Carpal tunnel surgery and physical therapy

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

What to Expect After Open Carpal Tunnel Surgery

After surgery, the hand is wrapped. The stitches are removed 10 to 14 days after surgery. You may be directed to wear a splint for several weeks. The pain and numbness may go away right after surgery, or may take several months to subside.

When you return to work depends upon whether the dominant hand was involved, your work activities, and the effort that you put into rehabilitative physical therapy.

• If you have had surgery on your non dominant hand and do not do repetitive, high-risk activities at work, you may return to work within 1 to 2 days; 7 to 14 days is most common.
• If you have had surgery on your dominant hand and do repetitive activities at work, you may require 6 to 12 weeks for a full recovery before you can return to previous work duties. Physical therapy may speed recovery.

What to Expect After Endoscopic Carpal Tunnel Surgery

You can expect a shorter recovery period after an endoscopic surgery than after open surgery, because the procedure does not require cutting the palm open and disturbing a large area of the hand.

The pain and numbness may go away right after surgery, or it may take several months. Try to avoid heavy use of your hand for a couple of weeks.

When you return to work depends on whether your dominant hand was involved, your work activities, and the effort that you put into rehabilitative physical therapy.

• If you have surgery on your non-dominant hand and don't do repetitive, high-risk activities at work, you may be able to return to work within 1 to 2 days.
• If you have surgery on your dominant hand and do repetitive activities at work, you may require 4 or more weeks for recovery. Physical therapy may speed recovery.


Your doctor may have you work with a physical or occupational therapist for four to six weeks after the surgery. You'll begin doing active hand movements and range of motion exercises. Therapists also use ice packs, soft-tissue massage, and hands-on stretching to help with the range of motion. When the stitches are removed, you may start carefully strengthening your hand by squeezing and stretching special putty with your hand and fingers. Therapists also use a series of "fist" positions to encourage the finger tendons to slide within the carpal tunnel.

As you progress, your therapist will give you exercises to help strengthen and stabilize the muscles and joints in the hand. Other exercises are used to improve fine motor control and dexterity. Some of the exercises you'll do are designed to get your hand working in ways that are similar to your work tasks and sport activities.

Your therapist will help you find ways to do your tasks that don't put too much stress on your hand and wrist. Before your therapy sessions end, your therapist will teach you a number of ways to avoid future problems.

Surgery, per se, may be a thing of the past for carpal tunnel syndrome. Here's why...

A much newer and much less invasive technique that has excellent results is percutaneous ultrasound guided release. In this technique, a small needle is inserted using local anesthetic. Using ultrasound guidance, multiple small holes are made in the flexor retinaculum (the tough fibrous roof over the carpal tunnel that compresses the median nerve). At the same time, fluid is injected into the retinaculum to spread and weaken the fibers. At the end of the procedure, the wrist is flexed (bent) and the weakened retinaculum is released. A splint is applied and the patient has full use of their hand by the next day.

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