NZAHT Inc Newsletter - August 2008

I’m looking forward to seeing you soon in Christchurch for “Under the Thumb”. No skiing trip
for me this year, but for those of you that are; avoid the “Skiers Thumb!”
The Waikato group are working hard to make next year a “costal” experience. The Forearm, by the
foreshore with Maggie Pearson.
A healthy contribution from the Wellington group this edition—thank you all and especially
Amanda who coordinated the group effort. CRPS, PIP, X-word, Mapping and Elephants!?!
Some detailed reports from the ACC and Education committees, who have obviously been working
hard and a great case study to absorb...Happy Reading on this bumper edition.
Cheers, Pam (Ed)
Deadlines for next Edition
A handy quote:(in honor of Maori Language week)
Post conference feedback
November
Whaia te iti kahurangi. Ki te tuohu
South
Island Group
koe, me he maunga teitei
Pursue excellence—should you stumble, let
it be to a lofty mountain
Chapter 1
Contents
Executive Report…………………….......2
Regional Reps………………………….…3
ACC committee report………..……......4 –9
Education committee report...………….10-15
Library………...……………..……..……..17
CRPS and Vit C...………………………...18-20
Cross word ……………………………....20-21
Strapping Workshop……………………..22-23
Localization mapping…………………….24
Lynne in India……………………………..25
PIP joint injuries Poster…………………..26
Reports:
Chapter 2
Case study by Brenda Sheat
NZAHT Inc Newsletter - August 2008
Editor; [email protected]
From the Executive
Hello there Hand Therapists,
I cannot believe we are up to August. Where is the year going? This is a very brief report as I am
currently preparing the report for the AGM and it seemed mad to give you all a double dose of
me.
The main events from Executive over the past couple of months has been further updating our
website to try to enhance its uses. As previously mentioned Suzanne has liaised a very successful
change of our website to a new host- Anzatea. This has meant we now are fully capable of our
own site updating – something we have not been able to do before now. This is a massive cost
saver and means then website can be far more up to date and relevant.
We are further concentrating on creating the site to be an effective tool for potential referrers or
patients wanting to contact us. Our current focus is upgrading our search engines so that
Registered Hand Therapists can be searched for under both name and location of work. We want
the information on each therapist to give the appropriate details also – in many cases a postal box
number is not the most helpful information that a referring doctor will need – they would be
more interested in physical work address and links to business websites ( if they have one). We
are heading along these lines in order to keep everything up to date.
We have been working closely with the Education committee to clarify our late log books
procedure and also clarifying procedures for updating ACC of our membership status. There will
be more of this in the annual report.
The Executive greatly looks forward to the Annual conference in Christchurch in just a couple of
weeks. I know the pressure will be on the organising committee as the count-down is on. In
advance – thank you for all your work – I know it is busy doing such a job over and above your
everyday work. Hang in there – it is greatly appreciated.
I look forward to catching up with everyone at conference. I always think the networking and
chats are as helpful as the actual educational content of the conference – no offense to any
conference organizers.
The Exec continues to welcome any feedback with regard to the way the our Association works
so feel free to keep the lines of communication open.
Please read your annual reports before the AGM and hope everyone is planning on attending.
We have a Treasurers job to fill…………..any takers???
Best wishes to all.
Sarah Waldin
President NZAHT
Suzanne Koster
President Elect
Olga Alkin
Secretary
Jane Sweeney
Treasurer
New Members
Welcome to…
Associates
Katie Northfield
Evelyn Willmann
Larissa Fisher
Michelle Chong
Auckland
Auckland
Auckland
Hamilton
Congratulations
Rochelle Malloy on the arrival of a healthy baby girl,
Hannah.
Regional Reports
For all new members—feel free to get in touch with your regional rep and find out if anything is going on in your area.
Northland
Jane Sweeney
ph (09) 456 5000 [email protected]
Auckland
Brenda Clow
ph: 09 815 6180 [email protected]
Waikato/Bay Of Plenty
Just thought I'd give everyone an update on the conference prep's. We
have confirmed the 16-18 Oct 09 with the Sebel hotel as venue in
Tauranga. The guest speaker is Margareta Persson and the topic is the
Forearm....
we thought we could have next local meeting after the conference, with a
conference update, maybe late September? What do you guys think?
Carina Fraser
ph: 021 687 657 [email protected]
Wellington/Nelson
Not much to report really other than the fact that we have had a couple of meetings since the last
submission; the first meeting discussed the most recent literature on carpal tunnel syndrome while the
second one was just a sharing of therapist ideas on conditions such as de Quervains, ulnar carpal
instability, mid carpal instability, SL dissociations. Our next meeting is scheduled on the 16th September
to catch up and discuss the topics covered in this year’s upcoming annual conference in Christchurch.
Amanda Johnson
ph: (04) 939 4263 [email protected]
Canterbury / West Coast
Kerry Cragg
ph: (03) 364 0694 [email protected]
Otago / Southland
Sandra Hall
Hawkes Bay/Manawatu:
ph: (03) 477 1744 [email protected]
either of Waikato or Wellington area
(Continued on page 4)
ACC Committee Report
URGENT: if you are an ACC HAND THERAPY CONTRACT
HOLDER (or SENIOR CLINICIAN in an INSTITUITION HOLDING
A CONTRACT).. please email [email protected] to advise contact details with subject “ acc contract holder details”. thankyou
Re the above , as a committee we have recently tried to canvass Contract
holding members , requesting feedback on Contract , pending ACCs annual
review process. There was a disappointing response to a mass email
(thankyou to those who responded!) and we wonder if our contact details are
not up to date. We also do not have accurate knowledge of exactly who
holds contracts as ACC is unable to provide this to us for privacy;but
obviously for us to be representative ,such knowledge would be useful .
A few points have arisen from our recent meetings that we feel may need
clarification .
1. ASSOCIATE to RHT in 2 YEARS.
• It is important to remember that our membership structure was in
place pre.Contract and stands alone. The Contract subsequently has its
own requirements of our membership .
• Ie from an NZAHT perspective an Associate can remain an Associate
for as long as they like… (if they pursue RHT they have a 3 year
window to accumulate required hours.)
• However…. Once an Associate becomes a Named Therapist on an
ACC Hand Contract, part of the agreement (and this should be part of
supervision agreement) is that the Associate will achieve RHT within
2 years of starting on the contract, in order to remain as a named
therapist
• ACC Healthwise have commented that a number of Associates are not
achieving RHT in the required time frame, and asked us for
clarification of process.
We have pointed out that the time frame can be tight but is largely
achievable.
NZAHT is aware that some of the delays can focus around the timing
case study submission and marking process , and the education
committee is currently addressing this.
However it is also important that all Associates on the contract start
their case studies in good time to allow for a marking/review period,
and that Supervisors are familiar with the marking criteria and giving
sound and constructive feedback . Any supervisor requiring help re
this. should contact education committee in first instance.
ACC for their part are prepared to give some leeway over the 2years
but this is dependent on them being adequately informed and
preferably before the 2year date, of any anticipated delays. This is the
responsibility of Associate/Contact Holder.
2. ACC 32 and NOTES REQUESTS:
These are areas that the committee has been actively pursuing with ACC
over this year. It is still a work in progress !
• ACC32. ACC are currently undertaking a review of the ACC32 form
and procedures, and we have raised our specific needs as HT and asked
to be represented in future meetings. One aspect we are pursuing is a
proposal that ACC approved elective surgery should have prior
approval for an agreed number of post op treatments, before an
extension is required.
• Notes Requests. We have raised concerns throughtout the year on
behalf of members, over the increasing number of clinical notes
requested and their relevance. Whilst often citing back ACCs right to
gather information to determine claims eligibility as reason for notes
requests, ACC have agreed that the procedures associated with
purchase orders and payments do need looking into and clarifying
• We advise members.
o If a request for notes seems unnecessary or unreasonable suggest
phoning the CM direct can often determine why and what is
needed, and sometimes a phone discussion will negate need for
notes.
o Check purchase orders carefully to be clear exactly what has
been approved. Ie if COPY only there will be no time reimbursed
for retrieval or editing.
o Be aware there are different $ rates of reporting between
Medical Officer and Treatment Providers.
o Any therapist or clinics having ongoing difficulties with
individual or bulk notes requests should address with their
Regional Relationship manager
o Please keep ACC committee advised of any ongoing procedural
or unresolved problems.
3. WOUND CARE PRODUCTS;
• This question has been raised by a number of members
• Our current contract does not detail any specific reimbursement for
wound care/ dressings : although Healthwise have agreed in recent
documents that ,where a dressing is required to be changed “as part of
the splinting process,” materials can be charged under the splint
allowance. It is up to individual providers how they utilise this
provision, remaining accountable.
• To pursue the future inclusion of Dressings and Wound care products
specifically in our contract, we were advised in the past, when we first
raised with ACC, that we would have to show “competency” in this
area.
So this is the route that NZAHT is now pursuing: firstly with
Education Committee setting up Wound Care training
workshops, after which we can pursue recognition of competency
with HPCA. .
None of this will happen quickly but it is in process, in the
meantime we have to work with what has been stated above .
• If any provider needs clarification of what is included in our Contract
we suggest they contact the ACC committee in the first instance.
This brings us to seeking to clarify the best line of Enquiry/Help for members
regarding the ACC HTC.
4. LINE OF ENQUIRY /HELP RE.CONTRACT
We are conscious that sometimes matters that are raised with us at
teleconference by ACC, could have been dealt with more simply if enquiry
had come through us first. Often this reflects the fact that we have been
involved with our contract since its inception, and dealt with many members
enquiries since, whereas the personel at ACC Heathwise have already
changed a number of times, and dealing with more tha just our contract.
We are happy to field enquiries from members and answer where we can and
direct on through the right chanel if we can not help. This also helps us keep
abreast of members concerns, so that we can be more effective in our
subsequent meetings with ACC.
Thankyou on behalf of NZAHT ACC COMMITTEE
Julie Rouse
Sue Sewell
Lisa Hansen
Robyn Baldwin
John Forest
See next page for the ACC Relationship Managers Map
Case Studies Co-ordinator
Please see Case Study guidelines and cover sheet in assigned section of the web site
Rebecca Clay
[email protected]
P.O. Box 22,
Waipapa, 0470
Education Committee Report
Alice Cornforth
Alison Derbyshire
Edel Kelly
Rebecca Clay
Jackie Chiplin
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
Compilation of ideas for ongoing education:
BOOKS belonging to NZAHT:
Therapeutic hand splints. A rational approach vol 1. Van Lede & Van Veldhoven 1998
Towards better results after flexor tendon repair in the hand. Silverskold
Evaluation of sensibility and reeducation of sensation in the hand. Lee Dellon.
VIDEOS belonging to NZAHT:
J Colditz: splinting 1994
Judy Colditz: splinting workshop nov 91
Instructional course flexor tendon surgery
Paul Brand: biomechanics of hand movement
The stiff hand workshop: Colditz, Fess, Green, Hunter, Mackin
Soft tissue coverage of the upper extremity- surgical technique
An update of tendon transfers- surgery green, therapy Mackin
Therapists workshops- basic hand splinting
Colditz- radial nerve palsy therapy workshop
Websites recommended by our members:
www.liveconferences.com/default.asp
www.e-hand.com
www.handuniversity.com
www.handtherapy.com
www.ifsht.org/forum.php
http://anatomy.med.umich.edu/musculoskeletal system/hand
questions.html
CD ROM’s
Under the skin DVD
Hand Therapy Tutor
ASHT test prep CD ROM for CHT exam
Interactive Hand
Chartered Hand Therapists recommended reading:
(see next page)
Primary References
These books are organized by topic area and include those references the Examination Committee recommends for review. Particular emphasis should be placed on the general textbooks.
Anatomy
Atlas of Hand Anatomy and Clinical Implications
Yu, H. Chase, R. & Strauch, B
St Louis: Mosby - 2004
Netter's Orthopaedics
Green, W
Philadelphia: Elsevier - 2006
Biomechanics
Basic Biomechanics of the Musculoskeletal System (3rd Ed.)
Nordin, M. & Frankel, V.H. (Eds.)
Philadelphia: Lippencott Williams & Wilkins - 2001
Clinical Mechanics of the Hand (3rd Ed.)
Brand, P.W. & Hollister, A.
St. Louis: Mosby - 1999
Elbow
The Elbow and Its Disorders (3rd Ed.)
Morrey, B.F. (Ed.)
Philadelphia: W.B. Saunders Co. - 2000
Ethics
Principles of Biomedical Ethics (5th Edition)
Beauchamp, T.L. & Childress, J.F.
New York: Oxford University Press - 2001
Evaluation
Clinical Assessment Recommendations
American Society of Hand Therapists
Muscles: Testing and Function (4th Ed.)
Kendall, F., McCreary, E.K.
Philadelphia: Lippencott Williams & Wilkins - 1993
Musculoskeletal Assessment: Joint Range of Motion and Manual Muscle Strength (2nd Ed.)
Clarkson, H.
Philadelphia: Lippencott Williams & Wilkins - 2000
Orthopedic Physical Assessment (4th Ed.)
Magee, D.J.
St. Louis: W.B. Saunders Co. - 2002
General Textbooks on the Hand
Core Knowledge in Orthopaedics: Hand, Elbow, and Shoulder
Trumble, T. Budoff, J. & Roger, C.
Philadelphia: Elsevier - 2006
Operative Hand Surgery (5th Ed.)
Green, D.P., Hotchkiss, R.N., Pederson, W.P. (Eds.)
Philadelphia: Elsevier Churchill Livingstone - 2005
Principles of Hand Surgery and Therapy
Trumble, T. (Ed.)
Philadelphia: W.B. Saunders Co. - 2000
Rehabilitation of the Hand and Upper Extremity (5th ed.)
Mackin, E., Callahan, A.D., Skirven, T., Schneider, L.H., & Osterman, A.L. (Eds.)
St. Louis: Mosby - 2002
Pediatrics
Hand Function in the Child: Foundations for Remediation
Henderson, A. Pehoski, C
St Louis: Mosby - 2006
Physical Agents
Modalities for Therapeutic Intervention (4th Ed.)
Michlovitz, S.L., & Nolan, T.P.
Philadelphia: F. A. Davis Company - June 23, 2005
Physical Agents in Rehabilitation: From Research to Practice (2nd Ed.)
Cameron, M.H.
St. Louis: W.B. Saunders Co. - 2003
Research
Foundations of Clinical Research: Applications to Practice (2nd Ed.)
Portney, L.G. & Watkins, M.P.
Saddle River, NJ: Prentice Hall Health - 2000
Shoulder
Shoulder Reconstruction
Neer, C.A.
St. Louis: W.B. Saunders Co. - 1990
The Shoulder (3rd Ed.)
Rockwood, C. & Matsen, F.A. (Eds)
St. Louis: W.B. Saunders Co. - 2004
Splinting
Hand Splinting Principles and Methods (3rd Ed.)
Fess, E.F. and others
St. Louis: Mosby-Year Book,Inc. - 2004
Splinting the Hand & Upper Extremity: Principles and Process
Jacobs, M. & Austin, N.
Philadelphia: Lippencott Williams & Wilkins - 2002
Target Populations
Fitting the Task to the Human: A Textbook of Occupational Ergonomics (5th Ed)
Kroemer, K. & Grandjean, E.
New York: Taylor and Francis - 1997
Musculoskeletal Disorders in the Workplace: Principles & Practice
Nordin, M. & Andersson, G.B.J. (Eds.)
St. Louis: Mosby-Year Book, Inc. - 1997
Occupational Medicine Secrets
Bowler, R. M. & Cone, J.
Philadelphia: Hanley & Belfus - 1999
Treatment
Critical Pathways in Therapeutic Intervention: Upper Extremities
Saidoff, D. & McDonough, A.
St. Louis: Mosby-Year Book, Inc. - 1997
Diagnosis and Treatment Manual for Physicians & Therapists (4th Ed.)
Cannon, N.M. (Ed.)
Indianapolis: The Hand Rehabilitation Center - 2001
Hand and Upper Extremity Rehabilitation: A Practical Guide (3rd Ed.)
Clark, G.L. (Ed.)
Churchill Livingstone - 2005
Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd Ed.)
Travell, J.G. & Simons, D.G.
Philadelphia: Lippencott Williams & Wilkins - 1998
Therapeutic Exercise: Foundations and Techniques (4th Ed.)
Kisner, C. & Colby, L.
Philadelphia: F.A. Davis Company - 2002
Therapeutic Exercise: Moving Toward Function
Hall, C.M. & Bordy, L.T.
Philadelphia: Lippencott Williams & Wilkins - 1999
Wrist
The Wrist and It's Disorders (2nd Ed.)
Lichtman, D.M. (Ed.)
Philadelphia: W.B. Saunders Co. - 1997
Review Materials
These materials provide an overview of the Hand and hand therapy. Some have a question and answer format that may be useful in preparing to take an examination.
Anatomy
Ultimate Anatomy Flash Cards
Edwards, Bryan
Bryan Edwards Publishing; 1 Crds edition - October 2004
General
CHT Exam Book
American Society of Hand Therapists
Chicago: American Society of Hand Therapists - 2006
Hand Pearls
Concannon, M. & Hurov, J.
Philadelphia: Lippencott Williams & Wilkens - 2001
Hand Rehabilitation: A Quick Reference Guide and Review, 2nd Ed with CD
Falkenstein, N., Weiss, S.
St. Louis: Mosby-Year Book, Inc. - 2004
Hand Secrets (3rd Ed.)
Jebson, P.J.L. & Kasdan, M.L. (Eds.)
Philadelphia: Hanley & Belfus - 2006
Multi-Media
Acland's DVD Atlas of Human Anatomy: The Upper Extremity Disc 1
Acland, Robert
Lippincott, Williams & Wilkins - September 2003
The Hand: An Interactive Study for Therapists
American Occupational Therapy Association
Bethesda, MD - 2001
From The Office
Cheers Marlene Pouri-Lane
41 Boundary Rd
Hamilton
(07) 854 8949
[email protected]
Editors Desk
Some ideas for next edition:
Case study
Course / Conference feedback ie:
(surprise me with your creativity...and colour inspiration)
•
•
•
•
Standards for publishing in Fingerprints
Electronic documents may be emailed as an attachment or posted in a disk
Please do spell checking and formatting as you would prefer it to be published. I may
make some minor changes to fit within the publication template.
Acknowledgement of author must be stated
Please obtain Copy right clearance /Authors permission where appropriate..
[email protected]
(07) 855 4156
Post to 2 Coldwell Place, Fairfield, Hamilton
Complex Regional Pain Syndrome and vitamin C
Jane Bertschinger and Neil Challenger
CCDHB (Hutt)
CRPS is a complication frequently encountered by hand therapists following trauma or elective surgery. Intense debate continues regarding just about every aspect of this condition as
evidenced by the plethora of published research and the many review articles attempting to
make sense out of the morass of apparently conflicting research data and theories regarding
pathology and management.
Much of the debate regarding pathology in the last two decades has been on the relative involvement of different branches of the nervous system. The traditional role of the autonomic
nervous system has been challenged (Schott 1995) and both the peripheral and central nervous systems have been implicated in recent years (Van Den Laan etal 1998, Moseley 2004,
2006). Recent focus in much of the literature has been on the apparently key role of the central nervous system especially dysfunction in cortical representation of the periphery.
Another, perhaps lesser known approach to explaining some of the features of CRPS
emerged from the Netherlands in the 1990’s (Van Den Laan etal 1998). The thinking of this
body of opinion was that CRPS was essentially an exaggerated peripheral inflammatory response. This subsequently drove various researchers to look at the use of free radical scavengers (Perez etal 2003). The idea was to attempt to reduce free radical concentration and subsequent secondary cell damage and hence greatly amplified inflammatory response which
was postulated to result. Hence the basis of this approach was that it was implicitly a peripheral dysfunction.
This theory does not seem to have found widespread traction outside of the Netherlands,
perhaps as a result of the many clinical features, such as symptom spread (Maleki etal 2000),
which are better explained by a CNS origin. However it is conceivable that it may be possible to link the two theories if one thinks of an exaggerated inflammatory response being essentially as a result of lack of central inhibition or, in control engineering parlance, as a failure of adequate negative feedback into the control loop.
Perhaps as a result of the apparent intellectual isolation of the uncontrolled inflammatory
response theory to explaining CRPS, there is an interesting, and cheap, approach to CRPS
prevention which has remained largely ignored. A group of researchers studied the effect of
vitamin C, a well known, cheap and readily available free radical scavenger on prevention of
CRPS in patients immobilized following distal radius fracture. Both an initial pilot study
(Zollinger etal 1999) and a larger main study (Zollinger etal 2007) demonstrated a significant effect of vitamin C as will be discussed here.
We chose to review these studies as they place an interesting alternative to CRP’s. Although
this is a prophylaxis and not a form of treatment, and is also outside the traditional scope of
practice for hand therapy, it may be of some interest.
A summary of the study from Zollinger etal (1999) in which only Patients with a Radius
Fracture who had been treated conservatively were included. All patients were informed of
the study and provided consent to take part. Each patient took 1 capsule for 50 days from the
day of their injury. The capsule contained either 500 mg Vit C or a placebo. The trial was
double blind. The end point of the study was defined by the presence or absence of CRP’s at
1 year post injury. CRP’s was diagnosed by the presence of 4 symptoms through an area larger than the wrist. This was either increased pain, skin temperature or oedema, change in
skin colour or limited active ROM than expected at the stage of healing. At the point of
CRP’s diagnosis the study was terminated so treatment could begin. A total of 123 patients
were able to do the trial. Of these 8 were not included for a variety of reasons including operations. 115 people took part. 52 received Vit C and 63 received a Placebo. Results showed
that 4 (7%) of the fractures in the Vit C group developed CRP’s and 14 (22%) in the placebo
group developed CRP’s. The study continues to break down who had developed CRP’s
showing predictive patterns including fracture type and complaints in plaster. It also was
able to show that the administration of Vitamin C in patients with a wrist fracture was associated with a lower frequency of CRP’s.
A later study in by Zolliger, Tuinebreijer, Breederveld and Kreis (2007) set about assessing
dosage of Vit C to reduce CRP’s. In this double blind multicenter study 416 patients were
included. Both non operative and operative patients were included, and their fracture treatment continued irrespective of the study. They were randomly allocated treatment with placebo, or 200, 500 or 1500mg of vitamin C daily for fifty days. The results showed that 328
patients received vitamin C and 99 received the placebo. The prevalence of CRP’s was
2.4% (8 of 328) patients receiving vitamin C and 10.1% (10 of 99) in the placebo group. The
results were best amongst the 500mg and 1500mg group. So their conclusion is that Vitamin
C in a daily dose of 500mg for fifty days is recommended for reducing the prevalence of
CRP’s.
These studies however are not widely accepted. Why? Is it possibly because they do not
use the IASP definition of CRP’s (this definition was first published in 1995 and has since
undergone further modification. The first study was probably already well underway when
the definition was first published).
It is also interesting that the trials did not have many drop outs (only one noted in the first
study who did not take the capsule). This is unusual.
It also doesn’t clearly explain (particularly in the second trial) why so many people were excluded (2137 patients were eligible for the study, there is no explanation why 961 patients
were not invited to take part. Only 416 patients took part.). There is also no baseline of vitamin C measured in the patients at the start of the study.
So there are some flaws in these studies, but it is still worth listening to what is coming out
of the Netherlands with regards to treatment using Vitamin C, as in NZ this is easily accessible, cheap food supplement, which is generally believed to be relatively free of side effects
and complication.
References>
Maleki, J., LeBel, A.A., Bennett, G.J. & Schwartzman, R.J. (2000). Patterns of spread in
complex regional pain syndrome, type I (reflex sympathetic dystrophy). Pain, 88,
259-266.
Moseley, G.L. (2004). Graded motor imagery is effective for long-standing complex regional pain syndrome: a randomised controlled trial. Pain, 108, 192-198.
Moseley, G.L. (2006). Graded motor imagery for pathologic pain, a randomised controlled
trial. Neurology, 67, 2129-2134.
Perez, R.S.G.M., Zuurmond, W.W.A., Bezemer, P.D.,Kuik, D.J., van Loenan, A.C., de
Lange, J.J & Zuidhof, A.J. (2003). The treatment of complex regional pain syndrome
type I with free radical scavengers: a randomised controlled study. Pain, 102, 297307.
Schott, G.D. (1995). An unsympathetic view of pain. The Lancet, 345, 634-636.
Van der Laan, L. & Goris, R.J.A. (1997) Reflex sympathetic dystrophy – an exaggerated
regional inflammatory response? Hand Clinics, 13, 373-385.
Van der Laan, L., ter Laak, H.J., Gabreels-Festen, A. & Goris, R.J.A. (1998). Complex regional pain syndrome type I (RSD): Pathology of skeletal muscle and peripheral
nerve. Neurology, 51, 20-25.
Zollinger, P.E., Tuinebreijer, W.E., Kreis, R.W. & Breederveld, R.S. (1999) Effect of vitamin C on frequency of reflex sympathetic dystrophy in wrist fractures: a randomised
trial. The Lancet, 354, 2025-2028.
Zollinger, P.E., Tuinebreijer, W.E., Kreis, R.W. & Breederveld, R.S. (2007) Can vitamin C
prevent complex regional pain syndrome in patients with wrist fractures: a randomised trial, controlled, multicenter dose-response study. The Journal of bone and joint
surgery (American), 89, 1424-1431.
Crossword
Attached (next page), is a crossword on MEM. All of the answers are in the conference
booklet. I hope that it stimulates some reading and that it is about the right level - not too
hard or too easy.
Please give us feedback on whether you want any more, harder/easier, etc.
The solution will be in the following Fingerprints!
Cheers
Caroline Durney