As a certified hand therapist, I am often asked if a wrist brace should be used when using a keyboard to control or prevent carpal tunnel syndrome.  The simple answer is - a wrist brace should not be used continuously throughout the day and night.  While helpful for controlling pain from carpal tunnel syndrome or tendinitis, wrist braces worn all the time can cause weakness and will lead to more problems and injury.     Here are some suggestions for the proper fitting and use of a wrist brace.

Purpose of the Brace

• For every 15 degrees that the wrist is bent forward or back, extra pressure is placed on the median nerve as it passes through the carpal tunnel.  The wrist brace is prescribed for carpal tunnel because it holds the wrist in a neutral position (straight, not bent forward or back).  This neutral position is the position in which the nerve has the most room in the tunnel so pressure is eased against the nerve.
  
• Most people tend to sleep with their wrists bent forward.  This is the reason that the numbness and tingling associated with carpal tunnel syndrome can wake us up at night.  Wearing a brace at night helps prevent the symptoms of carpal tunnel syndrome caused by the wrist bent forward position.
  
• During the day, a brace should be worn only when the wrist is painful.  It is better to develop better typing habits than to rely on a brace for positioning.  The brace should fit well so that you are not fighting against it to move.  Using a neoprene or soft brace without the metal support for day use can be helpful but not limit your activity as much. 

Correct Fit of the Brace

• When sizing a brace, the brace should fit comfortably.  It should not be too tight that circulation cut off. 
  
• If too tight, the brace can also place pressure at the base of the thumb and pinch a different nerve, the superficial branch of the radial nerve, causing more pain and problems. 
  
• The brace should not be too large that it prevents you from bending the fingers.  The fingers should be able to bend easily at the palm line that is closest to the fingers.

Comfort Tips

• The thinner the brace, the less that it will get in the way while typing or hit the keys.  Neoprene wrist supports that are thin and allow some movement can be good for typing activity.
  
• The thicker braces with heavier metal stays are going to immobilize the wrist more.  This is good while sleeping or when pain and/or symptoms are more severe.
  
• Purchase a brace that has a cotton sock that you place your hand through when putting the brace on.  This prevents the Velcro from rubbing against your skin.  It also makes it easier to put the brace on.
  
• If using a neoprene support, a thin cotton sock worn underneath it can help prevent heat rash.
  
• Anytime that you feel you are fighting against the brace to move, take the brace off.

Marji Hajic is an Occupational Therapist and a Certified Hand Therapist practicing at the Hand Therapy & Occupational Fitness Center in Santa Barbara, California. For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.