The Comparative Effectiveness of Combined Lumbrical Muscle Splints and Stretches on Symptoms and Function in Carpal Tunnel Syndrome Nancy A. Baker, ScD,

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The Comparative Effectiveness of Combined Lumbrical Muscle Splints and Stretches on Symptoms and Function in Carpal Tunnel Syndrome Nancy A. Baker, ScD, MPH, Krissy K. Moehling, MPH, Elaine N. Rubinstein, PhD, Ronit Wollstein, MD, Norman P. Gustafson, MS, CHT, Mark Baratz, MD Archives of Physical Medicine and Rehabilitation Volume 93, Issue 1, Pages 1-10 (January 2012) DOI: 10.1016/j.apmr.2011.08.013 Copyright © 2012 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 1 The cock-up splints and lumbrical splint used in the study. (A) AliMed Freedom Long Cock-up Splint (GspGst group, GspLst group), (B) AliMed QualCraft Cock-up Splint (GspGst group, GspLst group), (C) Lumbrical Positioning Splint (LspGst group, LspLst group). Abbreviations: LspLst, lumbrical splint/lumbrical stretch group; LspGst, lumbrical splint/general stretch group; GspLst, general splint/lumbrical stretch group; GspGst, general splint/general stretch group. Archives of Physical Medicine and Rehabilitation 2012 93, 1-10DOI: (10.1016/j.apmr.2011.08.013) Copyright © 2012 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 2 (A) Lumbrical stretches. Subjects rested their hand, palm down, on their thigh with the PIP and DIP joints fully flexed (A-1), and then pressed downward over the MCP joints with the opposite hand (A-2). Subjects pulled the wrist, MCP, PIP, and DIP joints into maximal extension with the opposite hand (A-3). (B) General stretches. Subjects held a position of composite wrist, MCP, PIP, and DIP extension (B-1), followed by a 5-second rest period (B-2), then a composite wrist, MCP, PIP, and DIP flexion (B-3), followed by another 5-second rest period (B-2). Archives of Physical Medicine and Rehabilitation 2012 93, 1-10DOI: (10.1016/j.apmr.2011.08.013) Copyright © 2012 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 3 The flow of subjects in the study. *Two subjects did not return for their 1-month follow-up visit but did mail back 12-week forms and thus were included in the 12-week analysis. Four subjects total (1 Group LspLst; 1 Group GspLst; 2 Group LspGst) did not return their 12-week follow-up survey forms but did mail back 24-week forms and thus were included in the 24-week analysis. Archives of Physical Medicine and Rehabilitation 2012 93, 1-10DOI: (10.1016/j.apmr.2011.08.013) Copyright © 2012 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 4 The score on the (A) CTQ-Symptom, (B) CTQ-Function, and (C) DASH at baseline, 4 weeks, 12 weeks, and 24 weeks for each treatment group. These graphs suggest that the general splint/lumbrical stretch combination had the greatest long-term positive effect on the scores of the CTQ-Function and DASH. Archives of Physical Medicine and Rehabilitation 2012 93, 1-10DOI: (10.1016/j.apmr.2011.08.013) Copyright © 2012 American Congress of Rehabilitation Medicine Terms and Conditions