Pillar pain is a medical condition that can arise following certain hand surgeries. It represents a specific type of discomfort distinct from typical incision site pain and is an acknowledged post-surgical outcome.
Defining Pillar Pain
Pillar pain is characterized by discomfort and tenderness at the base of the hand, specifically in the fleshy parts of the palm near the thumb (thenar eminence) and the little finger (hypothenar eminence). This pain is often described as a deep-seated ache in the heel of the palm, worsening when pressure is applied. Unlike immediate incision pain, which usually subsides within weeks, pillar pain can persist longer.
This sensation is distinct from general surgical soreness. It is located on either side of the surgical incision in the palm, where the transverse carpal ligament attaches to the carpal bones. It may involve changes in hand biomechanics, irritation of small nerve branches, or inflammation in nearby joints.
Common Causes
Pillar pain most commonly develops after carpal tunnel release surgery, which relieves pressure on the median nerve in the wrist. It can occur with both open and endoscopic techniques, though it is more frequently observed after open surgery. Approximately 13% of individuals undergoing this procedure may experience pillar pain.
During carpal tunnel release, the transverse carpal ligament is cut to decompress the median nerve. This alteration can lead to changes in the alignment and mechanics of the carpal bones and palm muscles, contributing to pain. Scar tissue formation and irritation to small sensory nerve branches during healing are also factors.
Symptoms and Diagnosis
Individuals experiencing pillar pain typically report tenderness and discomfort upon touch in the thenar and hypothenar eminences. The pain may be exacerbated by activities that involve gripping, pinching, or putting pressure on the palm, such as doing a push-up or holding a golf club. While symptoms usually resolve within three months, they can occasionally last for six months or even up to 9 to 12 months in some cases.
Diagnosis of pillar pain primarily involves a physical examination of the hand, where a medical professional assesses tenderness and discomfort in specific palm areas. A detailed patient history is also taken to understand symptom onset relative to any surgical procedures. The diagnostic process aims to differentiate pillar pain from other potential causes of hand discomfort, such as persistent nerve compression or arthritis in the wrist or thumb joints.
Treatment Approaches
Managing pillar pain often begins with non-surgical interventions aimed at reducing discomfort and improving hand function. Rest and the application of ice can help alleviate soreness and inflammation. Over-the-counter pain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may be recommended to manage pain and reduce inflammation.
Hand therapy plays a central role in rehabilitation, offering various techniques to address pillar pain. Therapists may utilize soft tissue mobilization, gently increasing pressure on sensitive areas of the thenar and hypothenar eminences. Specific exercises, including extrinsic stretching of wrist/hand flexors and tendon gliding exercises, can help restore mobility and reduce stiffness. Desensitization techniques, involving rubbing different textures over sensitive areas, are also employed to reduce nerve hypersensitivity. Median nerve glides, or nerve flossing, are often performed to facilitate nerve movement and improve mobility; in some instances, corticosteroid injections may also be considered to reduce localized inflammation and pain.