Carpal Tunnel Syndrome (CTS) occurs when the median nerve, which runs through a narrow passage in the wrist, becomes compressed. When non-surgical treatments fail, Carpal Tunnel Release surgery cuts the ligament to relieve pressure on that nerve. The long-term success of the procedure relies heavily on structured post-operative exercise. These movements are essential for preventing the formation of restrictive scar tissue and ensuring the newly freed nerve can move smoothly. A phased rehabilitation program helps patients restore range of motion and strength to the hand and wrist.
The Timeline for Starting Movement
The timing for beginning post-surgical movement is determined by the need to protect the incision while encouraging tissue recovery. In the first few days, the hand is protected by a dressing or splint, and the focus is rest and managing swelling. Most surgeons recommend beginning gentle finger and thumb movement almost immediately, often on the first day, to prevent stiffness.
The first major transition occurs around one to two weeks post-surgery, often when the external stitches are removed and the wound closure is stable. At this point, the focus shifts to incorporating light, active range-of-motion exercises for the wrist, moving beyond the initial finger-only phase. During this early stage, patients must avoid activities that place stress on the palm, such as forceful gripping or lifting anything heavier than one to two pounds. Progression will be guided by the healing of the incision and the specific advice of the hand therapist or surgeon.
Early Mobility and Nerve Gliding Drills
The earliest phase of exercise promotes mobility in the tendons and the median nerve without straining the healing carpal ligament. These initial movements are performed without external resistance and should be done frequently, such as five to ten repetitions every hour.
A foundational exercise is the Tendon Gliding sequence, which involves a specific progression of hand positions:
- Starting with a straight hand.
- Moving to a hook fist (bending only the furthest two finger joints).
- Then a gentle flat fist (bending at all three finger joints).
- Finally a full, but loose, fist.
Another important movement is the Median Nerve Glide, which aims to mobilize the nerve through the carpal tunnel, preventing it from becoming tethered by scar tissue. A common glide involves holding the arm straight out with the palm up, gently bending the wrist back, and then slowly tilting the head away from the hand. This subtle movement “flosses” the nerve along its path from the neck to the fingertips. Patients should also focus on simple Finger and Thumb Opposition, gently touching the tip of the thumb to the tip of each finger in sequence to restore fine motor coordination. All initial movements must be performed within a comfortable range, stopping before any sharp pain is felt.
Transitioning to Strength and Grip Work
The shift to strengthening exercises begins around four to six weeks post-operation, once the incision is fully healed and pain-free range of motion is restored. Rebuilding strength is a gradual process, as grip strength is often reduced and can take several months to fully return. The primary goal is to recondition the forearm and hand muscles, which may have weakened due to nerve compression and subsequent rest.
Resistance training starts with low-level isometric contractions, such as gently squeezing a soft stress ball or therapy putty for a few seconds. The initial effort should be minimal, perhaps 30% of maximum force, to avoid overstressing healing tissues. Exercises like Putty Sculpting are effective, molding the putty between the thumb and fingertips to strengthen pinch muscles. Light Wrist Curls, performed with the forearm supported and holding a small weight, such as a one-pound dumbbell, can also be introduced to rebuild wrist flexion and extension strength.
Recognizing Warning Signs During Exercise
While some soreness or achiness is expected during rehabilitation, patients must be aware of symptoms that signal a potential complication. Any sudden, sharp, or intense pain during an exercise requires the activity to stop immediately. Increased swelling, especially when accompanied by heat or spreading redness around the incision site, may indicate an infection and requires medical consultation. Patients should also monitor for a return of numbness or tingling that persists after resting, as this suggests a potential issue with the median nerve. Pillar pain, which is tenderness at the base of the palm, is common and usually temporary, but any new weakness that worsens over time should also be reported to the surgeon.