Journal of the Peripheral Nervous System Volume 4 n 1 1999 (Fourth Meeting of the Italian Peripheral Nerve Study Group -  Chieti, Italy March 26-27 1999

Manente G.1, Pineto F. 2, Torrieri F.3, Marini L. 4, Uncini A. 3

1 - Neurology Service "S. Stefano" Institute of Rehabilitation Porto Potenza Picena,
2 - Division of Neurosurgery Hospital of Teramo,
3 - Center for Neuromuscular Diseases University "G. d'Annunzio" Chieti,
4 - Marini's Orthopedic Laboratory, Ascoli Piceno, Italy.

Manente G.1, Pineto F.2, Torrieri F.3, Uncini A.3

1 - Neurology Service "S. Stefano" Institute of Rehabilitation Porto Potenza Picena
2 - Division of Neurosurgery, Hospital of Teramo
3 - Center for Neuromuscular Diseases University "G. d'Annunzio", Chieti, Italy

We describe a maneuvre capable to ease or abolish, in a few seconds, paresthesias and pain in patients with Carpal Tunnel Syndrome (CTS). We called it carpal tunnel syndrome relief maneuvre (CTS-RM). In the basic maneuvre the affected hand is maintained with palm up and the distal beads of metacarpal bones (excluding the first) are gently squeezed. When this is not sufficient a stretch of the III and IV finger is associated. We examined 200 hands of 120 consecutive patients referred for CTS. 112 hands of 71 patients presented positive symptoms (paresthesias and pain) at the moment of examination. In all 112 hands the CTS-RM was successful. In 23% there was the complete abolition and in 77% an improvement of paresthesias. CTS-RM, as a diagnostic test, is not only highly sensitive but also specific being negative in patients with symptoms and proven C6 or C7 radicolopathies. This maneuvre is helpful in clinical diagnosis of CTS, can be taught to the patient to relieve symptoms, and is the rationale to design an innovative splint for conservative treatment of CTS.

The rationale to design this innovative hand splint results from a recently developed maneuvre capable to ease or abolish paresthesias and pain in patients with CTS (Manente et al., in press 1999). This maneuvre suggests that the maintaining of a posture that squeezes the distal heads of metacarpal bones (excluding the first) and stretches the III and IV finger could be useful in conservative treatment of CTS. For this purpose we developed a splint (patent pending) made of the following  components: 1) an inelastic belt with a velcro-adjustable closure positioned at the level of distal heads of metacarpal bones, 2) a triangular shaped pad, made of soft material, positioned dorsally to the II and V finger producing a mild stretching of III and IV finger, 3) an elastic wrist band with a velcro adjustable closure, 4) a dorsal hand stand stabilizing the components 1 and 2 connected by an adjustable string, to the component 3. Although this splint does not impede 1) the movement of thumb, 2) the opposition between thumb and other fingers, 3) the wrist flexion and extention, we suggest it only for nocturnal use. A study is in progress to assess the efficacy and tolerability of this innovative splint.