Edema is the result of an imbalance in the filtration system between the capillary and interstitial spaces. The kidneys play a key role in regulating extracellular fluid volume by adjusting sodium and water excretion. Major causes of edema include venous obstruction, increased capillary permeability, and increased plasma volume secondary to sodium and water retention. A systematic approach is warranted to determine the underlying diagnosis. Treatment includes sodium restriction, diuretic use, and appropriate management of the underlying disorder. Leg elevation may be helpful in some patients. Loop diuretics often are used alone or in combination. In patients with New York Heart Association class III and IV congestive heart failure, spironolactone has been found to reduce morbidity and mortality rates. In patients with cirrhosis, ascites is treated with paracentesis and spironolactone. Dihydropyridine-induced edema can be treated with an angiotensin-converting enzyme inhibitor or angiotensin-receptor blocker. Lymphedema occurs when a protein-rich fluid accumulates in the interstitium. Compression garments and range-of-motion exercises may be helpful in patients with this condition.
Physical therapy splints are the stock and trade of many physical therapists. Fitting patients properly for these devices is key to their recovery. Having a good selection and good suppliers makes doing the job that much easier. In some cases, splints must be custom built. A good therapist can see that this is properly measured and orchestrated.
The purpose of a splint is to immobilize a bone or joint, such as a knee, during times when it would be stressed like when the patient is walking. This allows the injured area to rest and heal properly before strain is added to it. Most splints are designed to be removed when needed such as during bathing or sleeping. In these cases the splints must be able to be worked by the patient with little or no assistance from others.