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 2017 meta-analysis of systematic reviews found improved (self-reported) function when patients used external support devices such as tape, compression bandages, semirigid braces or boots, or walking casts.21 Secondary prevention utilizing brace wear during at-risk activities has been found to be the most important intervention to reduce recurrence.21,22
Harms: No direct injury from brace use has been reported, but consistent evidence exists that lack of early mobilization and rehabilitation can substantially affect the recovery from these injuries.
Bottom line: Consensus opinion recommends stirrup bracing for the treatment of grades 1 and 2 injuries.23,24 Controversy remains regarding brace use or complete immobilization for grade 3 injuries. Regardless of injury grade, early mobilization should be integrated into the treatment plan, coupled with active rehabilitation, including restoration of strength and proprioception. Prevention of second injuries is best accomplished with full rehabilitation and bracing during at-risk activities (eg, sports practices and competitions).21,22,25
A useful tool, but one not always covered by insurance
Bracing is a useful tool in the armamentarium of treating the common MSK complaints seen in everyday practice. Bracing must always be accompanied by a functional, active rehabilitation program.
Keep in mind, though, that many insurance plans may not cover the cost of bracing. Therefore, knowledge of its efficacy for a particular injury (or lack thereof) should guide treatment recommendations, along with shared decision making.
CORRESPONDENCE
Jeffrey C. Leggit, MD, CAQSM, 9706 Ethan Ridge Avenue, Frederick, MD 21704; jeff.leggit@usuhs.edu.
