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 diagnosis of carpal tunnel syndrome is suspected
based on the symptoms and the 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 the examiner by bending the wrist forward (referred to as
Phalen's maneuver).
The diagnosis is strongly suggested when a nerve
conduction velocity test is abnormal. This test involves measuring the
rate of speed of electrical impulses as they travel down a nerve.
In carpal tunnel syndrome, the impulse slows as it crosses through
the carpal tunnel. A test of muscles of the extremity, electromyogram (EMG), is sometimes performed to exclude or detect other conditions that might mimic carpal tunnel syndrome.
Blood tests may be performed to identify medical
conditions associated with carpal tunnel syndrome. These tests
include thyroid hormone levels, complete blood counts, and blood
sugar and protein analysis. X-ray tests of the wrist and hand
might also be helpful to identify abnormalities of the bones and joints of the wrist.
What is the treatment for carpal tunnel syndrome? Can carpal tunnel syndrome be prevented?
The choice of treatment for carpal tunnel syndrome
depends on the severity of the symptoms and any underlying disease that might be
causing the symptoms.
Initial treatment usually includes rest, immobilization
of the wrist in a splint, and occasionally ice application. Those
whose occupations are aggravating the symptoms should modify their
activities. For example, computer keyboards and chair height may
need to be adjusted to optimize comfort. These measures, as well as periodic resting and range of motion stretching
exercise of the wrists can actually prevent the symptoms of carpal tunnel syndrome that are caused by repetitive overuse. Underlying conditions
or diseases are treated individually. Fractures can require orthopedic
management. Obese individuals will be advised regarding weight
reduction. Rheumatoid disease is treated with measures directed
against the underlying arthritis.
Wrist swelling that can be associated with pregnancy resolves in time after
delivery of the baby.
Several types of medications have been used in the
treatment of carpal tunnel syndrome. Vitamin B6 (pyridoxine) has
been reported to relieve some symptoms of carpal tunnel syndrome,
although it is not known how this medication works. Nonsteroidal
anti-inflammatory drugs can also be helpful in decreasing inflammation
and reducing pain. Side effects include gastrointestinal upset
and even ulceration of the stomach. These medications should be
taken with food, and abdominal symptoms should be reported to the
doctor. Corticosteroids can be given by mouth or injected directly
into the involved wrist joint. They can bring rapid relief of the persistent
symptoms of carpal tunnel syndrome. Side effects of these medications,
when given in short courses, for carpal tunnel syndrome are minimal.
However, corticosteroids can aggravate diabetes and should be
avoided in the presence of infections.
Most patients with carpal tunnel syndrome improve
with conservative measures and medications. Occasionally, chronic
pressure on the median nerve can result in persistent numbness
and weakness. In order to avoid serious and permanent nerve and
muscle consequences of carpal tunnel syndrome, surgical treatment
is considered. Surgery involves severing the band of tissue around
the wrist to reduce pressure on the median nerve. This surgical
procedure is called "carpal tunnel release." It can now
be performed with a small diameter viewing tube, called an
arthroscope,
or by open wrist procedure. After carpal tunnel release, patients
often undergo exercise rehabilitation. Though it is uncommon,
symptoms can recur.
Carpal tunnel syndrome is caused by irritation of the
median nerve at the wrist.
Any condition that exerts pressure on the median
nerve can cause carpal tunnel syndrome.
Symptoms of carpal tunnel syndrome include numbness
and tingling of the hand.
Diagnosis of carpal tunnel syndrome is suspected
based on symptoms, supported by physical examination signs, and confirmed by
nerve conduction testing.
Treatment of carpal tunnel syndrome depends on the severity of symptoms and the underlying cause.
REFERENCES:
Koopman, William, et al., eds. Clinical Primer of Rheumatology. Philadelphia: Lippincott Williams & Wilkins, 2003.
Ruddy, Shaun, et al., eds. Kelley's Textbook of Rheumatology, 6th ed. Philadelphia: Saunders, 2001.
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.
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