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Treatment for ulnar neuropathy at the elbow (UNE)

Ulnar neuropathy at the elbow is the second most common type of condition in which a nerve becomes trapped or compressed (the most common affects the wrist). The ulnar nerve travels down the side of the elbow. This nerve is important for movement and the sense of touch in the hand at the little finger side. Symptoms of UNE are tingling of the fourth and fifth finger at night, pain at the elbow, and a change in sense of touch if the elbow is bent for a long time. When UNE is severe, some hand muscles can become weak. Diagnosis is by the symptoms and signs of the condition, as well as neurophysiological tests. Treatment of UNE can be surgical or nonsurgical (e.g. splints, physical therapy, and rehabilitation). The best way to treat UNE remains unclear.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Treatment for meralgia paraesthetica, a condition causing numbness and sometimes pain in the thigh

Meralgia paraesthetica is a common clinical condition caused by damage to the lateral cutaneous nerve of the thigh, resulting in pain, numbness and tingling in the front and outer side of the thigh. The diagnosis is easy to make clinically. Although not life‐threatening, the condition can cause a lot of discomfort to the affected individual. A number of interventions are in common use and we wanted to examine the evidence in the literature for their efficacy. We found no randomised controlled trials (RCTs) in the original review or when searches were updated in 2010 and 2012. Local injections of corticosteroid and surgical operations were found to be effective treatments in observational studies. However, a single observational study also showed that meralgia paraesthetica improved spontaneously in the majority of cases. RCTs of treatments for meralgia paraesthetica are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Surgical interventions for treating distal humeral fractures in adults

The distal humerus is the end of the upper arm bone (the humerus) and forms the upper part of the elbow joint. Its structure is highly complex as it connects with both forearm bones (the radius and ulna) to allow a wide range of motion: in bending and straightening out of the elbow, and rotating of the forearm. Fractures to the distal humerus most often occur in young men from high‐energy trauma; or older women, aged 60 years and over, who typically have osteoporosis and whose fracture results from a low‐energy fall. Most distal humeral fractures need surgical intervention because elbow motion is either very difficult or impossible. Open reduction and internal fixation, to hold the bone fragments in place until the bone is healed, with various plates and fixation techniques is the standard surgical treatment, especially in younger patients. Total elbow replacement or arthroplasty is where the distal humerus and ulna bone ends forming the elbow are replaced by an artificial joint. Imposed lifting restrictions, irrespective of age, are necessary for successful total elbow arthoplasty.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Metastatic Spinal Cord Compression: Diagnosis and Management of Patients at Risk of or with Metastatic Spinal Cord Compression

It is difficult to know what the true incidence of metastatic spinal cord compression (MSCC) is in England and Wales because the cases are not systematically recorded. However, evidence from an audit carried out in Scotland between 1997 and 1999 and from a published study from Ontario, Canada, suggests that the incidence may be up to 80 cases per million population per year. This would mean around 4000 cases per year in England and Wales or more than 100 cases per cancer network per year.

NICE Clinical Guidelines - National Collaborating Centre for Cancer (UK).

Version: November 2008
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Percutaneous vertebroplasty and percutaneous balloon kyphoplasty for the treatment of osteoporotic vertebral fractures: a systematic review and cost-effectiveness analysis

Study found that for people with painful osteoporotic vertebral compression fractures refractory to analgesic treatment, percutaneous vertebroplasty and balloon kyphoplasty significantly reduce pain and improve quality of life compared with optimal pain management. However, there is no evidence that either performs better than operative placebo with local anaesthetic. Complications from either procedure are rare but can be serious. Further research is needed to establish whether or not either procedure has a mortality advantage over or utility gain compared with operative placebo with local anaesthetic.

Health Technology Assessment - NIHR Journals Library.

Version: March 2014
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Varicose Veins in the Legs: The Diagnosis and Management of Varicose Veins

Varicose veins are dilated, often palpable subcutaneous veins with reversed blood flow, most commonly found in the legs. Estimates of the prevalence of varicose veins vary. Visible varicose veins in the lower limbs are estimated to affect at least a third of the population. There is little reliable information available in the literature on the proportion of people with varicose veins who progress to venous ulceration. One study reported that 28.6% of those who had visible varicose veins without oedema or other complications progressed to more serious venous disease after 6.6 years.83 However there was no information about the numbers progressing to ulceration. Other data on the lifetime prevalence of varicose veins estimate that approximately 3–6% of people who have varicose veins in their lifetime will develop venous ulcers.71 Risk factors for developing varicose veins are unclear although prevalence rises with age and they often develop during pregnancy. In some people varicose veins are asymptomatic or cause only mild symptoms, but in others they cause pain, aching or itching and can have a significant effect on their quality of life. Varicose veins may become more severe over time and can lead to complications such as changes in skin pigmentation, eczema, superficial thrombophlebitis, bleeding, loss of subcutaneous tissue, lipodermatosclerosis or venous ulceration.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: July 2013

Interventions for treating the posterior interosseus nerve syndrome: a systematic review of observational studies

For the posterior interosseus nerve syndrome (PINS), no randomised controlled trials or controlled clinical trials about the effectiveness of interventions are available; only case series can be found. Although the validity of case series is inferior to controlled trials, they may provide valuable data about the efficacy of treatment options. Therefore, we systematically reviewed all available observational studies on treatment of PINS. A literature search and additional reference checking was done. On the basis of previous checklists, we constructed a quality assessment and rating system to analyse the included case series. Studies with less than 50% of the maximum points on the methodological quality assessment were excluded from the analysis. The results are summarised according to a rating system for the strength of the scientific evidence. Six eligible case series for this review were found. After the data extraction and methodological quality assessment, two higher quality studies that evaluated the effectiveness of surgical decompression of the PIN were included in the final analysis. There is a tendency for the effectiveness of surgical decompression of the PIN in patients with PINS. The effectiveness of a conservative treatment for PINS is unknown because no higher quality studies are available. Additional high-quality controlled studies are needed to assess the level of 'conclusive evidence' for surgical treatment. There is also a need for high-quality controlled trials into the effectiveness of conservative treatments for PINS.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

A systematic review of evidence on malignant spinal metastases: natural history and technologies for identifying patients at high risk of vertebral fracture and spinal cord compression

Study reports that clinical consensus favours magnetic resonance imaging and computerised tomography for identifying patients with malignant spinal metastases who are at high risk of vertebral fracture and spinal cord compression.

Health Technology Assessment - NIHR Journals Library.

Version: September 2013
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Venous Thromboembolism: Reducing the Risk of Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism) in Patients Admitted to Hospital

Venous thromboembolism (VTE) is a term used to include the formation of a blood clot (a thrombus) in a vein which may dislodge from its site of origin to travel in the blood, a phenomenon called embolism. A thrombus most commonly occurs in the deep veins of the legs; this is called deep vein thrombosis. A dislodged thrombus that travels to the lungs is known as a pulmonary embolism.

NICE Clinical Guidelines - National Clinical Guideline Centre – Acute and Chronic Conditions (UK).

Version: 2010
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The Epilepsies: The Diagnosis and Management of the Epilepsies in Adults and Children in Primary and Secondary Care: Pharmacological Update of Clinical Guideline 20

This guideline is a partial update of ‘The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care’ (NICE clinical guideline 20, 2004). It updates the pharmacological management sections of the 2004 guideline and also includes the use of the ketogenic diet.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: January 2012
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Cardiopulmonary Syndromes (PDQ®): Health Professional Version

Expert-reviewed information summary about common conditions that produce chest symptoms. The cardiopulmonary syndromes addressed in this summary are cancer-related dyspnea, malignant pleural effusion, pericardial effusion, and superior vena cava syndrome.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: August 24, 2016

Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment

OBJECTIVE: To provide a qualitative systematic review of the risk of spinal manipulation in the treatment of lumbar disk herniations (LDH) and to estimate the risk of spinal manipulation causing a severe adverse reaction in a patient presenting with LDH.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

The positive effect of neurolysis on diabetic patients with compressed nerves of the lower extremities: a systematic review and meta-analysis

BACKGROUND: Despite proven benefits of upper extremity nerve decompression in diabetics, neurolysis for diabetic patients with lower extremity (LE) nerve compression remains controversial.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Non-surgical management of piriformis syndrome: a systematic review

This review evaluated conservative non-surgical management of Piriformis Syndrome. The authors' conclusions appeared to be that Botox injections may be an effective treatment for Piriformis Syndrome and that further research is recommended. This was a poorly reported review, with methodological weaknesses identified within a very limited evidence base. The extent to which the authors' conclusions are reliable is unclear.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Interventions for treating the radial tunnel syndrome: a systematic review of observational studies

This review evaluated the effectiveness of conservative and surgical interventions for treating radial tunnel syndrome (RTS) and concluded that there is a tendency for the effectiveness of surgical decompression of the radial tunnel in patients with RTS. The authors' cautious conclusions appeared to reflect the limited poor-quality evidence included in the review, but in the absence of full study details it was difficult to be completely confident about the reliability of the conclusions.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Spinal Injury: Assessment and Initial Management

The scope of this guideline is the assessment, imaging and early management of spinal injury and does not address rehabilitation. It is important to recognise that early management is intrinsically connected to rehabilitation and some later complications may be avoided with changes in early care. Early and ongoing collaborative multidisciplinary care across a trauma network is vital in ensuring that the patient with a spinal injury receives the best possible care.

NICE Guideline - National Clinical Guideline Centre (UK).

Version: February 2016
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Surgical treatment options for carpal tunnel syndrome

There is no strong evidence for the replacement of standard open carpal tunnel release (OCTR) by alternative surgical procedures for the treatment of carpal tunnel syndrome. The decision to apply special, minimally invasive operations instead of standard OCTR seems to be guided by the surgeon's and patient's preferences.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Surgical versus non‐surgical treatment for carpal tunnel syndrome

Carpal tunnel syndrome is caused by compression of the median nerve which goes through the carpal tunnel in the wrist. It causes tingling, numbness and pain, mostly in the hand. Treatment is controversial. This review aimed to compare surgical decompression with non‐surgical treatments such as splinting or corticosteroid injections. Four trials were found and included, while three are awaiting assessment. The results suggest that surgical treatment is probably better than splinting but it is unclear whether it is better than steroid injection. Further research is needed for those with mild symptoms.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Spinal manipulation in patients with disc herniation: a critical review of risk and benefit

The author's conclusion appears to be that there is some suggestion of an early benefit of spinal manipulation in patients with disc herniation, but there were insufficient good-quality trials to reach definitive conclusions. Given the methodological weaknesses in the included studies and the review process, and the limited reporting of study results, the author's conclusions should be treated with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

Oral steroids, splinting, ultrasound, yoga and wrist mobilisation provide short‐term relief from carpal tunnel syndrome, but other non‐surgical methods have not been shown to help.

Carpal tunnel syndrome is caused by compression of the median nerve at the wrist, leading to mild to severe pain and pins and needles in the hand. Other Cochrane reviews show benefit from nerve decompression surgery and steroids. This review of other non‐surgical treatments found some evidence of short‐term benefit from oral steroids, splinting/hand braces, ultrasound, yoga and carpal bone mobilisation (movement of the bones and tissues in the wrist), and insulin and steroid injections for people who also had diabetes. Evidence on ergonomic keyboards and vitamin B6 is unclear, while trials so far have not shown benefit from diuretics, non‐steroidal anti‐inflammatory drugs, magnets, laser acupuncture, exercise or chiropractic.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

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