Session Information
Session Type: Abstract Submissions (ARHP)
Background/Purpose:
Carpal tunnel syndrome (CTS) is a prevalent peripheral upper extremity neuropathy. Splinting and exercise is often recommended for those with mild to moderate symptoms. Lumbrical muscles of the hand appear to affect carpal tunnel canal pressure and CTS symptoms. We hypothesized that a lumbrical intensive treatment of nocturnal splinting and stretching exercises would provide greater improvements in impairments than less lumbrical intensive treatments.
Methods:
A randomized controlled 2×2 factorial design study was conducted with four groups: Lumbrical splint/Lumbrical stretch (Lsp/Lst); General splint/Lumbrical stretch (Gsp/Lst); Lumbrical splint/General stretch (Lsp/Gst); General splint/General stretch (Gsp/Gst). Appropriate patients with mild/moderate CTS were recruited by 2 hand surgeons.
Assessments were obtained at baseline and 4 weeks after completion of an at-home regimen of splinting and exercise. Grip strength and lateral and palmar pinch were measured using standardized assessment tools. Fine motor dexterity was evaluated using the Purdue Pegboard.
Results:
The average age of this cohort (N=103) was 53.3±11.8 years. The majority were female (71.8%), with chronic carpal tunnel symptoms ≥ 3 months (85.7%). As CTS was most prevalent for the right (43.7%) or bilateral hand (38.8%) and the majority were right handed (91.3%), only right-sided results are provided for strength measurements (Table 1). There were no significant differences in demographics between groups.
2-way ANOVAs were performed using SPSS 18 with group as the between-subjects factor and time as the within-subjects factor. Post hoc analyses used pairwise comparisons on difference scores for significant between-group outcomes with alpha set at .05. We calculated a Cohen’s D to identify the clinical effect of the intervention.
The main effect of time was significant for all but Purdue – both hands. When analyzing group by time interactions the only outcomes with significant changes were right lateral pinch (p=.03) with greatest improvement in the Gsp/Gst group, and Purdue – left hand only (p=.03) with greatest improvement in the Lsp/Lst group. Overall the group using the GSP/GST demonstrated the greatest clinical improvements (small to moderate D).
Conclusion:
All groups showed significant improvements over time regardless of treatment. Intensive lumbrical treatment was significantly better only for Purdue left hand, however, dexterity tasks such as Purdue both hands and Purdue assembly also showed greater improvement for this group (D scores were small to moderate). It appears that a more intensive lumbrical treatment may affect dexterity more than strength at 4 weeks follow-up. Future CTS research should examine the effects of more intensive lumbrical treatments on impairments over a longer follow-up period.
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Table 1 – Results of 2-way ANOVA between Baseline and 4 week follow-up |
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Group |
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LspLsta N=26 |
GspLstb N=30 |
LspGstc N=24 |
GspGstd N=23 |
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Variable |
Time |
M±SD (d score) |
M±SD (d score) |
M±SD (d score) |
M±SD (d score) |
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*Right Grasp (kg) |
Base |
22.8 ±12.5 |
25.2 ±11.1 |
24.0 ±11.3 |
24.9 ±12.7 |
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4 wk |
25.8 ±13.2 (0.24) |
27.6 ±10.6 (0.22) |
27.6 ±12.5 (0.32) |
28.2 ±12.9 (0.26) |
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*Right Palmar Pinch (kg) |
Base |
6.0 ±2.4 |
7.3 ±1.4 |
6.5 ±2.5 |
6.8 ±2.5 |
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4 wk |
6.5 ±2.4 (0.21) |
7.4 ±1.7 (0.07) |
6.7±2.5 (0.08) |
7.5 ±2.3 (0.28) |
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*Right Lateral Pinch (kg) |
Base |
7.3 ±2.3 |
8.4 ±2.0 |
7.0 ±2.2 |
7.8 ±2.5 |
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4 wk |
7.5 ±2.5 (0.09) |
8.5 ±2.1 (0.05) |
7.3 ±2.2 (0.14) |
8.6 ±2.1† (0.32) |
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*Purdue Right (n) |
Base |
11.6 ±3.1 |
12.3 ±2.1 |
11.6 ±2.5 |
12.5 ±2.1 |
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4 wk |
12.6 ±3.2 (0.32) |
13.5 ±2.9 (0.57) |
12.3 ±2.8 (0.28) |
13.2 ±1.9 (0.33) |
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*Purdue Left (n) |
Base |
11.3 ±2.5 |
12.2 ±2.6 |
12.0 ±2.9 |
12.3 ±1.8 |
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4 wk |
12.5 ±2.5† (0.48) |
12.6 ±2.5 (0.15) |
12.0 ±3.3 (0) |
13.3 ±2.0 (0.56) |
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Purdue Both (n) |
Base |
18.5 ±5.4 |
19.5 ±4.4 |
18.2 ±5.2 |
20.3 ±3.4 |
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4 wk |
19.5 ±5.4 (0.19) |
19.9 ±4.6 (0.09) |
19.0 ±5.1 (0.15) |
19.7 ±2.8 (-0.18) |
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*Purdue Assembly (n) |
Base |
25.6 ±8.3 |
28.3 ±8.5 |
25.2 ±9.2 |
29.8 ±7.3 |
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4 wk |
29.9 ±8.9 (0.52) |
28.8 ±7.2 (0.06) |
26.8 ±9.7 (0.17) |
31.5 ±8.7 (0.23) |
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a(lumbrical splint, lumbrical stretch); b(general splint, lumbrical stretch; c(lumbrical splint, general stretch); d(General splint, general stretch) |
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Disclosure:
N. A. Baker,
None;
K. Moehling,
None;
E. Rubinstein,
None;
N. Gustafson,
None;
M. Baratz,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/lumbrical-splinting-and-stretching-versus-standard-treatment-on-grip-pinch-and-dexterity-in-people-with-carpal-tunnel-syndrome/