Definition

A type of compression neuropathy (nerve damage) caused by compression and

irritation of the median nerve in the wrist. The nerve is compressed within the carpal
tunnel, a bony canal in the palm side of the wrist that provides passage for the median
nerve to the hand. The irritation of the median nerve is specifically due to pressure from
the transverse carpal ligament.

Carpal tunnel syndrome (CTS) can be due to trauma from repetitive work such
as that of supermarket checkers, checkers in other types of stores, assembly line
workers, meat packers, typists, word processors, accountants, writers, etc. Other
factors predisposing to CTS include obesity, pregnancy, hypothyroidism, arthritis, and
diabetes.

Incidence

The incidence of carpal tunnel syndrome is 1-3 cases per 1000 subjects per
year; prevalence is approximately 50 cases per 1000 subjects in the general population.
Incidence may rise as high as 150 cases per 1000 subjects per year, with prevalence
rates greater than 500 cases per 1000 subjects in certain high-risk groups.

Causes

The median nerve provides feeling and movement to the "thumb side" of the
hand (the palm, thumb, index finger, middle finger, and thumb side of the ring finger).

The area in your wrist where the nerve enters the hand is called the carpal
tunnel. This tunnel is normally narrow, so any swelling can pinch the nerve and cause
pain, numbness, tingling or weakness. This is called carpal tunnel syndrome.

Carpal tunnel syndrome is common in people who perform repetitive motions of the
hand and wrist. Typing on a computer keyboard is probably the most common cause of
carpal tunnel. Other causes include:

• Sewing
• Driving
• Assembly line work
• Painting
• Writing
• Use of tools (especially hand tools or tools that vibrate)
• Sports such as racquetball or handball
• Playing some musical instruments

The condition occurs most often in people 30 to 60 years old, and is more common
in women than men
Symptoms

• Numbness or tingling in the thumb and next two or three fingers of one or both
hands
• Numbness or tingling of the palm of the hand
• Pain extending to the elbow
• Pain in wrist or hand in one or both hands
• Problems with fine finger movements (coordination) in one or both hands
• Wasting away of the muscle under the thumb (in advanced or long-term cases)
• Weak grip or difficulty carrying bags (a common complaint)
• Weakness in one or both hands

Exams and Tests

• Physical Examination
• Electromyography
• Nerve conduction velocity
• Wrist x-rays should be done to rule out other problems (such as wrist arthritis)
• Blood Test

Treatment

You may try wearing a splint at night for several weeks. If this does not help, you
may need to try wearing the splint during the day. Avoid sleeping on your wrists. Hot
and cold compresses may also be recommended.

There are many changes you can make in the workplace to reduce the stress on your
wrist:

• Special devices include keyboards, different types of mouse, cushioned mouse

pads, and keyboard drawers.
• Someone should review the position you are in when performing your work
activities. For example, make sure the keyboard is low enough so that your wrists
aren't bent upward while typing. Your doctor may suggest an occupational
therapist.
• You may also need to make changes in your work duties or recreational
activities. Some of the jobs associated with carpal tunnel syndrome include those
that involve typing and vibrating tools. Carpal tunnel syndrome has also been
linked to professional musicians.

MEDICATIONS

Medications used in the treatment of carpal tunnel syndrome include nonsteroidal

anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. Corticosteroid
injections, given into the carpal tunnel area, may relieve symptoms for a period of time.
SURGERY

Carpal tunnel release is a surgical procedure that cuts into the ligament that is
pressing on the nerve. Surgery is successful most of the time, but it depends on how
long the nerve compression has been occurring and its severity.

Outlook (Prognosis)

Symptoms often improve with treatment, but more than 50% of cases eventually
require surgery. Surgery is often successful, but full healing can take months.

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.

Therapeutic and Pharmacologic Intervention

1. Wrist splint in slight extension (cock-up splint) to relieve pressure aggravated

by wrist flexion: worn at night, and during day if symptomatic.
2. Avoidance of flexion and twisting motion of the wrist.
3. Work or activity modification to relieve repetitive strain.
4. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 600 to 800
mg tid to relieve inflammation and pain.
5. Corticosteroid injection into tendon sheath to relieve inflammation.

Nursing Management

1. Monitor level of pain, numbness, paresthesias, and functioning.

2. Monitor for adverse effects of NSAID therapy, especially in elderly. GI distress
or bleeding, dizziness, or increased serum creatinine.
3. After surgery, monitor neurovascular status of affected extremity: pulses, color,
swelling, movement, sensation, or warmth.
4. Apply wrist splint so wrist is in neutral position, with slight extension of wrist
and slight abduction of thumb; make sure that it fits correctly without constriction.
5. Administer NSAIDs and assist with tendon sheath injections as required.
6. Apply ice or cold compress to relieve inflammation and pain.
7. Teach patient the cause of condition and ways to alter activity to prevent
flexion of wrists; refer to an occupational therapist as indicated.
8. Advise patient of NSAID therapy dosage schedule and potential adverse
effects; instruct patient to report GI pain and bleeding.
9. Teach patient to gentle range-of-motion exercises; refer to a physical therapist
as indicated.
Outlook (Prognosis)

Carpal tunnel
release decreases pain, nerve tingling, and numbness better, and restores muscle strength. Still,
most people are helped by this surgery.

How is carpal tunnel syndrome diagnosed?

The diagnosis of carpal tunnel syndrome is suspected based on the symptoms and the distribution of the hand
numbness. Examination of the neck, shoulder, elbow, pulses, and reflexes can be performed to exclude other
conditions that can mimic carpal tunnel syndrome. The wrist can be examined for swelling, warmth, tenderness,
deformity, and discoloration. Sometimes tapping the front of the wrist can reproduce tingling of the hand, and is
referred to as Tinel's sign of carpal tunnel syndrome. Symptoms can also at times be reproduced by the examiner by
bending the wrist forward (referred to as Phalen's maneuver).
The diagnosis is strongly suggested when anerve conduction velocity test is abnormal. This test involves measuring
the rate of speed of electrical impulses as they travel down a nerve. In carpal tunnel syndrome, the impulse slows as
it crosses through the carpal tunnel. A test of muscles of the extremity, electromyogram (EMG), is sometimes
performed to exclude or detect other conditions that might mimic carpal tunnel syndrome.
Blood tests may be performed to identify medical conditions associated with carpal tunnel syndrome. These tests
include thyroid hormone levels, complete blood counts, and blood sugar and protein analysis. X-ray tests of the wrist
and hand might also be helpful to identify abnormalities of the bones and joints of the wrist.
 DE LA SALLE HEALTH SCIENCES INSTITUTE

COLLEGE OF NURSING AND SCHOOL OF MIDWIFERY

DASMARIŇAS, CAVITE

Carpal Tunnel Syndrome

SUBMITTED BY:
Ellex John F. Benipayo

BSN 45 group 4