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Am Fam Physician. 2000;62(7):1636

Carpal tunnel syndrome is a common cause of upper extremity pain and paresthesias. Various treatment options include wrist splinting, anti-inflammatory medications, steroid injections and surgery. Wrist splinting has been shown to be effective in the management of this syndrome, but few studies used standardized symptom scales, or measured functional deficit or compliance with the splint. Walker and associates studied the efficacy of wrist splinting in patients with carpal tunnel syndrome, and determined the optimal instructions for splint use and if a subset of patients would respond better or worse to splinting.

Consecutive patients referred to an electrodiagnostic laboratory for evaluation of carpal tunnel symptoms were enrolled in the study. The study was a randomized prospective trial of wrist splinting for six weeks. Patients with positive electrodiagnostic studies for carpal tunnel syndrome were provided with a custom-made neutral-positioned wrist splint. One group of patients was instructed to wear the splint only when sleeping, while the other group was instructed to wear the splint at all times. At the end of the study, patients were reassessed for compliance with the splint, symptom relief and functional capabilities.

Both groups showed improvement in electrodiagnostic studies at the end of the trial, but the patients who wore the splint full time showed significantly greater improvement. Compliance with full-time wear instructions was poor for approximately one half of the patients. Patients wearing the splint only when sleeping showed better compliance with instructions. Both groups showed a significant improvement in symptoms.

The authors conclude that neutral-positioned wrist splints improve symptoms and functional status in patients who have carpal tunnel syndrome. The greatest benefit occurs when the splints are used full-time and not just while sleeping. Physicians should educate patients about the importance of complying with full-time wearing of the splint.

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