CARPAL

TUNNEL
SYNDROME
 DEFINITION

2
 Carpal Tunnel Syndrome (CTS) is an
entrapment neuropathy that occurs when the
median nerve at the wrist is compressed by a
thickened flexor tendon sheath, skeletakl
enroachment, edema, or a soft tissue mass.

3
”
 RISK FACTORS

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5 RISK FACTORS
▹ Women
▹ 30 – 60 years old
▹ Repetitive hand and wrist movement
▹ Rheumatoid arthritis
▹ Diabetes
▹ Acromegaly
▹ Hyperthyroidism
▹ Trauma
 CLINICAL
MANIFESTATIO
NS

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 CLINICAL
7 MANIFESTATIONS
▹ Pain
▹ Numbness
▹ Paresthesia
▹ Weakness along the median nerve distribution
▹ Night pain &/ clenching upon awakening
▹ (+) Tinel’s Sign
 8

PARESTHESIA IS
FELT DISTALLY
AFTER A TAP
OVER THE
CARPAL TUNNEL
 ASSESSMENT &
DIAGNOSIS

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10 PHALEN’S TEST

Flexes client’s wrist & holds

together for one minute.

(+) elicits tingling in thumb,

index, middle, and lateral
half of the ring finger.
 HAND ELEVATION
11 TEST
the patient holds the arm right above
head keeping it absolutely straight and
holds this position for at least 120
seconds. If the patient feels carpal tunnel
syndrome symptoms such as pain or
stiffness in the fingers, numbness or
tingling sensation, then the test is
considered positive or else it is not
 SCRATCH COLLAPSE
TEST
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the patient faces the examiner and adducts the arms, outstretches hands, flexes elbows
and keeps wrists in a neutral position. The examiner makes an external rotation
movement, which the patient has to resist with the help of pushing both forearms out. In
the next stage, this exercise is repeated while the examiner scratches the median nerve
right at the carpal tunnel level. The test is considered positive if the patient loses
resistance even for a short while when the examiner continues to scratch the median
nerve
 NERVE CONDUCTION
13 TEST

The NCS evaluation for CTS

involves measurement of
conduction velocity across the
carpal tunnel, as well as
determination of the amplitude of
sensory and motor responses
 THERAPEUTIC
REGIMEN

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 THERAPEUTIC
15 REGIMEN
▹ Oral/intra-articular injection of
corticosteroids
▹ Application of wrist splints
 SURGICAL
MANAGEMENT

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 SURGICAL
17 MANAGEMENT
▹ Traditional open nerve release
▹ Endoscopic laser surgery
 A 60 year old female presents with a complaints of “tingling” affecting the thumb, index and
middle fingers of the right hand.  This symptom began spontaneously about four months
previously and was not associated with any injury or change in her activities. She first noted this
symptom at night when it disrupted her sleep, sporadically at the outset but in recent weeks on
almost a nightly basis. She is employed as a legal secretary. Her right hand is dominant.
 
The physical examination of the right hand does not reveal abnormalities on inspection; in
particular the bulk of the intrinsic musculature of the hand, including the thenar eminence, is
normal.  There is no tenderness to palpation in the hand.  The neurologic examination shows that
the strength of the abductor pollicis brevis muscle is normal and is rated as grade V.  Two point
discrimination in the distribution of the median nerve is normal. The Phalen test is positive.  The
Tinel sign is positive – light tapping over the median nerve at the level of the carpal tunnel
causes paraesthesiae radiating into the index and middle fingers.

18
”
 WHAT WOULD BE A COUPLE OF BASIC
TESTS YOU COULD ORDER FOR THE
19 BEGINNING OF THE WORKUP?
▹ Phalen’s Test
▹ Hoffman-Tinel’s Test
▹ Hand Elevation Test
▹ Scratch Collapse Test
 HOW WILL YOU DESCRIBE THE
20 MANIFESTATIONS OF CTS?
▹ Intermittent numbness & tingling at palmar
aspect of 1st to 4th finger & distal palm (of
the dominant hand)
▹ Pain: aching sensation at the ventral aspect
of the wrist
 WHAT ARE THE POTENTIAL
21 CAUSES OF THIS CONDITION?
▹ Increased BMI
▹ Square-shaped wrist
▹ Wrist Fractures
▹ Rheumatoid Arthritis
▹ Diabetes Mellitus
▹ Genetics
▹ Exposure to vibration
▹ Occupational factors
 WHAT ARE THE NEXT STEPS IN
22 THE WORKUP?
▹ X – ray
▹ CT – scan
▹ MRI
 WHAT ARE THE VARIOUS TREATMENT
MODALITIES (PHARMACOLOGICAL AND
SURGICAL) THAT CAN BE UTILIZED TO
23 THIS PATIENT?
▹ Diuretics
▹ COX-2 inhibits
▹ Surgical release of the transverse ligament
 WHAT ARE SOME IMAGING MODALITIES
THAT CAN BE ATTEMPTED TO FURTHER
24 EVALUATION?
▹ Electroneutomyography (ENMG)
▹ Electromyogram (EMG)
▹ Ultrasonography
              
Assessment Diagnosis Scientific Analysis Planning Intervention Rationale Evaluation
             
25 Subjective:
“Masakit ang
 
Acute Pain r/t
Carpal Tunnel
Syndrome is the
- After 2 hours of
nursing intervention
1. Assess pain,
duration, intensity,
 
- To decrease pain
Goals met the
client is free
aking kamay di Inflammation and most common the patient verbalized location and   from pain and
ko maigalaw swelling entrapment pain is relieved/ frequency.   back to normal
aking mga daliri. secondary to neuropathy 90% of controlled.     ADL’s
As verbalized by pressure on similar disorder is   2. Assess age -To prevent further
the client. median nerve therefore an - After 3 hours of developmental issues complication.
  important condition nursing intervention affecting ability of  
Objective: for the nurse to be pain will be reduced individual to  
- Pain and able to assess and from 8/10 – 4/10. participate in own  
numbness that is diagnose. It occurs in   care. - For Client’s own
worst at night or individuals between - After 2 hours of   good personal
interrupts sleep. 40 years old and is in health teaching the 3. Assist the client to hygiene
both men and client will be able to improve self-care.  
- Facial grimace women. verbalize willingness    
is present and demonstrate 4. Provide for  
  participation in ADL’s, communication  
-Pain score is among those who are  
8/10 involved in caring for  
  the patient.  
- Difficulty    
gripping objects 5. Take meds as - To reduce pain
with the hand or ordered by the
dropping objects. physician.
            
Defining Characteristics Nursing Diagnosis Scientific Analysis Goal of Care Intervention Rationale
 

           
Independent:  
Subjective Data: Disturbed Sleeping Time Limited disruption Short Term:
26 “Dili ko katulog ug
tarung kay sakit
Pattern related to night
pain secondary to Carpal
of sleep ( natural,
periodic suspension of
- After 8 hours of
nursing intervention
1. Instructed to avoid flexion
and twisting motion of the
wrist.
- To avoid exacerbation of
pain.
 
akong kamot” as Tunnel Syndrome consciousness) pt. will verbalized    
verbalized by the amount and quality. understanding the 2. Provided comfort measures - To promote sleep and
(placing pillow in the affected comfort.
patient. importance of hand)  
  avoiding flexion and    
  twisting motion of the 3.Provided a quiet - This provides a conducive
Objective Data: wrist. environment environment for the patient to
  relax.
- Fatigue   4. Encouraged verbalization  
-Restlessness   of feelings of pain and -To explore other sleep aids.
-Eyebags Long Term: discomfort during HS.  
-Irritability - After series of    
5. Encouraged use of - This will help the client to
nursing Intervention relaxation technique such as relax.
pt. will have adequate deep breathing exercise.  
sleep rest.    
Dependent:  
1. Administered anti- - To relieve inflammation
inflammatory and pain relief and pain.
medications as prescribed.

Collaborative:
- Splinting the wrist and worn at - To provide relief.
night
            
Assessment Diagnosis Scientific Planning Intervention Rationale
Analysis
27  
Subjective:
 
Deficient
 
Deficient
 
Short term
   
1. Assess the patient’s level of  1. to help you formulate plan
“wala ko kabalo Knowledge knowledge is After 8 hours of nursing understanding of the of care
aning sakita kay r/t new related to a lack interventions, the patent will disease, its course, and its
be able to:
karon rako naka condition of information management
a.) report an increase in
dungog ani”. As about knowledge regarding the 2. Identify patient’s learning 2. this makes your teaching
verbalized by the management style (i.e., discussion, more effective
disease
client. and control of b.) demonstrate ability to demonstration, role
  disease. Your perform new skill related to playing, visual materials) 3. this makes your teaching
Objective: patient’s his lifestyle 3. provide a quiet more effective
-unable to answer understanding environment conducive to
when asked about of his condition Long term teaching and learning
After 5 days of nursing 4. assessment provides an
CTS. will diretly affect 4. Observe and note existing
interventions, the patent will important starting point in
his ability to be able to: misconceptions regarding
cope and his the disease. education. Knowledge serves
a.) demonstrate how to to correct faulty ideas.
recovery. incorporate new health
regimen into lifestyle
b.) exhibit ability to deal with 5. Assess motivation and 5. learning requires energy.
health situation and remain willingness of patient to Patient must see a need or
in control of life learn purpose for learning