Upper extremities evaluation

A 5-year-old boy has a rough, raised lesion on his neck. Physical examination shows that he has excessive freckling and some erythema (redness) of his face, lips, neck, and upper extremities as well as some clouding of his corneas. His mother reports that he has a tendency to sunburn easily and has an aversion to direct sunlight. Pathologic evaluation of a biopsy of the lesion reveals it to be a malignant melanoma. 

In 2005 and 2007 (Phase 2), a more recent study for the U. S. Marine Corps, by Hill et al., evaluated 13 self-applied tourniquets for their applicability in combat applications. This study attempted to measure the functionality of the candidate tourniquets in battlefield conditions by immersing them in a simulated blood/sand mixture prior to testing. In contrast to the earlier Army study by Walters et al., the conclusion drawn from this study was the recommendation that one of the ratcheting or stretch-retention type tourniquet systems be adopted for combat deployment. These types had the best user subjective ratings as well as the lowest application times especially on the upper extremities where one-handed application was required. The recommended group had application times 30-50% lower on the upper extremities than the windlass types recommended by the Army study. Velcro was observed to lose its effectiveness as a clamp when it became fouled with wet sand or mud and, therefore, should be avoided. It should be noted that none of the tourniquet types used in the Marine Corps study were pneumatic. 

Keyserling, W. M., Stetson, D. S., SUverstein, B. A., and Brouver, M. L. (1993), A Checklist for Evaluating Risk Factors Associated with Upper Extremity Cumulative Trauma Disorders, Ergonomics, Vol. 36, No. 7, pp. 807-831. 

Punnett and Bergqvist (1997) have proposed that keyboard design characteristics can lead to upper-extremity musculoskeletal disorders. There is controversy about this contention by Punnett and Bergqvist because there are many factors involved in computer typing jobs independent of the keyboard characteristics that may contribute to musculoskeletal disorders. Some ergonomists have designed alternative keyboards in attempts to reduce the potential risk factors for musculoskeletal disorders (Kroemer 1972 Nakaseko et al. 1985 Ilg 1987). NIOSH (1997) produced a publication that describes various alternative keyboards. Studies have been undertaken to evaluate some of these alternative keyboards (Swanson et i. 1997 Smith et al. 1998). The research results indicated some improvement in hand/wrist posture from using the alternative keyboards, but no decrease in musculoskeletal discomfort. 

This chapter is intended to illustrate the application of some principles and practices of human performance engineering, especially quantification of human performance in the field of occupational medicine. I have selected the problem of low back pain to illustrate a series of concepts that are essential to evaluation of both the worker and the workplace, while reahzing the importance of the disorders of the neck and upper extremities. By inference and generalization, most of these concepts can be extended to these situations. 

Behbehani, K., Kondraske, G. V., Tintner, R., TindaU, R. A. S., and Imrhan, S. N. 1990. Evaluation of quantitative measures of upper extremity speed and coordination in healthy persons and in three patients populations. Arc/z. Phys. Med. Rehabil. 71 106-111. 

Maheu V, Frappier J, Archambault PS, and Routhier F, Evaluation of the JACO robotic arm Clinico-economic study for powered wheelchair users with upper-extremity disabilities, IEEE International Conference on Rehabilitation Robotics, Zurich, Switzerland, June 29-July 1,2011. 

A physician was consulted to help develop a cumulative trauma disorder (CTD) surveillance program. As one result, the physician made the portion of the pre-placement physical examination that dealt with the upper extremities and the back more detailed for the employees in the slaughter department and the division where carcasses are dismantled. At the 1-month and 1-year anniversary dates, randomly selected employees are invited back to be reexamined. Examination results that indicate early development of CTD are reported to the employees. In addition, management is informed about positions that need further evaluation. However, no personal information that identifies particular employees is released to management. 

Use The Ergonomic Task Analysis Scoring Tool is limited to analysis of ergonomic risk factors impacting the upper extremities, and is appropriate for office work, assembly and process line work environments. The Initial Evaluation (IE Worksheet) is used to develop a baseline risk score and action level with possible control measures to reduce risk factor scores. It is suggested that videotape analysis be used to study task repetition, postures, lifts, pulls, pushes, carries, and other factors covered by the screening tool. 

Claudication is a clinical, easy to make diagnosis. Claudication of the upper extremities, although much less frequent than that of the lower extremities, is also a clinical diagnosis. The extremities should be examined carefully. Examination of the peripheral arterial system should include an evaluation of the volume and character of the arterial pulses of the carotids and of the arteries of the upper extremities the subclavian, the brachial, the radial, and the ulnar. Physical examination should definitely encompass the abdominal aorta for abnormal pulsations, ectasias and/or bruits, and the arteries of the lower extremities femoral, popliteal, dorsalis pedis, and posterior tibialis. The pulse volume can be graded on a scale of 0 to 4. In addition to palpation, physical examination of the peripheral arterial system should include auscultation over the carotids, auscultation over the subclavian arteries above, and below the mid-clavicular area. A bruit over the subclavian artery and disappearance of the radial pulse with compression of the subclavian artery is evidence for subclavian syndrome. On occasion, a bruit may be heard by auscultation deep in the axilla. The bruit, a composite of low frequency sounds, is better appreciated when the examiner is using the bell of the stethoscope. 

Levanon, Y., Gefen, A., Lerman, Y, Given, U. Ratzon, N.Z. (2012) Multi dimensional system for evaluating preventive program for upper extremity disorders among computer operators. Work, 41 Suppl 1, 669-75. 

Somatic dysfunction of the thorax may occur anteriorly, involving ribs, sternum, or clavicle, or posteriorly, involving costovertebral articulations or the scapulae. Muscle attachments connect the thoracic cage to the cervical spine, the thoracic spine, the lumbar spine, the innominate bones, and the upper extremities. These regions must be evaluated when problems occur in the thoracic cage. 

The wrist and hand are an important part of a person s ability to function in activities of daily living. Any pain, dysfunction, or disability requires a careful and thorough evaluation of the area. This examination may include the forearm and even other joints of the upper extremity and neck. As with other joints of the upper extremity, a history of the symptom and related information is the first step in the evaluation process. Then the examination may proceed. 

Plettenburg, D. H. (2006). Upper Extremity Prosthetics, Current Status Evaluation. VSSD... 

Zardoshti-Kermani M, Wheeler BC, Badie K et al. (1995) EMG feature evaluation for movement control of upper extremity prostheses. IEEE T Rehabil Eng 3 324-333... 

Chin EE, Zimmerman PT, Grant EG (2005) Sonographic evaluation of upper extremity deep venous thrombosis. J Ultrasound Med 24 829-838... 

Random Coding. We now turn to the subsidiary developments and theorems necessary in order to prove Theorem 4-11. The first obstacle in the path of deriving an upper bound to the probability of decoding error for a particular channel is the difficulty of finding good codes. Even if we could find such codes, the problem of evaluating their error probability would be extremely tedious if M and N were large both... 

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