MODERATE RECOMMENDATION This recommendation is based on one high-quality, five moderate-quality, and one low-quality study evaluating the use of postoperative splinting in comparison to no splinting. These studies demonstrate that there are no functional or outcome benefits of utilizing splinting after carpal tunnel release.
One high-quality article (Logli 2018) demonstrated no difference in patient reported or clinical outcomes at any follow up period to 12 months after mini-open CTS surgery in patients who utilized a non-removable orthotic (plaster, Webril cotton wrap) or patients who used a soft dressing (gauze wrap) when compared to a removable orthotic (V-Strap wrist brace).
One moderate-quality article (Cebesoy 2007) showed that patients who had been treated with a surgical intervention for CTS had a significantly better BCTQ-SSS score when treated with a post-op Bulky Bandage than patients who were treated with a splint.
One moderate-quality article (Ritting 2012) showed that patients treated with early mobilization after surgical intervention for CTS had better grip strength and tip pinch strength than patients treated with medicated gauze, cotton gauze, cast padding, and elastic roller bandage.
One moderate-quality article (Cook 1995) showed that patients who began range of motion exercises after CTS surgery post-op day one had significantly better outcomes in return to daily living, light duty work, and full duty work than patients who were splinted for two weeks following surgery. Grip strength, key-pinch strength, and VAS pain were also improved in the unrestricted movement group, however these effects only lasted until the one-month follow-up.
Two moderate-quality articles (Finsen 1999 and Huemer 2007) and one low-quality article (Kroeze 2020) showed no significant differences in observed outcomes between their restricted and unrestricted movement groups.
Benefits/Harms of Implementation
There are no harms associated with implantation of this recommendation.
Future Research
Future investigation should focus on determining benefits of early post operative mobilization, return to unrestricted activities of daily living and work activities.
- Cebesoy, O., Kose, K. C., Kuru, I., Altinel, L., Gul, R., Demirtas, M.. (2007). Use of a splint following open carpal tunnel release: a comparative study. Advances in Therapy, 24(3), 478-84.
- Cook, A. C., Szabo, R. M., Birkholz, S. W., King, E. F.. (1995). Early mobilization following carpal tunnel release. A prospective randomized study. , 20(2), 228-30.
- Finsen, V., Andersen, K., Russwurm, H.. (1999). No advantage from splinting the wrist after open carpal tunnel release. A randomized study of 82 wrists. Acta Orthopaedica Scandinavica, 70(3), 288-92.
- Huemer, G. M., Koller, M., Pachinger, T., Dunst, K. M., Schwarz, B., Hintringer, T.. (2007). Postoperative splinting after open carpal tunnel release does not improve functional and neurological outcome. Muscle & Nerve, 36(4), 528-31.
- Kroeze, M., Rakhorst, H., Houpt, P.. (2020). Arm sling after carpal tunnel surgery: myth or evidence based?. Journal of Hand Surgery: European Volume, 45(3), 255-259.
- Logli, A. L., Bear, B. J., Schwartz, E. G., Korcek, K. J., Foster, B. J.. (2018). A Prospective, Randomized Trial of Splinting After Minicarpal Tunnel Release. Journal of Hand Surgery - American Volume, 43(8), 775.e1-775.e8.
- Ritting, A. W., Leger, R., O'Malley, M. P., Mogielnicki, H., Tucker, R., Rodner, C. M.. (2012). Duration of postoperative dressing after mini-open carpal tunnel release: a prospective, randomized trial. , 37(1), 3-8.