Authors (including presenting author) :
Sey NW(1)(2), Wong KM(1), Kwok WL(1), Chan PS(2), Tsang SWD(2), Lo HT(2), Au LY(2)
Affiliation :
(1)Department of Orthopaedics & Traumatology, The Chinese University of Hong Kong, (2)Occupational Therapy Department, Prince of Wales Hospital
Introduction :
The effectiveness of nocturnal use of a wrist neutral splint for CTS splint was supported by numerous studies. However, the wrist position may not be the only consideration determining the efficacy of splinting. A recent study suggested a modified Lumbrical splint with both the wrist and metacarpophalangeal joints in neutral positions had a significant effect on improving CTS symptoms and hand functions at 4-week post treatment.The rationale for the modified Lumbrical splint to support the wrist and MCPJ additionally lies for the mechanics of lumbricals. There are only a few journals compared the effectiveness of modified Lumbrical splint and conventional wrist neutral splint in treating CTS patients. None of them was performed among the Hong Kong population. The additional benefits of using Lumbrical splint over wrist neutral splint are not clearly supported either.
Objectives :
To evaluate the effectiveness of Lumbrical splint and wrist neutral splint for improving CTS symptoms and hand functions on local patients with mild-to-moderate CTS in Hong Kong.
Methodology :
This is a prospective single-blinded (blinded assessors) randomized pilot study with two treatment groups. 30 patients were recruited to this study with either Lumbrical splint (treatment group) or wrist neutral splint (control group) fabricated for normal sleeping hours use for study period of 12 weeks. Primary outcome measures were CTS symptoms and hand function measured by Symptoms Severity Scale (SSS) and Functional Status Scale (FSS) of Chinese (HK) version of the CTS questionnaire. Secondary outcome measures included Moberg pick-up test, frequency of nocturnal awakening, moving 2-point discrimination at middle finger, grip and pinch strength and Disabilities of the Arm, Shoulder and Hand (DASH). Assessments were carried at baseline, 4-week and 12-week post-treatment and data analysis was done by SPSS.
Result & Outcome :
For treatment group, One-way Repeated Measures ANOVA revealed statistical significant improvement for CTS-SSS from 29.53±7.48 to 24.84±9.24 (p<0.001) and reduction in frequency of nocturnal awakening from 4.03±3.23 to 2.25±2.89 nights/week (p<0.001). For control group, statistical significant improvements were demonstrated for CTS-SSS from 26.77±4.51 to 21.95±7.97 (p<0.001), CTS-FSS from 13.77±3.91 to 12.23±2.16 (p=0.009), reduced nocturnal awakening from 3.14±2.85 to 1.32±2.21 nights/week (p<0.001), grip strength from 18.36±5.81 kgf to 20.45±4.84 kgf (p=0.031) and pinch strength from 5.57±1.64 kgf to 6.20±1.20 kgf (p=0.042). Two-way Repeated Measures ANOVA concluded there was significant interaction effect for splint group x time for one of the primary outcome measures CTSQ-FSS with p=0.019, suggesting wrist neutral splint may be more effective in promoting hand function than Lumbrical splint.
This study validates the nocturnal use of either splint design in improving CTS symptoms and reducing nocturnal awakening as conservative treatment for patients with mild-to-moderate CTS. Both Lumbrical splint and wrist neutral splint have similar effect in improving CTS symptoms, with greater improvement observed for hand function for those using wrist neutral splint. With pending further large scale randomized control trials ,wrist neutral splint is recommended as concluded from this pilot study.
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