Weight Bearing After Carpal Tunnel Release
Patients can immediately bear weight on their hands after carpal tunnel release surgery without any restrictions, as there is no need to avoid weight bearing following this procedure.
Understanding the Procedure Context
Carpal tunnel release is a soft tissue decompression procedure that involves dividing the transverse carpal ligament to relieve pressure on the median nerve. Unlike procedures involving bone healing (fractures, fusions) or tendon repairs under tension, this surgery does not require protected weight bearing for structural healing 1.
Evidence-Based Postoperative Management
Immediate Mobilization is Superior
Early mobilization beginning on the first postoperative day significantly improves outcomes compared to immobilization or splinting 1.
Patients who began range-of-motion exercises on the first postoperative day returned to activities of daily living faster, returned to work earlier (both light and full duty), and recovered grip and key pinch strength more quickly than those who were splinted 1.
Splinting the wrist after carpal tunnel release causes significant delays in functional recovery and increases pain and scar tenderness in the first month after surgery 1.
Dressing Management
The bulky postoperative dressing can be removed at 48-72 hours and replaced with a simple adhesive strip without causing wound complications 2.
Early dressing removal (48-72 hours) results in equal clinical and subjective outcomes compared to maintaining a bulky dressing for 2 weeks 2.
Return to Work Timeline
The timing for return to work depends on the physical demands of the occupation, not on weight-bearing restrictions:
- Desk-based duties: Median return at 7 days (range 0-30 days) 3
- Repetitive light manual duties: Median return at 15 days (range 1-56 days) 3
- Heavy manual duties: Median return at 30 days (range 1-90 days) 3
These timelines reflect pain tolerance, grip strength recovery, and functional demands rather than any structural healing requirement 3.
Recommended Postoperative Protocol
Day 1: Begin active range-of-motion exercises for the wrist and fingers 1
Days 2-3: Remove bulky dressing and apply adhesive strip 2
Ongoing: Exercise the wrist and fingers separately to avoid simultaneous finger and wrist flexion, which could theoretically cause bowstringing (though this complication is rare) 1
No splinting unless there are specific concerns about rare complications such as tendon bowstringing or median nerve entrapment in scar tissue 1
Clinical Outcomes
Both open and endoscopic carpal tunnel release techniques are equally effective for symptom relief and functional improvement, though endoscopic release may allow return to work approximately one week earlier 4, 5.
Surgical treatment provides superior symptom improvement compared to non-surgical options (splinting, corticosteroid injections) across multiple outcome measures including paraesthesia, function, and nerve conduction studies 4.
Common Pitfalls to Avoid
Do not routinely splint the wrist postoperatively, as this delays functional recovery without providing meaningful benefit 1.
Do not restrict weight bearing or hand use based on arbitrary timelines, as the procedure does not involve structures that require protected healing 1.
Avoid maintaining bulky dressings beyond 48-72 hours, as early dressing removal is safe and may facilitate earlier mobilization 2.