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Nerve and Tendon Gliding Exercises (Carpal Tunnel)

Draftsensory75%beginnermoderate evidence
View FHIR resourceFHIR R4 ActivityDefinition — the interoperable form of this exercise

Positions & Range of Motion

Start
seated, forearm supported, wrist and fingers in neutral, shoulder at side, elbow flexed
End
end of the glide sequence: for nerve glide, shoulder abducted with elbow, wrist and fingers extended and cervical spine laterally flexed away; for tendon glide, hand cycled through straight, hook fist, full fist, tabletop, and straight fist
Range of Motion
full available excursion of wrist/finger flexion–extension and elbow extension with graded cervical lateral flexion; gentle, non-provocative end ranges

How to Perform

Combined program of median nerve glides and tendon gliding for carpal tunnel syndrome. Nerve glides: sequential shoulder ABD → elbow extension → wrist/finger extension → cervical lateral flexion. Tendon glides: straight → hook fist → full fist → tabletop → straight fist. Proposed mechanisms include reducing intraneural pressure, improving nerve excursion, and preventing adhesion formation.

Watch on YouTube

Opens a YouTube search for “Nerve and Tendon Gliding Exercises (Carpal Tunnel)

Starting position: seated

Coaching Cues

  1. 1

    Quiet, sliding pattern — nerve and tendon move independently

    (verbal)
  2. 2

    Cycle through five hand shapes: straight, hook, fist, tabletop, straight fist

    (verbal)
  3. 3

    Open the hand toward the ceiling, then close into a fist

    (verbal)
  4. 4

    Tendons glide like ropes through a pulley

    (visual)

Evidence-Based Dosing & EMG Data

Recommended Dosing

5-10 reps of each position, 3-5x daily, 6-12 weeks; combine with nighttime neutral wrist splinting [Akalin 2002, Baysal 2006]

EMG Activation Data

Historical studies show modest improvements when combined with splinting. May help delay or reduce need for surgical intervention in mild-moderate CTS.

Muscles Involved (3)

Primary Movers

Flexor Digitorum SuperficialisTendon gliding through carpal tunnel
Flexor Digitorum ProfundusDifferential tendon excursion during gliding positions

Synergists & Assistors

Extensor DigitorumSynergistActive finger extension during nerve tensioning positions

Easier Variations ↓

1

Tendon Glides Only

Perform only the tendon gliding sequence without the nerve component. Less neural tension.

2

Single-Joint Nerve Glide

Move only one joint at a time (e.g., wrist extension only) instead of the full sequential mobilization.

3

Regress to tendon-gliding-sequence

AUDIT: If the combined nerve+tendon CTS program is symptom-provocative, drop the neural component and perform tendon gliding only (its named 'Tendon Glides Only' regression); tendon-gliding-sequence is the standard tendon-only post-CTR protocol. Advance back when neural tension is tolerated.

Harder Variations ↑

1

Full Sequential Nerve Glide

Complete the full shoulder-elbow-wrist-finger-cervical sequence for maximum neural excursion.

2

Nerve Glide with Sustained Hold

Hold the end-range position for 5-10 seconds to increase neural tensioning effect.

Target Movements (8)

Wrist ExtensionRadiocarpal Joint
Wrist FlexionRadiocarpal Joint
Finger Flexion (MCP)Metacarpophalangeal Joints
Finger Extension (MCP)Metacarpophalangeal Joints
Finger Flexion (DIP)Distal Interphalangeal Joints
Finger Flexion (PIP)Proximal Interphalangeal Joints
Finger Extension (DIP)Distal Interphalangeal Joints
Finger Extension (PIP)Proximal Interphalangeal Joints

Why This Exercise Matters

Everyday activities this exercise helps you do — essential means it directly trains the capacity the task needs:

Goals This Helps With

Rehab, performance, prevention, and mobility goals this exercise supports — essential means it's a cornerstone:

Research Notes

Historical studies show modest improvements when combined with splinting. May help delay or reduce need for surgical intervention in mild-moderate CTS.

Evidence Sources (2)