Neutral wrist splint for mild to moderate carpal tunnel syndrome
Keywords:
Carpal tunnel syndrome, splint, Boston carpal tunnel questionnaireAbstract
Background : Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Neutral wrist splint has been recommended for mild to moderate symptoms CTS. There is insufficient evidence regarding the effectiveness of splinting in longer periods of time (at least 3 months).
Objective : To evaluate the effects of 3 months neutral wrist splint on neurophysiologic condition, symptoms and functions for mild to moderate carpal tunnel syndrome (CTS).
Methods : Fifty-four patients with clinical symptoms, nerve conduction study (NCS), and diagnosed as mild to moderate CTS. During the 3-month duration of the study, the treatment group received day and night time, neutral wrist splints combined with condition-related patient instructions and the control group received only condition-related patient instructions. Neurophysiologic condition was evaluated by nerve conduction study including distal sensory latency (DSL) and distal motor latency (DML). Symptoms and functional status were assessed by Boston Carpal Tunnel Questionnaire (SYMPT BCTQ and FUNCT BCTQ).
Results : The treatment group demonstrated improvement in all measured outcomes (DSL, DML, SYMPT BCTQ, and FUNCT BCTQ). The treatment group also showed significantly more improvement than the control group in decreasing DSL and DML values. In linear regression analysis, the decrease in DSL was significantly associated with splint treatment (RR = 4.79, 95% CI = 1.35 - 17.11; P = 0.02).
Conclusions : Three-month daytime and nighttime neutral wrist splinting was more effective than patient instructions alone in improving neurophysiologic condition in mild to moderate CTS. This splinting modality shows good patient compliance and no serious side effects.
Downloads
References
Chammas M, Boretto J, Burmann LM, Ramos RM, Dos Santos Neto FC, Silva JB. Carpal tunnel syndrome - Part I (anatomy, physiology, etiology and diagnosis). Rev Bras Ortop 2014;49:429-36.
https://doi.org/10.1016/j.rbo.2013.08.007
Kozak A, Schedlbauer G, Wirth T, Euler U, Westermann C, Nienhaus A. Association between work-related biomechanical risk factors and the occurrence of carpal tunnel syndrome: an overview of systematic reviews and a meta-analysis of current research. BMC Musculoskelet Disord 2015;16:231.
https://doi.org/10.1186/s12891-015-0685-0
Piazzini DB, Aprile I, Ferrara PE, Bertolini C, Tonali P, Maggi L, et al. A systematic review of conservative treatment of carpal tunnel syndrome. Clin Rehabil 2007;21:299-314.
https://doi.org/10.1177/0269215507077294
Gelberman RH, Hergenroeder PT, Hargens AR, Lundborg GN, Akeson WH. The carpal tunnel syndrome. A study of carpal canal pressures. J Bone Joint Surg Am 1980;62: 1181-4.
https://doi.org/10.2106/00004623-198062070-00020
Huisstede BM, Friden J, Coert JH, Hoogvliet P, European HG. Carpal tunnel syndrome: hand surgeons, hand therapists, and physical medicine and rehabilitation physicians agree on a multidisciplinary treatment guideline-results from the European HANDGUIDE Study. Arch Phys Med Rehabil 2014;95:2253-63. https://doi.org/10.1016/j.apmr.2014.06.022
Page MJ, Massy-Westropp N, O'Connor D, Pitt V. Splinting for carpal tunnel syndrome. Cochrane Database Syst Rev. 2012;7:CD010003. https://doi.org/10.1002/14651858.CD010003
Stevens JC. AAEM minimonograph #26: the electrodiagnosis of carpal tunnel syndrome. American Association of Electrodiagnostic Medicine. Muscle Nerve 1997;20:1477-86.
https://doi.org/10.1002/(SICI)1097-4598(199712)20:12<1477::AID-MUS1>3.0.CO;2-5
Pongkanitanon P, Taechaarparkul V, Bunnag Y. Normal Value of Median Nerve at Chulalongkorn Hospital. J Thai Rahabil 1994;3:25-9.
Robinson LR, Strakowski J, Kennedy DJ. Is the combined sensory (Robinson) index routinely indicated for all cases of suspected carpal tunnel syndrome undergoing electrodiagnostic evaluation? PMR. 2013;5: 433-7. https://doi.org/10.1016/j.pmrj.2013.04.007
Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, et al. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am 1993; 75:1585-92. https://doi.org/10.2106/00004623-199311000-00002
Katz JN, Gelberman RH, Wright EA, Lew RA, Liang MH. Responsiveness of self-reported and objective measures of disease severity in carpal tunnel syndrome. Med Care 1994; 32:1127-33.
https://doi.org/10.1097/00005650-199411000-00005
Premoselli S, Sioli P, Grossi A, Cerri C. Neutral wrist splinting in carpal tunnel syndrome: a 3- and 6-months clinical and neurophysiologic follow-up evaluation of night-only splint therapy. Eura Medicophys 2006;42(2):121-6.
Walker WC, Metzler M, Cifu DX, Swartz Z. Neutral wrist splinting in carpal tunnel syndrome: a comparison of night-only versus full-time wear instructions. Arch Phys Med Rehabil 2000;81(4):424-9.
https://doi.org/10.1053/mr.2000.3856
Boonhong J, Kornvika S. Correlation between nerve conduction study (NCS) and clinical improvement in carpal tunnel syndrome (CTS). Chula Med J 2011;55:107-15.
Lee JH, An JH, Lee SH, Hwang EY. Effectiveness of steroid injection in treating patients with moderate and severe degree of carpal tunnel syndrome measured by clinical and electrodiagnostic assessment. Clin J Pain 2009;25:111-5. https://doi.org/10.1097/AJP.0b013e3181847a19
Schrijver HM, Gerritsen AA, Strijers RL, Uitdehaag BM, Scholten RJ, de Vet HC, et al. Correlating nerve conduction studies and clinical outcome measures on carpal tunnel syndrome: lessons from a randomized controlled trial. J Clin Neurophysiol 2005;22:216-21.
Papez BJ, Turk Z. Clinical versus electrodiagnostic effectiveness of splinting in the conservative treatment of carpal-tunnel syndrome. Wiener klinische Wochenschrift. 2004;116:24-7.
Kruger VL, Kraft GH, Deitz JC, Ameis A, Polissar L. Carpal tunnel syndrome: objective measures and splint use. Archives of physical medicine and rehabilitation. 1991;72:517-20.
Leite JC, Jerosch-Herold C, Song F. A systematic review of the psychometric properties of the Boston Carpal Tunnel Questionnaire. BMC Musculoskelet Disord. 2006;7:78. https://doi.org/10.1186/1471-2474-7-78
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Chulalongkorn Medical Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
