title: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Vascular Surgery, São Paulo University Medical School, Brazil. livio.nakano@gmail.com
authors.forename: Lívio
authors.initials: L
authors.lastname: Nakano
authors.forename: Nelson
authors.initials: N
authors.lastname: Wolosker
authors.forename: Ruben Ayzin
authors.initials: RA
authors.lastname: Rosoki
authors.forename: Baptista Muraco
authors.initials: BM
authors.lastname: Netto
authors.forename: Pedro
authors.initials: P
authors.lastname: Puech-Leão
mesh_terms: D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena / Q000295:instrumentation; D016022:Case-Control Studies; D004185:Disability Evaluation; D005080:Exercise Test / Q000379:methods; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000209:etiology / Q000503:physiopathology*; D007511:Ischemia / Q000150:complications / Q000503:physiopathology*; D007537:Isometric Contraction / Q000502:physiology; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013348:Subclavian Artery; D034941:Upper Extremity / Q000098:blood supply* / Q000503:physiopathology