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Cureus Dec 2023Cubital tunnel syndrome (CuTS) is a neuropathic condition characterized by the compression or irritation of the ulnar nerve at the elbow, resulting in a wide spectrum of... (Review)
Review
Cubital tunnel syndrome (CuTS) is a neuropathic condition characterized by the compression or irritation of the ulnar nerve at the elbow, resulting in a wide spectrum of symptoms ranging from pain and numbness to muscle weakness and impaired hand function. This comprehensive review delves into the diverse landscape of CuTS treatment approaches, emphasizing the importance of early intervention. The review explores how these strategies aim to alleviate symptoms and enhance patient well-being by beginning with conservative measures encompassing rest, splinting, medications, physical therapy, and lifestyle adjustments. Non-surgical medical interventions, including nerve gliding exercises, ultrasound-guided nerve injections, and orthotic devices, are considered alternative therapies for symptom relief. Surgical interventions, such as decompression procedures and emerging techniques, are discussed in detail, highlighting their indications and expected outcomes. Throughout this review, the critical role of patient-centered care is underscored, emphasizing the need for tailored treatment plans that respect individual preferences and goals. Recognizing the unique nature of each CuTS case, shared decision-making between patients and healthcare providers is advocated, ensuring that interventions align with specific patient needs. As research advances, promising developments in diagnosis, surgical techniques, and drug therapies offer hope for more effective management of CuTS, paving the way for improved symptom relief and enhanced nerve function.
PubMed: 38288228
DOI: 10.7759/cureus.51262 -
Clinical Oral Investigations Jan 2024To evaluate the temporomandibular joint (TMJ), condylar and mandibular movements in obstructive sleep apnea (OSA) patients treated with mandibular advancement device...
OBJECTIVES
To evaluate the temporomandibular joint (TMJ), condylar and mandibular movements in obstructive sleep apnea (OSA) patients treated with mandibular advancement device (MAD) and to identify the influence of these anatomic factors on upper airway (UA) volume and polysomnographic outcomes after treatment.
MATERIALS AND METHODS
Twenty OSA patients were prospectively treated with MAD. Clinical examinations, cone-beam computed tomography, and polysomnography were performed before MAD treatment and after achieving therapeutic protrusion. Polysomnographic variables and three-dimensional measurements of the TMJ, mandible, and upper airway were statistically analyzed.
RESULTS
Condylar rotation, anterior translation, and anterior mandibular displacement were directly correlated with total UA volume, while vertical mandibular translation was inversely correlated with the volume of the inferior oropharynx. MAD treatment resulted in an increase in the volume and area of the superior oropharynx. There was no statistically significant correlation between condylar rotation and translation and polysomnographic variables. With MAD, there was a significant increase in vertical dimension, changes in condylar position (rotation and translation), and mandibular displacement. The central and medial lengths of the articular eminence were inversely correlated with condylar rotation and translation, respectively. The lateral length of the eminence was directly correlated with condylar translation, and the lateral height was directly correlated with condylar rotation and translation.
CONCLUSION
Condylar and mandibular movements influenced UA volume. The articular eminence played a role in the amount of condylar rotation and translation.
CLINICAL RELEVANCE
Individualized anatomical evaluation of the TMJ proves to be important in the therapy of OSA with MAD.
Topics: Humans; Occlusal Splints; Mandible; Sleep Apnea, Obstructive; Temporomandibular Joint; Cone-Beam Computed Tomography; Mandibular Advancement; Treatment Outcome
PubMed: 38286954
DOI: 10.1007/s00784-024-05513-9 -
Disability and Health Journal Jul 2024Motor Neurone Disease (MND), is a debilitating neurodegenerative condition, which significantly impacts the quality of life of those affected. Neck weakness is one...
BACKGROUND
Motor Neurone Disease (MND), is a debilitating neurodegenerative condition, which significantly impacts the quality of life of those affected. Neck weakness is one challenge faced by those living with MND and as such may require a neck collar to assist. However, the user experience and requirements related to these neck collars have not been comprehensively explored. Understanding these priorities is crucial for enhancing the well-being of MND patients.
OBJECTIVE
To understand the priorities of people living with Motor Neurone Disease (MND) including user experience, requirements and the importance of neck collars used to aid neck weakness.
METHODS
An online survey was used to investigate the perspectives and experiences of off the shelf neck collars used by people living with MND. The MND Association was selected as a strategic partner by their affiliations and access to large data base of MND patients.
RESULTS
Survey highlighted a disparity between the actual duration MND patients wear their current neck collars and their desired duration, emphasising the need to integrate collars into daily activities. Key areas for improvement with existing neck collars centred on comfort and reduced restriction, with respondents expressing a preference for collars that offer support without impeding movement. Additionally, addressing pressure on the anterior neck region during collar use emerged as a critical requirement.
CONCLUSION
Current collars do not cause any clinical complications; however, they do fall short of meeting the expected needs of people living with MND, including discomfort, restricted movement, and pressure to the anterior region of the neck. This study highlights need to improve current collar designs to provide better quality of life for MND patients.
Topics: Humans; Motor Neuron Disease; Male; Female; Middle Aged; Quality of Life; Surveys and Questionnaires; Aged; Adult; Neck; Disabled Persons; Activities of Daily Living; Patient Preference; Muscle Weakness; Self-Help Devices; Orthotic Devices
PubMed: 38280827
DOI: 10.1016/j.dhjo.2024.101585 -
Medicina (Kaunas, Lithuania) Dec 2023Adolescent idiopathic scoliosis (AIS) is a lateral, rotated curvature of the spine. It is a 3-dimensional deformity that arises in otherwise healthy children at or... (Review)
Review
Adolescent idiopathic scoliosis (AIS) is a lateral, rotated curvature of the spine. It is a 3-dimensional deformity that arises in otherwise healthy children at or around puberty. AIS is the most common form of scoliosis in the pediatric population. The etiology is multifactorial, including genetic and environmental factors. The incidence is roughly equal between males and females, while there is a higher risk of progression in females. Guidelines for AIS treatment identify three levels of treatment: observation, physiotherapy scoliosis-specific exercises, and braces. In this paper, we carried out a review of the scientific literature about the indication and success rates of the braces provided for free by the National Health Service in Italy (SSN). Despite a general consensus on the efficacy of rigid bracing treatment and its use in AIS, an important heterogeneity about the treatment is present in the scientific literature, demonstrating a high degree of variability. The overall success rate of the braces provided by the SSN is high, suggesting an important therapeutic role in the treatment of AIS. Robust guidelines are needed to ensure uniform and effective treatments.
Topics: Male; Female; Humans; Adolescent; Child; Scoliosis; State Medicine; Braces; Spine; Italy
PubMed: 38276037
DOI: 10.3390/medicina60010003 -
Journal of Indian Prosthodontic Society Jan 2024Disc displacement with reduction (DDwR) is among the common disc disorders of temporomandibular joint (TMJ), which can be managed conservatively by splint therapy.... (Meta-Analysis)
Meta-Analysis Review
Effectiveness of anterior repositioning splint versus other occlusal splints in the management of temporomandibular joint disc displacement with reduction: A meta-analysis.
BACKGROUND
Disc displacement with reduction (DDwR) is among the common disc disorders of temporomandibular joint (TMJ), which can be managed conservatively by splint therapy. Anterior repositioning splint (ARS) is the most commonly prescribed splint by dental practitioners, but not getting a normal disc-condyle relationship always and other side effects lead to need of comparing with other occlusal splints. This review will help in informed decision-making by clinicians in choosing an appropriate splint type for patients.
AIM
The aim is to compare the effectiveness of ARS in the management of DDwR with other occlusal splints for TMJ and muscle pain, TMJ noise, any adverse effects, regaining normal disc-condyle relationship.
MATERIALS AND METHODS
We followed published protocol in the International prospective register of systematic reviews. Databases were searched till May 2023 using different search strategies as per the database. Title and abstract screening, followed by full-text screening and data extraction with risk of bias, was done by two independent reviewers in Covidence. Outcomes were reported as risk ratio (RR) or mean difference (MD) for dichotomous or continuous outcomes, respectively, using RevMan 5.4 (Review Manager 5.4) software. We used a random effect model for statistical analysis. Certainty of evidence was assessed using the Grading of Recommendation, Assessment, Development, and Evaluation Guideline Development Tool (GRADEpro GDT) software.
RESULTS
A total of 1145 reports were found from a database search. After screening, four studies were included for systematic reviews. Other occlusal splints reported were sagittal vertical extrusion device and mandibular ARS, full hard stabilization splint of canine or centric stabilization type. Data of only two studies could be used for meta-analysis having 30 participants received ARS and 40 received other occlusal splints. We did not find evidence of any difference between ARS and other occlusal splints for TMJ clicking in short term (RR 1.25, 95% confidence interval [CI] 0.91-1.72) but a small difference in favor of other occlusal splint in long term (RR 2.40, 95% CI 1.04-5.55). No evidence of any difference was found between both treatments for TMJ pain in short term (MD-5.68, 95% CI-17.31-5.95) and long term (MD 0.00, 95% CI-2.86-2.86) and muscle pain in short term. The certainty of evidence for comparison of two treatments for different outcomes was of low or very low level.
CONCLUSION
Evidence is uncertain that other occlusal splints reduced TMJ clicking slightly in comparison to ARS. For the remaining outcomes, no evidence of any difference was found between the two splints and it may be biased due to selection bias, inadequate blinding of participants, and outcome assessor.
Topics: Humans; Occlusal Splints; Splints; Dentists; Myalgia; Temporomandibular Joint Disc; Professional Role; Systematic Reviews as Topic; Temporomandibular Joint Disorders; Cartilage Diseases
PubMed: 38263554
DOI: 10.4103/jips.jips_355_23 -
The Journal of Bone and Joint Surgery.... Mar 2024The Proximal Femur Maturity Index (PFMI) can be used to assess skeletal maturity on existing whole-spine radiographs without additional radiation. However, the...
BACKGROUND
The Proximal Femur Maturity Index (PFMI) can be used to assess skeletal maturity on existing whole-spine radiographs without additional radiation. However, the relationship between the PFMI at the initiation of bracing for adolescent idiopathic scoliosis (AIS) and subsequent curve progression remains unknown. This study aimed to investigate the relationship between the PFMI and curve progression, and the predictability of risks to adulthood curve progression and surgical thresholds based on the PFMI grade at brace initiation.
METHODS
This was a prospective study of 202 patients with AIS who were prescribed underarm bracing according to the Scoliosis Research Society criteria and had good brace-wear compliance. The patients were followed from brace initiation until complete skeletal maturity. Longitudinal data on the coronal Cobb angle and skeletal maturity assessments using Risser staging, Sanders staging, the distal radius and ulna classification, and the PFMI were collected. Each patient was assessed on whether the major curve progressed to ≥40° (adulthood deterioration) and ≥50° (the surgical threshold). Logistic regressions were used to predict probabilities of curve progression to the 2 thresholds, adjusted for factors that were significant in univariate analyses.
RESULTS
The PFMI correlated with the other skeletal maturity indices (r s [Spearman rank correlation] = 0.60 to 0.72, p < 0.001 for all). The pre-brace PFMI grade correlated with progression to ≥40° (r rb [rank-biserial correlation] = -0.30, p < 0.001) and to ≥50° (r rb = -0.20, p = 0.005). Based on regression models (p < 0.001) adjusted for the pre-brace major Cobb angle and curve type, brace initiation at PFMI grades 2 and 3 for a curve of ≥30° had predicted risks of 30% (95% confidence interval [CI], 4% to 55%) and 12% (95% CI, 7% to 17%), respectively, for progression to the surgical threshold. Brace initiation at PFMI grade 5 had 0% progression risk.
CONCLUSIONS
The PFMI can be used for predicting curve progression and prognosticating brace outcomes in AIS. Patients with brace initiation at PFMI grade 4 for a curve of <30° or at grade 5 were unlikely to progress to the adulthood deterioration or surgical threshold. In comparison, skeletally immature patients initiating bracing at a PFMI grade of ≤3 for a major curve of ≥30° had a higher risk of progression despite compliant brace wear.
LEVEL OF EVIDENCE
Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.
Topics: Humans; Adolescent; Scoliosis; Prospective Studies; Retrospective Studies; Spine; Braces; Kyphosis; Femur; Disease Progression; Treatment Outcome
PubMed: 38261654
DOI: 10.2106/JBJS.23.00694 -
International Journal of Orthopaedic... May 2024The adhesive elastic tape use is indicated for controlling oedema, although currently there is not the definitive evidence regarding its effectiveness. Wrist fractures...
BACKGROUND
The adhesive elastic tape use is indicated for controlling oedema, although currently there is not the definitive evidence regarding its effectiveness. Wrist fractures are a frequent occurrence, often leading to oedema development in patients treated with forearm casts. This pilot study aims to investigate the effects of elastic tape in controlling hand oedema among patients with forearm casts for wrist fractures and the feasibility of a future randomized controlled trial.
METHODS
The study was conducted on adult patients with unilateral conservatively treated wrist fracture. The tape was applied to the intervention group after cast application, while the control group received the standard treatment. The circumference difference between baseline and the 7-day follow-up of both the 1st finger and the remaining 4 fingers merged together was evaluated. Ethical approval for the study has been obtained.
RESULTS
23 participants were enrolled. The intervention group showed a higher reduction in finger circumferences compared to the control group (median difference T1-T0 No tape vs Tape: 0 cm vs -0.2 cm for the 1st finger and 0.5 cm vs -0.5 cm for the remaining 4 fingers), although the changes were not statistically significant.
CONCLUSION
Although the number of enrolled patients was limited due to Covid-19 pandemic, the study results suggest a potential reduction in oedema after the use of adhesive elastic tape, justifying the needed of a future full-scale study. Given its low cost and ease of use, we believe that tape can be considered in clinical practice.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT04683887.
Topics: Humans; Pilot Projects; Edema; Male; Female; Casts, Surgical; Middle Aged; Wrist Injuries; Adult; Aged; Athletic Tape; COVID-19; Wrist Fractures
PubMed: 38261469
DOI: 10.1016/j.ijotn.2023.101059 -
Effects of elastic taping on kyphosis and body balance in the elderly: a randomized crossover study.Scientific Reports Jan 2024Kyphosis produces abnormal posture and reduced body balance in the elderly. Elastic tape may be useful at improving kyphotic posture and body balance. This study aims to... (Randomized Controlled Trial)
Randomized Controlled Trial
Kyphosis produces abnormal posture and reduced body balance in the elderly. Elastic tape may be useful at improving kyphotic posture and body balance. This study aims to evaluate the effects of elastic taping on kyphosis and body balance in the elderly. Ten elderly participants with degenerative kyphotic posture were recruited and randomly assigned to two groups (back taped with stretched elastic tape for 15 min and back taped with non-stretched elastic tape for 15 min). After a 1-h washout period, the groups were swapped over to receive the other intervention. The outcomes measured after each taping technique were Cobb's angle measurement by inclinometer, perceived pain, and balance measurements by single leg stance test, time up and go test, center of gravity alignment (COG) and modified clinical test of sensory interaction on balance test (mCTSIB). There was a significant reduction in kyphotic angle and back pain in both the stretched and non-stretched taping groups (p < 0.05). We also found both taping techniques significantly reduced sway velocity on a foam surface with eyes closed and open (p < 0.05). However, there was no significant difference between taping groups for kyphotic angle, pain reduction or balance. The application of 15 min of stretched and non-stretched elastic tape in the elderly reduced kyphotic angle, back pain, and sway velocity while standing on foam surface in the mCTSIB test. If these changes persist over the long term (days and weeks) taping may be a useful intervention for elderly patients with kyphosis.
Topics: Humans; Aged; Postural Balance; Cross-Over Studies; Time and Motion Studies; Back Pain; Kyphosis; Athletic Tape
PubMed: 38228810
DOI: 10.1038/s41598-024-52047-x -
Hand Surgery & Rehabilitation Apr 2024This study investigated whether dorsoradial ligament repair with internal brace augmentation provided more immediate stability in the trapeziometacarpal joint than...
This study investigated whether dorsoradial ligament repair with internal brace augmentation provided more immediate stability in the trapeziometacarpal joint than dorsoradial ligament repair alone. Seven matched pairs of cadaveric hands were used. One specimen from each pair was assigned to the repair-only group and the other to the repair + internal brace augmentation group. Trapeziometacarpal joint range of motion and translation were quantified under different conditions for both groups: (1) intact, (2) transected dorsoradial ligament, and (3) repaired dorsoradial ligament or repaired dorsoradial ligament plus internal brace augmentation. Load-to-failure tests were performed after repair. Range of motion and translation were increased by dorsoradial ligament transection and were decreased by dorsoradial ligament repair; however, compared to the intact condition, the repair-only group demonstrated greater flexion/extension range, while the repair + internal brace group showed no significant difference in range of motion. Mean loads at 2- and 3-mm displacements were greater in the repair + internal brace group than in the repair-only group (18.0 ± 1.8 N vs. 10.8 ± 1.3 N for 2 mm displacement and 35.3 ± 3.7 N vs. 23.1 ± 2.9 N for 3 mm displacement, respectively). Internal brace augmentation improved the load-to-failure characteristics of dorsoradial ligament repair without compromising range of motion. LEVEL OF EVIDENCE: IV.
Topics: Humans; Ligaments, Articular; Range of Motion, Articular; Braces; Biomechanical Phenomena; Cadaver; Carpometacarpal Joints; Female; Male; Middle Aged; Aged
PubMed: 38228245
DOI: 10.1016/j.hansur.2024.101643 -
Irish Journal of Medical Science Jun 2024
Letter to the editor regarding Unuvar BS, Yilmaz K, and Celik F: the acute effects of brace use on lower extremity performance in individuals with adolescent idiopathic scoliosis. Ir J Med Sci. 2023.
Topics: Humans; Scoliosis; Lower Extremity; Adolescent; Braces; Female
PubMed: 38217673
DOI: 10.1007/s11845-024-03605-9