Carpal Tunnel Release Post-Op Protocol

UVA HAND CENTER – THERAPY Open Carpal Tunnel Release Post-Op Guidelines

1st Post-Op CTR Visit (3-5 days): 

Initial Visit with OT/PT:  Therapist removes post-op dressing – wound check  Application of sterile dry dressing (remain over incision at all times until suture removal)  Assess finger mobility  Educate patient on ROM for fingers and wrist (no wrist flexion or extension)  Instruct patient on suture site care, tendon glides, and edema control  Educate patient on splint regimen (full time except for exercises)

2nd Post-Op Visit (10-12 days)  Surgical follow-up visit with attending surgeon or physician assistant   

Sutures removed New sterile dressing applied Educate about keeping hand dry until 2 weeks post-op; continue to wear splint and reinforce no heavy lifting

SUTURES OUT WITH OT/PT at 14 days post operatively

3rd Post-Op Visit (3 weeks)  Therapy Visit  Insure proper wound healing, scar mobility, AROM  Instruct in scar management & issue cica care  Begin desensitization as needed.  Review ROM program  Add Nerve gliding program  Begin wrist flexion/extension  Wean from splint (wear at night for an additional week)  Begin gentle grip/pinch strengthening exercises (theraputty)

415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903

434-982-HAND (4263)

UVA HAND CENTER – THERAPY Carpal Tunnel Release Home Exercise Program Visit 1 (3-5 days post operatively) Carpal tunnel syndrome is compression of the nerve that gives you sensation to the thumb, index and middle fingers of your hand. Surgery for this compression is to release the ligament that causes the compression. Symptoms often times resolve quite quickly after surgery, but it may take time for the numbness to resolve.

As your body heals from surgery, there is a risk that scar tissue can build up around the tendons and nerve, making it hard to bend your fingers. For this reason, it is very important that you do the following exercises to prevent this from happening. Tendon Gliding Exercises

Perform this sequence of fists 10 repetitions, 5 times per day Post operative instructions: Wound Care  Keep your sutures covered at all times. A gauze roll works well for this.  If you notice drainage that is not clear, or have symptoms of heat and redness at the incision site that is getting worse – you should contact your therapist or physician’s office as soon as possible. Precautions  Avoid bending your wrist forward until you are 2 weeks post operatively, your splint will help with this. Splint  Wear your splint at all times until you see your therapist for the 2nd visit, this will rest your wrist and allow the wound to heal. Returning to Activities  Most patients can resume light use of their hand after surgery right away, but don’t perform heavy lifting, gripping or grasping at this time.

415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903

434-982-HAND (4263)

UVA HAND CENTER – THERAPY Carpal Tunnel Release Home Exercise Program Visit 2 (3 weeks post operatively) Now that you are 3 weeks post operatively, you should have most if not all of your range of motion back, but you will need to continue doing your tendon gliding exercises for at least the next 3 weeks, as your body continues to form scar. Tendon Gliding Exercises

Perform this sequence of fists 10 repetitions, 5 times per day Now that your incision is healed and we can be more vigorous with your wrist motion, it is important to glide the median nerve along it’s path to avoid it also being surrounded by scar tissue. That is done by performing this series of motions:

Repeat this sequence 5 repetitions, 5 times per day – Hold each position 10 seconds Post operative instructions: Scar Care  Massage your scar with lotion for 5 minutes 5 times per day. Use a moderately deep pressure to help flatten the scar and decrease its sensitivity to pressure.  Wear the silicone scar pad to sleep to help soften the scar while you sleep. Make sure your skin is clean and dry before applying the scar pad each night. You can wash it each morning with soap and water, and dry it with a CLOTH towel. Splint  Wear your splint at night until 6 weeks post operatively as needed for support. Returning to Activities  Most patients can resume full use of their hand after surgery by about 6 weeks post operatively, but please let your comfort be your guide. Do not repetitively perform activities that cause you pain. A gradual return to activities without pain is our goal.  If you do not feel that your strength is returning by the 6th week, please contact your therapist as you might need one more session to add hand strengthening to your home exercises.

415 Ray C Hunt Drive, Suite 3200 Charlottesville, VA 22903

434-982-HAND (4263)