Skip to content

Patients › Rehabilitation

Liberación del túnel carpiano

PDF Evidence

Post-operative exercises and precautions after carpal tunnel release, including tendon and nerve glides.

Updated Jun 2026
Ilustración de un terapeuta de mano masajeando la palma de una mano abierta sobre una mesa.
Terapia de la mano para suavizar la cicatriz y recuperar la movilidad tras la liberación del túnel carpiano. Kieran Hirpara 4.0

Esta página se tradujo automáticamente y todavía no la ha revisado un médico. La versión en inglés es la versión oficial.

Este protocolo le servirá de guía durante su recuperación tras la liberación del túnel carpiano realizada por el Dr. Kieran Hirpara en el Mater Private Hospital Rockhampton. Explica qué puede esperar mientras cicatriza la herida, las precauciones que debe tomar durante las primeras semanas y el programa de ejercicios destinado a mantener el correcto deslizamiento de los nervios y tendones mientras todo se normaliza. Lleve esta página o su versión en PDF a su fisioterapeuta o terapeuta de mano para garantizar una rehabilitación coordinada.

Si tiene alguna duda respecto a la herida después de la cirugía, no dude en contactar con nuestra consulta. A menudo resulta útil tomar una fotografía de la herida y enviarla por correo electrónico para su revisión.

Qué esperar

El cuidado de la herida se explica en la guía de cuidado de heridas de la consulta. En la muñeca, el nervio y los tendones discurren muy cerca unos de otros, justo en la zona donde se produce la cicatrización; por eso los ejercicios de esta página son fundamentales: mantener el deslizamiento del nervio y los tendones evita que se adhieran al tejido en proceso de curación.

Los bordes de la zona donde se liberó el ligamento permanecen sensibles durante al menos cuatro a seis semanas. También es común sentir sensibilidad a ambos lados de la palma (donde el ligamento se inserta en los huesos); esto se conoce como “dolor de pilares” y desaparece gradualmente. En realidad, el ligamento no debe volver a unirse: el tejido cicatricial forma un “pseudoligamento” que cumple la misma función; por eso la liberación del ligamento permite descomprimir el nervio sin dejar la muñeca inestable.

Los estudios realizados con pacientes tras la liberación del túnel carpiano muestran cómo disminuye esta sensibilidad de forma predecible: aproximadamente cuatro de cada diez personas aún experimentan molestias tipo “dolor de pilares” un mes después de la cirugía; alrededor de una de cada cuatro, a los tres meses; y a los doce meses, prácticamente todas las manos ya no presentan este síntoma (Povlsen & Tegnell, 1996). Por lo tanto, si aún siente sensibilidad en los laterales de la palma unas semanas después de la operación, se trata de un proceso normal de curación, no de una complicación.

La recuperación de la fuerza de la mano sigue una curva bien documentada. En un estudio muy citado, la fuerza de agarre era aproximadamente un 25 % del nivel preoperatorio a las tres semanas de la cirugía; a las seis semanas, alcanzaba el 75 %; a los tres meses volvía al nivel previo y, a los seis meses, incluso lo superaba. La fuerza de pinza se recupera antes, llegando casi al nivel preoperatorio a las seis semanas (Gellman et al., 1989). Por eso es normal observar una disminución temporal de la fuerza de agarre en las primeras semanas; esto se debe al proceso de cicatrización del ligamento y de la palma, no a ningún problema quirúrgico; la fuerza se recupera a medida que disminuye el dolor de pilares.

El movimiento temprano es una estrategia deliberada y está respaldada por la evidencia científica. Las guías clínicas actuales indican que, tras la liberación del túnel carpiano, no es necesario mantener la muñeca inmovilizada con férula de forma rutinaria (AAOS, 2024); los protocolos de los centros de mano recomiendan iniciar de inmediato movimientos activos de dedos, pulgar y muñeca para favorecer el deslizamiento de tendones y nervio mediano mientras cicatriza la herida. Una revisión Cochrane sobre la rehabilitación post‑cirugía de túnel carpiano concluyó que la recuperación suele ser sencilla y que no existe un tratamiento complementario con evidencia sólida; por eso este programa de ejercicios es sencillo, y su terapeuta lo adaptará según la evolución de su propia mano (Peters et al., 2016).

Durante la primera semana, mantenga la mano elevada por encima del nivel del corazón siempre que sea posible; menos hinchazón significa menos dolor y un mejor deslizamiento del nervio. Su terapeuta también podría aplicar vendajes compresivos o cintas adhesivas (Coban, Tubigrip o cinta kinesiológica) para controlar la inflamación y sostener el arco de la palma.

Una vez que la herida haya cicatrizado, aplique calor a la mano durante 20 minutos antes de realizar estos ejercicios; después de terminarlos, puede aplicar hielo para prevenir inflamación.

En ocasiones la mano o la zona de la herida se vuelven sensibles; esto es normal y se puede prevenir o aliviar mediante una desensibilización diaria: toque y masaje suave sobre la herida (o el vendaje) y la palma, empezando inmediatamente después de la cirugía. Esta “retroalimentación sensorial” ayuda al nervio a volver a interpretar el tacto y la textura de forma normal. Las sesiones cortas y frecuentes son las más eficaces (por ejemplo, 2–3 minutos cada hora); su terapeuta le proporcionará una almohadilla de silicona o un guante para favorecer la curación de la cicatriz y reducir la sensibilidad.

Una vez que la herida esté completamente curada, comience el masaje de la cicatriz: realice círculos firmes sobre la incisión. En la página de cuidado de heridas encontrará más información sobre el manejo de cicatrices.

Volver al trabajo y a las actividades cotidianas

La mayoría de las personas regresan al trabajo unas pocas semanas después de la liberación del túnel carpiano; el momento exacto depende principalmente de las exigencias laborales que requieran el uso de la mano. Una revisión sistemática de 56 estudios reveló que quienes desempeñan labores de oficina o no manuales volvieron al trabajo en un promedio de tres semanas tras la cirugía (el rango reportado fue de una a seis semanas); en cambio, quienes realizan trabajos manuales lo hicieron en un promedio de unas cinco semanas y media (el rango reportado fue de tres a catorce semanas). Muchos volvieron antes, asumiendo tareas modificadas o menos exigentes, antes de retomar sus funciones habituales (Newington et al., 2018). Considere estas cifras como una guía, no como un plazo fijo: el momento adecuado para usted dependerá de la evolución de su herida, su comodidad y las precauciones que se detallan a continuación.

Como guía práctica, normalmente estará listo para retomar una tarea específica cuando:

  • la herida haya cicatrizado y soporte la presión o el contacto que dicha tarea implica;
  • pueda utilizar la mano cómodamente para cumplir con los requisitos de la tarea, respetando las precauciones indicadas; y
  • cualquier actividad que requiera agarre fuerte, levantamiento de pesos o exposición a vibraciones se posponga hasta que se levanten dichas precauciones.

Si su trabajo es físicamente exigente, repetitivo o implica el uso de herramientas vibratorias, coméntelo durante su revisión postoperatoria para que se pueda planificar una fecha de retorno y, si es necesario, tareas modificadas en el ínterin, en coordinación con su empleador.

Precauciones y limitaciones

Se recomienda un uso funcional moderado de la mano para tareas cotidianas como el aseo personal, la alimentación, el vestirse, la escritura y el mecanografiado. Más allá de eso, durante las primeras semanas se aplican las siguientes limitaciones:

  • No se permite levantar objetos, realizar agarres, soportar peso ni utilizar maquinaria vibratoria (por ejemplo, herramientas eléctricas o cortadoras de césped) durante las primeras 6 semanas tras la cirugía.
  • La conducción está restringida durante las primeras 1–2 semanas, o hasta que pueda cerrar el puño por completo.

Para su fisioterapeuta:

Manejo

  • Cuidado de la herida según las pautas de cuidado de heridas del consultorio.
  • Elevar la mano por encima del nivel del corazón tanto como sea posible durante la primera semana; usar vendajes compresivos o cintas adhesivas (Coban, Tubigrip, cinta kinesiológica) para controlar la hinchazón y brindar soporte al arco carpiano según sea necesario.
  • Realizar ejercicios de deslizamiento tendinoso y del nervio mediano según las fichas de ejercicios siguientes, para prevenir adherencias del nervio y los tendones durante la cicatrización.
  • Una vez cicatrizada la herida: aplicar calor en la mano durante 20 minutos antes de los ejercicios; aplicar hielo después de los ejercicios para evitar la inflamación.
  • Desensibilización diaria a partir del día posterior a la cirugía: golpeteo o frotamiento suave sobre la herida (vendaje) y la palma, para ayudar al nervio a normalizar su respuesta al tacto y a las texturas.
  • Masaje de la cicatriz (círculos firmes sobre la incisión) una vez que la herida esté totalmente curada.

Precauciones

  • Se recomienda un uso funcional moderado de la mano para actividades de la vida diaria (aseo personal, alimentación, vestirse, escritura, mecanografiado).
  • No se permite levantar objetos, realizar agarres, soportar peso ni utilizar maquinaria vibratoria (p. ej., herramientas eléctricas, cortadoras de césped) durante las primeras 6 semanas tras la cirugía.
  • La conducción está restringida durante las primeras 1–2 semanas, o hasta que pueda cerrar el puño por completo.

Notas basadas en evidencia

  • Inmovilización: existe evidencia moderada en contra del uso rutinario de férulas postoperatorias tras la liberación del túnel carpiano (AAOS CPG, 2024); el movimiento activo temprano según las fichas de ejercicios es el enfoque recomendado.
  • Adyuvantes de rehabilitación: la revisión Cochrane halló evidencia limitada y de baja certeza respecto a tratamientos de rehabilitación individuales tras la liberación del túnel carpiano (Peters et al., 2016); se debe adaptar el programa a cada paciente en lugar de seguir protocolos fijos.
  • Recuperación de la fuerza: se espera que la fuerza de agarre alcance aproximadamente el 28 % del nivel preoperatorio a las 3 semanas y el 73 % a las 6 semanas; volverá al nivel previo a los 3 meses y superará dicho nivel a los 6 meses; la fuerza de pinza se recupera más rápido (≈96 % a las 6 semanas) (Gellman et al., 1989).
  • Regreso al trabajo: el tiempo promedio es de 21 días para trabajos no manuales (rango 7–41) frente a 39 días para trabajos manuales (rango 18–101); las tareas modificadas pueden iniciarse antes (Newington et al., 2018).
  • Dolor en la zona de los pilares: se reporta en aproximadamente el 41 % a los 1 mes, el 25 % a los 3 meses y el 6 % a los 12 meses tras la liberación abierta del túnel carpiano (Povlsen & Tegnell, 1996).

Estos son los ejercicios descritos en su folleto; deben realizarse tal como se indica en cada ficha. Este programa de ejercicios se elaboró en colaboración con Sarah Farrell, BOccThy AHT (terapeuta ocupacional y terapeuta de mano acreditada), con orientación postoperatoria adicional de Ruby Doolan, Terapeuta de Mano Acreditada, Extend Rehabilitation.

Sus ejercicios

Estos son los ejercicios que aparecen en su folleto. Comience a realizarlos únicamente bajo la guía del Dr. Hirpara y de su terapeuta especializado en mano, respetando siempre los rangos y límites que le hayan indicado. El estiramiento de la muñeca y las dos series de deslizamientos tendinosos ayudan a mantener los tendones y el nervio liberado en movimiento, evitando que se adhieran a la cicatriz en proceso de curación; estos ejercicios se inician tempranamente, siempre dentro de lo cómodo para usted. Los deslizamientos del nervio mediano se añaden para que el nervio siga deslizándose en lugar de quedar adherido, mientras que la oposición del pulgar recupera la capacidad de pinzar, que suele estar debilitada previamente. Es normal sentir sensibilidad directamente sobre la cicatriz en la palma durante algunas semanas. Interrumpa cualquier ejercicio que provoque dolor agudo o una sensación eléctrica en los dedos.

Después de seguir este protocolo

Este protocolo complementa las recomendaciones generales de recuperación de la clínica: consulte control del dolor postoperatorio, cuidado de la herida y conceptos básicos de la terapia de la mano. En cuanto a la intervención quirúrgica en sí, consulte liberación del túnel carpiano.

Referencias

[1] Peters S, Page MJ, Coppieters MW, Ross M, Johnston V. Rehabilitación tras la liberación del túnel carpiano. Cochrane Database of Systematic Reviews. 2016;2:CD004158. https://pubmed.ncbi.nlm.nih.gov/26884379/ [2] Academia Estadounidense de Cirujanos Ortopédicos. Manejo del síndrome del túnel carpiano: guía de práctica clínica basada en evidencia. Actualización de 2024. https://www.aaos.org/quality/quality-programs/upper-extremity-programs/carpal-tunnel-syndrome/ [3] Newington L, Stevens M, Warwick D, Adams J, Walker-Bone K. Ausencia laboral tras la liberación del túnel carpiano: revisión sistemática de la literatura. Scand J Work Environ Health. 2018;44(6):557–567. https://pmc.ncbi.nlm.nih.gov/articles/PMC6215485/ [4] Gellman H, Kan D, Gee V, Kuschner SH, Botte MJ. Análisis de la fuerza de pinza y de agarre después de la liberación del túnel carpiano. J Hand Surg Am. 1989;14(5):863–864. https://pubmed.ncbi.nlm.nih.gov/2794407/ [5] Departamento de Servicios de Rehabilitación del Brigham and Women’s Hospital. Estándar de atención: liberación del túnel carpiano. 2007 (datos sobre la evolución natural del dolor según Povlsen & Tegnell, 1996). https://www.brighamandwomens.org/assets/BWH/patients-and-families/rehabilitation-services/pdfs/wrist-carpal-tunnel-release-pt.pdf

Reviewed by Dr Kieran Hirpara · 10 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Carpal Tunnel Release — Procedure Outcomes & Post-operative Rehabilitation (Open / Endoscopic Decompression)

Topic scope: post-operative rehabilitation after surgical decompression of the median nerve at the wrist by division of the transverse carpal ligament — open or endoscopic carpal tunnel release. This is a decompression, not a reconstruction: nothing is repaired or tightened, so the rehab is an early-motion pathway built around oedema control, scar/desensitisation work, and tendon + median-nerve gliding rather than months of protected healing.

Defining principle of the rehab here: carpal tunnel release relieves nerve compression and does not create a construct that needs protection. The divided ligament is meant to stay divided — a scar "pseudo-ligament" reconstitutes the carpal arch without re-tethering the nerve. So (unlike a tendon or ligament repair) immediate, unrestricted light use is the default, and the only deliberate restraint is a short window of heavy-load/grip/vibration avoidance while the palm and ligament edges heal. The therapy programme exists to keep the median nerve and flexor tendons gliding through the healing surgical bed so they do not adhere — not to immobilise. The single branch point is whether a concurrent procedure (e.g. flexor tenosynovectomy, revision with a fat-pad flap) was performed, which can extend the protected/oedema phase.

A. PROCEDURE OUTCOMES (open vs endoscopic)

Carpal tunnel release is one of the most reliable operations in upper-limb surgery: the great majority of patients obtain durable symptom relief, and the principal debate is over access (open vs endoscopic), not whether to decompress.

  • Both open and endoscopic release give equivalent long-term outcomes. Randomised comparisons and meta-analyses find no meaningful difference in symptom relief, function or patient satisfaction at long-term follow-up between open and single- or dual-portal endoscopic release. Endoscopic release offers a modestly faster early recovery and earlier return to work at the cost of a small increase in transient nerve-related events; by 5 years the two converge [HAND meta-analysis 2022; J Hand Surg 5-year RCT 2009; J Bone Joint Surg RCT 1994]. Strong (RCTs/SR).
  • Symptom relief is high and durable. Night symptoms and paraesthesiae typically resolve early; numbness and thenar weakness recover more slowly and may be incomplete where compression was long-standing. Five-year and elderly-cohort series confirm sustained benefit, including in patients over 65 [J Hand Surg 5-yr follow-up; elderly cohorts]. Moderate–strong.
  • Division of the transverse carpal ligament alters carpal-tunnel biomechanics (canal volume increases; the flexor tendons shift volarly), which is the anatomical basis for pillar pain and the transient grip-strength dip — both expected, self-limiting consequences of the decompression rather than complications [Clinical Biomechanics 2003]. Mechanistic.

B. REHABILITATION / THERAPY EVIDENCE

The central rehab questions are (1) should the wrist be immobilised afterwards, and (2) does routine formal hand therapy change the outcome. The evidence answers no to routine splinting and no to mandatory protocolised therapy — while supporting a simple, early-motion, glide-based home programme.

  • Routine post-operative splinting is NOT recommended. Moderate-quality evidence (AAOS 2024 CPG; supporting systematic reviews) finds wrist immobilisation by sling/orthosis after release does not improve pain, grip or function and may delay recovery. Early active motion is the intended default. Moderate (CPG + SR).
  • No single rehab adjunct has strong supporting evidence. The Cochrane review of rehabilitation following carpal tunnel release found only limited, low-certainty evidence for any individual add-on — orthoses, dressings, exercise, cold/ice, multimodal hand therapy, laser, electrotherapy, scar desensitisation or arnica. Recovery is usually straightforward; the implication is to keep the programme simple and individualise it rather than protocolise adjuncts [Peters et al., Cochrane 2016]. Moderate (Cochrane SR — of low-certainty primary evidence).
  • Tendon- and nerve-gliding exercises are biologically and clinically rationalised. The rationale is that wrist/digit motion produces longitudinal excursion of the median nerve through the surgical bed, preventing adhesion of nerve to flexor tendons; ultrasound studies confirm measurable nerve excursion during gliding exercises, and comparative-effectiveness work supports tendon/nerve gliding and neural mobilisation as low-risk adjuncts [Am J Phys Med Rehabil 2011; J Hand Therapy 2008 (excursion; neural mobilisation)]. The benefit is modest and the adhesion-prevention purpose is mechanistic/consensus rather than proven by hard outcome trials. Weak–moderate (mechanism strong, outcome modest).
  • Supervised therapy is not required for most patients. Outcome series using a standard protocol with a single hand-therapy visit and a home programme report good patient-reported outcomes, supporting selective rather than universal formal therapy. Moderate (cohort).

Recovery trajectory (expected, evidence-anchored)

Phase Window Restraint Hand use / therapy focus Strength / load Notes
I — Early motion & oedema control Week 0–1 None routine (no splint) Elevate above heart level; immediate active finger/thumb/wrist motion; tendon + median-nerve glides; desensitisation from day 1; compressive dressing/taping for swelling Light functional use only Less swelling → freer nerve. Grip is expected to be low
II — Wound & ligament healing Week 1–6 Heavy-load avoidance Continue glides; add scar massage once wound healed; heat before / ice after exercises No lifting, gripping, weight-bearing or vibrating-tool use up to 6 weeks; driving from ~1–2 weeks (once a full fist is achievable) Pillar tenderness peaks then settles; grip ≈¼ pre-op at 3 wk, ≈¾ by 6 wk
III — Return to load & work Week 6–12+ Restrictions lifted Progress gripping, lifting and task-specific loading Grip back to pre-op by ~3 months, exceeding it by ~6 months; pinch recovers sooner (≈ pre-op by 6 wk) Non-manual work median ~3 wk; manual work median ~5–6 wk, earlier on modified duties

(Phase windows mirror the precautions and recovery-curve figures in the patient protocol; they are typical guides, not trial-derived deadlines.)

C. KEY CONTROVERSIES / EVIDENCE QUALITY

  1. Open vs endoscopic. Equivalent long-term outcomes; endoscopic buys a faster early recovery for a small transient-complication trade-off. Choice is largely surgeon/patient preference and cost. Strong evidence of equivalence.
  2. To splint or not. Older practice favoured post-operative wrist splinting; current moderate-quality evidence and the AAOS 2024 CPG advise against routine immobilisation. This page's no-splint, early-motion default reflects the current guideline. Moderate.
  3. Does formal therapy change outcomes? No rehab adjunct has high-certainty benefit (Cochrane). Gliding exercises rest on a sound mechanistic (adhesion-prevention, nerve-excursion) rationale but modest outcome data. The defensible position is a simple home programme + selective therapy, not universal supervised rehab. Weak–moderate.
  4. Pillar pain & grip dip are expected, not failure. Both follow predictably from dividing the transverse carpal ligament and resolve on a well-described curve; mislabelling them as complications drives unnecessary anxiety. Strong natural-history data.
  5. Recurrence/revision is uncommon but real; persistent symptoms warrant assessment for incomplete release, the wrong diagnosis, or a second compression site rather than more of the same therapy [JAAOS recalcitrant-CTS review; revision-rate series]. Moderate.

D. EVIDENCE STRENGTH FLAGS (summary)

  • STRONG (RCT / SR): equivalence of open vs endoscopic release at long-term follow-up (faster early recovery with endoscopic); high, durable symptom relief from decompression.
  • MODERATE: AAOS 2024 CPG against routine post-operative splinting; Cochrane review (limited, low-certainty evidence for any single rehab adjunct → keep it simple); biomechanical basis of pillar pain / grip dip; uncommon but defined revision rate.
  • WEAK / CONSENSUS: the specific early-motion, glide-based therapy programme (mechanistically rationalised, outcome benefit modest; surgeon/hand-therapist protocols); exact phase timings (typical, not trial-derived).

CITATIONS

RAG corpus (180,000+ Orthopaedic articles)

  • Open versus single- or dual-portal endoscopic carpal tunnel release: a meta-analysis of randomized controlled trials. HAND. 2022. DOI: 10.1177/15589447221075665
  • Open compared with 2-portal endoscopic carpal tunnel release: a 5-year follow-up of a randomized controlled trial. J Hand Surg Am. 2009. DOI: 10.1016/j.jhsa.2008.10.026
  • Carpal tunnel release: a randomized comparison of three surgical methods. J Hand Surg (Eur Vol). 2013. DOI: 10.1177/1753193412475247
  • Carpal tunnel release. A prospective, randomised assessment of open and endoscopic methods. J Bone Joint Surg. 1994. DOI: 10.2106/00004623-199408000-00020
  • Five-year follow-up of carpal tunnel release in patients over age 65. J Hand Surg Am. 2010. DOI: 10.1016/j.jhsa.2009.10.020
  • Carpal tunnel syndrome (clinical review). BMJ. 2014. DOI: 10.1136/bmj.g6437
  • Biomechanical and anatomical consequences of carpal tunnel release. Clin Biomech. 2003. DOI: 10.1016/s0268-0033(03)00052-4
  • The comparative effectiveness of tendon and nerve gliding exercises in patients with carpal tunnel syndrome. Am J Phys Med Rehabil. 2011. DOI: 10.1097/phm.0b013e318214eaaf
  • The effects of neural mobilization in addition to standard care in persons with carpal tunnel syndrome. J Hand Ther. 2008. DOI: 10.1197/j.jht.2007.12.001
  • The excursion of the median nerve during nerve gliding exercise: an observation with high-resolution ultrasonography. J Hand Ther. 2008. DOI: 10.1197/j.jht.2007.11.001
  • Effective self-stretching of carpal ligament for the treatment of carpal tunnel syndrome: a double-blinded randomized controlled study. J Hand Ther. 2020. DOI: 10.1016/j.jht.2019.12.002
  • Use of conservative therapy before and after surgery for carpal tunnel syndrome. BMC Musculoskelet Disord. 2021. DOI: 10.1186/s12891-021-04378-3
  • Power grip, pinch grip, manual muscle testing or thenar atrophy — which should be assessed as a motor outcome after carpal tunnel decompression? A systematic review. BMC Musculoskelet Disord. 2007. DOI: 10.1186/1471-2474-8-114
  • Management of recalcitrant carpal tunnel syndrome. J Am Acad Orthop Surg. 2019. DOI: 10.5435/jaaos-d-18-00004
  • The rate and timing of revision carpal tunnel release with long-term follow-up. J Hand Surg Am. 2026. DOI: 10.1016/j.jhsa.2026.02.006
  • Does aging matter? The efficacy of carpal tunnel release in the elderly. Arch Plast Surg. 2015. DOI: 10.5999/aps.2015.42.3.278

Carpal tunnel rehabilitation literature (URLs)

  • Peters S, et al. Rehabilitation following carpal tunnel release. Cochrane Database Syst Rev. 2016;2:CD004158. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004158.pub3/full
  • O'Connor D, et al. Rehabilitation treatments following carpal tunnel surgery (original Cochrane review). 2003. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004158/full
  • American Academy of Orthopaedic Surgeons. Management of Carpal Tunnel Syndrome — Evidence-Based Clinical Practice Guideline (2024 update; moderate evidence against routine post-operative immobilisation). https://www.aaos.org/quality/quality-programs/upper-extremity-programs/carpal-tunnel-syndrome/
  • Wrist immobilization after surgical decompression of the median nerve in carpal tunnel syndrome: a systematic review. PMC. 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11374399/
  • Sensory nerve conduction velocity predicts improvement of hand function with nerve gliding exercise following carpal tunnel release surgery. PMC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8470096/
  • Patient-reported outcomes after open carpal tunnel release using a standard protocol with 1 hand therapy visit. J Hand Ther / ScienceDirect. https://www.sciencedirect.com/science/article/abs/pii/S089411301630031X

Published rehab protocols (patient-guidance — basis for the early-motion phase structure)

  • Bakker — Carpal Tunnel Release Post-op Protocol (Twin Cities Orthopedics). https://tcomn.com/wp-content/uploads/2017/11/Carpal-tunnel-release-protocol.pdf
  • University of Virginia — Carpal Tunnel Release Open Protocol and Home Exercise Program. https://med.virginia.edu/orthopaedic-surgery/wp-content/uploads/sites/242/2015/11/copy_of_CTROPENProtocolandHEP.pdf
  • Brigham and Women's Hospital, Department of Rehabilitation Services. Standard of Care: Carpal Tunnel Release (pillar-pain natural history after Povlsen & Tegnell 1996; grip-recovery after Gellman 1989). https://www.brighamandwomens.org/assets/BWH/patients-and-families/rehabilitation-services/pdfs/wrist-carpal-tunnel-release-pt.pdf

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.