When the carpal tunnel surrounding the thumb tendons as they pass from the wrist to the thumb becomes irritated or swells, the patient experiences tendonitis of the wrist. Pain and tenderness are evident when grasping or pinching. This is often caused by overuse and is also associated with some cases of arthritis.
Carpal Tunnel Syndrome (CTS)
CTS results when there is a compression of the median nerve as it passes through the wrist in a small rigid tunnel, which is surrounded by the bones of the wrist. This carpal tunnel is filled with tendons and covered with a tight ligament called the transverse ligament. The nerve in the tunnel is accompanied by nine tendons, which flex the fingers and thumb. When the membranes that lubricate the tendons as they glide in the tunnel swell, the patient suffers from CTS. The symptoms, which usually worsen without treatment, can range from numbness and tingling on the palmar surface of one of the five fingers, or digits, – with the exception of the little finger – to a pain that radiates up to the shoulder. Treatment usually is non-invasive if approached early. A simple Velcro-strapped wrist brace worn at night. Ibuprofen or Advil is also helpful. If this problem is work or computer related, changes in daily activity are also found to be beneficial.
In more severe cases, electrical tests are necessary and surgical consideration is given. Surgical treatment of carpal tunnel syndrome is limited to a one-inch mini incision in the heel of the hand, directly sectioning the hypertrophied and tight transverse carpal ligament. The wound is closed with three or four absorbable sutures, and a dressing is applied. The dressing is removed the next day and patients are started on exercises and activities as tolerated. Full activities of daily living are performed by the second or third postoperative day. Patients may return to heavy manual work before the end of the second month. Recurrence is minimal and complications are extremely rare.