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

Abstract

IntroductionA review of the literature from the last 10 years quite clearly shows that immobilization of the wrist in the splint (orthosis) is the most effective, initial method of conservative treatment of carpal tunnel syndrome (CTS). The particular advantages of the described method of treatment are: availability, low cost, good patient tolerance, simplicity and minimal incidence of complications. The aim of this study was to try to define the criteria of proceeding with the selection of the type of orthosis and the duration of its use depending on the clinical condition and the patient’s expectations.Material and MethodsThe PubMed electronic database was searched for appropriately selected studies published between 2012 and 2022. The search strategy used was based on the following keywords: carpal tunnel syndrome, immobilization, orthosis, conservative treatment. The authors also searched the cited literature on relevant research and review papers on potentially relevant topics related to conservative treatment of the CTS.ConclusionsImmobilization in an orthosis gives therapeutic effects in all patients, regardless of the stage of the carpal tunnel syndrome. Most often the orthosis is only used at night for several weeks. During the exacerbation of symptoms, it can also be used during the day during activities that increase symptoms. In practice, it is recommended to wear a splint that immobilizes the wrist in a neutral position or slightly extended at 0–15 degrees (most often 0–5 degrees). A splint immobilizing the wrist and the 2–5 metacarpophalangeal joints are recommended for patients with positive Berger test results. There are no statistically significant differences in the treatment results between individual and traditional orthoses. No statistically significant differences were observed in the treatment effects between rigid and soft orthoses.

Effectiveness of Orthosis for Carpal Tunnel Syndrome: A Narrative Review

“…Neoprene is commonly used for soft orthoses and thermoplastics for rigid orthoses. The choice between rigid and soft orthoses depends on the patient's preference and therapist's experience [15]. When manufacturing a rigid orthosis, making perforations for breathability can increase the patient's satisfaction with the orthosis [19].…”

“…The basic function of an orthosis for managing CTS is to maintain the wrist in a neutral position to minimize pressure on the carpal tunnel [15]. It is important to keep the wrist in a neutral position, as the pressure in the carpal tunnel increases when the wrist is flexed or extended [16].…”

“…It is important to keep the wrist in a neutral position, as the pressure in the carpal tunnel increases when the wrist is flexed or extended [16]. However, this posture can limit the wrist movement and cause discomfort during daily activities [15].…”

“…During sleep, the wrist is usually naturally flexed, increasing pressure on the carpal tunnel [8]. Therefore, orthoses for patients with CTS are typically prescribed during nighttime or sleep, but if requested or if symptoms worsen, they can also be prescribed during the day or during the patient's active hours [15].…”

“…Electroacupuncture: needles inserted into 8 acupuncture points (TW-5, PC-7, HT-3, PC-3, SI-4, LI-5, LI-10 and LU-5) followed by electrical stimulation(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) mA, 20-40 Hz, continuous wave) -Prefabricated wrist splint: wearing in neutral position for 8 hours each evening BCTQ, DASH Questionnaire, NRS, Semmes-Weinstein monofilament test, Dellon-modified pick-up test, maximal tip pinch strength De Moraes et al 2021 N = 100 (M:F = 17:83), age (mean) = 54.3 years Orthosis group: forearm-palmar orthosis with the wrist immobilized in a neutral position while sleeping Injection group: 6.43 mg (1 ml) of betamethasone dipropionate, 2.63 mg of betamethasone disodium phosphate, and 0.5 ml of 2% lidocaine (xylocaine), totaling 1.5 ml Remission of nocturnal paresthesia, Boston-Levine questionnaire, VAS, complications Golriz et al 2016 N = 24 (M:F = 4:20), age (mean ± sd) = 48.32 ± 12.85 years Orthosis group 1: wrist splint in neutral position (0 degree) Orthosis group 2: neutral wrist splint with an extended trim line to control the metacarpophalangeal joints in 0-10 degrees of flexion DASH Questionnaire, VAS, grip strength, key pinch Lewis et al 2020 N = 105 (M:F = 73:32), age (mean ± sd) = 49 ± 12 years Experimental group: -Education: presentation and booklet regarding CTS pathophysiology, treatment options, posture and activity modification principles -Night splint: neutral wrist orthosis with a custom palmar stay -Home exercises: median nerve-gliding and tendon-gliding exercises Control group: no specific intervention Global rating of change scale, participant satisfaction, BCTQ, DASH Questionnaire, self-report version of the Leeds Assessment of Neuropathic Symptoms and Signs scale, Patient-Specific Functional Scale, symptom distribution, complications Sim et al 2019 N = 41 patients with 56 wrists (M:F = 7:49), age (mean ± sd) = 52.43 ± 12.03 years Splinting only group: a neutral wrist splint applied to the palm of the hand for more than 23 hours daily Combination treatment group: -Orthosis: a neutral wrist splint applied to the palm of the hand for more than 23 hours daily -Supervised exercises: median nerve-gliding and tendon-gliding exercises -Ultrasound therapy: set at a frequency of 1 MHz, intensity of 1.0 W/cm 2 and pulsed mode of 1:4; each session consisted of International Journal of Pain…”