Postoperative Immobilization
Strong evidence supports no benefit to routine postoperative immobilization after carpal tunnel release.

Rationale
There were two high quality studies (Bury et al, Finsen et al) and four moderate quality studies (Cebesay et al, Cook et al, Huemer et al, Martins et al) that evaluated post-operative splinting in comparison to no splinting.  These studies did not identify any clear benefit to immediate post-operative splinting. 
 
One high quality study (Bury et al) showed no short or long-term difference in regards to grip strength, pinch strength, and range of motion between patients splinted for 2 weeks post-operatively and patients who had no splinting.  A second high quality study (Finsen et al) also showed no difference in grip strength and pinch at 1.4 and 5.9 months between the splinted and unsplinted groups.
 
A moderate strength study (Cook et al) did show a statistically significant improvement in grip and pinch strength at 2 weeks and 4 weeks in patients who were not splinted and allowed to begin early range of motion exercises compared with patients splinted for 2 weeks.   A treatment effect of allowing early range of motion exercises may have contributed to the increase in the improvement in motion in the short term. At three months after surgery, there was no difference between the splinted and unsplinted groups in regards to grip and pinch strength.
 
One moderate strength study (Martins, RS) did show a short-term benefit to post-operative splinting in regards to 2-point discrimination at 2 weeks in patients that were splinted, but this effect was not present at the 3 month follow-up.
 
One high quality study (Ritting et al) showed no difference in wound complications between patients who removed a bulky, post-operative dressing at 48-72 hours and patients who kept their dressing on for 2 weeks.  At two weeks follow-up, the group who removed their dressing early had better grip and 3-point pinch strength, however, there was no difference in 3-point pinch strength between the groups at week follow up six and 12 weeks after surgery.  Of note, the patients randomized to early dressing removal had better grip strength pre-operatively, compared to the group randomized to maintaining the dressing for 2 weeks, which may have accounted for the differences observed.  

LEARN MORE ABOUT AAOS

The Future of OrthoGuidelines

FIND OUT MORE

The OrthoGuidelines Process