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179 results for

Posterior Night Splint

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101. 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. 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

104. 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

105. Sleep Apnea (Follow-up)

. 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

106. 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

107. 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

108. Hand, Nerve Compression Syndromes: Upper Extremity

with advanced cases. Studies EMG or a nerve conduction velocity study can be used in difficult cases or with polyneuropathy. [ ] Occasionally, radiographs help rule out occult fractures, a foreign body, or tumors. Laboratory studies may include an erythrocyte sedimentation rate, blood glucose value, thyroid evaluation, and rheumatoid factor. Treatment Nonsurgical measures include wrist splinting in a neutral position to minimize intratunnel pressures at night due to posture; anti-inflammatory medications (...) The ulnar nerve arises from the medial cord of the brachial plexus. The ulnar nerve travels posterior to the brachial artery and remains within the flexor compartment of the upper extremity until it reaches the medial epicondyle. The nerve travels behind the medial epicondyle back into the flexor compartment underneath the flexor musculature. Above the elbow, the ulnar nerve lies on the long head and then the medial head of the triceps muscle, directly posterior to the medial intermuscular septum

2014 eMedicine Surgery

109. 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 Emergency Medicine

110. Plantar Fasciitis (Overview)

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 Emergency Medicine

111. 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 Emergency Medicine

112. 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

113. 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

114. 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

115. 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

116. 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

117. 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

118. 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

119. 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

120. 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

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