Applied Evidence

MSK injury? Make splinting choices based on the evidence

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From The Journal of Family Practice | 2018;67(11):678-683.

References

Harms: Both the 2012 Cochrane review and the AAOS statement indicate that there are no long-term harms other than some subjective discomfort in a minority of patients while wearing the splint.

Bottom line: A wrist splint should be considered in the treatment of CTS—especially if the condition is likely the result of repetitive wrist motion. If the patient can tolerate continuous use for 2 to 4 weeks, this should be employed. But at a minimum, nocturnal use for this duration would constitute a therapeutic trial. Combination therapy (ie, medication, occupational therapy, and splinting) is better than splinting alone.

de Quervain tendinopathy

This form of tendinopathy involves pain at the tendon sheaths of the abductor pollicis longus and the extensor pollicis brevis. Onset of symptoms has been attributed to overuse or repetitive movements of the wrist and thumb.

Goal of splinting: Immobilize the affected tendons to reduce irritation and/or inflammation. A thumb spica splint (FIGURE 2) is used to achieve this restriction.

Thumb spica splint IMAGE COURTESY OF: GEOFFREY A. MCLEOD, DO, CAQSM

Evidence: Three randomized controlled trials (RCTs) suggested that the natural course is not affected by splint use for patients with prolonged symptoms (>3 months), and eventual resolution was noted in about 12 months—regardless of intervention with bracing. Symptoms improved more rapidly with the combination of medications and splint wear for those with a shorter duration of symptoms.9-11 Symptom severity driven wear compared with full-time use yielded equivalent outcomes.9 Those patients with longer duration and increased severity of symptoms fared worse regardless of treatment.10

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