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Carpal Tunnel Release

Specialists

Ergonomist
Hand Surgeon
Occupational Therapist
Orthopedic (Orthopaedic) Surgeon
Physical Therapist
Plastic Surgeon

Comorbid Conditions

Cervical radiculopathy
Cervical spondylosis at C5-C6
Diabetes
Fluid retention with tissue swelling
High blood pressure
Hypothyroidism
Injury to the hand or wrist
Obesity
Renal failure
Rheumatoid arthritis
Tenosynovitis
Thoracic outlet syndrome

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Factors that alter the duration of disability include the severity of the individual’s case and the duration of symptoms before CTR was performed. The longer the median nerve was compressed, the longer it may take for the nerve to improve. Recovery times are variable. Any postoperative complications will increase length of disability. Length of disability relates to tolerance and hand activity (repetitive motion, awkward posture, grip force used) and may not directly relate to the amount of weight lifted.

Older individuals, those with severe preoperative symptoms, and individuals involved in heavy manual labor, especially those working with vibrating tools, have longer, slower recovery times from the procedure.

For individuals who seem to be unimproved or worse after surgery, postoperative nerve conduction studies should be obtained and compared to pre-operative nerve conduction studies. If the entire ligament was not cut, then pressure on the nerve may not have been released, and typically there will have been no improvement in the nerve conduction studies.

If carpal tunnel syndrome is present and sufficiently symptomatic bilaterally, then typically both sides are treated with surgery, but the second wrist is operated on 3–6 weeks after the first surgery. The timing of the disability duration in these cases should start on the date of the second surgery.

Duration Trends from Reference Data

DURATION TRENDS

ICD-9-CM: 04.43

Cases	Mean	Min	Max	No Lost Time	Over 6 Months
735	48	0	185	0.4%	0.3%

Percentile:	5^th	25^th	Median	75^th	95^th
Days:	10	26	42	66	109

Differences may exist between the duration tables and the reference graphs. Duration tables provide expected recovery periods based on the type of work performed by the individual. The reference graphs reflect the actual experience of many individuals across the spectrum of physical conditions, in a variety of industries, and with varying levels of case management. Selected graphs combine multiple codes based on similar means and medians.

Medical Codes

	ICD-9-CM:
	04.4 -	Lysis of Adhesions and Decompression of Cranial and Peripheral Nerves
	04.43 -	Lysis of Adhesions and Decompression of Cranial and Peripheral Nerves; Carpal Tunnel Release

Rehabilitation

Note on research and authorship

Individuals often receive therapy from an occupational therapist, a physical therapist, or a hand therapist. This can be helpful in regaining functions post surgery (Evans).

The progression of postoperative therapy is guided by wound healing principles and the tissue response to stress. Although controversy exists in the literature regarding the kind and the value of postoperative rehabilitation, therapy consistently focuses on the individual's preoperative status, surgical procedure, hand dominance, bilateral symptoms, associated conditions, and home and job requirements. Special attention must be paid during the recovery phase for signs of complex regional pain syndrome (Hayes).

Therapy addresses the anatomical regions adjacent to the surgical site and the specific needs for the postoperative care. The overall aim is to restore performance of usual and customary hand function that is both comfortable and safe. The adjacent anatomical regions are monitored for maintenance of full movement, strength patterns, and bodily posture.

For the surgical site itself, the first objective of therapy is to educate the individual on how to control pain and swelling. Thermal modalities may be used to increase muscle flexibility, to decrease pain, and to reduce edema. Individuals learn to perform scar massage to decrease the risk of forming painful adhesions (Evans; Hayes).

The second objective of therapy is to restore any lost range of motion at the wrist and hand that corresponds with the postoperative recovery plan; attention is also directed to safe body mechanics to protect the surgical site during healing while engaging in routine daily activities. Dynamic movement patterns are then progressed, and the individual is educated in safe patterns for exercise and activity related to CTS (Evans; Provinciali).

Concurrently, once the postoperative edema has resolved, a third objective is to monitor hand sensation, and provide a sensory re-education program.

The final objective of therapy is to discover if any factors in the individual's environment, either at work or home, may contribute to the CTS. If the compression can be attributed to or related to job duties or activities of daily living, education regarding the provocative positions and modifications in method or setup is provided. Such education may help abate the identified aggravating conditions, minimizing symptoms and preventing their return. The individual may benefit from an ergonomic consultation. The therapist will monitor the individual for potential complications such as severe and persistent edema, palmar pain, increased hand sensitivity, or joint stiffness (Finsen; Gerritsen).

FREQUENCY OF REHABILITATION VISITS
	Surgical
	Specialist	Carpal Tunnel Release
	Physical, Occupational or Hand Therapist	Up to 5 visits within 6 weeks

The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice.

Source: Medical Disability Advisor

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