Wrist Splinting Shows No Significant Benefit in Carpal Tunnel Syndrome: Study

These findings are published in the NEJM Evidence in March 2026.

While wrist splinting is widely utilized as a first-line conservative treatment for CTS, there is currently a lack of high-quality evidence to confirm its clinical benefit, prompting Dr. Isam Atroshi and colleagues to investigate whether rigid splints truly outperform placebo alternatives in alleviating symptoms and preventing the need for operative care.

In the parallel-group clinical trial, 142 patients diagnosed with untreated, primary idiopathic CTS for at least one month were randomly assigned to wear either a rigid wrist splint or a placebo soft bandage that allowed full motion for a duration of six to twelve weeks, with researchers monitoring changes in a six-item symptoms score and assessing the necessity for surgery after one year of follow-up while excluding anyone with prior treatments.

Key Clinical Findings of the Study Include:

• Insignificant 0.08 Symptom Difference: The trial demonstrated that the adjusted mean difference in the 12-week symptom score change between the two groups was statistically negligible (95% confidence interval [CI], -0.15 to 0.31; P=0.478).

• Comparable 51-57% Surgery Rates: Trial observed that at the one-year assessment, 57.1% of patients in the rigid splint group and 51.4% in the placebo group proceeded to surgery, yielding an adjusted relative risk of 1.10 (95% CI, 0.81–1.48).

• Sub-threshold 0.36 Improvement: Investigation found that neither group achieved the predefined minimal clinically important difference of 0.9, with symptoms decreasing by only 0.36 in the splint group and 0.28 in the placebo arm from their respective baselines.

• Uniform Safety with 12 Local Events: Research noted that minor local adverse events were identical across both treatment arms, with 12 patients in each group reporting issues and no serious complications recorded during the investigation.

• Identical ~2.80 Baseline Scores: Analysis revealed that cohorts were well-matched at the start of the trial, with baseline CTS symptom scores of 2.81 for the rigid splint group and 2.80 for the placebo bandage group.

The results suggest that for patients managing CTS, rigid wrist splinting does not provide a significantly better clinical outcome than a placebo bandage, as both interventions failed to meet the threshold for clinically important symptom improvement, and more than half of all patients eventually opted for surgery.

Thus, the trail concludes that healthcare practitioners might consider that traditional rigid splinting may not be more effective than minimal supportive bandaging for long-term symptom control in idiopathic carpal tunnel syndrome cases.

Although the study offers robust data on conservative management, specific limitations and future research needs were not explicitly outlined in the provided text, yet the findings highlight the critical need for continued investigation into effective non-surgical therapies for this common condition.

Reference

Atroshi I, Nordenskjöld J, Möllestam K. Wrist Splinting versus a Placebo Soft Bandage for Carpal Tunnel Syndrome. NEJM Evid 2026;5(4).