# Situation: The occupational health nurse of a garment factory cares for workers who operate sewing machines for 8-hour shifts, lift fabric rolls of up to 20 kg, and clean equipment with an alkaline cleaning solution. The diagnosis is confirmed, and a wrist splint is prescribed. Which instruction about the splint is correct?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630536  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: The occupational health nurse of a garment factory cares for workers who operate sewing machines for 8-hour shifts, lift fabric rolls of up to 20 kg, and clean equipment with an alkaline cleaning solution.

The diagnosis is confirmed, and a wrist splint is prescribed. Which instruction about the splint is correct?

## 보기

1. Wear it with the wrist in neutral, mainly at night **✔ 정답**
2. Wear it with the wrist bent downward, mainly at night
3. Wear it with the wrist bent upward during sewing only
4. Wear it during work only, removing it before sleep

**정답: 1**

## 해설

The splint holds the wrist in a neutral position, where pressure in the carpal tunnel is lowest. It is worn especially at night, because people often sleep with the wrists flexed, which compresses the median nerve and causes night symptoms.

## 심화 해설

Neutral position, mainly at night
For carpal tunnel syndrome, a wrist splint is one of the first conservative treatments. The correct instruction is to wear it with the wrist in neutral, straight in line with the forearm, and mainly at night. Pressure inside the carpal tunnel is lowest when the wrist is neutral and rises when the wrist bends either down (flexion) or up (extension). Holding the wrist straight therefore gives the compressed median nerve the most room.

Why night use is the main purpose
Many people sleep with their wrists curled into flexion, sometimes for hours. That posture squeezes the median nerve and explains why carpal tunnel symptoms are typically worst at night and wake people with numbness, tingling, or a need to shake the hand. A splint worn during sleep prevents the flexed posture and is often enough to relieve night symptoms. Daytime use may be added during aggravating tasks if it does not interfere with safe work.

| Wrist position | Carpal tunnel pressure | Use in splinting |
| --- | --- | --- |
| Neutral | Lowest | Correct |
| Flexed (bent down) | Raised | Avoid |
| Extended (bent up) | Raised | Avoid |

Why the other instructions are wrong
A splint that holds the wrist bent downward places it in flexion, the position that compresses the nerve most, which is the reverse of the goal. A splint holding the wrist bent upward during sewing only is wrong twice: extension also raises pressure, and limiting use to work hours misses the night, when symptoms are worst. Wearing the splint during work only and removing it before sleep discards its main benefit.

Other teaching for the worker
The nurse also teaches the worker to take regular breaks from repetitive tasks, to keep the wrists straight while sewing by adjusting chair and table height, to avoid prolonged forceful gripping, and to report weakness, dropping objects, or wasting at the base of the thumb, which suggest worsening nerve compression. If splinting and activity changes do not help, the physician may consider a corticosteroid injection or surgical release.

Exam takeaway
Key point Carpal tunnel splint: neutral wrist, worn especially at night. Any option with a flexed or extended wrist, or with removal at night, is wrong.

## 임상 시나리오

Wrist Splint for Carpal Tunnel SyndromePosition and timing
The splint holds the wrist in neutral, where pressure in the carpal tunnel is lowest. Flexion and extension both raise the pressure.

It is worn mainly at night, because people often sleep with wrists flexed, which causes the typical night symptoms.

Teach rest breaks, straight wrists during work, workstation adjustment, and reporting of weakness or thenar wasting.

CautionA splint that bends the wrist down or up worsens compression. Removing it before sleep loses its main benefit.

## 핵심 개념

- **Neutral wrist position** — A straight wrist in line with the forearm, neither flexed nor extended.
- **Wrist splint** — A brace that holds the wrist in a set position to rest the median nerve in carpal tunnel syndrome.
- **Wrist flexion** — Bending the wrist so the palm moves toward the forearm; it raises carpal tunnel pressure.
- **Thenar atrophy** — Wasting of the muscles at the base of the thumb, a sign of advanced median nerve compression.

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