Night Splints Research Articles

Effectiveness of Active Release Technique Versus Myofacial Release Technique on Patients with Plantar Faciitis: A Comparitive Study

Background: Plantar fasciitis is one of the most common causes of heel pain. The pain and discomfort associated with this disorder affect physical mobility and function dramatically. There are various conservative treatment strategies known to enhance symptoms of the condition including ice, heat, taping, electrical modalities, night splints, orthotics, stretching and strengthening. In addition, there are a number of soft tissue techniques such as Myofascial Release Technique (MFR) and Active Release Technique (ART) that may be effective in Plantar Fasciitis. Objective: To find out and compare the effectiveness of Active Release Technique versus Myofascial Release Technique on pain and functional performance in patients with plantar fasciitis. Methodology: Thirty patients who met the selection criteria were chosen for the study after receiving their informed consent. Participants were assigned randomly into two groups (Group A and Group B). Group A received the ART, whereas Group B received the MFR technique. Both groups jointly received ultrasound therapy and plantar fascia stretching exercise. The assessment of Numerical Pain Ratting Scale (NPRS) and Patient Specific Functional Scale (PSFS) is made before and after the six day treatment schedule. Result: Statistically significant improvements in NPRS (Z=3.44, P=0.001) and PSFS (t=10.2, P=0.001) were observed in group A patients. Statistically significant improvements in NPRS (Z=3.44, P=0.001) and PSFS (t=9.4, P=0.001) were noted in group B patients. When comparing group A and group B, NPRS (Z=2.59, P=0.009) showed significant differences between two groups and PSFS (t=1.92, P=0.06) was insignificant. Conclusion: The study concluded that both the Active release technique and the Myofascial release technique are effective in reducing pain and improving functional performance in patients with plantar fasciitis. However, the pain reduction in the Active release technique group is significantly higher than in the Myofacial release technique group, but the functional performance shows similar effects in both groups

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.

Qualitative analysis of impact of congenital hand differences on children visiting a tertiary care hospital

Congenital hand differences (CHD), being a visible deficiency, has immense negative influence on the physical, psychological and social wellbeing of a child. PurposeThe children and their mothers were given an opportunity to express their perspectives about the disability and its impact on the daily life of the child. MethodOLOGY: 12 children (6–15 years) and their mothers were enrolled between January to June 2017. In-depth interviews were conducted to know the experiences and perspectives of children with congenital hand differences and their mothers. Transcribed verbatim of interviews were analyzed by manual coding followed by thematic analysis. ResultsChildren expressed that they performed most of their daily activities with partial or minimal involvement of their parents. They exercised a certain degree of independence in meeting their self-care needs by adapting to the disability and reported that they were cared and supported by family members. Although these children encountered stigma from society, they were able to cope with the situation by accepting their disability with positive support from their parents. Majority of mothers and children reported that the surgical intervention has improved the physical functioning of hand. All the participants reported that they did not depend on any orthosis for daily activities. The orthosis provided were only to retain the correction of their deformities and was used mostly as a night splint. ConclusionChildren with congenital hand differences were capable of independent living and showed positive coping towards the societal stigma. Surgical treatment has improved the function and confidence of their children as stated by their mothers.

Premiers résultats de l’arthrodèse scapho-métacarpienne au moyen d’une greffe osseuse structurelle comme traitement de sauvetage des échecs de la trapézectomie

Treatment of symptomatic thumb base instability after multiple surgical procedures for thumb base arthritis including trapeziectomy remains a challenging problem. We hypothesized a scaphometacarpal arthrodesis with iliac bone graft to be an acceptable definitive salvage procedure for persistent pain and impaired strength after multiple procedures on the TMC joint. Three patients were revised with a scaphometacarpal arthrodesis in our department. They all underwent three to four procedures on the trapeziometacarpal (TMC) joint prior to the salvage procedure. The indication was persistent pain and loss of strength not responding to conservative therapy. An arthrodesis was performed using an autologous iliac bone block to fill the void after trapeziectomy. The construct was fixed with a 1.5-mm T-plate (DepuySynthes). Patients were immobilized with a thumb spica for eight weeks and a removable night splint was used afterwards. Clinical and radiological evaluation was performed 1 year postoperative. After 1 year, two out of three patients were satisfied with the result. Mean opposition decreased from 8 to 7. Mean retropulsion remained 1. Mean precision pinch increased from 1.5 to 2.6 kg. Mean grip strength increased from 3.3 to 10.5 kg. Bony incorporation of the bone graft was seen on CT in two out of three patients. Patients that remain symptomatic after multiple surgeries on the TMC joint are a difficult problem without a straightforward solution. Different procedures have been proposed as a salvage procedure after residual instability of the thumb but they all have their limitations. We performed a scaphometacarpal arthrodesis with iliac bone graft in three patients with acceptable outcomes. Pain was well tolerated and strength increased after 1 year follow-up. Although this procedure is no first-choice treatment, scaphometacarpal arthrodesis with iliac bone graft might provide for an acceptable and definitive treatment for painful residual instability after multiple procedures on the TMC joint. Scaphometacarpal arthrodesis with iliac bone graft is a new technique for symptomatic thumb base instability and can be used as a salvage procedure with acceptable outcomes in patients not responding to conservative therapy.

Dupuytren's disease: limited fasciectomy, night splinting, and hand exercises-long-term results.

Dupuytren's contracture (DC) is a fibroproliferative disorder of palmar fascia that causes flexion contractures of one or more digits. There is currently no gold standard operative and postoperative protocol for reducing recurrence rates. We propose a combination of surgical intervention, night splinting, and home hand exercises as a treatment protocol. Thirty patients were included in our study, diagnosed with DC Tubiana grade II-IV. Our treatment protocol was limited fasciectomy followed by a 24-week night splint application, combined with home hand exercises for eightweeks. The outcomes were recurrence, QuickDASH score, extension or flexion deficit, and grip strength. The mean follow-up was 4.9years (range 2-11years). Recurrence of DC occurred in two patients (7%), who had discontinued the use of the splint within twomonths postoperatively. All other patients had complied with the postoperative protocol. The mean QuickDASH score improved from 61.5 (SD 2.1) to 8.6 (SD 2) postoperatively (p < 0.001). Grip strength did not differ significantly in the operated hands (37.9kg, SD 1.3) when compared to the healthy hands (40.2kg, SD 1.3, p = 0.035). The recurrence was not significantly correlated either with the Tubiana grade (p = 0.7), or with the patients' age (p = 0.27). This study shows that limited fasciectomy followed by a 24-week night splint application, combined with home hand exercises for at least eightweeks, is a viable protocol which reduces the rates of recurrence of DC.

Ultrasonographic imaging of the effects of continuous, pulsed or sham ultrasound treatments on carpal tunnel syndrome: A randomized controlled study.

Clinical and electrophysiological effects of therapeutic ultrasound (US) were researched in many studies on patients with CTS with conflicting results. To assess the effects of continuous and pulsed US treatments by ultrasonographic imaging in addition to clinical and electrophysilogical parameters in patients with carpal tunnel syndrome (CTS). Fifty-four patients with idiopathic CTS were randomly divided into three groups. All patients used night splints for two weeks. In addition to splint therapy, continuous, pulsed or sham US treatments were applied to patients 10min/session, 5sessions/week for two weeks. Clinical situation (pain, hand function, strength), electrophysiological studies (motor distal latency, MDL, sensorial distal latency, SDL), and ultrasonographic area measurements of median nerve were evaluated. All evaluations were applied at pretreatment (baseline), posttreatment (2nd week) and in the 6th week. Whereas significant differences were detected for clinical, functional and ultrasonographic imaging findings in each group in the 2nd week and 6th week compared to baseline (p< 0.0167 for both), no electrophysiological improvements were detected in pulsed-US (p> 0.0167) and only improvement for SDL in sham US group in the 2nd week evaluation (p< 0.0167). According to the results of this study, continuous, pulsed or sham US treatments combined with splinting had similar effects on clinical, electrophysiological and ultrasonographic imaging improvements. Additionally, ultrasonographic imaging may be a preferable objective evaluation tool to prove the early posttreatment clinical improvements when electrophysiological changes could not be detected.

The clinical and cost-effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome (INSTINCTS trial): an open-label, parallel group, randomised controlled trial

SummaryBackgroundTo our knowledge, the comparative effectiveness of commonly used conservative treatments for carpal tunnel syndrome has not been evaluated previously in primary care. We aimed to compare the clinical and cost-effectiveness of night splints with a corticosteroid injection with regards to reducing symptoms and improving hand function in patients with mild or moderate carpal tunnel syndrome.MethodsWe did this randomised, open-label, pragmatic trial in adults (≥18 years) with mild or moderate carpal tunnel syndrome recruited from 25 primary and community musculoskeletal clinics and services. Patients with a new episode of idiopathic mild or moderate carpal tunnel syndrome of at least 6 weeks' duration were eligible. We randomly assigned (1:1) patients (permutated blocks of two and four by site) with an online web or third party telephone service to receive either a single injection of 20 mg methylprednisolone acetate (from 40 mg/mL) or a night-resting splint to be worn for 6 weeks. Patients and clinicians could not be masked to the intervention. The primary outcome was the overall score of the Boston Carpal Tunnel Questionnaire (BCTQ) at 6 weeks. We used intention-to-treat analysis, with multiple imputation for missing data, which was concealed to treatment group allocation. The trial is registered with the European Clinical Trials Database, number 2013-001435-48, and ClinicalTrial.gov, number NCT02038452.FindingsBetween April 17, 2014, and Dec 31, 2016, 234 participants were randomly assigned (118 to the night splint group and 116 to the corticosteroid injection group), of whom 212 (91%) completed the BCTQ at 6 weeks. The BCTQ score was significantly better at 6 weeks in the corticosteroid injection group (mean 2·02 [SD 0·81]) than the night splint group (2·29 [0·75]; adjusted mean difference −0·32; 95% CI −0·48 to −0·16; p=0·0001). No adverse events were reported.InterpretationA single corticosteroid injection shows superior clinical effectiveness at 6 weeks compared with night-resting splints, making it the treatment of choice for rapid symptom response in mild or moderate carpal tunnel syndrome presenting in primary care.FundingArthritis Research UK.

Conservative Treatment for Plantar Fasciitis

Category: Hindfoot Introduction/Purpose: The objective of this study was to compare the results obtained in the treatment of plantar fasciitis, by: group I, muscle stretching (plantar and gastrocnemius); Group II, use of the dorsiflexion night splints; and group III, permanent elevation use of shoe heel, 2 cm or more, in relation to forefoot. Methods: One hundred and fifty patients participated in the prospective and randomized study. After randomizing the method, the patients received treatment orientation. Prescription: 150 mg diclofenac sodium, single daily dose, for 7 days. Group II, they underwent daily physiotherapy with plantar stretching and electrotherapy, associated to the use of the night splints. The evaluations were at 30 and 60 days. In the first evaluation, eight patients underwent local infiltration of betamethasone dipropionate, betamethasone disodium phosphate: five from Group I and three from Group II. All patients were evaluated on the AOFAS score of the hindfoot. Results: First evaluation: group I, 52% showed little improvement (AOFAS: initial 53.5, 30 days 56.6); Group II, 38% were dissatisfied and uncomfortable with the night splints (AOFAS: initial 55.6, 30 days 63.3). In group III, 22% of the patients reported pain arising in the morning and after periods of sitting (AOFAS: initial 57.7, 30 days 81.6). Second evaluation: Group I, AOFAS 56.9; Group II AOFAS 72.2; group III AOFAS 88.6. Conclusion: heel elevation presented a satisfactory result, superior to the other methods used; difficulty for patient’s adhesion because it eliminates usage of shoes with no heels; AOFAS / scale close to all patients treated.

Local Injection of Autologous Platelet Rich Plasma and Corticosteroid in Treatment of Plantar Fasciitis in Female Patients

Background: Chronic plantar fasciitis is the commonest cause of foot complaints in India. The incidence of plantar fasciitis peaks in people between the ages of 40 to 60 years with no bias towards either sex. Numerous methods have been advocated for treating plantar fasciitis, including rest, non-steroidal anti-inflammatory medication, night splints, foot orthosis, stretching protocols and extracorporeal shock wave therapy. The aim of this study to compared the functional outcome of Local Steroid and PRP in Plantar Fasciitis. Methods: A prospective randomized control trial done on 63 patients with complaint of plantar fasciitis coming to SMS Medical College & Hospitals, Jaipur, who were attain the inclusion criteria in the study. Patient coming to OPD were randomly allocated C.R. number. Patients with Odd C.R. number were given PRP and those with even number were given Steroids. Patients were followed at 12 weeks and 24 weeks after the injection to look for the effect of PRP and corticosteroid. Then the results were obtained on mean VAS score and AOFAS score in both the groups. Results: The present study showed that the mean age was 40 years in group I and 39 years in group II. Maximum females were housewife (41.26%) in both groups. The difference of mean in between groups, VAS score & AOFAS was insignificant in first visit (P=0.8642 & P=0.3400) and statistical significant after 12 weeks (P<0.0001*** each) and 24 weeks (P<0.0001***each). Conclusions: We believe that PRP injection is safe and can be an excellent alternative to corticosteroid injection in plantar fasciitis, not responsive to conservative means. The findings of this preliminary study can be very relevant in clinical practice.

HOW DO BOARD-CERTIFIED HAND SURGEONS MANAGE CARPAL TUNNEL SYNDROME? A NATIONAL SURVEY.

ABSTRACTObjective:To evaluate tendencies in the planning, diagnosis, and treatment of carpal tunnel syndrome (CTS) by Brazilian hand surgery specialists. Methods:This cross-sectional study was performed at the 36th Brazilian Hand Surgery Congress. We prepared a questionnaire about preferences in the management of CTS, and board-certified hand surgeons that attended the congress were asked to fill out the questionnaires. A total of 174 questionnaires were analyzed. Results:Electromyography examination is used by most surgeons. Night splinting is the most commonly used conservative treatment option. Half of the surgeons utilized prophylactic antibiotics. Most of the interviewees conduct inpatient surgery in the operating room and prefer intravenous regional anesthesia. Most of surgeons use the standard open technique associated with proximal release of the antebrachial fascia and do not perform neurolysis. Compressive dressings are most commonly used for 7 days. Conclusion:The approach to CTS among Brazilian hand surgeons with regard to pre-, intra-, and post-operatory conduct is consistent with the international literature. However, there is a need to reflect and conduct new studies on non-surgical treatment involving local corticosteroid injection, use of prophylactic antibiotics, hospital admission, and type of anesthesia in order to provide more cost-effective approach to surgical treatment for CTS. Level of Evidence V; Expert opinion.

The effect of wearing night splints for one year on the standing motor function of patients with Duchenne muscular dystrophy

[Purpose] To investigate the effect of night splints on the standing motor function and ankle dorsiflexion angles of patients with Duchenne muscular dystrophy (DMD). [Subjects and Methods] Nine boys (age <11 years) with DMD were divided into the sufficiently-wearing group and the insufficiently-wearing group, according to how often they wore their splint for one year. We evaluated the changes between the pre-implementation and the one-year-after assessments of both the sufficiently-wearing group and the insufficiently-wearing group for the ankle dorsiflexion angle, North Star Ambulatory Assessment, 10-m running time, and time to stand from the floor. [Results] Only the left dorsiflexion angle of the ankle showed significantly difference for the sufficiently-wearing group. For other indicators, there were tendency toward improvement and maintenance in the sufficiently-wearing group. [Conclusion] The standing motor function improved significantly in some patients in the sufficiently-wearing group, suggesting that wearing night splints may promote the improvement and/or maintain of standing motor function in patients with DMD.

Continuous passive motion and physical therapy (CPM) versus physical therapy (PT) versus delayed physical therapy (DPT) after surgical release for elbow contractures; a study protocol for a prospective randomized controlled trial

BackgroundThe elbow is prone to stiffness after trauma. To regain functional elbow motion several conservative- and surgical treatment options are available. Conservative treatment includes physical therapy, intra-articular injections with corticosteroids and a static progressive or dynamic splinting program. If conservative treatment fails, an operative release of the posttraumatic stiff elbow is often performed. The best Evidence-Based rehabilitation protocol for patients after an operative release is unknown to date and differs per surgeon, hospital and country. Options include early- or delayed motion supervised by a physical therapist, immediate continuous passive motion (CPM), (night) splinting and a static progressive or dynamic splinting program.Methods/designThe SET-Study (Stiff Elbow Trial) is a single-centre, prospective, randomized controlled trial. The primary objective of this study is to compare the active Range of Motion (ROM) (flexion arc and rotational arc) twelve months after surgery between three groups. The first group will receive in-hospital CPM in combination with early motion Physical Therapy (PT) supervised by a physical therapist, the second group will receive only in-hospital early motion PT supervised by a physical therapist and the third group will receive outpatient supervised PT from postoperative day seven till ten. Secondary outcome measures will be Patient Reported Outcome Measures (PROMs) including the Mayo Elbow Performance Score (MEPS), the Oxford Elbow Score (OES), the quick Disabilities of Arm, Shoulder and Hand (qDASH) score, Visual Analogue pain Scale in rest and activity (VAS), Pain Catastrophizing Scale (PCS), the Short Form (SF)-36, the Centre for Epidemiological Studies Depression Scale Revised (CESD-R) and the Work Rehabilitation Questionnaire (WORQ) for the upper limb.DiscussionA successful completion of this trial will provide evidence on the best rehabilitation protocol in order to (re)gain optimal motion after surgical release of the stiff elbow.Trial registrationThe trial is registered at the Dutch Trial Register: NTR6067, 31–8-2016.

What are the most effective treatments for decreasing pain of plantar fasciitis?

EVIDENCE-BASED ANSWER The answer is unclear, but calcaneal antipronation taping and prefabricated heel cups/pads are better than stretching, and prefabricated heel cups/pads are better than full-length custom orthoses. The combination of night splints and full-length orthoses is better than orthoses alone (SOR: B, RCTs). Moderateintensity extracorporeal shockwave therapy (ESWT) and botulinum toxin type A injections are effective but comparison with other interventions is unknown (SOR: B, subgroup meta-analysis of RCTs and single RCT). Night splints, prefabricated or custom-made orthoses, and taping are recommended treatments (SOR: C, expert opinion).

The effectiveness of splinting and surgery on sleep disturbance in carpal tunnel syndrome.

III.

Particulate Umbilical Cord/Amniotic Membrane for the Treatment of Plantar Fasciitis

Category: Hindfoot Introduction/Purpose: Plantar fasciitis is the most common cause of heel pain, resulting in an estimated 1 million visits to medical professionals annually. Conservative treatments for plantar fasciitis include rest, orthotics, night splint, stretching and non- steroidal anti-inflammatory drugs. Such treatments are successful in nearly 90% of patients, however, more invasive treatments are required for patients whose heel pain symptoms persist greater than six months. Fetal tissues, including the umbilical cord (UC) and amniotic membrane (AM) have been increasingly used to modulate healing in different parts of the body over the last two decades. These tissues have been demonstrated to possess anti-inflammatory and anti-scarring properties in addition to containing growth factors, cytokines, and matrix components to promote healing, and offer a potential therapy for plantar fasciitis. Methods: In this clinical series, we sought to evaluate the efficacy of cryopreserved, particulate UC/AM tissues as a treatment for plantar fasciitis as well as to determine if multiple injections provide an even greater benefit compared to a single injection. A multicenter prospective study was performed where patients were randomized to receive 25, 50, or 100 mg UC/AM tissue and either a single injection or two injections (at baseline and six weeks). All injections were administered under ultrasound guidance into the plantar fascia. At six, 12, and 18 weeks, patients returned and data on foot pain as well as the FAAM questionnaire were collected. Results: Last year, we presented interim data on 18 patients who had completed 18 weeks of follow-up. This year, we present the completed results of the study. Overall, patient foot pain was found to be significantly reduced in all treatment groups from baseline. FAAM scores for both activities of daily living and sports subscales also improved in all treatment groups, with overall improvement ranging from 60 – 150% compared to baseline. All patients showed variable degrees of improvement with no patients showing any deterioration. Conclusion: The results of this case series are similar to the results of an earlier study which found that injection of a particulate human amniotic membrane product for plantar fasciitis was safe and comparable to corticosteroids. While all treatments demonstrated improvement in both foot pain and FAAM scores, there was both a dose dependent as well as injection dependent effect of particulate UC/AM tissue on foot pain reduction (100 mg &gt; 50 mg &gt;25 mg; 2 injections &gt; 1injection) suggesting a possible additive effect. Overall, these results are promising and highlight the potential effectiveness of UC/AM tissues as a treatment for plantar fasciitis.

Night Splinting for Idiopathic Trigger Digits.

This study assessed nighttime splinting for 6 weeks as treatment for recent onset idiopathic trigger fingers. Patients over 18 years with a Quinnell grade 1 or 2, idiopathic trigger finger or thumb causing symptoms for less than 3 months were eligible for a custom-made hand-based orthoplast night orthotic. Improvement of symptoms and/or resolution of triggering were recorded. Patients also completed the short version of the Disabilities of the Arm, Shoulder and Hand and a numerical rating scale for pain at the initial visit, after 6 to 8 weeks, and after 3 months. Thirty-four patients wore a night orthotic for at least 6 weeks. At final evaluation, there was a substantial reduction in disability and pain. Symptoms of triggering resolved completely in 18 patients (55%). Sixteen patients did not resolve their triggering after splinting and therefore underwent a steroid injection. Night splinting is a noninvasive treatment option for idiopathic trigger fingers/thumb with symptoms for less than 3 months.

Determination of the Effect of Hallufix Splint on Hallux Valgus Angle in Subjects with Mild and Moderate Hallux Valgus Compared with Night Splint: A Double-Blind Clinical Trial

Introduction: Hallux valgus is one of the most common foot disorders which is the subluxation of the first metatarsophalangeal (MTP) joint due to lateral deviation of the great toe and medial deviation of the first metatarsal bone. The most common interventions in cases with mild to moderate deformity is the use of orthosis which includes two types of splints, dynamic splint for daily use and static splint to be used during the night. The aim of this study was to compare the effect of hallufix dynamic splint on hallux valgus angle in subjects with mild and moderate hallux valgus with night splint. Materials and Methods: This quasi-experimental study was conducted on 34 subjects who had referred to orthopedic specialists in Isfahan and the surrounding towns, Iran, with complaints of hallux valgus. These subjects were divided into two groups of 17 people that were matched in terms of age, gender, and degree of deformity. Then, one group was given night splint and the other group hallufix splint, randomly. Hallux valgus angle was measured using anterior-posterior weight bearing radiograph at baseline and after 6 weeks of orthosis use. Results: The results showed that the use of both orthoses reduced the hallux valgus angle, but this reduction was not statically significant (P > 0.05). In addition, the effect of both splints on the reduction of hallux valgus angle was similar (P = 0.97). Conclusion: The use of night splint and hallufix dynamic splint for 6 weeks did not cause any improvement in hallux valgus angle.

The addition of a tension night splint to a structured home rehabilitation programme in patients with chronic plantar fasciitis does not lead to significant additional benefits in either pain, function or flexibility: a single-blinded randomised controlled trial

ObjectiveTo identify any improvements in pain or function in patients with chronic plantar fasciitis following the use of a tension night splint (TNS).MethodsSingle-blinded randomised controlled trial, with participants split evenly...

Injection versus Decompression for Carpal Tunnel Syndrome-Pilot trial (INDICATE-P)\u2014protocol for a randomised feasibility study

BackgroundCarpal tunnel syndrome (CTS) is the commonest peripheral nerve disorder in the UK, with over 52,996 carpal tunnel decompressions performed in 2011. By 2030, this figure is estimated to double. Whilst evidence supports conservative measures for mild symptoms, and early surgery for severe symptoms, controversy remains over the most appropriate management for patients that present with moderate disease, with regard to early surgery or late surgery following steroid injection. Injection versus Decompression for Carpal Tunnel Syndrome-Pilot trial (INDICATE-P) is a feasibility study for a multicentre, randomised controlled trial (INDICATE) to determine whether patients over the age of 18 with moderate CTS should undergo early surgical decompression of the median nerve or a single steroid injection (followed by later surgery if required).Methods/designINDICATE-P is a feasibility study for an open (non-blinded) randomised controlled pilot trial. Eligible participants will be adults with a clinical diagnosis of moderate CTS. This is defined as symptoms disturbing sleep or restricting activities of daily living or work, despite a 2-week trial of night splints. Participants will be randomised to one of two possible interventions: surgical decompression or a single steroid injection (followed by surgery later if required). Clinical outcome measures will be captured by postal questionnaire at 1, 3, 6 and 12 months post-randomisation. In order to improve the study design for the main INDICATE trial, feasibility data will also be collected to identify difficulties in recruitment and retention, to gain patient feedback on questionnaires and to confirm the suitability of the proposed outcome measures.DiscussionThe INDICATE-P feasibility study will contribute to the design and execution of the INDICATE trial, which will seek to assess the safety and effectiveness of two approaches to treatment for patients over 18 years of age with moderate CTS: early carpal tunnel decompression or a single steroid injection (followed by later surgery).

Evaluation of Serial Casting for Boys with Duchenne Muscular Dystrophy: A Case Report

ABSTRACTAim: To report the effects of below-knee serial casting in two boys with Duchenne muscular dystrophy who presented with well-preserved strength and calf shortening. Methods: Bilateral below-knee serial casts were applied over two weeks with follow-up of daily stretching and wearing of customized night splints. Outcome measures were performed at baseline, 1, 3, 6, and 12 months post-casting. These included measures of calf length, leg strength, motor function, endurance, and spatio-temporal gait parameters. Results: Both boys completed serial casting with gains in muscle length. No adverse effects on strength or motor function were observed over a 12-month follow-up period.