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Objective: Does early treatment of spasticity with botulinum-toxin (BoNTA), in (hyper)acute stroke patients without arm-function, reduce contractures and improve function. Design: Randomised placebo-controlled-trial Setting: Specialised stroke-unit. Participants & Intervention: Patients with an Action Research Arm Test (ARAT) grasp-score⩽2 who developed spasticity within six-weeks of a first stroke were randomised to receive injections of: 0.9%sodium-chloride solution (placebo) or onabotulinumtoxin-A (treatment). Outcome-Measures: Spasticity, contractures, splint use and arm function (ARAT) were taken at baseline, 12-weeks post-injection and six-months after stroke. Additionally, spasticity and contractures were measured at weeks-two, four and six post-injection. Results: Ninety three patients were randomised. Mean time to intervention was 18-days (standard deviation = 9.3). Spasticity was lower in the treatment group with difference being significant between week-2 to 12 (elbow) and week-2 to 6 (wrist). Mean-difference (MD) varied between –8.5(95% CI –17 to 0) to –9.4(95% CI –14 to –5) µV. Contracture formation was slower in the treatment group. Passive range of motion was higher in the treatment group and was significant at week-12 (elbow MD6.6 (95% CI –0.7 to –12.6)) and week-6 (wrist MD11.8 (95% CI 3.8 to 19.8)). The use of splints was lower in the treatment group odds ratio was 7.2 (95% CI 1.5 to 34.1) and 4.2 (95% CI 1.3 to 14.0) at week-12 and month-6 respectively. Arm-function was not significantly different between the groups MD2.4 (95% CI –5.3 to 10.1) and 2.9 (95% CI –5.8 to 11.6) at week-12 and month-6 respectively. Conclusion: BoNTA reduced spasticity and contractures after stroke and effects lasted for approximately 12-weeks. BoNTA reduced the need for concomitant contracture treatment and did not interfere with recovery of arm function. Trial Registration: EudraCT (2010-021257-39) and ClinicalTrials.gov-Identifier: NCT01882556. [ABSTRACT FROM AUTHOR]

Background: Although extension block pinning for mallet fracture is popular, it occasionally results in poor outcome. We reviewed previous cases to elucidate the factors associated with poor outcome. Methods: From 2012 to 2017, 50 mallet fingers in 50 patients were consecutively repaired by extension block pinning using modified Ishiguro method. Inserted Kirschner-wires (K-wires) were removed at 6 weeks, followed by night splinting in extension. For outcome evaluation, distal interphalangeal (DIP) joint motion was measured and classified as either good or poor. Poor outcome was defined as either > 10° of extension lag or < 40° of active flexion or the presence of DIP joint pain. Associations between outcome and age, affected finger, interval to operation, fragment size (in terms of joint surface and dorsal cortex ratios), and fixation angle were evaluated. Results: 33 fingers (66%) had good outcome and 17 (34%) had poor outcome. Mean age was significantly greater in the poor (50.6 years) than in the good (40.1 years) outcome group (p < 0.05). The dorsal cortex ratio was also significantly larger in the poor than in the good outcome group (p = 0.006), but there was no significant difference between two groups in joint surface ratio. Affected finger, interval to surgery, and fixation angle also did not significantly differ between groups. Conclusions: Fracture fragments with a long dorsal cortex and older age associated with poor outcome following extension block pinning for mallet finger. The dorsal cortex ratio should be evaluated pre-operatively to determine the appropriate treatment method. [ABSTRACT FROM AUTHOR]

Background: Stack splint is commonly used for mallet finger treatment but patients had a tendency to frequently remove it because of skin complications. We hypothesized that a comprehensively instructed splinting regime would increase patients' compliance and lead to favorable outcomes with fewer skin complications. The aims of this study were to assess the patients' compliance and to evaluate outcomes with that particular splinting regime. Methods: Forty-six consecutive patients were enrolled in this prospective study. They were instructed to wear the Stack splint for 24 hours a day every day in the first six weeks and remove it once a day for 10 minutes to vent. They were told to support distal interphalangeal joint volarly both while wearing the splint and when it was removed. Free movement of proximal interphalangeal joint within the splint was checked after each application. Following whole-day regime for 6 weeks, night splinting continued for 2 more weeks. Range of motion, skin complications, patients' compliance and satisfaction were assessed at last follow-up. Results: There were 26 patients with a mean age of 39.8 and mean follow-up period of 6.7 months. No skin complications or proximal interphalangeal joint stiffness were reported. However, nine patients declared that they wore the splint ≤ 4 weeks, the compliance rate to our regime was 65.4% (17/26). In the 17 fully compliant patients, mean distal interphalangeal joint extension lag was 12.4 and nine of them (52.9%) were satisfied with the outcome. Conclusions: Our both hypotheses failed; comprehensive instructions for the splinting regime did not improve patients' compliance satisfactorily, nor did it lead to favorable outcomes. Although Stack splint has practical points, we no longer use it. [ABSTRACT FROM AUTHOR]

Introduction: Windblown hand or congenital ulnar drift of hand is a rare deformity which affects all the digits including the thumb and can lead to functional impairment. Associated syndromes affecting the head, face, and feet should be ruled out. Windblown hand has three main features: (1) Contracture of the fingers with flexion deformity, (2) adduction contracture of the thumb causing narrowing of the first webspace, and (3) ulnar deviation of the fingers at the metacarpophalangeal joint. Early treatment is effective. Methods: We performed surgical correction in three cases of bilateral windblown hands. The extensor digitorum tendons were repositioned over the metacarpophalangeal heads by longitudinal plication of radial sagittal bands. In one case, skin contracture release for the first webspace was also done. Splinting with radial deviation and extension at metacarpophalangeal joint was done for 3 weeks. The average follow-up time was 6 months. Results: No skin necrosis or infection was seen in postoperative period. The patient satisfaction ranged from very good to excellent. For all the patients, first, the nondominant hand was operated, then all opted for surgical correction of the opposite hand as well. Conclusions: Windblown hand can lead to functional impairment and needs early correction. Parents and patients should be counseled about the chances of recurrence and incomplete correction. However, surgical treatment and subsequent physiotherapy can improve the functional range and aesthetics of the hand. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Osteoporosis / Turk Osteoporoz Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Seymour fractures occur in the form of juxta-epiphyseal fractures in the distal phalanx bone of children, which are often accompanied by nail bed injuries. These fractures are also associated with complications such as nail deformity, infection, and growth disturbance. This report introduces a 6-year-old boy whose Seymour fracture occurred with the interposition of the nail bed on the fracture site, resulting in nonunion and nail deformity in the form of bipartite growth. Nail bed injuries could be accompanied by Seymour fractures and their treatment is independent of the fracture treatment. Nail bed repair can prevent subsequent deformities. [ABSTRACT FROM AUTHOR]

The chronic sequelae of stroke are often a strong limitation to patient's quality of life. New non-invasive elective treatments are required to support postural and functional improvements long after the primary insult. This study is an uncontrolled pilot evaluation of pseudoelastic orthotics for post-stroke upper-limb rehabilitation. Six chronic hemiplegic patients (3.8 ± 1.7 years since stroke) were evaluated with clinical scales, covering the ICF domains of body functions and structures (Modified Ashworth Score [MAS], Medical Research Council Scale for Muscle Strength, Fugl-Meyer [FM], Motricity Index [MI]), activities (Wolf Motor Function Test [WMF], Motor Activity Log [MAL]) and participation (quality of life questionnaires); sensors applied to the orthosis were used to assess changes in the articular and functional domains over a month's treatment. Significant gains were achieved in elbow spasticity (MAS, p =.020), upper-limb motor function (FM, p =.005), reaching task (p =.035), and gait (p =.00046) speed. Most patients improved in functional tasks (WMF), but this did not reflect in daily-life activities as measured with MAL. Some patients reported an improved quality of life, especially the quality of sleep. Pseudoelastic orthoses could be a comfortable and useful adjunct in the long-term management of stroke. Broader trials will have to confirm these preliminary observations. Use of new materials in neuromuscular rehabilitation. Customised and adjustable therapeutic action obtained with dynamic personalised orthoses. Non-invasive interventions could be of help for patients with chronic disability. [ABSTRACT FROM AUTHOR]

Introduction: Distal radius fractures are extremely common injuries affecting a wide range of patient demographics. The purpose of this study was to evaluate the outcomes of distal radius fractures managed initially with closed reduction and immobilization in either a below elbow volar–dorsal splint versus sugar-tong splint prior to conversion into a short arm cast. Methods: We performed a retrospective study of patients with distal radius fractures placed in a sugar-tong (n = 45) and volar–dorsal splint (n = 36). Anteroposterior and lateral radiographs were evaluated immediately after closed reduction and placement into either a sugar-tong or volar–dorsal splint. The radial inclination, radial length, volar tilt, and intra-articular displacement were measured. Results: The average age was not significantly different between groups (Diff: 1.1 years, P = 0.8766). Initial clinic follow-up radiographs illustrated significantly lower radial inclination in the sugar-tong group than volar–dorsal group (17.1 vs. 19, P = 0.0443). Follow-up mean radial length was not significantly lower in the sugar-tong than volar–dorsal group (8.4 vs. 9.2, P = 0.0858). Palmar tilt and articular step-off was not significantly different between splint types. The loss of reduction was 28.8% for the sugar-tong and 25.0% for the volar–dorsal group (P = 0.696). Conclusion: Our results did not demonstrate a significant difference in loss of reduction rates between the two splint groups. There was no significant difference between the sugar-tong and volar–dorsal groups in terms of loss of radial length and volar tilt. Loss of reduction was similar between groups suggesting no advantage of a volar–dorsal splint compared to a sugar-tong splint. Level of evidence: Therapeutic level III. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to examine the effectiveness of intraoral thermoformed splint with a magnet device over a period of 3 months, that is, to assess acceptability of this method of treatment using both objective and self-reported measures.Materials and Methods: This study was designed as a prospective clinical pilot trial. 22 patients with xerostomia and hyposalivation were included. Xerostomia was assessed using a 4-question xerostomia questionnaire score and a test for unstimulated salivary flow rates. Evaluations were performed before the treatment and 3 months after the treatment using a thermoformed splint with a magnet device.Results: There was a significant reduction in subjective symptoms after using a thermoformed splint with a magnet device for 3 months. For all 4 scored items, there was a statistically significant difference (P < .001) in median VAS scores before and 3 months after treatment. There was also a statistically significant difference in USFR before (0,15 ± 0,04 ml/min) and after treatment (0,24 ± 0,03 mL/min).Conclusion: Our findings indicate that the use of this device alleviated oral dryness and stimulated the function of the submandibular salivary gland. An intraoral thermoformed splint with a magnet device is safe, physiologically indifferent, useful, and effective in treating xerostomia and hyposalivation. [ABSTRACT FROM AUTHOR]

Electronic Web-based survey. Therapists participating in an international survey selected relative motion extension (RME) as the "most used" approach for the postoperative management of zones V and VI extensor tendon repairs. A subgroup of respondents identified RME as their preferred approach and were asked about their routine RME practices. The purpose of this study was to capture data from routine RME users about their practices and compare this with the RME evidence. An English-language survey was distributed to 36 International Federation of Societies for Hand Therapy full-member countries. Participation required therapists to have postsurgically managed at least one extensor tendon repair within the previous year. Those who selected RME as their "most used" approach were asked to identify which variation of the RME approach they favored: RME plus (with wrist orthosis), RME only , or "both" RME plus and RME only , and then were directed to additional questions related to their choice. Respondents from 28 International Federation of Societies for Hand Therapy full-member countries completed the survey. RME users (N = 368; 41.5% of sample) contributed to this secondary data. Respondents favored the RME variation "RME plus " (47%), followed by "both" (44%), then "RME only " (9%) with most managing single digit/simple injuries (n = 287, 81%) versus multiple digit/complex injuries (n = 96, 27%), and partial repairs (n = 278, 79%). Practices not aligning with limited level II-IV evidence includes half of RME only users not adding/substituting an overnight orthosis; use of RME plus versus RME only for both repairs of independent extensor tendons and repairs proximal to the juncturae tendinum; fabrication of three not four-finger orthotic design; and restricting use to only repairs of one or two fingers. RME plus and RME only are used interchangeably depending on surgeon preferences and patient/tendon factors. Compared with RME plus , from this survey, it appears that the RME only approach yields similar uncomplicated, early return of motion and hand function. • Survey of 992 therapists from 28 IFSHT member countries selected relative motion extension (RME) as the "most used" approach for managing zones V and VI extensor tendon repairs. • Therapist interchangeably use RME with the wrist orthosis (RME plus) and RME only depending on surgeon preferences and patient/tendon factors. • Compared with RME plus , it is unclear whether respondents believe the RME only approach contributes to earlier return of motion, hand function, or fewer complications. [ABSTRACT FROM AUTHOR]

This is a case report. Anconeus is a small, triangular muscle in the posterior aspect of the elbow, and it functions as weak elbow extensor and abducts the ulna during pronation. The contribution of anconeus muscle can cause lateral elbow pain, which is difficult to diagnose and treat. It also does not respond to the regular treatment for lateral epicondylitis. The purpose of this study was to report anconeus muscle irritation as a sole cause for lateral elbow pain. The patient was given an elbow splint for 4-6 weeks followed with eccentric and concentric strengthening to the elbow and wrist. At the end of week 9, the patient was pain-free. The clients who are not responding with the usual treatment of lateral epicondylitis should be considered for any anconeus involvement. • Anconeus muscle is a small triangular muscle seen in the posterior aspect of the elbow. • The anconeus muscle is reported as a weak accessory extensor to the triceps brachii. • It abducts the ulna during pronation. • Anconeus, as a sole cause for the elbow pain is sparely reported in the literature. • Anconeus irritations can cause lateral elbow pain may mimic lateral epicondylitis. • All nonresponding patient should be evaluated for anconeus involvement. [ABSTRACT FROM AUTHOR]

Aim: Splint use is often recommended following wrist injection patients diagnosed with carpal tunnel syndrome (CTS), but there is not any data in the literature pertaining to the impact of splint treatment, used before injection, on the results of local injection treatment. The aim of this study to evaluate whether or not splint use starting before the injection would impact the local injection treatment outcomes. Materials and methods: Fifty seven patients (57 hands) with CTS and underwent ultrasound-guided injection were included in the study, and patients were divided into two groups in terms of splint use. Median nerve cross-sectional area (MNCSA), pain/numbness by visual analogue scale (VAS), symptoms and functionality by Boston Carpal Tunnel Questionnaire (BCTQ) were investigated before injection and 15 days after injection. Results: There was significant change over time in MNCSA, VAS, and BTCQ scores in groups. The patients not using splint group had significantly higher percentage change in VAS nighttime score. Conclusion: Our findings has shown that using neutral wrist splint, starting before and continuing after injection treatment, did not increase the injection treatment efficacy and may actually have negative effect on improvement in VAS nighttime scores. [ABSTRACT FROM AUTHOR]

This randomized clinical trial investigated the potential for early mobilization of the wrist following open reduction and internal fixation (ORIF) with a scaphoid specific volar locking plate and non-vascularized bone graft for scaphoid non-union. 16 patients with scaphoid non-union underwent internal fixation with a scaphoid-specific volar locking plate and iliac crest bone graft and were randomized to one of two treatment arms (A) The control were immobilized in a below elbow cast for 6 weeks (n = 9) and (B) The experimental arm were mobilized early with a removable wrist splint (n = 7). Outcomes were measured preoperatively, and at 3 months post operatively. These included the primary outcome of union, and secondary outcomes of grip strength and patient reported outcomes of disabilities of arm shoulder and hand (DASH) and patient reported wrist evaluation (PRWE). Discrete variables were analyzed using the chi squared test while continuous variables used the students t-test. The experimental (early mobilization) group developed metalware complications resulting in the early termination of the study. No significant difference in the demographic characteristics of age, gender, time to surgery, smoking status and handedness was found between groups. A significant difference was found in BMI, with significantly higher proportion of obese patients (p = 0.05) in the experimental group. There was no significant difference in the primary outcome measure of the rate of union between groups. The secondary outcomes of grip strength, Dash and PRWE also showed no significant difference between the immobilized and mobilized groups. We recommend immobilization following scaphoid non-union ORIF using a volar locking plate due to high complication rates in our cohort with early mobilization. Type of study/level of evidence: Therapeutic 2. Trial registration. Australian New Zealand Clinical Trials Registry (ACTRN12614001050640). Date of registration, 02/10/2014. [ABSTRACT FROM AUTHOR]

Study Design: Cross-sectional comparison. Introduction: Forearm supination range of motion is often limited by short or stiff pronators. Many studies have examined maximal isometric forearm supination torque (MIFST). However, there is little research comparing MIFST in two elbow positions between subjects with and without limited forearm supination range of motion (LSR). Purpose of the Study: The purpose of this study was to compare MIFST in two elbow positions (90º flexed elbow, extended elbow) between subjects with and without LSR. Methods: Thirteen right-handed subjects (seven men, six women) with LSR and 13 age- and gender-matched healthy controls participated in this study. The forearm supination range of motion and MIFST were measured using a Smart KEMA system. Two-way repeated-measures analysis of variance was used to compare MIFST in two elbow positions between subjects with and without LSR. Results: No significant difference between groups (p >.05) was found. However, there was an interaction effect between elbow position and group on MIFST (p <.05). Independent t-tests were used to confirm the simple effects. In the LSR group, the value of MIFST was significantly lower in the elbow-extended position than in the group without LSR (p <.05). Conclusions: These findings indicate that elbow position should be considered when assessing the strength or increasing the strength of the supinator muscle, especially in patients with LSR. [ABSTRACT FROM AUTHOR]

Background: Stabilization of luxated, avulsed, and root-fractured teeth is a part of the dental trauma treatment. The aim of the study was to assess the power chain and its comparison with two commonly used splinting materials. Methods: The evaluated splints were a wire-composite splint (WCS) with a diameter of 0.5 mm, a titanium trauma splint (TTS), and a power chain-composite splint (PCS). The splints were all fixed to the labial surfaces of permanent maxillary incisors in 10 human volunteers. The following parameters were measured: tooth mobility with Periotest before and after the splint application and removal, Aproximal Plaque Index (API), Sulcus Bleeding Index (SBI), and time needed to apply and to remove the splint. Each volunteer was also given a visual analogue scale (VAS) questionnaire to assess his/her subjective attitudes to splint materials. Results: The PCS was the most flexible material as it had the lowest horizontal Periotest values. For the two other methods, horizontal splint effects were similar and were also low. The PCS was the fastest to apply and remove and was also the most aesthetic splint. Conclusion: In this experimental study among volunteers, all three tested materials were found suitable for splinting the PCS has some advantages worth it to be further evaluated clinically in trauma patients. [ABSTRACT FROM AUTHOR]

Copyright of Kieferorthopädie: die Zeitschrift für die Praxis is the property of Quintessenz Verlags GmbH and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Few studies report on periprosthetic humeral shaft fractures after reverse total shoulder arthroplasty (RTSA). The authors evaluated outcomes of 5 patients with this complication who were initially treated nonoperatively. Of 152 patients who underwent RTSA at the authors' institution from 2012 to 2017, 4 experienced periprosthetic humeral shaft fractures. One patient was referred to the authors for fracture treatment. All 5 patients were initially treated nonoperatively. The mean duration of follow-up was 11.5 months (range, 1.5-26 months). The authors analyzed time to fracture union, Single Assessment Numeric Evaluation (SANE) score, visual analog scale (VAS) score for pain, and active shoulder range of motion. Fracture union occurred in 4 patients treated nonoperatively at a mean of 4.4 months. Mean SANE score was 55 of 100 (range, 20-85). Mean VAS score was 3.4 of 10 (range, 0-8). Mean forward elevation was 83° (range, 45°-110°); mean abduction was 65° (range, 45°-80°); and mean external rotation with the arm at the side was 15° (range, 0°-30°). Many factors must be considered when customizing treatment for patients with periprosthetic fracture after RTSA. This case series indicates that nonoperative treatment of postoperative periprosthetic humeral shaft fractures can be successful. [Orthopedics. 2020;43(6):e553-e560.]. [ABSTRACT FROM AUTHOR]

Objectives: There is no consensus on whether conservative treatment with night splints is indicated also in moderate and severe stages of carpal tunnel syndrome (CTS). The goal of this study was to compare the efficacy of night-time splinting at different stages of CTS.Material and Methods: Forty-five patients with electrodiagnostic (EDX) features of CTS included in the study were divided into 2 groups based on nerve conduction studies. The patients in the first group had only median nerve sensory fiber involvement, whereas the patients in the second group had also motor fiber involvement. The custom-made volar night splint was the only treatment for all of the included patients. The patients were assessed before the fabrication of orthosis and after 12 weeks of its use. The parameters measured were hand grip strength and the Visual Analogue Scale for pain and paraesthesia. The patients further completed the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) and a shorter version of the Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH).Results: In the first group, a statistically significant improvement was established in paraesthesia and hand grip strength (p = 0.019, p = 0.024, respectively), but there was no statistically significant improvement in pain, and the results of both BCTQ and QuickDASH. In the second group, a statistically significant improvement was found in paraesthesia, the BCTQ Symptom Severity Scale and QuickDASH results (p = 0.008, p < 0.001, p = 0.011, respectively), whereas no statistically significant improvement was established in pain, hand grip strength and the BCTQ Functional Status Scale. However, when comparing the change in the outcome measures between the 2 groups, no statistically significant differences were found.Conclusions: This study has shown that 12-week night-time splinting is beneficial not only for patients with mild CTS but also for those with advanced CTS, and those awaiting surgical treatment. Therefore, splinting is recommended for all patients with CTS. Int J Occup Med Environ Health. 2020;33(6):771-80. [ABSTRACT FROM AUTHOR]

Copyright of Quintessenz der Zahntechnik is the property of Quintessenz Verlags GmbH and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The prosthetic rehabilitation in temporomandibular disorders is a challenging task, This article reviews about the present condition and provides the data regarding the treatment needs of the TMD patients and what approach should be followed the practitioner. There has been tremendous development in Evaluating through MRI, it was inferred that the splint therapy through various means reduced the risk of the temporomandibular disorders by eliminating the etiological factor. Furthermore it allowed the patient to cope with the disease such as disk displacement with greater tolerance rate. Moreover, after treatment the patients are likely to cope with disc displacements with larger or smaller tolerance. [ABSTRACT FROM AUTHOR]

Introduction: Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment. Various treatments have been suggested for CTS and there is no consensus on their superiority and the order of their use. Laser therapy is a non-invasive treatment method for many musculoskeletal diseases, including CTS. This study aimed to determine and compare the effect of high-power lasers (HPLs) and low-power lasers (LPLs) on pain severity, function, pinch strength, and nerve conduction study findings in patients aged 30-50 years with mild or moderate CTS. Methods: This is a prospective, randomized, single-blind clinical trial. The study population included 45 patients aged 30-50 years who came to the physical medicine and rehabilitation clinic of Shohada-e-Tajrish hospital and mild or moderate CTS was confirmed for them. Patients were randomly assigned to control, LPL therapy, and HPL therapy groups. Pain, function, pinch strength, and nerve conduction study findings were recorded in all groups before, immediately and 12 weeks after the treatment. All data were compared using SPSS version 21. Results: All groups showed improvement regarding pain, function, and pinch strength. Laser therapy showed significantly better results compared to a wrist splint, but no significant difference was seen between high-power and LPL therapy groups. Nerve conduction evaluation findings did not reveal any significant difference. Conclusion: Both the wrist splint and laser therapy can improve the symptoms of carpal tunnel syndrome. HPL therapy showed better results, although not significantly different from LPL therapy. [ABSTRACT FROM AUTHOR]

AUTH Why you should read this article: • To enhance your knowledge of the different types of mallet finger injury • To explore the different splints available for immobilising a closed tendinous mallet finger injury • To understand the importance of optimal patient education and patient adherence Mallet finger injuries are a common presentation in the emergency department. These injuries result from a forced flexion at the distal interphalangeal joint (DIPJ) that causes extensor tendon disruption, and possibly bone avulsion, at the base of the distal phalanx. This article describes the anatomy, mechanisms, classification and assessment of mallet finger injury. It reviews different types of splints used in the conservative management of closed tendinous mallet finger injury and discusses the latest evidence regarding immobilisation methods and treatment duration. Maintaining the DIPJ in extension during treatment is essential, so the article stresses the importance of patient adherence to treatment. [ABSTRACT FROM AUTHOR]

Importance: Spasticity is one of the most common and disabling motor impairments after stroke. Objective: To examine the evidence for the effectiveness of stretching interventions, including splinting, on reducing upper extremity spasticity, increasing hand function, and improving functional tasks for adults with poststroke spasticity. Data Sources: Databases searched were MEDLINE, CINAHL, OTseeker, AgeLine, and the Cochrane Library; results were limited to studies published from 2004 to January 2017. Study Selection and Data Collection: Following PRISMA guidelines, we included articles describing Level I–III studies with participants who were adults with upper extremity spasticity and received a stretching intervention. Findings: Eleven articles describing 6 Level I and 5 Level III studies met inclusion criteria. Conclusion and Relevance: For reducing upper extremity spasticity, low strength of evidence was found to support the use of static splinting, strong strength of evidence was found for the use of stretching devices, and low strength of evidence was found to support the use of dynamic splinting; no evidence was found for manual stretching to address spasticity. For increasing hand function, moderate strength of evidence was found to support the use of static splinting, dynamic splinting, and manual stretching, and low strength of evidence was found for the use of stretching devices. For improving functional tasks, moderate strength of evidence was found to support the use of static splinting, dynamic splinting, and manual stretching, and low strength of evidence was found for the use of stretching devices. What This Article Adds: This updated synthesis summarizes the current literature regarding the effectiveness of stretching interventions to improve poststroke spasticity, hand function, and functional tasks. [ABSTRACT FROM AUTHOR]

Dynamic lycra splints are proposed to modify hypertonicity due to their characteristics – neutral warmth, circumferential pressure, and creating a low-intensity prolonged stretch on hypertonic muscles – to contribute to increased sensory awareness of the involved limb. The aim of this study was to investigate the effects of dynamic lycra orthosis as an adjunct to botulinum toxin-A injection and rehabilitation of the upper-limb in adults following stroke. Patients who had suffered a stroke more than three months previously were randomized into two groups: lycra sleeve plus rehabilitation (n = 10) and only-rehabilitation group (n = 10). After botulinum toxin injection, both groups underwent an upper-limb rehabilitation program. The intervention group wore a lycra sleeve for eight hours a day, five days a week for three weeks in addition to the rehabilitation program. Fugl Meyer upper-limb motor score, Motricity index, Modified Ashworth scale, Box and Block test, Stroke Impact Scale and change in touch-detection thresholds of the fingers measured via Semmes-Weinstein monofilaments were assessed by blinded investigators at before treatment, post-treatment (at 3 weeks) and three months post-treatment. This trial is registered with Clinicaltrials.gov, number NCT03546959. There were no differences between groups in terms of Fugl Meyer upper-limb motor score, Motricity Index, Modified Ashworth scale, Box and Block test, Stroke Impact Scale and change in light touch threshold at any follow-up time points. Using lycra splints as an adjunct to an upper-limb rehabilitation program after stroke did not provide additional benefit in spasticity, upper-limb motor function, light touch threshold of fingers or stroke-specific quality-of-life. [ABSTRACT FROM AUTHOR]

Introduction: The wire composite splint as a general rule is placed on the middle third of labial surface of the tooth. This is due to ease of application, better isolation, and fewer chances of contamination. However, these assumptions are opinion-based, with no scientific evidence to support them. In addition, to best of our knowledge no research has been carried out to evaluate the effect of position of wire splints on the mobility of the affected tooth and anchor teeth.Aim: The aim of this study was to evaluate the effect of the cervico-incisal position of splinting wire on the mobility of a replanted tooth and anchor teeth in a cadaveric model.Methodology: Three cadavers (one female, 45 years old and two males, each 40 years old) were included in the study. periotest S was used to assess physiologic-tooth-mobility in three cadavers at baseline and after "extraction-replantation-wire-composite" splinting-protocol.Results: Greatest splint effect for horizontal-mobility was found to be 9.33 ± 0.57 for Cadaver-I (incisal-third), whereas it was highest (3.66 ± 2.51) for vertical-mobility in Cadaver-II (cervical third).Conclusion: Middle third position of wire composite splint have lowest splint effect on both horizontal and vertical mobility of replanted teeth, thus rendering the most favorable position for the establishment of physiologic mobility. [ABSTRACT FROM AUTHOR]

Previous studies have shown that thumb interphalangeal (IP) joint arthrodesis is typically performed between 0 and 30° of flexion, with a recent study in healthy subjects having recommended a range of 15–30° to be an ideal functional IP joint fusion angle for various activities of daily living. The current study aimed to evaluate the ideal thumb IP fusion angle in patients with thumb carpometacarpal (CMC) osteoarthritis (OA). Twenty-seven patients with thumb CMC OA were evaluated; five patients had bilateral pathology, for a total of thirty-two thumbs included. Hand dominance was noted and baseline unsplinted measurements were obtained for power tasks, precision tasks, pinch, and grip strength testing. Patients' thumbs were then splinted at 0, 15, 30, and 45° with repeat measurements taken and compared to baseline. Outcomes were measured by use of a 10-point Visual Analogue Scale, timing of tasks, and a dynamometer. Outcomes were analyzed by Wilcoxon sign ranked tests for each category of trials. For significant outcomes, the most favorable simulated thumb fusion angles were 15° in the dominant hand and 0°, 15° in the nondominant hand (precision tasks); the least favorable position was found to be 45° in the dominant hand (precision tasks, pinch strength). When combining all outcomes that both reached and approached significance, the most favorable position was found to be 15° and least favorable position, 45°. In patients with thumb CMC OA, an IP fusion angle of 15° is preferable, while a fusion angle of 45° is to be avoided. Therapeutic Study, Level III. [ABSTRACT FROM AUTHOR]

The purpose of this in vivo study was to evaluate the biomechanical effects of splinting of implant-supported superstructures using piezoelectric transducers to measure the three-dimensional forces exerted on implants supporting fixed superstructures. Measuring devices were set into the implant fixtures at the mandibular right second premolar and first molar. During clenching, force magnitudes were allocated more evenly to the two implants if they were splinted compared with the unsplinted control implants. However, this equalization of load distribution was not apparent during wax biting. Splinting of implant-supported fixed superstructures affects the force exerted on implants, especially during clenching. [ABSTRACT FROM AUTHOR]

This study aimed to compare the effectiveness of a 3D-printed ear splint with that of a conventional thermoplastic ear splint after microtia reconstruction. Patients who underwent ear elevation surgery with postauricular fascia coverage between October 2017 and October 2018 were included. They were randomly divided into the experimental group (3D-printed ear splint) and the control group (thermoplastic ear splint) and underwent routine postoperative rehabilitation and antiscar therapy. Splint therapy was initiated 4 weeks postoperatively and continued until 24 weeks postoperatively. The evaluated indices were the Vancouver scar scale score (VSS score), cranioauricular distance, patient compliance, complications (dermatitis, skin ulcers, skin necrosis), and patient satisfaction. A two-group t -test was carried out to compare all variables except patient satisfaction, which was compared using the Mann–Whitney U-test; p < 0.05 was considered significant. Twenty patients were included in each group. At 4 weeks postoperatively, the VSS score (p = 0.748) and cranioauricular distance (p = 0.647) showed no significant differences between the groups. At 24 weeks postoperatively, the mean VSS scores were 4.85 ± 1.46 and 6.25 ± 1.74 (p = 0.009), the mean cranioauricular distances were 15.80 ± 1.82 mm and 13.95 ± 1.93 mm (p = 0.004), and the patient satisfaction scores were 4.5 ± 0.51 and 3.7 ± 0.47 (p < 0.001) in the experimental group and the control group, respectively, all showing significant differences. Two patients in each group exhibited skin irritation or skin ulcers, which resolved after 6 months of follow-up. The application of 3D-printed ear splints provides better inhibition of scar contracture, better maintenance of ear projection and higher patient satisfaction than conventional ear splints following ear elevation surgery in microtia patients. Therefore, 3D-printed ear splints should be preferred over conventional ear splints whenever possible. [ABSTRACT FROM AUTHOR]

Stiffness of the elbow is a relatively common problem that can result in disability. The elbow is prone to stiffness after injury or surgery and there is limited scope for compensatory motion in the shoulder and wrist. Despite advances in knowledge of the pathogenesis of elbow contractures and the development of new treatment regimens, elbow stiffness remains a challenging problem. To regain functional elbow motion several non-operative and operative treatments are available. Non-operative treatment modalities consist of static and dynamic splinting, both having comparable results and a low risk of complications. Surgical release is performed open or arthroscopically, depending on the severity of the contracture, the presence of concomitant pathology of the ulnar nerve and osseous deformity, as well as the surgeon's preference. The open lateral column procedure has been the gold standard for a number of years. With the increasing popularity and experience of arthroscopy, a shift is seen towards arthroscopic capsular release for some indications. Outcomes of both techniques are largely comparable, with low complication rates, although the rate of complications increases with the extent of the surgical procedure. With regard to the rehabilitation programme after surgical release, different protocols are used in different hospitals and countries and may include extensive physical therapy with or without the use of continuous passive motion. The current recommendation is to continue postoperative rehabilitation as long as the range of motion is improving and until no further increase is expected. The aim of this article is to provide an overview of the aetiology, treatment, rehabilitation options and outcome of elbow stiffness. Current treatment options are discussed and future perspectives are provided. [ABSTRACT FROM AUTHOR]

Objective: Current prehospital recommendations for an acute closed extremity joint injury (ACEJI) are to apply compression in some manner. However, the effectiveness of compression is unclear. We performed a systematic review to summarize and synthesize the evidence for the use of a compression bandage for ACEJI in the prehospital setting. Data Sources: Cochrane Library, PubMed, and Embase were searched for relevant literature in November 2019. Study Selection: Controlled trials involving adults in the prehospital setting with a recent ACEJI were included when compressive, nonimmobilizing interventions, feasible in a first aid setting, were applied and compared with no compression or any noncompressive intervention, such as braces, splints, or noncompressive stockings. Articles in all languages were included if an English abstract was available. Data Extraction: Data on study design, study population, intervention, outcome measures, and methodologic quality were extracted from each included article. Data Synthesis: Eight studies out of 1193 possibly relevant articles were included. All authors examined compression in the treatment of acute ankle sprains; no studies involved compression for the treatment of other ACEJIs. No difference in the major outcomes of pain reduction or swelling, ankle-joint function, or range of motion could be demonstrated. For the outcome of recovery time, no benefit was shown when comparing compression with no compression. Evidence was insufficient to inform a conclusion about the outcomes of time to return to work or sport. All evidence was of low to very low certainty. Conclusions: The evidence for the use of a compression wrap was limited to patients with closed ankle injuries. In this systematic review, we could not demonstrate either a beneficial or harmful effect from the application of a compression or elastic bandage compared with no compression or a noncompressive stocking, splint, or brace as a first aid treatment in the prehospital environment. [ABSTRACT FROM AUTHOR]

The local intrinsic abductor digiti minimi muscle flap is ideal for lateral, plantar lateral traumatic or diabetic foot wounds following adequate surgical debridement to eradicate any soft tissue and/or osseous infection. Although the indications and surgical technique have been well-described in the literature, the authors present a unique modification of tunnelling the harvested muscle flap directly from the donor site to the plantar recipient foot wound by maintaining the intact overlying skin island at the surface of the fifth metatarsal base. This modification allows preservation of the patient's skin integrity in this area, thereby minimising potential morbidity at the major pedicle site. After the harvested muscle is tunnelled through the intact skin island, an adjacent local random flap mobilisation, autogenous or allogeneic skin graft can then be used for coverage over the muscle inset if primary wound closure is not feasible. Simultaneous soft tissue or osseous surgical procedures and/or surgical offloading with external fixation at the time of index surgery may be necessary to achieve optimal outcomes. The authors present a modified surgical technique for the abductor digiti minimi muscle flap that can be performed in the surgical reconstruction of a soft tissue wound in patients with diabetic Charcot neuroarthropathy. [ABSTRACT FROM AUTHOR]

Chronic pain surrounding the temporomandibular joints and masticatory muscles is often the primary chief complaint of patients with temporomandibular disorders (TMD) seeking treatment. Yet, the neuro-pathophysiological basis underlying it remains to be clarified. Neuroimaging techniques have provided a deeper understanding of what happens to brain structure and function in TMD patients with chronic pain. Therefore, we performed a systematic review of magnetic resonance imaging (MRI) studies investigating structural and functional brain alterations in TMD patients to further unravel the neurobiological underpinnings of TMD-related pain. Online databases (PubMed, EMBASE, and Web of Science) were searched up to August 3, 2019, as complemented by a hand search in reference lists. A total of 622 papers were initially identified after duplicates removed and 25 studies met inclusion criteria for this review. Notably, the variations of MRI techniques used and study design among included studies preclude a meta-analysis and we discussed the findings qualitatively according to the specific neural system or network the brain regions were involved in. Brain changes were found in pathways responsible for abnormal pain perception, including the classic trigemino-thalamo-cortical system and the lateral and medial pain systems. Dysfunction and maladaptive changes were also identified in the default mode network, the top-down antinociceptive periaqueductal gray-raphe magnus pathway, as well as the motor system. TMD patients displayed altered brain activations in response to both innocuous and painful stimuli compared with healthy controls. Additionally, evidence indicates that splint therapy can alleviate TMD-related symptoms by inducing functional brain changes. In summary, MRI research provides important novel insights into the altered neural manifestations underlying chronic pain in TMD. [ABSTRACT FROM AUTHOR]

Background: Evidence for the use of splints to reduce pain and improve function and quality of life in thumb carpometacarpal osteoarthritis (CMC OA) is sparse and poor despite recommendations by international guidelines. Objective: To outline the protocol for a study designed to determine the feasibility of conducting a fully powered pragmatic randomized controlled trial (RCT) comparing soft splint vs no splint for thumb CMC OA. Methods: The proposed pragmatic, assessor-blinded, and partial participant blinded parallel-group feasibility RCT will recruit 30 adults with thumb CMC OA and randomise to: splint intervention or usual care control. Randomization will be stratified by hand dominance. Primary feasibility outcomes are recruitment rate over a 4-month period, retention rate at 6 months, intervention acceptability, and rate of adverse events. Study costs, intervention fidelity, and clinical outcomes will also be evaluated. Measurements will be collected at baseline, 4 weeks, and 6 months post-initiation of treatment. This trial has been registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618001639213. Major Findings: N/A. Conclusions: If shown to be effective, soft off-the shelf splints would be a good first-line non-pharmacological, non-surgical option for thumb CMC OA as prescribed by health professionals or accessed directly by patients. This feasibility study will inform a future, fully powered RCT as evaluated by success of the recruitment strategy; assessment time and acceptability; implementation and evaluation of 'usual care'; and intervention procedures and adherence. [ABSTRACT FROM AUTHOR]

Spasticity is a common manifestation of many upper motor neuron lesions such as stroke, traumatic brain injury, and multiple sclerosis. In some cases, spastic fingers in the hand press hard into the palm, resulting in skin breakdown and atypical pressure ulcerations. We treated 10 such patients living in the nursing homes with long‐standing treatment‐resistant hand ulcers in our spasticity clinic first, with Botulinum toxin A (BoNTA) injection into the spastic muscles followed by dressing, splinting, and hand therapy. These ulcers failed to respond to standard treatment, causing significant pain, offensive smell, increased carer burden, and difficulty in maintaining hygiene as hands could barely be opened for dressing and therapy. We noted complete healing of ulcers with significant improvement in the following outcome measures—Modified Ashworth Scale for spasticity, Visual Analog Scale for pain, pressure ulcer grading for the ulcers, Fingertip to Palm distance for hand opening, Carer Burden Scale, and in the Goal Attainment Scale pre, 4 weeks, and 3 months postinjection with P values of.003,.003,.004,.005,.004, and.004, respectively. Reducing spasticity with BoNTA should be the first step in treating hand ulcerations caused by focal spasticity, followed by dressing, splinting, and hand therapy. [ABSTRACT FROM AUTHOR]

Hypovascularized diabetic nonhealing wounds are due to reduced number and impaired physiology of endogenous endothelial progenitor cell (EPC) population that limits their recruitment and mobilization at the wound site. For enrichment of the EPC repertoire from nonendothelial precursors, abundantly available mesenchymal stromal cells (MSC) were reprogrammed into induced endothelial cells (iEC). We identified cell signaling molecular targets by meta-analysis of microarray data sets. BMP-2 induction leads to the expression of inhibitory Smad 6/7-dependent negative transcriptional regulation of ID1, rendering the latter's reduced binding to TWIST1 during transdifferentiation of Wharton jelly-derived MSC (WJ-MSC) into iEC. TWIST1, in turn, regulates endothelial gene transcription, positively of proangiogenic KDR and negatively, in part, of antiangiogenic SFRP4 Twist1 reprogramming enhanced the endothelial lineage commitment of WJ-MSC and increased the vasculogenic potential of reprogrammed endothelial cells (rEC). Transplantation of stable TWIST1 rEC into a type 1 and 2 diabetic full-thickness splinted wound healing murine model enhanced the microcirculatory blood flow and accelerated the wound tissue regeneration. An increased or decreased colocalization of GFP with KDR/SFRP4 and CD31 in the regenerated diabetic wound bed with TWIST1 overexpression or silencing (piLenti-TWIST1-shRNA-GFP), respectively, further confirmed improved neovascularization. This study depicted the reprogramming of WJ-MSC into rEC using unique transcription factor TWIST1 for an efficacious cell transplantation therapy to induce neovascularization-mediated diabetic wound tissue regeneration. [ABSTRACT FROM AUTHOR]

Background/aims: Fracture of the alveolar process is a common injury, but the traditional splinting fixation may not be possible in some cases. The aim of this study was to describe the osteosynthesis performed in segmental alveolar fractures by internal fixation and evaluate the prognosis of the fractures and teeth involved.Materials and Methods: Twenty-two patients who were identified as having segmental alveolar fractures treated with osteosynthesis by internal fixation at the authors' department from January 2007 to December 2016 were included with 90 traumatized teeth. The prognosis of the fractures and teeth involved in the fractures was evaluated by the post-operative computed tomography combined with a follow-up study.Results: All patients achieved healing and consolidation of the alveolar fractures. Furthermore, the occlusion was restored and the wounds healed. During the surgical procedures, no observed iatrogenic dental damage caused by the interdental drilling was found. Eventually, only 15.6% of the teeth had pulp necrosis, whereas the other healing complications were rare or not observed in the study.Conclusions: Osteosynthesis by internal fixation is an effective and safe treatment for some segmental alveolar fractures. The teeth involved in these fractures also have good prognosis. [ABSTRACT FROM AUTHOR]

Patients commonly present to UK emergency departments with injuries to the tips of their fingers. Mallet finger is one of the most common injuries, resulting from an injury to the extensor tendon over the dorsal surface of the distal phalanges of the hand. Timely recognition, diagnosis and management are required to prevent complications. This article provides an overview of the pathophysiology, signs, symptoms, diagnosis and management of mallet finger injuries. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to conduct a systematic review on the effectiveness of occlusal splints for improving muscle strength. Occlusal splints are oral appliances that cause joint stabilization. Methods: A mix of medical and sports science terms was used to perform the search on several databases (Web of Science, Science Direct, SPORT Discus, PubMed, and Springer). Results: Twelve studies were reviewed, and their analysis indicates a trend pointing toward a limited interaction between the use of occlusal splints and improved muscle strength. Discussion: The extent of occlusal splints' impact on muscle strength is presently unknown. At this stage, there is no general agreement as to whether occlusal splints can be used as ergogenic aids. The number of studies on this specific topic and their different experimental designs precludes drawing more definite conclusions. Further research is warranted to elucidate possible changes resulting from occlusal splints during exercise. [ABSTRACT FROM AUTHOR]

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The objective of this review was to systematically evaluate the available literature addressing the use of orthoses (splints and casts) with adult and pediatric burn survivors and determine whether practice guidelines could be proposed. This review provides evidence-based recommendations specifically for rehabilitation professionals who are responsible for burn survivor rehabilitation. A summary recommendation was made after the literature was retrieved using a systematic review and critical appraisal by multiple authors. The level of evidence of the literature was determined in accordance with the Oxford Centre for Evidence-based Medicine criteria. Due to the low level of evidence in the available literature, only one practice guideline could be recommended: orthotic use should be considered as a treatment choice for improving range of motion or reducing contracture in adults who have sustained a burn injury. To address the rehabilitation-specific gaps found in the literature regarding orthotic use in burn rehabilitation and provide guidance to clinicians, a formal expert consensus exercise was conducted as a final step to the project. The resultant manuscript provides a summary of the literature regarding orthotic use with burn patients, one practice guideline, proposed orthotic terminology and additional practice recommendations based on expert opinion. The limitations in the current literature are also discussed, and suggestions are made for future studies in the area of orthotic use after burn injury. [ABSTRACT FROM AUTHOR]

In people with carpal tunnel syndrome who are waitlisted for surgical consultation, does a therapist-led care pathway involving education, splinting and exercises reduce the need for surgery and improve patient outcomes? A multicentre, randomised controlled trial with concealed allocation, blinded assessment and intention-to-treat analysis. One hundred and five people with electrodiagnostically confirmed carpal tunnel syndrome on a waitlist for surgical consultation and recruited from four public hospitals in Australia. The experimental group (n = 52) received a one-off group session of education, splinting, and nerve and tendon gliding exercises. The control group (n = 53) continued on the waitlist without additional care. The primary outcome measures were conversion to surgery by 24 weeks, the global rating of change (GROC) scale and patient satisfaction. Secondary outcomes included symptom severity and functional limitation. At 24 weeks, conversion to surgery was 59% in the experimental group and 80% in the control group (risk difference −0.21, 95% CI −0.38 to −0.03). More participants in the experimental group identified as improved at 6 weeks (20% vs 4%; risk difference 0.15, 95% CI 0.03 to 0.28) but not at 24 weeks (24% vs 10%; risk difference 0.14, 95% CI −0.01 to 0.29). The intervention was also estimated to be beneficial on some measures of satisfaction, symptom severity and functional limitation. The study's estimates of the benefits came with some uncertainty, which makes it unclear whether the wider population of people awaiting carpal tunnel surgery would consider that the benefits make the intervention worthwhile. No serious adverse effects were reported. A therapist-led pathway reduced conversion to carpal tunnel surgery and increased perceived improvement and satisfaction in people who were already on a waitlist for surgical consultation. ACTRN12613001095752. [ABSTRACT FROM AUTHOR]