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.
Volar wrist braces have also been studied for conservative management of epicondyle pain. Equivalent outcomes were noted comparing volar wrist bracing with a counterforce brace. Higher rates of recovery were seen in patients who participated in combination therapies (ie, bracing, physical therapy, and medication use).12
Harms: Use of counterforce braces for ≥30 days resulted in higher rates of braces restriction, more medical visits per patients, and higher medical costs. Derebery et al13 concluded that this was due to deconditioning on returning to normal activity. Use of a volar wrist brace should be discouraged as it reduces the active range of wrist motion, further contributing to deconditioning with long-term application.14
Bottom line: A trial of counterforce bracing should be used if pain precludes active rehabilitation or vocational pursuits, but should not be used as the sole therapy.
Knee osteoarthritis
Knee osteoarthritis (OA) can result from multiple (often commingled) etiologies, which ultimately result in loss of cartilage, ensuing bony abnormalities, and affected joint/soft tissue structures. Patients can present with severe symptoms with little loss of structural architecture or major structural changes with a paucity of symptoms.
Goal of splinting: Depending on the orthoses used, the goals of splinting vary. A simple knee sleeve (FIGURE 4) provides warmth and proprioception, and a valgus unloader brace (FIGURE 5) provides valgus stress to open and unload the medial compartment.
Continue to: Evidence
