Upper Extremity Problem-Solving: Challenging Cases. 2018

Nathaniel H Mayer
Motor Control Analysis Laboratory, Department of PM&R, MossRehab, Einstein Healthcare Network, 60 Township Line Road, Elkins Park, PA 19027, USA; Department of Rehabilitation Medicine, Temple University Health Sciences Center, 3500 North Broad Street, Philadelphia, PA 19140, USA. Electronic address: nmayer@einstein.edu.

Consequences of an upper motor neuron syndrome (UMNS) include voluntary weakness or paresis, superimposed involuntary phenomena such as spastic co-contraction and associated reactions, and superimposed rheologic changes in affected muscles. This article describes the use of dynamic poly-electromyography to assess UMNS muscle overactivity and inform muscle selection for chemodenervation. Cases are presented that involve spastic co-contraction, spastic dystonia, associated reactions, hyperextended wrist and finger flexor tenodesis, differentiating neural versus non-neural (rheologic) hypertonia, upper motor neuron weakness, muscle selection for chemodenervation, and electrical stimulation for muscle specific targeting.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D009128 Muscle Spasticity A form of muscle hypertonia associated with upper MOTOR NEURON DISEASE. Resistance to passive stretch of a spastic muscle results in minimal initial resistance (a "free interval") followed by an incremental increase in muscle tone. Tone increases in proportion to the velocity of stretch. Spasticity is usually accompanied by HYPERREFLEXIA and variable degrees of MUSCLE WEAKNESS. (From Adams et al., Principles of Neurology, 6th ed, p54) Clasp-Knife Spasticity,Spastic,Clasp Knife Spasticity,Spasticity, Clasp-Knife,Spasticity, Muscle
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D016472 Motor Neuron Disease Diseases characterized by a selective degeneration of the motor neurons of the spinal cord, brainstem, or motor cortex. Clinical subtypes are distinguished by the major site of degeneration. In AMYOTROPHIC LATERAL SCLEROSIS there is involvement of upper, lower, and brainstem motor neurons. In progressive muscular atrophy and related syndromes (see MUSCULAR ATROPHY, SPINAL) the motor neurons in the spinal cord are primarily affected. With progressive bulbar palsy (BULBAR PALSY, PROGRESSIVE), the initial degeneration occurs in the brainstem. In primary lateral sclerosis, the cortical neurons are affected in isolation. (Adams et al., Principles of Neurology, 6th ed, p1089) Anterior Horn Cell Disease,Familial Motor Neuron Disease,Lateral Sclerosis,Motor Neuron Disease, Lower,Motor Neuron Disease, Upper,Lower Motor Neuron Disease,Motor Neuron Disease, Familial,Motor Neuron Disease, Secondary,Motor System Disease,Primary Lateral Sclerosis,Secondary Motor Neuron Disease,Upper Motor Neuron Disease,Lateral Scleroses,Lateral Scleroses, Primary,Lateral Sclerosis, Primary,Motor Neuron Diseases,Motor System Diseases,Neuron Disease, Motor,Neuron Diseases, Motor,Primary Lateral Scleroses,Scleroses, Lateral,Scleroses, Primary Lateral,Sclerosis, Lateral,Sclerosis, Primary Lateral
D034941 Upper Extremity The region of the upper limb in animals, extending from the deltoid region to the HAND, and including the ARM; AXILLA; and SHOULDER. Extremity, Upper,Membrum superius,Upper Limb,Extremities, Upper,Limb, Upper,Limbs, Upper,Upper Extremities,Upper Limbs

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