Chapter 185 - Repetitive trauma and occupational vascular problems

Question 1

Arterial disorder associated with occupational or recreational activities

Answer 1

MANUAL LABOUR 1) hand-arm vibration syndrome 2) hypothenar hammer syndrome EXPOSURE 1) acro-osteolysis 2) electrical burns 3) extreme thermal injuries ATHLETIC 1) chronic hand ischemia 2) quadrilateral space syndrome 3) humeral head compression of axillary artery 4) TOS

Question 2

First case of hand-arm vibration syndrome

Answer 2

1911 Loriga on italian miners with dead fingers Hamilton 1918 - cold and pneumatic drills in stone cutters

Question 3

Other historic names of hand-arm vibration syndrome

Answer 3

1) dead finger to Raynaud of occupational origin 2) traumatic vasospastic disease 3) vibration-induced white finger

Question 4

Taylor and Pelmear staging system for HAVS

Answer 4

TABLE 185.1

Question 5

Percentage of HAVS that progress to ulceration and gangrene

Answer 5

1%

Question 6

Onset and severity of HAVS related to what factor in the exposure

Answer 6

1) amount of acceleration 2) years of exposure

Question 7

Hypothesized mechanism of HAVS

Answer 7

1) endothelial damage with plt adhesion 2) sympathetic hyperactivity 3) smoking 4) lower level of serotonin 5) polymorphism of HTR1B

Question 8

Diagnostic tests of HAVS

Answer 8

1) Cold provocation test 2) Duplex 3) arteriography 4) MRA (diferentiate HAVS from hypothenar hammer)

Question 9

Arteriography of HAVS

Answer 9

1) multiple segmental occlusions 2) corkscrew configuration of vessels in hand

Question 10

Rate of HAVS with Raynaud phenomenon

Answer 10

91%

Question 11

Rate of abnormal cold response in HAVS

Answer 11

53%

Question 12

Rate of reduced SBP in HAVS

Answer 12

31%

Question 13

Treatment of HAVS

Answer 13

1) stop vibration 2) CCB Nifedipine 30-120 mg/day 3) prostanoid IV (PE1, prostacyclin, iloprost) for digital gangrene 4) cervical or digital sympathectomy (rare) 5) gloves and PPE limit exposure to cold and vibration

Question 14

Guyon canal

Answer 14

Pisiform and hamate forms this Ulnar artery and never travel through this

Question 15

Ulnar artery in Guyon canal is covered by

Answer 15

1) skin 2) sc tissue 3) palmaris brevis muscle

Question 16

First descriptions of hypothenar hammer syndrome is by

Answer 16

Conn Later Von Rosen (1934) and Guttani (1773) also published on this

Question 17

Incidence of HHS

Answer 17

1.1-1.6% of hand ischemia

Question 18

Arterial abnormality in HHS

Answer 18

1) thrombotic occlusion (intimal damage) 2) aneurysm formation (medial damage)

Question 19

Theory of Ferris on etiology of HHS

Answer 19

1) underlying FMD 2) second hit trauma cause HHS 3) 92% patients have controlateral asymptomatic abnormalities in ulnar artery

Question 20

Difference between HHS and typical Raynauds

Answer 20

1) 3 ulnar finger involvement 2) lack of thumb involvement 3) no hyperemic redness

Question 21

Treatment of HHS

Answer 21

1) smoke cessation 2) hand protection 3) avoid exposure to cold and trauma 4) CCB 5) antiplatelet 6) anticoagulation in necrosis 7) surgery if aneurysm - ligation or reconstruction

Question 22

Occupational acro-osteolysis caused by exposure to

Answer 22

Polyvinyl chloride First described by Wilson

Question 23

Symptoms of occupational acro-osteolysis

Answer 23

1) hand ischemia 2) resorption of distal phalangeal tufts (like scleroderma) 3) raynaud phenomenon 4) hypervascularity adjacent to bone resorption

Question 24

Treatment of acro-osteolysis

Answer 24

supportive only

Question 25

Electrical burn voltage and type of tissue damaged

Answer 25

< 1000 V = immediate skin and soft tissue > 1000 V = travel from entry to exit point causing damage throughout

Question 26

Arterial injury by electrical burns

Answer 26

1) arterial necrosis 2) thrombus or bleeding 3) spasm 4) aneurysm

Question 27

Extreme thermal injury to cold type of occupations

Answer 27

1) slaughterhouse 2) canning factories 3) fisheries

Question 28

Symptoms of extreme thermal injury and treatment

Answer 28

Raynaud phenomenon supportive care only

Question 29

Hand ischemia in athletes found in

Answer 29

1) frisbee 2) handball 3) karate 4) baseball catchers 5) baseball pitchers

Question 30

Percentage of baseball catchers that have digital artery occlusion

Answer 30

40%

Question 31

Ligament that compress digital artery in pitcher hyperextension

Answer 31

Cleland ligament

Question 32

Treatment of hand ischemia in athletes

Answer 32

1) dextran IV 2) pain control 3) pentoxyfylline 4) CCB 5) botox (vasospasm) 6) release of Cleland ligament 7) periarterial digital sympathectomy

Question 33

Quadrilateral space definition

Answer 33

1) teres minor superiorly 2) humeral shaft laterally 3) teres major inferiorly

Question 34

Structures in the quadrilateral space

Answer 34

1) posterior humeral circumflex artery 2) axillary nerve

Question 35

Quadrilateral space syndrome first described by

Answer 35

Cahill and Palmer 1983

Question 36

Motion that causes compression of the posterior humeral circumflex artery

Answer 36

abduction and external rotation of arm (cocked position)

Question 37

Two types of quadrilateral space syndrome

Answer 37

1) Vascular 2) neurogenic

Question 38

Treatment of vQSS

Answer 38

1) thrombolytic 2) aneurysm resection must preserve one of the two humeral circumflex arteries

Question 39

Structures that are supplied by the humeral circumflex arteries

Answer 39

Humeral head

Question 40

Treatment of nQSS

Answer 40

1) antiinflammatory 2) physiotherapy 3) limit activities 4) neurolysis and excision of fibrous bands

Question 41

Cause of neuro QSS

Answer 41

1) repetitive microtrauma to connective tissue 2) fibrous band build up

Question 42

Symptoms of neuro QSS

Answer 42

1) muscle atrophy 2) paresis 3) paresthesia 4) shoulder pain 5) tenderness in quadrilateral space

Question 43

Humeral head compression of axillary artery at which segment of axillary artery

Answer 43

distal 1/3

Question 44

Motion that causes HHC of axillary artery

Answer 44

Externally rotated and abduction Downward compression on the artery

Question 45

Symptoms of HCC of axillary artery

Answer 45

1) Raynaud 2) embolization 3) fatigue

Question 46

Treatment of HCC of axillary artery

Answer 46

1) patch repair 2) lifestyle modification 3) bypass

Question 47

Causes of arterial TOS in athletes

Answer 47

1) hypertrophy of scalene 2) hypertrophy of pec minor