Clinical versus electrodiagnostic effectiveness of splinting in the conservative treatment of carpal-tunnel syndrome.

BACKGROUND

Splinting is known as one of the most effective non-aggressive treatments for carpal-tunnel syndrome (CTS). Early and accurate diagnosis of CTS is critical for effective non-surgical management. Nerve-conduction studies confirm the diagnosis of CTS with a high degree of sensitivity and specificity. Many patients report that their symptoms decrease after splinting; consequently, improved electrophysiological findings are expected.

OBJECTIVE

The aim of the study was to evaluate the clinical and neurophysiological effectiveness of splinting in patients with CTS.

METHODS

In a prospective study of 77 hands with CTS symptoms, neurophysiological tests were performed before and after 12 weeks of using a splint. A custom-made volar thermoplastic wrist splint was fabricated in a neutral wrist position to maximize carpal-tunnel space and minimize the compressive forces on the median nerve. Each patient was provided with a custom-made splint, and was asked to wear it during sleep and whenever possible when awake. The case history was taken, and a physical examination and repeated nerve conduction studies were performed at the start and after 12 weeks. Data were analysed statistically.

RESULTS

We calculated the mean and the range for each electrophysiological test before and after 12 weeks of splint use. There was no significant difference between pre- and post-measurement of each parameter (p > 0.05). Good relief of symptoms occurred soon after the patients began wearing the splint; however, the electrodiagnostic test remained pathological.

CONCLUSION

Even though immobilization (wrist splint in neutral position) does not affect the common electrodiagnostic parameters in CTS diagnostics, it caused the disappearance of clinical symptoms in 75% of the patients. There is therefore a need for further research regarding the usefulness of repeated electrodiagnostic studies.