Systemic Disease and the Carpal Tunnel Syndrome

Abstract

It must be stressed that what disturbs the patient may seem rather unimportant to the physician, to whom a solution to the problem may be immediately evident. It should be remembered, however, that any solution must come through the patient's efforts, using whatever capac¬ ities he has, and also that any advice given must be on this basis. SUMMARY The treatment of heart disease due to anxiety consists of relieving the patient's anxiety and his cardiac aware¬ ness. Some long-standing or recent conflict is sought; the tension and anger connected with such conflicts are expressed, and their relationship to the palpitation, tachy¬ cardia, and weakness is pointed out.

The Neuropathy of Multiple Myeloma

“…These orbital and intracranial complications of multiple myeloma have recently been reviewed by Clarke (1953,1954). Herpes zoster is a rare complication of multiple myeloma (Anders and Boston, 1903;von Bomhard, 1914;Wallgren, 1920) and, most recently, median neuritis due to amyloid deposition in the carpal ligament has been describedt (Grokoest and Demartini, 1954).…”

Deposition of Nonamyloid Material in Connective Tissue in Uraemia

“…the com pression of the median nerve within the car pal tunnel which is formed anatomically from the carpal bones and the ligamentum carpi transversum. CTS is described to occur in a high incidence in long-term haemodialysis patients [3][4][5][6][7], As CTS is also a characteristic complication in systemic amyloidosis [8][9][10][11], and as furthermore perineural, amyloid like material was detected in some cases of CTS in haemodialysis patients [12][13][14][15][16] a study was performed in a large haemodialysis population as well as in patients with chronic renal disease still on conservative treatment, in order to further elucidate whether this clin ical syndrome is uraemia-related or rather a consequence of long-term dialysis treatment.…”

Familial carpal tunnel syndrome with onset in childhood.

“…This mechanism seems to be responsible for the carpal tunnel syndrome in patients with pleonosteosis (Watson-Jones, 1949), and thickening of the transverse carpal ligament in acromegaly may contribute to median nerve compression in that disorder (Johnston, 1960). In amyloidosis thickening of the tendon sheaths rather than the transverse carpal ligaments may result in compression of the median nerves in the carpal tunnel (Grokoest and Demartini, 1954). However, Lambird and Hartmann (1969) argue from pathological evidence that in their patients with familial amyloidosis and carpal tunnel syndrome the transverse carpal ligaments, which were infiltrated with amyloid material, though not thickened, were directly responsible for compression of the median nerves.…”