Splinting for carpal tunnel syndrome New
Carpal tunnel syndrome (CTS) is a condition where one of two main nerves in the wrist is compressed, which can lead to pain in the hand, wrist and sometimes arm, and numbness and tingling in the thumb, index and long finger. Splinting is usually offered to people with mild to moderate symptoms. However, the effectiveness and duration of the benefit of splinting for this condition remain unknown.
To compare the effectiveness of splinting for carpal tunnel syndrome with no treatment, placebo or another non‐surgical intervention.
We searched the Cochrane Neuromuscular Disease Group Specialized Register (10 January 2011), CENTRAL, NHSEED and DARE (The Cochrane Library 2011, Issue 4), MEDLINE (January 1966 to December 2011), EMBASE (January 1980 to January 2012), AMED (January 1985 to January 2012), and CINAHL Plus (January 1937 to January 2012), using no time limits. We searched the reference lists of all included trials and relevant reviews for further relevant studies.
All randomised and quasi‐randomised trials comparing splinting with no treatment (or a placebo) or with other non‐surgical treatments were eligible for inclusion. We also included studies comparing one splint type or regimen versus another. We excluded studies comparing splinting with surgical treatment. There were no language restrictions. We included all patients diagnosed with carpal tunnel syndrome unless they had undergone surgical release.
Data collection and analysis
Two review authors independently selected trials for inclusion, and performed data extraction. Two authors also independently performed the assessment of risk of bias. We calculated measures of effect as risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI) reported and statistical significance set at P < 0.05 for all outcome comparisons.
The review included 19 studies randomising 1190 participants with carpal tunnel syndrome. Two studies compared splinting with no treatment, five compared different splint designs, one compared different splint‐wearing regimens, seven compared splint delivered as a single intervention with another non‐surgical intervention, and five compared splint delivered alongside other non‐surgical interventions with another non‐surgical intervention. Only three studies reported concealing the allocation sequence, and only one reported blinding of participants. Three studies measured the primary outcome, short‐term overall improvement at three months or less. One low quality study with 80 wrists found that compared to no treatment, splints worn at night more than tripled the likelihood of reporting overall improvement at the end of four weeks of treatment (RR 3.86, 95% CI 2.29 to 6.51). However, the lack of patient blinding and unclear allocation concealment suggests this result should be interpreted with caution. A very low quality quasi‐randomised trial with 90 wrists found that wearing a neutral splint more than doubled the likelihood of reporting 'a lot or complete relief' at the end of two weeks of treatment compared with an extension splint (RR 2.43, 95% CI 1.12 to 5.28). The third study which measured short‐term overall improvement did not report outcome data separately per group. Nine studies measured adverse effects of splinting and all found either no or few participants reporting discomfort or swelling due to splinting; however, the precision of all RRs was very low. Differences between groups in the secondary outcomes ‐ symptoms, function, and neurophysiologic parameters ‐ were most commonly small with 95% CIs incorporating effects in either direction.
Overall, there is limited evidence that a splint worn at night is more effective than no treatment in the short term, but there is insufficient evidence regarding the effectiveness and safety of one splint design or wearing regimen over others, and of splint over other non‐surgical interventions for CTS. More research is needed on the long‐term effects of this intervention for CTS.
Matthew J Page, Nicola Massy‐Westropp, Denise O'Connor, Veronica Pitt
Plain language summary
Splinting for carpal tunnel syndrome
Carpal tunnel syndrome (CTS) is a condition where one of two main nerves in the wrist is compressed, which can lead to pain in the hand, wrist and sometimes arm, and numbness and tingling in the thumb, index and long finger. CTS is more common in women and older age groups. Many people undergo surgery to treat this condition, though sometimes other non‐surgical treatments, such as splinting, are offered. Splinting involves immobilisation of the wrist with a device that is worn over the wrist, which usually leaves the fingers and thumb free to move. We searched for study reports and found 19 randomised or quasi‐randomised controlled trials including 1190 participants overall that assessed the safety and benefit of splinting for people with CTS. The risk of bias of studies was low in some studies and unclear or high in others. One low quality study suggests that splinting at night leads to more overall improvement in the short term when compared to no treatment, but we cannot say from the evidence whether one splint design or wearing regimen is more effective than another, nor can we say that splinting is more effective than other non‐surgical interventions for CTS (for example exercises, oral steroids). Nine trials measured adverse effects of splinting and all found either no or few participants reported discomfort or swelling due to splinting. More research is needed to find out how effective and safe splinting is for people with carpal tunnel syndrome, particularly in the long term.
Matthew J Page, Nicola Massy‐Westropp, Denise O'Connor, Veronica Pitt
Implications for practice
Overall, there is limited evidence that a splint worn at night is more effective in the short term than no treatment, but insufficient evidence regarding the effectiveness and safety of one splint design or wearing regimen over others, and insufficient evidence regarding the effectiveness and safety of splints over other non‐surgical interventions for CTS.
Implications for research
There is a need for more evidence on the long‐term benefits of splinting. All future studies should attempt to blind participants, personnel, and outcome assessors where possible, and trialists should consider collecting data on overall improvement, adverse effects, CTS symptoms, function, and neurophysiologic parameters. If participants with bilateral CTS are included in the trial, trialists should use statistical methods which take the dependency between wrists into account, and report which statistical methods they used to achieve this. Finally, outcomes should be collected at long‐term follow‐up (that is, at least three months post‐treatment cessation).Get full text at The Cochrane Library
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