ASHT - Dupuytrens, etc.

Question 1

Convex Concave rule

Answer 1

Concave moving on convex: • Mobilize the concave joint in SAME direction as physiological movement ie. PIP jt • Convex surface moving on concave: • Mobilize the convex surface in OPPOSITE direction of physiological movement ie. carpals on radius

Question 2

Dupuytren’s Cords - central

Answer 2

contracture of PIP and MP

Question 3

Dupuytren’s Cords - spiral

Answer 3

contracture of PIP with neurovascular displacement

Question 4

Dupuytren’s cords - natatory

Answer 4

digital webspace contracture

Question 5

Dupuytren’s cords - commisural

Answer 5

contracture of thumb/index webspace

Question 6

Dupuytren’s cords - retrovascular

Answer 6

contracture of the DIP (and sometimes PIP)

Question 7

Dupuytren’s operative indications

Answer 7

≥30°MP contracture OR ≥20°PIP contracture with progression • Tabletop Test

Question 8

Dupuytren’s medical management

Answer 8

• Needle fasciotomy: • Most effective with mild MP contractures, • High risk of nerve and tendon injury
• Closed enzymatic fasciotomy (Xiaflex): Collagenase injected into the cords, dissolving collagen bonds and weakening the cords then Manipulation into extension to rupture the cords – up to 7 days post injection • Limited open fasciectomy: • Diseased fascia is removed, rest is undisturbed McCash- a variation in which the skin is left open to heal by
secondary intention
• Dermofasciectomy: • Removing diseased fascia and overlying skin, treated with
grafting
• Open radical fasciectomy: • Removing diseased fascia and normal fascia
• Excision of nodule: • Only performed if nodule is superficial to trigger finger or if it is causing severe night pain

Question 9

Dupuytren’s rehabilitation

Answer 9

• Pre-op visit • 1-3 days post op • Static extension orthosis • Full extension or no-tension protocol • AROM hourly • Edema control • Scar management • 3-4 weeks post op • Start strengthening

Question 10

Infection

Answer 10

10^5 bacteria/grams. red, warm, fever, pain

Question 11

Paronychia

Answer 11

most common, nail fold

Question 12

Cellulitis

Answer 12

dorsal finger or hand

Question 13

lymphangitis

Answer 13

red streaking up the arm

Question 14

felon

Answer 14

finger pulp

Question 15

bites

Answer 15

human and animal

Question 16

herpetic whitlow

Answer 16

medical/dental personnel

Question 17

Pyogenic granuloma

Answer 17

bandages, moist environment

Question 18

fascial space infections

Answer 18

dorsal subcutaneous, dorsal subaponeurotic, hypothenar, thenar, or midpalmar area

Question 19

Signs of Kanavel

Answer 19

medical emergency - Pyogenic flexor tenosynovitis- sausage finger, fusiform swelling, flexed position, pain with passive extension, tender at flexor tendon sheath - usually need OR

Question 20

ganglion cyst

Answer 20

dorsal wrist. Dorsal SL ligament, volar STT joint, SCR insertion

Question 21

benign tumors

Answer 21

• Giant-cell tumor/xanthoma - tendon sheath • Hemangioma - vascular • Lipoma - fat • Neurilemmoma/Neurofibroma - nerve • Enchondroma - bone

Question 22

malignant tumors

Answer 22

Squamous cell carcinoma - skin • Soft tissue sarcomas • Metastatic disease - rare in hand

Question 23

work conditioning

Answer 23

Single discipline, 4 hours per day, 3-5 days per week

Question 24

work hardening

Answer 24

Multidisciplinary, 8 hours per day, 5 days per week

Question 25

congenital limb- when is it formed?

Answer 25

UE formed between 26 days-8 weeks

Question 26

pre-axial vs. post-axial

Answer 26

pre-axial is radial; post-axial is ulnar

Question 27

research levels of evidence

Answer 27

1:Systematic Review of RCT 2: Systematic Review of Case Studies 3: Case Controlled Study 4: Case Series 5: Expert Opinion

Question 28

specificity vs. sensitivity

Answer 28

Specificity- proportion of true negatives. • Rules IN the diagnosis • Sensitivity- proportion of true positives • Rules OUT the diagnosis SPIN SNOUT

Question 29

thumb hypoplasia

Answer 29

I Minor deficiency with minimal shortening Usually unnecessary II Moderate deficiency, 1st web space contracture, MP instability, thenar hypoplasia Opponensplasty, first web space release, UCL reconstruction III Type II plus extrinsic deformities, IIAstable CMC, IIIB – unstable CMC IIIA – Reconstruction IIIB – Pollicization IV Pouce Flottant, rudimentary bony elements with narrow skin pedicle Pollicization V Complete thumb absence Pollicization

Question 30

symbradydactyl

Answer 30

Bones missing from fingers, some fingers missing altogether

Question 31

amelia

Answer 31

Lacking one or more limbs

Question 32

syntosis

Answer 32

Union or fusion of adjacent bones

Question 33

Camptodactyly

Answer 33

Flexion contractures

Question 34

macrodactyly

Answer 34

Large fingers

Question 35

polydactyly

Answer 35

Extra fingers

Question 36

arthrogryposis

Answer 36

Congenital contracture in 2+ areas of the body

Question 37

madelung deformity

Answer 37

a rare arm condition that affects the growth plate of the radius, a bone in the forearm. As a child grows, this abnormal growth results in a misalignment where the two long bones of the forearm (the radius and ulna) meet the bones of the wrist.

Question 38

VACTERYLS

Answer 38

a group of growth abnormalities (birth defects) that happen in the early stages of embryo development during pregnancy. The term VATER is an acronym that identifies parts of the body that didn’t form properly during fetal development. Each case of VATER syndrome is unique. A diagnosis occurs if your child has at least three parts of their body affected by symptoms. Missing radius (radial aplasia). Underdeveloped radius (radial hypoplasia). Missing thumb. Extra bone in the thumb (triphalangeal thumb). Symptoms can also affect other limbs on the body (the arms and legs beyond the radius) including: Clubfoot. Difficulty using certain fingers or toes (hypoplasia). Extra fingers or toes (polydactyly). Fused forearm bones (radioulnar synostosis). Webbed fingers and toes (syndactyly).