The Solution: “As a Hand Surgeon, Here’s What I Recommend”

Treatment starts with simple mechanical corrections that restore space for the nerve to glide. The

most effective first-line step, endorsed by the American Academy of Orthopaedic Surgeons (AAOS,

2024), is nighttime wrist splinting in neutral.

Why it works: Holding the wrist straight keeps tunnel pressure near its physiologic baseline (»8 mm

Hg). In randomized trials (Werner et al., Chesterton et al.), night-splinting produced symptom relief

comparable to steroid injection at 12 weeks, though injections may act faster. Bracing also helps

identify patients who respond to decompression—those who improve with neutral positioning often do

well surgically if needed later.

What to look for in a brace:

• Rigid or semi-rigid palmar stay maintaining 0° flexion/extension

• Breathable fabric for sleep comfort

• Adjustable tension that prevents curling the wrist under the pillow

Sleep hygiene for wrists: Keep hands out from under pillows, avoid side-sleeping with bent wrists,

and gently shake or stretch if tingling wakes you.

Daytime adjustments: Maintain wrists aligned with forearms, rest forearms on the desk rather than

the keyboard edge, and limit extreme angles when texting or gripping tools.

When to escalate: Persistent numbness or weakness warrants nerve testing and discussion of

corticosteroid injection or surgical release. Modern techniques offer high success rates with quick

recovery.

The bottom line: Typing isn’t the problem—pressure is. Protect your wrists by keeping them neutral

when you sleep, brace when needed, and seek help early before numbness becomes permanent.

References

1. Atroshi I, et al. Arthritis Rheum. 2007;56(5):1679–1685.

2. Andersen JH, et al. JAMA. 2003;289(22):2963–2969.

3. Thomsen JF, Gerr F, Atroshi I. BMC Musculoskelet Disord. 2008;9:134.

4. Shiri R, et al. J Neurol Sci. 2015;349(1–2):15–19.

5. Rempel DM, Keir PJ, Bach JM. J Orthop Res. 2008;26(5):623–628.

6. Werner RA, et al. Arch Phys Med Rehabil. 2005;86:7–11.

7. Chesterton LS, et al. Lancet. 2009;374(9695):733–740.

8. AAOS Clinical Practice Guideline: Management of Carpal Tunnel Syndrome. 2024.