Especially postoperatively when the patient doesn't do well in a very short time, it is usually because the condition was misdiagnosed in the first place, and the problem is actually in the cervical spine, thoracic outlet, or even the elbow. Unfortunately the ones we see post op have already undergone the trauma of surgery and have additional problems such as scar tissue to cope with. For the individual you are now treating, take a close look at the posture and especially the postion of the thoracic outlet. Correct postural problems such as cervical hyperextension, forward head, increased thoracic kyphos, rounded shoulders, internally rotated humerus and scapular protraction. You can continue to work on the wrist, but spend some time on these other areas and you will very likely find some long term problems that need to be addressed.
Patient education is critical.
If you can relieve her pain through passively positioning her in a corrected posture, it will go a long way toward convincing her to work with you in these areas. You are right in your assumption that if the problem was in the carpal tunnel, then opening it up will relieve the symptoms. Selby Street, Shenton Park, Fax.