Orthoses and Carpal Tunnel Syndrome

Nov 30, 2019

Carpal Tunnel Syndrome (CTS) is a common form of median nerve compression that typically results in tingling, numbness and pain in the hand and fingers. Multiple treatments ranging from conservative interventions of orthotic fabrication and exercises to surgery can be tried to alleviate these symptoms.

The Journal of Hand Therapy recently featured a randomized clinical trial that tested the effectiveness of several conservative treatments for CTS. The Turkish researchers evaluated the following treatments for patients diagnosed with mild to moderate carpal tunnel syndrome:

Kinesiotaping
Wrist orthoses
Paraffin

Conservative treatments put to the test

The study was conducted on a group of 110 female patients. These patients were evaluated using nerve conduction studies and ultrasonography. Clinical testing also included:

Hand grip and finger pinch measures
The Visual Analogue Scale (VAS) for pain
The Boston Carpal Tunnel Syndrome Questionnaire for symptoms and function.

The patients were randomly assigned to either treatment with:

A volar based wrist orthosis
Kinesiotaping and a wrist orthosis
Paraffin treatments and a wrist orthosis

See full article for details of these techniques and how they were applied.

Evaluations were performed at 3 weeks, 3 months and (for some patients) at a 6-month follow-up.

Notable improvements

Results of the study showed improvements in clinical, ultrasonographical and electrophysiological areas in all three treatment groups. The improvements were seen at the 3 week and 3 month evaluations and even lasted through to 6 months.

The group that was treated with orthotic wear and kinesiotaping appears to have statistically better results in terms of pain reduction and grip strength, especially for those patients with mild carpal tunnel syndrome.

All treatment groups showed evidence of clinical improvements as well as improved motor and sensory latency scores on electrodiagnostic testing. The researchers also noted improved results in ultrasonographic data, i.e. a decrease in the median nerve cross-sectional area.

The role of orthotic fabrication

The use of an orthosis continues to be an effective conservative treatment for patients with mild CTS and can also be helpful at reducing symptoms for those with moderate CTS. It may be useful to look into combining the orthosis with additional treatment techniques such as kinesiotaping (once the techniques of application have been mastered).

Orthotic fabrication ideas for carpal tunnel syndrome

Volar based orthosis

Learn how to fabricate a comfortable and effective volar wrist orthosis for the treatment of carpal tunnel syndrome. Watch our instructional video for a visual guide of the Volar Wrist Cock-Up Orthosis:

Materials

A volar wrist orthosis can be fabricated from many different materials, depending on the therapist’s and the patient’s preferences.

For most adults, 3 mm (1/8″) is the appropriate thickness for this design. However, for some individuals, 2 mm (1/12″) might offer enough support. If that’s the case, you can choose Orfit Colors NS.

Try Orfilight for a lightweight orthosis that will not add extra weight to the patient’s extremity.

Elastic materials are also excellent for this type of orthosis and will conform best when stretched. Try Orfit Classic, Orfit NS and Aquafit NS (Orfit Natural NS) for this application.

Lightweight materials, such as Orfilight NS, are perfect for a comfortable Carpal Tunnel Syndrome orthosis.

Dorsal based orthosis

A dorsal based design can also be a suitable option for carpal tunnel syndrome and is ideal for patients who want to leave their palms free.

Read about the Dorsal Cock-Up Orthosis in our Blog Post or follow the Splinting Guide for detailed instructions.

Materials

Try one of our dorsal wrist precuts in Orfit Classic and Orfit Eco for this very purpose.

Dorsal based wrist cock-up orthosis in Orfit Eco Black NS.

Reference

Kaplan, B. M., Akyuz, G., Kokar, S., & Yagci, I. (2019). Comparison of the effectiveness of orthotic intervention, kinesiotaping, and paraffin treatments in patients with carpal tunnel syndrome: A single-blind and randomized controlled study. Journal of Hand Therapy, 32(3), 297-304.

Written by Debby Schwartz, OTD, OTR/L, CHT

Physical Rehabilitation Product and Educational Specialist at Orfit Industries America.

Debby is a hand therapist with over 34 years of clinical experience. She completed her Doctorate of Occupational Therapy at Rocky Mountain University of Health Professions in 2010.

She is also an adjunct professor at the Occupational Therapy Department of Touro College in NYC and has written many articles for hand therapy journals, including the ASHT Times and the Journal of Hand Therapy.