Neutral Wrist Research Articles

Carpal tunnel syndrome severity, hand discomfort, and usability among three types of computer mouse.

Numerous people use computer mice for long hours, especially in offices. Mouse users reported various pains and discomfort. The study aimed to assess three types of most common mice (vertical, traditional, flat) in Iran in terms of their effects on carpal tunnel syndrome, hand discomfort, and usability. The Boston Carpal Tunnel Syndrome questionnaire, the Cornell Hand Discomfort Questionnaire (CHDQ), System Usability Scale (SUS), and Workplace Ergonomic Risk Assessment (WERA) scores were used to assess vertical, traditional, and flat mice. In addition, the participant's hand position was analyzed by observation method. Most participants had medium carpal tunnel syndrome severity; however, flat mouse users had a higher score, and the difference between mice was insignificant (p > 0.05). Most mouse users felt discomfort in their small and ring fingers, and the type of mouse significantly affected thumb discomfort level. More flat users felt Pain in the different parts of their hands. The flat mouse has the least SUS score. There was a significant difference between the three mice regarding SUS scores (p < 0.05). WERA mean values were acceptable for numerous mice. Adopting neutral wrist postures was more common among vertical, flat, and traditional mouse users, respectively; however, the flat mouse users tended to bend their fingers. There are differences between vertical and traditional flat mice in terms of ergonomic indicators. Although more studies are needed, it seems that vertical mice are better in some indicators.

Ultrasound image quality of the carpal tunnel during a pinch grip: effects of coupling media and wrist position

ABSTRACT High quality ultrasound is required for evaluating carpal tunnel dynamics. The purpose of this study was to subjectively assess ultrasound video quality of the carpal tunnel with two commonly used coupling media (coupling gel, 7 mm standoff pad) in two wrist positions (0° neutral, 30° flexion) over the entire time course of a pinch grip. Seventeen participants completed a pinch grip while their carpal tunnel was scanned with ultrasound. The ultrasound videos were graded by two independent reviewers using 10-point scales encompassing median nerve detail, resolution, and total video quality. Intra- and inter-rater reliability were highest for median nerve detail (ICCs>.85). Ultrasound videos in the 0° neutral wrist condition resulted in significantly greater ratings of nerve detail compared to those in 30° wrist flexion. Future studies may benefit from a more customised approach to standoff pad thickness during dedicated analysis of the median nerve in a neutral wrist position.

Association of ulnar variance with three-dimensional carpal alignment and demographics in asymptomatic volunteers.

Several carpal pathologies are considered to be related to ulnar variance. Recently, computer-aided computed tomography (CT) analysis software was introduced to quantify three-dimensional (3D) carpal alignment with high accuracy and reliability. To determine the association of ulnar variance with 3D carpal alignment and demographics. A wrist of 121 asymptomatic volunteers (69 men, 52 women; mean age = 38 ± 10.4 years) was imaged in the neutral wrist position with cone-beam CT. Computer-aided CT analysis software (Bonelogic), based on segmentation and numerical modelling, was used to define ulnar variance and standardized 3D axes for all carpal bones. The association of ulnar variance with 3D carpal alignment, age of the volunteer, and side and dominance of the imaged wrist was assessed. The mean ulnar variance was -1.6 ± 1.5 mm (range = -5.3 to 2.4 mm). The mean ulnar variance was -1.9 mm and -1.1 mm in men and women (P = 0.007), respectively. Of the imaged 121 wrists, 18 (15%) had positive and 103 (85%) negative ulnar variance. There was no association between ulnar variance and any of the radio- or intercarpal angle values in either the sagittal or coronal plane (ρ = -0.16…0.17, r = -0.13….0.12). The ulnar variance showed no association with side (P = 0.51) or dominance (P = 0.27) of the imaged wrist. 3D carpal alignment is not affected by ulnar variance. The association of ulnar variance with sex may in part explain the difference in reported prevalence of some carpal pathologies, such as ulnar impaction syndrome and Kienböck's disease.

Quantification of carpal tunnel morphology using centroid-to-boundary distance shape signatures.

Morphology analysis is valuable to understanding risk factors and the etiology of carpal tunnel (CT) syndrome. The objective of this study was to investigate morphology changes along the length of the CT using shape signatures (SS). Analysis was performed on ten cadaveric specimens in neutral wrist posture. Centroid-to-boundary distance SS were generated for proximal, middle, and distal CT cross-sections. Phase shift and Euclidean distance were quantified relative to a template SS for each specimen. Medial, lateral, palmar, and dorsal peaks were identified on each SS to generate metrics of tunnel width, tunnel depth, peak amplitude, peak angle. Width and depth measures were also performed using previously reported methods to serve as a basis of comparison. The phase shift revealed twisting of 21° between the ends of the tunnel. Distance from the template and width varied significantly over the length of the tunnel, while depth did not. Measures of width and depth using the SS method were consistent with previously reported methods. The SS method afforded the advantage of peak analysis with overall trends of peak amplitude indicating flattening of the tunnel at the proximal and distal ends relative to a rounder shape in the middle.

THE BIOMECHANICAL ANALYSIS OF A NOVEL IMPLANT FOR SCAPHOLUNATE INTEROSSEOUS LIGAMENT RUPTURE REPAIR

There is currently no commercially available and clinically successful treatment for scapholunate interosseous ligament rupture, the latter leading to the development of hand-wrist osteoarthritis. We have created a novel biodegradable implant which fixed the dissociated scaphoid and lunate bones and encourages regeneration of the ruptured native ligament. To determine if scaphoid and lunate kinematics in cadaveric specimens were maintained during robotic manipulation, when comparing the native wrist with intact ligament and when the implant was installed.Ten cadaveric experiments were performed with identical conditions, except for implant geometry that was personalised to the anatomy of each cadaveric specimen. Each cadaveric arm was mounted upright in a six degrees of freedom robot using k-wires drilled through the radius, ulna, and metacarpals. Infrared markers were attached to scaphoid, lunate, radius, and 3rd metacarpal. Cadaveric specimens were robotically manipulated through flexion-extension and ulnar-radial deviation by ±40° and ±30°, respectively.The cadaveric scaphoid and lunate kinematics were examined with 1) intact native ligament, 2) severed ligament, 3) and installed implant.Digital wrist models were generated from computed tomography scans and included implant geometry, orientation, and location. Motion data were filtered and aligned relative to neutral wrist in the digital models of each specimen using anatomical landmarks. Implant insertion points in the scaphoid and lunate over time were then calculated using digital models, marker data, and inverse kinematics. Root mean squared distance was compared between severed and implant configurations, relative to intact.Preliminary data from five cadaveric specimens indicate that the implant reduced distance between scaphoid and lunate compared to severed configuration for all but three trials.Preliminary results indicate our novel implant reduced scapho-lunate gap caused by ligament transection. Future analysis will reveal if the implant can achieve wrist kinematics similar to the native intact wrist.

Ulnar positive variance associated with TFCC foveal tear.

The ulnar positive variance (UPV) can be observed on simple radiography due to a triangular fibrocartilage complex (TFCC) foveal tear. This study investigated to identify how much radiographic UPV occurs due to a TFCC foveal tear, which may be misdiagnosed as an ulnar impaction syndrome (UIS). One hundred forty patients who underwent arthroscopic transosseus TFCC foveal repair from March 2013 to March 2019 in our institution were enrolled in this study. Ulnar variances were measured in preoperative, postoperative 6weeks, 1-year follow-up wrist posteroanterior (PA) radiograph, and power grip PA radiograph of the affected wrist and were compared with those of the same patient's unaffected wrist. In the neutral wrist PA radiograph, ulnar variance increased by 0.56mm (p < 0.001) after TFCC foveal tear compared to the unaffected side. In the power grip view, ulnar variance also increased by 0.39mm (p < 0.001) in the affected wrist. The preoperative ulnar positive variance was reduced after an arthroscopic transosseous TFCC foveal repair from 0.56 to 0mm (p < 0.001). No significant statistical difference was observed between an Atzei class 2 and 3 TFCC tear (0.56mm vs. 0.41mm, p = 0.263). This study revealed that TFCC foveal tear induces 0.56mm of radiologic UPV, which was successfully corrected after arthroscopic transosseous TFCC foveal repair. Therefore, UPV associated with TFCC foveal tear should not be misdiagnosed as an UIS. Also, when ulnar shortening osteotomy is planned in case of UIS combined with TFCC foveal tear, the amount of UPV induced by TFCC foveal tear should be considered to prevent over-shortening.

To Study the Impact of Wrist Splints and Nerve Tendon Gliding Exercises on Carpal Tunnel Syndrome in Women who Work at Computers and in Women Who Do Not

Background: To study the difference between the effects of wrist splint and nerve tendon gliding exercises forcarpal tunnel syndrome in women with computer desk job and the difference between the effects of wrist splintand nerve tendon gliding exercises in non computer desk job women with carpal tunnel syndrome.Methods: 34 Females objects with symptomatic carpal tunnel syndrome were selected randomly with age groupbetween 25-30 years with due consideration to inclusion and exclusion criteria. In this study 34 subjects areselected. They were randomly divided into two groups using lottery method. In group A (Non Computer deskjob women) wrist splint&amp; Exercises was given. In group B (Computer desk job women) Nerve tendon glidingtechnique &amp; exercises was done for 6 weeks. The beneficial effect of gliding exercises may be the mobilization ofthe nerve directly or facilitation of venous return or oedema dispersal. The pressure in the carpal tunnel is lowestin neutral wrist flexion extension range, with the pressure rising significantly as the wrist is moved into flexion orextension. Splint with the wrist in a neutral position, at night and during the day is used for starting 3 weeks andany at night during rest of period. Analyzing scores after 6 weeks the mean and SD values for pre and post FSSSores of group A were 27 &amp;21. 64 and 1.36 &amp; 1.80 respectively.Conclusion: The study showed that there was decrease in the pain and improvement in the functional abilitystatistically in carpal tunnel syndrome women with computer desk job by performing nerve and tendon glidingexercises and wrist splinting for both the groups for a period of 6weeks. This concluded that there was equalimprovement in pain in both the groups but the functional ability is more improved after the nerve and tendongliding exercises in group B. Therefore this study is rejecting the null hypothesis and accepts the alternatehypothesis.

Patient Satisfaction with Pisiform Excision for Pisotriquetral Instability or Arthritis: A Prospective Review.

Background Pisotriquetral pain and instability is an elusive cause of ulnar-sided wrist pain. Initial treatment of chronic pisotriquetral pathology should involve a trial of nonoperative therapy such as neutral wrist splint, anti-inflammatories, and intra-articular steroid injections. The mainstay of surgical management of pisotriquetral pain is pisiform excision. Purpose This prospective study seeks to understand patient satisfaction after pisiform excision in patients with isolated pisotriquetral pathology. Patients and Methods A consecutive series of nine cases of pisiform excision was performed by the senior surgeon. The primary outcome measure was determined a priori to be the Patient-Rated Wrist Evaluation (PRWE) score. Wrist range of motion, grip strength, and QuickDASH (shortened version of Disabilities of the Arm, Shoulder and Hand) scores were also collected preoperatively and at 3 and 12 months postoperatively as secondary outcome measures. Results There was a very rapid improvement in the PRWE by 3 months, which was maintained at 12 months. The QuickDASH score was slower to improve, with a significant improvement by 12 months. There was no change in grip strength or wrist range of motion at any time point. Conclusion Pisiform excision results in a very rapid improvement of symptoms and should be considered in cases of pisotriquetral instability or arthritis that fail conservative management. Level of Evidence Level IV, case series.

Inter- and intra-rater reliability of carpal tunnel volume measurement

ABSTRACT The reliability of carpal tunnel volume (CTV) measurement has not been previously reported. This study evaluated inter- and intra-rater reliability and assessed the variability of image segmentation and anatomical landmark selection. Analysis was performed by two raters on computed tomography images collected on two cadaveric specimens in neutral wrist posture. The variability of landmark selections was less than 0.3 mm. Intra-class correlation coefficients (ICC) for segmentation surpassed 0.88. The carpal tunnel volume calculations had ICC values greater than 0.98. These results suggest carpal tunnel volume can be reliably measured using the methods outlined in this study.

Carpal Tunnel Syndrome:Diagnosis and Treatment

Carpal tunnel syndrome(CTS)is a common entrapment neuropathy caused by compression of the median nerve around the wrist. The risk factors of CTS include female sex, diabetes mellitus, hypothyroidism, obesity, arthritis, hemodialysis, acromegaly, and pregnancy. CTS is characterized by paresthesia in the distribution of the median nerve. Patients are often unaware of ring-finger splitting and the combination of Tinel's sign and Phalen's test improves diagnostic accuracy. In addition, electrophysiological assessments can help to confirm a CTS diagnosis; their sensitivity ranges from 57-94% and their specificity from 51-97%. CTS negatively affects the quality of life but improvement by surgery can be expected. For conservative treatment, a neutral wrist splint worn at night or oral medication such as nonsteroidal anti-inflammatory drugs, vitamin B12, and pregabalin have been shown to be effective against CTS. CTS surgery may be indicated in patients with thenar muscle atrophy and when conservative treatment is ineffective. The surgery involves a small skin incision under a microscope and local anesthesia. Long-term outcomes with respect to pain, numbness, function, symptomatology relapse, and frequency of re-surgery do not significantly differ between patients subjected to open or endoscopic surgery.

Digitalization of Musculoskeletal Risk Assessment in a Robotic-Assisted Assembly Workstation

The ergonomic assessment of adopted working postures is essential for avoiding musculoskeletal risk factors in manufacturing contexts. Several observational methods based on external analyst observations are available; however, they are relatively subjective and suffer low repeatability. Over the past decade, the digitalization of this assessment has received high research interest. Robotic applications have the potential to lighten workers’ workload and improve working conditions. Therefore, this work presents a musculoskeletal risk assessment before and after robotic implementation in an assembly workstation. We also emphasize the importance of using novel and non-intrusive technologies for musculoskeletal risk assessment. A kinematic study was conducted using inertial motion units (IMU) in a convenience sample of two workers during their normal performance of assembly work cycles. The musculoskeletal risk was estimated according to a semi-automated solution, called the Rapid Upper Limb Assessment (RULA) report. Based on previous musculoskeletal problems reported by the company, the assessment centered on the kinematic analysis of functional wrist movements (flexion/extension, ulnar/radial deviation, and pronation/supination). The results of the RULA report showed a reduction in musculoskeletal risk using robotic-assisted assembly. Regarding the kinematic analysis of the wrist during robotic-assisted tasks, a significant posture improvement of 20–45% was registered (considering the angular deviations relative to the neutral wrist position). The results obtained by direct measurements simultaneously reflect the workload and individual characteristics. The current study highlights the importance of an in-field instrumented assessment of musculoskeletal risk and the limitations of the system applied (e.g., unsuitable for tracking the motion of small joints, such as the fingers).

Ultrasonographic and electrophysiological outcomes of carpal tunnel syndrome treated with low-level laser therapy: A double-blind, prospective, randomized, sham-controlled study.

Objectives The aim of this study was to investigate the therapeutic effects of low-level laser therapy (LLLT) on clinical, ultrasonographic (US), and electrophysiological findings in carpal tunnel syndrome (CTS).Patients and methods Between January 2015 and August 2015, 42 patients (7 males, 35 females; mean age: 50.4±8.7 years; range, 32 to 65 years) with mild-to-moderate CTS were randomly assigned to one of two groups: active LLLT (therapy group, n=22) 0.8 J/painful point and sham LLLT groups (n=20). Both groups wore neutral wrist orthoses. The patients were evaluated before and after 15 sessions of therapy (670 nm, 4 J/session over the carpal tunnel). Follow-up parameters included the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) Symptom Severity Scale (SSS), Functional Status Scale (FSS), nerve conduction studies and US evaluation of the median nerve cross-sectional area (CSA), vascularization (via power Doppler), flattening ratio (FR), and palmar bowing of the flexor retinaculum.Results Nocturnal paresthesia improved in both groups; however, pain and patients with a positive Phalen’s test reduced only in the therapy group (p=0.031). The FSS and SSS scores also improved only in the therapy group (p<0.001). Electrophysiologically, median sensory nerve conduction velocities showed a significant improvement only in the therapy group (p=0.002). The CSA, FR, and vascularization of the median nerve showed a significant improvement in the therapy group alone (p<0.001, p=0.048, and p=0.021, respectively).Conclusion Improvements in the signs and symptoms of CTS and hand function, the improvements in sensory nerve conduction studies, and reduction in median nerve CSA, FR and vascularity in the LLLT group can be attributed to the anti-inflammatory and analgesic effects of LLLT. This study provides new US data demonstrating efficacy of LLLT along with a clinical and electrophysiological improvement. The LLLT seems to be an easily applied, non-invasive treatment option.

Computer-based three-dimensional measurement of carpal alignment: measurement techniques and normal ranges.

The three-dimensional carpal alignment was measured in the neutral wrist position in 121 asymptomatic volunteers using computer-based cone-beam CT analysis. Normal values and the reliability of the automated analysis are reported. An analysis software based on segmentation of CT images and mathematical modelling was used to determine several axis variants based on different landmarks and to calculate the intercarpal angles automatically. Twenty wrists were imaged twice to determine intra-observer reliability. Mean values using the preferred axis variants were: scapholunate angle 57° (SD 9°), radiolunate angle 2° (SD 10°), lunocapitate angle -14° (SD 9°). Using alternate axis variants notably changed the angles produced. The intra-observer reliability of the analysis was excellent (mean intraclass correlation coefficient 0.97, SD 0.03). Computer-based CT analysis enables highly reproducible and automated assessment of carpal alignment. This study provides a reference database for measurement techniques and normal carpal angle values in three-dimensional imaging.

Tendon repair with intercalated partial extensor carpi radialis longus tendon graft for chronic extensor pollicis longus tendon rupture.

The main treatment choices for chronic extensor pollicis longus (EPL) tendon rupture consists of tendon transfer and tendon repair with tendon graft. Tendon transfer with extensor indicis proprius (EIP) is currently considered the gold standard treatment which yields predictable and satisfactory results, but potentially compromises the strength of independent extension of the index finger. We propose our method of using a partial extensor carpi radialis longus (ECRL) tendon graft to repair chronic EPL tendon tears. The distal stump of the EPL was located through an incision at the basal joint level. The proximal stump was located through a curved incision at the dorsoradial wrist where the partial ECRL tendon graft was harvested. The tendon graft was subcutaneously transposed, sutured at both ends, and tensioned at full thumb extension with a neutral wrist position. From March 2016 to June 2019, 23 patients (mean age: 59.7 years; mean follow-up: 29.6 months) were retrospectively reviewed. All the patients were followed for a minimum of 12 months. The final total active motion was 93.2% of the contralateral thumb. The mean Quick Disabilities of the Arm, Shoulder and Hand score was 6.0. There was one complication possibly due to poor EPL muscle quality, and the patient was subsequently treated with EIP tendon transfer. Our study showed that using a partial ECRL tendon graft to repair chronic EPL tendon rupture results in satisfactory functional outcomes. The advantages of this method include preservation of EIP function and using the same incision for graft harvesting and tendon repair. This method can be considered an alternative to EIP tendon transfer in patients with high demand for their index finger function.

A Preliminary Model of the Wrist Midcarpal Joint.

Background A challenge to deciphering the effect of structure on function in the wrist involves difficulty in obtaining in-vivo information. To provide a platform to study wrist mechanics using in vivo acquired forces, we developed a model of the midcarpal joint based on computed tomography (CT) scans of normal wrists. Finite element analysis (FEA) can enable application of in vivo collected information to an ex vivo model. Objectives The objectives of this study are to (1) create a three-dimensional model of the midcarpal joint of the wrist based on CT scans and (2) generate separate models for the midcarpal joint based on two distinct wrist types and perform a pilot loading of the model. Methods CT scans from a normal patient database were converted to three-dimensional standard template library (STL) files using OsiriX software. Five type 1 and five type 2 wrists were used for modeling. A simulated load was applied to the carpometacarpal joints in a distal-to-proximal direction, and FEA was used to predict force transfer in the wrist. Results There were 33% type 1 and 67% type 2 wrists. The midcarpal joint dimensional measurements estimated from the model had intermediate agreement between wrist type as measured on CT scan and as predicted by the model: 56% Cohen's kappa (95% confidence interval) = 0.221 (0.05-0.5). Surface stress on the carpometacarpal joints is different in type 1 and type 2 wrists. On loading the neutral wrist, the capitolunate angle was 90 degrees in type 1 wrists and 107 degrees in type 2 wrists ( p < 0.0001). Conclusions The model predicted differences in movement and force transfer through the midcarpal joint dependent on structural type. This knowledge can improve our understanding of the development of disparate patterns of degeneration in the wrist.

Effects of wrist position on eccentric exercise‐induced muscle damage of the elbow flexors

We tested the hypothesis that the magnitude of changes in indirect muscle damage markers would be greater after maximal elbow flexor eccentric exercise in the supinated (shorter biceps brachii) than neutral wrist (longer) position, and the difference in the magnitude would be associated with greater elongation over contractions for the supinated than neutral position, rather than the initial muscle length. Ten untrained men (21-39years) performed two bouts of 10 sets of 6 maximal isokinetic eccentric contractions of the elbow flexors in the supinated position for one arm and neutral position for the other arm separated by 2weeks in a randomized order. Biceps brachii myotendinous junction (MTJ) movements during eccentric contractions were recorded by B-mode ultrasonography, and the displacement from the start to end of each contraction was quantified. Peak torque (supinated: 367.8±112.5 Nm, neutral: 381.5±120.4 Nm) and total work (1816±539J, 1865±673J) produced during eccentric contractions were similar between conditions. The average MTJ displacement increased (P<.05) from the 1st set (8.0±2.0mm) to 10th set (15.8±1.9mm) for the supinated condition, but no such increase was found in the neutral condition (1st set: 5.1±1.0mm, 10th set: 5.0±0.8mm). Changes in indirect muscle damage markers (maximal voluntary isometric contraction torque, range of motion, serum creatine kinase activity, and muscle soreness) after exercise were greater (P<.05) for the supinated than neutral condition. These results suggest that the greater muscle damage marker changes for the supinated than neutral wrist position was associated with the greater muscle lengthening (strain).

Subluxation of the extensor carpi ulnaris on magnetic resonance imaging on neutral wrist position: correlation with tenosynovitis of the extensor carpi ulnaris and translation of the distal radioulnar joint.

To identify the subluxation degrees of extensor carpi ulnaris (ECU) tendon on neutral wrist MRI in patients with ulnar-sided wrist pain and to evaluate the relationships of ECU subluxation with accompanying imaging findings such as ECU tenosynovitis, distal radioulnar joint (DRUJ) stability, and triangular fibrocartilage complex (TFCC) pathology. A total of 297 MRIs of 292 patients having ulnar side pain were reviewed retrospectively. Degrees of ECU subluxation was classified into four grades: grade 0, no subluxation; grade 1, tendon displacement < 50% of the tendon width; grade 2, tendon displacement 51 to 99% of the tendon width; and grade 3, tendon displacement of 100% of the tendon width. ECU tenosynovitis, ECU tendinosis, injuries of triangular fibrocartilage and distal radioulnar ligaments (DRUL), translation ratio of the DRUJ, rotation angle of the DRUJ, and the width, depth, and length of the ulnar groove were assessed on wrist MRI. The relationships between degree of ECU subluxation and these imaging findings were investigated. Women had higher subluxation degrees of the ECU tendon (p = 0.001). Tenosynovitis of the ECU, sprain of the dorsal DRUL, dorsovolar translation ratio and rotation angle of the DRUJ, and depth and length of the ulnar groove were statistically significantly related to the subluxation degree of the ECU tendon (p = 0.000). High-grade subluxation of the ECU tendon was strongly correlated with ECU tenosynovitis and DRUJ translation. Clinicians and radiologists should scrutinize imaging findings, particularly when patients with ulnar-sided wrist pain have high-grade subluxation of the ECU tendon.

Evaluation of the relationship between coronary slow flow phenomenon and serum magnesium levels

Aim: Splint use is often recommended following wrist injection patients diagnosed with carpal tunnel syndrome (CTS), but there is not any data in the literature pertaining to the impact of splint treatment, used before injection, on the results of local injection treatment. The aim of this study to evaluate whether or not splint use starting before the injection would impact the local injection treatment outcomes.Materials and methods: Fifty seven patients (57 hands) with CTS and underwent ultrasound-guided injection were included in the study, and patients were divided into two groups in terms of splint use. Median nerve cross-sectional area (MNCSA), pain/numbness by visual analogue scale (VAS), symptoms and functionality by Boston Carpal Tunnel Questionnaire (BCTQ) were investigated before injection and 15 days after injection.Results: There was significant change over time in MNCSA, VAS, and BTCQ scores in groups. The patients not using splint group had significantly higher percentage change in VAS nighttime score.Conclusion: Our findings has shown that using neutral wrist splint, starting before and continuing after injection treatment, did not increase the injection treatment efficacy and may actually have negative effect on improvement in VAS nighttime scores.

The effect of splint use on outcomes in ultrasound guided injection of carpal tunnel syndrome

Aim: Splint use is often recommended following wrist injection patients diagnosed with carpal tunnel syndrome (CTS), but there is not any data in the literature pertaining to the impact of splint treatment, used before injection, on the results of local injection treatment. The aim of this study to evaluate whether or not splint use starting before the injection would impact the local injection treatment outcomes.Materials and methods: Fifty seven patients (57 hands) with CTS and underwent ultrasound-guided injection were included in the study, and patients were divided into two groups in terms of splint use. Median nerve cross-sectional area (MNCSA), pain/numbness by visual analogue scale (VAS), symptoms and functionality by Boston Carpal Tunnel Questionnaire (BCTQ) were investigated before injection and 15 days after injection.Results: There was significant change over time in MNCSA, VAS, and BTCQ scores in groups. The patients not using splint group had significantly higher percentage change in VAS nighttime score.Conclusion: Our findings has shown that using neutral wrist splint, starting before and continuing after injection treatment, did not increase the injection treatment efficacy and may actually have negative effect on improvement in VAS nighttime scores.

Splinting in Carpal Tunnel Syndrome: The Optimal Duration.

The purpose of this study was to evaluate optimal neutral wrist splint duration in treatment-naive mild and mild to moderate carpal tunnel syndrome (CTS). Neutral wrist splinting is a conservative treatment for CTS; however, no clear guidelines exist for how long splinting should be prescribed for optimal outcomes. In this prospective clinical trial subjects were assigned to wear a neutral wrist splint for 6 (group A) or 12weeks (group B). Symptom and functional outcomes were assessed by questionnaire at baseline, 6 and 12weeks. Median nerve sensory and motor latencies were recorded at baseline and 12weeks. Pretreatment, midtreatment, and posttreatment measures were compared within and between treatment groups where applicable. This study was approved by the United States Air Force Academy institutional review board. A total of 30 subjects (37 hands) were randomized to 2 treatment groups. Mean symptom severity and median sensory peak latency significantly improved in both groups at 12weeks, without a significant difference between groups. Mean functional severity significantly improved only in group A. Neutral wrist splint for 6weeks resulted in better clinical improvements in patients with untreated mild and mild to moderate CTS. There was no additional benefit in extending splinting 6 additional weeks. This is the first study to compare duration of wrist splint use beyond 8weeks. A larger sample size is needed to identify the reason for lack of functional improvement in group B. Long-term follow-up of this cohort will be helpful to determine the natural history of initial wrist splint use.