Night Splints Research Articles

Síndrome de túnel carpiano en el embarazo. Revisión de literatura y presentación de un caso clínico

Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy in the general population. In pregnant women the prevalence increases to 31-62 % probably by edema secondary to the hormonal changes of pregnancy. The definitive treatment is surgical decompression, but in pregnant reserves only in exceptional cases where other treatments have failed. This population receives mainly conservative therapy consisting of splints, physical therapy and infiltration. Objective: To review the management of CTS in pregnant about a case. Methods: The clinical case of a pregnant patient with CTS managed conservatively was revised, based on this existing literature was reviewed. Results: 32 years old woman, studying 18 weeks pregnancy, consultation by paresthesia and loss of strength of both hands since1.5 months, more than right. Physical examination was consistent with bilateral CTS. Use of night splint is indicated. The electrodiagnostic evaluation reporting neuropathic sensitive-motor commitment severe intensity, subacute bilateral median nerve, with moderate denervation. Patient with symptoms persist, it is decided to perform infiltration of carpal tunnel steroid with good clinical and electrophysiological response. Conclusions: This case exemplifies the conservative treatment of CTS in pregnancy delivered good results. The literature supports the use of splints and steroid injections in this population.

A Novel Approach To A Runner’S Foot Pain

HISTORY: 32-year old female recreational runner experienced the insidious onset of bilateral heel pain, followed by arch pain in the AM and after running. She was treated for plantar fasciitis by a podiatrist with custom orthotics, night splints and rest. She discontinued the orthotics due to discomfort and persistence of pain. She began cycling due to being unable to run. Three months later, her pain finally resolved and she returned to running. At this time, she decided to try transitioning to a forefoot strike pattern in minimal shoes. She increased her distance from 400m to 2000m before she experienced the onset of BIL dorsolateral foot pain, which she continued to run through. She increased to running 10km before a reaggravation of her heel and arch pain caused her to stop. She then sought treatment at the running clinic. PHYSICAL EXAMINATION: The patient reported pain with walking and running. Palpation of the 4th and 5th metatarsals elicited tenderness, reproducing her complaint of dorsolateral foot pain. Palpation of her medial arch elicited tenderness and reproduced her complaint of plantar fascia pain. A manual muscle test revealed normal muscle performance of her lower leg muscles. During running, she exhibited increased foot inversion at foot-strike, followed by rapid pronation. She also demonstrated increased femoral internal rotation and adduction. She reported a VAS of 6/10 for the dorsolateral foot pain, and 3/10 heel pain. DIFFERENTIAL DIAGNOSIS: -Plantar fasciitis -Metatarsal stress reaction/fracture FINAL/WORKING DIAGNOSIS: -Plantar fasciitis -Possible metatarsal stress reaction TREATMENT AND OUTCOMES: 1. 8 weeks of rest to unload possible stress reaction. During this time, her dorsolateral foot pain resolved. Her heel and arch pain did not. 2. Progressive intrinsic and extrinsic foot strengthening. 3. Movement reeducation, using bilateral dynamic movements and unilateral dynamic movements to improve her lower extremity control. 4. Gait training to reduce her excessive inversion, rapid pronation, femoral adduction/internal rotation during running. 5. Run time was slowly increased to 35 min over 4 weeks. Patient was pain free at discharge. 6. Patient then independently progressed to prior level of running. She has had no reaggravation of her plantar fasciitis as of a 2-year follow-up.

The Effectiveness of Carpal Bone Mobilization Accompanied by Night Splinting in Idiopathic Carpal Tunnel Syndrome

The Effectiveness of Carpal Bone Mobilization Accompanied by Night Splinting in Idiopathic Carpal Tunnel Syndrome

Efficacy of Splinting Variations in Two Different Treatment Protocols in Trigger Thumb

Introduction: The aim of this study was to evaluate the comparative final outcome of two different conservative treatment protocols for trigger thumb using three different types of splints with varying restrictions of interphalangeal (IP), metacarpophalangeal (MCP), and carpometacarpal (CMC) joint motions of the thumb and with additional exercise programs. Materials and Methods: Twenty-nine patients with 43 trigger thumbs were included in this study. Participants were divided into two treatment protocol groups and used three different types of thumb splints (1 daytime consistent to both groups and 2 different nighttime) with an additional exercise program and connective tissue manipulation (CTM). Patients were seen for follow-up after 10 weeks of the treatment; the preoutcome and postoutcome measures were assessed by stages of stenosing tenosynovitis (SST) and Visual Analog Scale (VAS). The data were analyzed to determine the efficacy of splint protocol intervention in relation to each other. Results: After using the thumb splints, there were statistically significant improvements in both SST and VAS scores in both groups (P < 0.05). This study demonstrates the benefit of splint usage and an additional exercise program with CTM in the conservative treatment of trigger thumb. Conclusions: Keeping in mind that splint 3 was used with both groups, splint 1 of the night splints that limited IP, MCP, and CMC joint flexion and extension was found to be more effective for conservative treatment in trigger thumb.

The effectiveness and tolerability of tension night splints for the treatment of patients with chronic plantar fasciitis – A case-series study

Objective To study the subjective perceptions of benefits of the use of tension night splints (TNS) in a clinical population of patients with plantar fasciitis. Methods Twenty consecutive patients who were prescribed TNS were identified from clinical logs. These were contacted to understand their perception of benefit from the TNS and their outcome. Seventeen of 20 patients responded (85% response rate). Results There was a mean reduction in pain first thing in the morning of 2.8 points, and pain overall of 1.9 points on a 0–10 visual analogue scale. Overall function improved by 17 percentage points. However, compliance was limited with about one-third of patients having significant sleep disturbance while wearing the TNS, and 30% ceasing to wear the splint within 1 month. Discussion TNS appear to have a beneficial role in the treatment of chronic plantar fasciitis. However, the exact benefits remain unclear, and issues including patient comfort and tolerability can limit their use.

Physiotherapeutic treatment of plantar fasciitis

Plantar fasciitis or heel pain syndrome is a common cause of heel and foot pain in adults that affects about 2 million Americans a year and it is estimated that about 10% of the world’s population have presented or will present foot pain at some time in their life. Objective: To review the literature in order to verify the effectiveness of the modalities of physical therapy in patients with plantar fasciitis. Method: An electronic search was conducted in the databases of the Cochrane Library, Medline (via Pubmed), PEDro, and LILACS, with no date or language restrictions. In the present study, articles about the physical therapy for plantar fasciitis and those that have focused on the surgical treatment were included. Results: In total, 23 studies met the inclusion criteria. The procedures were: Stretching sural triceps, manual therapy, bandaging, orthotics/ insoles and electrotherapy. Conclusions: There is moderate evidence that stretching exercises for the triceps surae provide benefits to patients with plantar fasciitis. The evidence of the application of bandages is still weak, but some studies have reported improvement in pain and function in the short term. There is good quality evidence supporting the use of custom insoles that can provide short-term improvement in pain and function in patients with plantar fasciitis. The use of night splints presents controversial results, although some studies have shown good results.

Effectiveness of orthotic devices in the treatment of Achilles tendinopathy: a systematic review.

Orthotic devices such as foot orthoses, splints, taping and bracing are recommended for Achilles tendinopathy (AT). This systematic review was conducted to review the current evidence for the effectiveness of orthotic devices for the treatment of mid-portion or insertional AT. Electronic bibliographic databases (MEDLINE, EMBASE, Current Contents, CINAHL and SPORTDiscus) were searched in May 2014. The methodological quality of included studies was evaluated using the Quality Index. Where possible, effects were determined using standardised mean differences. The strength of evidence for each intervention was determined according to the quality and number of studies. Twelve studies satisfied the inclusion criteria; nine studies investigated mid-portion AT, whilst three studies did not distinguish between mid-portion and insertional pathology. Weak evidence showed that foot orthoses were equivalent to physical therapy, and equivalent to no treatment. Very weak evidence supported the use of adhesive taping alone or when combined with foot orthoses. Moderate evidence showed that the AirHeel™ brace was as effective as a calf muscle eccentric exercise programme, and weak evidence showed that this intervention was not beneficial when added to a calf muscle eccentric exercise programme. Weak evidence showed that an ankle joint dorsiflexion night splint was equally effective to a calf muscle eccentric exercise programme, and strong evidence showed that this intervention was not beneficial when added to a calf muscle eccentric exercise programme. These findings may aid clinical decision making in the context of AT, however further high-quality studies are required.

The Effectiveness of Carpal Bone Mobilization accompanied by Night Splinting in Idiopathic Carpal Tunnel Syndrome

Objective: The aim of this study was to investigate the effectiveness of carpal bone mobilization (CBM) and night splinting and to compare it with night splinting as a control group in the treatment of Carpal Tunnel Syndrome (CTS). Methods: In the single-blind (assessor) prospective randomised controlled trial, a total of 40 patients with mild to moderate CTS were diagnosed by electroneuromyography (ENMG). In Group 1 (n=20), patients received CBM three times a week, total of 10 times, and used neutral volar wrist splint at night for 3 weeks. Patients in Group 2 (n=20) used only neutral volar wrist splint at night for 3 weeks. All of the patients were assessed at baseline and at the 3 rd month with respect to pain intensity using a numerical rating scale (0-10), handgrip and pinchgrip strength, functional status and symptom severity using the Boston Carpal Tunnel Questionnarie (BCTQ), and ENMG measurements. Results: There were improvements in all of the clinical variables, distal sensory latancy, and sensory nerve action potentials of the median nerve in Group 1. In Group 2, there was improvement in only BCTQ symptom severity and night/day pain intensity at the 3 rd month. Improvement in pinchgrip strength and BCTQ functional status were superior in Group 1 when compared to Group 2 at the 3 rd month.

Effects of placebo-controlled continuous and pulsed ultrasound treatments on carpal tunnel syndrome: a randomized trial

OBJECTIVE:The aim of this placebo-controlled study was to evaluate the effects of pulsed and continuous ultrasound treatments combined with splint therapy on patients with mild and moderate idiopathic carpal tunnel syndrome.METHODS:The study included 46 carpal tunnel syndrome patients who were randomly divided into 3 groups. The first group (n = 15) received a 0 W/cm2 ultrasound treatment (placebo); the second group (n = 16) received a 1.0 W/cm2 continuous ultrasound treatment and the third group (n = 15) received a 1.0 W/cm2 1:4 pulsed ultrasound treatment 5 days a week for a total of 15 sessions. All patients also wore night splints during treatment period. Pre-treatment and post-treatment Visual Analogue Scale, Symptom Severity Scale and Functional Status Scale scores, median nerve motor conduction velocity and distal latency and sensory conduction velocities of the median nerve in the 2nd finger and palm were compared. Clinicaltrials.gov: NCT02054247.RESULTS:There were significant improvements in all groups in terms of the post-treatment Functional Status Scale score (p<0.05 for all groups), Symptom Severity Scale score (first group: p<0.05, second group: p<0.01, third group: p<0.001) and Visual Analogue Scale score (first and third groups: p<0.01, second group: p<0.001). Sensory conduction velocities improved in the second and third groups (p<0.01). Distal latency in the 2nd finger showed improvement only in the third group (p<0.01) and action potential latency in the palm improved only in the second group (p<0.05).CONCLUSION:The results of this study suggest that splinting therapy combined with placebo and pulsed or continuous ultrasound have similar effects on clinical improvement. Patients treated with continuous and pulsed ultrasound showed electrophysiological improvement; however, the results were not superior to those of the placebo.

Acupuncture and related interventions for the treatment of symptoms associated with carpal tunnel syndrome

Acupuncture and related interventions for the treatment of symptoms associated with carpal tunnel syndrome

Efficacy of Kinesiotaping on Symptoms, Hand Functions, and Hand Grip Strength in Carpal Tunnel Syndrome: A Single-Blind and Randomized Controlled Study

Objective: In this study, we aimed to compare the efficacy of kinesiotaping method in combination with night splint and without splint in the treatment of mild carpal tunnel syndrome (CTS). Material and Methods: Forty patients (60 hands) who were diagnosed with mild and moderate severity of CTS were included in the study. They were randomized into four groups (Group 1: kinesiotaping (n=15), group 2: splint (n=15), group 3: kinesiotaping and splint (n=15), and group 4: control (n=15). Symptom severity and functional capacity by the Boston Questionnaire and Functional Capacity Scale, grip strength by Jamar hand dynamometer, lateral and pulp finger strength by pinchmeter, and finger dexterity by the Moberg Test and electrophysiologic parameters were evaluated before and after treatment. Results: Compared to other groups, more successful outcomes were seen in group 3, resulting in statistically significant improvements in all clinical parameters (p≤0.05). A statistically significant improvement was also recorded in groups 1 and 2 only for the second month (p≤0.05). Conclusion: Our study results suggest that kinesiotaping alone is effective only in the early period of treatment; however, combining it with a night splint is more effective in the treatment of patients with mild CTS.

Comparison of short-term effects of rigid tape and night splint on pain and function in patient with carpal tunnel syndrome: a randomized clinical trial

The aim of this study was to compare the short-term effects of rigid taping and night splinting in addition to classical physiotherapy and rehabilitation modalities of conservative treatment, on symptoms of patients with Carpal Tunnel Syndrome. The study included 30 patients (mean age: 46.2years) diagnosed as moderately severe Carpal Tunnel Syndrome, according to the electroneuromyographic findings. In addition to classical physiotherapy and rehabilitation modalities night splint was applied to a group of patients and rigid taping to other one for 21 sessions. Patients were evaluated by the same physiotherapist both before and after treatments, in regards to pain, paresthesia and function, using Symptom and Functional Scales of Boston Questionnaire, and 100 mm visual analogue scale. Demographic data were similar in each group. At the end of treatments, both groups showed significant improvements in Boston Questionnaire and visual analog scale scores, compared with baseline (p<0.05). In inter-group comparisons, rigid taping group showed more improvement in Boston Questionnaire and visual analog scale scores compared with night splinting group (p<0.05). In this study, both physical therapy and rehabilitation modalities, were found to be effective in decreasing pain and improving function in patients with carpal tunnel syndrome. However, it was concluded that, rigid taping around the wrist is more effective than night splinting in decreasing symptoms of carpal tunnel syndrome.

Carpal tunnel syndrome

Carpal tunnel syndrome is the commonest entrapment neuropathy and is due to combined compression and traction on the median nerve at the wrist. It is often idiopathic. Although spontaneous resolution is possible, the usual natural evolution is slow progression. Diagnosis is mainly clinical depending on symptoms and provocative tests. An electromyogram is recommended preoperatively and in cases of work-related disease. Medical treatment is indicated early on or in cases with no deficit and consists of steroid injection in the canal or a night splint in neutral wrist position. Surgical treatment is by section of the flexor retinaculum and is indicated in resistance to medical treatment, in deficit or acute cases. Mini-invasive techniques such as endoscopic and mini-open approaches to carpal tunnel release with higher learning curves are justified by the shorter functional recovery time compared to classical surgery, but with identical long-term results. The choice depends on the surgeon's preference, patient information, stage of severity, etiology and availability of material. Results are satisfactory in 90% of cases. Nerve recovery depends on the stage of severity as well as general patient factors. Recovery of force takes about 2–3 months after the disappearance of ‘pillar pain’. This operation has a benign reputation with a 0.2–0.5% reported neurovascular complication rate.

Muscle Disease

On the basis of strong research evidence, Duchenne muscular dystrophy (DMD), the most common severe childhood form of muscular dystrophy, is an X-linked recessive disorder caused by out-of-frame mutations of the dystrophin gene. Thus, it is classified asa dystrophinopathy. The disease onset is before age 5 years. Patients with DMD present with progressive symmetrical limb-girdle muscle weakness and become wheelchair dependent after age 12 years. (2)(3). On the basis of some research evidence,cardiomyopathy and congestive heart failure are usually seen in the late teens in patients with DMD. Progressive scoliosis and respiratory in sufficiency often develop once wheelchair dependency occurs. Respiratory failure and cardiomyopathy are common causes of death, and few survive beyond the third decade of life. (2)(3)(4)(5)(6)(7). On the basis of some research evidence, prednisone at 0.75 mg/kg daily (maximum dose, 40 mg/d) or deflazacort at 0.9 mg/kg daily (maximum dose, 39 mg/d), a derivative of prednisolone (not available in the United States), as a single morning dose is recommended for DMD patients older than 5 years, which may prolong independent walking from a few months to 2 years. (2)(3)(16)(17). Based on some research evidence, treatment with angiotensin-converting enzyme inhibitors, b-blockers, and diuretics has been reported to be beneficial in DMD patients with cardiac abnormalities. (2)(3)(5)(18). Based on expert opinion, children with muscle weakness and increased serum creatine kinase levels may be associated with either genetic or acquired muscle disorders (Tables 1 and 3). (14)(15)

A prospective randomized controlled trial comparing night splinting with no splinting after treatment of mallet finger.

The effectiveness of night splinting after treatment of mallet finger is unknown. We tested the hypothesis that there is no difference in extensor lag between patients with mallet finger that wear a night splint for an additional month after 6 to 8weeks of continuous splinting and patients that do not wear a night splint. Fifty-one patients were enrolled in this randomized controlled trial. At enrollment, range of motion was measured for the injured and contralateral uninjured finger. The follow-up was conducted approximately 4weeks later in person (41 patients) or by phone (10 patients). Analysis was by intention to treat. There were no significant differences in final extensor lag between patients that did and did not receive a night splint. Among the 41 patients with a final in-person evaluation, the final average extensor lag was 14°, and 34% (14 of 41 patients) had a lag of 20° or greater. Final extensor lag correlated significantly with age, enrollment distal interphalangeal joint (DIP) flexion and extensor lag, and final DIP flexion, with the latter two accounting for 28% of the variation in final lag in the final multivariable model (p < 0.001). There were no differences in disability (p = 0.67) or treatment satisfaction (p = 0.48) between patients that did and did not use night splints. Supplemental night splinting does not improve the outcome of mallet finger in terms of extensor lag, disability, or satisfaction with treatment. Patients with worse initial extensor lags should expect worse final lags; residual lags of 20° or greater are commonplace.

Update on Management of Compressive Neuropathy: Tarsal Tunnel Syndrome

The tarsal tunnel is located beneath the flexor retinaculum, which connects the medial malleolus and calacaneus. The tarsal tunnel contains the posterior tibialis tendon, flexor digitorum longus tendon, posterior tibial artery and vein, posterior tibial nerve, and flexor halluces longus tendon. Tarsal tunnel syndrome is a compressive neuropathy of posterior tibial nerve and its branches under the flexor retinaculum. The etiologies of tarsal tunnel syndrome are space-occupying lesion, hypertrophied flexor retinaculum, osteophytes, tarsal coalition, varicose vein, and trauma. The symptoms are foot pain and hypoesthesia or paresthesia at dermatome according to involving nerve branches. Clinical diagnosis can be obtained from a detailed history and physical examination such as compressive test at the tarsal tunnel area. Ultrasonography and magnetic resonance imaging can reveal the space-occupying lesion, such as ganglion, lipoma, and neuroma. The initial treatments of tarsal tunnel syndrome are conservative management, such as physical therapy, night splint, and steroid injection. Surgical decompression is indicated after failure of conservative managements. Variable results of surgical treatment have been reported. Favorable result after decompression could be obtained from young patients, early onset symptoms, and space-occupying lesion.

Physiotherapeutic treatment of plantar fasciitis

Plantar fasciitis or heel pain syndrome is a common cause of heel and foot pain in adults that affects about 2 million Americans a year and it is estimated that about 10% of the world’s population have presented or will present foot pain at some time in their life. Objective: To review the literature in order to verify the effectiveness of the modalities of physical therapy in patients with plantar fasciitis. Method: An electronic search was conducted in the databases of the Cochrane Library, Medline (via Pubmed), PEDro, and LILACS, with no date or language restrictions. In the present study, articles about the physical therapy for plantar fasciitis and those that have focused on the surgical treatment were included. Results: In total, 23 studies met the inclusion criteria. The procedures were: Stretching sural triceps, manual therapy, bandaging, orthotics/ insoles and electrotherapy. Conclusions: There is moderate evidence that stretching exercises for the triceps surae provide benefits to patients with plantar fasciitis. The evidence of the application of bandages is still weak, but some studies have reported improvement in pain and function in the short term. There is good quality evidence supporting the use of custom insoles that can provide short-term improvement in pain and function in patients with plantar fasciitis. The use of night splints presents controversial results, although some studies have shown good results.

Dupuytren's Disease: Current State of the Art

This review article critically examines the current literature for Dupuytren's disease. Five procedures are considered: dermofasciectomy, limited fasciectomy, segmental aponeurectomy, needle aponeurotomy, and collagenase injection. Studies regarding the efficacy of these treatments focus primarily on the initial degree of correction, rate of recurrence, and complications. No one treatment has been declared superior and substantial controversy exists. Comparison between studies has been hampered by the absence of uniform definitions for clinical success and measurable disease progression. Traditional post-operative care includes formal therapy and night splinting, but recent studies have questioned the value of these adjuncts. The extent of involvement at which the surgeon should intervene was previously well accepted by convention, but as the paradigm shifts towards less invasive procedures, treatment may be offered at an earlier stage. Future research should be structured to recognize the value-based decision making used by patients when selecting treatment.

Wrist &amp; Hand

The August 2013 Wrist &amp; Hand Roundup360 looks at: random group therapy is no good at treating OA of the hand; salvaging failed CMCJ arthroplasty; scaphocapitate arthrodesis for instability in manual workers; Brunelli tenodesis and scapholunate instability; night splints for Dupytren’s revisited; the smallest IM nail?; early diagnosis of CRPS?; and endoscopic carpal tunnel release?

AB0703 Temporomandibular joint involvement in children with juvenile idiopathic arthritis

BackgroundJuvenile idiopathic arthritis (JIA) is the most common autoimmune heterogenic diseases group of unknown etiology with7 subtypes. There are markedly high prevalence of temporomandibular joint (TMJ) involvement- 17 - 87%...