Instructional Concurrent Session IV
Beyond Xiaflex & McCash: Needle Aponeurotomy, Radiotherapy & Rehabilitation for Recurrent Dupuytren’s Disease
Have you treated clients with Dupuytren’s Disease (DD), only to have them return a year or more later, with a failed surgical outcome or new finger contractures? What else may we offer these clients? More common in Europe, radiation therapy is now under consideration as an alternative treatment for DD. This interactive seminar will focus on Dino’s story. Our dynamic guest speaker, Dino, will join us to share his lived experience and joy, by defeating depression from severe DD and failed surgical procedures. Dino will share his responses to Xiaflex, needle aponeurotomy, and his subsequent rehabilitation with radiation therapy. In Dino’s case, radiotherapy was used to prevent disease progression, as radiation is most effective for early-stage minimal contractures. His thoughts on what makes a good hand therapist will also validate our profession. This intermediate level seminar assumes that experienced hand therapists have a working knowledge of DD, including evaluation and treatment strategies. We will forge ahead to discuss needle aponeurotomy and radiation as a potential new approach.
- Identify symptoms, presentation, and risk factors for people receiving needle aponeurotomy or radiation to control Dupuytren’s Disease.
- Discuss the benefits and risks of needle aponeurotomy, radiation therapy as an alternative intervention for Dupuytren’s Disease.
- Gain insight into a patient’s lived bio-psycho-social experience, on treating Dupuytren’s Disease, with radiation therapy and hand therapy geared to meaningful functional outcomes.
Complex Regional Pain Syndrome from a Pain Management Perspective
Complex Regional Pain Syndrome (CRPS) is a complicated pain condition that drastically impacts the patient's upper extremity function. This presentation will discuss the evaluation and treatment of CRPS from an interventional pain management specialist lens and discuss the clinical decision making for common medical interventions utilized to manage this condition. This will assist the learner in understanding how and why certain interventions are chosen based on the patient presentation, as well as their expected outcomes. The presentation will also include the role of physical and occupational therapy to complement these medical interventions.
- Describe the diagnostic criteria for CRPS.
- Identify 3 medical interventions for CRPS and describe the clinical decision making for why an intervention is chosen.
- Explain the guiding principles for graded motor imagery.
Complex Traumatic Hand Injuries: Embrace the Challenge to Maximize Patient Outcomes
Each traumatic injury of the hand and upper limb is unique, complex, and challenging. These injuries involve multiple neuromusculoskeletal tissues that require hand therapists to use a high level of clinical reasoning throughout the rehabilitation process to maximize recovery of each tissue injury and/or repair without putting other neuromusculoskeletal tissues at risk for rupture or delaying healing. Traumatic hand injuries are challenging because there is frequently a need to address the psychosocial impact of the injury while addressing the physical impairments and functional limitations of the patient. Hand injuries involving multiple neuromusculoskeletal tissues are usually unique in that no two injuries are exactly alike, so it is difficult to apply a protocol for this population. Also, hand therapists may feel overwhelmed if they have limited or no experience with treating traumatic hand injuries. This course will offer a clinical reasoning approach, that aligns with the principles of tissue healing and evidence -informed practice, that facilitates decisions to be made in a timely manner to maximize functional recovery and well-being for patients as well as provide hand therapists with the tools needed to confidently treat this population.
- Describe the components of a tissue systems review to include in the initial and ongoing evaluation of a client with a traumatic hand injury.
- Integrate population specific rehabilitation considerations related to injured tissues, psychosocial impact, and expected outcomes.
- Establish a therapy plan of care that is relevant to the injured/repaired tissues, tissue healing timeframes, and best evidence germane to the unique traumatic hand condition.
Staged Approach to Surgery and Rehabilitation after Complex Penetrating Arm Trauma
Injuries of the arm from ballistic, degloving or explosive trauma can result in severe nerve and tissue loss in the upper limb. For an optimal result, there needs to be a coordinated stage effort between the surgeon and hand therapist. We have found that 4 stages are necessary in complex arm trauma with tissue loss. Initial stabilizing and exploratory surgery is followed by preparatory therapy. This is followed by nerve and tendon reconstruction and final therapeutic maneuvers to deliver a well functioning shoulder, elbow, wrist and hand. The goal is to give a rapid return to near normal function despite a devastating loss. With this protocol, we have met the goal in a large series of patients.
- Describe the four stages of care after ballistic trauma with tissue loss
- describe pros and cons of nerve transfer vs tendon transfer
- Discuss the timing of a second surgery after therapeutic efforts and preparation