CARPAL TUNNEL SYNDROMEREKHA RAJU

2ND YR M.Sc NURSING

DEFINITION

• Carpal tunnel syndrome is pressure on the

median nerve -- the nerve in the wrist that

supplies feeling and movement to parts of the

hand. It can lead to numbness, tingling,

weakness, or muscle damage in the hand and

fingers.

RISK FACTOR

• Sewing

• Driving

• Painting

• Writing

• Use of tools (especially hand tools or tools that vibrate)

• Sports such as handball

• Playing some musical instruments

CAUSES

• Bone fractures and arthritis of the wrist

• Acromegaly

• Diabetes

• Alcoholism

• Hypothyroidism

• Kidney failure and dialysis

• Menopause, premenstrual syndrome (PMS), and

pregnancy

• Infections

• Obesity

• Rheumatoid arthritis, systemic lupus erythematosus

(SLE), and scleroderma

• Synovitis

• Excessive hand exercise

• Edema or haemorrhage of the carpal tunnel

• Thrombosis of the median artery.

PATHOPHYSIOLOGY

• Due to the etiological factors

Synovium swollen

Pressure on the median nerve

Temporary blockage of mylineated nerve fibers

Numbness on the fingers and hands

Continued pressure causes

Ischemia, axonal death, muscular dystrophy, pain.

CLINICAL FEATURES

• Numbness or tingling in the thumb

• Axonal death, ischemia, muscular dystrophy, and pain

due to the continues pressure.

• Mild manifestation includes intermittent paresthesias,

tingling and pain in the median nerve distribution.

• Severe symptoms such as hypoesthesia, awkwardness,

loss of dexterity and pinch strength, clumsiness, thenar

atrophy, chronic and functional impairment secondary to

axonal death.

DIAGNOSTIC MEASURES

• Physical examination

• Electromyography

• Nerve conduction velocity

• Wrist x-rays

MEDICAL MANAGEMENT

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as

ibuprofen or naproxen

• Corticosteroid injections, given into the carpal tunnel

area, may relieve symptoms .

• Splint may be used to immobilize the wrist

• Physical therapy for hands to decrease the swelling and

promote healing.After the 6 weeks of physical therapy ,

vocational evaluation is performed to determine the

patient’s ability to returns previous job.

SURGICAL MANAGEMENT

• open tunnel release (OCTR)

• Endoscopic carpal tunnel release (ECTR)

COMPLICATIONS OF SURGERY

• Nerve damage with tingling and numbness (usually

temporary)

• Infection

• Scarring

• Pain

• Stiffness

• Loss of some wrist strength is a complication that affects

10% to a third of patients

NURSING MANAGEMENT

• Advise the patient hands should not be kept

under the head.

• Examine the patients hand and wrists for any

nail atrophy

• Note patients range of motion of fingers, wrists

and hand strength.

• Teach the patient how to remove the splint in

order to exercise, how to perform daily, gentle

range of motion exercise

• Teach the patient how apply splint.

• Advice the patient to do occasional exercise in

warm water is therapeutic.

• Encourage the patient to use the hands as much

as possible

• Encourage the patient to verbalize about

disease.

• If the patient hand is impaired, assist in daily

activities.

PREVENTION

• Avoid or reduce the number of repetitive wrist

movements whenever possible.

• Use tools and equipment that are properly designed to

reduce the risk of wrist injury.

• Ergonomic aids, such as split keyboards, keyboard

trays, typing pads, and wrist braces, may be used to

improve wrist posture during typing.

• Take frequent breaks when typing and always stop if

there is tingling or pain.

Nursing diagnosis

• Acute pain related to nerve compression

• Self-care deficit: bathing/hygiene,

dressing/grooming, feeding, and/or toileting

related to bandaged hands.

• Risk for peripheral neurovascular dysfunction

related to disease process.

• Risk for infection related to surgical procedure

COMPLICATIONS

• Numbness

• pain

• stiffness

• weakness