Original article
Efficacy of a Fabricated Customized Splint and Tendon and Nerve Gliding Exercises for the Treatment of Carpal Tunnel Syndrome: A Randomized Controlled Trial

https://doi.org/10.1016/j.apmr.2007.07.019Get rights and content

Abstract

Brininger TL, Rogers JC, Holm MB, Baker NA, Li Z-M, Goitz RJ. Efficacy of a fabricated customized splint and tendon and nerve gliding exercises for the treatment of carpal tunnel syndrome: a randomized controlled trial.

Objective

To compare the effects of a neutral wrist and metacarpophalangeal (MCP) splint with a wrist cock-up splint, with and without exercises, for the treatment of carpal tunnel syndrome (CTS).

Design

A 2×2×3 randomized factorial design with 3 main factors: splint (neutral wrist and MCP and wrist cock-up), exercise (exercises, no exercise), and time (baseline, 4wk, 8wk).

Setting

Subjects were evaluated in an outpatient hand therapy clinic.

Participants

Sixty-one subjects with mild to moderate CTS; 51 subjects completed the study.

Interventions

There were 4 groups: the neutral wrist and MCP group and the neutral wrist and MCP-exercise group received fabricated customized splints that supported the wrist and MCP joints; the wrist cock-up group and the wrist cock-up-exercise group received wrist cock-up splints. The neutral wrist and MCP-exercise and wrist cock-up-exercise groups also received tendon and nerve gliding exercises and were instructed to perform exercises 3 times a day. All subjects were instructed to wear the assigned splint every night for 4 weeks.

Main Outcome Measures

We used the CTS Symptom Severity Scale (SSS) and the Functional Status Scale (FSS) to assess CTS symptoms and functional status.

Results

Analysis of variance showed a significant main effect for splint and time on the SSS (P<.001, P=.014) and FSS (P<.001, P=.029), respectively. There were no interaction effects.

Conclusions

Our results validate the use of wrist splints for the treatment of CTS, and suggest that a splint that supports the wrist and MCP joints in neutral may be more effective than a wrist cock-up splint.

Section snippets

Participants

The trial included 61 subjects (14 men, 47 women) who were recruited from the University of Pittsburgh Medical Center’s Orthopedic Outpatient Hand Clinic between March 2004 and March 2005. To qualify for the study, subjects had to be at least 18 years of age, have a positive Tinel sign or Phalen maneuver, and have complaints of nocturnal numbness and tingling. Subjects were excluded if they had had a neuropathy other than CTS in the past year (symptoms of CTS might have been due to an

Results

Sixty-one of 79 eligible patients enrolled in the study. Four subjects withdrew because: they had an injection or surgery (n=2), developed an illness (n=1), or moved out of the area (n=1); 6 subjects were lost to follow-up (fig 3). Thus, 51 subjects (10 men, 41 women) completed the study. Their mean age was 50 years (range, 21–86y) and 55% of the subjects reported bilateral CTS. All groups were similar in demographic and clinical characteristics at baseline (table 1).

The results of the means

Discussion

Currently, several conservative interventions are used to treat CTS. Evidence on the effectiveness of these interventions is lacking, however. In this RCT, we used valid and reliable measures to evaluate the effectiveness of a nontraditional splint and tendon and nerve gliding exercises to treat mild-to-moderate CTS.

As expected, the study population’s sex and age were consistent with population-based studies of CTS prevalence.2, 4, 32 More women (77%) than men (23%) enrolled in the study and on

Conclusions

CTS is among the most commonly diagnosed upper-extremity neuropathies. Rising health care and indemnity costs are just a few of the many implications of CTS for modern society. Determining safe, effective, and economic conservative interventions for the treatment of mild-to-moderate CTS should be a priority. The purpose of this study was to compare the effects of a fabricated customized neutral wrist and MCP splint to a wrist cock-up splint, with and without tendon and nerve gliding exercises,

Acknowledgment

The opinions or assertions contained herein are the private views of the author(s) and are not to be construed as official or as reflecting the views of the U.S. Army or the U.S. Department of Defense.

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    Supported by the School of Health and Rehabilitation Science Development Fund, School of Health and Rehabilitation Sciences, University of Pittsburgh, PA.

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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    Copyright © 2007 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.