Carpal tunnel syndrome is caused by pressure on the median nerve as it passes through the wrist, leading to numbness and tingling in the hand. Risk factors include repetitive motions from activities like sewing, driving, or playing instruments. Symptoms range from mild intermittent tingling to severe functional impairment. Diagnosis involves physical exam, electromyography, and nerve conduction tests. Treatment includes splinting, corticosteroid injections, and surgery to release pressure on the nerve.

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

3. 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.

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

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

6. • 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.

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

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

9. 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.

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

11. 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.

12. SURGICAL MANAGEMENT
• open tunnel release (OCTR)

13. • Endoscopic carpal tunnel release (ECTR)

14. 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

15. 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

16. • 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.

17. 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.

18. 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

19. COMPLICATIONS
• Numbness
• pain
• stiffness
• weakness