Wrist and Hand Posture in Orthosis Design for Carpal Tunnel Syndrome: An Integrative Review Concept

ABSTRACT Introduction The prevalence of computers in the workplace has heightened the risk of carpal tunnel syndrome (CTS), particularly due to wrist extension during typing. This integrative review delves into the pivotal role of wrist and hand posture in orthotic design for managing CTS. By consolidating current research, the review explores how various wrist and hand positions impact CTS development and management, focusing on alleviating symptoms, decompressing nerves, and ensuring patient comfort. Emphasizing the importance of maintaining proper wrist and hand alignment during computer use underscores the necessity for a multidisciplinary approach to assessing hand and wrist posture for CTS patients while typing. This review seeks to guide future research and clinical practices, advocating for optimizing wrist and hand posture as a fundamental strategy in orthotic design for CTS management. Methods A comprehensive literature search was conducted using PubMed, Google Scholar, and Scopus, covering publications up to February 2024. The search strategy included keywords related to CTS, orthosis design, wrist and hand posture, and therapeutic outcomes. The selection process involved a rigorous appraisal of relevant studies, including 21 studies that met the criteria for analysis. The evidence was synthesized to examine the impact of wrist and hand posture on CTS. Findings Analysis of the selected studies revealed that non-neutral postures, such as wrist extension, ulnar deviation, metacarpophalangeal (MCP) hyperextension, and improper keyboard positioning, significantly increase the risk of developing CTS. Conclusions Maintaining a neutral wrist and hand posture during typing is critical for reducing the risk of CTS, as non-neutral positions like wrist extension and MCP hyperextension increase carpal tunnel pressure. Ergonomic interventions, such as wrist-hand orthoses, have shown promise in alleviating CTS symptoms by optimizing wrist and finger alignment. However, current orthotic designs often overlook the dynamic hand-wrist postures during typing, which could limit their effectiveness. Future research should focus on developing orthotic solutions that address both wrist and finger positioning to enhance therapeutic outcomes in CTS management. Clinical Relevance This review suggests an interdisciplinary approach involving clinicians, occupational therapists, and orthotists is critical for ensuring that both anatomical and functional considerations are met in orthosis design. This collaborative care model improves treatment outcomes and supports holistic management of CTS, promoting faster recovery and enhancing the orthotic design for CTS.