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This crossover design study was conducted to verify the usefulness of two-dimensional (2D) scan-based three-dimensional (3D)-printed wrist splints versus that of 3D scan-based 3D-printed wrist splints. To apply the two splints to the participants, made using different methods, a crossover design was applied by randomly assigning two groups of five people each. Their work performance and wrist pain were then evaluated. Work performance was evaluated by using a grooved pegboard. Wrist pain was evaluated by using the patient-rated wrist evaluation (PRWE) before and after performing the grooved pegboard test. No statistical difference existed in task performance between each splint group. Wrist pain was significantly higher for splints made with the 3D scanning method than for splints made with the 2D scanning method. Therefore, we believe that the 2D scanning method will be more useful for patients when making splints with 3D printing. [ABSTRACT FROM AUTHOR]

Wrist splint is a device for immobilising the wrist to facilitate the healing of wrist injury. However, conventional splint designing strategies lack consideration of biomechanical interaction with wrist joints, resulting in mechanical failure of splints or causing patient injuries. A novel design and optimisation method of customised functional wrist splints is needed clinically. In this study, we proposed a splint design method combining topology optimisation and additive manufacturing, based on the biomechanical analysis, to enable advanced customisation regarding functionality, comfort and ventilation. Three prototypes were fabricated via fused filament fabrication (FFF) horizontal printing, FFF vertical printing, and powder bed fusion (PBF). Finite element analysis was used to simulate the displacements of splints under the maximum loading provided by patients, with the results validated by physical tests. The stiffness and functionality of splints fabricated by different techniques were evaluated and compared. The results demonstrate that the developed splint is compatible with patients' functional and biomechanical needs, limiting 95.7% sagittal movement, 89.8% coronal movement, and 18.7% maximum grip strength. Moreover, among the three manufacturing methods, FFF vertical printing is recommended for general clinical use considering the safety, functionality, surface quality and cost.

Orthopedic splints are external medical devices designed to support and protect the functions of the human musculoskeletal system from pathological conditions or traumatic events. Tailoring these medical solutions to the morphology of the patient's limb is essential to ensure a correct and rapid rehabilitation pathway. Although traditional splinting techniques might achieve a unique fit, the procedures are highly dependent on the skill and experience of the medical operator, affecting the quality of the care treatment. In response to the drawbacks associated with traditional splinting techniques, the present article proposed an innovative and structured methodology to manufacture customized wrist immobilization splints, prioritizing simplicity and user-friendliness in fabrication activities. The customized splint manufacturing was based on the integration of reverse engineering (RE) and additive manufacturing (AM) techniques. The research designed a baseline model of a wrist splint, varying over different thickness values and manufacturing materials (ABS, nylon, PLA, PC, PA6-GF25, PA6-CF20). For every splint model, the production times and material costs were assessed. Technical tests were performed via finite element analysis (FEA). The conducted analysis and the resulting charts empower medical operators to select the most appropriate solution, ensuring a well-informed and effective decision-making approach. [ABSTRACT FROM AUTHOR]

Background: There is limited evidence regarding the efficacy of different treatment options in patients with carpal tunnel syndrome (CTS). This study aimed at assessing the effectiveness of nerve and tendon gliding exercises in the treatment of patients with mild CTS. Methods: The current prospective, randomized trial with pretest-posttest design was conducted on 80 patients with mild CTS randomly assigned to 2 groups. The treatment group was instructed to perform gliding exercises in addition to the wrist splint use. The control group only used the wrist splint. All the patients were instructed to use the splint at night and during the day if required. Patients were evaluated in terms of clinical parameters (ie, grip and pinch strength). The severity of symptoms and functional status was also determined using the Boston Carpal Tunnel Syndrome Questionnaire. The subjects were followed up for 6 weeks. Results: There were no significant differences in all parameters between groups. The pretest-posttest analysis showed a statistically significant improvement in subjective and objective parameters in the treatment group. However, in the control group, only a significant improvement was observed in grip strength. Wrist splint use led to a significant change in the severity of symptoms only over the second week. Conclusions: Both gliding exercise and wrist splint groups showed some improvement in the severity of symptoms and functional status scores. However, the gliding exercises did not offer additional benefit compared with wrist splint alone. [ABSTRACT FROM AUTHOR]

ObjectiveOptimal wrist/hand function facilitates the performance of activities of daily living (ADL), which are associated with independent living and increased quality of life. Rheumatological, musculoskeletal, and neurological conditions or injuries can negatively impact hand/wrist function, with wrist-hand orthoses (WHOs) being prescribed to control motion and improve wrist alignment whilst enhancing hand/wrist functionality. The objective of this follow-up study was to quantify and assess the efficacy and functionality of 10 commercially available WHOs during five ADLs.DesignRandomised comparative functional study of the wrist/hand with and without WHOs.ParticipantsTen right-handed healthy female participants with no underlying condition or pain affecting the wrist/hand that could influence their ability to undertake ADLs.Main outcome measuresThe primary outcome was ascertaining the impact of each WHO during five ADLs. Movement was quantified in sagittal, coronal, and transverse planes with and without WHO use. The resting position, maximum mean flexion, extension, pronation, supination, and radial and ulnar deviation attained were quantified, with the time spent in wrist flexion, wrist flexion and ulnar deviation, wrist extension >15°, and radial deviation recorded. Finally, the time to complete each task was compared between conditions.ResultsAt rest, four WHOs maintained the desired sagittal plane wrist position, with only one preventing radial deviation with variation observed in the transverse plane. All WHOs reduced mean maximum flexion, with only 10 out of 50 tests (20%) showing a successful restriction of flexion (p 15° for a significant amount of time (p

Background: Torus (buckle) fractures of the wrist are the most common fractures in children involving the distal radius and/or ulna. It is unclear if children require rigid immobilisation and follow-up or would recover equally as well by being discharged without any immobilisation or a bandage. Given the large number of these injuries, identifying the optimal treatment strategy could have important effects on the child, the number of days of school absence and NHS costs. Objectives: To establish whether or not treating children with a distal radius torus fracture with the offer of a soft bandage and immediate discharge (i.e. offer of a bandage) provides the same recovery, in terms of pain, function, complications, acceptability, school absence and resource use, as treatment with rigid immobilisation and follow-up as per usual practice (i.e. rigid immobilisation). Design: A pragmatic, multicentre, randomised controlled equivalence trial. Setting: Twenty-three UK emergency departments. Participants: A total of 965 children (aged 4–15 years) with a distal radius torus fracture were randomised from January 2019 to July 2020 using a secure, centralised, online-encrypted randomisation service. Exclusion criteria included presentation > 36 hours after injury, multiple injuries and an inability to complete follow-up. Interventions: A bandage was offered to 489 participants and applied to 458, and rigid immobilisation was carried out in 476 participants. Participants and clinicians were not blinded to the treatment allocation. Main outcome measures: The pain at 3 days post randomisation was measured using the Wong–Baker FACES Pain Rating Scale. Secondary outcomes were the patient-reported outcomes measurement system upper extremity limb score for children, health-related quality of life, complications, school absence, analgesia use and resource use collected up to 6 weeks post randomisation. Results: A total of 94% of participants provided primary outcome data. At 3 days, the primary outcome of pain was equivalent in both groups. With reference to the prespecified equivalence margin of 1.0, the adjusted difference in the intention-to-treat population was –0.10 (95% confidence interval –0.37 to 0.17) and the per-protocol population was –0.06 (95% confidence interval –0.34 to 0.21). There was equivalence of pain in both age subgroups (i.e. 4–7 years and 8–15 years). There was no difference in the rate of complications, with five complications (1.0%) in the offer of a bandage group and three complications (0.6%) in the rigid immobilisation group. There were no differences between treatment groups in functional recovery, quality of life or school absence at any point during the follow-up. Analgesia use was marginally higher at day 1 in the offer of a bandage group than it was in the rigid immobilisation group (83% vs. 78% of participants), but there was no difference at other time points. The offer of a bandage significantly reduced the cost of treatment and had a high probability of cost-effectiveness at a willingness-to-pay threshold of £30,000 per quality-adjusted life-year. Limitations: Families had a strong pre-existing preference for the rigid immobilisation treatment. Given this, and the inability to blind families to the treatment allocation, observer bias was a concern. However, there was clear evidence of equivalence. Conclusions: The study findings support the offer of a bandage in children with a distal radius torus fracture. Future work: A clinical decision tool to determine which children require radiography is an important next step to prevent overtreatment of minor wrist fractures. There is also a need to rationalise interventions for other common childhood injuries (e.g. ‘toddler’s fractures’ of the tibia). Trial registration: This trial is registered as ISRCTN13955395 and UKCRN Portfolio 39678. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 33. See the NIHR Journals Library website for further project information.

Introduction: Torus fractures, also known as buckle fractures, are among the most common types of fractures seen in children who present to the emergency department (ED). These injuries usually occur when a child falls onto an outstretched hand, resulting in the compression and buckling of the dorsal cortex of the radius while the volar cortex remains intact. These fractures generally have a good prognosis and heal well with simple immobilization with a low risk of complications. However, current treatment practices often involve using a rigid cast and scheduling multiple follow-up clinic visits, which increases the hospital's financial strain., Materials and Methods: We conducted an initial audit that reviewed the practice in our unit between August and October 2017 at Queen's Hospital, Burton Upon Trent, United Kingdom. It included all children below the age of 16 who had radiograph images confirming distal radius buckle fractures and have been referred to the fracture clinic. Patient demographics, clinic visits, treating doctor grade/specialty, radiographs, initial and final treatment outcomes, and cast application were collected. After the initial audit, compliance with National Institute for Health and Care Excellence (NICE) guidelines was promoted through the education of healthcare providers. A second audit was performed within 12 months to reassess the compliance., Results: This study looked at the management of pediatric distal radius buckle fractures in a cohort of 152 patients, of which 65 and 87 children were included in audit cycles I and II, respectively. In the ED, splint usage increased from 0% in the first cycle (all children initially treated in a back slab) to 20% following new recommendations. In the fracture clinic, there was a notable improvement in the use of splints over full plaster casts between the first and second cycles. Initially, in the first cycle, only 5% of patients were treated in a splint, with 95% receiving full plaster casts. Following recommendations, splint use increased significantly in the second cycle, rising to 53%, while cast use decreased to 47%. In the first audit, only 7.7% (five patients) were discharged at the first visit, compared to 44.8% (39 patients) in the second audit. In the first audit, 86.2% (56 patients) required a second visit, whereas in the second audit, this decreased to 55.2% (48 patients). Four individuals received a cast owing to splint size difficulties or patient preferences., Conclusion: Despite the improvement seen regarding compliance with NICE guidelines, work is still needed to further enhance compliance. Staff education and optimizing splint availability will be a priority to reduce the burden on fracture clinic resources by unnecessary follow-up appointments., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ali et al.)

Abdulkadir Aydın,1 Ramazan Atiç2 1Prosthetics and Orthotics Department, Dicle University Medical School, Diyarbakir, Turkey; 2Orthopedics and Traumatology Department, Dicle University Medical School, Diyarbakır, Turkey Background: Extracorporeal shock-wave therapy (ESWT) and wrist-extensor splints (WESs) are two commonly used methods in the treatment of lateral epicondylitis. In this study, the efficacy of these two methods was compared. Methods: The study was planned as a prospective randomized controlled study. A total of 67 patients were enrolled. The patients were divided into two groups: group 1 received ESWT (32 patients) and group 2 received WES (35 patients). Patients in group 1 underwent four sessions of ESWT once every week. In each session, an ESWT device at 10–12 Hz, 2,000 pulses, and 1.6–1.8 bar pressure was used. Patients in group 2 used a wrist splint, holding the wrist at 30°–45° extension for 4 weeks. Patients were assessed for handgrip strength, pain at rest, pain while working, and quality of life. Data were collected before and after treatment (at weeks 4, 12, and 24). A visual analog scale was used to evaluate pain at rest and while working, a hand dynamometer for handgrip strength, subscales of the SF36 Health Survey to evaluate quality of life, and the Turkish version of the patient-rated tennis-elbow evaluation was used to evaluate functioning of the affected arm during various daily life activities. Results: In both ESWT and WES groups, although there were considerably significant improvements (P0.05). Conclusion: Both ESWT and WES applications were found to yield significantly superior results when compared to pretreatment values. In comparison of the two groups, on the other hand, there was no statistically significant difference. Keywords: Lateral epicondylitis, elbow pain, shockwave therapy, orthosis, quality of life

Abstract Background Carpal tunnel syndrome is the most common peripheral entrapment neuropathy, for which conservative treatments are the first measures taken. However, these measures are not usually sufficient. Recently major attention has been drawn to platelet-rich plasma for its possible effects on axon regeneration and neurological recovery. Although few studies have evaluated the effects of this treatment in carpal tunnel syndrome, further investigation is required to reach concrete conclusion. Methods In this randomized controlled trial, women referring to the physical medicine and rehabilitation clinic at Shahid Modarres Hospital during 2016 with a diagnosis of mild and moderate idiopathic carpal tunnel syndrome were chosen. They were randomly assigned to two groups: (i) a control group using only a wrist splint, and (ii) a platelet-rich plasma group that received wrist splints along with a single local injection of platelet-rich plasma. The outcome measures were assessed via Visual Analogue Scale, the Boston Carpal Tunnel Syndrome Questionnaire and electrophysiological findings including the peak latency of sensory nerve action potential and the onset latency of the compound muscle action potential. Results A total of 41 women were included (20 wrists as control group) and (21 wrists as platelet-rich plasma group). Before treatment there were no significant differences between the two groups except for the median peak latency of sensory nerve action potential which was significantly higher among the patients in the platelet-rich plasma group (p = 0.03). All the measured variables significantly decreased in both groups after 10 weeks of treatment except for the median onset latency of the compound muscle action potential (p = 0.472). Finally, the changes in neither of the evaluated outcome measures were found to significantly differ between the two groups, even when the analyses were adjusted for age of the patients. Conclusion The findings of this study showed that in a relatively short period of time after treatment, a single injection of platelet-rich plasma in the wrist does not significantly add to the effects of conservative treatment with wrist splints, in regards to the women pain and symptom severity, functional status and electrophysiological parameters. Trial registration The trial has been retrospectively registered with an ID: IRCT2017041513442N13 (Date of registration: 2017–06-19).

Background: Splinting of the wrist after carpal tunnel release (CTR) has been practiced by many surgeons especially in North America. The main reason was to prevent possible adverse events of bowstringing of flexor tendons and the median nerve, pillar pain, entrapment of the median nerve in scar tissue and wound dehiscence. Studies on the effect of splinting after standard CTR had dismal results. The duration of splinting in standard CTR has been either too long (for 2-4 weeks) or too short (48 hours only). Objective: The aim of our study was to compare the effects of post-operative splinting for duration of one week with no splinting. Patients and Methods: All 20 of our patients underwent a standardized open CTR. Post operatively, they were randomized into a splinted (n=10) and a non-splinted (n=10) group. The splint was kept for 2 weeks. Patients were reviewed at regular intervals of one week, two weeks and three months. At each follow up, these patients were clinically assessed for outcome of the Boston questionnaire. Results: All patients presented with significant improvement in the post-operative evaluation within each group. However, there was no significant difference between the two groups for any of the outcome measurements at sequential and at final follow-up. Conclusion: We concluded that wrist splinting in the immediate post-operative period has no advantage when compared with the non-splinting wrist after a standard open carpal tunnel release. [ABSTRACT FROM AUTHOR]

Splinting of the wrist after carpal tunnel release (CTR) has been practised by many surgeons especially in North America. The main reason was to prevent possible adverse events of bowstringing of flexor tendons and the median nerve, pillar pain, entrapment of the median nerve in scar tissue and wound dehiscence. Studies on the effect of splinting after standard CTR have had dismal results. The duration of splinting in standard CTR has been either too long (for 2-4 weeks) or too short (48 hours only). The aim of our study was to compare the effects of post-operative splinting for a duration of one week with no splinting. Methods: All 30 of our patients underwent a standardized limited open CTR by a designated surgeon. Post operatively, they were randomized into a splinted (n=16) and a nonsplinted (n=14) group. The splint was kept for a week. Patients were reviewed at regular intervals of one week, two months and six months. At each follow up, these patients were clinically assessed for the following outcome measures: VAS (visual analogue score), 2PD (two-point discrimination), pinch grip, grip, Abductor Pollicis Brevis (APB) power and completion of the Boston questionnaire. Results: All patients presented with significant improvement in the postoperative evaluation in the analyzed parameters within each group. However, there was no significant difference between the two groups for any of the outcome measurements at sequential and at final follow-up. Conclusion: We conclude that wrist splinting in the immediate post-operative period has no advantage when compared with the unsplinted wrist after a limited open carpal tunnel release.

Rheumatoid arthritis is a chronic disease affecting the joints. Treatment can include immobilisation of the affected joint with a custom-fitting splint, which is typically fabricated by hand from low temperature thermoplastic, but the approach poses several limitations. This study focused on the evaluation, by finite element analysis, of additive manufacturing techniques for wrist splints in order to improve upon the typical splinting approach. An additive manufactured/3D printed splint, specifically designed to be built using Objet Connex multi-material technology and a virtual model of a typical splint, digitised from a real patient-specific splint using three-dimensional scanning, were modelled in computer-aided design software. Forty finite element analysis simulations were performed in flexion-extension and radial-ulnar wrist movements to compare the displacements and the stresses. Simulations have shown that for low severity loads, the additive manufacturing splint has 25%, 76% and 27% less displacement in the main loading direction than the typical splint in flexion, extension and radial, respectively, while ulnar values were 75% lower in the traditional splint. For higher severity loads, the flexion and extension movements resulted in deflections that were 24% and 60%, respectively, lower in the additive manufacturing splint. However, for higher severity loading, the radial defection values were very similar in both splints and ulnar movement deflection was higher in the additive manufacturing splint. A physical prototype of the additive manufacturing splint was also manufactured and was tested under normal conditions to validate the finite element analysis data. Results from static tests showed maximum displacements of 3.46, 0.97, 3.53 and 2.51 mm flexion, extension, radial and ulnar directions, respectively. According to these results, the present research argues that from a technical point of view, the additive manufacturing splint design stands at the same or even better level of performance in displacements and stress values in comparison to the typical low temperature thermoplastic approach and is therefore a feasible approach to splint design and manufacture. [ABSTRACT FROM AUTHOR]

Objective: Carpal tunnel symptoms are typical outside nerve involvement and a significant reason of inability. This syndrome often causes weakness and pain in the affected hand. Therefore, the researchers decided to perform a study that aimed to investigate the therapeutic effects of Wrist Splint (short wrist splint) in patients admitted to the neurology clinic of Vali Asr Hospital of Birjand with carpal tunnel syndrome (CTS) under ibuprofen treatment from an EMG-NCV perspective. Methods: This clinical trial was performed on patients admitted to the neurology clinic of Vali Asr Hospital during the spring and summer of 2013. The participants of the study were classified into two teams. The initial team of cases went under medical treatment with ibuprofen (800 mg BID for 4-6 weeks) and the second group of patients went under medical care with ibuprofen (800 mg BID for 4-6 weeks) with a short wrist splint. Results: 40 cases participated in the research. The mean age of participants was 32/ 75 ± 4/ 33 years (range 20 to 48 years), respectively. Most of the participants were females (n = 30, 75% respectively). The mean score, latency and velocity between the two groups were mainly distinct (respectively p = 0.05, 0.001, and 0.003). There were significant differences between amplitude before the start of the study (p = 0.000) among the participants. Discussion: The results showed that patients treated with ibuprofen and wrist splint along the para-clinics presented a better response to treatment. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to compare four different additive manufacturing (AM) processes to assess their suitability in the context of upper extremity splinting. Design/methodology/approach - This paper describes the design characteristics and subsequent fabrication of six different wrist splints using four different AM processes: laser sintering (LS), fused deposition modelling (FDM), stereolithography (SLA) and polyjet material jetting via Objet Connex. The suitability of each process was then compared against competing designs and processes from traditional splinting. The splints were created using a digital design workflow that combined recognised clinical best practice with design for AM principles. Findings - Research concluded that, based on currently available technology, FDM was considered the least suitable AM process for upper extremity splinting. LS, SLA and material jetting show promise for future applications, but further research and development into AM processes, materials and splint design optimisation is required if the full potential is to be realised. Originality/value - Unlike previous work that has applied AM processes to replicate traditional splint designs, the splints described are based on a digital design for AM workflow, incorporating novel features and physical properties not previously possible in clinical splinting. The benefits of AM for customised splint fabrication have been summarised. A range of AM processes have also been evaluated for splinting, exposing the limitations of existing technology, demonstrating novel and advantageous design features and opportunities for future research. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction: This study evaluated the applicability of diffusion tensor imaging (DTI) of therapeutic ultrasound (US) and wrist splints in addition to clinical and electrophysiological assessments of patients with carpal tunnel syndrome (CTS). Methods: This prospective study analyzed 41 patients (30 women, 11 men; 56 wrists) with CTS. Therapeutic US and wrist splints were performed for 3 and 4 weeks, respectively. Fractional anisotropy and the apparent diffusion coefficient (ADC) were evaluated in addition to a visual analog scale (VAS), symptom severity scale (SSS), functional status scale (FSS), and electrodiagnostic studies (EDX) before and after treatment. Results: There were significant decreases in the mean ADC, VAS, SSS, FSS, and EDX after treatment. Conclusions: This study suggests that DTI parameters provide helpful information that complements clinical and electrophysiological assessments for evaluating the efficacy of nonsurgical treatment of patients with CTS. Muscle Nerve 50: 950-955, 2014 [ABSTRACT FROM AUTHOR]

Carpal tunnel syndrome (CTS) is the commonest peripheral neuropathy presenting to specialist hand and wrist clinics. This study investigated the long-term outcome of carpal tunnel syndrome treated with isolated night wrist splint and the factors determining the likelihood of success of this intervention. Seventy-five patients referred to a specialist hand clinic with CTS were given night wrist splint treatment for 3 months as per a previous study protocol. Fifty-two patients from this cohort did not wish to have surgery after wrist splint treatment and were followed for a further 33-month period. Baseline pain and numbness levels were recorded on a Visual Analogue Scale (VAS) using a questionnaire upon first presentation. A further questionnaire at 36 months reassessed pain and numbness levels, patients’ satisfaction with the treatment, and whether they had subsequent surgical decompression. Of the patients who completed the follow-up questionnaire 33 months after their period of conservative management, 43% were successfully treated with splint treatment alone. There was no difference in the VAS for pain or numbness at the baseline and at 36 months between successful and failed treatment groups. Patients successfully treated with wrist splinting alone reported a higher level of satisfaction with their treatment compared to patients who failed wrist splint treatment or had surgical decompression. The results reinforce the previous recommendation on wrist splinting as a first-line treatment in the Primary Care setting. Referral to specialist hand and wrist clinics should be reserved for patients with symptoms refractory to this initial measure. [ABSTRACT FROM AUTHOR]

The efficacy of low-level laser therapy (LLLT) was evaluated in a total of 66 patients with mild to moderate carpal tunnel syndrome (CTS) with a double-blinded randomized controlled study. The patients were randomly assigned into two groups. Group I received 15 sessions of a gallium-aluminum-arsenide laser treatment at a dosage of 18 J per session over the carpal tunnel area with neutral wrist splint. Group II received placebo laser therapy with neutral wrist splint. The patients were evaluated with the following parameters: (1) clinical parameters which consisted of visual analog scale, symptom severity scale, functional status scale, and pinch strength and grip strength before the treatment and at 5- and 12-week follow-ups and (2) electroneurophysiological parameters from nerve conduction study which were evaluated before the treatment and at 12-week follow-up. Fifty nine patients (112 hands: unilateral CTS = 6 hands and bilateral CTS = 106 hands) completed the study. Both groups I and II had n = 56 hands. Improvements were significantly more pronounced in the LLLT-treated group than the placebo group especially for grip strength at 5- and 12-week follow-ups. At 12-week follow-up, distal motor latency of the median nerve was significantly improved in the LLLT group than the placebo group ( p < 0.05). LLLT therapy, as an alternative for a conservative treatment, is effective for treating mild to moderate CTS patients. It can improve hand grip strength and electroneurophysiological parameter with a carry-over effect up to 3 months after treatment for grip strength of the affected hands. [ABSTRACT FROM AUTHOR]

To define the role of phonophoresis and iontophoresis of corticosteroids in conjunction with wrist splint use in the treatment of carpal tunnel syndrome (CTS) compared to wrist splint use alone, 52 CTS subjects were analyzed based on clinical and electrophysiological criteria. A prospective, randomized controlled trial was carried out to assess symptom severity, motor skills, and hand function according to the Boston Symptom Severity Scale (BSSS), grip strength, and nine-hole peg test (NHPT), respectively, on the initial visit and in the 3rd month after treatment. The patients underwent conservative interventions randomly as follows: (1) 3 weeks of phonophoresis with betamethasone in conjunction with wrist splint use (group I, n: 18) or (2) 3 weeks of iontophoresis with betamethasone in conjunction with wrist splint use (group II, n: 16) or (3) wrist splint use alone (control, group III, n: 18). The mean age of the patients was 43.7 ± 8.4 (range 24-57) years. Groups I, II, and III showed a significant and further improvement in BSSS at the 3rd month evaluations compared with baseline ( P < 0.001, P = 0.001, P < 0.001, respectively), but no significant change was observed in grip strength or NHPT ( P > 0.05). There was a statistically significant difference between the phonophoresis and control groups after treatment only regarding BSSS, in favor of phonophoresis ( P = 0.012). We recommend the use of wrist splints especially with phonophoresis for relief of symptoms in patients with CTS. Our results demonstrated no superiority among the treatment groups. Further, transdermal steroid treatments are not key determinants of efficacy with respect to motor skills and hand dexterity. [ABSTRACT FROM AUTHOR]

Buckle fractures of the distal radius are unique to children. Immobilising the limb in a plaster cast is the traditional treatment. An alternative is to use a removable wrist splint and this has been adopted at the author's clinic. In this article, literature on the change of practice is reviewed, the change is described and the outcomes evaluated. It was found that treatment with the wrist splint was cost-effective and was preferred by children, families and carers. [ABSTRACT FROM AUTHOR]

Background: The outcome is unknown for 2 common bracing treatments utilized for patients with lateral epicondylitis. The purpose of this study was to compare the clinical outcomes of a wrist splint with that of a counterforce forearm strap for the management of acute lateral epicondylitis. Materials and methods: Forty-two patients (44 elbows) received either a wrist extension splint (Group I-24 elbows) or a counterforce forearm strap (Group II-20 elbows). Measures on the Mayo Elbow Performance (MEP) and American Shoulder and Elbow Society (ASES) Elbow Assessment Form were collected prior to treatment and at 6 weeks. A total score was derived, utilizing the ASES Elbow Assessment, as was a score utilizing the standard scoring system for the MEP. Results: Group I''s score derived from the ASES form improved 16 points and Group II''s score improved 13 points. Group I''s score on the MEP improved 13 points and Group II''s score improved 12 points. There was no significant difference measured between the Groups with the ASES (P = .60) nor MEP (P = .63) scores. However, within the ASES derived score, pain relief was significantly better with the extension splint group (P = .027). No other variables were statistically significantly different. Discussion: Significant pain relief with the wrist extension splint may be due to improved immobilization of the wrist extensor muscles in a resting position. Conclusion: The wrist extension splint allows a greater degree of pain relief than does the forearm strap brace for patients with lateral epicondylitis. [Copyright &y& Elsevier]

Background: Carpal tunnel syndrome (CTS) is one of the most common disease among the entrapment neuropathies. Wrist splinting has been conventionally used for the CTS treatment. The purposes of this study were to assess the efficacy of wrist splinting for CTS, and to evaluate the value of the motor nerve conduction measurement as a prognostic indicator for CTS. Methods: Two hundred and fourteen hands with CTS were treated by wrist splinting, and reviewed after a mean follow up of seven months. Severity of symptoms were minimal lesions in 177 hands, intermediate lesions in 33 hands, and severe lesions in four hands. Motor nerve conduction measurement was performed in all cases before and after treatment, and distal latency (DL) and amplitude on compound muscle action potential (CMAP) from the abductor pollicis brevis (APB) muscle were analyzed. Results: According to Kelly's grading of outcome, results were excellent in 41 hands, good in 110 hands, fair in 45 hands, and poor in 18 hands. Excellent or good results were obtained in 131 hands (74 percent) with minimal lesions, 20 hands (61 percent) with intermediate lesions, and in no cases with severe lesions. The ratio of excellent or good results was 79 percent in patients in whom DL of pre-treatment APB-CMAP was less than 8 milliseconds (ms), and 62 percent in patients whose DL was 8 ms or more, which showed a significant difference. In nine hands whose pre-treatment APB-CMAP was unrecordable, the results were good in one hand, fair in five, and poor in three. Conclusions: Wrist splinting is most effective in cases of minimal or intermediate lesions with DL of APB-CMAP less than 8 ms. If relief of symptoms is not obtained after five months of treatment by splinting, that would be the limit of splinting. Surgical release is recommended for cases with severe lesions and with unrecordable APB-CMAP. [ABSTRACT FROM AUTHOR]

Objective: Wrist-hand orthoses (WHOs) are prescribed for a range of musculoskeletal/neurological conditions to optimise wrist/hand position at rest and enhance performance by controlling its range of motion (ROM), improving alignment, reducing pain, and optimising grip strength. The objective of this research was to study the efficacy and functionality of ten commercially available WHOs on wrist ROM and grip strength., Design: Randomised comparative functional study of the wrist/hand with and without WHOs., Participants: Ten right-handed female participants presenting with no underlying condition nor pain affecting the wrist/hand which could influence motion or grip strength. Each participant randomly tested ten WHOs; one per week, for 10 weeks., Main Outcome Measures: The primary outcome was to ascertain the impact of WHOs on wrist resting position and flexion, extension, radial, and ulnar deviation. A secondary outcome was the impact of the WHOs on maximum grip strength and associated wrist position when this was attained., Results: From the 2,400 tests performed it was clear that no WHO performed effectively or consistently across participants. The optimally performing WHO for flexion control was #3 restricting 86.7%, #4 restricting 76.7% of extension, #9 restricting 83.5% of radial deviation, and #4 maximally restricting ulnar deviation. A grip strength reduction was observed with all WHOs, and ranged from 1.7% (#6) to 34.2% (#4)., Conclusion: WHOs did not limit movement sufficiently to successfully manage any condition requiring motion restriction associated with pain relief. The array of motion control recorded might be a contributing factor for the current conflicting evidence of efficacy for WHOs. Any detrimental impact on grip strength will influence the types of activities undertaken by the wearer. The design aspects impacting wrist motion and grip strength are multifactorial, including: WHO geometry; the presence of a volar bar; material of construction; strap design; and quality of fit. This study raises questions regarding the efficacy of current designs of prefabricated WHOs which have remained unchanged for several decades but continue to be used globally without a robust evidence-base to inform clinical practise and the prescription of these devices. These findings justify the need to re-design WHOs with the goal of meeting users' needs., Competing Interests: Conflict of Interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.