Test 4- Dupuytren's and CRPS

Question 1

Dupuytren’s: tissues affected

Answer 1

Affects the longitudinal fibers of the palmer fascia

• Nodules develop on the A1 pully cord
• Contractures develop on MP and PIP

Question 2

Dupuytren’s misdiagnosis

Answer 2

Mutation in collagen thickens fascia and makes it inable to extend fingers, leading it to be diagnosed as trigger finger
-Dupuytren’s much more shallow than trigger finger (palmar fascia)

Question 3

Dupuytren’s treatment

Answer 3

• Cannot reverse what has been lost, can only prevent spread
• Treatment: night splinting, built-up handles, table stretches (overstretching causes inflammation), collagenase (xiaflex) injections, surgery

Question 4

Ganglions

Answer 4

Ganglion cysts are common lumps in hand/wrist or adjacent joints/tendons
-usually fluid-filled and can appear in joints from overwork or stress on joint

Question 5

Ganglion treatment

Answer 5

• Needle aspiration to remove fluid
• Cortisone
• Splinting irritated tissue

Question 6

Complex Regional Pain Syndrome (CRPS)

Answer 6

Chronic pain syndrome, which is caused by several psychological and physiological systems
-Process is progressive and will get worse without intervention

Question 7

Two types of CRPS

Answer 7

• Type I: Occurs after an illness or injury that DID NOT directly damage the peripheral Nn of affected limb
• Type II: There is an identifiable peripheral N injury

Question 8

Grades of CRPS

Answer 8

• Grade 1: Algodystrophy (distribution of bone growth combined with sympathetic symptoms)
• Grade 2: Sympathetic dystrophy without pain
• Grade 3: Sympathetic maintained pain

Question 9

Common symptoms of CRPS

Answer 9

• Inflammation
• Skin color changes
• Stiffness
• Abnormal hair growth
• Spasms in blood vessels and muscles
• Osteopenia- bone density loss
• Insomnia
• Dystonia- motor planning difficulty

Question 10

CRPS Stages time frames

Answer 10

• 1. Acute phase: first 3 months
• 2. Subacute phase: 3 or more months
• 3. Chronic phase: 6 months onward

Question 11

Watson Carlson Stress Loading

Answer 11

Goal is to weight-bear as much as possible through affected arm, to increase the large fiber impulses to relieve pain
-involves compression and distraction (scrub and carry) and carrying 1 to 2 lbs during day (distraction)

Question 12

Watson Carlson- How often

Answer 12

Begin with 3 minutes 3 times a day, then move to 10-15 minutes 3 times a day

Question 13

Dystrophile

Answer 13

In Watson Carlson: device used to measure amount of weightbearing a person can perform

Question 14

Stress Loading Activities

Answer 14

• Scrubbing on plywood in quadruped position: every 2 hours starting 3-5 min, working up to 10 min
• Carry weighted bad w/ affected hand. Grade weight up ASAP
• Washing windows, scrubbing bath tile, carry groceries (functional activities)

Question 15

Graded Motor Imagery (GMI)

Answer 15

• Phase 1: Laterality- left/right discrimination, identifying body part as correct side
• Phase 2: Imagery- imagine the extremity in motion- static, dynamic, doing a task
• Phase 3: Mirror therapy- affected limb can be stimulated by visual cues originating from opposite side of body

Question 16

Laterality

Answer 16

Left/right discrimination

• Laterality lost with CRPS; brain tunes out affected limb (4.7 sec to recognize apposed to normal 2.4 sec)
• Laterality in GMI seeks to restore accuracy and speed of L vs R

Question 17

Medical interventions of CRPS

Answer 17

• Medications DO NOT alleviate the neurogenic pain of CRPS

- Can use: neural mobilization techniques, aerobic exercises, stress-loading (if safe), GMI

Question 18

Stellate Ganglion Nerve Blocks

Answer 18

Temporarily blocks SNS which temporarily blocks pain of CRPS

• This allows pt to go directly to therapy and perform w/o normal pain involved with it
• Pt may present with facial or UE paralysis