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Posterior Night Splint

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41. Heel Pain - Plantar Fasciitis

to the gastrocnemius and plantar fascia for short-term (1 week) pain reduction. INTERVENTIONS – FOOT ORTHOSES Clinicians should use foot orthoses, either prefabricated or custom fabricated/fitted, to support the medial longitudinal arch and cushion the heel in individuals with heel pain/ plantar fasci- itis to reduce pain and improve function for short- (2 weeks) to long- term (1 year) periods, especially in those individuals who respond positively to antipronation taping techniques. INTERVENTIONS – NIGHT SPLINTS (...) Clinicians should prescribe a 1- to 3-month program of night splints for individuals with heel pain/ plantar fasciitis who consistently have pain with the first step in the morning. Summary of Recommendations* B B C A F B A A A A A 44-11 Guidelines.indd 2 10/20/2014 7:10:39 PM Journal of Orthopaedic & Sports Physical Therapy® Downloaded from www.jospt.org at on December 26, 2014. For personal use only. No other uses without permission. Copyright © 2014 Journal of Orthopaedic & Sports Physical Therapy®

2014 The Orthopaedic Section of the American Physical Therapy Association (APTA), Inc.

43. Radial Nerve Entrapment: Diagnosis and Treatment

: radial tunnel syndrome (RTS) or posterior interosseous nerve syndrome (PINS) 1,2 . Although RNE may occur from compression at any point along the course of the radial nerve due to acute trauma (e.g. humerus fracture, Saturday night palsy), space- occupying lesion (e.g. lipoma, ganglion), local edema or inflammation, this guideline focuses on RTS and PINS, which are more typical for RNE arising from repetitive work activities. RTS and PINS have been described to occur at one of five potential sites (...) . Returning to Work following Surgery VII. ELECTRODIAGNOSTIC WORKSHEET References *This guideline does not apply to severe or acute traumatic injury to the upper extremities. 2 I. Review Criteria *Work-Related Radial Nerve Entrapment: radial tunnel syndrome (RTS) or posterior interosseous nerve syndrome (PINS) Review Criteria for the Diagnosis and Treatment of Work-Related Radial Nerve Entrapment (RNE*) CLINICAL FINDINGS CONSERVATIVE TREATMENT SURGICAL TREATMENT SUBJECTIVE (Symptoms) OBJECTIVE (Signs

2010 Washington State Department of Labor and Industries

44. The Approach to the Painful Joint (Diagnosis)

of the provocative occupational or athletic activity, shoe modification, a heel lift to reduce tendon stretching during walking, and NSAID therapy. Physical therapy includes local heat application, gentle stretching exercises, and a temporary splint with slight plantar flexion. Retrocalcaneal bursitis (see ) is inflammation of the retrocalcaneal bursa, resulting in pain and tenderness at the back of the heel. The area anterior to the Achilles tendon and posterior to the calcaneus is tender; passive dorsiflexion (...) , spine, or knees may also have pain at rest and at night. Pain that arises from small peripheral joints tends to be more accurately localized than pain arising from larger proximal joints. For example, pain arising from the hip joint may be felt in the groin or buttocks, in the anterior portion of the thigh, or in the knee. Stiffness is a perceived sensation of tightness when attempts are made to move joints after a period of inactivity. It typically subsides over time. Its duration may serve

2014 eMedicine.com

45. Ulnar Neuropathy (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.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. Neuropathy of Leprosy (Diagnosis)

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

48. Leprosy (Diagnosis)

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 and distribution of sensory (...) 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

49. Middle Cerebral Artery Stroke (Diagnosis)

by cerebrovascular accident. The MCA supplies most of the outer convex brain surface, nearly all the basal ganglia, and the posterior and anterior internal capsules. Infarcts that occur within the vast distribution of this vessel lead to diverse neurologic sequelae. Understanding these neurologic deficits and their correlation to specific MCA territories has long been researched. Research has also focused on the correlation between specific neurologic deficits after and differing outcomes and prognoses (...) spasticity. Bracing, especially at night, allows continuous passive range to tight, spastic muscle. This includes serial casting, which allows gradual increase in range over weeks. [ ] Oral medications also are often used for spasticity management, including tizanidine, baclofen, dantrolene, and benzodiazepines. . The functional benefit of these drugs is not well demonstrated despite their common use. These medications often have at least some sedating effect on patients, which should be weighed

2014 eMedicine.com

50. Rehabilitation Management of Neuromuscular Disease (Diagnosis)

is hypoventilation, which leads to hypercapnia (elevated carbon dioxide levels in the blood). End-tidal carbon dioxide levels or arterial blood gases should be periodically measured, depending on the clinical circumstances. Pulse oximetry, which measures only oxygen saturation levels, may be inadequate. Performing a thorough review of systems is important. Patients who are hypoventilating become hypercapnic at night and experience a morning headache as a result. They may also have nocturnal restlessness (...) , mainly at night, may initially avoid the need for tracheostomy and maintain a reasonable quality of life (QOL). However, bulbar palsy may occur in ALS and in some rare forms of SMA. In such cases, if better airway access becomes necessary and an informed patient wishes more aggressive care, a tracheostomy may be performed. However, an alternative procedure, laryngeal diversion (or laryngotracheal separation), has several distinct advantages over tracheostomy. In laryngeal diversion, the trachea

2014 eMedicine.com

51. Obstructive Sleep Apnea-Hypopnea Syndrome (Diagnosis)

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

52. Obstructive Sleep Apnea (Diagnosis)

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

53. 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

54. 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

55. 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

56. Middle Cerebral Artery Stroke (Overview)

by cerebrovascular accident. The MCA supplies most of the outer convex brain surface, nearly all the basal ganglia, and the posterior and anterior internal capsules. Infarcts that occur within the vast distribution of this vessel lead to diverse neurologic sequelae. Understanding these neurologic deficits and their correlation to specific MCA territories has long been researched. Research has also focused on the correlation between specific neurologic deficits after and differing outcomes and prognoses (...) spasticity. Bracing, especially at night, allows continuous passive range to tight, spastic muscle. This includes serial casting, which allows gradual increase in range over weeks. [ ] Oral medications also are often used for spasticity management, including tizanidine, baclofen, dantrolene, and benzodiazepines. . The functional benefit of these drugs is not well demonstrated despite their common use. These medications often have at least some sedating effect on patients, which should be weighed

2014 eMedicine.com

57. Leprosy (Overview)

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 and distribution of sensory (...) 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

58. Stress Fracture (Overview)

, MHA; Marshfield Clinic Department of Radiology. This image is of an 18-year-old female soccer player with a 3-week history of left leg pain, which was worse at night and with activity. Upon examination, she reported tenderness in response to palpation over the midtibia. Bilateral pes planus was noted. Plain film radiography failed to demonstrate a fracture. Bone scanning revealed a focal area of delayed uptake on the posterior medial aspect of the proximal third of the left tibia, confirming (...) uptake in the posterior elements of L5. Courtesy of Michael Spieth, MD, and Nandita Bhattacharjee, MD, MHA; Marshfield Clinic Department of Radiology. Same patient as in the above 2 images. Subsequent MRI revealed an area of bright signal in the left pars interarticularis of L5 on T2-weighted images, confirming the diagnosis of acute unilateral spondylolysis. The patient was treated successfully with activity restriction and bracing with a lumbar corset for 3 months, at which point he

2014 eMedicine.com

60. Geriatric Rehabilitation (Treatment)

, 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 the visual impairments described above (...) 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 of accidental death, and more

2014 eMedicine.com

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