Night Splints Research Articles

Camptodactyly.

Camptodactyly is a congenital difference with flexion contracture of the proximal interphalangeal (PIP) joint. Camptodactyly limited to one finger is believed to be due to an anomaly of the lumbrical muscle that inserts into the flexor digitorum superficialis (FDS) tendon instead of the extensor expansion, whereas multiple finger camptodactyly is believed to be a result of shortage of soft tissues on the flexor surface of the fingers. It is important to differentiate camptodactyly from other causes of extension lag at the PIP joint. It is difficult to obtain good results after the release of flexion contractures in camptodactyly. The main goal of surgery is to prevent progressive contracture with appropriate postoperative therapy using night splinting and stretching. We should strive for a considered approach based on a thorough understanding of the pathophysiology of camptodactyly. Level of Evidence: Level V (Therapeutic).

The Effects of Thermal and Pulsed Ultrasound on Pain and Function in Patients with Carpal Tunnel Syndrome: A Randomized Controlled Trial

ABSTRACT Objective While ultrasound therapy is common for carpal tunnel syndrome, the relative merits of thermal versus pulsed ultrasound remain unclear. This study compares their therapeutic effects. Design Randomized, double-blinded, placebo-controlled trial. Ninety-two adults aged 30-60 years with mild-moderate carpal tunnel syndrome (characteristic symptoms, positive clinical tests, abnormal electrophysiology) were randomized into 4 groups receiving 4 weeks night splinting plus 12 ultrasound sessions: Group A: 1 MHz, 1.0 W/cm2 continuous ultrasound for 5 minutes; Group B: 1 MHz, 25% duty cycle, 1.0 W/cm2 pulsed ultrasound for 15 minutes; Group C: 5 minutes thermal plus 15 minutes pulsed ultrasound; Group D: sham ultrasound for 15 minutes. Pain (VAS), function (DASH-Arabic), nerve conduction, and grip strength were measured at baseline, 4, and 8 weeks. Results Thermal and pulsed ultrasound groups improved in all outcomes versus placebo over 8 weeks (p < 0.05). Pulsed ultrasound decreased pain and distal motor latency more than placebo (p < 0.05). Thermal ultrasound increased sensory nerve action potentials versus placebo (p < 0.05). Conclusion Thermal and pulsed ultrasound with splinting improved pain, disability, grip strength, and nerve conduction in carpal tunnel syndrome. Pulsed ultrasound was optimal for pain and motor function, while thermal ultrasound enhanced sensory nerve function.

Efficacy of Laser Acupuncture on Neurophysiological Parameters of Median Nerve and Hand Function in Postpartum Women: A Randomized Controlled Clinical Trial.

Objective: This study was conducted to ascertain the efficacy of photo acupuncture (PA) on the neurophysiological parameters of the median nerve and hand function in postnatal women. Background: Carpal tunnel syndrome (CTS) has been documented in up to 62% of pregnant females. PA, a noninvasive treatment that utilizes photo therapy on acupoints, could aid in the management of CTS. Material and Methods: Thirty-six postpartum women diagnosed with CTS depending on their medical history, physical examination, and electrodiagnostic study were distributed into two equal-sized groups at random. The PA group (n = 18) received PA for 12 min on the following acupuncture points: PC4, PC6, PC7, PC8, HT2, HT3, HT7, LI10, LI11, LI4, LU9, and LU10. The treatment was given 3 times weekly for four weeks; in addition, night splints were worn. Women in the control group (n = 18) just wore night splints. Before and after the 12-session treatment, each woman was assessed using an electrodiagnostic test to measure the motor distal latency (MDL), sensory distal latency (SDL), motor conduction velocity (MCV), sensory conduction velocity (SCV), pinch dynamometer for assessing pinch strength, and the Brief Michigan Hand Questionnaire (BMHQ) for assessing hand function. Results: A statistically significant improvement was observed in both groups after therapy regarding SDL, SCV, MDL, MCV, pinch strength, and BMHQ (p < 0.05) in favor of the PA group. Conclusion: Adding PA to a night splint should be suggested as an effective conservative therapy for CTS in postpartum women.

Which kinesiotaping technique is effective? Comparision of two different techniques in patients with carpal tunnel syndrome

Background &amp; Objective: Although different kinesiotaping (KT) techniques can be applied in the treatment of carpal tunnel syndrome (CTS), to our knowledge, there is no study in the literature showing the superiority of these techniques over each other. The aim of this study is to compare the effectiveness of KT techniques applied to the dorsal surface and palmar surface of the forearm in patients with CTS. Methods: Forty six patients (70 wrists) diagnosed with CTS were randomized into 3 groups. Fabricated night splint was applied to the first group, KT was applied to the palmar surface of the wrist to the second group, and KT was applied to the dorsal surface of the wrist to the third group. Clinical, electrophysiological and ultrasonographic evaluations before treatment and at the end of 3-week treatment were compared. Results: In the comparison pre- and post-treatment, the changes in pain evaluated with Visual Analog Scale, and median motor nerve distal latency were significant in all groups, the change in median nerve sensory conduction velocity was significant in Groups 1 and 2, the change in median motor nerve conduction velocity was significant in only Group 2, the change in The Boston Carpal Tunnel Questionnaire (BCTQ)-Symptom Severity Status was significant in Group 1 and Group 3, the change in BCTQ-Functional Severity Scale and median nerve cross-sectional area was significant in only group 1. When the changes in treatment between the groups were compared, no statistically significant difference was found in any of the parameters. Conclusion: While splinting and different KT methods provided various benefits in CTS patients, they were not statistically superior to each other.

Congenital malformations of the hand and fingers

Congenital anomalies of the upper limb are in Denmark estimated to have an incidence of around 20 in 10,000 live births. This covers a wide array of conditions summarised in this review. At the time of referral, the patient is thoroughly examined, and a treatment plan is discussed with the family. In some cases, no treatment is needed, in others there might be a need for surgery, night splinting, or an upper limb prosthesis. In case an underlying syndromatic cause is suspected, the patient is referred for paediatric evaluation at specialized centre.

Risk factors, associations, and high-risk patient profiles for nocturnal pain in carpal tunnel syndrome: implications for patient care.

Carpal tunnel syndrome results from chronic compression of the median nerve, causing pain and paresthesia, especially at night. The impact of these symptoms on patients includes disrupted sleep patterns and a desire to alleviate discomfort through hand movements. Our study aims to investigate risk factors, associations, and high-risk patient profiles associated with these nocturnal manifestations in carpal tunnel syndrome. Utilizing a retrospective case-control design, our study comprises 681 patients with carpal tunnel syndrome, including 581 with nocturnal symptoms and 90 without. Data were obtained through personalized phone calls and health records, covering health profiles, medical comorbidities, perioperative variables, and selected outcomes. Analyzing 591 patients with night symptoms revealed significant differences compared to the non-night symptoms group. The night symptoms group exhibited a lower mean age (51.3 vs. 56.6 years, p = 0.001), higher prevalence of diabetes (30.1% vs. 45.6%, p = 0.003), and paresthesia (98.5% vs. 81.1%, p < 0.001). In addition, the night symptoms group reported a higher incidence of disabling pain (89.2% vs. 70.0%, p < 0.001), weak hand grip (80.5% vs. 62.2%, p < 0.001), and night splints use (37.7% vs. 24.4%, p < 0.001). Preoperatively, the night symptoms group exhibited slightly higher intraoperative anxiety (40.9% vs. 30.0%, p = 0.12) and a slightly longer recovery time (1.7 vs. 1.4 months, p = 0.22), with no significant difference in pain relief scores (8.1 vs. 7.7, p = 0.16). Patients with night symptoms show increased likelihood of comorbidities (diabetes, and renal, conditions), along with a propensity for disabling symptoms and paresthesia. Although they experience slightly longer recovery times, they demonstrate improved pain relief scores. Case-Control Study.

The Effect of Therapeutic Approaches on Hallux Valgus Deformity.

Hallux valgus (HV) is a relatively frequent disease caused by a complicated structural malformation of the primary ray. The bunion or middle projection generated by the hallux's lateral displacement and pronation is merely one element of the three-dimensional abnormality. HV may trigger severe discomfort and affect joint kinematics. The specific kinematic cause is still unknown. Female age, gender, restrictive footwear, and heritage are risk indicators. HV frequently coexists along metatarsal adducts, equines contracture, hammertoe imperfection, and pes planus. HV is a frequent foot ailment with multiple, complicated, unknown etiology and course. HV has a preference for females. It is an ongoing condition for which there is no known treatment to reduce or prevent improvement.Fibrodysplasia ossificans progressiva (FOP) is distinguished by hereditary symmetrical HVdeformities or symptoms that begin heterotopic calcification that is either idiopathic or caused by trauma, such as subcutaneous immunizations. Localized heterotopic calcification may be preceded by aggravating, recurring soft-tissue enlargements (flare-ups). Heterotopic calcification may happen anywhere; however, it most commonly impacts locations near the axial bone structure during the early/mild phases until advancing to the appendicular skeleton. As an effect of calcification affecting the flexibility of the joints, it might cause limitations in motion.The initial line of therapy focuses on non-surgical methods including night splinting, orthotics, and larger shoes. The next suggested line of action is surgical intervention if conservative therapy fails. Patients have good postoperative tolerance, and bone union often happens six to seven weeks after surgery. Stretching exercises help to restore function by extending shortened soft tissue and restoring range of motion (ROM). The goal of joint mobilization, a form of manual treatment method, is to extend the ligament, the soft tissue surrounding the limited joint, and the restricting joint capsule by applying modest amplitude passive movement to the joint components.

Use of antidepressants in the treatment of chronic orofacial pain caused by temporomandibular disorders: A randomized controlled clinical trial

Background and objectiveTemporomandibular disorders (TMDs) are a common pathology, associated with pain in the facial territory and with associated psychological disorders, such as anxiety and depression. The aim of this study was to evaluate the efficacy of antidepressants in the treatment of pain associated with TMD. Materials and methodsSixty four patients suffering from chronic orofacial pain, randomly distributed in 3 groups: control group treated with night splint, group treated with 10mg/day of citalopram and group treated with 25mg/day of amitriptyline. Pain intensity was assessed, randomly, by a single blinded evaluator, according to the VAS at baseline and after one, three, six and nine weeks. ResultsAll groups showed a reduction of pain throughout the period of time evaluated, however, the group treated with amitriptyline showed the best pain reduction results 3.3±1.5, 1.5±1.4 and 0.9±1.3 at 3, 6 and 9 weeks, respectively. ConclusionsLow doses of amitriptyline appear to be a good therapeutic option in patients with TMDs suffering from chronic orofacial pain.

A Review of Common Interventions and Preventive Options Used in the Treatment of Plantar Fasciitis

Plantar fasciitis is a frequent, chronic ailment that significantly affects day-to-day functioning. This review takes a deep look at the different therapies and preventions used in the treatment of this condition to improve foot function, reduce pain, and improve patient outcomes. The efficacy of common treatment options such as physical therapy, medication, stretching, night splints, therapeutic ultrasound, and extracorporeal shock wave therapy has been mentioned again in this study. Moreover, the importance of injection treatment and surgery also play a significant role in the management of plantar fasciitis. In addition to conventional treatment, the health care professional also needs to pay attention to the prevention of this overuse foot injury. The available approaches involve stretching the particular posterior muscles of the low limbs. Eventually, the impact of interdisciplinary considerations, including physiological factors and strength training methods, on plantar fasciitis was explored in order to provide a certain theoretical basis for clinical practice.

De l’évolution des représentations du handicap à l’évolution des modèles de conception des appareillages

The device occupies an important place in the therapeutic arsenal used in cerebral palsy. The molded seat (or seat corset), the pelvic-pedal splints for verticalization, the night splints represent the daily life of a large number of cerebral palsy subjects. Unfortunately, it is a source of pain or discomfort, which limits its use when the initial objectives seemed relevant. The tools allowing the development of the specifications of these devices have evolved in connection with the representation that we have of disability and of the person with a disability. This evolution opens up new perspectives in the representation and design of the device: This would no longer be only a tool for compensating for a deficiency but that of an adaptive and enabling tool.

Splinting in carpal tunnel syndrome—should we use it during the daytime?

BackgroundSplinting is frequently used in the treatment of CTS (carpal tunnel syndrome) and is mostly preferred at night. On the other hand, there are some studies suggesting the use of splint throughout the day. However, there is still no consensus. The aim of this randomized controlled study was to evaluate the effects of day and night splinting in terms of pain, symptom severity, functional status, and quality of life in patients with CTS.ResultsSeventy wrists of 46 patients with CTS were evaluated. In the day-night splint group, according to without splint group and night-only splint group, a statistically significant improvement was found in terms of pain level assessed by Visual Analogue Scale (p = 0.001, p = 0.015, respectively), Boston Carpal Tunnel Questionnaire-Functional Severity Scale (p = 0.004, p = 0.020, respectively), The Nottingham Health Profile-pain (p = 0.001, p = 0.003, respectively), The Nottingham Health Profile-social isolation (p = 0.001, p = 0.001, respectively), and The Nottingham Health Profile-total score (p = 0.001, p = 0.012, respectively). In addition, it was found that even the use of splint only at night resulted in a significant reduction in pain compared to the control group (p = 0.018).ConclusionsContinuation of splinting as much as possible during the daytime in addition to night splinting is beneficial in terms of pain, nocturnal symptoms, functionality, and quality of life.

Efficiency of therapeutic underwater ultrasound therapy in mild-to-moderate carpal tunnel syndrome: A randomized sham-controlled study.

This study aimed to evaluate the efficiency of therapeutic pulsed ultrasound (US) applied underwater in mild-to-moderate carpal tunnel syndrome (CTS). This randomized, placebo-controlled study included 75 patients (114 hands; 7 males, 68 females; mean age: 46.7±9.9 years; range, 24 to 64 years) diagnosed with CTS through clinical evaluation and electroneuromyography (ENMG) results between March 2012 and January 2013. Patients were randomized into three groups. Group 1 received underwater pulsed US, Group 2 received sham US, and Group 3 was the control group. All groups were given night splints. Patients were evaluated at baseline, at the end of treatment (two weeks), and 12 weeks after the treatment using clinical examination tests (Tinel, Phalen, and hand elevation test), hand grip strength, Visual Analog Scale (VAS) for pain, Pain Quality Assessment Scale (PQAS), and ENMG. In all groups, a significant improvement was detected in the clinical assessment parameters, including the pain VAS, PQAS scores, physical examination outcomes, and hand grip strength. The decrease in VAS score and PQAS was found to be superior in the pulsed US group at both two weeks after the treatment and at the 12th week after the treatment compared to the sham US and control groups (p<0.001). Improvement in ENMG parameters, such as median motor latency, median sensorial velocity, and median sensory latency, was observed only in the underwater pulsed US group (p<0.001). Therapeutic underwater pulsed US is an effective, safe, and easy-to-apply treatment option in the conservative treatment of mild-to-moderate CTS.

Semitendinosus Tendon Graft for Hand Tendon Reconstruction

Background: Hand tendon reconstruction is required in both acute and chronic tendon injuries. A number of donor sites have been described; one such novel donor site is semitendinosus tendon used a graft for hand tendon reconstruction. Based on data reviewed, only a few cases are described up till now. Methods: Semitendinosus tendon was utilized in total of 18 patients undergoing tendon reconstruction for chronic tendon injuries and for tendon transfer to achieve adequate length. All cases were performed during&#x0D; January 2019 To December 2020. Full length uni/bilateral semitendinosus tendon was harvested using a tendon harvester. Tendon was used as a single slip or was split into further slips as needed for tendon reconstruction. Post operatively splints were continued as per protocol (keeping splint for 6 weeks, encouraging active physiotherapy at 8 weeks, continuing night splint age for total of 10 weeks and advising patient to avoid lifting heavy weight for at least 12 weeks). Patients were followed with assessment of strength via MRC (Medical&#x0D; Research Council) grading scale, and tendon excursion measurements via tip to palm distance. Results: Patients had a mean age for 27.5±2.3 with a predominant male population (72.2%). Post-operative assessment showed finger strength of MRC 5 in twelve patients and MRC 4 in three and MRC 3 in three patients. Tendon excursion was documented measuring a tip to palm distance. Three patients developed tendon adhesions which were treated with tenolysis. Conclusion: Semitendinosus is a recommended option for hand tendon (both flexor &amp; extensor) reconstruction, providing adequate length &amp; strength for reconstruction with high predictable availability and reliability. Although Palmaris longus remains the recommended option for single tendon reconstruction, it is absent in a few cases or is rudimentary, making it difficult to be utilized.

A comparative prospective study of platelet rich plasma versus corticosteroid injection in chronic plantar fasciitis

Background: The Plantar fasciitis is a common reason for heel pain which manifests as pain at medial process of calcaneal tuberosity. Patients are mostly diagnosed clinically on the basis of history. Conservative treatment in the form of stretching, non-steroidal anti-inflammatories, night splinting, ice packs, strapping, orthosis, and shoe modifications have been in use traditionally. Recently, the use of injectables like corticosteroids and platelet rich plasma (PRPs) has increased. This study aims at comparing the clinic-radiological outcomes of the two injectables in the treatment of chronic plantar fasciitis. Methods: This was a Prospective, Comparative, Randomized, Hospital-based clinical case study conducted in the Department of Orthopaedics, Sawai Man Singh Medical College, Jaipur, Rajasthan. 60 patients of chronic plantar fasciitis were taken and divided randomly into group A (PRP) and group B (corticosteroids) and the results were assessed based on the visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) score, and the plantar fascia thickness. Results: Mean VAS in Group A decreased from 8.07 before injection to 2.9 after injection and in Group B decreased from before 8.33 injection to 3.13 after injection, at the final follow-up. Mean AOFAS score improved from 54.06 to 90.60 and from 54.86 to 75.13 in the respective groups at the 6-months follow-up. Plantar fascia thickness (as measured using ultrasonography) decreased from 5.77 to 3.32 and from 5.6 to 3.73 in the respective groups. The improvements observed were statistically significant. Conclusions: Local injection of platelet rich plasma is an effective treatment option for chronic plantar fasciitis when compared with steroid injection with long lasting beneficial effects.

Effectiveness of kinesio taping and night splinting along with physical therapy intervention on symptoms and functionality: A Double-Blind Randomized Controlled Trial for Moderate Carpal Tunnel Syndrome.

To compare the effects of kinesio taping (KT) and night splinting (NS) along with physical therapy intervention on symptoms in patients with moderate carpal tunnel syndrome (CTS) undergoing rehabilitation. In this double-blind, randomized controlled trial, forty-five patients with moderate CTS were included and randomly assigned to three groups: KT Group (n = 15), NS Group (n = 15), and control group (CG) (n = 15). All patients received 20 physical therapy intervention sessions. The primary outcome was self-reported disability status measured by the Boston Carpal Tunnel Questionnaire, and secondary outcomes were pain and paresthesia (rest, activity, and night) measured by the Numeric Rating Scale. Outcomes were recorded at baseline and four weeks. All patients showed clinically meaningful improvements for all outcome measures over time (p < 0.05). The intergroup analysis revealed that the KT group demonstrated better results in all measures than the NS (p < 0.05) except for pain during activity (p = 0.054), at night (p = 0.191), and paresthesia at rest (p = 0.575). Additionally, the KT group showed better outcomes than the CG (p < 0.05) except for the activity pain (p = 0.022). However, there were negligible differences between NS and CG (p > 0.05). Kinesio taping in combination with physical therapy intervention is more effective than NS in combination with physical therapy intervention or physical therapy intervention alone and may be recommended.

The Association of Night Splint to NSAID+ ADL Instruction in Improving Pain and Functional Performance: An Observational Study

Background: Plantar fasciitis causes heel pain. The disease normally develops without injury. Clinically, standing or walking causes sole of foot pain, usually under the heel. Planter fasciitis is diagnosed clinically. Rest, stretching, strengthening exercises, shoe modification, arch supports, orthotics, night splints, anti-inflammatory medications, and surgery can treat plantar fasciitis. Injections and NSAIDs provide brief relief. Calf and plantar fascia stretching may help. When conservative treatment fails for chronic plantar fasciitis, surgery is recommended. In this trial, night splints were used to treat plantar fasciitis. Objective: In this study our main goal is to evaluate the association of Night splint to NSAID + ADL instruction in improving pain and functional performance. Method: This randomized clinical experiment was undertaken on 50 plantar fasciitis patients at NITOR, Dhaka. Group A and Group B was randomly assigned. Group A received NSAID, ADL, and a night splint; Group B received NSAID and ADL. Pain score, Tenderness index, and Visual analogue scale data were gathered from both groups every 2 weeks from the initial visit for up to 6 weeks. SPSS version 23 analyzed all data. Results: The present study showed pain and tenderness were significantly improved in Group A who were treated with Night Splint, NSAID &amp; ADL instructions than in Group B who were treated with NSAID &amp; ADL instructions after 6 weeks (P&lt;0.05). Conclusion: The results of this study suggest that application of Night Splint along with NSAIDs and ADL instructions is more effective in reduction of pain and other symptoms in patient with planter fasciitis than the drugs and ADL.

Patient Outcomes on Treatment of Insertional Achilles Tendinopathy with Extracorporeal Shockwave Therapy: A Retrospective Study

Category: Ankle; Other Introduction/Purpose: Insertional achilles tendinopathy (IAT) affects approximately one-third of patients who report achilles tendon pain during their lifetime. It is characterized by stiffness and pain that are aggravated by prolonged rest and physical activity, respectively. Known treatments for IAT include eccentric exercises, night splints, pharmacologic or biologic injections, and extracorporeal shockwave therapy (ESWT). However, pain and functional outcomes following ESWT treatment for IAT vary throughout the literature. In addition, ESWT protocols have varied across studies. This retrospective study aimed to collect information on patient outcomes following ESWT treatment for IAT at a single institution to better characterize patient-reported pain and functional outcomes and to determine if patient-reported outcomes differ according to varying ESWT protocols. Methods: 44 patients who presented with IAT and received ESWT from 2/1/2016 to 10/1/2021 were included. Confirmation of IAT was determined by a review of each patient's chart. Patient-reported outcomes included NRS or VAS scores and PROMIS-10 were collected prior to ESWT sessions and at follow-up time points. Additionally, demographic information for each patient was collected including age, gender, race, ethnicity. Information regarding their achilles tendinopathy included symptom duration, laterality, prior interventions before ESWT, concurrent foot or ankle injuries on the same side, pain (baseline and follow-ups), PROMIS-10 (baseline and follow-ups) was also collected. Finally, ESWT information was reviewed including focused vs radial, number of sessions, number of pulses, energy intensity, frequency, any adverse outcomes after ESWT (e.g., tendon rupture, increase in pain; immediate or delayed), and if any interventions were needed during or after ESWT (physical therapy, cortisone injection, PRP, surgery, medications, orthotics). Results: Out of the 44 patients who were included in the study, 27 were female and 17 male. Mean symptom duration was 23.3 months (SD 26.7 months). 34 patients had unilateral pain while 5 had bilateral pain. Every patient had undergone previous treatment with a majority having tried physical therapy (n=33) and bracing (n=21). Mean number of ESWT sessions between patients was 3.3 (SD 1.5 sessions). 30 patients received focused shockwave therapy, 3 received radial shockwave therapy and 1 received both. The remaining 10 patient charts were inconclusive as to which type of shockwave was performed. 13 patients reported no improvement whereas the remaining 31 patients reported improvement, with a majority (n=18) reporting at least 50% improvement or greater. Conclusion: Insertional achilles tendinopathy can be treated with a wide variety of modalities, therapies and adjuncts. When considering treatment for cases that do not respond to the traditional methods including physical therapy, bracing and injections, ESWT shows promising data to be an effective treatment option, regardless of type or intensity. Most patients require more than 1 ESWT to be effective.

Achilles Pain - Track And Field

HISTORY: An 18-year-old, female, Division 1 collegiate track and cross-country athlete presented mid-season with acute on chronic, right posterior ankle pain after running. She was treated the season prior for insertional Achilles tendinopathy with protected weight bearing, manual therapy, eccentric strengthening, night splints, oral and topical NSAIDs, nitroglycerin patches and intra-tendinous prolotherapy. Her pain returned this season with running or direct contact of the Achilles tendon. PHYSICAL EXAMINATION: On inspection there was bilateral pes planus and slight swelling of the Achilles tendon 1-2 cm proximal to the insertion with tenderness to palpation. She had full ankle range of motion with mild pain only on end range of passive dorsiflexion. There was a non-antalgic gait pattern and no pain with toe and heel walking or with heel pumps. Ankle strength was normal and sensation to light touch was intact throughout. DIFFERENTIAL DIAGNOSIS:1. Achilles tendinopathy, recalcitrant2. Achilles paratenonitis3. Retrocalcaneal bursopathy4. Posterior ankle impingement TEST AND RESULTS: Diagnostic musculoskeletal ultrasound showed a normal appearing Achilles tendon without fusiform swelling, hypoechogenicity, fiber disruption, neovascularization or cortical irregularities FINAL/WORKING DIAGNOSIS: Achilles paratenonitis TREATMENT AND OUTCOMES:1. Referral to sports physical therapy for a progressive tendon loading program and return to run program using a weight assisted treadmill2. Despite strength and flexibility gains, the patient was unable to return to run without pain3. We performed an ultrasound guided, percutaneous Achilles paratenon brisement with saline to dissect the tight, adhesive paratenon from the tendon itself4. Additionally, during the same procedure, we performed an ultrasound guided, percutaneous, Achilles tendon scraping to disrupt peritendinous neovessels and neonerves5. After 1 week of protected rest, patient returned to physical therapy and was able to complete a return to run program and return to sport without pain within 1 month.

Plantar Fasciopathy - Pathophysiology Diagnostics and Therapy - A Clinical Guideline

Plantar Fasciopathy - Pathophysiology Diagnostics and Therapy - A Clinical Guideline Abstract. Plantar fasciitis (often referred to as "heel spurs") is a common problem in daily practice. Approximately 4-10% of the general population is affected, in athletes the prevalence is even higher with an estimated prevalence of 5-18%. Heel pain is one of the most common running injuries. Besides runners, overweight individuals exposed to several hours of standing or walking daily are also at risk. The reduction in quality of life can be considerably high. The diagnosis can usually be secured by means of a targeted anamnesis and clinical examination, backed up by ultrasound examination or MRI. The most common differential diagnoses are irritation of the Baxter's nerve, tarsal tunnel syndrome, and insertional tendinopathy of the Achilles tendon. Plantar heel pain is a domain of conservative therapy, surgical procedures are very rarely required. The basic therapy consists of patient education and stretching exercises, it can be expanded by low dye taping, insoles, and extracorporeal shock wave therapy. If this does not lead to a significant improvement in symptoms, night splints and infiltrations can be useful.

Elbow flexion contractures in neonatal brachial plexus palsy: A one-year comparison of dynamic orthosis and serial casting

Objective Elbow flexion contractures are common complications of neonatal brachial plexus palsy, but evidence on how to treat these contractures is weak. This study compared the treatment of elbow flexion contractures using a dynamic orthosis or serial circular casting. Methods A randomized controlled trial was conducted with one-year follow-up. Children with an elbow flexion contracture of ≥30° were treated with either a night-worn dynamic orthosis for one year or serial casting for four weeks followed by night splinting. For pragmatic reasons, some participants were included in an open part of this study, this group was also analyzed separately. Degree of contracture and goal attainment scaling was evaluated at baseline and after 8, 20 and 54 weeks. Results 55 patients were analyzed in this trial, 32 of whom were randomized to treatment. At one-year follow-up of the randomized group, both dynamic splinting (median −8.5°, interquartile range [IQR] −13.5, −5) and serial casting (median −11.0°, IQR −16, −5) resulted in significant reduction of contracture (P < 0.001). The reduction was significantly greater with serial casting in the first 20 weeks, but not at one-year follow-up (P = 0.683). In the entire cohort, the individual functional goals had been reached in 24 out of 32 cases (80%) of dynamic splinting and 18 out of 23 cases (82%) of serial casting, respectively. Conclusion The dynamic night orthosis is comparable to serial casting for treating elbow flexion contractures in children with brachial plexus birth injury. We recommend selecting one of these treatment modalities in close consultation with parents and patients.