Background
The carpal bones are eight small, marble-sized bones that form the wrist. These bones are right in between your long forearm bones, and your hand bones. The “carpal tunnel” is the name for a natural structure that exists in everyone. As the name suggests, it is a tunnel — the carpal bones (wrist bones) make up the floor and walls, and a broad flat ligament creates the roof. A nerve, called the Median Nerve, runs through the tunnel, along with 9 tendons that allow forearm muscles to control the fingers.
Repetitive hand movements can increase the pressure within the carpal tunnel, resulting in pressure on the Median Nerve. This creates numbness, tingling, hand “falling asleep,” pain, and weakness in your hand and fingers. If you don’t have carpal tunnel surgery when your symptoms are mild, they can become very severe and sometimes irreversible. However, there is a quick and very effective procedure that relieves the pressure inside the tunnel, and creates nearly-instantaneous relief. Short-term hand therapy is typically needed afterward to help the hand and wrist heal, to minimize stiffness/swelling, and to help regain strength and range of motion like before the symptoms started.
Hand Therapy
Week 0-2:
- You should notice dramatic improvement in your original symptoms (numbness, tingling etc) within the first few days after surgery.
- At the start of therapy, a controlled regimen of active and passive range of motion will be started. Your therapist will advise you on what activities are safe, and which movements are necessary and most beneficial. Exercises will typically involve selective motion of the forearm, wrist, hand, and fingers, plus specific movement patterns that facilitate full tendon and nerve gliding through your wrist.
- Exercises will involve fine motor coordination/finger dexterity, and sensory re-education to calm hypersensitive nerves or facilitate the return of sensation that was reduced from chronic pressure on the nerve inside the carpal tunnel.
- At 10-14 days post-op, your sutures will be removed. At this time, your therapist will begin working to soften and mobilize the scar tissue that forms at incisions. Your therapist will also begin manual techniques to reduce swelling in the wrist and hand.
By 3 weeks after surgery, the skin at the incision should be rapidly healing. Mild dryness and flaking may still be present, but redness and swelling should be starting to resolve. You will typically have 50-75% of normal wrist range of motion at this point. Post-op soreness should be virtually gone, though therapy exercises may still cause minor discomfort.
Week 3-4:
- Gentle hand strengthening will begin around this time, progressively increasing as tolerated and appropriate. Your therapist will closely monitor you during this phase to ensure you are healing well, moving as expected, and on track to meet your functional goals. Your therapist will continue techniques to help flatten and soften your scar, while helping direct your exercises.
By 4-5 weeks after surgery, the typical person will have 80-90% or more of final wrist range of motion. Discomfort should be fully resolved, and the incisional scar will be blending into the rest of your palm. By this phase, many people’s wrist scar will no longer be visible to others at all. Grip strength will be roughly 25-50% of normal.
Week 6+:
- During the final week or so of formal therapy, hand and finger strength and endurance will be emphasized. Final functional goals will be dependent on the person’s age, prior level of function, and physical needs for daily life. The majority of swelling will have resolved by this point, but may continue to improve over the next 4-6 months. By 6 weeks post-op, range of motion should be within normal limits, and hand/finger strength should be 75-85% of normal.
*This recovery timeline is generalized to apply to the average person. However, individual recovery time may vary depending on severity of pre-operative condition, prior level of function, age, health, lifestyle factors, tobacco/alcohol use, medical comorbidities, and other factors.
