Postoperative management following carpal tunnel release surgery: principles of rehabilitation

The patient with an unsatisfactory result following carpal tunnel release is fortunately the exception rather than the rule. The vast majority of appropriately selected and treated patients will recover uneventfully without the need for extensive therapy. Although uncommon, the dissatisfied patient presents an extremely difficult management problem. Inasmuch as there are a number of factors that may potentially contribute to a poor result, failure to recognize and treat excessive edema and stiffness in the early postoperative period are responsible for a significant percentage of poor results. Patients with a poor result present with three basic signs or symptoms, which may occur in combination or alone. These signs and symptoms include excessive edema, stiffness, and hypersensitivity. If left untreated, these are the patients who will go on to develop persistent median nerve symptoms, stiffness, and possibly even reflex sympathetic dystrophy or sympathetically mediated pain. If identified early and placed in an appropriate therapy program, most of these patients will receive the proper treatment and will ultimately be satisfied with their result. The author presents here a protocol for the postoperative management of the patient who has undergone carpal tunnel release surgery, with emphasis on the recognition and treatment of those patients at risk for a poor result.