Department was 120 per 1 million person-years. The incidence was significantly higher in males. With the widespread popularity of the activity, it is important for Emergency Physicians and Hand Surgeons to understand how to properly evaluate and manage these injuries.     

5km越野训练导致急性脑缺氧综合征32例临床分析

目的　了解新兵 5km越野后急性脑缺氧综合征的病情特点 ,探讨有效的防治措施。方法　对 2 0 0 1年 12月— 2 0 0 3年 12月 ,某部新兵5km越野训练中发生急性脑缺氧综合征 3 2例的临床资料进行分析。结果　 3 2例中 5例为过度疲劳后参加训练 ,4例训练前未作准备活动 ,6例由他人搀扶强行到达终点 ,3例为带病训练 ,7例为到达终点静坐后突然起立发病 ;临床表现为四肢软瘫者 10人次 ,四肢抽搐或四肢僵直者 16人次 ,木呆、烦躁等精神症状者 17人次 ,合并颜面部擦伤者 9例 ,头皮血肿 4例 ,头皮裂伤 3例 ,肩部擦伤 2例。结论　 5km越野发生急性脑缺氧综合征有其独特的临床特点 ,针对不同情况采取不同的防治措施可减少其发生     

Ligamentous and capsular restraints to experimental posterior elbow joint dislocation

Pathological external forearm rotation (PEFR) relates to posterolateral elbow joint instability, and is considered a possible requisite step in a simple posterior elbow joint dislocation. The aim of this study was to evaluate the capsuloligamentous restraint to PEFR. In all, 18 elbow joint specimens were examined in a joint analysis system developed for experimental elbow dislocation. Sequential cutting of capsule and ligaments followed by stability testing provided specific data relating to each capsuloligamentous structure. The primary stabilizers against PEFR in the extended elbow were the anterior capsule and the lateral collateral ligament complex (LCLC), whereas in the flexed elbow the anterior capsule did not have a stabilizing effect. In flexed joint positions, the LCLC seems to be the only immediate stabilizer against PEFR, and thereby against posterolateral instability and possibly against posterior dislocation. The medial collateral ligament did not have any immediate stabilizing effect, but it prevented the final step of the posterior dislocation.     

Influence of pectoralis minor and upper trapezius lengths on observable scapular dyskinesis

ObjectivesAlthough a relationship between short pectoralis minor and upper trapezius and scapular dyskinesis has been postulated, no studies have investigated this theory. Understanding the effect of these muscle lengths on observable scapular dyskinesis may aid in determining risks and therefore making treatment decisions. Being aware of the magnitude of this effect would help gauge the significance of risks involved. Our aim was to evaluate the influence of pectoralis minor and upper trapezius lengths on scapular dyskinesis.DesignCross-sectional study.SettingUniversity research laboratory.ParticipantsAsymptomatic participants (n = 148; 296 arms) were evaluated.Main outcome measuresScapular Dyskinesis Test (SDT) was used to identify scapular dyskinesis, Pectoralis Minor Index (PMI) and Upper Trapezius Length Testing were used to determine muscle length.ResultsSDT+ arms had shorter pectoralis minor resting length (PMI: 7.49 ± 0.38) (p < 0.001) and greater incidence of short upper trapezius (ISUT) (66.7%) (p < 0.001) compared to SDT- arms (PMI:8.58 ± 0.75, ISUT:22.5%). With each decrease in PMI, the likelihood of having scapular dyskinesis increased 96% (p < 0.001). Arms with short upper trapezius were 2.049 times more likely to exhibit scapular dyskinesis than those with normal length (p = 0.042).ConclusionsHaving a shorter pectoralis minor and upper trapezius length substantially increased the likelihood of having visually observable scapular dyskinesis.     

缺血修饰白蛋白的检测在急性冠脉综合征早期诊断中的意义

目的探讨血清缺血修饰白蛋白在急性冠脉综合征早期诊断中的意义。方法选择80例急性冠脉综合征患者,其中不稳定型心绞痛组35例;心肌梗死组45例。分别于胸痛发作2、4、6、12、24 h采静脉血检测其缺血修饰白蛋白的水平,并与正常对照组比较,分析缺血修饰白蛋白对急性冠脉综合征患者早期诊断的意义。结果不稳定型心绞痛和心肌梗死患者胸痛2、4 h缺血修饰白蛋白水平均明显高于正常对照组,差异有统计学意义(P<0.05),而胸痛6、12、24 h缺血修饰白蛋白水平与正常对照组比较,差异无统计学意义(P>0.05);胸痛2、4 h的缺血修饰白蛋白水平明显高于同组胸痛6、12、24 h,差异有统计学意义(P<0.05)。结论检测缺血修饰白蛋白的水平对于急性冠脉综合征早期诊断及治疗有一定临床价值。     

上肢深静脉血栓形成及介入治疗

上肢深静脉血栓形成(UEDVT)曾被认为是一种并不严重的病变.近年来随着对其认识和研究不断深入,现已知道UEDVT是导致肺栓塞的重要危险因素之一,病情严重甚至可以导致患者死亡.本文对UEDVT的病因、流行病学、临床特征、诊断、介入治疗、护理和预防做了综述.     

Increase in upper extremity fractures in young male soccer players in the Netherlands, 1998–2009

Young male soccer players have been identified as a target group for injury prevention, but studies addressing trends and determinants of injuries within this group are scarce. The goal of this study was to analyze age‐specific trends in hospital‐treated upper extremity fractures (UEF) among boys playing soccer in the Netherlands and to explore associated soccer‐related factors. Data were obtained from a national database for the period 1998–2009. Rates were expressed as the annual number of UEF per 1000 soccer players. Poisson's regression was used to explore the association of UEF with the number of artificial turf fields and the number of injuries by physical contact. UEF rates increased significantly by 19.4% in boys 5–10 years, 73.2% in boys 11–14 years, and 38.8% in boys 15–18 years old. The number of injuries by physical contact showed a significant univariate association with UEF in boys 15–18 years old. The number of artificial turf fields showed a significant univariate association with UEF in all age groups, and remained significant for boys aged 15–18 years in a multivariate model. This study showed an increase of UEF rates in boys playing soccer, and an independent association between artificial turf fields and UEF in the oldest boys.     

下肢损伤保肢治疗的评估及方法

下肢损伤的保肢治疗需要综合多方面的病情评估,如骨折缺损程度、肌肉的活性、血管及神经损伤、肢体缺血时间及当地医疗水平等。根据对病情评估的结果,结合现在医疗技术水平,才能更好地实施相应治疗。本文就下肢损伤保肢治疗的评估及方法作一简要综述。     

Phased Array Coils for Upper Extremity MRA

A phased array coil was constructed for imaging the upper extremity vasculature for patients undergoing dialysis treatment. The phased array coil exhibits improved signal-to-noise ratio (SNR) over the body coil and allows imaging of the entire upper extremity. SNR as a function of depth was measured on a homogeneous phantom with the arm coil and compared with the body coil. Near the coil there is an improvement of a factor of 7 and at a depth of approximately 6–7 cm, there is an improvement of factor 2. In vivo SNR measurements resulted in similar improvements. Images of the upper extremity vasculature of healthy volunteers were generated using 2D-time-of-flight (2DTOF) angiography. Blood flow velocity was assessed in a CINE-phase contrast study.     

Upper extremity lymphangiography as an aid to treatment planning for stage 1A epitrochlear Hodgkin's disease

A 6-year-old girl with Stage 1A Hodgkin's disease confined to the right epitrochlear area is described. An upper extremity lymphangiogram, for planning primary radiation therapy, demonstrated a lymph node adjacent to the medial midhumeral shaft. The implication of this finding and the role of the lymphangiogram in treatment planning are discussed.     

Weismann-Netter-Stuhl syndrome in two siblings

Cases of Weismann-Netter-Stuhl syndrome involving the upper extremities and affecting siblings have rarely been reported. We present the radiological findings of Weismann-Netter-Stuhl syndrome in two siblings, with upper extremity involvement in one of them.     

儿童阻塞性睡眠呼吸暂停低通气综合征的上气道低剂量多层螺旋CT表现

目的分析儿童阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的上气道多层螺旋CT(MSCT)表现及其应用价值。方法对36例经多导睡眠监测(PSG)确诊的儿童OSAHS患者,采用16层多层螺旋CT行上气道低剂量扫描,进行冠、矢状面及垂直气道长轴的斜位断面重建,测量鼻咽、口咽上部、口咽下部及喉咽咽腔横截面积,分析儿童OSAHS的上气道狭窄原因及解剖学定位。并选择阴性对照组,检查与测量方法同OSAHS患儿组,对比OSAHS患儿与无鼾症儿童是否存在显著性差异。结果36例儿童OS-AHS患者鼻咽、口咽上部及口咽下部咽腔横截面积明显小于对照组,两者存在显著性差异。患儿均可见腺样体肥大与扁桃体肿大,其中腺样体咽腔比值(A/N)≥0.71者32例,占88.9%;扁桃体Ⅲ°肿大33例,占91.7%。结论儿童OSAHS存在上气道解剖学狭窄,低剂量MSCT扫描是检查儿童OSAHS上气道可靠方法。     

Reliability of in vivo determination of forearm muscle volume using 3.0 T magnetic resonance imaging

Purpose:

To apply magnetic resonance imaging (MRI) as a tool for quantifying muscle volume of forearm muscles feasibility and reliability of volume estimation of the flexor carpi ulnaris (FCU) and the extensor carpi ulnaris (ECU).

Materials and Methods:

Forearms of 10 subjects were scanned twice. Muscle volumes were calculated from manual outlines on axial slices, slice thickness, and the number of slices. Observer agreement and repeatability were estimated using intraclass correlation, coefficient of variation, and the smallest detectable difference.

Results:

The average volume of the FCU and ECU was 31.0 mL (SD 11.5 mL) and 16.4 mL (SD 7.7 mL), respectively. Intraclass correlation coefficients of the volumes were all above 0.99 and the coefficient of variation varied between 5.7% and 0.8%. The smallest detectable difference corresponded to ≈7% of muscle volume.

Conclusion:

MRI muscle volume measurement of forearm muscles is feasible, reproducible, and allows for longitudinal studies where expected responsiveness exceeds 7%. J. Magn. Reson. Imaging 2010;31:1252–1255. © 2010 Wiley‐Liss, Inc.