An advanced stage of carpal tunnel syndrome – is night-time splinting still effective?

Abstract

Objectives: There is no consensus on whether conservative treatment with night splints is indicated also in moderate and severe stages of carpal tunnel syndrome (CTS). The goal of this study was to compare the efficacy of night-time splinting at different stages of CTS. Material and Methods: Forty-five patients with electrodiagnostic (EDX) features of CTS included in the study were divided into 2 groups based on nerve conduction studies. The patients in the first group had only median nerve sensory fiber involvement, whereas the patients in the second group had also motor fiber involvement. The custom-made volar night splint was the only treatment for all of the included patients. The patients were assessed before the fabrication of orthosis and after 12 weeks of its use. The parameters measured were hand grip strength and the Visual Analogue Scale for pain and paraesthesia. The patients further completed the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) and a shorter version of the Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH). Results: In the first group, a statistically significant improvement was established in paraesthesia and hand grip strength (p = 0.019, p = 0.024, respectively), but there was no statistically significant improvement in pain, and the results of both BCTQ and QuickDASH. In the second group, a statistically significant improvement was found in paraesthesia, the BCTQ Symptom Severity Scale and QuickDASH results (p = 0.008, p < 0.001, p = 0.011, respectively), whereas no statistically significant improvement was established in pain, hand grip strength and the BCTQ Functional Status Scale. However, when comparing the change in the outcome measures between the 2 groups, no statistically significant differences were found. Conclusions: This study has shown that 12-week night-time splinting is beneficial not only for patients with mild CTS but also for those with advanced CTS, and those awaiting surgical treatment. Therefore, splinting is recommended for all patients with CTS.

The use of orthoses in the treatment of carpal tunnel syndrome. A review of the literature from the last 10 years

“…Studies by Šošić et al [6] show that the use of the immobilizing scales at night has beneficial effects not only in patients with mild, but also with severe CTS. Therefore, this method of therapy is recommended for all patients, regardless of the stage of the syndrome [6]. This may be important information, especially in the case of patients qualified for surgery and awaiting surgery.…”

“…As a rule, the orthosis is only used at night for several weeks [1,6,[11][12][13]. In the period of exacerbation of symptoms, it is advisable to use it also during the day during everyday activity [1,7].…”

“…Wearing wrist splints in a neutral position or a slight extension of 0-15 degrees (most often 0-5 degrees) can increase the carpal tunnel space, reduce pressure on the median nerve, and thus alleviate symptoms. Moreover, the neutral position improves hemodynamic parameters [1,2,4,6,12,14,15,17,18].…”

“…The need to discontinue treatment due to skin irritation or orthosis intolerance is reported by less than 1% of patients [1,6,[22][23][24][25][26][27]. Due to the above, the use of kinesiotaping may be an alternative method of CTS treatment, the effects of which are similar to immobilization in an orthosis.…”

“…The spe-cific advantages of the described method of treatment include: availability, low cost, good patient tolerance, simplicity and a negligible number of complications [1][2][3][4][5]. The American Academy of Orthopedic Surgeons (AAOS) guidelines on CTS suggest that there is strong evidence to support the use of splint (orthosis) fixation to improve Reumatologia 2022; 60/6 patient-reported outcomes [6]. Many studies show that the use of splints can reduce the intensity of symptoms within just a few weeks of treatment [7].…”