CARPAL TUNNEL SYNDROME

CARPAL TUNNEL SYNDROME

• Entrapment neuropathy occurs when median nerve at wrist compressed by thickened flexor
tendon sheath, skeletal encroachment, edema, soft tissue mass.
• Edema and soft tissue mass may be a complication of pregnancy
• Commonly due to repetitive hand activities but may be associated with arthritis,
hypothyroidism, pregnancy

CLINICAL MANIFESTATIONS
• Experiences pain
• Numbness
• Paresthesia
• Possible weakness along median nerve (Thumb, 1st / 2nd finger)
• Decreased strength – No strength to open twist tops
• Night pain is common – Sleep disturbances

DIAGNOSTICS
• Tinel’s Sign
o Percussing lightly over median nerve; patient reports tingling, numbness, pain test
considered positive
o May be used to help identify carpal tunnel syndrome
• Phalan’s Test
o Flexion of wrist for 60 seconds
• Electromyogram
o Nerve conduction

TREATMENT
Based on cause

• Rest splints prevent hyperextension, prolonged flexion wrist – Elevate wrist at night
• Avoidance of repetitive flexion wrist
• Ice / Heat treatment
• NSAID’s
• Economically safe equipment - rubber padded handles
• Vitamin B6 – Oral aid decreases symptoms with constriction
• Carpal canal cortisone injections may relieve symptoms
o 3-4 month relief
o Increases side effects
o Masks s/s of infection; breakdown bone
• Surgical release transverse carpal ligament may be necessary

Full recovery of motor or sensory function after surgical release may take several weeks or months
NURSING DIAGNOSIS
• Pain R/T nerve compression (Medial)
• Sensory alteration R/T numbness
• Sleep pattern disturbance R/T Pain
• Ineffective coping R/T need for job change

NURSING CARE
• Application of Ice and Heat
• Meds – Take same time daily with food
• Apply splints
• Monitor / taught – increases discomfort
• Assess ROM
• Elevate hand with pillow parallel with body

COMMUNITY AGENCIES
• Workers compensation
• Vocational Rehab
• SS
• OT