CARPAL TUNNEL SYNDROME
hyperextension & prolonged flexion
Prepared by: Denise M. Espinosa
 Condition that causes pain,
numbness, tingling and paresthesia &
possibly weakness along the median
nerve (thumb and the first two
fingers).
 Carpal tunnel syndrome is caused by
a compressed nerve in the carpal
tunnel, a narrow passageway on the
palm side of your wrist.
 Due to repetitive use of the wrists (Ex.
computer programmers,
stenographers)
CAUSES:
 Anything that squeezes or irritates the
median nerve in the carpal tunnel
space may lead to carpal tunnel
syndrome.
 Conditions or illnesses that can cause
or contribute to arm pain or swelling in
the joints and soft tissues in the arm, or
to reduced blood flow to the hands.
These include obesity, rheumatoid
arthritis, gout, diabetes, lupus,
and hypothyroidism.
 Repeated hand and wrist movements.
They can cause the membranes
surrounding the tendons to swell
(tenosynovitis).
 Broken wrist bones, dislocated bones,
new bone growth from healing bones,
or bone spurs. These can take up
space in the carpal tunnel and put
more pressure on the median nerve
RISK FACTORS:
 Anatomic factors
 Sex
 Nerve-damaging conditions
 Inflammatory conditions
 Obesity
 Alteration in the balance body fluids
 Workplace factors
DIAGNOSIS:
 History
 Physical examination (Tinel’s sign,
tapping over the carpal tunnel,
reproduction of pain, numbness,
tingling is a positive test)
 X-ray
 Electromyogram
 Nerve condition study
MANAGEMENT:
The goal of treatment for carpal tunnel
syndrome is to allow you to return to your
normal function and activities and to
prevent nerve damage and loss of muscle
strength in your fingers and hand.
 Rest and splint to prevent
of the wrist.
 NSAIDs, such as ibuprofen (Advil,
Motrin IB, others), may help relieve
pain from carpal tunnel syndrome in
the short term.
 Corticosteroids. Your doctor may
inject your carpal tunnel with a
corticosteroid such as cortisone to
relieve pain.
 Surgery - Surgery may be
appropriate if your symptoms are
severe or don't respond to other
treatments. The goal of carpal tunnel
surgery is to relieve pressure by
cutting the ligament pressing on the
median nerve.
 Endoscopic surgery
 Open surgery
NURSING INTERVENTIONS:
1. Monitor level of pain, numbness,
paresthesia, 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
 CARPAL TUNNEL SYNDROME
Prepared by: Denise M. Espinosa
 Condition that causes pain, numbness, tingling and paresthesia & possibly weakness
along the median nerve (thumb and the first two fingers).
 Carpal tunnel syndrome is caused by a compressed nerve in the carpal tunnel, a narrow
passageway on the palm side of your wrist.
 Due to repetitive use of the wrists (Ex. computer programmers, stenographers)
CAUSES:

 Anything that squeezes or irritates the median nerve in the carpal tunnel space may
lead to carpal tunnel syndrome.
 Conditions or illnesses that can cause or contribute to arm pain or swelling in the joints and
soft tissues in the arm, or to reduced blood flow to the hands. These
include obesity, rheumatoid arthritis, gout, diabetes, lupus, and hypothyroidism.
 Repeated hand and wrist movements. They can cause the membranes surrounding the
tendons to swell (tenosynovitis).
 Broken wrist bones, dislocated bones, new bone growth from healing bones, or bone spurs.
These can take up space in the carpal tunnel and put more pressure on the median nerve

RISK FACTORS:

 Anatomic factors (wrist fracture or dislocation, or arthritis that deforms the small bones in the wrist,
can alter the space within the carpal tunnel and put pressure on the median nerve.)
 Sex (Carpal tunnel syndrome is generally more common in women. This may be because the carpal
tunnel area is relatively smaller in women than in men. Women who have carpal tunnel syndrome
may also have smaller carpal tunnels than women who don't have the condition.)
 Nerve-damaging conditions (Some chronic illnesses, such as diabetes, increase your risk of nerve
damage, including damage to your median nerve.)
 Inflammatory conditions (Illnesses that are characterized by inflammation, such as rheumatoid
arthritis, can affect the lining around the tendons in your wrist and put pressure on your median nerve.)
 Obesity (Being obese is a significant risk factor for carpal tunnel syndrome.)
 Alteration in the balance body fluids (Fluid retention may increase the pressure within your carpal
tunnel, irritating the median nerve. This is common during pregnancy and menopause. Carpal tunnel
syndrome associated with pregnancy generally resolves on its own after pregnancy.)
 Workplace factors (t's possible that working with vibrating tools or on an assembly line that requires
prolonged or repetitive flexing of the wrist may create harmful pressure on the median nerve or worsen
existing nerve damage.)

DIAGNOSIS:

 History
 Physical examination (Tinel’s sign, tapping over the carpal tunnel, reproduction of pain,
numbness, tingling is a positive test)
  X-ray
 Electromyogram (test measures the tiny electrical discharges produced in muscles.
During this test, your doctor inserts a thin-needle electrode into specific muscles to
evaluate the electrical activity when muscles contract and rest. This test can identify
muscle damage and also may rule out other conditions.)
 Nerve condition study (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)

MANAGEMENT:

The goal of treatment for carpal tunnel syndrome is to allow you to return to your normal
function and activities and to prevent nerve damage and loss of muscle strength in your
fingers and hand.

 Rest and splint to prevent hyperextension & prolonged flexion of the wrist.
 NSAIDs, such as ibuprofen (Advil, Motrin IB, others), may help relieve pain from carpal
tunnel syndrome in the short term.
 Corticosteroids. Your doctor may inject your carpal tunnel with a corticosteroid such as
cortisone to relieve pain.

 Surgery - Surgery may be appropriate if your symptoms are severe or don't respond to
other treatments. The goal of carpal tunnel surgery is to relieve pressure by cutting the
ligament pressing on the median nerve.

 Endoscopic surgery (Your surgeon uses a telescope-like device with a tiny camera
attached to it (endoscope) to see inside your carpal tunnel. Your surgeon cuts 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 (Your surgeon makes an incision in the palm of your hand over the carpal
tunnel and cuts through the ligament to free the nerve.

Nursing Interventions:
1. Monitor level of pain, numbness, paresthesia, 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