Median nerve gliding exercises1
Begin with position one and sequentially through the positions until symptoms are provoked, i.e. tingling. That is the maximum position to use. Sustain that position for 5 to 30 seconds without making the symptoms worse. Then alternate between that position and the preceding position. When the patient can be moved into that position without eliciting symptoms, progress to the next position and repeat the mobilizing routine. These exercises may be done three or four times per day so long as symptoms are not exacerbated.
Wrist neutral + flexed fingers and thumb.
Image Source: Victoria Squissato
Wrist neutral + extended fingers + neutral thumb.
Image Source: Victoria Squissato
Wrist and fingers extended + neutral thumb.
Image Source: Victoria Squissato
All extended.
Image Source: Victoria Squissato
All extended + supinated forearm.
Image Source: Victoria Squissato
All extended + supinated forearm + thumb stretched into extension
Image Source: Victoria Squissato
Finally, incorporation of proximal neural elements: upper limb tension positions.
Wrist neutral + flexed fingers and thumb.
Image Source: Victoria Squissato
Wrist neutral + extended fingers + neutral thumb.
Image Source: Victoria Squissato
Wrist and fingers extended + neutral thumb.
Image Source: Victoria Squissato
All extended.
Image Source: Victoria Squissato
All extended + supinated forearm.
Image Source: Victoria Squissato
All extended + supinated forearm + thumb stretched into extension
Image Source: Victoria Squissato
Finally, incorporation of proximal neural elements: upper limb tension positions.
Tendon gliding exercises1
These gliding exercises are designed to maintain or develop free gliding between the tendons of FDS, FDP, and the flexor sheaths as well as between the tendons and bones in the wrist, hand, and fingers. Start with a neutral wrist position progressing to a flexed, then extended wrist position to establish combined finger and wrist mobility. The following progression is suggested,
Straight hand.Image Source: Victoria Squissato
Claw (Hook) fist: PIP and DIP flexion while maintaining MCP extension.
Image Source: Victoria Squissato
Full fist: flexion of all joints simultaneously.
Image Source: Victoria Squissato
Table top: MCP flexion, PIP and DIP extension.
Image Source: Victoria Squissato
Straight fist: MCP and PIP flexion while maintaining DIP extension.
Image Source: Victoria Squissato
Role of the Physiotherapist
Although there is limited evidence for median nerve and tendon gliding exercises as an efficacious conservative treatment option, these exercises may have a greater role to play post-operatively. Physiotherapists can assist patients with these exercises thereby facilitating swelling reduction, stiffness, and pain post-operatively. Therapy can also help to restore strength after surgery. Not everyone needs physiotherapy following surgery, but it may be helpful in select cases.