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.
Evidence: A conservative management strategy for an isolated injury is generally adequate to allow for sufficient healing, and “return to play” without prolonged disability. With conservative management, the affected joint is protected with a hinged knee brace for about 3 to 6 weeks.19,20 Data gathered on patients 9 years postinjury support the use of bracing of grades 1 to 2 injuries, but it is unclear what the optimal strategy is for grade 3 injuries.19
Harms: Generally well tolerated, and no harms have been reported.
Bottom line: Isolated grades 1 to 2 MCL injuries can be treated conservatively, and a hinged knee brace should be used as part of the rehabilitative process. It is unclear how to optimally manage grade 3 injuries.
Lateral ankle sprain
Lateral ankle sprains involve inversion injury to 1 or more of the 3 lateral ankle ligaments. Injuries are graded using the same grade schema as MCL injuries.
Goal of splinting: There are a variety of braces designed to provide lateral stability to patients with lateral ankle sprains. These stirrup braces differ in degree of support and additional fixation points—rigid (pneumatic) vs semirigid (Velcro, lace-up, etc) (FIGURE 7).
Continue to: Evidence
