Bracing & Orthotics: Counterforce bracing (epicondylitis) or extension splinting (cubital tunnel)

Q1. What is the difference between a counterforce brace and an extension splint?

Both are orthopedic supports for the elbow, but they serve entirely different purposes:

• Counterforce brace: A strap worn around the forearm during daily activities or sports. It relieves tension on the forearm muscles and tendons, commonly used for tennis elbow or golfer's elbow.
• Extension splint: A rigid or semi-rigid brace worn at night. It prevents the elbow from bending too much, protecting the ulnar nerve for patients with cubital tunnel syndrome.

Q2. How does a counterforce brace help with epicondylitis (tennis or golfer's elbow)?

Epicondylitis is an overuse injury where the tendons in your elbow become irritated and painful. A counterforce brace works by applying gentle pressure to the forearm muscles just below the painful tendon attachment. When you grip or lift, the brace acts as a new, temporary anchor point. This absorbs some of the force and muscle tension, preventing it from pulling directly on the injured tendon at the elbow joint, allowing the tissue to rest and heal.

Q3. What is extension splinting, and how does it help cubital tunnel syndrome?

Cubital tunnel syndrome occurs when the ulnar nerve (often called the \"funny bone\" nerve) gets squeezed or stretched as it passes through a narrow tunnel on the inner side of your elbow. When you bend your elbow, this tunnel gets narrower, stretching the nerve. Extension splinting keeps your elbow in a gently straight position (usually bent at about 30 to 45 degrees) during sleep. This keeps the tunnel open, reduces pressure on the nerve, and relieves symptoms like nighttime numbness, tingling, and pain in the ring and small fingers.

Q4. When should I wear my counterforce brace?

You should wear your counterforce brace during activities that trigger or worsen your elbow pain. This includes tasks involving repetitive gripping, squeezing, twisting, or lifting, such as:

• Typing or using a computer mouse
• Gardening, weeding, or pruning
• Playing sports like tennis, squash, or golf
• Using hand tools, painting, or heavy lifting

You do not need to wear the brace when you are resting, relaxing, or sleeping.

Q5. When and how long should I wear my night extension splint?

You should wear your extension splint every night when you go to bed. Most patients wear the splint consistently for 3 to 6 months. It is important to wear it every single night because nerve healing is a slow process. Preventing repetitive nighttime bending is key to letting the nerve recover without daily setbacks.

Q6. How tight should my counterforce brace be?

The brace should be snug but not uncomfortably tight. It should apply enough pressure to compress the forearm muscles, but it should not cause your fingers to feel cold, tingle, turn blue, or swell. If you feel any throbbing, numbness, or changes in skin color, loosen the strap immediately.

Q7. Where exactly should I place the counterforce brace on my arm?

Place the brace on your forearm, about one to two inches (roughly two finger-widths) below the spot on your elbow where it hurts the most. The padded portion of the brace should rest directly over the bulk of the muscles that feel tender when you lift your wrist or fingers.

Q8. Are there any risks or side effects of wearing these braces?

Bracing is very safe, but minor issues can occur if used incorrectly:

• Skin irritation: Redness or itching from the fabric, sweat, or friction. Keep your brace clean and dry.
• Nerve compression: Temporary numbness if the brace is fastened too tightly.
• Muscle weakness: Wearing a brace too much without exercising can cause mild muscle weakness. To prevent this, always combine bracing with a targeted rehabilitation program.

Q9. Can I use a counterforce brace for cubital tunnel syndrome or an extension splint for tennis elbow?

No. These devices are designed for specific conditions. A counterforce brace will not relieve ulnar nerve compression in the cubital tunnel. Similarly, a night extension splint is designed to prevent nerve stretching and will not help reduce activity-related tendon strain from tennis elbow. Use the device recommended by Dr. Veillette for your specific diagnosis.

Q10. Should I wear the counterforce brace all day long?

No. Wearing a counterforce brace all day is not recommended. It should only be worn during activities that aggravate your symptoms. Overusing the brace can make your forearm muscles lazy and weak, which can delay long-term recovery.

Q11. How long will I need to use these braces before I see improvement?

For tennis elbow, many patients feel a reduction in pain almost immediately when wearing a counterforce brace during activities. For cubital tunnel syndrome, it can take 4 to 6 weeks of consistent nighttime extension splinting to see a significant reduction in daytime numbness and tingling, as nerves take longer to recover.

Q12. Can I wash my brace or splint?

Yes. Most braces and splints can be washed. Remove any rigid metal or plastic inserts first. Wash the fabric portion by hand using mild soap and warm water, then let it air dry completely. Do not put them in a dryer, as the heat can damage the elastic fibers and velcro.

Q13. Will bracing cure my elbow condition completely?

Bracing is an excellent tool for managing symptoms and protecting your elbow, but it is rarely a cure on its own. It should be used as part of a comprehensive recovery plan that includes rest, activity modification, stretching, and strengthening exercises to address the underlying cause of the condition.

Q14. What should I do if my symptoms get worse despite using the brace?

If you experience increased pain, persistent numbness, loss of hand strength, or if your symptoms do not improve after several weeks of consistent brace use, contact Dr. Veillette's clinic. You may need a different treatment strategy, such as physical therapy, injections, or further diagnostic tests like an EMG (electromyogram).

Q15. Can I make a temporary extension splint at home?

Yes, as a temporary measure. You can wrap a thick bath towel around your elbow and secure it with tape or elastic bandages, or wear a backward-facing elbow pad to prevent your arm from bending while you sleep. However, a custom or commercial extension splint is much more comfortable and effective for long-term use.

We encourage you to write down any specific questions you have and discuss them thoroughly with your surgeon, doctor, or physical therapist. They are your best resource for personalized advice and care.

Disclaimer: This brochure provides general information and is not a substitute for professional medical advice. Always consult your doctor or qualified healthcare provider with any questions you may have regarding your specific medical condition and treatment plan.