From the Guidelines
Splinting should not be the initial treatment approach for carpal tunnel syndrome due to potential harm, including increasing attention and focus to the area, exacerbating symptoms, and leading to muscle deconditioning, and instead, strategies that encourage normal movement patterns and resting postures should be tried first. When considering treatment for carpal tunnel syndrome, it's essential to prioritize interventions that promote normal movement and function, as splinting may prevent restoration of normal movement and function 1. The potential problems with splinting, such as increasing accessory muscle use, compensatory movement strategies, immobilization leading to muscle deconditioning, learnt non-use, and increased pain, should be carefully weighed against any potential benefits 1.
Some key points to consider when treating carpal tunnel syndrome include:
- Employing anxiety management and distraction techniques when undertaking tasks can be helpful 1
- Using strategies that encourage normal movement patterns and resting postures before considering splinting 1
- If a splint is issued, the person should be monitored regularly and feel empowered to discontinue use in the event of adverse side effects such as pain and skin breakdown 1
- Removable splints may have an overall positive effect in some cases, but benefits should be balanced against potential harm 1
In real-life clinical practice, it's crucial to prioritize treatments that minimize harm and promote normal function, even if it means not using splinting as a first-line treatment for carpal tunnel syndrome.
From the Research
Recommended Treatment for Carpal Tunnel Syndrome
- The goal of therapy for carpal tunnel syndrome (CTS) is to improve symptoms and reduce signs of the disease, as well as prevent progression and loss of hand function 2.
- Treatment alternatives include pharmacotherapy, splinting, and activity modification, with surgery being superior to conservative therapies for most persistently symptomatic patients 2.
Splinting for Carpal Tunnel Syndrome
- Neutral wrist splinting is a conservative treatment for CTS, with studies suggesting that a splint worn at night may be more effective than no treatment in the short term 3, 4.
- The optimal duration of splinting is unclear, with one study suggesting that 6 weeks of neutral wrist splinting may be sufficient for patients with mild and mild to moderate CTS 3.
- Another study found that night-time splinting may result in a higher rate of overall improvement in the short term, with a risk ratio of 3.86 (95% CI 2.29 to 6.51) 4.
- However, the evidence is limited, and more research is needed to determine the long-term effects of splinting for CTS 4, 5.
Comparison of Splinting with Other Treatments
- Studies have compared splinting with other non-surgical interventions, such as corticosteroid injection, nonsteroidal anti-inflammatory drugs, and rehabilitation, with mixed results 6, 5.
- One study found that splinting combined with a nonsteroidal anti-inflammatory drug was as effective as corticosteroid injection in improving CTS symptoms 6.
- Another study found that splinting may not provide additional benefits in symptoms or hand function when given together with corticosteroid injection or rehabilitation 5.