POSTOPERATIVE THERAPY (Recommendation Against)

This recommendation is based on one high-quality, two moderate-quality, and one low-quality study evaluating the use of physical therapy after carpal tunnel release (Provinciali 2000, Pomerance 2007, Schroeder 2022, Gil 2020). These studies consistently demonstrate that there are no functional or outcome benefits of using therapy after carpal tunnel release. There was one high-quality study that demonstrated short term benefits (of improved motor dexterity at one month and shorter return-to-work) (Provinciali 2000).

Benefits/Harms of Implementation
The benefit of the use of therapy after carpal tunnel release has not been demonstrated. Its use may result in unnecessary costs (direct, indirect, intangible). There may be scenarios or patients in whom post-operative therapy may be beneficial, however, studies are required to identify this potential patient population. While formal physical therapy is not substantiated across the majority of patients, it may benefit some patients on a case-by-case basis.

Future Research
Future research is needed to determine which patients may benefit from physical therapy after carpal tunnel release. Research evaluating the cost-effectiveness of physical therapy post-operatively, particularly in specific patient populations, may be beneficial to promote high-quality low-cost care.