CARPAL TUNNEL SYNDROME

NCM 104.1-NA

SUBMITTED BY:

QUEENIE ROSE E. ARSENAL

SUBMITTED TO:

PHILIP ELI B. NALZARO, RN, MN

DEXTER DAVE D. ORIGINES, RN, MN

February 23, 2017

A. DISEASE CONDITION

 Carpal tunnel syndrome is a painful condition of the hand and fingers caused by
compression of a major nerve where it passes over the carpal bones through a
passage at the front of the wrist, alongside the flexor tendons of the hand. It may
be caused by repetitive movements over a long period, or by fluid retention, and
is characterized by sensations of tingling, numbness, or burning.
 Affects an estimated 3 percent of adult Americans
 Three times more common in women 30-60 years of age than in men
 High prevalence rates have been reported in persons who perform certain
repetitive wrist motions (frequent computer users)

B. PREDISPOSING/PRECIPITATING FACTORS

PREDISPOSING FACTORS

 AGE- it can occur in various ages and age groups but it is more common in
young adulthood to middle adulthood
 SEX- it is more common to women than men due to their anatomical structure
 GENETICS- hereditary factors such as having small anatomical structures and
diseases that can induce carpal tunnel syndrome may be included.

PRECIPITATING FACTORS

 Wrist or hand injuries

 Inflammatory conditions (ex. Rheumatoid Arthritis, SLE)
 Nerve damaging condition (Diabetes)
 Conditions that cause fluid build-up (Pregnancy)
 Repetitive hand movements
 Other medical conditions. Certain conditions, such as menopause, obesity,
thyroid disorders and kidney failure, may increase your chances of carpal tunnel
syndrome.

D. CLINICAL MANIFESTATION

Carpal tunnel syndrome usually starts gradually with numbness or tingling in your
thumb, index and middle fingers that comes and goes. This may be associated with
discomfort in your wrist and hand. Common carpal tunnel syndrome symptoms include:

 Pain
 Numbness
 Weakness
 Tingling
  Positive Tinel’s sign (detection of irritated nerves by lightly tapping or percussing
over the nerve to elicit sensation of tingling or “pins and needles”.

E. DIAGNOSTIC STUDIES

 History of symptoms. The pattern of your signs and symptoms may offer clues to
their cause. For example, because the median nerve doesn't provide sensation to
your little finger, symptoms in that finger may indicate a problem other than carpal
tunnel syndrome.

Usual times when you experience symptoms due to carpal tunnel syndrome include
while holding a phone or a newspaper, gripping a steering wheel, or waking up
during the night.

 Physical examination. Pressure on the median nerve at the wrist, produced by

bending the wrist, tapping on the nerve or simply pressing on the nerve, can bring
on the symptoms in many people.

o Tinel’s sign
o Phalen maneuver (Forced flexion of hands for 30-60 second)

 X-ray. Some doctors recommend an X-ray of the affected wrist to exclude other

causes of wrist pain, such as arthritis or a fracture.

 Electromyogram. Electromyography measures the tiny electrical discharges

produced in muscles. During this test, insertion of a thin-needle electrode into

specific muscles. The test evaluates the electrical activity of your muscles when

they contract and when they're at rest. This test can determine if muscle damage

has occurred and also may be used to rule out other conditions.

 Nerve conduction study. In a variation of electromyography, two electrodes are

taped to your skin. A small shock is passed through the median nerve to see if
electrical impulses are slowed in the carpal tunnel. This test may be used to
diagnose your condition and rule out other conditions.

F. MEDICAL AND SURGICAL MANAGEMENT

If the condition is diagnosed early, nonsurgical methods may help improve carpal tunnel
syndrome. Methods may include:

 Wrist splinting. A splint that holds your wrist still while you sleep can help relieve
nighttime symptoms of tingling and numbness. Nocturnal splinting may be a good
option if you're pregnant and have carpal tunnel syndrome.
 Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs such as ibuprofen
(Advil, Motrin IB, others) may help relieve pain from carpal tunnel syndrome in the
short term.
 Corticosteroids. Corticosteroid injections such as cortisone to relieve your pain.

Oral corticosteroids aren't considered as effective as corticosteroid injections for

treating carpal tunnel syndrome.

 Wear a wrist splint at night. The splint should be snug but not tight.
 Avoid sleeping on your hands to help ease the pain or numbness in your wrists and
hands.

Nursing Management

 Assist the patient with hygiene if necessary before surgical correction and
with postoperative dressings after surgery.
 Patients wearing wrist splints may need assistance with certain activities of
daily living (ADLs).
 Assist the patient in exercising the hand; encourage performance of activi-
ties through physical therapy.
 Monitor the motion and sensation in the hand following surgery—check cap-
illary refill, color, and sensation of fingers.
 Encourage movement of fingers after surgery.
 Monitor postoperative dressing for drainage.
 Explain to the patient:
• Use, interactions, and side effects of anti-inflammatory medications.
• Proper use of wrist splints.
• Encourage appropriate exercises.
• Use of ergonomic devices, such as wrist rests or keyboard trays for com-
puter work.

Surgery

If symptoms are severe or persist after trying nonsurgical therapy, surgery may be the
most appropriate option.

The goal of carpal tunnel surgery is to relieve pressure on your median nerve by cutting
the ligament pressing on the nerve.

 Endoscopic surgery. In endoscopic surgery, your surgeon uses a telescope-like

device with a tiny camera attached to it (endoscope) to see inside your carpal tunnel
and cut the ligament through one or two small incisions in your hand or wrist.

Endoscopic surgery may result in less pain than does open surgery in the first few
days or weeks after surgery.

 Open surgery. In open surgery, your surgeon makes a larger incision in the palm of
your hand over the carpal tunnel and cuts through the ligament to free the nerve.
 This procedure may also be conducted using a smaller incision, which may reduce
the risk of complications.

Alternative medicine

Alternative forms of therapy can be integrated into your regular health plan to help
you deal with the signs and symptoms of carpal tunnel syndrome. You may have to
experiment to find a treatment that works for you. Still, always check with your doctor
before trying any complementary or alternative treatment.

 Yoga. Yoga postures designed for strengthening, stretching and balancing each
joint in the upper body, as well as the upper body itself, may help reduce the pain
and improve the grip strength of people with carpal tunnel syndrome.
 Hand therapy. Preliminary evidence suggests that certain physical and
occupational hand therapy techniques may help improve symptoms of carpal tunnel
syndrome.
 Ultrasound therapy. High-intensity ultrasound can be used to raise the
temperature of a targeted area of body tissue to reduce pain and promote healing. A
course of ultrasound therapy over several weeks may help improve the symptoms of
carpal tunnel syndrome.

Prevention

There are no proven strategies to prevent carpal tunnel syndrome, but you can
minimize stress on your hands and wrists by taking the following precautions:

 Reduce your force and relax your grip. Most people use more force than needed
to perform many manual tasks. If your work involves a cash register, for instance, hit
the keys softly. For prolonged handwriting, use a big pen with an oversized, soft grip
adapter and free-flowing ink. This way you won't have to grip the pen tightly or press
as hard on the paper.
 Take frequent breaks. Give your hands and wrists a break by gently stretching and
bending them periodically. Alternate tasks when possible. If you use equipment that
vibrates or that requires you to exert a great amount of force, taking breaks is even
more important.
 Watch your form. Avoid bending your wrist all the way up or down. A relaxed
middle position is best. If you use a keyboard, keep it at elbow height or slightly
lower.
 Improve your posture. Incorrect posture can cause your shoulders to roll forward.
When your shoulders are in this position, your neck and shoulder muscles are
shortened, compressing nerves in your neck. This can affect your wrists, fingers and
hands.
 Keep your hands warm. You're more likely to develop hand pain and stiffness if
you work in a cold environment. If you can't control the temperature at work, put on
fingerless gloves that keep your hands and wrists warm.
G. NURSING DIAGNOSIS

 Acute Pain
 Impaired mobility
 Disturbed sensory perception (tactile)

SOURCES:

www.mayoclinic.org/diseases-conditions/carpaltunnelsyndrome/.../con-20031513

http://www.emedicine.medscape.com/article/766373-overviewcarpaltunnelsyndrome

www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/.../carpaltunnel-2365

Brunner &Suddarth, Textbook of Medical-Surgical Nursing, Carpal Tunnel Syndrome,

Lipincott Williams & Wilkins, 2010.vol. 2yo . P734