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Posterior Night Splint

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41. Neuropathy of Leprosy (Overview)

around the neck of the fibula Superficial peroneal nerves in front of the ankles Posterior tibial nerves immediately below the internal malleoli Sural nerves In TT disease, thickening is usually confined to 1 nerve. In lepromatous (LL) disease, the increase in nerve size is symmetrical; however, the degree of nerve thickening may differ between the 2 sides. The enlargement often may be segmental rather than diffuse and uniform. Disparity may be noted between specific areas of thickened nerves (...) after clinical cure and release from treatment. Local treatment measures include the following: Appropriate splints (eg, for wrist drop or foot drop) Exercises Prevention of corneal exposure when the facial nerve is involved Prevention of injuries to anesthetic areas Prevention and protection of plantar ulcers through the wearing of special controlled-rigidity footwear for redistributing pressure Rest, splints, and physiotherapeutic measures may be appropriate. Thalidomide is not useful for reversal

2014 eMedicine.com

42. Obstructive Sleep Apnea-Hypopnea Syndrome (Overview)

and end with a snort Gasping and choking sensations that arouse the patient from sleep, though in a very low proportion relative to the number of apneas they experience Nocturia Insomnia; restless sleep, with patients often experiencing frequent arousals and tossing or turning during the night Daytime symptoms may include the following: Nonrestorative sleep (ie, “waking up as tired as when they went to bed”) Morning headache, dry or sore throat Excessive daytime sleepiness that usually begins during (...) collapse during sleep include the following: Innate anatomic variations (facial elongation, posterior facial compression) Retrognathia and micrognathia Mandibular hypoplasia Brachycephalic head form - Associated with an increased AHI in whites but not in African Americans. [ ] Inferior displacement of the hyoid Adenotonsillar hypertrophy, particularly in children and young adults High, arched palate (particularly in women) Structural factors related to nasal obstruction that predispose patients

2014 eMedicine.com

43. Obstructive Sleep Apnea-Hypopnea Syndrome (Overview)

and end with a snort Gasping and choking sensations that arouse the patient from sleep, though in a very low proportion relative to the number of apneas they experience Nocturia Insomnia; restless sleep, with patients often experiencing frequent arousals and tossing or turning during the night Daytime symptoms may include the following: Nonrestorative sleep (ie, “waking up as tired as when they went to bed”) Morning headache, dry or sore throat Excessive daytime sleepiness that usually begins during (...) collapse during sleep include the following: Innate anatomic variations (facial elongation, posterior facial compression) Retrognathia and micrognathia Mandibular hypoplasia Brachycephalic head form - Associated with an increased AHI in whites but not in African Americans. [ ] Inferior displacement of the hyoid Adenotonsillar hypertrophy, particularly in children and young adults High, arched palate (particularly in women) Structural factors related to nasal obstruction that predispose patients

2014 eMedicine.com

44. Obstructive Sleep Apnea (Overview)

and end with a snort Gasping and choking sensations that arouse the patient from sleep, though in a very low proportion relative to the number of apneas they experience Nocturia Insomnia; restless sleep, with patients often experiencing frequent arousals and tossing or turning during the night Daytime symptoms may include the following: Nonrestorative sleep (ie, “waking up as tired as when they went to bed”) Morning headache, dry or sore throat Excessive daytime sleepiness that usually begins during (...) collapse during sleep include the following: Innate anatomic variations (facial elongation, posterior facial compression) Retrognathia and micrognathia Mandibular hypoplasia Brachycephalic head form - Associated with an increased AHI in whites but not in African Americans. [ ] Inferior displacement of the hyoid Adenotonsillar hypertrophy, particularly in children and young adults High, arched palate (particularly in women) Structural factors related to nasal obstruction that predispose patients

2014 eMedicine.com

45. Assistive Devices to Improve Independence (Follow-up)

; and diabetic retinopathy (eg, microaneurysms, dot hemorrhages), which can be managed with glycemic control or laser surgery. The result of these various changes is a loss of visual acuity, decrease in peripheral vision, and a decline in dark adaptation ability. These visual impairments are related to a higher incidence of falls in the geriatric population, especially at night. Correction and management of visual impairment In the majority of the geriatric population, eyeglasses are sufficient to correct (...) thick carpet, repairing unstable furniture, and installing good lighting. A well-lit pathway to the bathroom that is clear of clutter must be emphasized. Large touch-lights or automatic sensory lights, which do not require dexterity, can be placed at the patient's bedside or in other areas to help decrease the risk of falls, especially at night. Motion-detector lights are helpful in providing illumination (eg, to the bathroom) at night. Falls in the shower and bathtub are the third leading cause

2014 eMedicine.com

46. Ulnar Neuropathy (Diagnosis)

Author: Charles F Guardia, III, MD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE Share Email Print Feedback Close Sections Sections Ulnar Neuropathy Overview Background The ulnar nerve is an extension of the medial cord of the brachial plexus. It is a mixed nerve that supplies innervation to muscles in the forearm and hand and provides sensation over the medial half of the fourth digit and the entire fifth digit (the ulnar aspect of the palm) and the ulnar portion of the posterior aspect of the hand (...) to be satisfactory. Next: Anatomy Course of ulnar nerve The ulnar nerve is the terminal branch of the medial cord of the brachial plexus and contains fibers from C8, T1, and, occasionally, C7. [ , ] It enters the arm with the axillary artery and passes posterior and medial to the brachial artery, traveling between the brachial artery and the brachial vein. At the level of the insertion of the coracobrachialis in the middle third of the arm, the ulnar nerve pierces the medial intermuscular septum to enter

2014 eMedicine.com

47. Plantar Fasciitis (Follow-up)

, NSAID therapy, strapping and taping, and over-the-counter (OTC) orthoses. Counseling as to activity modification, as well as choice of shoe gear, is important. After 6 weeks, recalcitrant cases should be treated additionally with a night splint and, possibly, an injection, along with the initial regimen for another 6 weeks. If pain persists, referral to a foot and ankle specialist should be considered. Injection therapy, immobilization in a cast or walker boot, physical therapy, and custom orthotics (...) in patients with chronic plantar fasciitis that does not respond to conservative management. IPST may be considered before surgery when ESWT devices are not available. A randomized, double-blind, prospective clinical pilot study showed that IPST is safe and effective; however, the exact mechanism is unknown and thus warrants further research. [ ] Previous Next: Splints and Orthoses Night splints Most people naturally sleep with their feet in a plantar-flexed position, which causes the plantar fascia

2014 eMedicine Surgery

48. Cubital Tunnel Syndrome (Diagnosis)

, 2018 Author: Charles F Guardia, III, MD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE Share Email Print Feedback Close Sections Sections Ulnar Neuropathy Overview Background The ulnar nerve is an extension of the medial cord of the brachial plexus. It is a mixed nerve that supplies innervation to muscles in the forearm and hand and provides sensation over the medial half of the fourth digit and the entire fifth digit (the ulnar aspect of the palm) and the ulnar portion of the posterior aspect (...) appear to be satisfactory. Next: Anatomy Course of ulnar nerve The ulnar nerve is the terminal branch of the medial cord of the brachial plexus and contains fibers from C8, T1, and, occasionally, C7. [ , ] It enters the arm with the axillary artery and passes posterior and medial to the brachial artery, traveling between the brachial artery and the brachial vein. At the level of the insertion of the coracobrachialis in the middle third of the arm, the ulnar nerve pierces the medial intermuscular

2014 eMedicine Surgery

49. Snoring and Obstructive Sleep Apnea, Physiologic Approach

effort could stimulate arousal. The clinical relevance of RERA is not as well documented as the apnea-hypopnea index (AHI), but RERA is assumed to impact daytime somnolence. When patients are noted to have several RERAs but have a clinically insignificant AHI, they are often thought to have UARS. Patients with UARS often present with daytime somnolence and snoring. These patients may display anthropomorphic abnormalities and decreased posterior airspace with retrodisplacement of the tongue. Airflow (...) desaturation or the number of arousals throughout the night. Both of these could be indices for daytime symptoms and pathogenic sequelae of the disorder. Obstructive sleep apnea syndrome Obstructive sleep apnea syndrome (OSAS) is defined as a chronic respiratory sleep disorder typified by recurrent episodes of partial or complete upper airway obstruction during sleep that cause cessation of airflow in the presence of respiratory effort. These episodes cause repeated arousals and fragmented sleep

2014 eMedicine Surgery

50. Ulnar Neuropathy (Overview)

: Charles F Guardia, III, MD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE Share Email Print Feedback Close Sections Sections Ulnar Neuropathy Overview Background The ulnar nerve is an extension of the medial cord of the brachial plexus. It is a mixed nerve that supplies innervation to muscles in the forearm and hand and provides sensation over the medial half of the fourth digit and the entire fifth digit (the ulnar aspect of the palm) and the ulnar portion of the posterior aspect of the hand (dorsal (...) to be satisfactory. Next: Anatomy Course of ulnar nerve The ulnar nerve is the terminal branch of the medial cord of the brachial plexus and contains fibers from C8, T1, and, occasionally, C7. [ , ] It enters the arm with the axillary artery and passes posterior and medial to the brachial artery, traveling between the brachial artery and the brachial vein. At the level of the insertion of the coracobrachialis in the middle third of the arm, the ulnar nerve pierces the medial intermuscular septum to enter

2014 eMedicine.com

52. Assistive Devices to Improve Independence (Overview)

; and diabetic retinopathy (eg, microaneurysms, dot hemorrhages), which can be managed with glycemic control or laser surgery. The result of these various changes is a loss of visual acuity, decrease in peripheral vision, and a decline in dark adaptation ability. These visual impairments are related to a higher incidence of falls in the geriatric population, especially at night. Correction and management of visual impairment In the majority of the geriatric population, eyeglasses are sufficient to correct (...) thick carpet, repairing unstable furniture, and installing good lighting. A well-lit pathway to the bathroom that is clear of clutter must be emphasized. Large touch-lights or automatic sensory lights, which do not require dexterity, can be placed at the patient's bedside or in other areas to help decrease the risk of falls, especially at night. Motion-detector lights are helpful in providing illumination (eg, to the bathroom) at night. Falls in the shower and bathtub are the third leading cause

2014 eMedicine.com

53. Tendon Transfers (Overview)

is performed in an end-to-side manner so that if reinnervation occurs, the continuity of the reinnervated ECRB is not lost. Low-profile dynamic splints can be worn during the day, with night splints maintaining the digits and wrist in extension. [ ] All joints must maintain full passive range of motion, including the first web space. During World War I, Sir Robert Jones developed a set of tendon transfers for radial nerve paralysis, which formed the basis for reconstructive tendon transfer surgery (...) , tenodesis, capsulodesis, and pulley release Protect the tendon transfer postoperatively, with no tension on the transfer; for example, if a tendon passes volarly, the wrist is splinted in palmar flexion The first three steps in the above list are also referred to as the three-column theory or principle for tendon transfers. Drawing out these steps in three columns facilitates the decision-making process. Previous Next: Radial Nerve Paralysis Tendon transfers for radial nerve paralysis have the best

2014 eMedicine Surgery

54. Swan-Neck Deformity (Overview)

after the procedure, the patient is fitted for a dynamic outrigger splint that maintains extension in an appropriate anatomic position of the fingers while the patient undergoes active flexion exercises. Night splints are manufactured to maintain the fingers in extension. Splinting is required for the next 4-8 weeks. Follow-up radiographs are obtained to confirm the appropriate positioning of the implants. Crossed intrinsic transfer of the extensor tendons from the ulnar side to the radial side (...) this problem should be considered. First, MP joint dislocation produces a fixed deformity with a flexed and ulnarly deviated finger. Second, volar and ulnar subluxation of the extensor tendons into the gutters between the phalanges limits extensor function as the extensors essentially become flexors in this position. In this condition, the patient can sometimes maintain MP extension actively after the finger is passively extended. Finally, paralysis due to posterior interosseous nerve compression can also

2014 eMedicine Surgery

55. Ulnar-Sided Wrist Pain (Overview)

by an average of 11°. The distal radius has a biconcave articular surface with two articular facets that are separated by an anterior and a posterior ridge. The lateral scaphoid facet is triangular, whereas the medial lunate facet is quadrilateral. The ulnar aspect of the radius has a concavity: the sigmoid notch, which articulates with the convex semicircular head of the distal ulna. The distal radioulnar joint (DRUJ) is the articulation of the distal radius and ulnar head. [ ] When the DRUJ is considered (...) palpable over the ECU sheath. An injection of lidocaine and cortisone into the sheath can be both diagnostic and therapeutic. As with subluxation, MRI can be used to confirm the diagnosis. Conservative treatment includes activity modification, ice, splinting, steroid injections, and nonsteroidal anti-inflammatory drugs (NSAIDs). Surgical release is often necessary with progressive fibrosis of the sixth compartment. With partial rupture or , the ECU may be tender, red, and tense. A radiograph

2014 eMedicine Surgery

56. Ulnar Nerve Entrapment (Overview)

Author: Charles F Guardia, III, MD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE Share Email Print Feedback Close Sections Sections Ulnar Neuropathy Overview Background The ulnar nerve is an extension of the medial cord of the brachial plexus. It is a mixed nerve that supplies innervation to muscles in the forearm and hand and provides sensation over the medial half of the fourth digit and the entire fifth digit (the ulnar aspect of the palm) and the ulnar portion of the posterior aspect of the hand (...) to be satisfactory. Next: Anatomy Course of ulnar nerve The ulnar nerve is the terminal branch of the medial cord of the brachial plexus and contains fibers from C8, T1, and, occasionally, C7. [ , ] It enters the arm with the axillary artery and passes posterior and medial to the brachial artery, traveling between the brachial artery and the brachial vein. At the level of the insertion of the coracobrachialis in the middle third of the arm, the ulnar nerve pierces the medial intermuscular septum to enter

2014 eMedicine Surgery

57. Ulnar-Sided Wrist Pain (Diagnosis)

by an average of 11°. The distal radius has a biconcave articular surface with two articular facets that are separated by an anterior and a posterior ridge. The lateral scaphoid facet is triangular, whereas the medial lunate facet is quadrilateral. The ulnar aspect of the radius has a concavity: the sigmoid notch, which articulates with the convex semicircular head of the distal ulna. The distal radioulnar joint (DRUJ) is the articulation of the distal radius and ulnar head. [ ] When the DRUJ is considered (...) palpable over the ECU sheath. An injection of lidocaine and cortisone into the sheath can be both diagnostic and therapeutic. As with subluxation, MRI can be used to confirm the diagnosis. Conservative treatment includes activity modification, ice, splinting, steroid injections, and nonsteroidal anti-inflammatory drugs (NSAIDs). Surgical release is often necessary with progressive fibrosis of the sixth compartment. With partial rupture or , the ECU may be tender, red, and tense. A radiograph

2014 eMedicine Surgery

58. Plantar Heel Pain (Diagnosis)

. J Bone Joint Surg Am . 2010 Nov 3. 92 (15):2514-22. . Berlet GC, Anderson RB, Davis H, Kiebzak GM. A prospective trial of night splinting in the treatment of recalcitrant plantar fasciitis: the Ankle Dorsiflexion Dynasplint. Orthopedics . 2002 Nov. 25 (11):1273-5. . Attard J, Singh D. A comparison of two night ankle-foot orthoses used in the treatment of inferior heel pain: a preliminary investigation. Foot Ankle Surg . 2012 Jun. 18 (2):108-10. . Tisdel CL, Harper MC. Chronic plantar heel pain (...) Soft heel cushion to absorb shock. Soft heel cushion and a cup. Custom-molded orthotic. Stretching exercise. Lean against the wall with the knee kept straight and the heel touching the floor. Stretching the back of the leg at the edge of a stair. Massaging and stretching the plantar fascia using a can. A night splint applied on back of the leg and foot. A night splint applied on the front of the leg. Lateral radiograph of the hindfoot showing a cyst in the anterior aspect of the calcaneus in a 19

2014 eMedicine Surgery

59. Plantar Fasciitis (Diagnosis)

effort to maintain a heel-cord stretching program or to wear a night splint. They should also be taught proper performance of a home exercise program involving stretching the plantar fascia. The following recommendations are appropriate: Wear shoes with adequate arch support and cushioned heels; discard old running shoes and wear new ones; rotate work shoes daily Avoid long periods of standing Lose weight Stretch the plantar fascia and warm up the lower extremity before participating in exercise (...) Podiatr Med Assoc . 2001 Feb. 91(2):55-62. . Batt ME, Tanji JL, Skattum N. Plantar fasciitis: a prospective randomized clinical trial of the tension night splint. Clin J Sport Med . 1996 Jul. 6(3):158-62. . Wapner KL, Sharkey PF. The use of night splints for treatment of recalcitrant plantar fasciitis. Foot Ankle . 1991 Dec. 12(3):135-7. . Powell M, Post WR, Keener J, Wearden S. Effective treatment of chronic plantar fasciitis with dorsiflexion night splints: a crossover prospective randomized outcome

2014 eMedicine Surgery

60. Cubital Tunnel Syndrome (Follow-up)

symptoms. The ulnar nerve should be protected from prolonged elbow flexion during sleep and protected during the day through avoidance of direct pressure or trauma. For initial conservative treatment of cubital tunnel syndrome, use of an elbow pad or night splinting for a 3-month trial period is recommended. [ , ] If symptoms do not improve with splinting, daytime immobilization for 3 weeks should be considered. Surgical release may be warranted if the symptoms do not improve with conservative (...) option is to apply a commercial soft elbow splint, with a thermoplastic insert, for persistent symptoms. For constant pain and paresthesia, one should consider using a rigid thermoplastic splint positioned in 45° of flexion to decrease pressure on the ulnar nerve. Initially, patients should wear this splint at all times; as symptoms subside, they can wear it only at night. Patient education and insight are important. Resting on elbows at work, using elbows to lift the body from bed, and resting

2014 eMedicine Surgery

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