From the Guidelines
A neutral wrist splint is the primary orthotic device used in carpal tunnel syndrome, designed to hold the wrist in a neutral position and prevent excessive wrist flexion, which can exacerbate compression within the carpal tunnel 1.
Key Characteristics of the Splint
- The splint should be worn primarily at night to prevent unconscious wrist flexion during sleep, which can increase pressure in the carpal tunnel.
- For those with severe symptoms, wearing the splint during daytime activities that aggravate symptoms may also be beneficial.
- The splint works by preventing wrist flexion and extension, reducing pressure on the median nerve as it passes through the carpal tunnel, thereby decreasing inflammation, pain, and numbness.
Types of Splints
- Most splints are prefabricated and available over-the-counter at pharmacies or medical supply stores.
- Custom-made splints may be prescribed in certain cases, such as when a patient requires a specific fit or has unique anatomical characteristics.
Important Considerations
- The splint should be comfortable but secure, with the rigid support positioned on the palm side of the wrist.
- The splint should extend from mid-forearm to the palm, leaving fingers free to move.
- While surgical treatment may relieve symptoms significantly better than non-surgical treatment, including splinting, it is associated with more complications 1.
- A custom-made neoprene splint has been shown to be effective in reducing symptoms of carpal tunnel syndrome when worn at night 1.
From the Research
Types of Splints Used in Carpal Tunnel Syndrome
- A neutral wrist splint is commonly used in the treatment of carpal tunnel syndrome 2, 3.
- A wrist splint with a metacarpophalangeal unit has also been shown to be effective in reducing pain and improving function in patients with mild-to-moderate carpal tunnel syndrome 4.
- The use of a thermoplastic, custom-molded, neutral wrist splint has been found to improve symptoms, function, and physiologic impairment in patients with carpal tunnel syndrome 2.
Efficacy of Different Splinting Regimens
- Full-time splint wear instructions have been found to be more effective than night-only wear instructions in improving distal latency in patients with carpal tunnel syndrome 2.
- Night-only splint wear therapy has been shown to provide symptom relief and neurophysiological improvement that lasts up to six months 3.
- The efficacy of different splinting regimens may depend on the severity of the carpal tunnel syndrome, with more severe cases potentially requiring full-time splint wear 2.
Comparison of Splint Types
- A comparison of a classic thermoplastic wrist splint and a wrist splint with a metacarpophalangeal unit found that both types of splints significantly decreased pain and increased function, grip strength, and pinch strength in patients with mild-to-moderate carpal tunnel syndrome 4.
- However, the wrist splint with a metacarpophalangeal unit was found to be more effective than the classic thermoplastic wrist splint in pain reduction and improvement of function 4.