ABSTRACT
PURPOSE: To examine the effectiveness of wrist orthoses in reducing pain in individuals with carpal tunnel syndrome. MATERIALS AND METHODS: The searches were carried out in the CINAHL, Cochrane Library, EMBASE, Regional Portal of the Virtual Health Library, PubMed, Scopus, and Web of Science databases on 18 February 2021, and updated on 16 February 2023. Four independent evaluators performed the steps for inclusion of studies following the recommendations of the PRISMA and methods of the Cochrane Handbook for systematic review. RESULTS: Three randomized clinical trials, two quasi-randomized clinical trials and one cohort study met the inclusion criteria. The visual analogue scale and numeric analog scale were used as a tool to assess pain outcome. The treatment period ranged from 2 weeks to 3 months. The period of use varied between nighttime only, and nighttime plus daytime. Most orthoses promoted a statistically significant reduction in intensity pain at night, at rest or during activities. Only one study carried out follow-up after the end of treatment and showed that pain reduction was maintained up to 6 months after treatment. CONCLUSIONS: The findings suggest that the isolated use of orthoses were effective in reducing pain in individuals with carpal tunnel syndrome.
Orthoses are effective in reducing pain in individuals with carpal tunnel syndrome.Orthoses can be used nighttime or nighttime plus daytime according to the necessity.Prefabricated orthosis may represent lower cost and greater accessibility.Pain reduction can be maintained up to 6 months after the end of treatment.
ABSTRACT
BACKGROUND: Conservative treatment for carpal tunnel syndrome (CTS) often includes wrist orthosis. However, there is no consensus on whether commercial or custom-made wrist orthosis is better for the treatment. PURPOSE: To assess feasibility of a study comparing nocturnal use of commercial versus custom-made wrist orthosis in the treatment of mild/moderate CTS and estimate their potential effects on function and symptoms. STUDY DESIGN: Randomized clinical trial. METHODS: Twenty-four individuals with mild/moderate CTS were randomized to wear either a commercial orthosis (nâ¯=â¯12) or a custom-made orthosis (nâ¯=â¯12). Participants used the assigned orthosis at night for 45 days and performed gliding exercises at home/work. We collected data on access to eligible population and feasibility of protocol. Data on use of orthosis, performance of exercises, and symptoms were collected through a dairy filled by the participant. Outcomes were pain (using Numeric Pain Rating Scale), symptom severity and functional status (using Boston Questionnaire), pinch strength (by dynamometry), and electromyographic activity of forearm muscles (sampled during a reach-to-grasp task). Outcomes were measured before and after the intervention. RESULTS: There were no loses to follow-up in either intervention group. After treatment, we found increased tripod pinch strength and better symptoms and function in both orthosis groups, with better outcomes for the custom-made orthosis, although the differences were not statistically significant. CONCLUSIONS: The preliminary results showed a potential for better outcomes from the custom-made orthosis. We established that a larger study would be feasible and could be designed and conducted based on the estimates provided by this study. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (ReBEC) - registration number: RBR-74rqnz.
