Are wrist braces effective for mild-to-moderate carpal tunnel syndrome with nocturnal symptoms?

Wrist Braces for Carpal Tunnel Syndrome

Yes, wrist braces are effective for mild-to-moderate carpal tunnel syndrome with nocturnal symptoms and should be offered as first-line conservative treatment, worn at night in a neutral position for 6 weeks. 1, 2

Evidence for Efficacy

Night-time splinting in a neutral wrist position more than triples the likelihood of overall symptom improvement compared to no treatment (RR 3.86,95% CI 2.29 to 6.51) after 4 weeks. 2 This represents the strongest evidence for conservative management of mild-to-moderate CTS with nocturnal symptoms.

Optimal Splinting Protocol

Duration and Timing

• Wear splints at night only for 6 weeks - this duration provides optimal clinical improvement without additional benefit from extending to 12 weeks. 3
• Night-only splinting is as effective as continuous 24-hour wear, making it more practical and improving patient compliance. 1

Splint Design

• Use a neutral wrist splint rather than an extension splint - neutral positioning more than doubles the likelihood of symptom relief (RR 2.43,95% CI 1.12 to 5.28) compared to extension splints. 2
• A wrist splint incorporating a metacarpophalangeal (lumbrical) unit provides superior pain reduction and functional improvement compared to classic thermoplastic wrist splints alone. 4

When to Recommend Splinting

Splinting should be offered to patients with:

• Mild-to-moderate CTS confirmed clinically (with or without electrodiagnostic confirmation). 1
• Recent symptom onset - shorter duration of symptoms (<1 year) predicts better outcomes with conservative treatment. 5
• No objective weakness or severe sensory deficits - these findings indicate severe CTS requiring surgical referral. 1

Important Clinical Considerations

Avoid Common Pitfalls

• Do not rely on NSAIDs or acetaminophen as adequate conservative treatment - these medications have not shown benefit for CTS and do not address median nerve compression. 5, 1
• Do not proceed directly to surgery in patients with very mild electrodiagnostic findings without attempting conservative treatment, as 48-63% will respond to splinting. 5
• Ensure proper splint fitting - poorly fitted splints reduce compliance and effectiveness. 6

Expected Outcomes and Follow-up

• Assess response at 6 weeks - if symptoms persist or worsen, consider corticosteroid injection or surgical referral. 5, 1
• Benefits may diminish over time - some patients experience symptom recurrence during follow-up periods up to 12 months, which may require additional intervention. 7
• Adverse effects from splinting are minimal, with only occasional reports of discomfort or swelling. 2

Adjunctive Conservative Treatments

While splinting forms the cornerstone of conservative management, consider combining with:

• Therapeutic exercises including stretching of wrist flexors/extensors and manual lymph drainage techniques, which improve functionality and reduce pain. 7
• Corticosteroid injection if splinting fails after 6 weeks - injections provide slightly greater symptom improvement than splinting alone at 6 weeks, with similar outcomes at 6 months. 1

When to Refer for Surgery

Proceed to surgical decompression if:

• Conservative treatment fails after 4-6 months of appropriate splinting and other non-surgical interventions. 5
• Severe CTS is present with objective weakness, thenar atrophy, or significant sensory deficits at initial presentation. 1
• Moderate-to-severe disease confirmed by electrodiagnostic studies - surgery provides superior symptom relief compared to all non-surgical options in these cases. 5