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Corticosteroid injection vs. nonsteroidal antiinflammatory drug and splinting in carpal tunnel syndrome.

OBJECTIVE: To compare the efficacy of local corticosteroid injection to a nonsteroidal antiinflammatory drug and splinting for the treatment of carpal tunnel syndrome. DESIGN: This study was a prospective, unblinded, randomized clinical trial with an 8-wk follow-up. Thirty-three hands of 23 patients were randomly treated with acemetacine and splinting (group A) or with corticosteroid injection (group B). Clinical (symptom severity scale, visual analog scale, Tinel and Phalen tests) and electromyographic evaluations were performed on initial visit and after 8 wk. RESULTS: Clinical and electromyographic parameters, which were similar at baseline, were improved in both groups after treatment. Improvement was also similar when both groups were compared at 8 wk. CONCLUSION: Both splinting combined with the use of a nonsteroidal antiinflammatory drug and steroid injection into the carpal tunnel resulted in significant improvement in carpal tunnel syndrome.

Adult↗

The microbiology and cleaning of thermoplastic splints in burn care.

The ability of thermoplastic splints to be a vehicle for the transfer of microorganisms from the burn wound was explored. Twenty splints were evaluated and 10 (50%) were found to have recoverable microorganisms immediately after being removed from the burn patient. Air drying for 10 minutes was not shown to be an effective method of removing contaminating microorganisms. A cleaning protocol using a quaternary ammonia solution proved to be 100% effective in removing microorganisms from thermoplastic splint material.

Adolescent↗

A new splinting approach for dorsal foot burns.

Successful treatment of dorsal foot burns is a challenge. By extrapolating from various treatments of dorsal hand burns the design of a static progressive splint was applied to the treatment of dorsal foot burns to prevent contracture deformities. The splint is composed of a base, dorsal thermoplastic piece, and Velcro strap. Soft hook and loop Velcro encircles the ankle and midfoot providing a base for the attachment of a Velcro strap. A thermoplastic piece is conformed to the dorsum of the toes and then affixed to the Velcro strap. The Velcro strap is then attached to the plantar surface of the base to create an adjustable static progressive stretch. This splint is designed to prevent dorsal foot contractures during the scar maturation phase of wound healing.

Burns↗

Treatment of displaced, proximal, humeral, epiphyseal fractures with a two-prong splint.

To evaluate the use of a two-prong splint for displaced, proximal, humerus, epiphyseal fractures, seven children with Neer-Horwitz Classification Type 3-4 fractures of the proximal humerus were retrospectively investigated. After closed reduction, fracture stabilization was accomplished with the use of a two-prong splint, and at an average follow-up of 54 months (range 48-62 months), all children were evaluated radiographically and functionally. There were no complications, and all patients had full painless range of shoulder and elbow motion, without malunion, joint incongruity, nonunion, avascular necrosis, and limb-length discrepancy. The results did not change over time. Treatment of displaced, proximal, humeral, epiphyseal fractures with a two-prong splint gives satisfactory results while allowing immediate motion and gradual reduction of the fragments without anesthesia, and it may be the treatment of choice for such injuries in children.

Adolescent↗

Splint appliance for the management of posttrauma lip deformities: technical note and case reports.

Trauma sustained to the commissures of the lips will result in perioral tissue deficits. Without intervention, this will lead to functional and esthetic deformities. Splinting devices have proven to be an effective and economical means of treatment. Reviews have appeared in the literature describing techniques and treatment regimens for the use of such oral commissure splints. Each has specific advantages and disadvantages in application. A variation of these previously described splints now in use at the University of Chicago Hospitals is presented. Three case histories are presented with discussion of the uses and advantages of this appliance.

Adult↗

The use of nasal splints in the primary management of unilateral cleft nasal deformity.

Primary surgical correction of the cleft lip nasal deformity is routinely performed at the Craniofacial Center at Chang Gung Memorial Hospital. Over time, however, there is a tendency for the lower lateral cartilage to retain its memory and, subsequently, recreate the preoperative nasal deformity. Therefore, it is current practice to use a nostril retainer for a period of at least 6 months to maintain the corrected position of the nose. The aim of this study was to qualitatively assess the benefit of postoperative nasal splinting in the primary management of unilateral cleft nasal deformity. Data from two groups of 30 patients with complete unilateral cleft lips each were retrospectively collected and analyzed. The first group served as a control (no nasal splints), and the second group used the nasal retainer compliantly for at least 6 months postoperatively. All patients had their primary lip repair at 3 months of age. A photographic evaluation of the results when the patients were between 5 and 8 years of age was conducted. The parameters used to assess the nasal outcome were nostril symmetry, alar cartilage slump, alar base level, and columella tilt. The first scores were based on residual nasal deformity, and the second set were based on overall appearance. It was found that the mean scores of residual nasal deformity for all four parameters in patients who used the nasal stent were statistically better than the scores of patients who did not (p values ranged from 0.0001 to 0.005). The overall appearance scores for the four parameters in the patients who used the nasal stent after surgery were also statistically better than the scores for those who did not (p values ranged from 0.0001 to 0.01). The results show that postoperative nasal splinting in the primary management of the unilateral cleft nasal deformity serves to preserve and maintain the corrected position of the nose after primary lip and nasal correction, resulting in a significantly improved aesthetic result. Therefore, it is recommended that all patients undergoing primary correction of complete unilateral cleft deformity use the nasal retainer postoperatively for a period of at least 6 months.

Cleft Lip↗

Alternative splinting methods for the prevention and correction of burn scar torticollis.

Significant neck burns may lead to deforming lateral flexion and rotation contractures. A two-device splinting regimen has been designed to prevent such contractures. In the acute phase, the Dynamic Antitorticollis Strap is applied while the patient is in bed to gently rotate the head and neck toward the neutral position. This dynamic strap includes a Velfoam headband attached to Thera-Band secured to the patient's bed. The antitorticollis neck splint is used in the rehabilitation phase and can be serially adjusted to correct lateral flexion contractures of the neck. Thermoplastic material is cut from a modified neck splint pattern and draped over the temporaloccipital region and anterior/posterior shoulder ipsilateral to the contracture and the anterior and contralateral aspect of the neck. The combined use of these devices during the scar maturation phase provides therapists with alternatives in preventing burn scar torticollis.

Burns↗

Axillary burns: extended grafting and early splinting prevents contractures.

The development of contractures is a common complication after burn injuries. Axillary burns often result in limited abduction of the arm and present a major hindrance in rehabilitation. To prevent axillary contractures after burn injury, we perform a special grafting technique. In this study we treated 17 patients with 23 axillary burns using this technique. Patients were splinted early, and an intensive physiotherapy program was started 5 days after splinting. After 12 months, the mean abduction of the successfully treated axillary burns was 152 degrees. A secondary reconstruction was needed in only 5 of the 23 treated axillary burns. For the treatment of axillary burns, we recommend the described grafting technique in combination with early splinting and intensive physiotherapy.

Adolescent↗

A modified dynamic mouth splint for burn patients.

The prevention and management of microstomia contracture is very important for the quality of life in a patient who has experienced facial burns. Mouth opening is important for speech, eating, dental hygiene, expression, social interaction, psychosocial well being, and administrating general anesthesia. Principles of scar management state a need for opposing horizontal, vertical, and circumferential forces for effective management of microstomia. At the Royal Brisbane and Women's Hospital, horizontal and circumferential stretch was provided well; however, a suitable vertical stretch component was required. After a literature review, we introduced and trialed a dynamic mouth splint. Subsequently, a modified dynamic mouth splint was developed. The presentation here of four case studies will demonstrate that the use of the splint in combination with current practice has improved mouth opening and consequently functional outcomes.

Adult↗

Intranasal splints and their effects on intranasal adhesions and septal stability.

Intranasal splints have been used to maintain septal stability and prevent intranasal adhesions following septal surgery. However, their efficacy and attendant morbidity have received surprisingly little attention. Our prospective study of 100 adults was divided into patients undergoing septoplasty or submucous resection of the nasal septum alone (n = 50) and those undergoing combined septal and inferior turbinate surgery (n = 50). All patients were randomized to have paired silicon rubber splints inserted for 7 days or not at all. All noses were additionally packed with 2 pieces of Jelonet for 12-20 h and examined and cleaned at 1 and 6 weeks post-operatively. The position of the septum, patency of the airways, presence of adhesions and degree of discomfort were recorded. Statistical analysis of the 89 complete sets of results obtained indicated splints added significantly to post-operative discomfort in both groups, with no demonstrable benefit to the patient.

Adolescent↗

Treatment of mandibular dysfunction: the clinical usefulness of biofeedback in relation to splint therapy.

The long-term treatment effects of biofeedback and occlusal splints on mandibular dysfunction were compared. Thirty female patients were randomly divided into two treatment groups. One group had full coverage splints, the other group received biofeedback training. At the re-examinations 1 and 12 months after completion of therapy, the subjective and clinical symptoms were significantly reduced in both groups. No significant differences between the groups were found. A stepwise analysis of regression indicated that biofeedback training may be a useful alternative to splint therapy in cases where night time bruxing is not the dominating feature.

Adult↗

An electromyographic study of the immediate effect of an occlusal splint on the postural activity of the anterior temporal and masseter muscles in different body positions with and without visual input.

With the mandible at rest, the clinical postural position was measured and electromyographic recordings (in seated and supine position, eyes open and eyes closed, before as well as 15 min after insertion of an occlusal splint) were from the anterior temporal and masseter muscles in thirty-one patients with signs and symptoms of mandibular dysfunction and nocturnal bruxism. The results indicated that when the patients were seated upright, there was a distinct postural activity in the anterior temporal and in some patients also in the masseter muscles. This postural activity decreased significantly with closure of the eyes and in supine position. Fifteen minutes after insertion of an occlusal splint, the postural activity in the temporal muscles decreased in 52%, increased in 22% and remained unchanged in 26% of the patients. Moreover, the postural activity reached its lowest level in supine position. The results indicate that the supine position is the body position to be preferred for centric relation recording as well as for occlusal and splint adjustment.

Adolescent↗

The effect of acrylic bite plane splints and their vertical dimension on jaw muscle silent period in healthy young adults.

A significant question relative to treatment and disappearance of symptoms is raising the bite in combination with a maxillary bite plane splint in patients with TMJ muscle dysfunction. The objective of this research was to investigate the effect, if any, occlusal bite plane splints have on the latency and duration of the mention tap silent period and particularly whether the degree to which the bite is raised is of significance. Recordings were made in healthy young adults from both anterior temporal and masseteric muscles while subjects were clenching at their 70% maximum clenching effort. Placement of a splint significantly (P less than 0.05) prolonged the silent period duration (SPD). However, mean SPD values taken at two different vertical raised bites did not differ significantly (P greater than 0.05). The anterior temporal muscle SPD was less sensitive to a smaller change of vertical dimension than the masseteric SPD. Silent period latencies remained unchanged in all experimental conditions.

Acrylic Resins↗

A clinical and electromyographic study of the long-term effects of an occlusal splint on the temporal and masseter muscles in patients with functional disorders and nocturnal bruxism.

The postural activity of the temporal and masseter muscles in thirty-one patients with signs and symptoms of functional disorders were studied: before, during and after 3-6 months of occlusal splint therapy. The fluctuating signs and symptoms, as well as the postural activity of the temporal and masseter muscles were significantly reduced after treatment. Further, the coefficients of correlation within pairs of postural activity of the right and left muscles increased significantly. After cessation of the splint therapy the signs and symptoms recurred to the pre-treatment level within 1-4 weeks in about 80% of the patients. The results indicate that an occlusal splint can eliminate or diminish signs and symptoms of functional disorders and re-establish symmetric and reduced postural activity in the temporal and masseter muscles, which can facilitate procedures, such as functional analysis and occlusal adjustment.

Adolescent↗

Subjective, clinical and EMG effects of biofeedback and splint treatment.

Patients suffering from myofascial pain dysfunction (MPD) were trained to maintain constant levels of EMG masseter activity with the aid of biofeedback. Treatment effects were compared with the effects of a nightly full-coverage splint and with a no-treatment control group. The biofeedback group showed significantly more improvement in clinical dysfunction and subjective symptoms related to pain and mandibular movement than either the splint group or the control group. The results of the splint group were not substantially different from the control group. The EMG results indicate that during biofeedback the ratio between EMG activity of the trained and the non-trained masseter shifted towards a higher contribution of the trained muscle. This effect was significant at high task levels. During biofeedback EMG task performance improved but this effect did not generalize to non-feedback situations. It is suggested that the treatment effects of biofeedback depend upon the increase in perceived control reported by the biofeedback group.

Biofeedback, Psychology↗

First experiences with resin-bonded bridges and splints--a cross-sectional retrospective study, Part II.

This second report establishes that the success of treatment with resin-bonded bridges was dependent upon many factors. Factors controlled by the clinician, such as case selection and treatment planning greatly influence the clinical success. It was possible to show that framework preparation and the amount of available enamel were significant factors, whereas isolation technique, type of retention mechanism and type of adhesive used were of less importance. Longitudinal studies are needed to confirm these observations. Seventeen clinicians placed 496 resin-bonded bridges and splints with different retention mechanisms and bonding agents. These reconstructions were examined in regard to the failure rate and in regard to reattachment problems. Ninety-seven per cent of the bridges and 90% of the splints were still in place after 1 year. For bridges and splints a 90% success rate was ascertained after 2 years.

Adhesives↗

Postural and maximum activity in elevators during mandible pre- and post-occlusal splint treatment of temporomandibular joint disturbance syndrome.

Electromyograms (EMGs) of the temporal and masseter muscles in sixty patients with temporomandibular joint disturbance syndrome (TMJDS) and thirty controls were recorded and integrated on-line in the postural position and during maximum clenching, before and after occlusal splint therapy. Contrasting with the controls, the myoelectrical activity of the patients was higher in the postural position and lower during maximum clenching, whilst the former in percentage terms increased when compared to the latter. After treatment, the EMG indexes in some patients returned partially, and in others completely, to a normal level. Tenderness in the mandibular elevators, deviated opening and organic change in the TMJ increased the postural myoelectrical activity, in percentage terms, against that of maximum clenching. The myoelectrical activity of the mandibular elevators in the postural position and during maximum clenching was smaller in patients with the occlusal splint than in those without. The results show that the mandibular elevators in the patients with TMJDS were hyperactive and tense, and that the occlusal splint was useful for treating such dysfunction.

Adult↗

Postural contractile activities of human jaw muscles following use of an occlusal splint.

As induced by an occlusal splint over a period of 1 week, this study monitored surface electromyographic changes in the postural contractile activities of jaw elevator and depressor muscles in six healthy adults. The immediate effect of the occlusal splint was to increase the postural contractile activities of the suprahyoid muscles. All postural muscle activities showed wide-ranging biological variation, but the activities induced by the splint tended to stabilize within 1 week, with decreased postural activities in the masseter and anterior temporalis muscles, and increased postural activities in the suprahyoid muscles.

Adult↗