MSK injury? Make splinting choices based on the evidence
Which devices do—and don’t—have evidence to support their use when it comes to injuries like carpal tunnel syndrome, “tennis elbow,” or an ankle sprain? Read on.
PRACTICE RECOMMENDATIONS
› Consider a wrist splint for carpal tunnel syndrome secondary to repetitive motion. B
› Recommend a simple knee sleeve to help patients with osteoarthritis reduce their pain and improve daily function. B
› Use ankle bracing for secondary prevention of a recurrent ankle sprain. A
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
From The Journal of Family Practice | 2018;67(11):678-683.
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.
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
Continue to: Harms
