Osteoarthritis Clinic · Home exercise program

Carpal tunnel syndrome

Median nerve compression

Gentle exercises and simple aftercare to follow at home after your corticosteroid injection. Start slowly, build up as comfort allows, and stop anything that causes sharp pain.

Corticosteroid injectionDepo-Medrol (methylprednisolone acetate)
About this conditionAll patient guides
Reviewed
Reviewed. The exercises, repetition counts, hold times, and order of the exercises on this sheet have been checked by Dr. Mahendira against the clinic's printed handout.
SMH Osteoarthritis Clinic · Carpal tunnel syndrome · Corticosteroid injection (Depo-Medrol (methylprednisolone acetate))
Reviewed by Dr. Mahendira against the clinic handout.

Your injection

A long-acting corticosteroid injected into the carpal tunnel, the narrow passageway on the palm side of the wrist through which the median nerve and flexor tendons travel. It reduces inflammation and swelling of the tendon sheaths, decreasing pressure on the median nerve and relieving numbness, tingling, and pain in the hand.

After your injection

What to expect

  • Mild soreness at the injection site on the inner wrist is normal for 24 to 48 hours (a steroid flare).
  • The Depo-Medrol usually begins working within 2 to 7 days. Full effect may take 2 to 3 weeks.
  • Numbness, tingling, and nighttime symptoms should gradually improve as nerve pressure decreases.
  • Relief typically lasts weeks to months. Symptoms may return if the underlying cause is not addressed.

First 24 hours

  • Rest the hand and wrist. Avoid gripping, typing, and repetitive hand motions.
  • Apply ice wrapped in a cloth for 10 to 15 minutes every 2 to 3 hours if the wrist is sore or swollen.
  • Keep the injection site clean and dry.
  • Take acetaminophen (Tylenol) as needed. Avoid NSAIDs for 24 hours unless directed by your provider.

Days 2 to 14

  • Gradually resume light daily activities as comfort allows. Let symptoms be your guide.
  • Continue to avoid forceful gripping, sustained wrist flexion, and vibration exposure.
  • Begin gentle nerve gliding and tendon gliding exercises after 48 hours.
  • Wear your wrist splint at night consistently. This is when most nerve compression occurs.

Important reminders

Limit injections to 2 to 3 for carpal tunnel syndrome. Repeated injections carry a small risk of median nerve injury and tendon damage. People with diabetes should monitor blood sugar for 3 to 5 days. If two injections fail to provide lasting relief or symptoms are severe, carpal tunnel release surgery may be recommended.

Your exercises

Begin gently after about 48 hours if you are comfortable. Move slowly and stay within a mild, pain-free range. The counts below are a guide for how much to do.

1

Median nerve glide (6 positions)

Most important

Progress through 6 positions: 1) fist; 2) straighten fingers, thumb tucked; 3) extend the wrist back; 4) extend the thumb out; 5) turn the palm up; 6) gently pull the thumb with the other hand. Hold each 3 to 5 seconds.

2 sets of 5 cycles through all 6, 3x daily

This is the most important exercise. Stop at any position that increases tingling.

2

Tendon glide sequence

Start with fingers straight. Move through: 1) hook fist (curl tips only); 2) full fist; 3) tabletop (bend at the large knuckles); 4) straight fist (fingers together, curled at the base). Return to straight.

2 sets of 8 cycles, 2 to 3x daily

Keeps the flexor tendons gliding smoothly through the carpal tunnel.

3

Wrist flexion and extension stretch

Extend the affected arm in front with the elbow straight. Use the opposite hand to gently bend the wrist downward (flexion stretch, hold 15 seconds), then upward (extension stretch, hold 15 seconds).

3 reps of a 15 second hold each, 2 to 3x daily

Keep the stretch gentle. You should feel mild tension, not pain.

4

Wrist circles

Hold the forearm steady with the opposite hand. Slowly circle the wrist clockwise 10 times, then counterclockwise 10 times. Move through the full, comfortable range of motion.

2 sets of 10 circles each direction, 2x daily

Promotes synovial fluid movement and reduces stiffness.

5

Finger spread and squeeze

Spread all fingers apart as wide as possible, hold 5 seconds. Then bring fingers together and gently squeeze a soft ball or rolled towel, hold 5 seconds. Alternate between spread and squeeze.

2 sets of 10 reps, 2x daily

Use a very soft ball. Avoid hard grip strengtheners.

6

Prayer stretch (bilateral)

Press your palms together in a prayer position in front of your chest, fingers pointing up. Slowly lower your hands toward your waist while keeping palms pressed together until you feel a stretch. Hold 15 to 20 seconds.

3 reps of a 20 second hold, 2 to 3x daily

Stretches the carpal tunnel structures on both sides.

7

Wrist pronation and supination

Hold a light object (a pen or small can) with the elbow bent at 90 degrees and tucked to your side. Slowly rotate the forearm palm-up (supination) then palm-down (pronation). Control the motion throughout.

2 sets of 10 reps, 2x daily

Maintains forearm mobility. Keep the elbow still.

Exercise guidelines

  • Stop if any exercise increases numbness, tingling, or pain in the fingers.
  • Nerve glides should produce a gentle stretch, never sharp or electric sensations.
  • Shake out your hands gently for 10 seconds between exercise sets.
  • Perform exercises with the wrist in a neutral position unless the stretch requires otherwise.
  • Consistency matters most. Do exercises daily for best results.

Protecting the area every day

  • Keep your wrist in a neutral position as much as possible. Avoid sustained bending or extension.
  • Use an ergonomic keyboard and mouse. Keep wrists straight while typing, not bent upward or down.
  • Take a 30 to 60 second break every 20 to 30 minutes during repetitive hand tasks to stretch and shake out the hands.
  • Avoid gripping tools or objects tightly. Use tools with padded, wide-diameter handles to reduce grip force.
  • Reduce vibration exposure. Wear anti-vibration gloves when using power tools or machinery.
  • Sleep with a wrist splint to prevent the wrist from curling into flexion overnight, which compresses the nerve.
  • Avoid resting your wrists on the hard edge of a desk. Use a padded wrist rest or ergonomic support.
  • Manage contributing conditions. Diabetes, thyroid disorders, and fluid retention can worsen carpal tunnel syndrome.

Wrist splint (neutral position)

Wear it at night and during aggravating activities. The splint holds the wrist at 0 to 15 degrees of extension, the position that maximizes space in the carpal tunnel and reduces pressure on the nerve.

Tracking your progress

Tick a box each day you complete your exercises, and circle how the area feels.

 MonTueWedThuFriSatSun
Week 1
Week 2
Week 3
Week 4
Symptom severity today (circle one)
012345678910
0 = none10 = worst
!When to call your doctor. Contact the clinic or seek care if you notice any of the following: Increasing pain, swelling, or redness at the wrist injection site lasting more than 48 hours; Fever above 38C (100.4F), which may indicate infection. Seek care urgently; New or worsening numbness, tingling, or burning in the thumb, index, middle, or ring finger; Sudden loss of grip strength, dropping objects frequently, or an inability to pinch with the thumb; Visible wasting (thinning) of the muscle at the base of the thumb (thenar atrophy); Symptoms of high blood sugar in people with diabetes: excessive thirst, frequent urination, blurred vision; No improvement after 2 to 3 weeks, or symptoms that return quickly after initial improvement.
This is general information, not medical advice. Your exercises and recovery depend on your own situation, and your clinician will guide you.

Back to the carpal tunnel syndrome guide