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Splinting or surgery for carpal tunnel syndrome? Design of a randomized controlled trial [ISRCTN18853827].

BACKGROUND: Carpal tunnel syndrome is a common disorder, which can be treated with surgery or conservative options. However, there is insufficient evidence and no consensus among physicians with regard to the preferred treatment for carpal tunnel syndrome. Therefore, a randomized controlled trial is conducted to compare the short- and long-term efficacy of surgery and splinting in patients with carpal tunnel syndrome. An attempt is also made to avoid the (methodological) limitations encountered in earlier trials on the efficacy of various treatment options for carpal tunnel syndrome. METHODS: Patients of 18 years and older, with clinically and electrophysiologically confirmed idiopathic carpal tunnel syndrome, are recruited by neurologists in 13 hospitals. Patients included in the study are randomly allocated to either open carpal tunnel release or wrist splinting during the night for at least 6 weeks. The primary outcomes are general improvement, waking up at night and severity of symptoms (main complaint, night and daytime pain, paraesthesia and hypoesthesia). Outcomes are assessed up to 18 months after randomization.

Carpal Tunnel Syndrome↗

Swing design dynamic traction splinting for the treatment of intra-articular fractures of the digits.

The concept of treating acute PIP fractures with traction splinting to allow early motion to mitigate against the known deleterious effects of prolonged immobilization of this problematic joint has been around for a long time and was made popular by Schenck. Our author in this PF piece has modified a splint design of Griet Van Veldhoven to further refine the dynamic traction approach.

Equipment Design↗

Sideline splinting, bracing, and casting of extremity injuries.

Emergent and nonemergent splinting, bracing, and casting are effective ways to safely remove an injured athlete from the playing field, allow immediate return to play, and permit an athlete to return to play before an injury has completely healed. Sideline providers should be familiar with the materials and resources currently available, and be aware of the sport-specific guidelines regarding their use. Properly applied splints, casts, braces, and padding should function to prevent further injury, promote comfort, and not pose a risk of injury to other participants.

Athletic Injuries↗

A protective thermoplast splint for the forearm and hand in nonhuman primates.

A custom-made thermoplastic splint was developed for the protection of the upper extremity after experimental surgery. It was used in 39 cases for a duration of 12-79 days. Complications were minimal and transient. The cast was easy to make, in one piece and inexpensive. Frequent removal for wound inspection was simple. This splint provides a good immobilization and protection of the arm and hand in the nonhuman primate.

Animals↗

Treatment of ulnar nerve palsy at the elbow with a night splint.

Twenty-two patients with ulnar nerve palsy at the elbow, confirmed by electromyography, were treated by a night splint which prevented flexion of the elbow beyond 60 degrees. The splint was worn all night regularly for at least six months. At a mean follow-up of 11.3 months, 17 patients had clinical and electromyographic assessment and five were contacted by telephone. There was improvement in the symptoms in every patient, including three who had failed to respond to surgical decompression. There was electromyographic improvement in 16 of the 17 patients re-examined at follow-up. The mean improvement in motor nerve conduction velocity was 6.5 m/s and in sensory nerve conduction velocity 9.5 m/s. The efficacy of this treatment suggests that nocturnal elbow flexion is an important cause of ulnar nerve lesions at the elbow.

Adult↗

An easily fabricated occlusal splint.

An easy and inexpensive method for fabrication of an occlusal splint has been described. It has a high degree of patient acceptance and is effective in treating TMJ dysfunction symptoms. If a hard acrylic occlusal splint is preferred, the aforementioned method can be used as an interim appliance until necessary appointments can be scheduled.

Dental Occlusion↗

Increase of condylar displacement between centric relation and maximal habitual intercuspation after occlusal splint therapy.

The present study assessed condylar displacement between initial maximal habitual intercuspation (MHI) and centric relation (CR), recorded after using a deprogramming occlusal splint for an average period of 7.8 +/- 2.1 months prior to any orthodontic treatment. The sample consisted of 22 subjects, 11 male and 11 female, with an average age of 14.2 +/- 1.4 years, with Class II malocclusion and with no apparent signs or symptoms of temporomandibular dysfunction (TMD). Condylar displacement was measured using a Panadent axis position indicator in decimal fractions of a millimeter. The original mean vertical displacements and the corresponding standard deviations were 4.24 +/- 2.53 mm and 3.86 +/- 2.72 mm, respectively, for the right and left sides. Because a significant negative correlation was observed between original condylar displacements and age factors, the displacement values were statistically adjusted to 2.74 +/- 2.00 mm and 2.44 +/- 1.93 mm. On the horizontal plane, the mean displacements measured were -0.72 +/- 1.53 mm on the right side and -0.51 +/- 1.98 mm on the left. The mean displacement on the transversal plane was 0.03 +/- 0.87 mm. A comparison between these values and those observed in non-deprogrammed groups, as well as those published in the related literature, indicates that use of occlusal splints results in greater mean condylar displacement values, especially vertically, between CR and MHI positions, which contributed to a more accurate orthodontic diagnosis.

Adolescent↗

Periodontal splinting with wire and composite resin. A revised approach.

A method for periodontal splinting of anterior teeth with wire and composite resins is described. The method combines the use of a double wire reinforcement shallow tooth preparation, and acid etching to obtain good strength and sealing properties. The sequence of steps are exclusively designed to suit the properties of composite resins. The technique has the advantages of conservatism and simplicity, good esthetics and strength that surpasses that of conventional wire and acrylic or composite splints.

Acid Etching, Dental↗

Light protection of fiber-reinforced strip using aluminum foil for the direct splinting technique.

The critical point of the clinical procedure of direct splinting is the placement of the fiber-reinforced strip, which has to be well adapted to tooth surfaces. This article describes the use of aluminum foil to cover and protect the fiber-reinforced strip from light polymerization during the direct splinting technique. The advantage of using aluminum foil is to prevent premature curing of the fiber-reinforced strip, which would necessitate repetition of the procedure. With this technique, the strip is gradually exposed and adapted to the lingual/palatal surfaces of the teeth and light cured, allowing for ample working time.

Acid Etching, Dental↗

The effect of a partial bite-raising splint on the inclination of upper and lower front teeth.

In a previous paper it was maintained that the effect of the permanent use of an anterior partial bite-raising splint was an intrusion of the front teeth and an eruption of the others. However, the effect might have been merely a change in the inclination of the front teeth. The present study comprised the same material as earlier. Linear and angular changes in the position of upper and lower incisors were measured on cephalometric radiographs. In the upper jaw a possible average proclination occurred, whereas in the lower jaw no or only a very small retroclination took place. The values were well within the method error, and it was concluded that the effect of the splint had been one of intrusion of the upper and lower front teeth and not merely a change in their inclination.

Adolescent↗

A dental splint for use during peroral endoscopy.

Damage to teeth is a well known complication of peroral endoscopy. A case is described in which potentially fatal complications of such damage occurred. This spurred on the development of a dental splint as an aid in the prevention of such damage. This splint is described, and evidence for the beneficial results of its use is presented.

Aged↗

Positioning, splinting and pressure management of the burned hand: a method.

A splinting procedure to avoid hand and finger deformities in deep dermal and subdermal burns of the hand is presented. The same splint may be used in the healing phase as well as in the rehabilitation period. The method is characterized by a combination of simple materials, active exercises and a teamwork involving the patient and the staff.

Bandages↗

New splinting materials.

Plaster of Paris (P.o.P.) bandage has been the pre-eminent external splinting material for over 150 years and from time to time synthetic alternatives have been tried. So far none has seriously challenged the dominance of P.o.P. as a primary or secondary material in the management of fractures. The recent introduction of Polyurethane coated fibreglass bandage appears to offer a more serious challenge than previous contenders. This technical note reviews bandage type splinting materials and explains some of the properties of the PU materials.

Bandages↗

Treatment of congenital subluxation and dislocation of the hip by knee splint harness.

The results are reported from a study of 103 cases fitted with the knee splint harness (KSH) which is an orthotic device used for the treatment of congenital subluxation and dislocation of the hip. The knee splint harness consists of a harness attached to posterior plastic shells at the knee which prevent flexion beyond 90 degrees while permitting full and free knee extension. No case was encountered in a 10 year period which failed to reduce. In cases of hip subluxation, reduction was obtained within an average of 5.8 days. In cases of dislocation, reduction was obtained in 6.7 days on average. Follow-up roentgenograms, established that there were no cases presenting with any sign of ischaemia of the epiphysis.

Equipment Design↗

A dynamic splint for use after total wrist arthroplasty.

Total wrist arthroplasty has been performed at the Mayo Clinic for the past 5 years. The procedure has necessitated the development of a dynamic wrist splint for post-operative care. This article provides a step-by-step outline for construction of this splint.

Arthritis, Rheumatoid↗

Magnetic splint for object retrieval.

The magnetic splint and complementary adapted objects allow patients with high-level spinal cord injuries independence in retrieving commonly used objects. This device has proved effective for patients with high-level spinal cord injuries who are not presently using an assistive splint and who are capable of bringing the hand to the mouth, often with the assistance of a mobile arm support or overhead sling.

Activities of Daily Living↗

Far-forward fracture stabilization: external fixation versus splinting.

With improvements in body armor, soldiers often survive previously fatal injuries but incur devastating extremity trauma. Orthopaedic and general surgeons in forward-deployed areas must be well-versed in the selection and application of both external fixation and splinting devices in order to best preserve life and limb of the wounded. The surgeon must consider tactical environment, injury severity, injury location, available resources, and his or her own level of experience. Advantages to using external fixation in the field include preventing future injury to the traumatized soft-tissue envelope, reducing the risk of infection, minimizing fracture hemorrhage, providing pain control, and facilitating medical evacuation. Splinting is reserved for closed, low-energy, stable fractures of either the upper or lower extremity and for unstable fractures that are not amenable to battlefield external fixation; because of the risks of compartment syndrome, casts are avoided.

Fracture Fixation↗