Alternatives to Knee Braces

2021 ◽  
Author(s):  
John Milner ◽  
Davis Hartnettt ◽  
Steven F. DeFroda
Keyword(s):  
Current Evidence ◽  
Compression Stockings ◽  
Postoperative Rehabilitation ◽  
Over The Counter ◽  
Rehabilitation Period ◽  
Chronic Injuries ◽  
Knee Braces ◽  
Muscle Groups ◽  
Musculoskeletal Care ◽  
The Ideal

AbstractKnee braces continue to be a widely utilized piece of medical equipment, ranging from simple over the counter sleeves to more complex functional braces, with the ability to provide electrical stimulation to muscle groups. Despite their popularity, alternatives to knee braces exist for patients who find braces to be ineffective, uncomfortable, cumbersome, or overly expensive. While high-quality studies are lacking for modalities such as neoprene sleeves, compression stockings, and kinesiotaping, there is promising evidence that these interventions can confer an element of stability and pain relief for a variety of knee pathologies both with regard to acute and chronic injuries as well as in the postoperative rehabilitation period. While no “holy grail” exists for the ideal brace, or bracing alternative, it is important for providers to be aware of the options available to patients as well as the current evidence for these various modalities, so that the provider can best guide musculoskeletal care.

scholarly journals COMPARATIVE EFFICACY OF COMBINATION CONTACT AND TRANSURETHRAL PERCUTANEOUS LITHOTRIPSY WITH REMOTE LITHOTRIPSY IN CORALLOID NEPHROLITHIASIS TREATMENT

2011 ◽  
Vol 2 (1) ◽  
pp. 31-34
Author(s):  
V A Perepechai ◽  
A V Zozulya ◽  
I I Skorikov ◽  
S N Dimitriadi ◽  
V N Gornostaev
Keyword(s):  
Retrospective Analysis ◽  
Open Surgery ◽  
High Efficiency ◽  
Complete Elimination ◽  
Comparative Efficacy ◽  
Postoperative Rehabilitation ◽  
Rehabilitation Period ◽  
Analysis Of Results ◽  
Percutaneous Nephrolithotripsy ◽  
Choice Method

A retrospective analysis of results of percutaneous nephrolithotripsy (PNLT) for corallike nephrolithiasis in lithotripter "Swiss LithoClast ® Master" and transurethral nephrolithotripsy (TUNLT). In the period 20072010 167 PNLT and 11 TUNLT were performed. Complete elimination at PNLL was achieved in 83.2% of patients, residual concretions – in 16,8% of cases, with complete elimination TUNLT – 36,4%, residual concretions – 63,6%. In 3% of patients needed for the complete elimination of the implementation of additional percutaneous accesses, while 12.6% of the patients was necessary to repeat PNLT. Complications from PNLT + DLT developed in 30,2% of cases, and when the TUNLT + DLT – in 18,2%. Percutaneous technology in comparison to open surgery with corallike nephrolithiasis can significantly shorten the postoperative rehabilitation period and be choice method of the treatment due to its high efficiency and less traumatic.

scholarly journals Prevention and Management of the Post-Thrombotic Syndrome

2020 ◽  
Vol 9 (4) ◽  
pp. 923 ◽  
Author(s):  
Ilia Makedonov ◽  
Susan R. Kahn ◽  
Jean-Philippe Galanaud
Keyword(s):  
Venous Insufficiency ◽  
Current Evidence ◽  
Low Molecular Weight ◽  
Compression Stockings ◽  
Low Molecular Weight Heparins ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Lifestyle Measures ◽  
Deep Vein

The post-thrombotic syndrome (PTS) is a form of chronic venous insufficiency secondary to prior deep vein thrombosis (DVT). It affects up to 50% of patients after proximal DVT. There is no effective treatment of established PTS and its management lies in its prevention after DVT. Optimal anticoagulation is key for PTS prevention. Among anticoagulants, low-molecular-weight heparins have anti-inflammatory properties, and have a particularly attractive profile. Elastic compression stockings (ECS) may be helpful for treating acute DVT symptoms but their benefits for PTS prevention are debated. Catheter-directed techniques reduce acute DVT symptoms and might reduce the risk of moderate–severe PTS in the long term in patients with ilio-femoral DVT at low risk of bleeding. Statins may decrease the risk of PTS, but current evidence is lacking. Treatment of PTS is based on the use of ECS and lifestyle measures such as leg elevation, weight loss and exercise. Venoactive medications may be helpful and research is ongoing. Interventional techniques to treat PTS should be reserved for highly selected patients with chronic iliac obstruction or greater saphenous vein reflux, but have not yet been assessed by robust clinical trials.

scholarly journals The Potential of Carnosine in Brain-Related Disorders: A Comprehensive Review of Current Evidence

Nutrients ◽  
2019 ◽  
Vol 11 (6) ◽  
pp. 1196 ◽  
Author(s):  
Martin Schön ◽  
Aya Mousa ◽  
Michael Berk ◽  
Wern L. Chia ◽  
Jozef Ukropec ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Food Supplement ◽  
Current Evidence ◽  
Comprehensive Overview ◽  
Cross Sectional ◽  
Over The Counter ◽  
Peripheral Tissues ◽  
Promising Therapeutic Target

Neurological, neurodegenerative, and psychiatric disorders represent a serious burden because of their increasing prevalence, risk of disability, and the lack of effective causal/disease-modifying treatments. There is a growing body of evidence indicating potentially favourable effects of carnosine, which is an over-the-counter food supplement, in peripheral tissues. Although most studies to date have focused on the role of carnosine in metabolic and cardiovascular disorders, the physiological presence of this di-peptide and its analogues in the brain together with their ability to cross the blood-brain barrier as well as evidence from in vitro, animal, and human studies suggest carnosine as a promising therapeutic target in brain disorders. In this review, we aim to provide a comprehensive overview of the role of carnosine in neurological, neurodevelopmental, neurodegenerative, and psychiatric disorders, summarizing current evidence from cell, animal, and human cross-sectional, longitudinal studies, and randomized controlled trials.

Effect of Suture Caliber and Number of Core Strands on Repair of Acute Achilles Ruptures: A Biomechanical Study

2017 ◽  
Vol 38 (5) ◽  
pp. 564-570 ◽  
Author(s):  
Jonathon D. Backus ◽  
Daniel Cole Marchetti ◽  
Erik L. Slette ◽  
Kimi D. Dahl ◽  
Travis Lee Turnbull ◽  
...  
Keyword(s):  
Biomechanical Study ◽  
Published Data ◽  
Postoperative Rehabilitation ◽  
Rehabilitation Protocol ◽  
Advanced Stages ◽  
Number Of Cycles ◽  
Active Patients ◽  
Repair Group ◽  
Cycles To Failure ◽  
The Ideal

Background: Controversy exists regarding the ideal Achilles rupture treatment; however, operative treatment is considered for athletes and active patients. The ideal repair construct is evolving, and the effect of suture caliber or number of core strands has not been studied. Methods: Simulated mid-substance Achilles ruptures were performed in 24 cadavers. Specimens were randomized to three 6-core-strand style repair constructs: (1) 4 No. 2 sutures and two 2-mm tapes (2T); (2) 2 No. 2 sutures and four 2-mm tapes (4T); (3) 12 (double-6-strand) strand repair (12 No. 2-0 sutures [12S]). Repairs were subjected to a cyclic loading protocol representative of postoperative rehabilitation. These data were compared to a previously published standard open repair technique (6-core strands with No. 2 sutures) on 9 specimens tested under the same conditions.6 Results: No significant elongation differences were observed between the repair groups and the previously published standard repair group in the first 2 stages of the simulated rehabilitation protocol. Both the 2T and 12S repairs survived a significantly greater number of cycles to failure ( P = 0.0005, P = 0.0267, respectively) and had a significantly higher failure load ( P = .0005, P = .0118, respectively) compared to the previously published data. These 2 constructs consistently survived the advanced stages of the simulated rehabilitation protocol. The majority of repairs failed at the knots. Conclusions: In this study, the 2T and 12S constructs survived the later stages of our simulated rehabilitation protocol, suggesting that they may be able to accommodate a more aggressive clinical rehabilitation protocol. Substituting suture-tape for 2 core strands or doubling the core strands with a smaller-caliber suture created a biomechanically stronger construct. Clinical Relevance: Achilles repair with an added nonabsorbable, high–tensile strength tape allowed for a stronger construct that may allow for a more aggressive, early rehabilitation protocol and earlier return to function.

scholarly journals Importance of the Wrist Extensor Muscle Training: Two Cases of Elbow Flexorplasty following Traumatic Brachial Plexus Injuries

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Shigeki Kubota ◽  
Tadashi Kubo ◽  
Hiromi Kameda ◽  
Yoshiyasu Itoh
Keyword(s):  
Brachial Plexus ◽  
Elbow Flexion ◽  
Wrist Flexion ◽  
Postoperative Rehabilitation ◽  
Wrist Extensor ◽  
Antagonist Muscles ◽  
Extensor Muscles ◽  
Muscle Groups ◽  
Flexion Strength

The modified Steindler procedure—a reconstructive surgery used to restore elbow flexion following upper brachial plexus injuries—involves shifting the origins of the muscle groups responsible for wrist flexion and forearm pronation originating from the medial epicondyle to the proximal direction to be used as flexors of the elbow. In the postoperative rehabilitation, we focused on strengthening not only the transferred muscle but also the wrist extensor muscles as antagonist muscles. After reconstruction surgery for elbow flexion via the modified Steindler procedure for traumatic brachial plexus injury, we performed long-term rehabilitation to strengthen the antagonist muscles. As a result, in two cases, excellent elbow flexion strength and gripping strength were achieved, confirming the importance of the antagonist muscles.

scholarly journals Over-the-counter analgesics during pregnancy: a comprehensive review of global prevalence and offspring safety

2020 ◽  
Vol 27 (1) ◽  
pp. 67-95 ◽  
Author(s):  
Aikaterini Zafeiri ◽  
Rod T Mitchell ◽  
David C Hay ◽  
Paul A Fowler
Keyword(s):  
Health Outcomes ◽  
In Utero ◽  
Current Evidence ◽  
In Utero Exposure ◽  
Over The Counter ◽  
Comprehensive Review ◽  
Global Prevalence ◽  
High Prevalence ◽  
Consumption Rates ◽  
Maternal Consumption

Abstract BACKGROUND Analgesia during pregnancy is often necessary. Due to their widespread availability, many mothers opt to use over-the-counter (OTC) analgesics. Those analgesic compounds and their metabolites can readily cross the placenta and reach the developing foetus. Evidence for safety or associations with adverse health outcomes is conflicting, limiting definitive decision-making for healthcare professionals. OBJECTIVE AND RATIONALE This review provides a detailed and objective overview of research in this field. We consider the global prevalence of OTC analgesia during pregnancy, explain the current mechanistic understanding of how analgesic compounds cross the placenta and reach the foetus, and review current research on exposure associations with offspring health outcomes. SEARCH METHODS A comprehensive English language literature search was conducted using PubMed and Scopus databases. Different combinations of key search terms were used including ‘over-the-counter/non-prescription analgesics’, ‘pregnancy’, ‘self-medication’, ‘paracetamol’, ‘acetaminophen’, ‘diclofenac’, ‘aspirin’, ‘ibuprofen’, ‘in utero exposure’, ‘placenta drug transport’, ‘placental transporters’, ‘placenta drug metabolism’ and ‘offspring outcomes’. OUTCOMES This article examines the evidence of foetal exposure to OTC analgesia, starting from different routes of exposure to evidence, or the lack thereof, linking maternal consumption to offspring ill health. There is a very high prevalence of maternal consumption of OTC analgesics globally, which is increasing sharply. The choice of analgesia selected by pregnant women differs across populations. Location was also observed to have an effect on prevalence of use, with more developed countries reporting the highest consumption rates. Some of the literature focuses on the association of in utero exposure at different pregnancy trimesters and the development of neurodevelopmental, cardiovascular, respiratory and reproductive defects. This is in contrast to other studies which report no associations. WIDER IMPLICATIONS The high prevalence and the challenges of reporting exact consumption rates make OTC analgesia during pregnancy a pressing reproductive health issue globally. Even though some healthcare policy-making authorities have declared the consumption of some OTC analgesics for most stages of pregnancy to be safe, such decisions are often based on partial review of literature. Our comprehensive review of current evidence highlights that important knowledge gaps still exist. Those areas require further research in order to provide pregnant mothers with clear guidance with regard to OTC analgesic use during pregnancy.

Rehabilitation Protocols After Isolated Meniscal Repair: A Systematic Review

2016 ◽  
Vol 45 (7) ◽  
pp. 1687-1697 ◽  
Author(s):  
Kevin O’Donnell ◽  
Kevin B. Freedman ◽  
Fotios P. Tjoumakaris
Keyword(s):  
Systematic Review ◽  
Range Of Motion ◽  
Significant Variation ◽  
Clinical Success ◽  
Meniscal Repair ◽  
Postoperative Rehabilitation ◽  
Treatment Groups ◽  
Rehabilitation Protocols ◽  
Outcome Scores ◽  
The Ideal

Background: Current postoperative rehabilitation protocols after isolated meniscal repair vary widely. No consensus exists with regard to the optimal amount of weightbearing, range of motion, or speed at which the patient progresses through the rehabilitation phases. Confounding factors including concomitant ligamentous or cartilaginous injuries have made studying isolated meniscal tears problematic. Purpose: To systematically review and evaluate the influence of range of motion and weightbearing status during the postoperative rehabilitation period after isolated meniscal repair on clinical efficacy and outcome scores. Study Design: Systematic review. Methods: A search of PubMed, Scopus, and Cochrane Central Register of Controlled Trials was conducted. The selection criteria for inclusion were English-language in vivo clinical studies reporting on isolated meniscal repairs utilizing an arthroscopically assisted technique that outlined the postoperative rehabilitation protocol and included at least a 2-year follow-up. Titles, abstracts, and articles were reviewed, and data concerning patient demographics, tear type, repair technique, postoperative protocol details, clinical failures, and outcome scores were extracted from the eligible studies. Rehabilitation protocols were divided into “accelerated,” “motion restricted,” “weight restricted,” and “dual restricted” according to the limitations placed on the treatment groups. Results: Fifteen studies, containing 17 different treatment groups, met the inclusion criteria. The 2 accelerated groups, 2 motion-restricted groups, 4 weight-restricted groups, and 9 dual-restricted groups showed similar efficacy in terms of clinical success and postoperative outcome scores. Early range of motion and weightbearing status showed no influence over clinical outcomes. Of the 17 groups, 13 reported a greater than 70% clinical success rate with significant variation in the tear type, fixation technique, and postoperative restrictions. Conclusion: Early range of motion and immediate postoperative weightbearing appear to have no detrimental effect on the chances for clinical success after isolated meniscal repair. Significant variation exists between postoperative protocols, with no current consensus on the ideal parameters for weightbearing and range of motion. Studies reporting outcomes regarding isolated meniscal repair are limited. Future research should include determining the ideal combination of weightbearing and range of motion for specific tear types.

Silastic Medialization and Arytenoid Adduction: The Vanderbilt Experience

1993 ◽  
Vol 102 (6) ◽  
pp. 413-424 ◽  
Author(s):  
James L. Netterville ◽  
R. E. Stone ◽  
Francisco J. Civantos ◽  
Elizabeth S. Luken ◽  
Robert H. Ossoff
Keyword(s):  
General Anesthesia ◽  
Skull Base ◽  
Vocal Cord ◽  
Surgical Procedures ◽  
Vocal Cord Paralysis ◽  
Postoperative Rehabilitation ◽  
True Vocal Cord ◽  
Arytenoid Adduction ◽  
Rehabilitation Period ◽  
Surgical Setting

From April 1987 to April 1992, 116 phonosurgical procedures were performed to treat glottal incompetence. The initial numbers of these surgical procedures included the following: 29 primary Silastic medializations, 3 primary Silastic medializations with arytenoid adduction, 53 secondary Silastic medializations, 4 secondary Silastic medializations with arytenoid adduction, and 11 bilateral Silastic medializations. These procedures are useful in treating unilateral true vocal cord paralysis, scarring, bowing, or paresis, as well as bilateral true vocal cord bowing. Of the initial 100 patients, 16 later underwent a revision with either a larger implant's being placed or an arytenoid adduction. Primary Silastic medialization is the placement of an implant under general anesthesia in the same surgical setting in which laryngeal innervation is sacrificed. Secondary Silastic medialization is the placement of an implant under local anesthesia for a preexistent vocal cord malfunction. In either case, overall voice results for unilateral paralysis are very good. Primary Silastic medialization significantly decreases the postoperative rehabilitation period in skull base patients because of the immediate postoperative glottal competence and decreased use of perioperative tracheotomy. Bilateral implants yielded good results in 6 patients with presbylaryngis, but 6 other patients with bowing from other causes experienced only moderate improvement in speech quality. There were no implant extrusions; however, 1 implant was removed secondary to a persistent laryngocutaneous fistula in a patient who had previously undergone laryngeal irradiation. This was the only complication in this series.

Current Evidence and Clinical Applications of Therapeutic Knee Braces

2007 ◽  
Vol 86 (8) ◽  
pp. 678-686 ◽  
Author(s):  
Kelvin T. L. Chew ◽  
Henry L. Lew ◽  
Elaine Date ◽  
Michael Fredericson
Keyword(s):  
Clinical Applications ◽  
Current Evidence ◽  
Knee Braces

scholarly journals Current Evidence for Stereotactic Body Radiotherapy in Lung Metastases

2021 ◽  
Vol 28 (4) ◽  
pp. 2560-2578
Author(s):  
Enrique Gutiérrez ◽  
Irving Sánchez ◽  
Omar Díaz ◽  
Adrián Valles ◽  
Ricardo Balderrama ◽  
...  
Keyword(s):  
Stereotactic Body Radiation Therapy ◽  
Lung Metastases ◽  
Current Evidence ◽  
Malignant Neoplasms ◽  
Disease Course ◽  
Lung Sbrt ◽  
Technical Requirements ◽  
Metastatic Lung ◽  
The Subject ◽  
The Ideal

Lung metastases are the second most common malignant neoplasms of the lung. It is estimated that 20–54% of cancer patients have lung metastases at some point during their disease course, and at least 50% of cancer-related deaths occur at this stage. Lung metastases are widely accepted to be oligometastatic when five lesions or less occur separately in up to three organs. Stereotactic body radiation therapy (SBRT) is a noninvasive, safe, and effective treatment for metastatic lung disease in carefully selected patients. There is no current consensus on the ideal dose and fractionation for SBRT in lung metastases, and it is the subject of study in ongoing clinical trials, which examines different locations in the lung (central and peripheral). This review discusses current indications, fractionations, challenges, and technical requirements for lung SBRT.

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