Why Over-The-Counter Wrist Braces Can Worsen Carpal Tunnel Syndrome

Transcript

Welcome And Why Braces Backfire

SPEAKER_00 0:00

Welcome back to the Hand to Shoulder Solution where pain meets its match. I'm your host, Carl Petito. I'm an occupational therapist and a board certified hand therapist. I specialize in the rehabilitation of orthopaedic conditions that affect the fingertips through the shoulder. Today I want to again talk about carpal tunnel syndrome. A lot of patients come in who have purchased over-the-counter braces, and in a lot of ways, over-the-counter braces cause more harm than good. And I want to show you a couple of details. I also want to show you something that you can do at home to modify your over-the-counter brace so that it is not making your carpal tunnel syndrome worse.

Carpal Tunnel Anatomy And Pressure

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The carpal tunnel is located in the heel of the palm. So if you rest on the bottom of your palm on the heel of your palm, that's right on the carpal tunnel. And the nerve that goes through that tunnel is about as wide as a pencil and thick like a noodle, and it's just underneath the skin, it's pretty shallow. It's called the carpal tunnel because it's made up of the carpal bones. There's eight of them, and when you look down from the palmer surface, it's a concave shape, and then over the top is a thick, heavy ligament, and that's a tunnel that these tendons travel through. Watch some of my other episodes when I talk about the anatomy and I talk about carpal tunnel syndrome in more detail. But the point is we don't want any pressure on there. And when people have a carpal tunnel release surgery, it's called a carpal tunnel release surgery because it's releasing pressure off the nerve. So we don't want any pressure on the nerve because when there's pressure on the nerve, that causes numbness and tingling and aching and a lot of pain. When you cross your leg and your foot goes to sleep after a short period of time, or if you sit on your foot and your foot goes to sleep, that's because of pressure on the nerve. That's not a circulatory issue, that's pressure on a nerve. So nerves do not like any pressure or any stress.

How Brace Bars Irritate Nerves

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So here I have an over-the-counter brace, and inside is a stiffener bar, and that stiffener bar puts pressure right on the carpal tunnel. I can feel it on my carpal tunnel right now, especially watch this. So, and I'm in a moment, I'm gonna take that stiffener bar out and I'm gonna show it to you. So if I'm sleeping at night and my head is resting on it, it's jamming it into my wrist. Also, if I extend my wrist, now the heel of the pond, the carpal tunnel, is moving forward right into that stiffener bar. And guess what? If I have any arthritis on the base of my thumb, the edge of that stiffener bar is grinding on the base of my thumb, making my arthritis worse. And this hole where my thumb goes through, a lot of times there's yeah, there we go, there's a stitched edge, and that edge rubs on those tendons, and that starts to cause uh very severe tendonitis called decrevanes tenosinovitis, which I also have another episode on describing that.

Remove The Stiffener Bar At Home

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Here's the thing to do at home is take your splint off, and these are yeah, they're just hard to deal with. And normally I was having a hard time just sliding the doctor through the through the loop here, so I'm just gonna slide it off. And by the way, most patients are coming in, sliding in and out of these things, and it's aggravating the arthritis and aggravating aggravating any underlying condition that they have. So you take your splendor at home and go in here, there's a little um loop, and you could fold back some material, or sometimes maybe in your brace, you have to you might have to cut a little slit, and then you can reach in there with some pliers or something, but this one slides out pretty easy, and then that there's that bar, so that metal bar is actually hitting the carpal tunnel right there. We don't want that there at all, and this get rid of that, and then the brace is usually thick enough so that it blocks extremes of flexion, which pinches off the carpal tunnel, and extremes of extension, which causes extra pressure in the carpal tunnel. And usually, if a patient has one that's pretty bulky and just the material itself is is pretty stiff, then I would remove the bar for the patients and say, you know what, let's just try it like that at night before we make a custom orthosis for you. And more often than not, that does the trick.

Custom Splints And Optimal Wrist Position

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The ideal thing, the best thing, is to make a custom orthosis, which I do demonstrate on another video about how we make those splints, that does not dig into the base of the thumb. It is it's made optimally to really hold the wrist in slight slight flexion toward the palm and slight only deviation toward the small finger, and studies have shown that that maintains the widest diameter of the carpal tunnel, therefore relieving pressure on the nerve.

Evaluation Ergonomics And Next Steps

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So, you know, it's a there's a lot of details, it's very important to get into your healthcare professional to get properly thoroughly evaluated and have the best treatment plan for you. There's a lot of really easy techniques to reduce the symptoms of carpal tunnel syndrome. Also, it's really crucial to discuss ergonomic considerations for work and home and other things and just get this to go away. So, a big part of what I do is help people avoid the need for surgery, and then people who do need surgery really optimize them after surgery if they need it. So, thank you very much for watching. Thank you for liking and subscribing to the channel, and thank you for checking out my website, CarlPetito.com. This is the hand-to-shoulder solution where we are the solution to your pain. Thank you.