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182 results for

Posterior Night Splint

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101. Swan-Neck Deformity (Diagnosis)

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

102. Stress Fracture (Follow-up)

, and Nandita Bhattacharjee, MD, MHA; Marshfield Clinic Department of Radiology. A 17-year-old female dancer with a 2-week history of left shin pain. Plain film imaging was unremarkable. Three-phase bone scanning demonstrated an area of linear uptake in the posterior medial aspect of the left tibia on blood pool images, but delayed images were considered normal. This scintigraphic pattern is consistent with medial tibial stress syndrome (shin splints), but not with stress fracture. Courtesy of Michael (...) 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 the diagnosis of stress fracture. Courtesy of Michael Spieth, MD, and Nandita Bhattacharjee, MD, MHA; Marshfield Clinic Department of Radiology. A 63-year-old man

2014 eMedicine.com

103. The Approach to the Painful Joint (Follow-up)

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

104. Geriatric Rehabilitation (Follow-up)

, 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

106. 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

107. Stress Fracture (Diagnosis)

, 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

108. Plantar Fasciitis (Treatment)

, 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 Emergency Medicine

109. Mandibular Condylar and Subcondylar Fractures

a mandibular malunion has occurred, mandibular motion, in some cases, cannot be reestablished without surgical intervention. Patients with no Dentition Patients who are edentulous entail special consideration. Certainly, preexisting dentures or gunning splints may be wired in and adapted for interarch elastics. In most cases, however, an equally good outcome can be obtained with careful physical therapy that trains patients to open to a normal distance without deviation. Some patients require preexisting (...) that the second criterion is lateral extracapsular displacement and not just mild lateral displacement. The relative indications listed by Kent and Zide are as follows: Bilateral subcondylar fractures in a patient who has no dentition and where a splint is unavailable or when splinting is impossible because of alveolar ridge atrophy Bilateral or unilateral subcondylar fractures when splinting is not recommended for medical reasons or where adequate physiotherapy is impossible Bilateral condylar fractures

2014 eMedicine Surgery

111. Assistive Devices to Improve Independence (Diagnosis)

; 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

112. Geriatric Rehabilitation (Diagnosis)

, 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

113. Plantar Fasciitis (Diagnosis)

. [ ] Commonly prescribed silicone inserts are effective in reducing pain and increasing functions in the short term. Both affordable and readily available, popular recommendation includes first-line treatment with silicone orthotics for patients with plantar fasciitis. [ ] Combined use of foot orthoses and night splits may provide better outcomes than either modality alone. [ ] Dorsiflexing both the ankle and metatarsophalangeal joints can reduce the tension of the posterior calf along with the plantar (...) fascia, thereby reducing pain. These modalities can be applied both during the day, while being active, and at night, increasing the chance of pain reduction. [ ] While evidence has been somewhat inconsistent regarding the effectiveness of night splints and orthoses used separately for reducing pain caused by plantar fasciitis, recent studies suggest that the treatment protocol combining the 2 modalities is more effective than orthotics alone in relieving foot pain in patients with plantar fasciitis

2014 eMedicine.com

114. 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.com

115. Arthrogryposis (Treatment)

be harmful in patients with diastrophic dysplasia, because it may lead to joint ankylosis. Recurrence of deformities following stretching is common, and surgery is often indicated. Splinting combined with physical therapy appears preferable to continuous casting. Night splinting after surgical procedures is indicated to maintain increased range of motion. Feeding assistance and intubation is needed in patients with severe trismus. See Deterrence/Prevention for information on recurrence risk. Next (...) are more common than fixed knee deformities and are more resistant to treatment. A mild contracture (< 20°) does not interfere with functional ambulation and can be treated with passive stretching and splinting. Moderate contractures (20-60°) need soft-tissue releases, including posterior capsulotomy of the knee joint, followed by long-term bracing. Severe contractures (>60°) may need femoral shortening, in addition to soft-tissue releases, to decrease tension on neurovascular structures behind

2014 eMedicine Pediatrics

116. Obstructive Sleep Apnea Syndrome (Treatment)

. CPAP acts as a pneumatic splint to maintain airway patency. By simultaneously increasing the functional residual capacity, this pressure also helps prevent oxygen desaturation even if airway obstruction breaks through. BiPAP or noninvasive ventilation is the preferred form of treatment over CPAP in children with OSA due to neuromuscular disease. [ ] Marcus et al demonstrated improvements in daytime sleepiness, ADHD symptoms, internalizing behaviors and overall quality of life in children with OSA (...) as early as 3 months following the initiation of CPAP therapy. The findings held true in a heterogeneous group of children with OSA and were present even with a mean use of 3 hours/night. These authors suggest that despite the challenges of adherence in young or developmentally delayed children with OSA, clinicians should encourage use of CPAP therapy in appropriate children. [ ] Various patient interfaces are available, including nasal masks, facemasks, gel masks, and nasal pillows to help facilitate

2014 eMedicine Pediatrics

117. Sleep Apnea (Treatment)

. CPAP acts as a pneumatic splint to maintain airway patency. By simultaneously increasing the functional residual capacity, this pressure also helps prevent oxygen desaturation even if airway obstruction breaks through. BiPAP or noninvasive ventilation is the preferred form of treatment over CPAP in children with OSA due to neuromuscular disease. [ ] Marcus et al demonstrated improvements in daytime sleepiness, ADHD symptoms, internalizing behaviors and overall quality of life in children with OSA (...) as early as 3 months following the initiation of CPAP therapy. The findings held true in a heterogeneous group of children with OSA and were present even with a mean use of 3 hours/night. These authors suggest that despite the challenges of adherence in young or developmentally delayed children with OSA, clinicians should encourage use of CPAP therapy in appropriate children. [ ] Various patient interfaces are available, including nasal masks, facemasks, gel masks, and nasal pillows to help facilitate

2014 eMedicine Pediatrics

118. Plantar Fasciitis (Treatment)

, 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

119. Mucopolysaccharidosis (Treatment)

in these patients. Night splinting and occupational aids have also been helpful. Bone marrow transplantation (BMT) has been successful in the treatment of MPS conditions, especially Hurler syndrome. Children treated with BMT generally have an increased lifespan compared to untreated children. Untreated children commonly died of cardiorespiratory compromise in the first decade of life. However, the musculoskeletal condition (dysostosis multiplex) did not improve with BMT. Skeletal radiographs of children treated (...) growth" techniques. Severe deformities may also necessitate corrective osteotomy, usually of the proximal tibia. Ankle valgus can be also be treated with guided growth techniques. Kyphosis is progressive in many of these patients, especially at the thoracolumbar level and sometimes associated with thoracic scoliosis. [ ] Posterior spinal fusion is proved to prevent further progression. In the cervical spine, odontoid hypoplasia can be seen leading to atlantoaxial instability. Fusion from C1 to C3 can

2014 eMedicine Surgery

120. Plantar Heel Pain (Treatment)

the ankle in dorsiflexion can be worn. [ ] Patients who wear a posterior night splint should be warned to take it off before getting out of bed. As an anecdotal example, one patient walked to the toilet while wearing the splint, slipped, and sustained a humeral fracture. However, a dorsally applied splint, as opposed to a posterior splint, need not be taken off before the patient gets out of bed (see images below). A night splint applied on back of the leg and foot. A night splint applied on the front (...) of the leg. Attard et al compared the effectiveness of the posterior night splint, which dorsiflexes the foot, with that of the anterior night splint, which maintains the foot in a plantigrade position. [ ] In this study, two thirds of all participants confirmed that morning pain and stiffness was less after wearing the night splints; both types were relatively easy to don and doff, but the posterior orthosis was more uncomfortable and disrupted sleep. On average, the anterior night splint reduced heel

2014 eMedicine Surgery

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