A new type of splint for the conservative therapy of the Carpal Tunnel Syndrome: a multiparametric evalutation.
Authors: N.Paciello, L.Padua, I.Aprile, R.Padua, P.TonaliUsing splint is a conservative therapy for the Carpal Tunnel Syndrome (CTS). Splint's action consists of riduction of bending-extension moviments and taking the wrist in a position which minimize intracarpal pression. Study's object is to verify the real effectiveness of a new type of splint (POLICARPAL) made by semi-rigid componentes and projected to make possible moviments of the hand like thumb's opposition and fingers' flession.
In our study we have used the multiparametric evaluation of the "Gruppo Italiano Studio Sindrome del Tunnel Carpale".
Before and after splint's application we have evaluated the patients with: Boston Carpal Tunnel Questionaire; clinic evaluation by anamnestic and clinical evidence; neurophysiological evaluation, following the AAEM criteria and an our own classification.
We have selected 30 patients with CTS of neurophysiological grade "minimum","mild","medium".Using the above mentioned multiple evaluation we have found a better evolution both in sobjective (paresthesia and pain) and objective (motor and sensitive conduction parameters) elements, with this new splint.
Institute of Neurology and Orthopedic, Cattolica Sacro Cuore University- Rome.
Neurological Sciences, Supplement to Number 6, Vol. 19, 1998.
14° Aggiornament Cours of Italian Society of Neurology.
Carpal Tunnel Syndrome: the cause dictates the treatment.
Authors: Carneiro RS.Department of Plastic Surgery, Cleveland Clinic, Florida, USA. Mild carpal tunnel syndrome should be conservatively treated and severe carpal tunnel syndrome usually requires surgery; however, management of moderate carpal tunnel syndrome is more complex. Usually, the treatment is dictated by the cause, which may be occupational injury, acute trauma, systemic disease such as diabetes, hypothyroidism, or rheumatoid arthritis, or other causes.
Cleve Clin J Med 1999 Mar;66(3):159-64. PMID: 10079585 [PubMed- indexed for Medline].
Neutral wrist splinting in carpal tunnel syndrome: a comparison of night-only versus full-time wear instructions.
Authors: Walker WC, Metzler M, Cifu DX, Swartz Z.Department of Physical Medicine and Rehabilitation, Medical College of Virginia at Virginia Commonwealth University, Richmond, USA.
Obiective: to compare the effeCTS of night-only to full-time splint wear instructions on symptoms, function and impairment in carpal tunnel syndrome (CTS).
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 (chi2 analysis, p=.004). Results: subjeCTS receiving full-time wear instructions showed superior distal latency improvement, both motor (.35 vs -.07 msec, p=.04) and sensory (.46 vs .13 msec, p=0.5) when compared with subieCTS receiving night-only wear instructions. Conclusions: this study provides added scientific evidence to support the efficacy of neutral wrist splint in CTS and suggests that physiologic improvement is bet with full-time splint wear instructions.
Arch Phy Med Rehabil. 2000 Apr:81(4);424-9.
PMID: 10768530 [PubMed -indexed for Medline].
Splinting for symptoms of carpal tunnel syndrome during pregnancy.
Authors: Courts RBOccupational Therapy Clinic, darnall Army Community Hospital, Fort Hood Texas, USA.
Objective: to determine whether splints are effective in decreasing symptoms of carpal tunnel syndrome during pregnancy.
Methods: case series at a military hospital of 82 pregnant women who had symptoms of carpal tunnel syndrome (135 hands). The author compared the ratings of eight subjective symptoms and grip and pinch strengths at the time of referral and 1 week after splinting (polyform volar splint with the wrist in 10 to 15 degrees of extension). Forty-eight women (82 hands) returned 1 month postpartum for reassessment. Grip and pinch strengths of an additional 26 women who had not had problems with their hands during pregnancy were measured 1 month postpartum.
Results: one week after splinting, there was an average increase of 5.4 pounds in grip strength and over 1 pound in each type of pinch strength (p<0.0001). there was a decrease in each of the eight symptoms (range, -0.9 to -1.6; scale of 5).
At 1 month postpartum, symptoms had resolved completely for 76% of the subjeCTS. Strength was improved, but was not normal. However, the women who had not had hand problems during pregnancy did have normal stregths.
Conclusions: splinting is a noninvasive method for helping to decrease the uncomfortable symptoms of carpal tunnel syndrome during pregnancy.
J. Hand Ther 1995 Jan-Mar;8(1):31-4.
PMID: 7742893 [PubMed - indexed for Medline].
Prevalence of carpal tunnel syndrome and upper extremity tendonitis among dental hygienists.
Authors: Werner RA, Hamann C, Franzblau A, Rodgers PA.Ann Arbor VA Medical Center, University of Michigan, USA.
Purpose: this study was undertaken to determine the prevalence of carpal tunnel syndrome (CTS) and upper extrmity (UE) tendonitis among dental hygienists.
Methods: in a cross-sectional study dental hygienists (n=305) were screened using sensory nerve conduction, a focused physical examination of the UE, and a symptom questionnaire. CTS was diagnosed if the subject had slowing of the median nerve at the wrist and symptoms of numbness, tingling of pain in the median distribution. Localized tendonitis of the UE was diagnosed if the subject had focal symptoms and associated findings on physical examination. Results: three percent of the participating dental hygienists were diagnosed with CTS. Thirteen were diagnosed with shoulder tendonitis, while 6% had a tendonitis of the elbow and 7% had tendonitis of the hand or wrist. Twenty-eight percent had a giagnosis of some UE tendonitis or CTS. Conclusions: the prevalence of handand finger sympotms in the dominant hand among dental hygienists in this study was high, but the prevalence CTS was nearly the same as the general population. There was a high rate of US tendonitis noted within this population.
PMID: 12078576 [PubMed - indexed for Medline].
Prevalence and risk factors of tendinitis and related disorders of the distal upper extremity among U.S. workers: comparison to carpal tunnel syndrome.
Authors: Tanaka S, Petersen M, Cameron L.Division of Surveillance, Hazard Evaluations. and Field Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, U.S. Public Health Service, Cincinnati, Ohio 45226, USA.
Background: national estimates of tendinitis and related disorders of the distal upper extremity among U.S. workers have not been available with the exception of carpal tunnel syndrome. Methods: the Occupational Health Supplement Data of the 1988 National Health Interview Survey were analyzed for tendinitis and related disorders of the hand/wrist and elbow (distal upper extremity) using the Survey Data Analysis (SUDAAN) software. Results: among the 30,074 respondents (statistically weighted population of 127 milion) who had worked anytime during the previous 12 months, 0.46% (95% CI: 0.36, 0.56) reported that they experienced a "prolonged" hand discomfort which was called tendinitis, synovitis, tenosynovitis, deQuervain's disease, epicondylitis, ganglion cyst, or trigger finger, by a medical person. This corresponds to 588,000 persons (95% CI: 457,000; 712,000) reporting one of these disorders, 28% (or 164,000) of which were thought to be work-related by the medical person. Among various risk factors examined by multiple logistic regression analysis, bending/twisting of the hand/wrists at work and female gender were significantly associated with reporting of these disorders.
Conclusions: by combining these cases with the previously reported cases of work-related carpal tunnel syndrome, we estimate that there were approximately 520,000 cases of work-related musculoskeletal disorders of the distal upper extremity among US workers in 1988.
PMID:11241566 [PubMed- indexed for Medline].
Effectiveness of hand therapy interventions in primary management of carpal tunnel syndrome: a systematic review.
Authors: Muller M, Tsui D, Schnurr R, Biddulph-Deisroth L, Hard J, MacDermid JC.Scool of Rehabilitation Science, McMaster University, Hamilton Ontario, Ontario, Canada.
The purpose of this study was to determine the effectiveness of hand therapy interventions for carpal tunnel syndrome (CTS) based on the best available evidence. A qualitative systematic review was conducted. A literature search using 40 key terms was condected from the earliest available date to january 2003 using seven databases. Articles were randomly assignes to two of five reviewers and evaluated according to predetermined criteria for inclusion at each of the title, abstract, and article levels. included studies were independently scored by two reviewers using a structured effectiveness quality evaluation scale and also graded according to Sackett's Levels of Evidence. There were 2027 articles identified from the literature search, of which 345 met the inclusion criteria. Twenty-four studies were used to formulate 30 recommendations. Current evidence demonstrates a significant benefit (grade B recommendations) from splinting, ultrasound, nerve gliding exercises, carpal bone mobilization, magnetic therapy, and yoga for people with carpal tunnel syndrome.
J Hand Ther. 2004 Apr-Jun; 17(2):210-28.
[PubMed-indexed for MEDLINE]
Long-term effectiveness of steroid injections and splinting in mild and moderate carpal tunnel syndrome.
Authors: Sevim S, Dogu O, Camdeviren H, Kaleagasi H, Aral M, Arslan E, Milcan A.Department of Neurology, Faculty of Medicine, Mersin University, Noroloji Anabilim Dali, 33070 Mersin, Turkey. serhansevim(at)mail(dot)koc(dot)net
To evaluate the long-term efficacy of non-surgical treatment methods for mild and moderate carpal tunnel syndrome, 120 patients with clinical symptoms and electrophysiological evidence were included in a prospective, randomizes blinded trial: 60 patients were instructed to wear splints every night, 30 received injection of betametasone 4 cm proximal to the carpal tunnel , and 30 received injiction distal to the carpal tunnel. After approximately 1 year (mean, 11 months;range, 9-14), 108 patients were available for final evaluation. We assessed clinical symptoms an performed detailde electrophisiological examinations before and after treatment. Splinting provided symptomatic relief and improved sensory and motor nerve conduction velocities at the lomg-term follow-up when the splints were worn almost every night. Proximal and distal injections of steroid were ineffective on the basis of both clinical symptoms and electrophysiological findings.
Neurol Sci. 2004 Jun;25(2):48-52.
PMID: 15221621 [PubMed-indexed for MEDLINE]
Conservative interventions for carpal tunnel syndrome.
Authors: Michlovitz SL.Temple University, Philadelphia, PA 19140, USA. Susan.Michlovitz@temple.edu
The assessment and conservative interventions in patients with carpal tunnel syndrome (CTS) are described in this paper. Information about surgical procedures and postoperative care has also been included. It is difficult to make definitive conclusions about the literature regarding success of treatment for CTS due to variations in outcome measures, severity of CTS, and inconsistencies in duration, dosage, and follow-up time for interventions. Based on what is known to date, this author recommends that patients with mild or moderate CTS be provided with a conservative program of splinting the wrist in neutral for nocturnal wear. In addition, intermittent exercise (nerve-gliding exercises) and activity modification, including avoidance of protracted periods of sustained gripping activities and awkward wrist positions, can be useful. This conservative program may be complemented by pain-relieving modalities during times of activity and supplemental participation in other exercise such as yoga. If symptoms are not relieved to the satisfaction of the patient, or they recur, then it is incumbent upon the therapist to refer the patient to a hand surgeon for injection or possible surgical decompression.
J Orthop Sports Phys Ther. 2004 Oct;34(10):589-600.
PMID: 15552705 [PubMed - indexed for MEDLINE]
Randomized controlled trial of nocturnal splinting for active workers with symptoms of carpal tunnel syndrome.
Authors: Werner RA, Franzblau A, Gell N.Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, MI 48105, USA. rawerner@umich.edu
OBJECTIVES: To determine whether nocturnal splinting of workers identified through active surveillance with symptoms consistent with carpal tunnel syndrome (CTS) would improve symptoms and median nerve function as well as impact medical care. DESIGN: Randomized controlled trial. SETTING: A Midwestern auto assembly plant. PARTICIPANTS: Active workers with symptoms suggestive of CTS based on a hand diagram. INTERVENTION: The treatment group received customized wrist splints, which were worn at night for 6 weeks; the control group received ergonomic education alone. MAIN OUTCOME MEASURES: Change in wrist, hand, and/or finger discomfort, carpal tunnel symptom severity index, median sensory nerve function, and the percentage of subjects who had carpal tunnel release surgery. RESULTS: The splinted group, unlike the controls, had a significant reduction in wrist, hand, and/or finger discomfort and a similar trend in the Levine carpal tunnel symptom severity index, which was maintained at 12 months. A secondary analysis showed that more median nerve impairment at baseline was associated with less clinical improvement among controls but not among the splinted group. CONCLUSIONS: Workers identified with CTS symptoms in an active symptom surveillance tended to benefit from a 6-week nocturnal splinting trial, and the benefits were still evident at the 1-year follow-up. The splinted group improved in terms of hand discomfort regardless of the degree of median nerve impairment, whereas the controls showed improvement only among subjects with normal median nerve function. Results suggest that a short course of nocturnal splinting may reduce wrist, hand, and/or finger discomfort among active workers with symptoms consistent with CTS.
Arch Phys Med Rehabil. 2005 Jan;86(1):1-7.
PMID: 15640980 [PubMed - indexed for MEDLINE]
Long-term effectiveness of steroid injections and splinting in mild and moderate carpal tunnel syndrome.
Authors: Sevim S, Dogu O, Camdeviren H, Kaleagasi H, Aral M, Arslan E, Milcan A.Department of Neurology, Faculty of Medicine, Mersin University, Noroloji Anabilim Dali, 33070 Mersin, Turkey. serhansevim@mail.koc.net
To evaluate the long-term efficacy of non-surgical treatment methods for mild and moderate carpal tunnel syndrome, 120 patients with clinical symptoms and electrophysiologic evidence were included in a prospective, randomized and blinded trial: 60 patients were instructed to wear splints every night, 30 received injections of betamethasone 4 cm proximal to the carpal tunnel, and 30 received injections distal to the carpal tunnel. After approximately 1 year (mean, 11 months; range, 9-14), 108 patients were available for final evaluation. We assessed clinical symptom severity and performed detailed electrophysiologic examinations before and after treatment. Splinting provided symptomatic relief and improved sensory and motor nerve conduction velocities at the long-term follow-up when the splints were worn almost every night. Proximal and distal injections of steroids were ineffective on the basis of both clinical symptoms and electrophysiologic findings.
Neurol Sci. 2004 Jun;25(2):48-52.
PMID: 15221621 [PubMed - indexed for MEDLINE]
