April 24, 2000 -- Wrist splints really can help people with carpal tunnel syndrome, even those with severe symptoms, new research has shown.
Carpal tunnel syndrome (CTS) is caused by compression of a nerve that runs through the carpal tunnel in the wrist and is thought to be caused by repetitive motions, such as typing. People with the syndrome typically experience pain, weakness, and numbness or tingling in the hand and arm. Those who seek treatment can get a recommendation of anti-inflammatory drugs, occupational therapy, surgery, or wrist splints, depending on the health professional they see.
The new study, reported in the Archives of Physical Medicine and Rehabilitation, clears up some of the confusion, at least as far are wrist splints are concerned. There have been few previous studies that scientifically measured the benefits of wrist splints and tried to determine which kinds of splints should be worn and for how long.
For the study, William C. Walker, MD, from the Medical College of Virginia, and colleagues assigned 17 people with CTS to either full-time or night-only splint use for six weeks. Both before and after this period, the participants answered a series of questions about how severe their symptoms were and how well they were able to function. They also underwent before-and-after electrodiagnostic testing, in which delicate machinery is used to measure the speed with which nerves sense and respond to stimulation.
Wearing the splints either at night only or all the time brought significant improvement after the six-weeks, with full-time splint wearers faring slightly better. Symptoms improved, functions were gained, and nerves began to work a bit faster.
"The splinting intervention is already a frequently used strategy in treatment, and this study will provide even greater justification ... for use of wrist splinting," says Brian J. Dudgeon, PhD, OTR, who reviewed the article for WebMD. Dudgeon is an occupational therapist and lecturer in the department of rehabilitation medicine at the University of Washington School of Medicine, where he specializes in carpal tunnel syndrome.
In a surprising finding, patients in this study with severe CTS experienced improvements that were similar to or greater than those with mild to moderate CTS. As Dudgeon tells WebMD, "The currently accepted therapy for CTS is dependent on its severity." Mild to moderate symptoms are often treated more conservatively, with splints, while severe symptoms are typically treated with surgery. But, according to Walker, "these findings support the use of splints in severe CTS."
While splint use may be beneficial, some patients in the study had a hard time following their splint schedules. Most who were supposed to wear splints full time admitted to taking breaks during the day, sometimes leaving them off for more than half the day. Despite the difficulty of constant splint wearing, Walker and his team still recommend continuous wear.
Participants in both treatment groups wore rigid, custom-molded, thermoplastic wrist splints. The choice of splints -- both in material and position -- is essential, Dudgeon says. Many commercial and even some custom-made splints fail to hold the wrists in a neutral position. Neutral positions are thought to minimize carpal tunnel pressure, minimize pain, and facilitate healing.
- People with carpal tunnel syndrome saw measurable improvement of symptoms and gained function after six weeks of wrist-splint therapy.
- A full-time splint schedule provided more dramatic improvements, suggesting patients should strive to wear their splints as often as possible.
- Patients with both severe and mild-to-moderate carpal tunnel syndrome benefited from wearing wrist splints.