Carpal tunnel
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Carpal tunnel






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Carpal tunnel Carpal tunnel Presentation Transcript

  • 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.
  • RISK FACTOR • Sewing • Driving • Painting • Writing • Use of tools (especially hand tools or tools that vibrate) • Sports such as handball • Playing some musical instruments
  • CAUSES • Bone fractures and arthritis of the wrist • Acromegaly • Diabetes • Alcoholism • Hypothyroidism • Kidney failure and dialysis • Menopause, premenstrual syndrome (PMS), and pregnancy
  • • 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.
  • PATHOPHYSIOLOGY • Due to the etiological factors Synovium swollen Pressure on the median nerve Temporary blockage of mylineated nerve fibers
  • Numbness on the fingers and hands Continued pressure causes Ischemia, axonal death, muscular dystrophy, pain.
  • 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.
  • DIAGNOSTIC MEASURES • Physical examination • Electromyography • Nerve conduction velocity • Wrist x-rays
  • 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.
  • SURGICAL MANAGEMENT • open tunnel release (OCTR)
  • • Endoscopic carpal tunnel release (ECTR)
  • 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
  • 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
  • • 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.
  • 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.
  • 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
  • COMPLICATIONS • Numbness • pain • stiffness • weakness