Clinical versus electrodiagnostic effectiveness of splinting in the conservative treatment of carpal-tunnel syndrome

Background. Splinting is known as one of the most effective non-aggressive treatments for carpal-tunnel syndrome (CTS). Early and accurate diagnosis of CTS is critical for effective non-surgical management. Nerve-conduction studies confirm the diagnosis of CTS with a high degree of sensitivity and specificity. Many patients report that their symptoms decrease after splinting; consequently, improved electrophysiological findings are expected. Objective: The aim of the study was to evaluate the clinical and neurophysiological effectiveness of splinting in patients with CTS. Methods: In a prospective study of 77 hands with CTS symptoms, neurophysiological tests were performed before and after 12 weeks of using a splint. A custom-made volar thermoplastic wrist splint was fabricated in a neutral wrist position to maximize carpal-tunnel space and minimize the compressive forces on the median nerve. Each patient was provided with a custom-made splint, and was asked to wear it during sleep and whenever possible when awake. The case history was taken, and a physical examination and repeated nerve conduction studies were performed at the start and after 12 weeks. Data were analysed statistically. Results: We calculated the mean and the range for each electrophysiological test before and after 12 weeks of splint use. There was no significant difference between pre- and post-measurement of each parameter (p>0.05). Good relief of symptoms occurred soon after the patients began wearing the splint; however, the electrodiagnostic test remained pathological. Conclusion: Even though immobilization (wrist splint in neutral position) does not affect the common electrodiagnostic parameters in CTS diagnostics, it caused the disappearance of clinical symptoms in 75% of the patients. There is therefore a need for further research regarding the usefulness of repeated electrodiagnostic studies.