Post-Operative Carpal Tunnel Release Rehabilitation
Early mobilization without wrist splinting should be initiated on the first postoperative day, as splinting delays return to activities of daily living, return to work, and recovery of grip strength. 1
Immediate Post-Operative Phase (Days 1-14)
Begin range-of-motion exercises on postoperative day one rather than immobilizing the wrist, as this approach significantly accelerates functional recovery without increasing complication rates. 1
- Initiate a home-based exercise program where the wrist and fingers are exercised separately to avoid simultaneous finger and wrist flexion, which can cause tendon bowstringing. 1
- Apply cryotherapy during the first postoperative week to reduce pain and swelling. 2
- Patients who undergo early mobilization return to activities of daily living, light duty work, and full duty work significantly faster than those who are splinted. 1
Common Pitfall to Avoid
Routine wrist splinting for 2 weeks post-operatively is detrimental and should be avoided unless there are specific concerns about rare complications like tendon bowstringing or median nerve entrapment in scar tissue. 1
Early Rehabilitation Phase (Weeks 2-6)
A single hand therapy visit at 10-14 days postoperatively is sufficient for uncomplicated cases, with patients showing significant symptom improvement by this timepoint. 3
- Patients demonstrate significant improvement on the Boston Carpal Tunnel Questionnaire Symptom Severity Scale by 10-14 days postoperatively. 3
- Functional Status Scale improvements typically occur by 6 weeks postoperatively. 3
- Monitor for pillar pain and palm pain, which occur in approximately 13% of patients with standard protocols. 3
Progression Criteria
Advancement should be based on:
- Absence of pain during exercises 1
- No increase in swelling or inflammation 4
- Progressive improvement in grip and pinch strength 1
Intermediate Phase (Weeks 6-12)
Functional ability continues to improve through 12 weeks post-operatively, with the magnitude of change being 1.51 points on the Symptom Severity Scale and 0.91 points on the Functional Status Scale. 3
- Customized rehabilitation programs should include patient education, home-based exercises, and physiotherapeutic treatment as needed. 5
- The timing of when post-operative rehabilitation is started significantly affects outcomes, with earlier initiation associated with better results. 5
- There is a high correlation between hand function improvement and patients' subjective feelings about their quality of daily living. 5
Evidence Quality and Clinical Decision-Making
The overall evidence for specific post-operative rehabilitation interventions is limited and of low quality. 6 A 2013 Cochrane review found that most rehabilitation interventions (including immobilization, dressings, exercise, controlled cold therapy, laser therapy, electrical modalities, and scar desensitization) showed small, non-statistically significant differences compared to control groups. 6
Key Clinical Implications:
- Given the limited evidence for most interventions, the decision to provide specific rehabilitation treatments beyond early mobilization should be based on clinical expertise and patient preferences. 6
- The strongest evidence supports early mobilization without splinting as the primary intervention. 1
- Additional formal therapy beyond one visit may not be necessary for uncomplicated cases. 3
Return to Work and Function
- Patients with early mobilization protocols return to light duty and full duty work significantly faster than those who are immobilized. 1
- Grip strength and key pinch strength recovery is significantly delayed with wrist splinting, making early mobilization critical for occupational recovery. 1
- Functional outcomes should be monitored using validated tools like the Boston Carpal Tunnel Questionnaire or DASH questionnaire. 6