Comparison of use of plaster casting versus elastic bandage following carpal tunnel release: a randomized controlled study

Abstract

Objective To compare the effects of two postoperative regimens following carpal tunnel release; plaster casting and elastic bandaging. Design A randomized controlled study. Patients Patients with carpal tunnel syndrome and planned surgical carpal tunnel release were invited to participate. Methods A total of 94 patients were randomized to either plaster casting or elastic bandaging to be used 2 weeks postoperatively. Muscle strength, pain rated on a visual analogue scale, range of movement, sensibility, oedema, and different scores regarding symptoms and function were measured before and 2, 4, 6, 8 and 26 weeks after surgery. Results No differences were found between the 2 groups for any measurement, except for the DASH (Disability of the Arm, Shoulder and Hand) Health Score and daily function, rated 2 weeks postoperatively, in which the bandage group scored better. Both groups improved significantly over time for all measurements, sensibility was improved after 2 weeks, while strength was not fully recovered until week 26. Conclusion Following carpal tunnel release no benefits were found in using plaster casting, compared with elastic bandaging. Among these patients there was more discomfort during plaster casting compared with elastic bandaging; therefore plaster casting is not recommended following this type of surgery. LAY ABSTRACT No clear consensus exists regarding benefits of use of plaster casting following carpal tunnel release. This study aimed to compare two different postoperative regimens in a randomized controlled study. A total of 94 patients were randomized to either plaster casting or elastic bandage to be used for 2 weeks after surgery for carpal tunnel release. Muscle strength, rated pain, range of movement, sensibility, oedema, and different scores regarding symptoms and function were measured before and 2, 4, 6, 8 and 26 weeks after surgery. No differences were found between the 2 groups for any measurement, except for health score and rated daily function 2 weeks postoperatively, in which the bandage group scored better. Both groups improved significantly over time for all measurements, sensibility was improved after 2 weeks, while strength was not fully recovered until week 26. This study found no benefits, but some disadvantages, of plaster casting following carpal tunnel release, and therefore plaster casting is not recommended for these patients.

The significance of wrist immobilization for endoscopic carpal tunnel release

“…The change in postoperative strength showed a similar tendency to postoperative pain (13,28). It took nearly 2 months for both groups to recover normal strength, which could provide a reference for the therapist to formulate accurate postoperative physiotherapy.…”

“…To minimize the complications, some surgeon traditionally immobilizes the wrist in question for 1–4 weeks after OCTR ( 25 , 26 ). An increasing body of evidence suggests that wrist immobilization following OCTR is ineffective and adversely affects postoperative rehabilitation ( 10 – 13 , 16 , 17 , 19 ). However, relevant study concerning wrist immobilization following ECTR is rare.…”

“…Earlier studies have demonstrated little value of wrist immobilization after OCTR, and the outcomes even worsened with early immobilization. As already mentioned, splint casting would weaken the strength and cause stiffness of the wrist, which in turn delayed rehabilitation ( 13 ). However, we found that wrist immobilization is necessary for the early stage and contributes to symptom relief at 2 weeks postoperatively.…”

“…However, postoperative immobilization is still subject to much controversy. Earlier studies showed comparable outcomes and even worse prognosis of splint immobilization after open release compared with initial active motion (10)(11)(12)(13)(14)(15)(16)(17)(18)(19). According to the 2016 American Academy of Orthopedic Surgeons (AAOS) evidencebased guidelines, postoperative immobilization yields no benefit (20).…”