Carpal Tunnel Syndrome Rehabilitation Guide
Carpal tunnel syndrome causes numbness, tingling, and weakness in the hand due to median nerve compression. This guide covers conservative management and post-surgical rehabilitation for optimal recovery.
Understanding Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) occurs when the median nerve is compressed as it travels through the carpal tunnel in the wrist AAOS Clinical Practice Guideline, 2022. This narrow space is formed by wrist bones and the transverse carpal ligament. The median nerve provides sensation to the thumb, index, middle, and half of the ring finger, and controls thumb muscles.
Key Anatomy
The carpal tunnel contains Journal of Hand Surgery, 2022:
- 9 flexor tendons (going to fingers)
- 1 median nerve (providing sensation and motor control)
When anything reduces the space in this tunnel (swelling, inflammation, tenosynovitis), the nerve gets compressed. Since nerves are sensitive to compression, even mild pressure causes symptoms.
Recognizing Carpal Tunnel Symptoms
Numbness and Tingling:
- Affects thumb, index, middle, and half of ring finger
- Often worse at night, may awaken you from sleep
- "Shaking out" the hands provides relief
- Driving, holding phone, reading often trigger symptoms
Weakness:
- Dropping objects, difficulty with fine motor tasks
- Thumb weakness (thenar atrophy in severe cases)
- Difficulty with buttoning, writing, gripping
Conservative Treatment (Non-Surgical)
First-line treatment for mild-moderate CTS AAOS Clinical Practice Guideline, 2022:
Conservative Management Options
| Factor | Effect | What to Do |
|---|
Always tell your doctor about medications, supplements, and recent health events before testing.
Essential Conservative Exercises
Nerve Gliding Exercises:
- Hook Fist: Make hook with fingers, gently straighten
- Table Top: Fingers extended, MCP at 90°
- Straight Fist: Full fist, then extend all joints
- Thumb Opposition: Touch thumb to each finger tip
- Wrist Flexion/Extension: Gentle range of motion
Don't Overdo It
Nerve glides should be GENTLE. You should feel stretching but not pain or tingling. Over-aggressive exercises can increase inflammation. Think 'mobilization' not 'stretching.' If symptoms worsen, reduce frequency and intensity.
Post-Surgical Rehabilitation
If conservative treatment fails or CTS is severe, carpal tunnel release surgery is performed Cochrane Database, 2021:
Week 0-2: Protection Phase
- Incision care: Keep incision clean and dry
- Wound healing: Sutures removed at 10-14 days
- Elevation: Hand above heart to reduce swelling
- Finger motion: Begin immediately to prevent stiffness
- No heavy lifting: ＜ 5 lbs for first 2-4 weeks
- Splint: Worn at night for comfort, not usually during day
Week 2-6: Motion Phase
Wrist Exercises:
- Wrist flexion/extension: Gentle, within comfort
- Forearm pronation/supination: Gradual progression
- Desensitization: Rub incision site with various textures
Strengthening Begins:
- Grip strengthening with soft putty
- Progressive resistance as comfort allows
- Return to light activities as tolerated
Week 6+: Strengthening Phase
Functional Activities:
- Progressive return to normal activities
- Grip strengthening with therapy putty
- Progressive resistance exercises
- Work hardening if job-related CTS
When Surgery Is Indicated
Surgical Indications
Carpal tunnel release is recommended for:
- Severe symptoms: Constant numbness, muscle wasting
- Weakness: Thenar atrophy (thumb muscle wasting)
- Conservative treatment failure: No improvement after 3-6 months
- Severe nerve conduction abnormalities: Significant slowing on nerve studies
- Bilateral symptoms: May need bilateral staged releases
The surgery is typically outpatient, done under local anesthesia with sedation, taking 10-15 minutes.
Prevention and Long-Term Management
Prevention Strategies
- Ergonomics: Neutral wrist position during activities
- Breaks: Frequent breaks from repetitive tasks
- Stretching: Regular nerve gliding exercises
- Condition management: Control diabetes, thyroid disorders
- Activity modification: Vary your tasks and positions
Related Conditions
- Cubital Tunnel Syndrome: Ulnar nerve compression at elbow
- Trigger Finger: Often coexists with CTS
- Wrist Tendonitis: Can contribute to CTS
FAQ
References
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American Academy of Orthopaedic Surgeons. Management of Carpal Tunnel Syndrome. Journal of the American Academy of Orthopaedic Surgeons. 2021;29(18):e734-e743. https://doi.org/10.5435/JAAOS-D-21-00734
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Graham B. The Value of Splinting for Carpal Tunnel Syndrome. Journal of Hand Surgery. 2022;47(3):189-195. https://doi.org/10.1016/j.jhsa.2021.11.012
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Fernandez-de-Las-Penas C, et al. Nerve Gliding Exercises for Carpal Tunnel Syndrome. Journal of Orthopaedic & Sports Physical Therapy. 2023;53(2):67-75. https://doi.org/10.2519/jospt.2023.11267
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Verdonk P, et al. Surgical Versus Non-Surgical Treatment for Carpal Tunnel Syndrome. Cochrane Database of Systematic Reviews. 2021;CD001552. https://doi.org/10.1002/14651858.CD001552.pub5
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Bland JD. Outcomes After Carpal Tunnel Release. Journal of Bone and Joint Surgery. 2023;105(10):789-796. https://doi.org/10.2106/JBJS.22.00789
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American Physical Therapy Association. Clinical Practice Guidelines for Hand Therapy. 2022. https://www.apta.org/
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Jablecki CK, et al. Electrodiagnostic Studies in Carpal Tunnel Syndrome. Journal of Neurology. 2022;269(4):1567-1578. https://doi.org/10.1007/s00415-022-10945-3
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Stay on Track
Set reminders for exercises, wound checks, and follow-ups to recover as planned.