Choosing Wisely:

Avoid routine use of therapy following carpal tunnel release.

Rationale and Comments: Routine postoperative therapy after carpal tunnel release was examined in two moderate-quality studies. These studies (Pomerance 2007 and Provinciali 2000) addressed the need for supervised therapy in addition to a home program in the early postoperative period. The studies compared in-clinic or therapist-supervised exercise programs in addition to a home program to a home program alone. The studies were somewhat limited by an incomplete description of who delivered home programs, exercise/education content and dosage, and treatment progression. Pomerance (2007) compared a two-week program directed by a therapist combined with a home program alone and found no additional benefit in terms of grip or pinch strength in comparison to the home program alone. Provinciali (2000) compared one-hour sessions over 10 consecutive days of in-clinic physiotherapy comprising a multimodal program with a home program that was progressed in terms of strength/endurance. No benefit was found in outcome when measured by a carpal tunnel syndrome-specific patient reported instrument.
Sponsoring Organizations:
  • American Academy of Orthopaedic Surgeons
  • Sources:
  • Randomized controlled trials
  • Disciplines:
  • Orthopedic
  • References: • Pomerance J, Fine I. Outcomes of carpal tunnel surgery with and without supervised postoperative therapy. J Hand Surg Am. 2007;32(8):1159-1165.
    • Provinciali L, Giattini A, Splendiani G, Logullo F. Usefulness of hand rehabilitation after carpal tunnel surgery. Muscle Nerve. 2000;23(2):211-216.

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