Neutral wrist splinting in carpal tunnel syndrome: a comparison of night-only versus full-time wear instructions. Efficacy of acupuncture versus night splinting for carpal tunnel syndrome: a randomized clinical trial. The usefulness of nocturnal resting splints in the treatment of ulnar deviation of the rheumatoid hand. Randomized controlled trial of nocturnal splinting for active workers with symptoms of carpal tunnel syndrome. Long-term effectiveness of steroid injections and splinting in mild and moderate carpal tunnel syndrome. Neutral wrist splinting in carpal tunnel syndrome: a 3- and 6-months clinical and neurophysiologic follow-up evaluation of night-only splint therapy. Controlled assessment of the efficacy of occlusal stabilization splints on sleep bruxism. The efficacy of oral splints in the treatment of myofascial pain of the jaw muscles: a controlled clinical trial. The effectiveness of conservative treatments of carpal tunnel syndrome: splinting, ultrasound, and low-level laser therapies. Foot orthoses for the treatment of plantar fasciitis. Quantitative polygraphic controlled study on efficacy and safety of oral splint devices in tooth-grinding subjects. Night splinting does not increase ankle range of motion in people with Charcot-Marie-Tooth disease: a randomised, cross-over trial. Efficacy of splinting and oral steroids in the treatment of carpal tunnel syndrome: a prospective randomized clinical and electrophysiological study. Efficacy of a soft hand brace and a wrist splint for carpal tunnel syndrome: a randomized controlled study. Efficacy of a fabricated customized splint and tendon and nerve gliding exercises for the treatment of carpal tunnel syndrome: a randomized controlled trial.
To compare the effects of night-only to full-time splint wear instructions on symptoms, function, and impairment in carpal tunnel syndrome (CTS).
                Randomized clinical trial with 6-week follow-up.
                Veterans Administration Medical Center, outpatient clinic.
                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.
                Thermoplastic, custom-molded, neutral wrist splints with subjects receiving either full-time or night-only wear instructions.
                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).
                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.
                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. To compare the efficacy of acupuncture with night splinting for carpal tunnel syndrome (CTS).
                Sixty one mild-to-moderate degree CTS patients, aged 27-67 were randomly assigned to acupuncture (Acu) and night splinting (NS) groups. The Acu group received 10 sessions of electro-acupuncture twice a week. The NS group received prefabricated volar neutral wrist splint during the night for 5 weeks. Outcomes were assessed at baseline and the end of treatment protocol by Boston Carpal Tunnel Scale comprising symptom severity scale (SSS) and functional status scale (FSS). Pain was measured by 100 mm visual analog scale (VAS).
                VAS decreased more in Acu than in the NS group (p = 0.028) whereas improvements in SSS and FSS were not significant between both groups.
                Electro-acupuncture was as effective as night splinting in respect of overall symptoms and functions in mild-to-moderate degree CTS. However, pain was reduced more by electro-acupuncture than night splinting. Seven patients with definite RA and bilateral ulnar deviation of Fearnley grade I were included in a study of the usefulness of nocturnal resting splints. Each patient used the splint on average 17 months on one hand, randomly chosen, with the free hand as control. Joint mobility, grip strength, pain and radiographic findings were recorded at start and finish of the study. Splint treatment influenced grip strength positively, and most patients stated pain relief during the night. However, all but one patient showed progression of ulnar deviation in both hands, and there was no significant difference in progression between treated and nontreated hands. This study thus supported the use of resting splints at night for pain relief but not for prevention of ulnar deviation. To determine whether nocturnal splinting of workers identified through active surveillance with symptoms consistent with carpal tunnel syndrome (CTS) would improve symptoms and median nerve function as well as impact medical care.
                Randomized controlled trial.
                A Midwestern auto assembly plant.
                Active workers with symptoms suggestive of CTS based on a hand diagram.
                The treatment group received customized wrist splints, which were worn at night for 6 weeks; the control group received ergonomic education alone.
                Change in wrist, hand, and/or finger discomfort, carpal tunnel symptom severity index, median sensory nerve function, and the percentage of subjects who had carpal tunnel release surgery.
                The splinted group, unlike the controls, had a significant reduction in wrist, hand, and/or finger discomfort and a similar trend in the Levine carpal tunnel symptom severity index, which was maintained at 12 months. A secondary analysis showed that more median nerve impairment at baseline was associated with less clinical improvement among controls but not among the splinted group.
                Workers identified with CTS symptoms in an active symptom surveillance tended to benefit from a 6-week nocturnal splinting trial, and the benefits were still evident at the 1-year follow-up. The splinted group improved in terms of hand discomfort regardless of the degree of median nerve impairment, whereas the controls showed improvement only among subjects with normal median nerve function. Results suggest that a short course of nocturnal splinting may reduce wrist, hand, and/or finger discomfort among active workers with symptoms consistent with CTS. To evaluate the long-term efficacy of non-surgical treatment methods for mild and moderate carpal tunnel syndrome, 120 patients with clinical symptoms and electrophysiologic evidence were included in a prospective, randomized and blinded trial: 60 patients were instructed to wear splints every night, 30 received injections of betamethasone 4 cm proximal to the carpal tunnel, and 30 received injections distal to the carpal tunnel. After approximately 1 year (mean, 11 months; range, 9-14), 108 patients were available for final evaluation. We assessed clinical symptom severity and performed detailed electrophysiologic examinations before and after treatment. Splinting provided symptomatic relief and improved sensory and motor nerve conduction velocities at the long-term follow-up when the splints were worn almost every night. Proximal and distal injections of steroids were ineffective on the basis of both clinical symptoms and electrophysiologic findings. The aim of the study was to evaluate the long-term efficacy of night-only splint wear therapy for carpal tunnel syndrome (CTS).
                We conducted a randomized case-control trial with evaluation after three and six months of follow-up of outpatients with mild, recent onset symptoms of CTS recruited from the department clinic. Fifty patients (50 hands) were enrolled, of which 36 completed the study at 6 months. The case group utilized a thermoplastic neutral wrist splint for night-only wear. Outcome measures were instrumental parameters (sensory and motor nerve conduction velocity), symptom and function alterations (as measured by Levine's self-administered questionnaire), clinical parameters (pressure-provocative and Phalen tests).
                Improvements were observed in Levine's symptom status score at the three-month (P=0.001) and the six-month (P=0.001) follow-up visits, in functional score (P=0.0001) and (P=0.0004), in median distal sensory latency (P=0.01) and (P=0.02), in pressure-provocative test outcome (P=0.01) and (P=0.003), in Phalen test outcome (P=0.04) and (P=0.05) respectively.
                Symptom relief and neurophysiological improvement after night-only splint wear therapy lasted up to the six-month follow-up visit. To assess the efficacy of occlusal stabilization splints in the management of sleep bruxism (SB) in a double-blind, parallel, controlled, randomized clinical trial.
                Twenty-one participants were randomly assigned to an occlusal splint group (n = 11; mean age = 34.2 +/- 13.1 years) or a palatal splint (ie, an acrylic palatal coverage) group (n = 10; mean age = 34.9 +/- 11.2 years). Two polysomnographic recordings that included bilateral masseter electromyographic activity were made: one prior to treatment, the other after a treatment period of 4 weeks. The number of bruxism episodes per hour of sleep (Epi/h), the number of bursts per hour (Bur/h), and the bruxism time index (ie, the percentage of total sleep time spent bruxing) were established as outcome variables at a 10% maximum voluntary contraction threshold level. A general linear model was used to test both the effects between splint groups and within the treatment phase as well as their interaction for each outcome variable.
                Neither occlusal stabilization splints nor palatal splints had an influence on the SB outcome variables or on the sleep variables measured on a group level. In individual cases, variable outcomes were found: Some patients had an increase (33% to 48% of the cases), while others showed no change (33% to 48%) or a decrease (19% to 29%) in SB outcome variables.
                The absence of significant group effects of splints in the management of SB indicates that caution is required when splints are indicated, apart from their role in the protection against dental wear. The application of splints should therefore be considered at the individual patient level. Oral splints are widely used in the treatment of myofascial pain of masticatory muscles, even though their mechanism of action is unknown. The present study evaluated the therapeutic efficacy of splints using a parallel, randomized, controlled and blind design. Following a sample size estimation, 63 subjects were recruited and assigned to 3 groups: (1) passive control: full occlusal splint worn only 30 min at each appointment; (2) active control: palatal splint worn 24 h/day; and (3) treatment: full occlusal splint worn 24 h/day. On each of 7 visits over 10 weeks, subjects rated on 100 mm visual analogue scales their pain intensity and unpleasantness at rest and after experimental mastication. The effect of pain on the quality of life was also rated on category scales. All pain ratings decreased significantly with time, and quality of life improved for all 3 groups. However, there were no significant differences between groups in any of the variables. These data suggest that the gradual reduction in the intensity and unpleasantness of myofascial pain, as well as the improvement of quality of life during the trial, was non-specific and not related to the type of treatment. The objective of this study was to investigate the effectiveness of splinting, ultrasound (US), and low-level laser (LLL) in the management of carpal tunnel syndrome (CTS).
                CTS is the entrapment mononeuropathy most frequently seen in clinical practice, caused by compression of the median nerve at the wrist. Although several treatment modalities are routinely in use, there is no consensus about the best way to manage CTS.
                In our study, patients were randomly allocated to three groups that received the following treatment protocols: splinting only, splinting plus US, and splinting plus LLL therapy. Patients were assessed with the Boston Questionnaire, patient satisfaction inquiry, visual analogue scale for pain, and electroneuromyography.
                The study was completed with a total of 100 hands of 50 women patients with bilateral CTS at 3 mo after treatment. At the end of the follow-up period, each of the groups had improvements to varying degrees. It appeared that the combinations of US or LLL therapy with splinting were more effective than splinting alone in treating CTS. However, LLL therapy plus splinting was more advantageous than US therapy plus splinting, especially for the outcomes of lessening of symptom severity, pain alleviation, and increased patient satisfaction. The literature suggests mechanical interventions such as foot orthoses and night splints are effective in reducing pain from plantar fasciitis. There is, however, a lack of controlled trials. We studied the effects of foot orthoses and night splints, alone or combined, in a prospective, randomized trial with 1-year followup.
                Forty-three patients (34 women and nine men with a mean age of 46 years) with plantar fasciitis were randomized to receive foot orthoses (n = 13), foot orthoses and night splints (n = 15), or night splints alone (n = 15). Data were available for 34 (79%) patients after treatment (12 weeks), and for 38 (88%) at 1-year followup. Pain, functional limitations, and quality of life were evaluated with the Foot and Ankle Outcome Score.
                All groups improved significantly in all outcomes evaluated across all times (p < 0.04). At 12 weeks, pain reduction of 30% to 50% compared to baseline were seen (p < 0.03). At 52 weeks, pain reduction of 62% was seen in the two groups using foot orthoses compared to 48% in the night splint only group (p < 0.01). Better compliance and fewer side effects were reported for orthosis use. At 12 months, 19 of 23 patients reported still using foot orthoses compared to 1 of 28 still using the night splint.
                Foot orthoses and anterior night splints were effective both short-term and long-term in treating pain from plantar fasciitis. Parallel improvements in function, foot-related quality of life, and a better compliance suggest that a foot orthosis is the best choice for initial treatment plantar fasciitis. The efficacy of occlusal splints in diminishing muscle activity and tooth-grinding damage remains controversial. The objective of this study was to compare the efficacy and safety of an occlusal splint (OS) vs. a palatal control device (PCD). Nine subjects with sleep bruxism (SB) participated in this randomized study. Sleep laboratory recordings were made on the second night to establish baseline data. Patients then wore each of the splints in the sleep laboratory for recording nights three and four, two weeks apart, according to a crossover design. A statistically significant reduction in the number of SB episodes per hour (decrease of 41%, p = 0.05) and SB bursts per hour (decrease of 40%, p < 0.05) was observed with the two devices. Both oral devices also showed 50% fewer episodes with grinding noise (p = 0.06). No difference was observed between the devices. Moreover, no changes in respiratory variables were observed. Both devices reduced muscle activity associated with SB. What is the effect of wearing splints at night to stretch the plantarflexors on dorsiflexion range of motion (ROM) in people with Charcot-Marie-Tooth disease?
                Randomised, assessor-blinded, cross-over trial.
                14 people (1 dropout) aged 7 to 30 years with Charcot-Marie-Tooth disease Type 1A and with < or = 15 degrees dorsiflexion range of motion (ROM).
                A splint holding the ankle in maximum dorsiflexion was worn nightly on one leg for 6 weeks followed by the opposite leg for the subsequent 6 weeks.
                The primary outcome was dorsiflexion ROM; secondary outcomes were eversion ROM, and dorsiflexion, eversion, and inversion strength, measured before and after splinting, and three months later.
                There was no significant difference between the experimental and the control intervention in terms of ROM or strength. Wearing the splint at night increased dorsiflexion ROM by 1 degree (95% CI -3 to 4; p = 0.72) and eversion ROM by 1 degree (95% CI -1 to 3; p = 0.28) compared to not wearing the splint. Wearing the splint increased dorsiflexion strength by 41 N (95% CI -53 to 135; p = 0.38), reduced eversion strength by 6 N (95% CI -112 to 101; p = 0.92) and reduced inversion strength by 8 N (95% CI -110 to 95; p = 0.88) compared to not wearing the splint.
                Wearing night splints does not increase ankle ROM or strength in people with Charcot-Marie-Tooth disease Type 1A. To study the efficacy of splinting and oral steroids in the management of carpal tunnel syndrome (CTS).
                Prospective, randomized, open-label, clinical and electrophysiological study with 3-month follow-up.
                Forty patients with CTS were randomly divided into splint group (N-20), wearing splint in neutral position for 4 weeks; and steroid group (N-20), who received oral prednisolone 20 mg/day for 2 weeks followed by 10 mg/day for 2 weeks. Clinical and electrophysiological evaluations were done at baseline and at 1-month and 3-month follow-up. Independent 't' test and paired 't' test were used for statistical analysis.
                Primary outcome measure was the symptom severity score and functional status score. Secondary outcome measures were median nerve sensory and motor distal latency and conduction velocity.
                At the end of 3 months, statistically significant improvement was seen in symptom severity score and functional status score in both groups (P<0.001). Median nerve sensory distal latency and conduction velocity also improved significantly in both the groups at 3 months. Improvement in motor distal latency was significant (P=0.001) at 3 months in steroid group, while insignificant improvement (P=0.139) was observed in splint group. On comparing the clinical and electrophysiological improvement between the two groups, except for the functional status score, there was no significant difference at 3-month follow-up. Improvement in functional status score was significantly more in steroid group (P=0.03).
                There was significant improvement in both groups, clinically as well as electrophysiologically, at 3 months. On comparing the efficacy of the two treatment methods, except for the functional status score, there was no significant difference between the two groups. To examine, in a randomized, controlled, single blinded trial, the efficacy of a soft hand brace and a wrist splint for carpal tunnel syndrome (CTS).
                We randomized 120 patients with CTS into a group wearing the soft hand brace MANU and into another group wearing the wrist splint CAMP TIELLE at night for 3 months. We re-evaluated the patients after 3 (T1) and 9 months (T2). The primary efficacy measures were changes in scores of Boston Carpal Tunnel Questionnaire (BCTQ) and in Visual Analogical Scale (VAS) for pain and paresthesias.
                At T1, both groups showed a significant reduction in symptomatic and functional BCTQ (T0-T1 differences: MANU BCTQ sympt: 0.88 (0.68-1.08), funct: 0.45 (0.19-0.72); TIELLE BCTQ sympt: 0.78 (0.55-1.01), funct: 0.41 (0.22-0.59). At T2, a less evident benefit on symptoms persisted in both groups, except for pain VAS score that was significantly reduced only in the CAMP TIELLE group. No significant functional benefits persisted in either group. There were no differences in BCTQ and VAS scores between the two groups at T1 and T2 compared with that at baseline.
                A 3-month treatment with either the hand brace or the wrist splint induces a symptomatic and functional benefit in patients with CTS. To compare the effects of a neutral wrist and metacarpophalangeal (MCP) splint with a wrist cock-up splint, with and without exercises, for the treatment of carpal tunnel syndrome (CTS).
                A 2x2x3 randomized factorial design with 3 main factors: splint (neutral wrist and MCP and wrist cock-up), exercise (exercises, no exercise), and time (baseline, 4wk, 8wk).
                Subjects were evaluated in an outpatient hand therapy clinic.
                Sixty-one subjects with mild to moderate CTS; 51 subjects completed the study.
                There were 4 groups: the neutral wrist and MCP group and the neutral wrist and MCP-exercise group received fabricated customized splints that supported the wrist and MCP joints; the wrist cock-up group and the wrist cock-up-exercise group received wrist cock-up splints. The neutral wrist and MCP-exercise and wrist cock-up-exercise groups also received tendon and nerve gliding exercises and were instructed to perform exercises 3 times a day. All subjects were instructed to wear the assigned splint every night for 4 weeks.
                We used the CTS Symptom Severity Scale (SSS) and the Functional Status Scale (FSS) to assess CTS symptoms and functional status.
                Analysis of variance showed a significant main effect for splint and time on the SSS (P<.001, P=.014) and FSS (P<.001, P=.029), respectively. There were no interaction effects.
                Our results validate the use of wrist splints for the treatment of CTS, and suggest that a splint that supports the wrist and MCP joints in neutral may be more effective than a wrist cock-up splint.
Overall, there is limited evidence that a splint worn at night is more effective than no treatment in the short term, but there is insufficient evidence regarding the effectiveness and safety of one splint design or wearing regimen over others, and of splint over other non-surgical interventions for CTS. More research is needed on the long-term effects of this intervention for CTS.