The Hand to Shoulder Solution

Ep 25 - Why Your Wrist Brace Might Be Making Things Worse! The hidden danger of OTC splints

• Carl Petitto • Season 1 • Episode 25

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The episode explores the crucial differences between over-the-counter splints and custom orthoses, emphasizing how improperly fitted devices can actually worsen your injuries. You will gain valuable insights into how personalized care plays a pivotal role in effective recovery from a Certified Hand Therapsit with decades of experience!


You will learn:

• Importance of custom orthoses for hand and wrist injuries 
• Dangers of over-the-counter splints in exacerbating conditions 
• Patient experiences underline the need for proper fitting and assessment 

If you're seeking a better understanding of your splinting options drop your questions below! Make sure you subscribe for more free tips for hand, wrist, elbow, and shoulder pain!

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This is a resource to help you mitigate pain at home and become more educated on what to ask your doctors and therapists. No medical advice will be given, and you should always see your medical professional for any questions.

Thank you, and welcome to the show!

Speaker 1:

Welcome back to the Hand-to-Shoulder Solution Giving Pain the Middle Finger. I'm your host, carl Petito. I'm an occupational therapist and a board-certified hand therapist. As a hand therapist, I rehabilitate orthopedic conditions affecting the fingertips through the shoulder. I want to talk today about over-the-counter splints. My experience with patients in the clinic is that more often than not, these do end up doing more harm than good, and I want to explain why. I want to explain the difference between an over-the-counter brace and a custom orthosis that I fabricate from scratch in the office, and why it's beneficial to have something that's molded custom onto your body that will really do what it's designed to do, do the optimal job to get you well in minimal time. Now I want to make a note that this is not treatment or treatment advice. This is information sharing so that way you can make a well-informed, optimal decision regarding your own healthcare. So let's get right to it.

Speaker 1:

There is a lot on the market. Most of them are made out of very flimsy material In order to keep them from bending and flapping around. There's internal stiffener bars, and those stiffener bars often wreak havoc on the skeletal system. So the first example I have here is a wrist brace, and the stiffener bar is right here on the palmar surface of the forearm and wrist and this gets snugged down with straps. The stiffener bar puts pressure directly on the carpal tunnel. If you look at your hand, the heel of your palm is the carpal tunnel and why is that significant? Of your palm is the carpal tunnel and why is that significant? It's significant because the median nerve, which is about as wide as a pencil, thick like a noodle, travels through the tunnel and nerves do not like any pressure on them. When you cross your leg and your foot goes to sleep, that's not circulation, that's because of pressure on a nerve. Now, when you have pressure on your nerve in your carpal tunnel, such as carpal tunnel syndrome, which we talked about in previous episodes, that causes numbness and tingling and aching and even clumsiness and even muscle atrophy. That is why I don't want any stiffener bar over that carpal tunnel.

Speaker 1:

Now, if I bend my wrist a little bit, it removes some pressure from this location of my carpal tunnel, on that stiffener bar. But if I, let's say, I'm wearing this at night or even during the day, if I'm moving the second I bring my hand back, it puts extra pressure on the carpal tunnel on that stiffener bar. Sometimes, if a patient is only dealing with carpal tunnel syndrome and they come in with a big, bulky nylon brace, what I'm able to do is this one is thin, there's not much to it, but some braces are very sturdy and bulky enough so that I can remove this stiffener bar and and now they don't have that pressing on their carpal tunnel and the brace not this one, but others are thick enough to, at night, prevent people from sleeping with their wrists bent, so it's not choking off the carpal tunnel or way back here like this. So it's not choking off the carpal tunnel. If there's a little bit of motion, that's okay, because that wrist brace is out. But in the case of this, without the wrist brace in there, there's just really nothing. There's no substance to this. Now let's look at this stiffener bar and there it is, right there. And patients are usually surprised. You know, I had a patient come in a couple of weeks ago and they were wearing something like this continuously and they say you know what, since I've been wearing the splint, I think my carpal tunnel syndrome symptoms are worse. And I took this out and he was quite surprised that that was. I showed him that's right on your carpal tunnel and I had him only wear the brace at night without this in, and his symptoms, his symptoms reduced very nicely, very quickly. So that's that.

Speaker 1:

Let's look at another one. And you know people will have a sore thumb and go to the store and say, let me buy a thumb splint and I'll show you what's the problem with that. So if you have a thumb splint and this is secured here and that's something like this, and there's a stiffener bar now on the outside part of the thumb, and what do you have right here just below your wrist, now the radial styloid and that bony prominence right there is easily, easily inflamed. Then it leads to a terrible tendonitis disease called decrevain's tenosynovitis and it's just it's a long word that just means it's inflammation of the tendon and the sheath that the tendon travels through. And then this is called radial styloiditis, again that ending in itis. Itis means inflammation. That's the radial styloid, the spawning prominence, and it's a very, very painful condition and I have seen these braces cause that problem.

Speaker 1:

Sometimes I can just remove the stiffener bars, but more often than not this just is best not to even use so in the office. I'll make a template, I'll make a pattern for a custom orthosis. I'll trace it out on a piece of flat stock, heat it up in hot office. I'll make a template. I'll make a pattern for a custom orthosis. I'll trace it out on a piece of flat stock, heat it up in hot water, cut out the design and then heat it up again. Mold it directly onto the patient. I can use a heat gun on specific areas of the splint. Push out that splint, so now there's a bubble over that bony prominence, so the patient doesn't get any of those tendonitis problems or the problem of the radial styloid inflammation.

Speaker 1:

And it's very important to note also that some over-the-counter braces they over-immobilize, they immobilize too many joints. So if you have one specific problem that's causing thumb pain and you only need to immobilize that one joint for a temporary period, now we're immobilizing a lot of different things because again it's a cookie cutter situation where these over-the-counter braces are just being handed out to people or someone is self-treating. They're treating themselves at the store by just looking at all these different packages and saying, well, what should I, what should I get? Hmm, that one looks good, it's. It's not that simple. Of course, most things never are right and we have to really know exactly, firstly, what is going on and you know, get your condition diagnosed and then get it treated properly, because you know it also goes back to the longer something continues on, the worse most things get, and then also it leads to other problems.

Speaker 1:

And speaking of the thumb tendonitis, let's go back to that first brace, when there's usually a seam. Right here there's quite a tight seam. This one isn't as tight as some. I've seen some seams dig into people so hard. When they take this off there is a strong indent and then I'll say pick your thumb up, does it hurt? Oh yeah, a lot of pain in the tendons. And because it's a friction point, those tendons are gliding underneath that sharp edge that's digging in and causing inflammation and really leading to that tendonitis which should never have occurred in the first place.

Speaker 1:

That's why it's really important to get a custom, a custom orthosis fabricated, which in the office it takes me about 20 minutes. So you know, I do the pattern, I cut it out, I mold it on the person. Some nice paddings, some nice soft Velcro straps and I have them. You know I always tell people to just wear it tight enough so it doesn't slide around. It doesn't have to be, you know, cranked down and excessively tight. We want the blood flow, we don't want to choke off any blood flow. We don't want to put pressure on nerves, we don't want to make anything worse. So there's other splints too, some other more basic ones that are designed to. You know, it looks nice and soft and wow, that's going to be comfortable. But there's that stiffener bar right there on the carpal tunnel, and look how tight this one is. This one is really digging into the base of my thumb. If I'm having arthritis at the base of my thumb now, that's going to make that worse. If I have tendonitis there, it's going to get a lot worse. If I don't have tendonitis, I'm probably going to after wearing this for a while. Now I found another interesting one that has a little beanbag pad over the carpal tunnel, designed to be a pad for the carpal tunnel for people who have carpal tunnel syndrome.

Speaker 1:

Let's go back to carpal tunnel syndrome. Real briefly, it's pressure on the nerve which is causing the symptoms downstream of numbness and tingling and aching and clumsiness. Now, because of that, why in the world would I want any extra pressure on my carpal tunnel? This is an extra large. It's supposed to be one size fits all. But my mother used to tell me I have baseball mitts for hands. So here's that beanbag pad. So some people will use this and rest on that while they're typing. Now I have extra pressure on my tendons and on the nerve, and the pressure on the tendons, by the way, aggravates the tendons. So now the tendons are sliding with the pressure, sliding with the pressure and they're going to get inflamed and irritated and occupy more space within the tunnel and choke off the nerve internally. That way, within the carpal tunnel, in my experience I've had people come in with very severe symptoms because they've been using something over-the-counter, that's cookie-cutter, one-size-fits-all, etc.

Speaker 1:

Versus a custom splint. Now you see how tight that is on my thumb. I don't have tendonitis now, but boy, I will after a few weeks of wearing this, all right. So I hope this was helpful. Look what I found. It was leaning right on me.

Speaker 1:

It's a compression glove. So for arthritis sometimes it's nice to have a little bit of compression. And just, I have some specific compression gloves in the office I like to use this. One's okay, it's just a little bit too tight for my hand. But look at this Now, why does this glove need a wrist strap, but there's a wrist strap on it.

Speaker 1:

So now I put that wrist strap on, it's right over the radial styloid. I don't mean to get upset, but it's a little frustrating. There's the radial styloid, so I'm going to end up with radial styloiditis. It's choking off the tendon. The tendons glide on me. Do you see my tendons pop up? All right, there's a strap of ligamentous material under the skin that holds the tendons against the bone so they don't bolstering higher, so they don't pop up more, and that maintains mechanical advantage of the tendons pulling the thumb up. Now lay a strap over there real tight and and try to tell me that that doesn't increase friction. And increased friction causes you've got it increased inflammation, which causes yes, you're right again more pain. It just makes things worse and worse and worse. So thank you for watching. I really appreciate it. If you like the channel and subscribe, that will support us to bring further information to you. Thank you.