Has anyone seen any evidence to support or refute the use of wrist braces for the prevention of wrist MSDs? Tons on backs but that is a different beast entirely. I have heard an people argue against their use on the basis of ‘deconditioning’ but the biological plausibility of this theory is thin, at least to me.
I am unfamiliar, and unable at the moment to look up, specific research on this. However, if you take motion away from the wrist and they still have to perform a task then likely another joint will have to increase range or compensatory motions are likely to be employed. For example, if I have to place an object in a box in front of me and I am unable to bend my wrist I am likely to elevate (hike) and abduct my shoulder to perform the task. This would be my biggest concern.
The specific job (are we talking computing, assembly, lab, material handling, etc) is always important as well. Can you share where you are looking at applying this so the group can give a more focused answer?
Anecdotally I have used wrist braces and/or taping (I come from the therapy world so this is a common modality to OTs/PTs but I know not to everyone in the ergo world) as a short term tactile cue or training device. Unfortunately I don’t have any data to back up efficacy, but personally I would never use it as a long term solution (Unless I discover convincing data from this thread!) Other questions this brings up are: could a flexible brace serve as a tactile cue and through increased awareness increase compliance to better postures or could it lead the worker to think their risk is reduced and possibly use riskier postures?
Great question. I look forward to others input with more specific data.
I recall NIOSH taking a fairly strong position on this question at one time, so you might want to look to them for some background and research. Here’re my thoughts on the question:
I’m unaware of scientific evidence that a wrist brace prevents wrist MSDs. I recognize that, under the right conditions, a brace may have treatment benefits, but I’m unaware of any prevention benefits.
As ErgonomicsSimplified pointed out, immobilizing a wrist joint in tasks that exhibit wrist bending will only cause the person to bend at a different joint (often creating new and potentially worse elbow and shoulder postures). But worse yet, the person is likely to exert force against the brace as he/she tries to access their work. When it comes to hand/wrist MSDs, force is often a greater risk factor than posture.
If the purpose of a wrist brace is to keep the person’s wrist in a neutral posture, yet work tasks require the person to change arm postures, a wrist brace is likely to worsen the risk of MSD. The best solution is to focus on the design of the work layout and process so that more neutral postures are a natural occurrence. A wrist brace seems to be a forced approach that ignores the root cause of the problem, and will therefore fail far more often than it will help. In a roundabout way, a wrist brace tends to place the blame for bad work design on the user, not the poorly designed workstation and processes that are the root of the problem, which runs contrary to ergonomics as I know it.
The two previous users mentioned an unintended consequence of using a wrist brace. Specifically, if you are unable to move your wrist, but the job task still requires a motion like that, the worker will have to move another body part to achieve the task. As mentioned above, there is a good possibility that the WRIST is the body part that needs to be moved, and the task cannot be completed otherwise. In this event, the worker is going to move the wrist, but will now have to do it by applying excessive force to bend the wrist. This is going to make the situation worse, not better.
I do not support the use of wrist braces as a preventive tool.
There seem to be some assumption in the responses that the brace with restrict ROM and thereby cause increased compensatory motion elsewhere. However, your wrist “task” could be one requiring a static, neutral positioned wrist – e.g. lifting boxes, or the handle of a bucket. In that case, the brace may help maintain the neutral wrist position causing less recruitment of forearm muscles for co-contraction. In addition, the brace may encourage the use of other, stronger joints/muscles for lifting. Seems to me your answer is “depends on the task”.
You’re correct that this may depend on the task, but very few, if any, real world work tasks are performed with a consistently neutral wrist position. Subtasks, perhaps, but unlikely when considering a job as a whole (a series of tasks).
I suggest that wrist braces, or other braces for that matter, when warranted, are best worn during rest, not during work, particularly where exertions and movement can be expected. Seems to me that the use of a brace while working would be a reactive exception, and certainly not a proactive preventative measure.
Thank you all for your responses. They were insightful. They application for which I considered using wrist braces involved lifting steel parts in a relatively neutral position, or at least a static position. The task would not involve any change in position of the wrist; therefore the shoulder and elbows would not have any alternate action within the task. Given these more specific descriptors I would have to agree with m2koehler that it should not create any adverse risk to other joints and would likley reduce some of the peak activation of the forearm muscles, if everything went as planned.
As per NIOSH’s stance, I was only aware of their equivocal stance on lumbar braces. If anyone saw anything on their opinion about wrist braces I would certainly value a link.
Wrist braces have been implicated in “deconditioning of the muscles” that they “support” exposing the user to increased risks.
Their main purpose like that of back braces is to provide initial support/protection following injury.
Further the wrist is the most common area for the development of chronic pain, (especially following a Colles fracture) the use of a wrist brace may change the normal sensation that the wrist etc receives and create a feed-back loop when the person takes the brace off. This can result in the development of conditions such as chronic regional pain syndromes. As ergonomists should we be looking at redesigning the task to fit the person?
The purpose of a wrist brace is to rest the wrist in a neutral posture so the internal pressures are kept as low as possible. The normal wrist pressure is 0-3mmHg pressure, with bending it goes to about 30 and with extension to about 35 or so. That is for the healthy wrist. For people with increased synovial tissue and or thickening, the resting pressures can be as high as 30-35mmHg and so a wrist splint might slow the decline of nerve function but would not generally reverse it. A resting night splint, as you know, is designed to keep the wrist neutral and does so during a time of reduced activity, thus helping the ischemic nerve get as much blood flow as possible which is why people can sleep with fewer paresthesias.
In my experience, wrist splints often serve as inappropriate substitutions for the redesign of a task or work method. Further, symptom march often evolves as the person tries to substitute more proximal muscle groups to redistribute the load and create rest breaks and decreased muscle fatigue.
In the task you suggest a wrist splint, depending on the one you choose to use, has another unanticipated consequence, namely it changes the friction for the user and adds additional force to maintain the grip, potentiating an increase in carpal tunnel pressures. The splint’s palmar component can make gripping harder to perform successfully. Further, bands that are used to secure the splint about the thumb can further irritate the skin, creating other problems during hand use.
I would suggest that you use splints for the medical purpose of rest and alignment to reduce carpal tunnel pressures and/or assist in protecting a vulnerable joint from unexpected stresses during arthritic flares.
I hope this response serves you and your worker.
Tom McCoy DO, CPE
Some studies you may find helpful – this question has come up many times in the meat industry and we have eliminated all wrist splints with significant ongoing reduction of injury – no increases after years – I still think they may be helpful at night for CTS.
Forces are increased
A Study of the Effect of a “Resting Splint” on Peak Grip Strength
Graciela Perez-Balke and Bryan O. Buchholz1
Work Environment Department, College of Engineering, University of Massachusetts at Lowell, 1 University Place, Lowell, Massachusetts 01854
The purpose of this research was to study the effect of a resting wrist splint on the change in peak power grip strength (PGS) as compared with bare handed PGS, and to investigate the role of hand morphology on the results. Ninety-six subjects were tested for (PGS) with a Jamar Dynamometer under two conditions: with and without a resting splint. The results showed that PGS decreased by an average of 13.71 % (1.35 SE) while subjects wore the wrist splint as compared with the bare handed PGS. A paired t-test was performed on this difference and found to be significant (p<.0005). Female subjects (N = 44) experienced a two-fold greater percent decrease in their PGS (18.52%, 1.49 SE) than male subjects (9.97%, 1.96 SE). The results of this study suggest that PGS is attenuated with the use of a wrist splint, however none of the anthropometric measurements taken of the hand and wrist proved to be correlated with the dependant variables, change and & percent change in PGS. Correlational analysis found that the independent variables: sex, hand span, wrist circumference, and hand length had correlations greater than .5 with both bare and splinted PGS. These variables were entered into a regression analysis and yielded models for the dependant variables, bare and splinted PGS, with R = .5975 and .5835, respectively. An ANOVA, however, revealed that sex and hand length were the only significant independant variables (p<.001 and p<.05, respectively). Qualitatively, subjects complained that the metal bar of the splint decreased their ability to grip the dynamometer. In some cases, subjects reported discomfort while gripping with a splinted wrist. This combination of obstruction, discomfort and force attenuation may decrease the amount of force that workers are able to apply during work activities. Hand morphology failed to identify workers who might improve hand grip with the use of a wrist splint. The results of this study have important implications for the use of a wrist splint while performing work activities that require the use of a power grip.
Forces are transferred
OBJECTIVE. The purpose of this study was to test the hypothesis that wearing a wrist splint while performing
a common light manufacturing task (moving an object from a bin) increases shoulder muscle activity.
METHODS. Electromyography (EMG) signals were evaluated from the anterior, middle, and posterior deltoid,
trapezius, supraspinatus, and infraspinatus of 14 volunteers while they moved an object from a bin. Two
test conditions were measured: with and without a wrist splint. The height of the bin was also varied.
RESULTS. Wearing a wrist splint increased maximum EMG for all six muscles and average levels for the
deltoid (anterior, middle, posterior) and trapezius. As bin height increased, maximum muscle activity increased
in the deltoid (anterior, middle, and posterior) and trapezius, and the average increased in the deltoid (middle
and posterior) and trapezius.
CONCLUSIONS. Workplace factors can modify the activation of a patient’s shoulder muscles when he or
she is wearing a wrist splint. An ergonomic job analysis should be conducted for patients who are returning to
work wearing wrist splints.
Mell, A. G., Friedman, M. A., Hughes, R. E., & Carpenter, J. E. (2006). Shoulder muscle activity increases with wrist splint
use during a simulated upper-extremity work task. American Journal of Occupational Therapy, 60, 320–326.
Many studies supporting wrist splints are poorly done
see the following Cochrane review:
The authors of this review from Melbourne, Australia compared the effectiveness of splinting for carpal tunnel syndrome with no treatment, placebo, or another non-surgical treatment for improving clinical outcome. They followed Cochrane’s high quality methodology and undertook an extensive search of the literature, up until 10 January 2012, and found 19 studies involving 1190 randomised participants (some studies included people with bilateral CTS thus data were from 1287 wrists). Studies comparing splinting with surgical treatment and studies with participants who had previous surgery for CTS were excluded and the Cochrane Collaboration’s ‘Risk of bias’ tool was applied to the studies they included.
Here’s what they found
• The duration, type and routine of splint wear was varied (the most common was between two and four weeks, and nocturnal wear)
• Only 3 studies reported on short-term overall improvement at three months or less
• One low quality study with 80 wrists found that compared to no treatment, splints worn at night more than tripled the likelihood of reporting overall improvement at the end of four weeks of treatment (RR 3.86, 95% CI 2.29 to 6.51)
• A very low quality quasi-randomised trial with 90 wrists found that wearing a neutral splint more than doubled the likelihood of reporting ‘a lot or complete relief’ at the end of two weeks of treatment compared with an extension splint (RR 2.43, 95% CI 1.12 to 5.28)
• The third study which measured short-term overall improvement did not report outcome data separately per group.
• Nine studies measured adverse effects of splinting and all found either no or few participants reporting discomfort or swelling due to splinting;
• Differences between groups in the secondary outcomes – symptoms, function, and neurophysiologic parameters – were small with 95% CIs incorporating effects in either direction.
The authors concluded
“Overall, there is limited evidence that a splint worn at night is more effective than no treatment in the short term, but there is insufficient evidence regarding the effectiveness and safety of one splint design or wearing regimen over others, and of splint over other non-surgical interventions for CTS. More research is needed on the long-term effects of this intervention for CTS.”
NIOSH also summarized:
http://ergonomics.uq.edu.au/public/pdf/01-108.pdf see excerpt below (NIOSH)
This document illustrates NIOSH efforts to advise companies
about engineering controls to reduce MSDs and describes more
than 20 examples of engineering controls from the scientific and
technical literature. Although engineering controls are preferred,
administrative controls can be helpful as temporary measures until
engineering controls can be implemented, or when engineering
controls are not technically feasible. One limitation of administrative
controls is that they do not eliminate hazards and, therefore,
their success depends on their maintenance as long as the hazardous
exposure potential persists. The evidence that braces, wrist
splints, back belts, and similar devices are effective in preventing
MSDs is inconclusive. Furthermore, we agree with OSHA.s position
that PPE only be used to supplement engineering, work practice,
and administrative controls.
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