Certified Hand Therapist (CHT) Practice Exam

What is the first step in the collagenase injection protocol for Dupuytren's?

1. Immediate passive extension of the finger

2. Patient returns 24 hours later for extension procedure

3. Application of a splint for 5 days

4. Scheduled follow-up in one week

The correct answer is: Patient returns 24 hours later for extension procedure

The first step in the collagenase injection protocol for Dupuytren's contracture involves having the patient return 24 hours later for the extension procedure. This timing is critical because the collagenase enzyme needs time to work effectively on the contracted tissue before any passive extension is attempted. After the injection, the enzyme begins to break down the collagen in the cords causing the contracture. A waiting period ensures that the collagenase has sufficient time to facilitate tissue softening and breakdown, leading to more effective outcomes when the finger is subsequently extended. Immediate passive extension of the finger is not advisable right after the injection, as the connective tissue has not yet been sufficiently altered to reduce resistance. Similarly, application of a splint for several days is not appropriate immediately following injection without the proper extension procedure that comes afterward. Scheduled follow-up in one week typically occurs after the initial extension procedure, rather than being an immediate step in the protocol. Thus, returning the patient 24 hours post-injection for the extension procedure aligns with the intended timeline and method for achieving optimal results from collagenase treatment in Dupuytren's contracture management.