Displaying publications 1 - 20 of 73 in total

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  1. Azwa, N., Shalimar, A., Jamari, S.
    Malays Orthop J, 2007;1(2):33-35.
    MyJurnal
    Although lipoma is common in the upper limbs, it rarely occurs in the palm, and usually does not compress the surrounding structures. Here, we report a patient presenting with compressive neuropathy of the ulna and median nerves secondary to a palmar lipoma. Surgical excision led to full neurological recovery.
    Matched MeSH terms: Upper Extremity
  2. Ab Halim MAH, Rampal S, Devaraj NK, Badr IT
    Med J Malaysia, 2020 09;75(5):594-596.
    PMID: 32918435
    Morel-Lavallee lesions (MLL) are post-traumatic, closed internal degloving injuries that can result in severe complications if not diagnosed early. It is conventionally seen in cases of the high energy injuries of the pelvis and lower limb. The accumulation of extravasated blood, secondary to fracture and soft tissue damage may cause internal degloving injury, skin necrosis, soft tissue damage and acute osteomyelitis. We report here the clinical and radiological features in a 32-year-old male referred from the emergency department of a tertiary hospital who had sustained high energy motor vehicle accident. On examination, there was a fluctuant, mobile, non-tender subcutaneous mass over the distal arm with suspicion of internal degloving injury. Plain radiographs showed no fractures. Ultrasound showed a fluid collection with the presence of septations and echogenic debris within the collection. Extravasation was noted between subcutaneous tissue layer and fascia at the posterolateral aspect of the arm. Wound debridement under general anaesthesia was carried out. Intraoperative findings reported a significant amount of thick serous fluid with necrotic debris. Unhealthy skin and fat layers were debrided. Underlying muscles were found to be healthy. The results of the intraoperative fluid culture and sensitivity showed no growth. Negative pressure vacuum dressing was carried out. After five cycles of vacuum dressing, the wound showed signs of healing with an improved range of motion of the elbow. Orthopaedic surgeons need to be vigilant of the possibility of MLL in the upper limb as a differential diagnosis in the management of high energy trauma.
    Matched MeSH terms: Upper Extremity/injuries*
  3. Harith HH, Mohd MF, Nai Sowat S
    Appl Ergon, 2021 Sep;95:103455.
    PMID: 33991852 DOI: 10.1016/j.apergo.2021.103455
    Manual harvesting is still prevalent in the agricultural industry. Accordingly, it is one of the largest contributors toward work-related musculoskeletal disorder. The cutting task in oil palm harvesting uses a long pole and involves repetitive and forceful motion of the upper limbs. Exoskeleton technology is increasingly explored to assist manual tasks performance in manufacturing and heavy industries, mainly for reducing discomfort and injuries, and improving productivity. This paper reports an initial investigation on the feasibility of using an upper limb exoskeleton to assist oil palm harvesting tasks. Previous studies highlighted that exoskeletons for agricultural activities should be adaptable to changing field tasks, tools and equipment. The immediate difference in the activity of three muscles were analyzed for a range of harvesting-simulated tasks. Lower activities were observed for tasks involving overhead work when using the prototype. Nevertheless, users' feedback highlighted that its design should be optimized for better acceptance.
    Matched MeSH terms: Upper Extremity
  4. Sen A, Richardson S
    J Hum Ergol (Tokyo), 2007 Dec;36(2):45-50.
    PMID: 18572794 DOI: 10.11183/jhe1972.36.2_45
    Personal computers are one of the commonest office tools in Malaysia today. Their usage, even for three hours per day, leads to a health risk of developing Occupational Overuse Syndrome (OOS), Computer Vision Syndrome (CVS), low back pain, tension headaches and psychosocial stress. The study was conducted to investigate how a multiethnic society in Malaysia is coping with these problems that are increasing at a phenomenal rate in the west. This study investigated computer usage, awareness of ergonomic modifications of computer furniture and peripherals, symptoms of CVS and risk of developing OOS. A cross-sectional questionnaire study of 136 computer users was conducted on a sample population of university students and office staff. A 'Modified Rapid Upper Limb Assessment (RULA) for office work' technique was used for evaluation of OOS. The prevalence of CVS was surveyed incorporating a 10-point scoring system for each of its various symptoms. It was found that many were using standard keyboard and mouse without any ergonomic modifications. Around 50% of those with some low back pain did not have an adjustable backrest. Many users had higher RULA scores of the wrist and neck suggesting increased risk of developing OOS, which needed further intervention. Many (64%) were using refractive corrections and still had high scores of CVS commonly including eye fatigue, headache and burning sensation. The increase of CVS scores (suggesting more subjective symptoms) correlated with increase in computer usage spells. It was concluded that further onsite studies are needed, to follow up this survey to decrease the risks of developing CVS and OOS amongst young computer users.
    Matched MeSH terms: Upper Extremity/injuries*
  5. Erna Faryza, Mohd Suleiman Murad, Syamsul Anwar
    MyJurnal
    The computer is well known as one of the important tools in the office that gives a lot of benefits but silently leads to musculoskeletal pain. There are many different kinds of musculoskeletal complaints pain but the most common seen among computer users in developed countries is the complaint of arm, neck and shoulder (CANS). Despite this, definite factors that can be associated with the prevalence of CANS have not been established. This study was conducted to identify the prevalence and factors associated with work-related complaints of arm, neck and shoulder (CANS) among office workers in Selangor and Kuala Lumpur. A survey study design was conducted where 110 (n=110) office workers were recruited from around the Selangor and Kuala Lumpur area for 5 months periods. Participants were required to answer the Maastricht Upper Extremity Questionnaire (MUEQ) and the Level of Ergonomic Knowledge Questionnaire. The study showed the highest percentage of CANS reported was at neck region (53.6% of participants), followed by shoulders with 53.0%. The majority of participants have low level of computer ergonomic awareness where only 19.09% (n=21) from government sector and 10% (n=11) office workers from private sector reported knowledge of ergonomics. Majority of the participants did not have the know-how in implementing correct computer ergonomics. However there was a weak association (r=
    Matched MeSH terms: Upper Extremity
  6. Moore K, Prasad AM, Satheesha Nayak B
    Kathmandu Univ Med J (KUMJ), 2021 6 24;18(71):313-315.
    PMID: 34158443
    The musculocutaneous and median nerves frequently show variations from their normal course. The purpose of this paper is to report a rare variation, in which the right musculocutaneous nerve was absent. Consequently, the median nerve supplied motor innervation to the flexor compartment of the arm and sensory innervation to the lateral aspect of the forearm. The primary targets of this paper are orthopedic surgeons, anesthesiologists and radiologists. In cases of injuries to the upper limb, knowledge of these variations can assist them in avoiding misdiagnoses.
    Matched MeSH terms: Upper Extremity
  7. El-Ansary D, LaPier TK, Adams J, Gach R, Triano S, Katijjahbe MA, et al.
    Phys Ther, 2019 12 16;99(12):1587-1601.
    PMID: 31504913 DOI: 10.1093/ptj/pzz126
    Cardiac surgery via median sternotomy is performed in over 1 million patients per year worldwide. Despite evidence, sternal precautions in the form of restricted arm and trunk activity are routinely prescribed to patients following surgery to prevent sternal complications. Sternal precautions may exacerbate loss of independence and prevent patients from returning home directly after hospital discharge. In addition, immobility and deconditioning associated with restricting physical activity potentially contribute to the negative sequelae of median sternotomy on patient symptoms, physical and psychosocial function, and quality of life. Interpreting the clinical impact of sternal precautions is challenging due to inconsistent definitions and applications globally. Following median sternotomy, typical guidelines involve limiting arm movement during loaded lifting, pushing, and pulling for 6 to 8 weeks. This perspective paper proposes that there is robust evidence to support early implementation of upper body activity and exercise in patients recovering from median sternotomy while minimizing risk of complications. A clinical paradigm shift is encouraged, one that encourages a greater amount of controlled upper body activity, albeit modified in some situations, and less restrictive sternal precautions. Early screening for sternal complication risk factors and instability followed by individualized progressive functional activity and upper body therapeutic exercise is likely to promote optimal and timely patient recovery. Substantial research documenting current clinical practice of sternal precautions, early physical therapy, and cardiac rehabilitation provides support and the context for understanding why a less restrictive and more active plan of care is warranted and recommended for patients following a median sternotomy.
    Matched MeSH terms: Upper Extremity/physiopathology*
  8. Anita, A.R., Yazdani, A., Hayati, K.S., Adon, M.Y.
    MyJurnal
    Automotive industry in Malaysia is one of the booming industries which encompass the design, development and manufacturing of motor vehicles. However, it has its own setback as the interaction between complex tools, machines, and instruments, coupled with humans as workers pose several health hazards. A cross-sectional study was conducted to determine the prevalence of musculoskeletal disorders (MSD) and the association with awkward posture among automotive assembly line workers. A simple random sampling method was adopted and data were collected based on Standardized Nordic Questionnaire (SNQ) and Rapid Upper Limb Assessment (RULA) method for analysing awkward posture. With a response rate of 83%, a total of 232 assembly line workers with at least one year job tenure participated in this study. The findings revealed that 78.4% of workers reported MSD while the highest percentage of complaints concerned the lower back (50.9%). Three factors were found to be significantly associated with MSD: age (χ2=5.61, p=0.018), job tenure (χ2= 8.26, p=0.004) and awkward posture (χ2= 65.37, p < 0.001). Logistic regression analysis indicated that significant risk factors for MSD symptoms were workers aged ≥ 25 years old (OR= 2.25, 95%CI 1.14-4.46) and those workers with equal and more than three years job tenure (OR= 2.44, 95%CI 1.04-5.63). In addition, workers in the very high and high RULA action level who were 69 times (OR = 69.38, 95%CI 14.51- 331.73) and 12 times (OR = 12.42, 95%CI 5.21-29.58), respectively, also had higher odds of complaints of MSD. The high prevalence of MSD shows that MSD symptoms is a significant problem among automotive assembly line workers while age, job tenure and awkward posture based on RULA action level are the significant factors for MSD. In particular, this study proves that the prevalence of MSD increases as the RULA action level and job tenure increases. Thus, this problem could be reduced by decreasing RULA action level through appropriate ergonomic workstation design and ergonomic training for workers.
    Matched MeSH terms: Upper Extremity
  9. Behrani P, Ahmad Shahrul Nizam, Rohani Salleh
    Work-related upper-extremity disorders (WRUEDs) are frequently occurring among workers in general. Various researches support the empirical results of the Autogenic factors related to such problems of health and safety. Research shows the association of different aspects of work organization strengthen the possibilities of work-related stress and other psychosocial factors, which may lead towards adverse health conditions. To review the previous work done for finding the association between psychosocial factors and upper extremity disorders. Findings from different studies have been reviewed to examine the psychosocial factors association in developing WRUEDs. Published studies, which were primarily focused on WRUEDs and psychosocial factors association, were reviewed. Various studies have shown the relationship between psychosocial factors and UEDs. Due to the different nature of epidemiology of the disorder and variable differences, findings from different studies contradicts. Finally, this review presents the limitations in existing studies, and further research has been proposed for future.
    Matched MeSH terms: Upper Extremity
  10. Rabiul Islam SM, Mamman KG, Pande KC
    Malays Orthop J, 2016 Nov;10(3):39-41.
    PMID: 28553447 DOI: 10.5704/MOJ.1611.002
    Subcutaneous emphysema is the presence of gas or air in the subcutaneous tissue plane. The term is generally used to describe any soft tissue emphysema of the body wall or limbs, it can result from benign causes, most commonly secondary to trauma or from a life-threatening infection by gas gangrene or necrotising fasciitis. A case of subcutaneous emphysema involving the upper limb resulting from a trivial laceration to the elbow is reported and the importance of distinguishing between the two causes of subcutaneous emphysema is highlighted.
    Matched MeSH terms: Upper Extremity
  11. Yew KL, Anderson S, Farah R, Lim SH
    Asian Cardiovasc Thorac Ann, 2014 Oct;22(8):979-80.
    PMID: 24887840 DOI: 10.1177/0218492313491583
    Central vein stenosis is not uncommon in hemodialysis-dependent patients as a result of mechanical damage to the vessel walls from prior cannulation. It can cause ipsilateral upper limb swelling and pain, resulting in suboptimal hemodialysis. It is unfortunate for bilateral central vein stenosis to develop concomitantly, and rare in the setting of an in-situ pacemaker. This case illustrates the successful ligation of a nondependent left arteriovenous fistula and stenting of the right subclavian vein with functioning ipsilateral arteriovenous fistula, to overcome the problem of symptomatic bilateral upper limb swelling.
    Matched MeSH terms: Upper Extremity/blood supply*
  12. Hadizie D, Munajat I
    Malays Orthop J, 2017 Nov;11(3):1-9.
    PMID: 29326760 MyJurnal DOI: 10.5704/MOJ.1711.009
    Introduction: Both-bone forearm fractures in children can be treated non-operatively with a cast. Most previous studies have shown favourable outcome; however, information on the functional outcome after skeletal maturity is still scanty. Therefore, this study was conducted to determine the functional outcome after skeletal maturity in fractures with at least four years of growth remaining. Materials and Methods: This retrospective study was conducted from March 2012 until March 2013. Age at the time of fracture was taken as until 10 years for females and until 12 years old for males with at least four years of growth remaining. Fractures occurring in the diaphysis were included in the study. Functional outcomes were assessed at or after skeletal maturity. Results: Forty-four children fulfilled the criteria. The ages of the youngest and the oldest at the time of fracture was five and 12 years old respectively. Follow-up of the male and female patients were 7.4 years and 5.5 years respectively. There was a significant difference between post-reduction angulation and angulation at skeletal maturity of the radius and ulna (p<0.001). Out of 44 patients, 39 had excellent and five had good functional outcomes. No patient had fair or poor functional outcome. There was no association between the functional outcome and the angulation of forearm bones after skeletal maturity. Age at the time of fracture had a significant association with the functional outcome. Conclusion: Non-operative treatment of both-bone diaphyseal forearm fractures in a cast has good to excellent functional outcomes in children who still have four years of growth remaining.
    Matched MeSH terms: Bones of Upper Extremity
  13. Lee YJ, Harmony T, Jamal-Azmi IS, Gunasagaran J, Ahmad TS
    Malays Orthop J, 2021 Mar;15(1):113-118.
    PMID: 33880157 DOI: 10.5704/MOJ.2103.017
    Introduction: Bowling is an immensely popular, but scarcely researched sport associated with overuse injuries in its participants. The purpose of this study was to investigate and report on the incidence of common upper extremity complaints in elite bowling athletes.

    Materials and methods: All Malaysian national level bowlers (n=39) were evaluated via questionnaire on their upper limb symptoms. A focused, relevant clinical examination was performed on each subject to exclude de Quervain's tenosynovitis, tennis and golfer's elbow, carpal tunnel syndrome and trigger finger. The athletes were then allowed to resume bowling for two hours before completing another symptom-related questionnaire.

    Results: Pain was the predominantly observed symptom, with a predilection for the wrist, ring and middle fingers, and thumb. De Quervain's tenosynovitis was found in 53.8% (n=21) of the subjects, with 52.4% and 42.9% of them experiencing pain during and after training, respectively. Other repetitive injury-related disorders were also considerably more common than in their non-playing limb and the general population.

    Conclusion: The incidence of de Quervain's tenosynovitis was exceptionally high in this population. Further studies on sports kinematics are needed to prevent long term morbidities in these athletes.

    Matched MeSH terms: Upper Extremity
  14. Shariati NH, Zahedi E, Jajai HM
    Physiol Meas, 2008 Mar;29(3):365-74.
    PMID: 18367811 DOI: 10.1088/0967-3334/29/3/007
    Bilateral PPG signals have been used for comparative study of two groups of healthy (free from any cardiovascular risk factors) and diabetic (as cardiovascular disease risk group) subjects in the age-matched range 40-50 years. The peripheral blood pulsations were recorded simultaneously from right and left index fingers for 90 s. Pulses have been modeled with the ARX440 model in the interval of 300 sample points with 100 sample points overlap between segments. Model parameters of three segments based on the highest fitness (higher than 80%) of modeled segments were retained for each subject. Subsequently, principal component analysis (PCA) was applied to the parameters of retained segments to eliminate the existing correlation among parameters and provide uncorrelated variables. The first principal component (contains 78.2% variance of data) was significantly greater in diabetic than in control groups (P < 0.0001, 0.74 +/- 2.01 versus -0.53 +/- 1.66). In addition the seventh principal component, which contains 0.02% of the data variance, was significantly lower in diabetic than in control groups (P < 0.05, -0.007 +/- 0.03 versus 0.005 +/- 0.03). Finally, linear discrimination analysis (LDA) was used to classify the subjects. The classification was done using the robust leaving-one-subject-out method. LDA could classify the subjects with 71.7% sensitivity and 70.2% specificity while the male subjects resulted in a highly acceptable result for the sensitivity (81%). The present study showed that PPG signals can be used for vascular function assessment and may find further application for detection of vascular changes before onset of clinical diseases.
    Matched MeSH terms: Upper Extremity/blood supply*
  15. Mageswaran R, Choy YC
    Med J Malaysia, 2010 Dec;65(4):300-3.
    PMID: 21901950
    A prospective randomized double-blind study was conducted which involved, 60 ASA 1-2, aged 18-65 years patients, who had elective or emergency orthopaedic surgeries of the upper limbs. They were randomly divided into two groups: Group I received 30 mls of 0.5% ropivacaine; and Group II received 0.5% levobupivacaine for infraclavicular brachial plexus block based on the coracoid approach. The onset time required for sensory block of all required dermatomes (C5-T1) and the onset time of motor block were documented. Based on the Visual Analogue Score, pain scores were recorded every 30 minutes during surgery and at the 6th hour. The mean onset time (SD) for sensory block with ropivacaine was 13.5 +/- 2.9 minutes compared to levobupivacaine at 11.1 +/- 2.6 minutes (p = 0.003). The onset time for motor block was 19.0 +/- 2.7 minutes in Group I compared to 17.1 +/- 2.6 minutes (p = 0.013) in Group II. Patients in both groups experienced both mild to moderate pain at the 6th hour. In conclusion, there were statistically significant differences in the onset-time for sensory and motor block. However, there was no statistically significant difference in terms of effectiveness of analgesia at the 6th hour. Although the clinical advantage of levobupivacine is not substantial, its safety profile becomes a major consideration in the choice of local anaesthetic for brachial plexus block where a large volume is required for an effective result.
    Matched MeSH terms: Upper Extremity/surgery
  16. Harvinder, G.S., Chee, W.S.S., Karupaiah, T., Sahathevan, S., Chinna, K., Ghazali, A., et al.
    Malays J Nutr, 2013;19(3):271-283.
    MyJurnal
    Introduction: Malnutrition is a serious unresolved nutritional problem amongst dialysis patients associated with increased mortality and morbidity and prevalence differs according to dialysis modalities. This study compared proteinenergy malnutrition (PEM) prevalence in haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients. Methods: A total of 155 HD and 90 CAPD patients were enrolled. PEM prevalence was determined using body mass index (BMI), serum albumin, Dialysis Malnutrition Score (DMS) and dietary intake. Results: CAPD patients had significantly higher BMI (24.1 ± 4.8 kg/m2 vs. 22.7 ± 4.8 kg/m2; p=0.024) and mid-arm muscle area (32.1±12.4 cm2 vs. 29.5 ± 15.9 cm2; p=0.044) than HD patients. They also had significantly lower serum albumin (31 ± 5 g/L vs. 35 ± 6 g/L; p
    Matched MeSH terms: Upper Extremity
  17. Hanafi MH, Kassim NK, Ibrahim AH, Adnan MM, Ahmad WMAW, Idris Z, et al.
    Malays J Med Sci, 2018 Mar;25(2):116-125.
    PMID: 30918461 MyJurnal DOI: 10.21315/mjms2018.25.2.12
    Background: Stroke is one of the leading causes of mortality and morbidity in Malaysia. Repetitive transcranial magnetic stimulation (rTMS) is one of the new non-invasive modality to enhance the motor recovery in stroke patients.

    Objectives: This pilot study compared the motor evoked potential (MEP) changes using different settings of rTMS in the post-ischemic stroke patient. The goal of the study is to identify effect sizes for a further trial and evaluate safety aspects.

    Methods: Eight post-stroke patients with upper limb hemiparesis for at least six months duration were studied in a tertiary hospital in Northeast Malaysia. Quasi experimental design was applied and the participants were randomised into two groups using software generated random numbers. One of the two settings: i) inhibitory setting, or ii) facilitatory setting have been applied randomly during the first meeting. The motor evoked potential (MEP) were recorded before and after application of the rTMS setting. A week later, a similar procedure will be repeated but using different setting than the first intervention. Each patient will serve as their own control. Repeated measures ANOVA test was applied to determine the effect sizes for both intervention through the options of partial eta-squared (η2p).

    Result: The study observed large effect sizes (η2p > 0.14) for both rTMS settings in the lesion and non-lesion sides. For safety aspects, no minor or major side effects associated with the rTMS was reported by the participants.

    Conclusions: The partial eta square of MEP value for both rTMS settings (fascilitatory and inhibitory) in both lesion and non-lesion sides represents large effect sizes. We recommend further trial to increase number of sample in order to study the effectiveness of both settings in ischemic stroke patient. Our preliminary data showed both settings may improve the MEP of the upper extremity in the ischemic stroke patient. No significant improvement noted when comparing both settings.

    Matched MeSH terms: Upper Extremity
  18. Tan GC, Yap YP, Shiran MS, Sabariah AR, Pathmanathan R
    BMJ Case Rep, 2009;2009.
    PMID: 21686408 DOI: 10.1136/bcr.11.2008.1221
    Mycobacterial spindle cell pseudotumour (MSCP) has been reported in various sites, including skin, lymph nodes, bone marrow, lung and spleen. Cutaneous lesions are extremely rare and the differential diagnoses include various spindle cell lesions. Literature review shows that this lesion has preponderance for upper limb involvement and occurs largely in immunosuppressed individuals. We report a case of MSCP of the skin due to atypical mycobacterium and discuss the risk of misdiagnosis as a sarcoma.
    Matched MeSH terms: Upper Extremity
  19. Lin-Wei O, Xian LLS, Shen VTW, Chuan CY, Halim SA, Ghani ARI, et al.
    Malays J Med Sci, 2021 Apr;28(2):48-62.
    PMID: 33958960 DOI: 10.21315/mjms2021.28.2.5
    The deep tendon reflex (DTR) is a key component of the neurological examination. However, interpretation of the results is a challenge since there is a lack of knowledge on the important features of reflex responses such as the amount of hammer force, the strength of contraction, duration of the contraction and relaxation. The tools used to elicit the reflexes also play a role in the quality of the reflex contraction. Furthermore, improper execution techniques during the DTR assessment may alter the findings and cloud the true assessment of the nervous system. Therefore, understanding the basic principles and the key features of DTR allows for better interpretation of the reflex responses. This paper discusses the brief history of reflexes, the development of the reflex hammer, and also the key features of a reflex response encompassing the amplitude of force needed to elicit a reflex response, the velocity of contraction, the strength of contraction, and the duration of contraction and relaxation phases. The final section encloses the techniques of eliciting DTR in the upper extremities, trunk, and lower extremities, and the interpretation of these reflexes.
    Matched MeSH terms: Upper Extremity
  20. Zadry HR, Dawal SZ, Taha Z
    Int J Occup Saf Ergon, 2016 Sep;22(3):374-83.
    PMID: 27053140 DOI: 10.1080/10803548.2016.1150094
    This study was conducted to develop muscle and mental activities on repetitive precision tasks. A laboratory experiment was used to address the objectives. Surface electromyography was used to measure muscle activities from eight upper limb muscles, while electroencephalography recorded mental activities from six channels. Fourteen university students participated in the study. The results show that muscle and mental activities increase for all tasks, indicating the occurrence of muscle and mental fatigue. A linear relationship between muscle activity, mental activity and time was found while subjects were performing the task. Thus, models were developed using those variables. The models were found valid after validation using other students' and workers' data. Findings from this study can contribute as a reference for future studies investigating muscle and mental activity and can be applied in industry as guidelines to manage muscle and mental fatigue, especially to manage job schedules and rotation.
    Matched MeSH terms: Upper Extremity/physiology*
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