CARPAL TUNNEL SYNDROME

 Carpal tunnel syndrome is a common condition that causes pain, numbness,

tingling, and weakness in the hand and wrist. 
 It happens when there is increased pressure within the wrist on a nerve called
the median nerve. This nerve provides sensation to the thumb, index, and middle
fingers, and to half of the ring finger. The small finger (the “pinky”) is typically not
affected.

CAUSE/S

Carpal tunnel syndrome is caused by pressure on the median nerve.

The median nerve runs from the forearm through a passageway in the wrist (carpal
tunnel) to the hand. It provides sensation to the palm side of the thumb and fingers,
except the little finger. It also provides nerve signals to move the muscles around the
base of the thumb (motor function).

RISK FACTORS

 Anatomic factors
 Sex
 Nerve-damaging conditions
 Inflammatory conditions
 Medications
 Obesity
 Body fluid changes
 Other medical conditions
 Workplace factors

SIGNS AND SYMPTOMS

 Tingling or numbness. You may notice tingling and numbness in the

fingers or hand. Usually the thumb and index, middle or ring fingers are
affected, but not the little finger. You might feel a sensation like an electric
shock in these fingers.
 The sensation may travel from the wrist up the arm. These symptoms often
occur while holding a steering wheel, phone or newspaper, or may wake
you from sleep.

Many people "shake out" their hands to try to relieve their symptoms. The
numb feeling may become constant over time.

 Weakness. You may experience weakness in the hand and drop objects.

This may be due to the numbness in the hand or weakness of the thumb's
pinching muscles, which are also controlled by the median nerve.

DIAGNOSIS

 History of symptoms
 Physical examination
 X-ray
 Ultrasound
 Electromyography

TREATMENT

NON-SURGICAL THERAPY

 Wrist splinting

 Nonsteroidal anti-inflammatory drugs (NSAIDs

 Corticosteroids

SURGERY

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

The surgery may be performed with two different techniques:

 Endoscopic surgery.  Your surgeon cuts the ligament through one or two small
incisions in the hand or wrist
  Open surgery. Your surgeon makes an incision in the palm of the hand over the
carpal tunnel and cuts through the ligament to free the nerve.

Surgery risks may include:

 Incomplete release of the ligament

 Wound infections
 Scar formation
 Injuries to the nerves or blood vessels

NURSING MANAGEMENT

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

 Monitor for adverse effects of NSAID therapy, especially in elderly. GI distress or
bleeding, dizziness, or increased serum creatinine.
 After surgery, monitor neurovascular status of affected extremity: pulses, color,
swelling, movement, sensation, or warmth.
 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.
 Administer NSAIDs and assist with tendon sheath injections as required.
 Apply ice or cold compress to relieve inflammation and pain.
 Teach patient the cause of condition and ways to alter activity to prevent flexion
of wrists; refer to an occupational therapist as indicated.
 Advise patient of NSAID therapy dosage schedule and potential adverse effects;
instruct patient to report GI pain and bleeding.
 Teach patient to gentle range-of-motion exercises; refer to a physical therapist as
indicated