American Society of Hand Therapists (ASHT) 2014 Conference in Boston, USA

Alex RetallickAlex Retallick recently attended the American Society of Hand Therapists (ASHT) conference in Boston USA in September.  Some of the findings.

Wide Awake Tendon Repair:

This has become a more widely preferred technique with surgeons.  Research has suggested that the most frequent causes of flexor tendon rupture after surgery are pulley friction, and suture gapping due to low tension.  Wide awake surgery allows patient participation in the surgery.  Patients are asked to actively glide the repaired tendon during surgery.  If there is friction at the pulley, the pulley is able to either be partially or fully resected.  If a suture repair is gaping under tension, it can be tightened before surgical closure.  There is preference for low profile suturing, particularly anteriorly to prevent friction at the pulleys. Furthermore, the surgeon is able to give more objective information to the treating hand therapist on how far the patient can move actively into flexion before gapping or friction occurs.  Research by Dr Peter Amadio and Donald Lalonde have shown reduced rupture rates using these techniques.

Relative Motion Splinting for Boutonniere Deformity

A very interesting paper presented by Julianne Howell, found that a yolk splint blocking MCP joint extension allows the lateral bands to be realigned dorsally by placing tension on the Extensor Digitorum Communis (EDC) tendon.  At the same time the Flexor Digitorum Profundus (FDP) tendon is on low tension allowing the bands to shift easily toward the dorsum of the joint axis.

Collagenase for Dupuytrens Contracture Management:

Several papers were presented by both Surgeons and Therapists looking at outcomes using collagenase.  Early findings are encouraging.  The procedure is less invasive than open Dupuytrens release, though still an expensive option.  Due to the less invasive approach, there is less scar tissue and adhesion, so splining timeframes are shortened and less therapy visits are required.  Fixed flexion contracture of the PIP joint is more likely to resolve, producing improved and faster functional outcomes for patients.  As the technique is relatively new, there are no studies that follow the patients in the long term to see if positive outcomes are maintained.

Risk Factors for CTS:

We have long thought that risk factors for carpal tunnel syndrome include repetitive and resistive gripping and wrist flexion, along with heavy vibration have been factors correlated with the development of CTS.  A paper that was presented during the conference has found that while resistive gripping and wrist flexion are certainly factors that will increase risk, repetition alone or vibration do not seem to be important.