Outcomes of carpal tunnel surgery with and without supervised postoperative therapy

To assess if a formal 2-week hand therapy improves outcomes and justifies its expense.

A prospective randomized study was completed using a contemporary short incision and a 2-week program of therapy. Patients were randomized into 2 treatment groups: one group received instruction on home therapy exercises to be followed after carpal tunnel release, and a second group received the home program in addition to a therapist-directed program for 2 weeks. Variables measured were patient age, gender, preoperative and postoperative pain scores, grip and pinch strengths, return to modified and regular work, insurance coverage, and job category. Both groups were followed for 6 months postoperatively.

One hundred fifty patients (110 women and 40 men) entered and completed the study. The average age was 46 years (range, 29-70 years). The average age, gender distribution, insurance coverage, and breakdown of job categories between groups was not statistically significant. There was no difference in return to work times between those with and without postoperative therapy; however, patients covered by workers' compensation insurance were slower to return to both modified and regular work compared with the other groups. The postoperative grip and pinch strengths, pain and Disabilities of the Arm, Shoulder, and Hand scores did not show statistical differences between groups at any of the measured time periods. Depending on insurance carrier, directed therapy added $600 to $900 to the cost of care.

The current randomized study failed to show benefit in a 2-week course of hand therapy after carpal tunnel release using a short incision. The cost of supervised therapy for an uncomplicated carpal tunnel release seems unjustified.