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Meta-Analysis
. 2012 Jul 11;2012(7):CD010003.
doi: 10.1002/14651858.CD010003.

Splinting for carpal tunnel syndrome

Matthew J Page  1 , Nicola Massy-Westropp, Denise O'Connor, Veronica Pitt
Affiliations
Meta-Analysis

Splinting for carpal tunnel syndrome

Matthew J Page et al. Cochrane Database Syst Rev. .

Update in

  • Splinting for carpal tunnel syndrome.
    Karjalainen TV, Lusa V, Page MJ, O'Connor D, Massy-Westropp N, Peters SE. Karjalainen TV, et al. Cochrane Database Syst Rev. 2023 Feb 27;2(2):CD010003. doi: 10.1002/14651858.CD010003.pub2. Cochrane Database Syst Rev. 2023. PMID: 36848651 Free PMC article. Review.

Abstract

Background: Carpal tunnel syndrome (CTS) is a condition where one of two main nerves in the wrist is compressed, which can lead to pain in the hand, wrist and sometimes arm, and numbness and tingling in the thumb, index and long finger. Splinting is usually offered to people with mild to moderate symptoms. However, the effectiveness and duration of the benefit of splinting for this condition remain unknown.

Objectives: To compare the effectiveness of splinting for carpal tunnel syndrome with no treatment, placebo or another non-surgical intervention.

Search methods: We searched the Cochrane Neuromuscular Disease Group Specialized Register (10 January 2011), CENTRAL, NHSEED and DARE (The Cochrane Library 2011, Issue 4), MEDLINE (January 1966 to December 2011), EMBASE (January 1980 to January 2012), AMED (January 1985 to January 2012), and CINAHL Plus (January 1937 to January 2012), using no time limits. We searched the reference lists of all included trials and relevant reviews for further relevant studies.

Selection criteria: All randomised and quasi-randomised trials comparing splinting with no treatment (or a placebo) or with other non-surgical treatments were eligible for inclusion. We also included studies comparing one splint type or regimen versus another. We excluded studies comparing splinting with surgical treatment. There were no language restrictions. We included all patients diagnosed with carpal tunnel syndrome unless they had undergone surgical release.

Data collection and analysis: Two review authors independently selected trials for inclusion, and performed data extraction. Two authors also independently performed the assessment of risk of bias. We calculated measures of effect as risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI) reported and statistical significance set at P < 0.05 for all outcome comparisons.

Main results: The review included 19 studies randomising 1190 participants with carpal tunnel syndrome. Two studies compared splinting with no treatment, five compared different splint designs, one compared different splint-wearing regimens, seven compared splint delivered as a single intervention with another non-surgical intervention, and five compared splint delivered alongside other non-surgical interventions with another non-surgical intervention. Only three studies reported concealing the allocation sequence, and only one reported blinding of participants. Three studies measured the primary outcome, short-term overall improvement at three months or less. One low quality study with 80 wrists found that compared to no treatment, splints worn at night more than tripled the likelihood of reporting overall improvement at the end of four weeks of treatment (RR 3.86, 95% CI 2.29 to 6.51). However, the lack of patient blinding and unclear allocation concealment suggests this result should be interpreted with caution. A very low quality quasi-randomised trial with 90 wrists found that wearing a neutral splint more than doubled the likelihood of reporting 'a lot or complete relief' at the end of two weeks of treatment compared with an extension splint (RR 2.43, 95% CI 1.12 to 5.28). The third study which measured short-term overall improvement did not report outcome data separately per group. Nine studies measured adverse effects of splinting and all found either no or few participants reporting discomfort or swelling due to splinting; however, the precision of all RRs was very low. Differences between groups in the secondary outcomes - symptoms, function, and neurophysiologic parameters - were most commonly small with 95% CIs incorporating effects in either direction.

Authors' conclusions: Overall, there is limited evidence that a splint worn at night is more effective than no treatment in the short term, but there is insufficient evidence regarding the effectiveness and safety of one splint design or wearing regimen over others, and of splint over other non-surgical interventions for CTS. More research is needed on the long-term effects of this intervention for CTS.

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Conflict of interest statement

The authors declare no competing commercial or copyright interests in this review.

Figures

1
1
Study flow diagram.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
1.1
1.1. Analysis
Comparison 1 Splint versus no treatment, Outcome 1 Short‐term overall improvement (3 months or less).
1.2
1.2. Analysis
Comparison 1 Splint versus no treatment, Outcome 2 Adverse effects.
1.3
1.3. Analysis
Comparison 1 Splint versus no treatment, Outcome 3 Short‐term improvement in CTS symptoms (Levine questionnaire) (3 months or less).
1.4
1.4. Analysis
Comparison 1 Splint versus no treatment, Outcome 4 Short‐term improvement in CTS symptoms (pressure‐provocative test time) (3 months or less).
1.5
1.5. Analysis
Comparison 1 Splint versus no treatment, Outcome 5 Short‐term improvement in CTS symptoms (Phalen test time) (3 months or less).
1.6
1.6. Analysis
Comparison 1 Splint versus no treatment, Outcome 6 Short‐term improvement in functional status (Levine questionnaire) (3 months or less).
1.7
1.7. Analysis
Comparison 1 Splint versus no treatment, Outcome 7 Short‐term improvement in distal motor latency (ms) (3 months or less).
1.8
1.8. Analysis
Comparison 1 Splint versus no treatment, Outcome 8 Short‐term improvement in sensory nerve conduction velocity (m/s) (3 months or less).
1.9
1.9. Analysis
Comparison 1 Splint versus no treatment, Outcome 9 Short‐term improvement in sensory nerve action potential (uV) (3 months or less).
1.10
1.10. Analysis
Comparison 1 Splint versus no treatment, Outcome 10 Short‐term improvement in distal sensory latency (ms) (3 months or less).
1.11
1.11. Analysis
Comparison 1 Splint versus no treatment, Outcome 11 Short‐term improvement in motor nerve conduction velocity (m/s) (3 months or less).
1.12
1.12. Analysis
Comparison 1 Splint versus no treatment, Outcome 12 Short‐term improvement in motor nerve action potential (mV) (3 months or less).
2.1
2.1. Analysis
Comparison 2 Different splint designs (neutral versus extension splint), Outcome 1 Short‐term overall improvement (3 months or less).
2.2
2.2. Analysis
Comparison 2 Different splint designs (neutral versus extension splint), Outcome 2 Short‐term improvement in CTS symptoms (night‐time symptoms) (3 months or less).
2.3
2.3. Analysis
Comparison 2 Different splint designs (neutral versus extension splint), Outcome 3 Short‐term improvement in CTS symptoms (day‐time symptoms) (3 months or less).
3.1
3.1. Analysis
Comparison 3 Different splint designs (standard splint versus hand brace), Outcome 1 Adverse effects.
3.2
3.2. Analysis
Comparison 3 Different splint designs (standard splint versus hand brace), Outcome 2 Short‐term improvement in CTS symptoms (Levine) (3 months or less).
3.3
3.3. Analysis
Comparison 3 Different splint designs (standard splint versus hand brace), Outcome 3 Short‐term improvement in CTS symptoms (VAS pain 0‐100) (3 months or less).
3.4
3.4. Analysis
Comparison 3 Different splint designs (standard splint versus hand brace), Outcome 4 Short‐term improvement in CTS symptoms (VAS paraesthesia 0‐100) (3 months or less).
3.5
3.5. Analysis
Comparison 3 Different splint designs (standard splint versus hand brace), Outcome 5 Short‐term improvement in functional status (Levine) (3 months or less).
3.6
3.6. Analysis
Comparison 3 Different splint designs (standard splint versus hand brace), Outcome 6 Short‐term improvement in distal motor latency (ms) (3 months or less).
3.7
3.7. Analysis
Comparison 3 Different splint designs (standard splint versus hand brace), Outcome 7 Short‐term improvement in sensory nerve conduction velocity (m/s) (3 months or less).
3.8
3.8. Analysis
Comparison 3 Different splint designs (standard splint versus hand brace), Outcome 8 Short‐term improvement in sensory nerve action potential (SNAP) amplitude (3 months or less).
3.9
3.9. Analysis
Comparison 3 Different splint designs (standard splint versus hand brace), Outcome 9 Long‐term improvement in CTS symptoms (Levine) (>3 months or less).
3.10
3.10. Analysis
Comparison 3 Different splint designs (standard splint versus hand brace), Outcome 10 Long‐term improvement in CTS symptoms (VAS pain 0‐100) (>3 months or less).
3.11
3.11. Analysis
Comparison 3 Different splint designs (standard splint versus hand brace), Outcome 11 Long‐term improvement in CTS symptoms (VAS paraesthesia 0‐100) (>3 months or less).
3.12
3.12. Analysis
Comparison 3 Different splint designs (standard splint versus hand brace), Outcome 12 Long‐term improvement in functional status (BCTQ) (>3 months or less).
4.1
4.1. Analysis
Comparison 4 Different splint designs (carpal lock versus volar supporting orthosis), Outcome 1 Short‐term improvement in CTS symptoms (VAS 0‐10 pain) (3 months or less).
4.2
4.2. Analysis
Comparison 4 Different splint designs (carpal lock versus volar supporting orthosis), Outcome 2 Short‐term improvement in CTS symptoms (VAS 0‐10 dysesthesia) (3 months or less).
4.3
4.3. Analysis
Comparison 4 Different splint designs (carpal lock versus volar supporting orthosis), Outcome 3 Short‐term improvement in sensory conduction velocity of second finger‐to‐wrist segment (m/s) (3 months or less).
4.4
4.4. Analysis
Comparison 4 Different splint designs (carpal lock versus volar supporting orthosis), Outcome 4 Short‐term improvement in sensory conduction velocity of palm‐to‐wrist segment (m/s) (3 months or less).
5.1
5.1. Analysis
Comparison 5 Different splint‐wearing regimens, Outcome 1 Short‐term improvement in CTS symptoms (3 months or less).
5.2
5.2. Analysis
Comparison 5 Different splint‐wearing regimens, Outcome 2 Short‐term improvement in functional status (3 months or less).
5.3
5.3. Analysis
Comparison 5 Different splint‐wearing regimens, Outcome 3 Short‐term improvement in motor distal latency (msec) (3 months or less).
5.4
5.4. Analysis
Comparison 5 Different splint‐wearing regimens, Outcome 4 Short‐term improvement in sensory distal latency (msec) (3 months or less).
6.1
6.1. Analysis
Comparison 6 Splint versus yoga, Outcome 1 Short‐term improvement in CTS symptoms (VAS Pain) (3 month or less).
6.2
6.2. Analysis
Comparison 6 Splint versus yoga, Outcome 2 Short‐term improvement in CTS symptoms (sleep disturbance) (3 months or less.
6.3
6.3. Analysis
Comparison 6 Splint versus yoga, Outcome 3 Short‐term improvement in CTS symptoms (number of wrists with improvement in Tinel sign) (3 months or less).
6.4
6.4. Analysis
Comparison 6 Splint versus yoga, Outcome 4 Short‐term improvement in CTS symptoms (number of wrists with improvement in Phalen sign) (3 months or less).
6.5
6.5. Analysis
Comparison 6 Splint versus yoga, Outcome 5 Short‐term improvement in functional ability (grip strength, mmHg) (3 months or less).
6.6
6.6. Analysis
Comparison 6 Splint versus yoga, Outcome 6 Short‐term improvement in median nerve motor distal latency (ms) (3 months or less).
6.7
6.7. Analysis
Comparison 6 Splint versus yoga, Outcome 7 Short‐term improvement in median nerve sensory distal latency (ms) (3 months or less).
7.1
7.1. Analysis
Comparison 7 Splint versus acupuncture, Outcome 1 Adverse effects.
7.2
7.2. Analysis
Comparison 7 Splint versus acupuncture, Outcome 2 Short‐term improvement in CTS symptoms (Levine) (3 months or less).
7.3
7.3. Analysis
Comparison 7 Splint versus acupuncture, Outcome 3 Short‐term improvement in CTS symptoms (VAS pain 100mm) (3 months or less).
7.4
7.4. Analysis
Comparison 7 Splint versus acupuncture, Outcome 4 Short‐term improvement in functional ability (functional status score) (3 months or less).
8.1
8.1. Analysis
Comparison 8 Splint versus oral steroid, Outcome 1 Adverse effects.
8.2
8.2. Analysis
Comparison 8 Splint versus oral steroid, Outcome 2 Short‐term improvement in CTS symptom severity (Levine) (3 months or less).
8.3
8.3. Analysis
Comparison 8 Splint versus oral steroid, Outcome 3 Short‐term improvement in functional status (Levine) (3 months or less).
8.4
8.4. Analysis
Comparison 8 Splint versus oral steroid, Outcome 4 Short‐term improvement in median nerve motor distal latency (ms) (3 months or less).
8.5
8.5. Analysis
Comparison 8 Splint versus oral steroid, Outcome 5 Short‐term improvement in median nerve sensory distal latency (ms) (3 months or less).
8.6
8.6. Analysis
Comparison 8 Splint versus oral steroid, Outcome 6 Short‐term improvement in motor nerve conduction velocity (m/s) (3 months or less).
8.7
8.7. Analysis
Comparison 8 Splint versus oral steroid, Outcome 7 Short‐term improvement in sensory nerve conduction velocity (m/s) (3 months or less).
9.1
9.1. Analysis
Comparison 9 Splint plus steroid injection versus nerve and tendon gliding exercises, Outcome 1 Short‐term improvement in CTS symptoms (symptom total point) (3 months or less).
9.2
9.2. Analysis
Comparison 9 Splint plus steroid injection versus nerve and tendon gliding exercises, Outcome 2 Short‐term improvement in CTS symptoms (Tinel's test) (3 months or less).
9.3
9.3. Analysis
Comparison 9 Splint plus steroid injection versus nerve and tendon gliding exercises, Outcome 3 Short‐term improvement in CTS symptoms (Phalen's test) (3 months or less).
9.4
9.4. Analysis
Comparison 9 Splint plus steroid injection versus nerve and tendon gliding exercises, Outcome 4 Short‐term improvement in CTS symptoms (Compression test) (3 months or less).
9.5
9.5. Analysis
Comparison 9 Splint plus steroid injection versus nerve and tendon gliding exercises, Outcome 5 Short‐term improvement in CTS symptoms (Reverse Phalen's test) (3 months or less).
9.6
9.6. Analysis
Comparison 9 Splint plus steroid injection versus nerve and tendon gliding exercises, Outcome 6 Short‐term improvement in functional ability (functional status score) (3 months or less).
9.7
9.7. Analysis
Comparison 9 Splint plus steroid injection versus nerve and tendon gliding exercises, Outcome 7 Short‐term improvement in functional ability (two‐point discrimination) (3 months or less).
9.8
9.8. Analysis
Comparison 9 Splint plus steroid injection versus nerve and tendon gliding exercises, Outcome 8 Long‐term improvement in CTS symptoms (patient satisfaction) (>3 months).
10.1
10.1. Analysis
Comparison 10 Splint plus steroid injection plus nerve and tendon gliding exercises versus nerve and tendon gliding exercises, Outcome 1 Short‐term improvement in CTS symptoms (symptom total point) (3 months or less).
10.2
10.2. Analysis
Comparison 10 Splint plus steroid injection plus nerve and tendon gliding exercises versus nerve and tendon gliding exercises, Outcome 2 Short‐term improvement in CTS symptoms (Phalen's test) (3 months or less).
10.3
10.3. Analysis
Comparison 10 Splint plus steroid injection plus nerve and tendon gliding exercises versus nerve and tendon gliding exercises, Outcome 3 Short‐term improvement in CTS symptoms (Tinel's test) (3 months or less).
10.4
10.4. Analysis
Comparison 10 Splint plus steroid injection plus nerve and tendon gliding exercises versus nerve and tendon gliding exercises, Outcome 4 Short‐term improvement in CTS symptoms (Reverse Phalen's test) (3 months or less).
10.5
10.5. Analysis
Comparison 10 Splint plus steroid injection plus nerve and tendon gliding exercises versus nerve and tendon gliding exercises, Outcome 5 Short‐term improvement in CTS symptoms (Compression test) (3 months or less).
10.6
10.6. Analysis
Comparison 10 Splint plus steroid injection plus nerve and tendon gliding exercises versus nerve and tendon gliding exercises, Outcome 6 Short‐term improvement in functional ability (functional status score) (3 months or less).
10.7
10.7. Analysis
Comparison 10 Splint plus steroid injection plus nerve and tendon gliding exercises versus nerve and tendon gliding exercises, Outcome 7 Short‐term improvement in functional ability (two‐point discrimination) (3 months or less).
10.8
10.8. Analysis
Comparison 10 Splint plus steroid injection plus nerve and tendon gliding exercises versus nerve and tendon gliding exercises, Outcome 8 Long‐term improvement in CTS symptoms (patient satisfaction) (>3 months).
11.1
11.1. Analysis
Comparison 11 Splint plus steroid injection versus therapeutic ultrasound, Outcome 1 Short‐term improvement in CTS symptoms (symptom severity score) (3 months or less).
11.2
11.2. Analysis
Comparison 11 Splint plus steroid injection versus therapeutic ultrasound, Outcome 2 Short‐term improvement in CTS symptoms (VAS pain) (3 months or less).
11.3
11.3. Analysis
Comparison 11 Splint plus steroid injection versus therapeutic ultrasound, Outcome 3 Short‐term improvement in functional ability (functional status score) (3 months or less).
11.4
11.4. Analysis
Comparison 11 Splint plus steroid injection versus therapeutic ultrasound, Outcome 4 Short‐term improvement in functional ability (grip strength) (3 months or less).
11.5
11.5. Analysis
Comparison 11 Splint plus steroid injection versus therapeutic ultrasound, Outcome 5 Short‐term improvement in functional ability (two‐point discrimination) (3 months or less).
11.6
11.6. Analysis
Comparison 11 Splint plus steroid injection versus therapeutic ultrasound, Outcome 6 Short‐term improvement in median nerve motor distal latency (3 months or less).
11.7
11.7. Analysis
Comparison 11 Splint plus steroid injection versus therapeutic ultrasound, Outcome 7 Short‐term improvement in median sensory nerve conduction velocity (3 months or less).
12.1
12.1. Analysis
Comparison 12 Splint plus NSAID versus local corticosteroid injection, Outcome 1 Short‐term improvement in CTS symptoms (VAS 0‐10 pain) (3 months or less).
12.2
12.2. Analysis
Comparison 12 Splint plus NSAID versus local corticosteroid injection, Outcome 2 Short‐term improvement in CTS symptoms (Levine) (3 months or less).
12.3
12.3. Analysis
Comparison 12 Splint plus NSAID versus local corticosteroid injection, Outcome 3 Short‐term improvement in CTS symptoms (Phalen's sign) (3 months or less).
12.4
12.4. Analysis
Comparison 12 Splint plus NSAID versus local corticosteroid injection, Outcome 4 Short‐term improvement in CTS symptoms (reverse Phalen's sign) (3 months or less).
12.5
12.5. Analysis
Comparison 12 Splint plus NSAID versus local corticosteroid injection, Outcome 5 Short‐term improvement in CTS symptoms (Tinel's sign) (3 months or less).
12.6
12.6. Analysis
Comparison 12 Splint plus NSAID versus local corticosteroid injection, Outcome 6 Short‐term improvement in motor distal latency (ms) (3 months or less).
12.7
12.7. Analysis
Comparison 12 Splint plus NSAID versus local corticosteroid injection, Outcome 7 Short‐term improvement in sensory distal latency (ms) (3 months or less).
13.1
13.1. Analysis
Comparison 13 Splint plus ergonomic education versus ergonomic education, Outcome 1 Long‐term improvement in CTS symptoms (Levine) (>3 months).
13.2
13.2. Analysis
Comparison 13 Splint plus ergonomic education versus ergonomic education, Outcome 2 Long‐term improvement in CTS symptoms (VAS elbow and forearm pain) (>3 months).
13.3
13.3. Analysis
Comparison 13 Splint plus ergonomic education versus ergonomic education, Outcome 3 Long‐term improvement in CTS symptoms (VAS wrist, hand and finger pain) (>3 months).
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References

References to studies included in this review

Arinci Incel 2005 {published data only}
    1. Arinci Incel N, Sezgin M, Aksit C, Sahin G. Effect of gabapentin in carpal tunnel syndrome: a controlled clinical trial [Karpal tunnel sendromunda gabapentin tedavisinin etkinligi: karsilastirmali klinik calisma]. Journal of Rheumatology and Medical Rehabilitation 2005;16(4):224‐30. [EMBASE: 2007022406]
Bardak 2009 {published data only}
    1. Bardak AN, Alp M, Erhan B, Paker N, Kaya B, Onal AE. Evaluation of the clinical efficacy of conservative treatment in the management of carpal tunnel syndrome. Advances in Therapy 2009;26(1):107‐16. [PUBMED: 19165436] - PubMed
Bilgici 2010 {published data only}
    1. Biligici A, Ulusoy H, Canturk F. The comparison of ultrasound treatment and local steroid injection plus splinting in the carpal tunnel syndrome: a randomized controlled trial. Bratislavske Lekarske Listy 2010;111(12):659‐65. [PUBMED: 21384736] - PubMed
Brininger 2007 {published data only}
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Bye 2011 {published data only}
    1. Bye R, Hajiaqai B, Frorough B. Comparison between efficacy of manu splint and cock‐up splint in carpal tunnel syndrome treatment. Journal of Babul University Medical Sciences 2011;13(1):51‐7.
Celiker 2002 {published data only}
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De Angelis 2009 {published data only}
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de Entrambasaguas 2006 {published data only}
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Madjdinasab 2008 {published data only}
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Manente 2001 {published data only}
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Premoselli 2006 {published data only}
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Sevim 2004 {published data only}
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Walker 2000 {published data only}
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Werner 2005 {published data only}
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Zinnuroglu 2010 {published data only}
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References to studies excluded from this review

Akalin 2002 {published data only}
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Baysal 2006 {published data only}
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Davis 1998 {published data only}
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Eftekharsadat 2011 {published data only}
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Heebner 2008 {published data only}
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Yagci 2006 {published data only}
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References to studies awaiting assessment

Taspinar 2007 {published data only}
    1. Taşpınar Ş, Şahin F, Erçalık C, Kuran B, Barkut K, Çelik M, et al. Comparison of the efficacy of corticosteroid injection, night splint, and physiotherapy in diabetic carpal tunnel syndrome [Diyabetik karpal tünel sendromunda kortikosteroid enjeksiyonu, gece ateli ve fizik tedavinin etkinliğinin karşılaştırılması]. Turkish Journal of Physical Medicine and Rehabilitation 2007;53(2):54‐60.

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References to other published versions of this review

O'Connor 2003
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