Neutral wrist splinting in carpal tunnel syndrome: a comparison of night-only versus full-time wear instructions

Arch Phys Med Rehabil. 2000 Apr;81(4):424-9. doi: 10.1053/mr.2000.3856.


Objective: To compare the effects of night-only to full-time splint wear instructions on symptoms, function, and impairment in carpal tunnel syndrome (CTS).

Design: Randomized clinical trial with 6-week follow-up.

Setting: Veterans Administration Medical Center, outpatient clinic.

Subjects: Outpatients with untreated CTS were consecutively recruited from our electrodiagnostics lab. Twenty-one patients (30 hands) were enrolled, and 17 patients (24 hands) completed the study.

Interventions: Thermoplastic, custom-molded, neutral wrist splints with subjects receiving either full-time or night-only wear instructions.

Outcome measures: Symptoms and functional deficits were measured by Levine's self-administered questionnaire, and physiologic impairment was measured by median nerve sensory and motor distal latency. COMPLIANCE AND CROSSOVER: Almost all (92%) of the combined sample reported frequent splint use, but their adherence to specific wearing instructions was limited. A majority (73%) of the full-time group reported splint wear less than one half of waking hours, and some (23%) of the night-only group reported occasional daytime wear. Despite this tendency for treatment crossover, the two treatment groups differed in daytime wear as intended (chi2 analysis, p = .004).

Results: The combined sample improved in three of four outcome measures: sensory distal latency (mean = .28msec, standard deviation [SD] = .37, p = .004), symptom severity (mean = .64, SD = .46, p = .0001), and functional deficits (mean = .49, SD = .51, p = .0001). Severity of CTS was a factor only in sensory distal latency improvement (more improvement in severe CTS). Subjects receiving full-time wear instructions showed superior distal latency improvement, both motor (.35 vs -.07msec, p = .04) and sensory (.46 vs . 13msec, p = .05) when compared with subjects receiving night-only wear instructions.

Conclusions: This study provides added scientific evidence to support the efficacy of neutral wrist splints in CTS and suggests that physiologic improvement is best with full-time splint wear instructions.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carpal Tunnel Syndrome / rehabilitation*
  • Equipment Design
  • Humans
  • Median Nerve / physiology
  • Middle Aged
  • Neural Conduction
  • Prospective Studies
  • Splints*
  • Time Factors
  • Treatment Outcome