{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T21:54:47Z","timestamp":1778882087027,"version":"3.51.4"},"reference-count":35,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2023,11,28]],"date-time":"2023-11-28T00:00:00Z","timestamp":1701129600000},"content-version":"unspecified","delay-in-days":27,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004482","name":"Kuwait University","doi-asserted-by":"publisher","award":["NO01\/14"],"award-info":[{"award-number":["NO01\/14"]}],"id":[{"id":"10.13039\/501100004482","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To compare the efficacy of a traditional cock-up splint, which supports the wrist only, with a modified splint that supports the wrist and the metacarpophalangeal (MCP) joints of the medial four digits in the treatment of carpal tunnel syndrome (CTS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>An assessor-blind randomised controlled trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Hospital-based hand therapy clinics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Fifty-nine adults with mild-to-moderate CTS were randomly assigned to wear a wrist splint (control group) or an MCP splint (intervention group) for 6 weeks.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcome measures<\/jats:title><jats:p>The standardised outcome measures used included grip and pinch strength, the static two-point discrimination test, Phalen\u2019s manoeuvre test, Tinel\u2019s sign and the Boston CTS Questionnaire.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Both groups improved significantly from splint use in some clinical features. The wrist splint and the MCP splint groups had significant improvements in lateral pinch strength (p=0.032 and p=0.002, respectively), two-point discrimination of the thumb (p=0.003 and p=0.041, respectively), two-point discrimination of the index (p=0.035 and p=0.023, respectively) and the Phalen\u2019s manoeuvre symptoms (p=0.025 and p=0.002, respectively). The MCP splint group had additional improvements over the wrist splint group in tip pinch (p=0.012) and Palmar pinch (p=0.011) strength.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Splinting is a practical and effective intervention option for improving the symptoms of CTS. A wrist splint that incorporates the MCP joints is more effective than the traditional wrist-only splint, with long-lasting improvements that remained consistent after 6\u2009months of the splint intervention. Using the more effective MCP splint may consequently reduce disability, facilitate return to work and lower the associated costs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration number<\/jats:title><jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"isrctn\" specific-use=\"clinicaltrial \" xlink:href=\"ISRCTN13189602\">ISRCTN13189602<\/jats:ext-link>.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2023-076961","type":"journal-article","created":{"date-parts":[[2024,2,15]],"date-time":"2024-02-15T03:38:17Z","timestamp":1707968297000},"page":"e076961","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Efficacy of splinting the wrist and metacarpophalangeal joints for the treatment of Carpal tunnel syndrome: an assessor-blinded randomised controlled trial"],"prefix":"10.1136","volume":"13","clinical-trial-number":[{"clinical-trial-number":"isrctn13189602","registry":"10.18810\/isrctn"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4281-5630","authenticated-orcid":false,"given":"Mohammed Sh","family":"Nadar","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naser","family":"Alotaibi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fahad","family":"Manee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,11,28]]},"reference":[{"key":"2024020708340113000_13.11.e076961.1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/1558944718810855","article-title":"The direct and indirect costs to society of Carpal tunnel release","volume":"15","author":"Gabrielli","year":"2020","journal-title":"Hand"},{"key":"2024020708340113000_13.11.e076961.2","unstructured":"United States Department of Labor BoLS . Nonfatal occupational injuries and illnesses requiring days away from work. 2015. Available: https:\/\/www.bls.gov\/news.release\/osh2.nr0.htm"},{"key":"2024020708340113000_13.11.e076961.3","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1007\/s10926-015-9579-0","article-title":"Confirmatory factor analysis of the Boston Carpal tunnel questionnaire","volume":"25","author":"Lue","year":"2015","journal-title":"J Occup Rehabil"},{"key":"2024020708340113000_13.11.e076961.4","doi-asserted-by":"crossref","first-page":"851","DOI":"10.5603\/FM.a2021.0121","article-title":"Carpal tunnel syndrome: state-of-the-art review","volume":"81","author":"Osiak","year":"2022","journal-title":"Folia Morphol"},{"key":"2024020708340113000_13.11.e076961.5","doi-asserted-by":"publisher","DOI":"10.1177\/0269215507077294"},{"key":"2024020708340113000_13.11.e076961.6","doi-asserted-by":"crossref","first-page":"CPG1","DOI":"10.2519\/jospt.2019.0301","article-title":"Hand pain and sensory deficits: carpal tunnel syndrome","volume":"49","author":"Erickson","year":"2019","journal-title":"J Orthop Sports Phys Ther"},{"key":"2024020708340113000_13.11.e076961.7","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1007\/s12178-020-09616-0","article-title":"Non-operative treatment of Carpal tunnel syndrome","volume":"13","author":"Ostergaard","year":"2020","journal-title":"Curr Rev Musculoskelet Med"},{"key":"2024020708340113000_13.11.e076961.8","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/j.jbspin.2017.11.003","article-title":"Treatment of Carpal tunnel syndrome: from Ultrasonography to ultrasound guided Carpal tunnel release","volume":"85","author":"Petrover","year":"2018","journal-title":"Joint Bone Spine"},{"key":"2024020708340113000_13.11.e076961.9","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.10.1245"},{"key":"2024020708340113000_13.11.e076961.10","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.2106\/00004623-199511000-00008","article-title":"Position of the wrist associated with the lowest carpal-tunnel pressure: implications for splint design","volume":"77","author":"Weiss","year":"1995","journal-title":"J Bone Joint Surg Am"},{"key":"2024020708340113000_13.11.e076961.11","doi-asserted-by":"publisher","DOI":"10.1370\/afm.21"},{"key":"2024020708340113000_13.11.e076961.12","doi-asserted-by":"publisher","DOI":"10.1007\/s10926-007-9116-x"},{"key":"2024020708340113000_13.11.e076961.13","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1007\/s10926-009-9210-3","article-title":"A systematic review of workplace ergonomic interventions with economic analyses","volume":"20","author":"Tompa","year":"2010","journal-title":"J Occup Rehabil"},{"key":"2024020708340113000_13.11.e076961.14","doi-asserted-by":"publisher","DOI":"10.1007\/s10926-005-8038-8"},{"key":"2024020708340113000_13.11.e076961.15","doi-asserted-by":"publisher","DOI":"10.1016\/S0363-5023(05)80444-7"},{"key":"2024020708340113000_13.11.e076961.16","doi-asserted-by":"publisher","DOI":"10.1016\/0266-7681(94)90207-0"},{"key":"2024020708340113000_13.11.e076961.17","doi-asserted-by":"publisher","DOI":"10.1016\/S0363-5023(05)80005-X"},{"key":"2024020708340113000_13.11.e076961.18","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.clinbiomech.2004.08.006","article-title":"Tendon and nerve displacement at the wrist during finger movements","volume":"20","author":"Ugbolue","year":"2005","journal-title":"Clin Biomech"},{"key":"2024020708340113000_13.11.e076961.19","doi-asserted-by":"crossref","unstructured":"Nadar MS , Dashti MH , Cherian J . Finger position alters the median nerve properties within the carpal tunnel: a pre-post MRI comparison study. PLoS One 2013;8:e79273. doi:10.1371\/journal.pone.0079273","DOI":"10.1371\/journal.pone.0079273"},{"key":"2024020708340113000_13.11.e076961.20","doi-asserted-by":"publisher","DOI":"10.1002\/mus.1105"},{"key":"2024020708340113000_13.11.e076961.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2007.07.019"},{"key":"2024020708340113000_13.11.e076961.22","doi-asserted-by":"crossref","first-page":"761","DOI":"10.3233\/BMR-140580","article-title":"Comparison of static wrist splint with static wrist and metacarpophalangeal splint in carpal tunnel syndrome","volume":"28","author":"Bulut","year":"2015","journal-title":"J Back Musculoskelet Rehabil"},{"key":"2024020708340113000_13.11.e076961.23","doi-asserted-by":"publisher","DOI":"10.1177\/0309364615592695"},{"key":"2024020708340113000_13.11.e076961.24","doi-asserted-by":"publisher","DOI":"10.1053\/mr.2000.3856"},{"key":"2024020708340113000_13.11.e076961.25","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199311000-00002"},{"key":"2024020708340113000_13.11.e076961.26","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1186\/s12891-020-3187-7","article-title":"Test-retest reliability of tip, key, and Palmar pinch force sense in healthy adults","volume":"21","author":"Li","year":"2020","journal-title":"BMC Musculoskelet Disord"},{"key":"2024020708340113000_13.11.e076961.27","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/J.JHSB.2004.02.008","article-title":"The two-point discrimination test--time for a re-appraisal","volume":"29","author":"Lundborg","year":"2004","journal-title":"J Hand Surg Br"},{"key":"2024020708340113000_13.11.e076961.28","doi-asserted-by":"crossref","first-page":"579","DOI":"10.3389\/fnhum.2013.00579","article-title":"Two-point orientation discrimination versus the traditional two-point test for tactile spatial acuity assessment","volume":"7","author":"Tong","year":"2013","journal-title":"Front Hum Neurosci"},{"key":"2024020708340113000_13.11.e076961.29","unstructured":"Urbano FL , ed. Tinel\u2019s sign and Phalen\u2019s maneuver: physical signs of Carpal tunnel syndrome. Orthopedics 2000."},{"key":"2024020708340113000_13.11.e076961.30","doi-asserted-by":"crossref","first-page":"51","DOI":"10.3233\/TAD-1999-111-208","article-title":"Effectiveness of Splinting for work-related Carpal tunnel syndrome: a three-month follow-up study","volume":"11","author":"Li","year":"1999","journal-title":"TAD"},{"key":"2024020708340113000_13.11.e076961.31","first-page":"1417","article-title":"Incursion of lumbrical muscles within carpal tunnel: a cadaveric study","volume":"6","author":"Afroze","year":"2015","journal-title":"Res J Pharm Biol Chem Sci"},{"key":"2024020708340113000_13.11.e076961.32","doi-asserted-by":"publisher","DOI":"10.1258\/ht.2010.010006"},{"key":"2024020708340113000_13.11.e076961.33","doi-asserted-by":"publisher","DOI":"10.1111\/j.1552-6569.2008.00256.x"},{"key":"2024020708340113000_13.11.e076961.34","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.jht.2022.03.003","article-title":"In vivo evidence of Lumbricals incursion into the carpal tunnel in healthy hands: an ultrasonographic cross sectional study","volume":"35","author":"Nadar","year":"2022","journal-title":"J Hand Ther"},{"key":"2024020708340113000_13.11.e076961.35","doi-asserted-by":"publisher","DOI":"10.1016\/S0363-5023(89)80091-7"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-076961","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,15]],"date-time":"2024-02-15T03:38:30Z","timestamp":1707968310000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-076961"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11]]},"references-count":35,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11,28]]},"published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1136\/bmjopen-2023-076961"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-076961","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11]]}}}