Splinting for carpal tunnel syndrome.

Area of Science:

• Neurology
• Orthopedics
• Rehabilitation Medicine

Background:

• Carpal tunnel syndrome (CTS) is a common nerve compression disorder affecting the median nerve, leading to pain, numbness, and tingling in the hand.
• Wrist splinting is a frequently recommended non-surgical treatment for mild-to-moderate CTS, but its efficacy is not well-established.

Purpose of the Study:

• To evaluate the benefits and harms of wrist splinting for individuals diagnosed with carpal tunnel syndrome.

Main Methods:

• A systematic review and meta-analysis of 29 randomized controlled trials involving 1937 adults with CTS.
• Included studies compared splinting against no active treatment, other non-surgical interventions, or different splinting regimens.
• Trials were assessed for risk of bias, and evidence certainty was determined using the GRADE approach.

Main Results:

• Splinting showed little to no significant short-term benefit for CTS symptoms (mean difference in Boston Carpal Tunnel Questionnaire Symptom Severity Scale: 0.37 points better, low-certainty evidence).
• Short-term improvements in hand function were modest (mean difference in Boston Carpal Tunnel Questionnaire Functional Status Scale: 0.24 points better, moderate-certainty evidence).
• Night-time splinting demonstrated a higher rate of overall improvement in the short term (risk ratio: 3.86, low-certainty evidence), but long-term effects and impact on surgical referral remain uncertain.

Conclusions:

• There is insufficient evidence to definitively conclude the benefits of wrist splinting for carpal tunnel syndrome.
• While small improvements in symptoms and function may occur, their clinical significance is unclear.
• Night-time splinting may offer a greater chance of improvement, and given its low cost and minimal harms, it could be considered for patients not opting for surgery or injections.