Efficacy of splinting the wrist and metacarpophalangeal joints for the treatment of Carpal tunnel syndrome: an assessor-blinded randomised controlled trial

• Published in: BMJ open 2023-11, Vol.13 (11), p.e076961-e076961
• Main Authors: Nadar, Mohammed Sh, Alotaibi, Naser, Manee, Fahad
• Format: Article
• Language: English
• Subjects: Adult; Carpal tunnel syndrome; Carpal Tunnel Syndrome - therapy; Ethics; Hand & wrist; Hand Strength; Hospitals; Humans; Intervention; Metacarpophalangeal Joint; Musculoskeletal disorders; Occupational Therapy; Orthopedics; Rehabilitation Medicine; Steroids; Surgery; Treatment Outcome; Wrist
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-076961

ObjectivesTo compare the efficacy of a traditional cock-up splint, which supports the wrist only, with a modified splint that supports the wrist and the metacarpophalangeal (MCP) joints of the medial four digits in the treatment of carpal tunnel syndrome (CTS).DesignAn assessor-blind randomised controlled trial.SettingHospital-based hand therapy clinics.ParticipantsFifty-nine adults with mild-to-moderate CTS were randomly assigned to wear a wrist splint (control group) or an MCP splint (intervention group) for 6 weeks.Outcome measuresThe standardised outcome measures used included grip and pinch strength, the static two-point discrimination test, Phalen’s manoeuvre test, Tinel’s sign and the Boston CTS Questionnaire.ResultsBoth groups improved significantly from splint use in some clinical features. The wrist splint and the MCP splint groups had significant improvements in lateral pinch strength (p=0.032 and p=0.002, respectively), two-point discrimination of the thumb (p=0.003 and p=0.041, respectively), two-point discrimination of the index (p=0.035 and p=0.023, respectively) and the Phalen’s manoeuvre symptoms (p=0.025 and p=0.002, respectively). The MCP splint group had additional improvements over the wrist splint group in tip pinch (p=0.012) and Palmar pinch (p=0.011) strength.ConclusionSplinting is a practical and effective intervention option for improving the symptoms of CTS. A wrist splint that incorporates the MCP joints is more effective than the traditional wrist-only splint, with long-lasting improvements that remained consistent after 6 months of the splint intervention. Using the more effective MCP splint may consequently reduce disability, facilitate return to work and lower the associated costs.Trial registration numberISRCTN13189602.