What is the AAOS Carpal Tunnel Protocol?

The AAOS Carpal Tunnel Protocol is a set of evidence-based guidelines and exercises developed by the American Academy of Orthopaedic Surgeons (AAOS) for managing carpal tunnel syndrome. It focuses on specific hand and wrist movements designed to relieve symptoms, improve function, and reduce the need for surgical intervention.

Why do orthopedic surgeons recommend these 5 specific exercises?

Orthopedic surgeons recommend these exercises because they target the flexor tendons and median nerve in the wrist, enhancing mobility, reducing inflammation, and relieving pressure. Research shows these movements can significantly decrease symptoms like numbness and tingling while supporting recovery without surgery.

Can the AAOS Carpal Tunnel Protocol be done at home?

Yes, the protocol is designed for use by patients at home. The exercises are simple, require no special equipment, and can be incorporated into daily routines after guidance from a healthcare professional regarding correct form and frequency.

How often should I perform the AAOS carpal tunnel exercises for best results?

Most patients benefit from doing the exercises 2–3 times per day, as recommended by their healthcare provider. Consistency is key, but it’s important to follow your doctor’s instructions and stop if any exercise causes increased pain or discomfort.

Are these exercises effective for all cases of carpal tunnel syndrome?

While these exercises are effective for many mild to moderate cases, they may not resolve severe or long-standing carpal tunnel syndrome. In such cases, further evaluation and treatments—including possible surgery—may be necessary. Always consult an orthopedic specialist to determine the best course of action for your symptoms.

The AAOS Carpal Tunnel Protocol: Why Orthopedic Surgeons Swear By These 5 Specific Exercises

person Olivia Williams

The AAOS Carpal Tunnel Protocol: Why Orthopedic Surgeons Swear By These 5 Specific Exercises

Introduction

Carpal Tunnel Syndrome (CTS) affects millions worldwide, causing hand pain, numbness, and tingling that can disrupt daily routines. Exercise is a cornerstone in managing CTS, promoting healing and restoring function without surgery. The American Academy of Orthopaedic Surgeons (AAOS) has developed a tested protocol for CTS that highlights five evidence-based exercises. In this post, you’ll discover the AAOS Carpal Tunnel Protocol and learn why orthopedic surgeons enthusiastically recommend these essential exercises for carpal tunnel relief.

Understanding Carpal Tunnel Syndrome

Anatomy of the carpal tunnel

The carpal tunnel is a narrow passageway in your wrist, bounded by bones and ligaments. It houses the median nerve and the flexor tendons that control finger movement. When tissues in this area swell or thicken, they can compress the median nerve.

Common causes and risk factors

CTS often results from repetitive hand movements, wrist injuries, or conditions such as diabetes, thyroid disorders, and rheumatoid arthritis. Frequent computer use and assembly line work are also well-known risk factors.

Signs and symptoms

The hallmark symptoms include numbness, tingling, burning, and pain in the thumb, index, and middle fingers. Many sufferers experience nighttime discomfort and weakened grip strength.

Impact on daily life and work

CTS can dramatically limit everyday tasks—typing, gripping objects, buttoning shirts—affecting productivity and quality of life. Untreated cases may result in permanent nerve damage.

The AAOS Carpal Tunnel Protocol: An Overview

The AAOS Carpal Tunnel Protocol was formulated by orthopedic experts and relies on the latest scientific research. Its evidence-based foundation ensures the highest standard of non-surgical care for CTS. The protocol primarily aims to:

Improve nerve and tendon mobility
Reduce pain and discomfort
Restore hand function and prevent further injury

Why Exercises Matter: The Science Behind Movement

Targeted carpal tunnel exercises increase blood flow, stretch tight tissues, and help move the median nerve and tendons through the carpal tunnel with ease. Unlike invasive treatments, these exercises are low-risk and can be performed at home. Increasing research shows that exercise-based protocols are equally or even more effective than splinting alone or steroid injections for many patients. Orthopedic surgeons repeatedly affirm the importance of movement—for both symptom relief and long-term wrist health.

The Five Must-Do AAOS Exercises

Nerve Gliding Exercise

Description and purpose: Nerve gliding helps the median nerve travel smoothly through the wrist, minimizing nerve irritation and promoting recovery.
How-to:
1. Start with your arm extended, palm facing upward, and fingers straight.
2. Bend your wrist backward, keeping the fingers straight.
3. Next, make a fist, then gently bend your wrist downward.
4. Hold each position for 3-5 seconds. Repeat 5-10 times per session.
Benefits: Enhances median nerve mobility, reduces numbness, and improves nerve health.

Tendon Gliding Exercise

Description and purpose: This exercise moves your flexor tendons through their full range, reducing adhesions and scar tissue.
How-to:
1. Start with your hand in a neutral, open position.
2. Make a tabletop by bending your fingers at the lower joints, keeping the knuckles straight.
3. Form a hook fist (bend your top two finger joints, keeping knuckle straight).
4. Make a full fist, then return to the open hand. Hold each for 3-5 seconds. Repeat 5-10 times.
Benefits: Improves tendon flexibility and reduces stiff adhesions within the carpal tunnel.

Wrist Flexor Stretch

Description and purpose: Stretching the wrist flexors relieves tension in the forearm, taking pressure off the carpal tunnel.
How-to:
1. Extend your arm with the palm facing upward.
2. With the opposite hand, gently pull your fingers and palm downward until you feel a stretch in the forearm.
3. Hold for 15-30 seconds and repeat 2-3 times.
Benefits: Decreases forearm tightness and reduces wrist strain.

Wrist Extensor Stretch

Description and purpose: This stretch targets muscles on the top of your forearm, improving wrist extension and flexibility.
How-to:
1. Extend your arm with the palm facing downward.
2. Gently pull your hand and fingers towards your body with the opposite hand until you feel a stretch.
3. Hold for 15-30 seconds and repeat 2-3 times.
Benefits: Relieves dorsal wrist and forearm tension, enhancing range of motion.

Wrist Range of Motion (ROM) Exercises

Description and purpose: These dynamic movements help maintain and improve the mobility of your wrist in all directions.
How-to:
1. Bend your wrist up and down (flexion and extension) slowly.
2. Move your wrist side to side (radial and ulnar deviation).
3. Make gentle circles with your wrist.
4. Do each motion 10 times in both directions.
Benefits: Prevents stiffness and maintains essential flexibility for everyday tasks.

Implementation and Safety Tips

When to start: Most people can begin these exercises at home, but those with severe pain or injury history should consult a hand therapist or physician first.
Frequency and reps: Perform exercises 2–3 times daily. Start with 5–10 repetitions and progress as tolerated.
Warning signs: Stop immediately if you notice worsening numbness, pain, or weakness. Consult a healthcare professional if symptoms persist.
Common mistakes: Avoid aggressive stretching, rushing through movements, or continuing through severe pain. Always use slow, controlled motions.
Consistency: Daily practice is crucial for best results—skipping sessions reduces the effectiveness of the protocol.

Surgeon Endorsements: Why Orthopedic Experts Rely on These Exercises

Leading orthopedic surgeons and hand specialists champion the AAOS carpal tunnel exercise protocol for its safety and proven results. According to Dr. Susan Bell, MD, “Regular nerve and tendon gliding exercises help most mild to moderate CTS patients avoid surgery.” Compared to treatments like steroid injections or night splinting, AAOS exercises target the root dysfunction and empower patients to take control. Many surgeons recommend combining the exercises with ergonomic improvements and prescribed wrist supports, especially for persistent or work-related cases.

Limitations and When to Seek Further Medical Attention

Signs exercises aren’t enough: If symptoms don’t improve after several weeks, if hand weakness increases, or if there is visible muscle wasting in the thumb, seek help immediately.
Alternatives: Bracing, corticosteroid injections, nerve hydrodissection, and—when necessary—surgical release are other options considered by orthopedic specialists.
Personalized plans: Treatment should be tailored to your specific situation. Always consult a healthcare provider if you’re unsure how to proceed.

Conclusion

The AAOS Carpal Tunnel Protocol stands out as an effective, evidence-based approach to conservative CTS management. These five targeted exercises are trusted by orthopedic surgeons for their unique ability to improve symptoms, restore hand function, and help many patients avoid surgery. Taking charge of your carpal tunnel health through regular exercise empowers you to regain comfort and control. Always consult your healthcare provider before starting any exercise program to ensure it’s right for you.

Additional Resources

Check out this amazing product: Alexills™ - 3-in-1 Wrist Support.