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Medical Knowledge

Anatomy/Physiology/Embryology

The resident will achieve a detailed knowledge of the anatomy, physiology, and embryology of the upper extremity and will utilize this knowledge in the complete management of the hand, arm, and brachial plexus.

Objectives

  1. Describe in detail the anatomy and physiology of the muscles, tendons, ligaments, and bones of the hand and upper extremity.
  2. Identify in detail the anatomy of the vascular tree of the upper extremity, including relationships to the surrounding structures.
  3. Identify in detail the anatomy of the major nerves and their branchings in the upper extremity, including relationships to surrounding structures.
  4. Draw the anatomy of the brachial plexus.
  5. Demonstrate the detailed radiographic anatomy of the bony structures of the upper extremity.
  6. Utilize the radiologic techniques, including plain films, CT scan, angiography and MRI of the upper extremities.
  7. Discriminate the principles of electrical evaluation and recite knowledge of the techniques of electrical examination of the upper extremities, including conduction studies and EMG evaluation.
  8. Recite the principles of upper extremity biomechanics.

Congenital Disorders

The resident will achieve familiarity with the spectrum of congenital abnormalities of the upper extremity and perform comprehensive diagnostic evaluation and surgical management of such problems.

Objectives

  1. Recite the classification system for congenital hand anomalies including:

    a. Failure of part formation
    b. Failure of differentiation
    c. Duplication
    d. Overgrowth
    e. Undergrowth
    f. Congenital bands

  2. Generalized musculoskeletal anomalies
  3. Describe the embryologic development and the physiologic theories which explain the etiology of hand anomalies
  4. Recite the operations, including timing and techniques used in the surgical management of hand anomalies

Benign and Malignant Tumors

The resident will understand the principles of diagnosis and treatment of extremity tumors and undertake comprehensive management of a wide variety of such lesions.

Objectives

  1. Describes the principles and techniques of management of upper extremity tumors.
  2. Describe the etiologic factors, epidemiology, and modalities of treatment for tumors of the upper extremities.
  3. Describe the clinical manifestations of both soft and hard tissue tumors of the upper extremities.
  4. Describe the reconstructive principles and techniques for restoration of form and function after surgical resections.
  5. Recite the indications and use of adjunctive therapy (i.e. radiation therapy and chemotherapy) in the management of and the prognosis for upper extremity tumors.
  6. Describe the principles and techniques of management for upper extremity tumors, including reconstruction after surgical extirpation, for:

    a. Vascular tumors
    b. Nerve tumors
    c. Benign deep soft tissue tumors
    d. Malignant deep soft tissue tumors
    e. Primary bone tumors

  7. Rationalize the utilization of radiotherapy, medical oncology, hand therapy, occupational therapy, and prosthetics where appropriate for patients with upper extremity tumors.

Trauma

The resident will understand the principles of diagnosis and treatment of extremity trauma and perform comprehensive management of acute injuries and other trauma-related problems of the hand and arm.

Objectives:

  1. Recite the principles and applications of diagnostic techniques for the evaluation of hand and upper extremity trauma.
  2. Describe the techniques for operative management of traumatic injuries of the upper extremity, their indications and contraindications, and their possible complications and the treatment thereof.
  3. Explain the indications for, contraindications to, and techniques in nonoperative management of traumatic injuries of the hand and upper extremity.
  4. Describe the options for soft tissue coverage of upper extremities including:

    a. Skin grafts
    b. Local flaps
    c. Free tissue transfer

V. Functional Problems of the Upper Extremities

The resident will achieve familiarity with aesthetic and functional problems of the hand and arm, understand the principles of rehabilitation of the upper extremity and the management, including comprehensive rehabilitation of the upper extremity.

Objectives:

  1. List the surgical and nonsurgical treatment of nerve compression and entrapment syndromes of the upper extremity.
  2. Draw the pathologic anatomy and physiology of upper extremity contractures and Dupuytren's disease.
  3. Recite the basic pathophysiology of rheumatoid and nonspecific arthritis of the upper extremity.
  4. Describe the pharmacological therapy of rheumatoid arthritis.
  5. Demonstrate the surgical treatment of rheumatoid arthritis, timing of therapeutic treatment and interactions with medical therapy.
  6. Describe the common circulatory disorders of the upper extremity including, but not limited to:

    a. Arterial thromboses
    b. Aneurysms
    c. Embolic disorders
    d. Arteriovenous fistulae
    e. Vasospastic disease
    f. Scleroderma

  7. Describe the diagnosis and treatment of common pain syndromes including sympathetic dystrophy.
  8. Recite the management of upper extremity lymphedema.

Reconstruction

The resident will understand the principles and techniques of upper extremity reconstruction and apply these to a variety of developmental, traumatic, and acquired problems.

Objectives:

  1. Recite the diagnostic techniques for evaluation of function, including EMG and conduction studies, arteriography, CT scan, and MRI evaluation.
  2. Recite the use of tendon transfers.
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