Splinting after Carpal Tunnel Release: Current Practice, Scientific Evidence, and Trends

Henry, Steven L.; Hubbard, Bradley; Concannon, Matthew J.

doi:10.1097/prs.0b013e31818459f4

Cited by 15 publications

(18 citation statements)

References 12 publications

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“…Previous online surveys with similar methodological designs have reported higher response rates in the range of 45 % [5] and 50 % [9]. Past questionnaires that were sent through regular mail to ASSH members have had impressive response rates of 64.7 % [1] and 48 % [4]. The reason for our relatively low response rate is open to speculation.…”

Section: Discussionmentioning

confidence: 90%

“…Previous reports have studied surgeon practice attitudes towards CTS [1][2][3][4]. In 1987, Duncan et al studied the treatment of CTS by members of the American Society for Surgery of the Hand (ASSH) [1].…”

Section: Discussionmentioning

confidence: 99%

“…Since then, there has been continued debate over the optimal management of this disease. Surgeon attitudes have consistently varied both within the United States and globally [1][2][3][4]. Numerous factors such as the surgeon's academic background, residency training, and clinical experience may affect the decision making for the evaluation and treatment of patients with carpal tunnel syndrome.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of Carpal Tunnel Syndrome by Members of the American Association for Hand Surgery

Shin

Bachoura

Jacoby

et al. 2012

Hand (New York, N,Y.)

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Background Carpal tunnel syndrome (CTS) is the most common compressive neuropathy affecting the upper extremity, yet evidence-based guidelines for its diagnosis and treatment are lacking. We set out to expose any potential discrepancies in CTS practice attitudes based on surgeon's academic background, residency training, clinical experience, and other factors. Methods This was an online survey-based study. Members of the American Association for Hand Surgery (AAHS) were sent an electronic mail request (n0817). The online questionnaire consisted of 12 questions that queried surgeons' approaches to the diagnosis as well as operative and non-operative management of carpal tunnel syndrome. Results One hundred twenty-three surgeons responded to the survey (15.1 %). The locations of surgical practices varied within the United States and beyond. Most respondents were either orthopedic or plastic surgeons. With respect to practice duration, 15.4 % had been in practice for 5 years or less, 30.9 % of the respondents had been in practice between 6 and 15 years, 30.9 % had been in practice between 16 and 25 years, and 26.8 % had been in practice for more than 25 years. The most notable interspecialty differences were related to the use of operative antibiotics and the surgical approach. Plastic surgeons were less likely to recommend antibiotic use during surgery and more likely to utilize an open extensile approach during surgical release. Younger surgeons were more likely to employ a mini-open approach for carpal tunnel release.Conclusions We conclude that background training and generational differences contribute to the varied approaches observed in the diagnosis and management of CTS.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment of Carpal Tunnel Syndrome by Members of the American Association for Hand Surgery

Shin

Bachoura

Jacoby

et al. 2012

Hand (New York, N,Y.)

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“…Splinting is common after carpal tunnel release, despite a lack of scientific evidence supporting its value [11], and some surgeons still prefer to immobilize the wrist in a splint for a period of 2–4 weeks. The theoretical advantages mentioned by those proponents have included patient comfort, avoidance of wound dehiscence, prevention of bowstringing of the flexor tendons, prevention of subluxation and tethering of the median nerve in the scar and improved grip strength [12–18].…”

Section: Introductionmentioning

confidence: 99%

Does wrist immobilization following open carpal tunnel release improve functional outcome? A literature review

Isaac

Okoro

Danial³

et al. 2010

Curr Rev Musculoskelet Med

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Carpal Tunnel Syndrome (CTS) is a compressive neuropathy of the median nerve in the carpal tunnel. It is the most common peripheral entrapment neuropathy. The surgical management includes dividing the flexor retinaculum to decompress the median nerve. Post-operative mobilization of the wrist is controversial. Some surgeons splint the wrist for 2–4 weeks whilst others encourage early mobilization. The literature has been inconclusive as to which method is most beneficial. The purpose of this study is to review the literature regarding the effectiveness of wrist immobilization following open carpal tunnel decompression. We reviewed all published clinical trials claiming to evaluate the mobility status following open carpal tunnel release. Studies not in the English language as well as those with small number of patients (n < 30) were excluded. There were five studies that fulfilled the eligibility criteria and were included in this review. We conclude that there is no beneficial effect from post-operative immobilization after open carpal tunnel decompression when compared to early mobilization.

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“…Following open carpal tunnel release surgery, volar or dorsal plaster casting is sometimes used for a few weeks. However, the use of plaster casting is questioned and, frequently, an elastic bandage alone is used ( 1 , 2 ). The benefit of casting is considered to be unloading of the surgical site and the nerve, thus facilitating healing and promoting pain relief ( 3 ).…”

mentioning

confidence: 99%

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

Svegard¹,

Persson²,

Zetterlund³

et al. 2021

J Rehabil Med

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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.

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Splinting after Carpal Tunnel Release: Current Practice, Scientific Evidence, and Trends

Cited by 15 publications

References 12 publications

Treatment of Carpal Tunnel Syndrome by Members of the American Association for Hand Surgery

Treatment of Carpal Tunnel Syndrome by Members of the American Association for Hand Surgery

Does wrist immobilization following open carpal tunnel release improve functional outcome? A literature review

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

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