Objective Evaluation of Upper Limb Claudication: Use of Isokinetic Dynamometry

Abstract

OBJECTIVE: The objective of this work is to present an objective, practical, and reproducible method for evaluating the functional limitation caused by occlusive arterial disease in upper limbs: a stress test using an isokinetic dynamometer. METHODS: Twenty-three patients with unilateral subclavian artery occlusive disease were included in the study, forming group 1. Seven patients of similar age, with atherosclerotic or Takayasu's disease in the aorto-iliac segment, without subclavian artery occlusive disease, were included as a control group (group 2). For all tests, we utilized the CYBEX© 6000 isokinetic dynamometer. The elbow was tested using a series of 30 repetitions of extension and flexion of the arm, performed up to a maximum of 270 repetitions (9 series) or until the limit of the tested limb was reached. RESULTS: We initially compared all the limbs without arterial disease of both groups to analyze whether they presented similar functional performance. No significant difference was found for any of the parameters studied. Considering that upper limbs without arterial disease have a similar response to exercise in these analyzed parameters, we compared the upper limbs in group 1 (with and without subclavian artery occlusive disease). For all parameters, the limbs with subclavian artery occlusive disease presented significantly lower values than the control limbs (P < 0.05), which can be objectively attributed to the ischemia (there were different responses in different individuals, which allows the quantification of the limitation caused by subclavian artery occlusive disease). CONCLUSION: In this study, we present a new stress test for impairment in patients with subclavian artery occlusive disease that might facilitate the classification of patients according to their functional impairment, and thus result in a better choice of therapeutic approach for each case as well as reporting of objective parameters that allow comparisons of the results of different treatments, including for long-term follow-up.

Eccentric Strength and Endurance in Patients with Unilateral Intermittent Claudication

“…It results in exercise intolerance during common daily activities such as walking, leading to a reduction in daily physical activity levels and a decrease in health-related quality of life. 1 – 4 …”

Creatine supplementation as a potential therapeutic aid in peripheral arterial obstructive disease rehabilitation

“…31 In this field, scientific literature has been previously documented reduced values of strength, power and endurance in patients when compared with non diseased controls. [7][8][9]16,17,30,[32][33][34] Once muscular strength could be strongly correlated with walking capacity (most accessed measure of fitness capacity) in PAOD patients by Regensteiner et al 34 and Gerdle et al 32 interventions (resistance training) to counteract this condition has been proposed 11,12 and studied with documented positive benefits. [13][14][15][16][17] Additional to resistance training, as a beneficial exercise type prescription in non diseased population, 35 association of Cr supplementation has been studied and proposed as a more effective intervention to improvements muscular strength.…”

“…4,5 In peripheral arterial obstructive disease (PAOD), the chronic obstruction in blood flow to distal territories due to atherosclerotic process, and its consequence and constant mismatch between oxygen delivery and demand, lead to a progressive disability cycle involving muscle fiber atrophy and denervation, negative muscle metabolism alterations, reduced strength and endurance, impairing general physical fitness capacity, specially walking capacity, in diseased individuals. [6][7][8][9] Cost-effectiveness strategies 10 to counteract muscle, nerve and metabolism impairments, and to reduce the loss of physical fitness capacity, like exercise training have been previously proposed 11,12 and studied. [13][14][15][16][17] Therefore, adding up the cost-effectiveness and the safety profile of studied benefits of Cr supplementation 18,19 and the clinical frame of PAOD, the use of Cr rises as a potential therapeutic aid to be considered.…”

Avaliação e tratamento fisioterápico na doença arterial obstrutiva periférica de membro superior: um estudo de caso

“…1 In the upper limbs, the claudicating symptom may occur especially when the activity is performed with elevated arms. [2][3][4] POAD in the upper limbs has lower incidence and is more frequently associated with iatrogenesis secondary to catheterization. 2,3 Forms of treatment for POAD are surgical intervention, drug therapy and physical therapy rehabilitation program as alternatives for reduction in claudicating symptoms, improvement in functional capacity, prevention of vascular occlusion progression and cardiovascular complications.…”

“…[2][3][4] POAD in the upper limbs has lower incidence and is more frequently associated with iatrogenesis secondary to catheterization. 2,3 Forms of treatment for POAD are surgical intervention, drug therapy and physical therapy rehabilitation program as alternatives for reduction in claudicating symptoms, improvement in functional capacity, prevention of vascular occlusion progression and cardiovascular complications. 5 However, there are no specific protocols for the functional assessment of upper limb claudication, not even specific protocols for rehabilitation of these patients, probably due to low incidence/prevalence of upper limb claudication.…”