Advertisement

Neutral wrist splinting in carpal tunnel syndrome: A comparison of night-only versus full-time wear instructions

  • William C. Walker
    Affiliations
    Department of Physical Medicine and Rehabilitation, Medical College of Virginia at Virginia Commonwealth University (Dr. Walker, Ms. Metzler, Dr. Cifu, Dr. Swartz) and McGuire Veterans Administration Medical Center (Dr. Walker), Richmond, VA.
    Search for articles by this author
  • Marie Metzler
    Affiliations
    Department of Physical Medicine and Rehabilitation, Medical College of Virginia at Virginia Commonwealth University (Dr. Walker, Ms. Metzler, Dr. Cifu, Dr. Swartz) and McGuire Veterans Administration Medical Center (Dr. Walker), Richmond, VA.
    Search for articles by this author
  • David X. Cifu
    Affiliations
    Department of Physical Medicine and Rehabilitation, Medical College of Virginia at Virginia Commonwealth University (Dr. Walker, Ms. Metzler, Dr. Cifu, Dr. Swartz) and McGuire Veterans Administration Medical Center (Dr. Walker), Richmond, VA.
    Search for articles by this author
  • Zachary Swartz
    Affiliations
    Department of Physical Medicine and Rehabilitation, Medical College of Virginia at Virginia Commonwealth University (Dr. Walker, Ms. Metzler, Dr. Cifu, Dr. Swartz) and McGuire Veterans Administration Medical Center (Dr. Walker), Richmond, VA.
    Search for articles by this author
  • Author Footnotes
    NO LABEL a. Nicolet Biomedical, 5225 Verona Road, Building 2, Madison, WI 53711.

      Abstract

      Walker WC, Metzler M, Cifu DX, Swartz Z. Neutral wrist splinting in carpal tunnel syndrome: a comparison of night-only versus full-time wear instructions. Arch Phys Med Rehabil 2000;81:424-9. Objective: To compare the effects of night-only to full-time splint wear instructions on symptoms, function, and impairment in carpal tunnel syndrome (CTS). Design: Randomized clinical trial with 6-week follow-up. Setting: Veterans Administration Medical Center, outpatient clinic. Subjects: Outpatients with untreated CTS were consecutively recruited from our electrodiagnostics lab. Twenty-one patients (30 hands) were enrolled, and 17 patients (24 hands) completed the study. Interventions: Thermoplastic, custom-molded, neutral wrist splints with subjects receiving either full-time or night-only wear instructions. Outcome Measures: Symptoms and functional deficits were measured by Levine's self-administered questionnaire, and physiologic impairment was measured by median nerve sensory and motor distal latency. Compliance and Crossover: Almost all (92%) of the combined sample reported frequent splint use, but their adherence to specific wearing instructions was limited. A majority (73%) of the full-time group reported splint wear less than one half of waking hours, and some (23%) of the night-only group reported occasional daytime wear. Despite this tendency for treatment crossover, the two treatment groups differed in daytime wear as intended (χ2 analysis, p =.004). Results: The combined sample improved in three of four outcome measures: sensory distal latency (mean =.28msec, standard deviation [SD] =.37, p =.004), symptom severity (mean =.64, SD =.46, p =.0001), and functional deficits (mean =.49, SD =.51, p =.0001). Severity of CTS was a factor only in sensory distal latency improvement (more improvement in severe CTS). Subjects receiving full-time wear instructions showed superior distal latency improvement, both motor (.35 vs −.07msec, p =.04) and sensory (.46 vs.13msec, p =.05) when compared with subjects receiving night-only wear instructions. Conclusions: This study provides added scientific evidence to support the efficacy of neutral wrist splints in CTS and suggests that physiologic improvement is best with full-time splint wear instructions. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • American Association of Electrodiagnostic Medicine, American Association of Neurology, American Association of Physical Medicine and Rehabilitation
        Practice parameter for electrodiagnostic studies in carpal tunnel syndrome: summary statement.
        Muscle Nerve. 1993; 16: 1389-1391
        • Duncan KH
        • Lewis RC
        • Foreman KA
        • Nordyke MD.
        Treatment of carpal tunnel syndrome by members of the American Society for Surgery of the Hand: results of a questionnaire.
        J Hand Surg [Am]. 1987; 12: 384-391
        • Goodwill CJ.
        The carpal tunnel syndrome: long-term follow-up showing relation of latency measurements to response to treatment.
        Ann Phys Med. 1965; 8: 12-21
        • Goodman HV
        • Gilliatt RW.
        The effect of treatment on median nerve conduction in patients with the carpal tunnel syndrome.
        Ann Phys Med. 1961; 6: 137-155
        • Phalen GS.
        The carpal-tunnel syndrome: seventeen years experience in diagnosis and treatment of 654 hands.
        J Bone Joint Surg Am. 1966; 48: 211-218
        • Gelberman RH
        • Aronson D
        • Weisman MH.
        Carpal-tunnel syndrome: results of a prospective trial of steroid injection and splinting.
        J Bone Joint Surg Am. 1980; 62: 1181-1184
        • Roaf R.
        Compression of median nerve in carpal tunnel.
        Lancet. 1947; 1 ([letter to the editor]): 387
        • Brain WR
        • Wright AD
        • Wilkinson M.
        Spontaneous compression of both median nerves in the carpal tunnel. Six cases treated surgically.
        Lancet. 1947; 1: 277-282
        • Gelberman RH
        • Hergenroeder P
        • Hargens A
        • Lundborg GN
        • Akeson WH.
        The carpal tunnel syndrome: a study of carpal canal pressures.
        J Bone Joint Surg Am. 1981; 63: 380-383
        • Gellman H
        • Chandler DR
        • Petrasek J
        • Sie I
        • Adkins R
        • Waters RL.
        Carpal tunnel syndrome in paraplegic patients.
        J Bone Joint Surg Am. 1988; 70: 517-519
        • Rojviroj S
        • Sirichativapee W
        • Kowsuwon W
        • Wongwiwattanason J
        • Tamnanthong N
        • Jeeravipoolvarn N.
        Pressures in the carpal tunnel. A comparison between patients with CTS and normal subjects.
        J Bone Joint Surg Br. 1990; 72: 516-518
        • Szabo RM
        • Chidgey LK.
        Stress carpal tunnel pressures in patients with CTS and normal patients.
        J Hand Surg [Am]. 1989; 14: 624-627
        • Tanzer RC.
        The carpal-tunnel syndrome: a clinical and anatomical study.
        J Bone Joint Surg Am. 1959; 41: 626-634
        • Weiss ND
        • Gordon L
        • Bloom T
        • So Y
        • Rempel DM.
        Position of the wrist associated with the lowest carpal-tunnel pressure: implications for splint design.
        J Bone Joint Surg Am. 1995; 77: 1695-1699
        • Bauman TD
        • Gelberman RH
        • Mubarak SJ
        • Garfin SR.
        The acute carpal tunnel syndrome.
        Clin Orthop. 1981; 156: 151-156
        • Rempel D
        • Bach JM
        • Gordon L
        • So Y.
        Effects of forearm pronation/supination on carpal tunnel pressure.
        J Hand Surg [Am]. 1998; 23: 38-42
        • Keir PJ
        • Bach JM
        • Rempel DM.
        Effects of finger posture on carpal tunnel pressure during wrist motion.
        J Hand Surg [Am]. 1998; 23: 1004-1009
        • Rempel D
        • Keir PJ
        • Smutz WP
        • Hargens A.
        Effects of static fingertip loading on carpal tunnel pressure.
        J Orthop Res. 1997; 15: 422-426
        • Burke DT
        • Burke MM
        • Stewart GW
        • Cambre A.
        Splinting for carpal tunnel syndrome: in search of the optimal angle.
        Arch Phys Med Rehabil. 1994; 75: 1241-1244
        • Heathfield KWG.
        Aeroparesthesiae and the carpal-tunnel syndrome.
        Lancet. 1957; 2: 663-666
        • Kruger VL
        • Kraft GH
        • Deitz JC
        • Ameis A
        • Polissar L.
        Carpal tunnel syndrome: objective measures and splint use.
        Arch Phys Med Rehabil. 1991; 72: 517-520
        • Crow RS.
        Treatment of the carpal-tunnel syndrome.
        BMJ. 1960; 1: 1611-1615
        • Quinn CE.
        Carpal tunnel syndrome: treatment by splinting.
        Ann Phys Med. 1961; 6: 72-75
        • Dolhanty D.
        Effectiveness of splinting for carpal tunnel syndrome.
        Can J Occup Ther. 1986; 53: 275-280
        • Sailer SM.
        The role of splinting and rehabilitation in the treatment of carpal and cubital tunnel syndromes.
        Hand Clin. 1996; 12: 223-241
        • Levine DW
        • Simmons BP
        • Koris MJ
        • Daltroy LH
        • Hohl GG
        • Fossel AH
        • et al.
        A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome.
        J Bone Joint Surg Am. 1993; 75: 1585-1592
        • Katz JN
        • Gelberman RH
        • Wright EA
        • Lew RA
        • Liang MH.
        Responsiveness of self-reported and objective measures of disease severity in carpal tunnel syndrome.
        Med Care. 1994; 32: 1127-1133
        • Jabiecki CK
        • Andary MT
        • So YT
        • Wilkins DE
        • Williams FH
        • for the AAEM Quality Assurance Committee
        Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome.
        Muscle Nerve. 1993; 16: 1392-1414
        • Chaudry V
        • Cornblath DR
        • Mellits ED
        • Avila O
        • Freimer ML
        • Glass JD
        • et al.
        Inter- and intra-examiner reliability of nerve conduction measurements in normal subjects.
        in: Ann Neurol. 30. 1991: 841-843
        • Melvin JL
        • Harris DH
        • Johnson EW.
        Sensory and motor conduction velocities in the ulnar and median nerves.
        Arch Phys Med Rehabil. 1966; 47: 511-519
      1. Electrodiagnostic medicine. Hanley and Belfus, Philadelphia1995
        • DiBenedetto M
        • Mitz M
        • Klingbeil GE
        • Davidoff D.
        New criteria for sensory nerve conduction especially useful in diagnosing carpal tunnel syndrome.
        Arch Phys Med Rehabil. 1986; 67: 586-589
        • Johnson EW
        • Melvin JL.
        Sensory conduction studies of median and ulnar nerves.
        Arch Phys Med Rehabil. 1967; 48: 25-30
        • Buchathal F
        • Rosenfalck A.
        Sensory conduction from digit to palm and from palm to wrist in carpal tunnel syndrome.
        J Neurol Neurosurg Psychiatry. 1974; 34: 243-252
        • Felsenthal G
        • Spindler H.
        Palmar conduction time of median and ulnar nerves of normal subjects and patients with carpal tunnel syndrome.
        Am J Phys Med. 1979; 58: 131-138
        • DeLean J.
        Transcarpal median sensory conduction: detection of latent abnormalities in mild carpal tunnel syndrome.
        Can J Neurol Sci. 1988; 15: 388-393
        • Stevens JC.
        AAEM minimonograph #26: the electrodiagnosis of carpal tunnel syndrome.
        Muscle Nerve. 1997; 20: 1477-1486
        • Carroll GJ.
        Comparison of median and radial nerve sensory latencies in the electrophysiological diagnosis of carpal tunnel syndrome.
        Electroencephalogr Clin Neurophysiol. 1987; 68: 101-106
        • Pease WS
        • Cannell CD
        • Johnson EW.
        Median to radial latency difference test in mild carpal tunnel syndrome.
        Muscle Nerve. 1989; 12: 905-909
        • Belcon MC
        • Haynes RB
        • Tugwell P.
        Critical review of compliance studies in rheumatoid arthritis.
        Arthritis Rheum. 1984; 27: 1227-1233
        • Feinberg J.
        Effect of the arthritis professional on compliance with use of resting hand splints by patients with rheumatoid arthritis.
        Arthritis Care Res. 1992; 5: 17-23
        • Callinan NJ
        • Mathiowetz V.
        Soft versus hard resting hand splints in rheumatoid arthritis: pain relief, preference and compliance.
        Am J Occup Ther. 1995; 50: 347-353
        • Rempel D
        • Manojlovik R
        • Levinsohn DG
        • Bloom T
        • Gordon L.
        The effect of wearing a flexible wrist splint on carpal tunnel pressure during repetitive hand activity.
        J Hand Surg [Am]. 1994; 19: 106-110
        • Hicks JE
        • Leonard JA
        • Nelson VS
        • Fisher SV
        • Esquaenazi A.
        Prosthetics orthotics, and assistive devices. 4. Orthotic management of selected disorders.
        Arch Phys Med Rehabil. 1989; 70: S210-S217
        • Chang MH
        • Chiang HT
        • Lee SSJ
        • Ger LP
        • Lo YK.
        Oral drug of choice in carpal tunnel syndrome.
        Neurology. 1998; 51: 390-393
        • Nicholas JJ
        • Gruen H
        • Weiner G
        • Crawshaw C
        • Taylor F.
        Splinting in rheumatoid arthritis: I. Factors affecting patient compliance.
        Arch Phys Med Rehabil. 1982; 63: 92-94
        • Oakes TW
        • Ward JR
        • Gray RM
        • Kaluber MR
        • Moody PM.
        J Chronic Dis. 1970; 22: 757-764