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A Prospective, Randomized, Controlled Study of Splinting after Mini-Open Carpal Tunnel Release
Anthony L Logli, BA1, Brian J Bear, MD2
1University of Illinois College of Medicine at Rockford, Rockford, IL, 2OrthoIllinois, Rockford, IL
Purpose: In this prospective, randomized, controlled study we sought to determine if any significant difference in patient-reported or clinical outcomes existed among 3 different postoperative splinting regimens- no splint, night-time removable splint, and plaster non-removable splint- following mini-open carpal tunnel release (CTR) surgery for symptomatic, isolated, nerve conduction study positive carpal tunnel syndrome (CTS).
Methods: A total of 249 patients received a mini-open CTR and were subsequently randomized into 1 of the 3 splinting regimens to be removed at the first postoperative visit 10-14 days later. Patient-reported outcomes included QuickDASH surveys, Levine-Katz Symptom Severity Scale (SSS) and Functional Status Scale (FSS), and Pain at Rest and Pain in Action using a Numerical Pain Rating Scale (NPRS). Clinical outcomes included wrist range of motion (ROM) during flexion and extension, grip strength, and lateral pinch strength. All outcomes were evaluated bilaterally at 10-14 days, 6 weeks, 3 months, 6 months, and 12 months after surgery. Demographic information was also obtained preoperatively and included age, sex, BMI, hand dominance, tobacco use, and workers’ compensation status. We conducted repeated measures MANCOVAs with Bonferroni post-hoc tests and ANOVAs to test for statistical significance.
Results: There were no significant differences in any patient-reported or clinical outcome measures at any follow-up time period except at 6 and 12 months: the lateral pinch strength of the non-removable splint group with surgery on the dominant hand was weaker than that of the no-splint group (p=.001, p=.026) and the removable splint group (p=.005, p=.000). Patient demographics did not significantly influence measured outcomes at any time.
Conclusion: The use of no splint, night-time removable splint, or plaster non-removable splint does not change any patient-reported outcome up to at least 12 months following mini-open CTR. Lateral pinch strength was slightly weaker in the non-removable splint group at 6 and 12 months. We no longer use any kind of postoperative splint following routine CTR. Type of Study/level of evidence: Therapeutic I. Key words: Carpal tunnel syndrome (CTS), mini-open carpal tunnel release (CTR), postoperative splint, postoperative dressing.
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