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Carpal Tunnel Syndrome
Tarsal Tunnel Syndrome

What is carpal tunnel syndrome?

Carpus is a word derived from the Greek word "karpos" which means "wrist." The wrist is surrounded by a band of fibrous tissue which normally functions as a support for the joint. The tight space between this fibrous band and the wrist bone is called the carpal tunnel. The median nerve passes through the carpal tunnel to reach the thumb, index, and middle fingers of the hand. Any condition that causes swelling or a change in position of the tissue within the carpal tunnel can squeeze and irritate the median nerve. Irritation of the median nerve causes tingling and numbness of the thumb, index, and the middle fingers, a condition known as "carpal tunnel syndrome."

What is tarsal tunnel syndrome?

Anatomy similar to that of the wrist and hand exists in the ankle and foot. Tarsal is a word from Latin which means ankle. When the sensory nerve that passes through the tarsal tunnel is irritated, numbness and tingling of the foot and toes can be felt. This condition is referred to as "tarsal tunnel syndrome." It is an analogous to, but far less common than, carpal tunnel syndrome.

What conditions and diseases cause carpal tunnel syndrome?

For most patients, the cause of their carpal tunnel syndrome is unknown. Any condition that exerts pressure on the median nerve can cause carpal tunnel syndrome. Common conditions that can lead to carpal tunnel syndrome include obesity, pregnancy, hypothyroidism, arthritis, diabetes, and trauma. Tendon inflammation resulting from repetitive work, such as uninterrupted typing, can also cause carpal tunnel symptoms. Carpal tunnel syndrome from repetitive maneuvers has been referred to as one of the repetitive stress injuries. Some rare diseases can cause deposition of abnormal substances in and around the carpal tunnel, leading to nerve irritation. These diseases include amyloidosis, sarcoidosis, multiple myeloma and leukemia.

How does a patient with carpal tunnel syndrome feel?

Patients with carpal tunnel syndrome initially feel numbness and tingling of the hand in the distribution of the median nerve (the thumb, index, middle, and part of the fourth fingers). These sensations are often more pronounced at night and can awaken patients from sleep. The reason symptoms are worse at night may be related to the flexed-wrist sleeping position and/or fluid accumulating around the wrist and hand while lying flat.

As the disease progresses, patients can develop a burning sensation, cramping and weakness of the hand. Decreased grip strength can lead to frequent dropping of objects from the hand. Occasionally, sharp shooting pains can be felt in the forearm. Chronic carpal tunnel syndrome can also lead to wasting (atrophy) of the hand muscles.

How is carpal tunnel syndrome diagnosed?

The diagnosis of carpal tunnel syndrome is suspected based on the symptoms and distribution of the hand numbness. Examination of the neck, shoulder, elbow, pulses, and reflexes can be performed to exclude other conditions that can mimic carpal tunnel syndrome. The wrist can be examined for swelling, warmth, tenderness, deformity, and discoloration. Sometimes tapping the front of the wrist can reproduce tingling of the hand, and is referred to as Tinel's sign of carpal tunnel syndrome. Symptoms can also at times be reproduced by bending the wrist forward, and is referred to as Phalen's maneuver.

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