Systemic Disease and the Carpal Tunnel Syndrome

Median nerve compression in the volar carpal tunnel (the carpal tunnel syndrome) has been recognized as an effect of trauma¹and has been ascribed in two reports²to the tenosynovitis of rheumatoid arthritis. There have been numerous reports³describing the spontaneous development of the carpal tunnel syndrome without known pathogenesis. We have recently observed five patients with a bilateral median neuritis as the first manifestation of amyloid disease, both primary and secondary, and one clearly defined case of rheumatoid arthritis complicated by a bilateral median neuritis. It is the purpose of this report to call attention to the importance of underlying disorders that, in the absence of trauma, may lead to the carpal tunnel syndrome. REPORT OF CASES Case 1. —A 54-year-old school teacher was in excellent health until the summer of 1951 when peculiar sensations were noted in the right thumb, followed shortly by tingling pain