Physical Therapy After Carpal Tunnel Surgery

Carpal tunnel syndrome affects about 10 percent of the population, and over 500,000 surgeries are performed every day to alleviate the painful symptoms. After surgery, the wrist and hand will be swollen, stiff, weak and less flexible. Physical therapy, as part of the rehabilitation process, is believed to increase strength and speed of recovery.

Recommendation

• Many physicians will suggest physical therapy in addition to a home exercise program. Recommendation for physical therapy will depend on the severity of damage before surgery and the condition of the hand after surgery. When having the operation on both hands, physical therapy is highly recommended to speed the recovery of the first hand before performing surgery on the second hand.

Treatment

• Physical therapy will generally begin within a few days after surgery while the arm is still wrapped in a soft cast. Sessions may be two or three times a week for about four to six weeks. Therapists use a combination of ice, massage, assisted stretching and exercises throughout the course of treatment. Heat, ultrasound, paraffin wax and electrical stimulation may also be used on occasion.

Initial Therapy

• Doctors recommend that for the first few days after surgery, keep the hand elevated above heart level and apply ice packs to the wrist periodically at home to keep swelling down. A physical therapist will use soft tissue massage and ice in the initial visits to combat swelling as well. Because there will still be stitches in the wound, exercises will be basic and will primarily focus on improving range of motion in the fingers and hand. In these early days of recovery, exercises include bending the fingers, opening and closing the hand and, eventually, slowly rotating the wrist. Assisted stretches are also used to increase flexibility.

Intermediate Therapy

• Within 10 to 14 days post-surgery, stitches will be removed and a wrist brace with a metal stabilizer will be worn in place of the soft cast. Therapy will focus on increasing strength. Patients will begin gripping exercises and lifting light weight with the fingers. Gentle tapping on the scar and friction massage will be used to decrease sensitivity in the incision area. Therapists also will introduce a series of "fist positions" that encourage tendons to slide within the carpal tunnel and prevent scar tissue buildup around the cut carpal ligament.

Advanced Therapy

• As rehabilitation progresses, exercises are meant to strengthen the hand in order to stabilize muscles and joints. Patients will begin to squeeze and stretch a special putty. Wrist curls, while holding a 1 to 2 pound weight, and movements that promote fine motor control will also be introduced. The goal of therapy in this last stage is to prepare the patient to return to work and other activities. Because certain occupational and recreational use can sometimes cause or aggravate carpal tunnel syndrome, therapists will show patients a variety of techniques to avoid future problems.