The carpal tunnel is a narrow, tunnel-like structure found on the inside of the wrist. The bottom and sides of this tunnel are formed by the wrist (carpal) bones. The top of the tunnel is covered by a strong band of connective tissue called the transverse carpal ligament.

The median nerve travels from the forearm into the hand through this tunnel in the wrist. The median nerve controls feeling in the palm side of the thumb, index finger, and long fingers. The nerve also controls the muscles around the base of the thumb. The tendons that bend the fingers and thumb also travel through the carpal tunnel. These tendons are called flexor tendons.

Carpal tunnel syndrome occurs when the tissues surrounding the carpal tunnel in the wrist swell and put pressure on the median nerve. When this occurs, patients often report numbness and tingling in the distribution of the median nerve. Symptoms can often wake patients from sleep and be extremely painful upon wakening.

Carpal tunnel syndrome is typically initially treated conservatively with splinting or corticosteroid injections. In severe cases, a carpal tunnel release may be indicated. This is a surgery that involves releasing the ligament that is pressing down on the carpal tunnel, which provides more room for the median nerve and tendons passing through the tunnel.

When surgery is indicated, Dr. Dedhia utilizes an open repair technique. He begins by making an incision (approximately 3cm long) in the palm of the hand. Directly below the skin incision is a sheet of connective tissue, which is dissected to expose the carpal ligament. Once visible, scissors are used to release the carpal ligament with caution to ensure the median nerve and flexor tendons are protected in the process.

Once the carpal ligament has been successfully divided, Dr. Dedhia closes the skin incision. The loose ends of the carpal ligament are left apart to keep pressure off the median nerve.

The decision to move forward with a carpal tunnel release is based on numerous factors and can be discussed in detail during your office visit with Dr. Dedhia.

Tendons are tissues that connect muscles to bone. When muscles contract, tendons pull on bones. This is what causes some parts of the body to move. The flexor tendons of the hand, which allow the fingers to form a fist — extend from the muscles through the wrist and attach to the small bones of the fingers and thumb on the palm side of the hand. When you bend or straighten your fingers, the flexor tendon slides

through a snug tunnel, comprised of five tendon sheaths.

Trigger finger, also known as stenosing tenosynovitis, occurs when

one of the tendons responsible for bending a finger or the thumb

develops a thickening, known as a nodule, and inflammation in

the tendon sheath. When this occurs, the tendons have difficulty

gliding smoothly. The tendon can often times become stuck within

the tendon sheath causing an audible “pop” when attempting to

straighten the finger. Other symptoms may include:

• A tender lump in your palm
• Swelling
• Catching or popping sensation in your finger or thumb joints
• Pain when bending or straightening your finger

Often times, trigger fingers can be resolved with a cortisone injection into the tendon sheath. Other non-surgical treatments include rest and anti-inflammatories. When non-surgical treatment options are unsuccessful, surgery may be indicated.

The procedure for treating a trigger finger is called a trigger finger release and involves opening the inflamed tendon sheath to allow for easier movement of the tendons.

During this procedure, Dr. Dedhia first identifies the flexor tendon in the palm of the hand. A small skin incision, approximately 2cm in length, is made over the tendon. The tissue is then dissected down to the level of the flexor tendon sheath. Once identified, Dr. Dedhia cuts through the tendon sheath. The finger is then bent and straightened to ensure that the tendons move smoothly without catching or locking. The wound is irrigated and the incision is then closed with sutures.

The decision to move forward with a trigger finger release can be discussed at your appointment with Dr. Dedhia.