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To the Editor:—
Commenting on the remarks of Dr. Carl V. Granger, who replied to the note on "Morning 'stiffness,'" there is much to be said for his point of view. The numbness and stiffness occurring in the hands after a night's sleep may occur because of pressure from swelling on the median nerve as it passes through the carpal tunnel. Such swelling may be caused by rheumatoid arthritis, or from trauma or other sources. The Tinel's sign is not very reliable for diagnosis, nor is the Phelan sign. Measurement of nerve conductivity is much more accurate, as stated by Dr. Granger. Sometimes there is a bulge of tissue palpable just proximal to the wrist on the ulnar side of the volar surface of the wrist. This is the location of the common tendon sheath of the flexors of the third, fourth, and fifth fingers, anatomically called the ulnar bursa.
Hollander JL. Stiffness of the Wrists. JAMA. 1968;204(8):741. doi:10.1001/jama.1968.03140210097034
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