Carpal Tunnel Syndrome-razon and Yonson

8/8/2019 Carpal Tunnel Syndrome-razon and Yonson

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What is a Carpal Tunnel Syndrome?


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DEFINITION:CTS is compression of the median nerve at the

wrist, which may result in numbness, tingling,

weakness, or muscle damage in the hand andfingers.

CTS is an entrapment neuropathy that occurs

when the median nerve at the wrist is compressed

by a thickened flexor tendon sheath, skeletalencroachment, edema or soft tissue mass.


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SYNONYMS:

E n t r a p m e n t N e u r o p a t h y

M e d i a n N e r v e D y s f u n c t i o n


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CAUSES:

Inflammation of the flexortendon sheath caused byactivities involving repetitivewrist flexion.

Examples:

-Assembly packing

-Computer keyboard work

-Playing a musicalinstrument

-Craftwork Edema from trauma of any

type (eg, fractures), whichcan compress the mediannerve

Strong association betweenbeing overweight or obeseand the presence of CTS

Acromegaly

Rheumatoid arthritis

Gout or pseudo gout

Tuberculosis

Renal failure andhemodialysis

Hypothyroidism Amyloidosis

Has been associated withdiabetes mellitus


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PREDISPOSING FACTORS


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Family history may have a significant role in individualssusceptibility

Trauma related; fractures one of the arm bones (CollesF

racture) Dislocation if the carpal bone on the wrist

Pregnancy and hypothyroidism, fluid is retained in tissues whichswells the tenosynovium

Acromegaly, disorder of the growth hormones

Tumors such as ganglion or lymphoma

Common activities identified as repetitive stress induced CTSincludes:

Computer keyboarding or typing

Playing video or computer games

Playing musical instrument

Construction workers


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A feature of a variety of conditions of carpal

tunnel syndrome (CTS) is caused by compressionof the median nerve in the narrow tunnel formed

by the small bones of the hand, multiple

longitudinal flexor tendons, and the transverse

carpal ligament. Repeated use of the hands may

cause inflammation of these tendons and may leadto swelling in the wrist and subsequent pressure on

the nerve. Nerve entrapment syndromes result from

focal injury to a peripheral nerve and are more

common in the upper extremities. The mostcommon entrapment neuropathy is CTS, which

affects the wrist.


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SIGNANDSYMPTOMS:

Symptoms usually start gradually, with frequentburning, tingling, or itching numbness in the palmof the hand and the fingers, especially the thumb

and the index and middle fingers.First appear in one or both hands during the night,

since many people sleep with flexed wrists.

Decreased grip strength may make it difficult to

form a fist, grasp small objects, or perform othermanual tasks.

Some are unable to tell between hot and cold bytouch.


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DIAGNOSTIC TEST


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Phalen's Maneuver

The patient is asked to

hold their wrist incomplete and forced

flexion (pushing the

dorsal surfaces of both

hands together) for3060 seconds.

http://www.webmd.com/painmanagement/carpal-tunnel/carpal-tunnel-syndrome-exams-and-testst


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Nerve testing

To evaluate any loss of

normal functioning in the

median nerve. Nerve

testing for carpal tunnel

syndrome is used in

specific situations, such as

when surgery is being

considered or thediagnosis is unclear.

http://www.webmd.com/painmanagement/carpal-

tunnel/carpal-tunnel-syndrome-exams-and-testst


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X-rays

y To check for boneproblems caused by pastinjury, arthritis, recentlybroken or dislocatedbones, or tumors. X-raysare not used to diagnosecarpal tunnel syndrome,but they can be helpful foridentifying signs of

arthritis or an old or newwrist or neck injury thatmay be contributing toyour symptoms.




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Ultrasound

y To look at the size of

the median nerve. It is

inexpensive,comfortable, and

quick. However, its

use for carpal tunnel

syndrome diagnosis isstill unproven and

relatively uncommon.




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MANAGEMENT:

MEDICAL / PHARMACOLOGIC

Nsaids (Non-Steroidal Inflammatory Drugs)

examples: Ibuprofen, Naproxen,

Carpal canal cortisone injections may relieve the

symptoms

Prednisone (oral steroid)

Tylenol ; anti-inflammatory

Diuretics useful during pregnancy


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SURGICAL

Traditional open nerve release/

open method

Endoscopic laser surgery- has a

small incision


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NURSING INTERVENTION


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Hot and cold compress

Avoid repetitive flexion of the wrist

Wrist splint to prevent hyperextension

Relaxing and resting the affected area

Mild analgesics

Perform range of motion exercises

After surgery, monitor vital signs, and regularly

check the color, sensation, and motion of the

affected hand


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BURNER AND SUDDARTS MED-SURG.NSG.

VOL.2; 11TH




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Documents

Carpal Tunnel Syndrome-razon and Yonson