Carpal tunnel

1. CARPAL TUNNEL SYNDROME REKHA RAJU 2 ND YR M.Sc NURSING

2. DEFINITION Carpal tunnel syndrome is pressure on the median nerve -- the nerve in the wrist that supplies feeling and movement to parts of the hand. It can lead to numbness, tingling, weakness, or muscle damage in the hand and fingers.

3. RISK FACTOR Sewing Driving Painting Writing Use of tools (especially hand tools or tools that vibrate) Sports such as h andball Playing some musical instruments

4. CAUSES Bone fractures and arthritis of the wrist Acromegaly Diabetes Alcoholism Hypothyroidism Kidney failure and dialysis Menopause, premenstrual syndrome (PMS), and pregnancy

5. Infections Obesity Rheumatoid arthritis, systemic lupus erythematosus (SLE), and scleroderma Synovitis Excessive hand exercise Edema or haemorrhage of the carpal tunnel Thrombosis of the median artery.

6. PATHOPHYSIOLOGY Due to the etiological factors   Synovium swollen   Pressure on the median nerve Temporary blockage of mylineated nerve fibers

7. Numbness on the fingers and hands   Continued pressure causes Ischemia, axonal death, muscular dystrophy, pain.

8. CLINICAL FEATURES Numbness or tingling in the thumb Axonal death, ischemia, muscular dystrophy, and pain due to the continues pressure. Mild manifestation includes intermittent paresthesias, tingling and pain in the median nerve distribution. Severe symptoms such as hypoesthesia, awkwardness, loss of dexterity and pinch strength, clumsiness, thenar atrophy, chronic and functional impairment secondary to axonal death.

9. DIAGNOSTIC MEASURES Physical examination Electromyography Nerve conduction velocity Wrist x-rays

10. MEDICAL MANAGEMENT Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen Corticosteroid injections, given into the carpal tunnel area, may relieve symptoms . Splint may be used to immobilize the wrist Physical therapy for hands to decrease the swelling and promote healing.After the 6 weeks of physical therapy , vocational evaluation is performed to determine the patient’s ability to returns previous job.

11. SURGICAL MANAGEMENT open tunnel release (OCTR)

12. Endoscopic carpal tunnel release (ECTR)

13. COMPLICATIONS OF SURGERY Nerve damage with tingling and numbness (usually temporary) Infection Scarring Pain Stiffness Loss of some wrist strength is a complication that affects 10% to a third of patients

14. NURSING MANAGEMENT Advise the patient hands should not be kept under the head. Examine the patients hand and wrists for any nail atrophy Note patients range of motion of fingers, wrists and hand strength. Teach the patient how to remove the splint in order to exercise, how to perform daily, gentle range of motion exercise

15. Teach the patient how apply splint. Advice the patient to do occasional exercise in warm water is therapeutic. Encourage the patient to use the hands as much as possible Encourage the patient to verbalize about disease. If the patient hand is impaired, assist in daily activities.

16. PREVENTION Avoid or reduce the number of repetitive wrist movements whenever possible. Use tools and equipment that are properly designed to reduce the risk of wrist injury. Ergonomic aids, such as split keyboards, keyboard trays, typing pads, and wrist braces, may be used to improve wrist posture during typing. Take frequent breaks when typing and always stop if there is tingling or pain.

17. Nursing diagnosis Acute pain related to nerve compression Self-care deficit: bathing/hygiene, dressing/grooming, feeding, and/or toileting related to bandaged hands. Risk for peripheral neurovascular dysfunction related to disease process. Risk for infection related to surgical procedure

18. COMPLICATIONS Numbness pain stiffness weakness