Renewed Hope For A Special Pair Of Hands

Ken Venturi's departure from the recent U.S. Open Championship at Bellerive Country Club in St. Louis was a sad, stirring moment in sport. It was reasonable for all those who follow golf to assume, after his tormented year, that Venturi's appearance in the Open might well be his last in tournament golf.

What has ailed Venturi since shortly after he won the 1964 Open in one of the game's most brilliant comebacks is a loss of feeling in his hands. The cause has now been identified as the "carpal tunnel syndrome." Despite its somewhat forbidding and unfamiliar name, it has undoubtedly plagued the human race for centuries, ever since man began pounding away at various objects with his hands clenched tightly around a hammer or a club. Now, however, the condition is recognized as a disease entity and precise surgery to alleviate it has been devised. If it is caught in time, as Mayo doctors believe is the case with Venturi, recovery is usually complete.

Last January, Ken played through the chilling winds of the Crosby tournament at Pebble Beach with a hand warmer in his pocket. He was then under the care of Dr. Robert M. Woods, a Los Angeles internist and Dodgers' team physician who successfully treated Pitcher Sandy Koufax. Exploratory surgery in Venturi's right shoulder blade and left leg suggested that he had serious inflammation of the arteries, periarteritis nodosa. The prescription: lots of medicines, and rest those hands. Venturi could not play nor would he quit. He tried and failed dismally at Pensacola, Miami, Jacksonville and then in the Masters, where his 36-hole score of 157 was nine strokes above the cut.

The following week Venturi flew to Rochester, Minn., the city of 45,000 built around the Mayo Clinic, and put himself under the care of Internist James V. Ross. A team of Mayo specialists—dermatologists, rheumatologists and vascular experts—worked over Venturi and could no longer find anything wrong with his arteries. But when the doctors tapped the inside of Venturi's wrist (near the point where your doctor takes your pulse) Ken said it felt like an electric shock. This pretty well proved the tentative diagnosis of carpal tunnel syndrome: in each wrist the median nerve (the main nerve controlling both sensation and movement in the fingers) was being squeezed where it passed through the tunnel in the carpal (wrist) joint.

Before the Mayo doctors could attempt corrective treatment, Venturi had to be weaned from one of the drugs he had been taking, a variant of cortisone. A heavy dosage of this drug and also of ACTH had, over a period of several months, produced a bad Case of acne on his back, and he was getting heavy jowls. When cortisone-type hormones are stopped suddenly, a severe reaction may result. So Venturi was ordered to taper off gradually over a period of six weeks. The only medicine that Dr. Ross prescribed was a drug to relax the muscle in the walls of the small arteries in Venturi's wrists and hands and thus, hopefully, increase the blood flow to his fingers.

Dr. Ross permitted Venturi to go to Palm Springs to try to pull his golf game together during his last days on the cortisone medicine. By this time Ken's hands were somewhat better, and the medical picture was clearer. Every time he flexed his right wrist he felt that electric shock in the middle finger. The doctors wanted him to return immediately, but Venturi was determined to defend his U.S. Open title in St. Louis. After he missed the cut there, he went back to Mayo's the following Monday. He was operated on three days later, on June 24.

With his patient under a local anesthetic and talking a streak, Dr. Edward D. Henderson, an orthopedic surgeon, first operated on the left hand. He made a curved incision a little more than two inches long, beginning over the fleshy part of the base of the palm and extending a short distance past the outermost skin crease that shows clearly when the hand is bent inward. Dr. Henderson was not sure what he would find after this first cut, because some people have a long tendon (the palmaris longus) close beneath the skin, while others lack it. Venturi had it, and Dr. Henderson removed part of the tendon, along with a piece of palmar fascia (gristle) 1 by 1� inches, to make sure that this could not press down on the median nerve. Then he cut deeper. In this anatomically crowded space Dr. Henderson knew exactly what he was looking for: the transverse carpal ligament (see diagram), which in Venturi's wrist was about 1� inches long (across the joint), 1 inch wide and ranged in thickness from 1[1/16], to ? inch. This ligament forms the roof (looking at the hand palm upward) of the carpal tunnel. The floor consists of the small bones of the wrist, lying as close together as the pieces in a terrazzo pavement. Inside the tunnel are nine tendons, each in its own sheath, like an electric cable with insulated wires. Also passing through the tunnel is that all-important median nerve.

What had happened in Venturi's wrist was that either the tendon sheaths had swollen or the ligamentous "roof" had thickened and become tighter. Even on direct view the surgeons could not be sure which was the case. But the effect was the same: squeezing of the median nerve. Dr. Henderson could see that the nerve was unnaturally pale. He slit the ligament across its full width, and as he thus released the pressure in the tunnel, within 30 seconds he could see the nerve turn a healthy pink. He also could see the small vein that runs beside it begin to fill up. This happened again when he repeated the operation on the right hand. The surgeon closed each wound with a dozen nylon sutures.

The Mayo Clinic has no monopoly on diagnosing the carpal tunnel syndrome or on surgery to relieve it, but it has a justifiable proprietary interest in both. Mayo neurologists first assembled the symptoms that patients in different walks of life complained about and identified the activities that constituted their common denominator: repeated bending of wrist and fingers in precision tasks. Women around 50 are the most frequent victims, usually those who knit or crochet. Burly truck drivers get it. So do pianists and plumbers and men who hammer out the bumps in auto body repair shops.

Usually compression of the nerve in the carpal tunnel causes a pins-and-needles sensation, and that electric shock on bending the wrist, with some impairment of movement. But Venturi had a complication uncommon in this condition, called Raynaud's phenomenon—cold, numbness and blanching of the hands. Presumably there was interaction between the squeezed median nerve and the sympathetic nerves controlling the blood supply to the fingers. The doctors believe that the one operation will relieve both conditions. If they are right, Venturi's fingers will tingle less and less in the next few weeks. Scar tissue will fill in the space left when Dr. Henderson severed the ligament, but it will not squeeze down as tightly as did the ligament itself. Within a month after his operation, Venturi should be able to exercise his hands. A couple of weeks after that he should be able to grip a club and swing.