Carpal Tunnel Syndrome

Carpal Tunnel Release Surgery

Although nighttime symptoms are often relieved immediately, other symptoms, such as constant numbness, weakness or clumsiness are due to nerve damage and may not be completely relieved. These resolve very gradually, and recovery may be incomplete. Maximum improvement may take 6 to 12 months. Occasionally, the numbness may be more obvious after surgery because the pain and tingling are improved.

Gentle exercise and light use of the hand is encouraged beginning the day after surgery. Tenderness around the scar usually lasts for 8-12 weeks after surgery. This may take 6 months to resolve completely.

You may not be able to return to all activities at home or at work immediately after surgery and activity modification and work modification may be necessary. A cast or splint may be helpful if strenuous activity is unavoidable.

  

Figure 1

Range of motion of the fingers is important after surgery and encouraged. It helps the nerve to glide so adhesions don’t form. However, simultaneous wrist and finger flexion should be avoided for at least 3 weeks after surgery. (Figure 1)

                        
As the wound heals the scar tissue shrinks and matures. This results in adhesions that pull on the median nerve and often result in brief shooting or electrical pains with motion. This commonly happens when you stretch your hand out to reach an item at arm's length. Sudden shooting or electrical shock pains may also occur spontaneously while you are doing nothing. Both of these are normal and improve with time.

Scar formation results in a lump at the base of the palm. This is noticeable when you lean on the hand or push off. This is normal and improves with time and massage. Leaning on your knuckles with the wrist in a straight position will help.

Grip strength is usually weak for 2 to 3 months following surgery. Full recovery is expected but may take 6 months.

You can resume light activities within your own tolerance, including driving, as soon as you feel comfortable enough to do so. Please use common sense and avoid activities that hurt. Suture removal is between 1 to 2 weeks and the next follow up appointment is made for 4 to 6 weeks after surgery.

 

Carpal Tunnel Release:
Post-operative Instructions

0-5 days after surgery:
Gentle exercise and light use of the hand is encouraged beginning the day after surgery. Finger motion (full extension and flexion) is important for all fingers. Resistive activities (i.e. squeezing a ball) are avoided for the 6 weeks following surgery. 

1-6 weeks after surgery:
The sutures are removed approximately 7 to 14 days after surgery. Your Physician may allow you to remove your dressing in 2 to 3 days after surgery and apply Band-Aids and sometimes a removable splint.

            • Remove your dressing 2-3 days after surgery and apply Band-Aids

You should start active range of motion exercises of the wrist. Avoid simultaneous wrist and finger flexion for 3 to 6 weeks (Figure 1).  However, the wrist can be moved through a full range of motion with the fingers straight (Figures 2a-c).

 

Figure 2a

Figure 2b

Figure 2c

   
Your physician may want you to wear a splint at night for 3 weeks or intermittently during the day or for heavy activities. If so:

                • Wear your splint during sleep for 3 weeks after surgery.
                
                • Wear your splint intermittently during the day for 3 weeks.

Edema (swelling) control, scar massage and desensitization are initiated when the incision is healed. Scar massage can be started approximately 2 weeks after surgery if the wound has healed. Use a non-perfumed lotion (Vitamin E lotion is OK). Gentle but firm pressure is applied to the wound and massage in a circular fashion. This can be performed for a few minutes 5 times a day at first and over time less frequently as the tenderness improves.

The palm will remain tender for at least 4 to 6 weeks after surgery and mildly so for 6 months. Return to golf and hand sports is usually possible at 6 to 8 weeks. Likewise, impact loading to the palm should be avoided for at least 6 weeks after surgery. A padded glove (bicycle or weight lifting glove) may be helpful.

6-12 weeks after surgery:
Start progressive strengthening exercises.