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Early Active Motion Versus Protective Splinting Following Open Carpal Tunnel Release Surgery
Blake D. Murphy, MD, PhD; Gloria Rockwell, MD, MSc
Division of Plastic Surgery, University of Ottawa, Ottawa, ON, Canada

Introduction: Splinting after open carpal tunnel release remains a controversial issue, with significant variability in practice among surgeons. We carried out a single blinded, randomized controlled trial to assess differences in outcome and complication rates between splinted and non-splinted patients following open carpal tunnel release.

Materials & Methods: One hundred and sixty-two patients undergoing open carpal tunnel release by a single surgeon using a standardized technique were prospectively randomized to Protective Splinting (77 patients, splinted two weeks post-operatively) or Early Active Motion (85 patients, no splinting). Visual Analog Pain Scale, Boston Carpal Tunnel Questionnaire (BCTQ), and the Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire were completed pre-operatively, and at two, six, and twelve weeks post-operatively. Daily range of motion activities were prescribed for all patients throughout the study. Complications (pillar pain, scar sensitivity, surgical site infection, bowstringing of flexor tendons) were recorded at each follow-up appointment. Duration until return to modified and full duties at work was also recorded. Statistical analysis was performed using a repeated measures analysis of variance for continuous variables between groups and Pearson Chi-Square for binary outcome complication data. Return to modified and full duties at work was assessed using a Studentís t-test. Significance was set at a p < 0.05 for all comparisons.

Results: There were no significant differences in post-operative pain (p=0.973), Boston Carpal Tunnel symptom severity (p=0.828), functional severity scores (p=0.773), or DASH scores (p=0.642) between the Protective Splinting and Early Active Motion groups. In addition, there were no significant differences in the occurrence of pillar pain (p=0.930), infection (p=.104), wound dehiscence (p=0.882), or scar hypersensitivity (p=0.465) between groups. Bowstringing of the flexor tendons was not observed in any patients in either group. There were no difference in return to modified (p=0.199) and full (p=0.471) duties at work between Protective Splinting (21.1 and 32.7 days, respectively) and Early Active Motion (16.7 and 36.3 days, respectively) groups.

Conclusions: No significant differences were identified in the subjective or objective outcome measures between patients in the Protective Splinting group and the Early Active Motion group. In addition, there was no significant difference in complication rate or return to work times between the two groups of patients. This data further suggests that there is no benefit to immobilization post-operatively following open carpal tunnel release surgery but also suggests that there was no detrimental effect of splinting as has been show in some previous studies.

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