From the Research
The correct treatment for a patient with carpal tunnel syndrome, characterized by pain along the median nerve distribution and a positive Tinel's sign, includes casting the hand in a neutral position, as a neutral wrist splint may be more effective than an extension splint, according to the most recent evidence 1. When immobilizing the wrist for carpal tunnel syndrome, the neutral position is optimal as it minimizes pressure within the carpal tunnel. This position reduces compression on the median nerve by creating the most space within the tunnel and decreasing intracarpal pressure. Some key points to consider in the treatment of carpal tunnel syndrome include:
- The use of night-only splinting is as effective as continuous wear 1
- Local corticosteroid injection can provide relief for more than one month and delay the need for surgery at one year 2
- Patients with severe carpal tunnel syndrome or whose symptoms have not improved after four to six months of conservative therapy should be offered surgical decompression 2 In contrast, wrist flexion would increase pressure within the carpal tunnel, potentially worsening symptoms. Dorsiflexion is another term for extension, but in this context, wrist extension is not the most recommended position, as the neutral position is preferred 1. Adduction would move the hand toward the midline and would not address the pressure on the median nerve. The splint or cast should be worn primarily at night but can also be used during daytime activities that exacerbate symptoms. It's worth noting that the most recent and highest quality study 1 provides the best evidence for the treatment of carpal tunnel syndrome, and its findings should be prioritized in clinical decision-making.