Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
The other day I was flying across the country and exited the
in-flight lavatory to find my flight attendant standing in the back
kitchen. She was holding an ice pack over her wrist. She
spontaneously blurted out in explanation, "My carpal tunnel is acting
up." She then showed me where she was having pain and tenderness
along the tendon of the thumb side of her wrist.
Carpal tunnel syndrome is numbness, tingling pain, and weakness in the thumb,
index and middle fingers as a result of irritation of the median nerve being
irritated at the wrist.
In fact, as I next explained to her, she did not have carpal tunnel syndrome
at all. She was suffering from a common form of inflammation of the tendon
(tendinitis) that extends the thumb called De Quervain's tendinitis. Her
treatment for the acutely injured tendon was correct (rest and ice), but her
diagnosis was not. If her symptoms persisted, they could be completely
cured by simple splinting and possibly by a cortisone injection.
Carpus is a word derived from the Greek word karpos,
which means "wrist." The wrist is surrounded by a band
of fibrous tissue that 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 receive sensations from 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 in this manner 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 derived from the Latin word for "ankle." When the sensory nerve that passes through the tarsal tunnel is irritated by pressure in the tunnel, numbness and tingling of the foot and toes can be felt. This condition is referred to as "tarsal tunnel syndrome." Tarsal tunnel syndrome is analogous to, but far less common, than carpal tunnel syndrome. It is treated similarly.
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 at the wrist 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.
What are carpal tunnel syndrome
symptoms?
People 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 people 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. Carpal tunnel syndrome may be a temporary condition that completely resolves or it can persist and progress.
Picture of carpal tunnel syndrome
As the disease progresses, patients can develop a
burning sensation, and/or 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, particularly those near the base of the thumb in the palm of the hand.
Carpal Tunnel Syndrome or Tarsal Tunnel Syndrome - Describe Your ExperienceQuestion: Please describe your experience with carpal tunnel syndrome or tarsal tunnel syndrome.
A pinched nerve can be caused of a variety of conditions, for example, carpal tunnel syndrome, herniated disc, sciatica, arthritis, spinal stenosis, trauma, and more. Common symptoms of a pinched nerve include pain, numbness, tingling, and weakness. Treatment of a pinched nerve depends on the cause of the pinched nerve.
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints, the tissue around the joints, as well as other organs in the body. Because it can affect multiple other organs of the body, rheumatoid arthritis is referred to as a systemic illness and is sometimes called rheumatoid disease.
Leukemia is a type of cancer of the blood cells in which the growth and development of the blood cells are abnormal. Strictly speaking, leukemia should refer only to cancer of the white blood cells (the leukocytes) but in practice it can apply to malignancy of any cellular element in the blood or bone marrow, as in red cell leukemia (erythroleukemia).
Hypothyroidism is any state in which thyroid hormone production is below normal. Normally, the
rate of thyroid hormone production is controlled by the brain at the pituitary.
Hypothyroidism is a very common condition and the symptoms of hypothyroidism are
often subtle.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Ankle pain is commonly due to a sprain or tendinitis. The severity of ankle sprains ranges from mild (which can resolve within 24 hours) to severe (which can require surgical repair). Tendinitis of the ankle can be caused by trauma or inflammation.
Sarcoidosis, a disease resulting from chronic inflammation, causes small lumps (granulomas) to develop in a great range of body tissues and can appear in almost any body organ. However, sarcoidosis most often starts in the lungs or lymph nodes.
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of
arthritis including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout,
and pseudogout.
Multiple myeloma is a form of cancer that develops in plasma cells, the white blood cells that make antibodies. Symptoms include bone pain, weakness, extreme thirst, nausea, frequent urination, and broken bones. Treatment of multiple myeloma depends upon the staging and symptoms of the disease.
Obesity is the state of being well above one's normal weight. A person has traditionally been
considered to be obese if they are more than 20 percent over their ideal weight.
That ideal weight must take into account the person's height, age, sex, and
build.
A number of vital tasks carried out during sleep help maintain good health and enable people to function at their best. Sleep needs vary from individual to individual and change throughout your life. Not getting enough sleep can hurt memory performance, health, and your mood.
Diabetic Neuropathy is a complication of diabetes that causes damage to the nerves; this is related to the blood glucose of the body being too high for a long period of time. The four types of neuropathy include peripheral, autonomic, proximal and focal.
Amyloidosis is a group of diseases resulting from abnormal deposition of certain proteins (amyloids) in various bodily areas. The amyloid proteins may either be deposited in one particular area of the body (localized amyloidosis) or they may be deposited throughout the body (systemic amyloidosis). There are three types of systemic amyloidosis: primary (AL), secondary (AA), and familial (ATTR). Primary amyloidosis is not associated with any other diseases and is considered a disease entity of its own. Secondary amyloidosis occurs as a result of another illness. Familial Mediterranean Fever is a form of familial (inherited) amyloidosis. Amyloidosis treatment involves treating the underlying illness and correcting organ failure.
Compartment syndrome is a condition in which swelling and an increase in pressure within a limited space presses and compresses blood vessels, nerves, or tendons that run through the compartment. There are two types of compartment syndrome, acute compartment syndrome is treated with surgery (fasciotomy) and chronic compartment syndrome, which is treated with rest and modality to the affected limb. Symptoms of compartment syndrome include pain, change in sensation, change in color, paralysis, or numbness in the affected limb.
Diabetic neuropathy, a common complication of diabetes, is damage to the nerves that allow you to feel sensations such as pain. There are a number of ways that diabetes damages the nerves, but they all seem related to blood sugar being too high for a long period of time.
Diabetes-related nerve damage can be painful, but it isn't severe pain in most cases.
There are four types of diabetic neuropathy: peripheral, autonomic, proximal, and focal.
Diabetic Peripheral Neuropathy
The areas of the body most commonly affected by
diabetic peripheral neuropathy are the feet and legs.
Nerve damage in the feet can result in a loss of foot sensation, increasing your risk of foot problems. Injuries and sores on the feet may go unrecognized due to lack of sensation. Therefore, you should practice proper skin and foot care. Rarely, other areas of the body such as the arms, abdomen, and back may be affecte...
The other day I was flying across the country and exited the
in-flight lavatory to find my flight attendant standing in the back
kitchen. She was holding an ice pack over her wrist. She
spontaneously blurted out in explanation, "My carpal tunnel is acting
up." She then showed me where she was having pain and tenderness
along the tendon of the thumb side of her wrist.
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