Carpal Tunnel Syndrome &
Tarsal Tunnel Syndrome
Medical Author: William C. Shiel Jr., MD, FACP, FACR
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"Carpal Tunnel" It Wasn't!
Medical Author: William C. Shiel Jr.,
MD, FACP, FACR
 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.
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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 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 from Latin which means
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.
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