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The comparative effectiveness of combined lumbrical muscle splints and stretches on symptoms and function in carpal tunnel syndrome.

Abstract

OBJECTIVE
To compare the effectiveness of an intensive lumbrical splint/stretch combination with 3 less intensive lumbrical splint/stretch combinations on carpal tunnel symptoms and function.
DESIGN
Randomized Clinical Trial.
SETTING
Outpatient hand therapy clinics.
PARTICIPANTS
Volunteers (N=124) with mild to moderate carpal tunnel syndrome.
INTERVENTIONS
A 4-week home regimen of nocturnal splints (lumbrical splints or cock-up splints) combined with stretches (lumbrical intensive or general) performed 6 times daily.
MAIN OUTCOME MEASURES
The effect of the intervention on carpal tunnel symptoms and function was examined with the Carpal Tunnel Symptom Severity and Function Questionnaire (CTQ) and Disabilities of the Arm, Shoulder, and Hand (DASH). We also evaluated whether subjects obtained surgery at 24 weeks.
RESULTS
There were significant main effects over time for all outcome measures at 4, 12, and 24 weeks. There was a significant interaction effect for the CTQ-Function and DASH at 12 weeks. Post hoc analyses indicated significant differences between the lumbrical splint/general stretch and general splint/lumbrical stretch groups and the other 2 groups. At 24 weeks, a significantly greater percentage of subjects in the general splint/lumbrical stretch group achieved a clinically important improvement on the CTQ-Function. By 24 weeks, only 25.5% of subjects had elected to undergo surgery.
CONCLUSIONS
A combination of a cock-up splint with lumbrical intensive stretches was the most effective combination for improvements in functional gains at 24 weeks postbaseline. Our findings support further evaluation of this combination as a method of conservative carpal tunnel syndrome treatment.

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  • Publisher Full Text
  • Authors

    Baker NA, Moehling KK, Rubinstein EN, Wollstein R, Gustafson NP, Baratz M

    Source

    Archives of physical medicine and rehabilitation 93:1 2012 Jan pg 1-10

    MeSH

    Adult
    Aged
    Ambulatory Care
    Analysis of Variance
    Carpal Tunnel Syndrome
    Chi-Square Distribution
    Combined Modality Therapy
    Education, Medical, Continuing
    Electromyography
    Female
    Follow-Up Studies
    Hand Strength
    Humans
    Male
    Middle Aged
    Muscle Stretching Exercises
    Pain Measurement
    Range of Motion, Articular
    Reference Values
    Risk Assessment
    Severity of Illness Index
    Splints
    Time Factors
    Treatment Outcome

    Pub Type(s)

    Comparative Study
    Journal Article
    Randomized Controlled Trial
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    22200381