Carpal Tunnel Syndrome—Initial Manifestation of Systemic Disease

Severe pain and paresthesias in the hands were the features common to the 3 cases here described. In the first patient, a woman aged 55, median neuropathy was the first indication of rheumatoid arthritis, and neurolysis at the right wrist gave immediate relief of pain. In the second, a man aged 51, the diagnosis proved to be gouty arthritis, and the decompression of the median nerve, which relieved the symptoms in the right hand, also revealed tophaceous deposits. In the third, a man aged 63, decompression of the median nerves at the wrists was followed by prompt, complete relief of pain in both hands; biopsy material confirmed the diagnosis of myeloma. Recognition of the carpal tunnel syndrome in each case helped to settle the diagnosis, and led to relief by surgery from severe, prolonged suffering.