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Alterations in forearm position and environmental temperature influences the segmental volume expansion during venous occlusion plethysmography--special attention on hand circulation.
Dept of Physiology and Pharmacology, Karolinska Institutet. Dept of Hand Surgery, Södersjukhuset. .
Dept of Molecular Medicine and Surgery, Section of Clinical Physiology, Karolinska Institutet. Dept of Clinical Physiology Karolinska University Hospital.
Dept of Physiology and Pharmacology, Karolinska Institutet.
2009 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 29, no 5, 376-81 p.Article in journal (Refereed) Published
Abstract [en]

AIM: To find evidence that small changes in the positioning of the strain gauge, the environmental temperature (sympathetic activation) and position of the arm (venous pressure) alters the outcome of the venous occlusion plethysmography (VOP) measurement of forearm blood flow and to investigate if the hand circulation influences the results.

METHODS: Forearm blood flow was measured with VOP (n = 6) on three occasions with air temperatures of 13, 20 and 38 degrees C, respectively. At each occasion the arm position was varied; raised by 10 degrees , horizontal or lowered by 15 degrees . Strain gauges were placed on the forearm at the maximal circumference; 5 cm distal; and 5 cm proximal to this site, respectively. The hand circulation was excluded in half of the measurements.

RESULTS: The simple main effect of temperature was highly significant (P<0.001). With excluded hand circulation (but not when included), there was a two factor interaction between arm position - strain gauge position (P<0.05). The highest expansion rate was found in the proximal segment when the arm was elevated, but in the distal segment when the arm was lowered. With hand circulation (but not without) there was a two factor interaction between temperature and strain gauge position (P<0.01). The highest expansion rate was found in the distal segment at normal and high temperatures, but in the proximal segment at low temperature.

CONCLUSION: The volume expansion rate in a particular segment is dependent not only on arterial inflow. Segmental differences in capacity for venous expansion results in redistribution of blood to and from a segment, thus influencing the results obtained.

Place, publisher, year, edition, pages
2009. Vol. 29, no 5, 376-81 p.
National Category
Research subject
URN: urn:nbn:se:uu:diva-169649DOI: 10.1111/j.1475-097X.2009.00883.xPubMedID: 19522855OAI: oai:DiVA.org:uu-169649DiVA: diva2:507487
Available from: 2012-03-05 Created: 2012-03-05 Last updated: 2012-03-06
In thesis
1. Blood Flow in Human Skeletal Muscle: The Effect of Adrenaline and the Influence of a Small Muscle Injury
Open this publication in new window or tab >>Blood Flow in Human Skeletal Muscle: The Effect of Adrenaline and the Influence of a Small Muscle Injury
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

A variety of vasoregulatory systems are involved in the complex control of blood flow inhuman skeletal muscle. The interaction between these systems where one system canoverride or modify the other makes blood flow regulation complicated. Determinations ofmuscle blood flow can thus be challenging especially when considering the shortcomingsand limitations of the available measurement methods. This thesis focuses on two differenttopics of which both are dependent on sympathetic tone.

First, the common use of venous occlusion plethysmography (VOP) with only one straingauge attached per limb is a method with obvious pitfalls. The inherent problems with thissimplification of the original VOP method are highlighted in Study I-II where small variationsin sympathetic tone and venous pressure proved to have a considerable influence on theresults. The basic circumstance to this variability is the curvo-linear pressure/volumerelationship in the veins and the fact that redistribution of blood can occur betweenindividual limb segments. The results clearly demonstrate that events taking place underone strain gauge cannot be strictly duplicated in adjacent portions of the limb.

Secondly, recent reports have indicated that a minor muscle trauma might change the localblood flow response to adrenaline. Two studies were conducted to test if an acute smallmuscle injury (Study III) and chronic muscle damage (Study IV) influences the normal bloodflow effect of adrenaline. In support of the hypothesis we found that the microdialysiscatheter-induced muscle injury in Study III caused a significant vasoconstriction during an i.v.adrenaline infusion, as measured with 133Xenon clearance next to the catheter, whereas nosignificant change in blood flow was seen with adrenaline-infusion in the absence of thecatheter (conventional 133Xe administration). The adverse adrenaline effect is likely to berelated to the degree of invasiveness. Hence, it would be expected that any type of invasivemeasuring device causing a muscle injury could possibly provoke a similar reaction. Thisfinding has a general physiological implication, but has also implications for the use ofinvasive techniques to study blood flow regulation in skeletal muscle.Previous studies of tennis elbow (TE) have reported signs of diffuse muscle damage anddecreased blood flow in the affected extensor carpi radialis brevis (ECRB) muscle. Weconducted a case-control study (IV) to test the hypothesis that the muscle damage in the ECRBin TE alters the blood flow response to adrenaline in a vasoconstrictory direction. Muscleblood flow was determined with local clearance of 99mTechnetium during an i.v. infusion ofadrenaline. In support of the hypothesis, the blood flow reaction to adrenaline was markedlydifferent in the two study groups. Whereas the infusion did not significantly influence99mTechnetium-clearance in the ECRB of controls there was a significantly decreased clearancein the patients. The altered adrenaline effect indicates a vascular dysregulation in TE, which islikely to be of clinical significance by contributing to the development and maintenance of thechronic muscle pain in this large patient group. Whether the vasoregulatory alteration, whichwould be expected to involve recurring relative muscle ischemia, represents the primaryaetiology in TE or is a secondary effect of the muscle injury cannot be determined.In conclusion, a small muscle injury, acute or chronic, seems to alter the effect of adrenalineon skeletal muscle blood flow in a vasoconstrictory direction.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet, 2010. 68 p.
adrenaline, blood flow, blood redistribution, ischemia, muscle injury, skeletal muscle, strain-gauge plethysmography, sympathetic tone, transmural pressure, 99mTechnetium clearance, tennis elbow, venous compliance, venous occlusion plethysmography, 133Xenon clearance
National Category
urn:nbn:se:uu:diva-169655 (URN)978-91-7409-659-0 (ISBN)
Public defence
2010-12-10, Aulan Södersjukhuset, Stockholm, 09:00 (Swedish)
Available from: 2012-03-06 Created: 2012-03-05 Last updated: 2012-03-08Bibliographically approved

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