Median nerve compression in the carpal tunnel.

portant that the physiotherapist should supervise the movements and make sure that the metacarpal is again moved through a full active range at the new joint. This treatment is continued until the patient can return to light work, which is usually a matter of four to six weeks. Some patients complain of pain for longer than this, but others are surprisingly pain free; one started milking cows within a month of operation. Results and Case Reports All the patients have been very satisfied with the results of the operation, and have reported improved function and little or no pain. Removal of the trapezium leaves the thumb a little weaker than the normal, but a full range of movement of the metacarpal is regained with no obvious deformity. Mr. E. B., aged 48, farm worker. Pain and swelling at the base of the right thumb which he dated from an injury two years before. The right trapezium was excised in April, 1944. He worked full time after this, but attended again in I947, complaining of pain in the left thumb (Fig. 2). The left trapezium was excised in February, 1947. He was able to do full work inside two months and has been doing full farm work since. He states there is no pain and he can do anything. On examination in January, I948, there was a full and painless range of movement with good power in both thumbs, but slight crepitus on movement on the right side (Fig. 4). left bones were excised in November, I945 (Fig. I). She is now very satisfied and has no pain, but states that her hands are not quite so strong for turning taps as previously. The radiographs taken in January, 1948, show a satisfactory result on 'the right, but on the left a fragment of the trapezium remains in situ (Fig. 5). It is interesting to note how this fragment has increased in size since the film taken one year after operation (Fig. 6). Miss E. W., aged 46, sempstress. Four years of pain and difficulty in carrying out her work. The right trapezium was excised in April, 1944. She has been working full time since with no pain. Miss N., aged 58. Symptoms following an injury nine months before. Pain on using. left thumb and a marked cystic swelling over the trapezio-metacarpal joint (Fig. 3). The trapezium was excised in April, i944. …