Carpal tunnel syndrome (CTS) is the most common nerve entrapment condition, affecting the hand and wrist. It occurs when the median nerve becomes compressed within the narrow carpal tunnel in the wrist. This pressure causes symptoms like tingling, numbness, and pain in the thumb, index, middle, and half of the ring finger. Since symptoms often worsen at night due to unconscious wrist positions, wrist splints and braces are a frequently recommended initial course of action for people with mild to moderate symptoms.
How Wrist Splints Relieve Carpal Tunnel Pressure
The primary function of a wrist splint is to mechanically maintain the wrist in a neutral position (a straight or slightly extended angle). This positioning minimizes the pressure exerted on the median nerve inside the carpal tunnel. When the wrist is bent too far forward (flexed) or backward (extended), the space within the tunnel decreases, physically squeezing the nerve.
Keeping the wrist straight maximizes the cross-sectional area of the carpal tunnel, providing relief. The rigid or semi-rigid stay, often made of metal or plastic, prevents the wrist from inadvertently moving into positions that increase nerve compression, especially during sleep. These devices, often mistakenly called “gloves,” differ from simple compression sleeves because they actively immobilize the joint to reduce pressure.
Clinical Evidence on Effectiveness
Wrist splinting is an effective, low-risk conservative treatment for mild to moderate carpal tunnel syndrome. The highest efficacy is seen when the splint is used consistently at night, as this is when symptoms typically flare up. Consistent nocturnal use significantly reduces nighttime pain and paresthesia, often leading to better sleep quality.
Clinical data suggests that nighttime splinting improves symptoms and function. One study indicated that it more than tripled the likelihood of reporting overall improvement compared to no treatment over a short period. Improvement can take time, with recommendations suggesting consistent use for at least eight weeks before evaluating the full benefit. Long-term use, such as six months, may provide better results than shorter periods.
Splinting is a first-line treatment because it is an inexpensive and safe intervention with few side effects. Full-time use may not offer additional benefits over night-time use and can potentially lead to muscle weakness and stiffness if worn constantly.
Guidelines for Proper Use
A splint must be comfortable and properly fitted to be effective. It should be snug enough to hold the wrist straight but not so tight as to restrict circulation or cause swelling. If the splint is too loose, it will fail to maintain the necessary neutral position.
Users should be able to move their fingers freely without increased tingling or numbness, which indicates the brace is too tight. While nighttime wear is the most important guideline, a splint may also be beneficial during the day for tasks involving repetitive wrist movements or sustained awkward postures. Wearing the splint around the clock is discouraged because it can weaken the hand and wrist muscles.
Alternative and Advanced Treatments
If conservative approaches like consistent splinting fail to provide adequate symptom relief after several weeks, a physician will explore other non-surgical or advanced treatments. Local corticosteroid injections are a common next step, delivering anti-inflammatory medication into the carpal tunnel to reduce swelling around the tendons and nerve. These injections can provide relief for several months and may help delay the need for surgery.
Other non-surgical options include targeted physical or occupational therapy, often involving specialized exercises like nerve gliding. Ergonomic adjustments to the workspace and the use of non-steroidal anti-inflammatory drugs (NSAIDs) may also be recommended to manage pain and inflammation. For individuals with severe CTS, or those whose symptoms have not improved after four to six months of conservative management, surgical decompression may be necessary. This procedure involves cutting the ligament that forms the roof of the carpal tunnel to permanently relieve pressure on the median nerve.