Reliability of Lower Extremity Girth Measurements and Right- and Left-Side Differences

1995 ◽  
Vol 4 (2) ◽  
pp. 108-115 ◽  
Author(s):  
Susan L. Whitney ◽  
Larry Mattocks ◽  
James J. Irrgang ◽  
Pamela A. Gentile ◽  
David Pezzullo ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Physical Therapists ◽  
Lower Extremities ◽  
Tape Measure ◽  
The Right

The purpose of this two-part study was to determine if lower extremity girth measurements are repeatable. Sixteen males and 14 females participated in the intra- and intertester reliability portion of this study. Girth was assessed at five different lower extremity sites by two physical therapists using a standard tape measure. Thirty measures (15 by each examiner) were collected on the subject's right leg, and a mean of the three measures was used in the analysis. The measurements were repeated 7 days later. It was found that by using a simple standardized procedure, girth measurements in the clinic can be highly repeatable in experienced clinicians. Part 2 of the study involved testing the right and left legs of 22 subjects to determine if girth of the right and left legs was similar. All subjects had their girth assessed at five sites on their right and left legs during one session. It was found that girth measures on the right and left lower extremities are comparable. In an acutely injured lower extremity, it might be assumed that the girth of both lower extremities is similar.

scholarly journals Salvage of Necrotic-Appearing Limb after In Utero Endoscopic Lysis of Constriction Bands

2017 ◽  
Vol 07 (02) ◽  
pp. e74-e78 ◽  
Author(s):  
A. Chon ◽  
B. Chen ◽  
W. Burkhalter ◽  
R.H. Chmait ◽  
M. Abdel-Sattar
Keyword(s):  
Blood Flow ◽  
Lower Extremity ◽  
Color Doppler ◽  
Lower Extremities ◽  
In Utero ◽  
Postnatal Life ◽  
Amniotic Band ◽  
Constriction Band ◽  
The Right ◽  
And Function

AbstractWe report a case of amniotic band syndrome complicated by constriction bands and marked distal swelling of both lower extremities. Color Doppler interrogation of the right lower extremity revealed complete lack of blood flow below the level of the constriction. Upon fetoscopic survey, the right lower extremity beyond the constriction band appeared dusky red and discolored with desquamation, consistent with a necrotic appearance. The constriction bands were cut in utero using endoshears, thereby allowing restoration of blood flow on postoperative day 1. The patient was counseled extensively regarding the possibility of limb dysfunction or amputation. However, the baby was born with functional lower extremities, and at 21 months of age, the child was cruising and jumping on his own. This case demonstrates that there is unique plasticity in fetal limb recovery after a severe ischemic injury that is not otherwise seen in postnatal life. Reperfusion of the necrotic-appearing limb resulted in restoration of appearance and function without apparent deleterious effects on the fetus. We believe the favorable outcome in this case was likely due to timeliness of the in utero lysis of amniotic bands and the plasticity of fetal healing.

scholarly journals Discrepancies in Prevalence of Peripheral Arterial Disease between Lower Extremities at Rest and Postexercise

2017 ◽  
Vol 26 (03) ◽  
pp. 179-185 ◽  
Author(s):  
Kevin Cohoon ◽  
Guillaume Mahe ◽  
David Liedl ◽  
Thom Rooke ◽  
Paul Wennberg
Keyword(s):  
Peripheral Arterial Disease ◽  
Lower Extremity ◽  
Medical Condition ◽  
Lower Extremities ◽  
Arterial Disease ◽  
Left Lower Extremity ◽  
Pressure Decrease ◽  
Exercise Treadmill ◽  
Peripheral Arterial ◽  
The Right

Background Lower extremity peripheral arterial disease (PAD) is a common medical condition causing substantial morbidity. Limited data exist on whether discrepancies in PAD prevalence exist between the lower extremities using resting ankle-brachial indices (ABIs) and postexercise pressures. Objective We predicted the prevalence of PAD between the lower extremities. Methods and Results Consecutive patients who had undergone a noninvasive arterial lower extremity study at Mayo Clinic, Rochester, MN, between January 1996 and December 2012 with suspected PAD were retrospectively reviewed. We identified 12,312 consecutive patients who underwent an arterial lower extremity and an exercise treadmill study. Prevalence of PAD was assessed at rest and after exercise using two criteria: a resting ABI ≤ 0.90 and a postexercise pressure decrease of > 30 mm Hg. Mean age was 67 ± 12 years and there were 4,780 (39%) women studied. At rest, we found a higher prevalence of PAD on the left extremity (27.4%) compared with the right (24.6%) (p < 0.0001). After exercise, we found a higher prevalence of PAD on the right extremity (25.1%) compared with the left (19.0%) (p < 0.0001). These discrepancies between the prevalence of PAD at rest and after exercise were present in women and men. Conclusion Using validated criteria of a resting ABI of ≤ 0.90 and postexercise ankle pressure decrease > 30 mm Hg, our results suggest that there is a significantly higher prevalence of PAD in the left lower extremity at rest, in contrast to a greater prevalence of abnormal postexercise testing in the right lower extremity. The reason(s) of these discrepancies remain to be studied.

scholarly journals Comparison of Gluteus Medius Muscle Electromyographic Activity During Forward and Lateral Step-up Exercises in Older Adults

2009 ◽  
Vol 89 (11) ◽  
pp. 1205-1214 ◽  
Author(s):  
Vicki Stemmons Mercer ◽  
Michael T. Gross ◽  
Subhashini Sharma ◽  
Erin Weeks
Keyword(s):  
Older Adults ◽  
Lower Extremity ◽  
Repeated Measures ◽  
Lower Extremities ◽  
Gluteus Medius ◽  
Emg Activity ◽  
Gluteus Medius Muscle ◽  
Left Lower Extremity ◽  
Hip Abductor ◽  
The Right

Background Step-up exercises often are suggested for strengthening the hip abductor muscles and improving balance in older adults. Little is known, however, about whether the forward or lateral version of these exercises is best for activating the hip abductor muscles. Objective The purpose of this study was to examine the electromyographic (EMG) amplitude of the gluteus medius (GM) muscles bilaterally during forward and lateral step-up exercises. Design The study design involved single-occasion repeated measures. Methods Twenty-seven community-dwelling adults (7 men and 20 women) with a mean (SD) age of 79.4 (8.0) years performed forward and lateral step-up exercises while the surface EMG activity of the GM muscles was recorded bilaterally. Pressure switches and dual forceplates were used to identify the ascent and descent phases. Subjects were instructed to lead with the right lower extremity during ascent and the left lower extremity during descent. Differences in normalized root-mean-square EMG amplitudes with exercise direction (forward versus lateral) and phase (ascent versus descent) were examined by use of separate repeated-measures analyses of variance for the right and left lower extremities. The alpha level was set at .05. Results Gluteus medius muscle EMG activity was significantly greater for lateral than for forward step-up exercises for the left lower extremity during the ascent phase and for both lower extremities during the descent phase. In addition, right GM muscle EMG activity was significantly greater during ascent than during descent for both exercise directions. Limitations Study limitations include use of a convenience sample and collection of limited information about participants. Conclusions Step-up exercises are effective in activating the GM muscle, with lateral step-up exercises requiring greater GM muscle activation than forward step-up exercises. Further study is needed to determine whether exercise programs for hip abductor muscle strengthening in older adults should preferentially include lateral over forward step-up exercises.

scholarly journals Molecular Mechanisms Associated with ROS-Dependent Angiogenesis in Lower Extremity Artery Disease

Antioxidants ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 735
Author(s):  
Greg Hutchings ◽  
Łukasz Kruszyna ◽  
Mariusz J. Nawrocki ◽  
Ewa Strauss ◽  
Rut Bryl ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Blood Vessel ◽  
Lower Extremity ◽  
Molecular Mechanisms ◽  
Lower Extremities ◽  
Tissue Response ◽  
Peripheral Arteries ◽  
Artery Disease ◽  
Lower Extremity Artery Disease

Currently, atherosclerosis, which affects the vascular bed of all vital organs and tissues, is considered as a leading cause of death. Most commonly, atherosclerosis involves coronary and peripheral arteries, which results in acute (e.g., myocardial infarction, lower extremities ischemia) or chronic (persistent ischemia leading to severe heart failure) consequences. All of them have a marked unfavorable impact on the quality of life and are associated with increased mortality and morbidity in human populations. Lower extremity artery disease (LEAD, also defined as peripheral artery disease, PAD) refers to atherosclerotic occlusive disease of the lower extremities, where partial or complete obstruction of peripheral arteries is observed. Decreased perfusion can result in ischemic pain, non-healing wounds, and ischemic ulcers, and significantly reduce the quality of life. However, the progressive atherosclerotic changes cause stimulation of tissue response processes, like vessel wall remodeling and neovascularization. These mechanisms of adapting the vascular network to pathological conditions seem to play a key role in reducing the impact of the changes limiting the flow of blood. Neovascularization as a response to ischemia induces sprouting and expansion of the endothelium to repair and grow the vessels of the circulatory system. Neovascularization consists of three different biological processes: vasculogenesis, angiogenesis, and arteriogenesis. Both molecular and environmental factors that may affect the process of development and growth of blood vessels were analyzed. Particular attention was paid to the changes taking place during LEAD. It is important to consider the molecular mechanisms underpinning vessel growth. These mechanisms will also be examined in the context of diseases commonly affecting blood vessel function, or those treatable in part by manipulation of angiogenesis. Furthermore, it may be possible to induce the process of blood vessel development and growth to treat peripheral vascular disease and wound healing. Reactive oxygen species (ROS) play an important role in regulation of essential cellular signaling pathways such as cell differentiation, proliferation, migration and apoptosis. With regard to the repair processes taking place during diseases such as LEAD, prospective therapeutic methods have been described that could significantly improve the treatment of vessel diseases in the future. Summarizing, regenerative medicine holds the potential to transform the therapeutic methods in heart and vessel diseases treatment.

A Study of Transcutaneous Oxygen Saturation by Pulse Oximetry in Symptomatic Ischaemic Lower Limb – A Cross Sectional Analytical Study in a Tertiary Care Hospital in Tirupathi

2021 ◽  
Vol 8 (32) ◽  
pp. 3018-3022
Author(s):  
Sadhu Nagamuneiah ◽  
Gandikota Venkata Prakash ◽  
Sabitha P ◽  
Jandla Bhulaxmi ◽  
Dintyala Venkata S.S.Dintyala Venkata S.S. Mythri ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Pulse Oximetry ◽  
Analytical Study ◽  
Lower Extremities ◽  
Care Hospital ◽  
Colour Doppler ◽  
Duplex Scan ◽  
Cross Sectional ◽  
Transcutaneous Oxygen ◽  
Arterial Insufficiency

BACKGROUND Chronic arterial insufficiency (CAI) results in stenotic-occlusive disease of vascularized arterial disorders of tissues and organs. CAI of the lower extremities represents a significant medical and socio-economic problem due to a high incidence of morbidity, invalidity and mortality. METHODS A cross sectional analytical study was conducted in a group of 100 patients, admitted at the Vascular Department of the Sri Venkateshwara Ramnaraian Ruia Government General Hospital, Tirupati during the period from September 2018 to August 2019, with evident symptoms and signs of different stages of lower extremities CAI verified by ultrasonography. In patients with lower extremity disorder of tissue arterial capillaries, SpO2 was determined by pulse oximetry. CAI of the lower extremity was determined on the basis of clinical findings and colour Doppler duplex scan echo sonography results. Using the conventional method (single-gate) and colour Doppler duplex scan (multi-gate), the presence and localization of stenosis, the segmental predominance (with multisegmental forms) and the degree of progression of stenotic-occlusive lesions were verified. RESULTS Results Using pulse oximetry, depending on the of stage of lower extremities CAI, we revealed a considerable difference in the stages of functional ischemia Mean SpO2: Fontaine I – 95.50 %, Fontaine II – 92.90; in stage critical ischemia SpO2: Fontaine III – 65.00 % and Fontaine IV – 49.87 %. In 29 patients with gangrenous foot and fingers SpO2 was immeasurable and progressive decrease in SpO2 of arterial capillaries (p<0.01 between stages). CONCLUSIONS Due to the reliability and simplicity of pulse oximetry it can be a routinely used diagnostic device for patients with early determined stage of lower extremities CAI. KEYWORDS Chronic Arterial Insufficiency, SPO2, Pulse Oximetry, Ischemia

scholarly journals EFEKTIVITAS ELEVASI EKSTREMITAS BAWAH TERHADAP PROSES PENYEMBUHAN ULKUS DIABETIK DI RUANG MELATI I RSUD DR. MOEWARDI TAHUN 2014

2015 ◽  
Vol 3 (1) ◽  
Author(s):  
Dwi Ariani Sulistyowati
Keyword(s):  
Lower Extremity ◽  
Ulcer Healing ◽  
Healing Process ◽  
Lower Extremities ◽  
Tissue Perfusion ◽  
Analysis Data ◽  
Control Group ◽  
Control Group Design ◽  
Diabetic Ulcer ◽  
Equivalent Control

AbstractIntroduction: People with Diabetes Mellitus have poor circulation, especially in areas far from heart, these causing the length of time of wounds healing. One of the interventions to improve the peripheral tissue perfusion of patients with Diabetic Ulcer is lower extremity elevation.Purpose: The purpose of this research is describe the characteristics of respondents, knowing Diabetic Ulcer healing process without lower extremity elevation, knowing Diabetic Ulcer healing process with lower extremity elevation and knowing the effectiveness of Diabetic Ulcer healing without lower extremity elevation and with lower extremity elevation.Research Methods: This research is to design an quasy experiment non equivalent control group design and analysis data used Independent T TestResearch Results: Results of this research is the elevation of lower extremities more effectively to increased Ulcers Diabetic healing process. It’s evidenced by Independent T Test obtained p = 0,000Conclusion: Elevation of lower extremities more effectively to increased Diabetic Ulcer healing in patients with Diabetic Ulcer in Melati I RSUD Dr. Moewardi.Advice: Lower extremity elevation expect can be applied in patients with Diabetic Ulcer.Key Words: Lower Extremity Elevation, Diabetic Ulcer Healing Process

Clinical application of the anterolateral thigh free flap in high energy injuries of the lower extremity

2021 ◽  
Vol 9 (4) ◽  
pp. 1192
Author(s):  
Del Carmen-Ortega Ignacio ◽  
Cahuana-Quispe Alberto Ignacio ◽  
Jaimes-Duran Edwing Michel ◽  
Soulé-Martínez Christian Enrique
Keyword(s):  
Lower Extremity ◽  
Free Flap ◽  
Donor Site ◽  
High Energy ◽  
Road Accident ◽  
Anterior Tibial Artery ◽  
Osteosynthesis Material ◽  
Anterior Tibial ◽  
End To End ◽  
The Right

One of the recurring problems in plastic and reconstructive surgery is the loss of tissues of the lower extremities as a result of high-energy injuries. The difficulty of this reconstruction lies in the need for a sufficiently suitable and resistant tissue to allow this restoration. The thigh-free anterolateral flap, since its description in 1984, has great versatility for complex or extensive lower extremity reconstructions. We presented the case of a 37-year-old male patient who had a high-energy road accident on a bicycle, impacting a moving vehicle causing a multi fragmented fracture of the right proximal tibia AO 41 C2.2/Schatzker V. He was treated surgically with material from osteosynthesis and iliac crest graft. It is complicated by infection of the surgical wound, exposure of osteosynthesis material and absence of skin covering. Reconstruction of the upper third of the right leg was performed with a thigh-free anterolateral free flap with 2 end-to-end venous anastomoses from the flap to anterior tibial veins, and 1 end-to-end anastomosis from perforating artery to anterior tibial artery, with no associated complications. The thigh-free anterolateral free flap is a versatile and reliable mechanism for the reconstructive surgeon, as it provides excellent coverage for complex lower extremity wounds as well as low donor site morbidity. Outpatient follow-up with adequate clinical evolution was done. 

PRINCESS ELIZABETH, SECOND DAUGHTER OF KING CHARLES I, AND RICKETS

PEDIATRICS ◽  
1979 ◽  
Vol 64 (2) ◽  
pp. 241-241
Author(s):  
T. E. C.
Keyword(s):  
Relative Proportion ◽  
Spinal Column ◽  
Lower Extremities ◽  
Long Bone ◽  
Upper Arm ◽  
Charles I ◽  
King Charles I ◽  
The Right ◽  
Shoulder Blade ◽  
Unequal Length

In 1856 the coffin of Princess Elizabeth (1635-1650) was discovered during the demolition of old St. Thomas's Church at Newport, Isle of Wight, England. Mr. Ernest P. Wilkins, MRCS, examined the remains of the Princess and noted:1 The bones of the upper arm were slightly curved outwards—more particularly the right humerous—while those of the forearm were somewhat twisted and considerably curved outwards. The spinal column, retaining the relative position of the vertebrae during life, presented an extremely curved condition constituting the double lateral or S curvature of pathologists, which must have caused considerable projection of the right shoulder-blade and its attendant deformity .... The condyles of the lower extremities were very large in relative proportion. The femur or thigh bone of the left side was curved forwards and inwards, that of the right side was more distorted than any other long bone. It was very much curved forwards and inwards. This bone was much flattened, its greatest diameter being from before, obliquely outwards and backwards; the concavity of the curve was somewhat filled in, and the bone thus strengthened by additional osseous deposit in accordance with the natural reparative tendency of Nature's laws. The bones of the leg, the tibia and fibula, were much curved outwards. The bones of the skeleton indicate the great deformity which existed during life—there was evidently considerable "growing out" of the right shoulder-blade and corresponding flattening of the left side of the back. The lower extremities were contorted and of unequal length, the knees were what is termed "knocked"; below the knees the legs were bowed, the heels thrown outwards and the toes inverted.

Lower Extremity Blood Flow Velocity in Obese versus Nonobese Pregnant Women

2019 ◽  
Vol 37 (04) ◽  
pp. 384-389 ◽  
Author(s):  
Eryn H. Dutta ◽  
Ralph N. Burns ◽  
Luis D. Pacheco ◽  
Caroline C. Marrs ◽  
Aristides Koutrouvelis ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Pregnant Women ◽  
Lower Extremities ◽  
Duplex Ultrasound ◽  
Volume Flow ◽  
Venous Stasis ◽  
Chi Square ◽  
Mean Velocity ◽  
Venous Flow ◽  
Increased Risk

Objective Obesity and pregnancy are risk factors for venous thromboembolism (VTE). In nonpregnant individuals, abdominal obesity is associated with venous insufficiency. This study aimed to compare venous Doppler volume flow and velocity in the lower extremities of obese versus nonobese women. Study Design A prospective cohort study was performed. Duplex ultrasound examined bilateral lower extremity venous flow and velocity (time-averaged mean velocity, TAMV). Flow was analyzed at the superficial femoral (SFV), distal external iliac (DEI), common femoral, profunda femoris, and popliteal veins. Mann–Whitney U-test, Spearman's correlation, and chi-square tests were used, with a significance of p < 0.05. Results Left SFV TAMV and volume flow were higher in the obese group (5.1 [4.1–5.7] vs. 2.8 [1.7–3.4] cm/second; p < 0.001) and (89 [73–119] vs. 48 [26–62] cm/minute; p = 0.005). Significant differences were noted for right DEI flow (obese 326 [221–833] vs. nonobese 182 [104–355] cm/minute; p = 0.049). The right femoral profunda flow was also higher in obese (49 [40–93] cm/minute) compared with nonobese (31 [22–52] cm/minute; p = 0.041). Conclusion Volume flow and TAMV in the lower extremities of obese gravidas are higher compared with nonobese ones. Thus, the increased risk of VTE among obese pregnant women may not be caused by venous stasis.

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