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

• Published in: Archives of physical medicine and rehabilitation Vol. 88; no. 11; pp. 1429 - 1435
• Main Authors: Brininger, Teresa L., MAJ, Rogers, Joan C., PhD, Holm, Margo B., PhD, Baker, Nancy A., ScD, Li, Zong-Ming, PhD, Goitz, Robert J., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-11-2007; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Carpal tunnel syndrome; Carpal Tunnel Syndrome - diagnosis; Carpal Tunnel Syndrome - physiopathology; Carpal Tunnel Syndrome - rehabilitation; Combined Modality Therapy; Cranial nerves. Spinal roots. Peripheral nerves. Autonomic nervous system. Gustation. Olfaction; Equipment Design; Exercise Therapy; Female; Follow-Up Studies; Humans; Male; Median Nerve - physiopathology; Medical sciences; Metacarpophalangeal Joint - physiopathology; Middle Aged; Miscellaneous; Muscle Weakness - diagnosis; Muscle Weakness - physiopathology; Muscle Weakness - rehabilitation; Nervous system (semeiology, syndromes); Neurology; Physical Medicine and Rehabilitation; Physical Therapy Modalities; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Rehabilitation; Splints; Tendons - physiopathology; Treatment outcome; Wrist Joint - physiopathology; Carpal tunnel syndrome; Treatment outcome; Rehabilitation; Splints; Physical exercise; Human; Nervous system diseases; Compression; Prognosis; Diseases of the osteoarticular system; Metacarpophalangeal joint; Metacarpophalangeal; Hand; Wrist; Symptomatology; Reeducation; Treatment; Wear; Peripheral nerve disease; Ambulatory; Splint; Tendon
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2007.07.019

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.