Carpal Tunnel Syndrome:
Conservative:
Pt. is fitted with a wrist splint to be worn when sleeping with wrist in neutral. Pt. is instructed in tendon gliding exercises and instructed to perform exercises 3-4 times daily. Pt. is educated in how to minimize symptoms by improving wrist positioning during ADLs, avoiding a sustained grip and pinch especially with wrist flexed and reducing repetitive overuse of wrist during ADLs. Pt. is instructed in ergonomic considerations that may apply to their situation. Pt. may require therapy for modalities to help decrease pain and to learn exercises and precautions depending on the patient and their situation.
Surgical Release:
10-14 days post-op: Initiation of Tendon gliding and AROM of the wrist, heat/pain modalities, scar massage and desensitization
3 weeks post-op: Initiation of light putty exercises for gripping/pinching and progression of strengthening as tolerated. Ultrasound may be beneficial if scar is thick.
4-6 weeks post-op: Strengthening is progressed to include weights in addition to continued scar maturation techniques and desensitization if needed.
Cubital Tunnel Syndrome:
Conservative:
Pt. is issued an elbow pad to be worn during the day and fitted with an elbow splint with elbow in 35-45 degrees of flexion to be worn when sleeping. Pt. is educated in how to decrease symptoms by minimizing repetitive motion at elbow, decreasing sustained positions with elbow in flexion and pressure to the posterior medial aspect of the elbow. Pt. is instructed in ergonomic considerations that may apply to their situation.
Surgical Release:
1-2 weeks post-op: Initiation of AROM to elbow and forearm, heat/pain modalities, scar massage
3-4 weeks post-op: May initiate gentle strengthening and progression as tolerated. Initiation of PROM if needed.
Submuscular Ulnar Nerve Transposition
3 weeks post-op: Initiation of AROM of elbow, forearm and wrist, heat/pain modalities,scar massage
5 weeks post-op: AAROM may be added to therapy program.
6 weeks post-op: PROM may be added to therapy program. Initiation of gentle strengthening and progression as tolerated. Elbow extension splinting may be added at this time if needed.
