The carpal tunnel is a narrow passageway on the palm side of the wrist through which the median nerve travels. Compression of the median nerve within the carpal tunnel can occur due to local swelling related to overuse of the wrist and fingers, or trauma to the area. Median nerve compression within the carpal tunnel can lead to pain, numbness, tingling and weakness in the hand and lower arm. If these symptoms are severe and do not respond to other treatment, surgery may be necessary to relieve pressure on the median nerve. Physical therapy is employed after surgery to promote healing, increase range of motiion and strength, and reduce possible exaggerated sensitivity. Follow your healthcare provider's instructions regarding what physical therapy is best for you.
Range of Motion
Range-of-motion exercises restore movement to the fingers and wrist after carpal tunnel surgery. Tendon-gliding exercises are examples of this type of postoperative physical therapy. Nine tendons travel through the carpal tunnel, connecting muscles in the lower arm to the fingers they move. Common tendon-gliding exercises include making a hook fist -- bending only the finger knuckles inward so that the tip of each finger rests against the lower part of the finger; flat fist -- bending the fingers flat straight against the palm; and full fist -- bending all of the finger joints inward to the palm. Thumb exercises include bending the thumb toward the palm, touching it to the tip of each finger, and lifting the thumb up and outward to the side. Wrist range-of-motion exercises may also be performed to help reduce stiffness after carpal tunnel surgery.
Inflammation in the carpal tunnel may cause the median nerve to adhere to the surrounding tissues. Nerve-gliding exercises improve movement of the median nerve. The median nerve is glided through a series of hand and finger positions to improve and sustain its mobility after carpal tunnel surgery. Beginning with the wrist straight and fingers in a fist, the fingers are first straightened, then the wrist is bent backward. The thumb is moved out to the side and the forearm is rotated into a palm-up position. Then a gentle stretch is applied to the thumb using the opposite hand.
Strengthening exercises after carpal tunnel surgery release and target the small muscles that bend the thumb into the palm, oppose it against other fingers, and move it outward to the side. These muscles are powered by the median nerve and may become weak from median nerve compression.These exercises, which include grip-strengthening exercises, typically start 3 to 4 weeks after surgery and can be performed with exercise putty, rubber bands or other hand-specific exercise equipment.
After carpal tunnel surgery, people may experience uncomfortable, increased sensitivity at the site of the surgery and in the fingers whose sensation comes from the median nerve -- the palm side of the thumb, index and middle fingers, and half of the ring finger. Desensitization physical therapy exposes these areas of the hand to different textures until they are no longer irritating to the touch. Items such as a towel, cotton ball, pencil eraser, popcorn kernels, beans and dry rice may be used for desensitization. These items are typically gently rubbed on the sensitive skin several times daily for up to 15 minutes until sensation returns to normal.
Reviewed and revised by: Tina M. St. John, M.D.