Upper extremities wrist

Peripheral neuropathy may appear after chronic high-dose lead exposure, usually following months to years of blood lead concentrations higher than 100 mcg/dL. Predominantly motor in character, the neuropathy may present clinically with painless weakness of the extensors, particularly in the upper extremity, resulting in classic wrist-drop. Preclinical signs of lead-induced peripheral nerve dysfunction may be detectable by electrodiagnostic testing. 

These injections can likewise enable patients to wear and use orthotic devices more effectively. Injection into the triceps surae musculature can improve the fit and function of an ankle-foot orthosis by preventing excessive plantar flexor spasticity from pistoning the foot out of the orthosis.49 Injections into severely spastic muscles can also increase patient comfort and ability to perform ADL and hygiene activities. Consider, for example, the patient with severe upper extremity flexor spasticity following a CVA. Local injection of botulinum toxin into the affected muscles may enable the patient to extend his or her elbow, wrist, and fingers, thereby allowing better hand cleansing, ability to dress, decreased pain, and so forth.7... 

Injection of a local anesthetic into or around individual peripheral nerves or nerve plexuses produces even greater areas of anesthesia than do the techniques described above. Blockade of mixed peripheral nerves and nerve plexuses also usually anesthetizes somatic motor nerves, producing skeletal muscle relaxation, which is essential for some surgical procedures. The areas of sensory and motor block usually start several centimeters distal to the site of injection. Brachial plexus blocks are particularly useful for procedures on the upper extremity and shoulder. Intercostal nerve blocks are effective for anesthesia and relaxation of the anterior abdominal wall. Cervical plexus block is appropriate for surgery of the neck. Sciatic and femoral nerve blocks are useful for surgery distal to the knee. Other useful nerve blocks prior to surgical procedures include blocks of individual nerves at the wrist and at the ankle, blocks of individual nerves such as the median or ulnar at the elbow, and blocks of sensory cranial nerves. 

Peripheral motor neuropathy, affeoting mainly the upper extremities, oan cause severe extensor muscle weakness ( wrist drop ). 

Wrist posture may not be an independent risk factor. It may contribute to an increased incidence of distal upper-extremity disorders when combined with intensity of exertion. 

Moore and Garg (1994) compared exposure factors for jobs associated with WUEDs to jobs without prevalence of such disorders. They found that the intensity of exertion, estimated as a percentage of maximal strength and adjusted for wrist posture and speed of work, was the major discriminating factor. The relationship between the incidence rate for distal upper-extremity disorder and the job risk factors was defined as follows ... 

It has been shown that in the dynamic tasks involving upper extremities, the posture of the hand itself has very little predictive power for the risk of musculoskeletal disorders. Rather, it is the velocity and acceleration of the joint that significantly differentiate the musculoskeletal disorders risk levels (Schoenmarklin and Marras 1990). This is because the tendon force, which is a risk factor of musculoskeletal disorders, is affected by wrist acceleration. The acceleration of the wrist in a dynamic task requires transmission of the forearm forces to the tendons. Some of this force is lost to friction against the ligaments and bones in the carpal tunnel. This frictional force can irritate the tendons synovial membranes and cause tenosynovitis or carpal tunnel syndrom (CTS). These new research results clearly demonstrate the importance of dynamic components in assessing CTD risk of highly repetitive jobs. 

Musculoskeletal disorders of the upper extremities (such as carpal tunnel syndrome and rotator cuff tendinitis) due to work factors are common and occur in nearly tdl sectors of our economy. More than 2 hUlion in workers compensation costs are spent annually on these work-related problems. Musculoskeletal disorders of the neck and upper extremities due to work factors affect employees in every type of workplace and include such diverse workers as food processors, automobile and electronics assemblers, carpenters, office data-entry workers, grocery store cashiers, and garment workers. The highest rates of these disorders occur in the industries with a substantial amount of repetitive, forceful work. Musculoskeletal disorders affect the soft tissues of the neck, shoulder, elbow, hand, wrist, and fingers. 

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. 

The range of joint motion should be tested both passively and actively, with any restrictions noted. A general motion screening is performed by asking the patient to raise both arms slowly and touch the backs of his hands over the head. The physician observes scapular motion and symmetry of shoulder, elbow, and wrist angles. The inability to perform this test indicates motion restriction in the upper extremity. The areas of restriction must then be identified. 

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. 

Examination of the upper extremity revealed several areas of dysfunction. Most of the muscle groups of the arm were weaker than those of the left arm. Range of motion was normal except in the wrist, which was restricted in abduction/... 

Torso and organs, including rib cage, chest area, pelvic and torso Upper extremities, including shoulder, arm, hand, fingers and wrist... 

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