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Carpal Tunnel Syndrome
Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) can be due to trauma from repetitive work such
as that of supermarket checkers, checkers in other types of stores, assembly line
workers, meat packers, typists, word processors, accountants, writers, etc. Other
factors predisposing to CTS include obesity, pregnancy, hypothyroidism, arthritis, and
diabetes.
Incidence
The incidence of carpal tunnel syndrome is 1-3 cases per 1000 subjects per
year; prevalence is approximately 50 cases per 1000 subjects in the general population.
Incidence may rise as high as 150 cases per 1000 subjects per year, with prevalence
rates greater than 500 cases per 1000 subjects in certain high-risk groups.
Causes
The median nerve provides feeling and movement to the "thumb side" of the
hand (the palm, thumb, index finger, middle finger, and thumb side of the ring finger).
The area in your wrist where the nerve enters the hand is called the carpal
tunnel. This tunnel is normally narrow, so any swelling can pinch the nerve and cause
pain, numbness, tingling or weakness. This is called carpal tunnel syndrome.
Carpal tunnel syndrome is common in people who perform repetitive motions of the
hand and wrist. Typing on a computer keyboard is probably the most common cause of
carpal tunnel. Other causes include:
• Sewing
• Driving
• Assembly line work
• Painting
• Writing
• Use of tools (especially hand tools or tools that vibrate)
• Sports such as racquetball or handball
• Playing some musical instruments
The condition occurs most often in people 30 to 60 years old, and is more common
in women than men
Symptoms
• Numbness or tingling in the thumb and next two or three fingers of one or both
hands
• Numbness or tingling of the palm of the hand
• Pain extending to the elbow
• Pain in wrist or hand in one or both hands
• Problems with fine finger movements (coordination) in one or both hands
• Wasting away of the muscle under the thumb (in advanced or long-term cases)
• Weak grip or difficulty carrying bags (a common complaint)
• Weakness in one or both hands
• Physical Examination
• Electromyography
• Nerve conduction velocity
• Wrist x-rays should be done to rule out other problems (such as wrist arthritis)
• Blood Test
Treatment
You may try wearing a splint at night for several weeks. If this does not help, you
may need to try wearing the splint during the day. Avoid sleeping on your wrists. Hot
and cold compresses may also be recommended.
There are many changes you can make in the workplace to reduce the stress on your
wrist:
MEDICATIONS
Carpal tunnel release is a surgical procedure that cuts into the ligament that is
pressing on the nerve. Surgery is successful most of the time, but it depends on how
long the nerve compression has been occurring and its severity.
Outlook (Prognosis)
Symptoms often improve with treatment, but more than 50% of cases eventually
require surgery. Surgery is often successful, but full healing can take months.
Prevention
Nursing Management
Carpal tunnel
release decreases pain, nerve tingling, and numbness better, and restores muscle strength. Still,
most people are helped by this surgery.
The diagnosis of carpal tunnel syndrome is suspected based on the symptoms and the distribution of the hand
numbness. Examination of the neck, shoulder, elbow, pulses, and reflexes can be performed to exclude other
conditions that can mimic carpal tunnel syndrome. The wrist can be examined for swelling, warmth, tenderness,
deformity, and discoloration. Sometimes tapping the front of the wrist can reproduce tingling of the hand, and is
referred to as Tinel's sign of carpal tunnel syndrome. Symptoms can also at times be reproduced by the examiner by
bending the wrist forward (referred to as Phalen's maneuver).
The diagnosis is strongly suggested when anerve conduction velocity test is abnormal. This test involves measuring
the rate of speed of electrical impulses as they travel down a nerve. In carpal tunnel syndrome, the impulse slows as
it crosses through the carpal tunnel. A test of muscles of the extremity, electromyogram (EMG), is sometimes
performed to exclude or detect other conditions that might mimic carpal tunnel syndrome.
Blood tests may be performed to identify medical conditions associated with carpal tunnel syndrome. These tests
include thyroid hormone levels, complete blood counts, and blood sugar and protein analysis. X-ray tests of the wrist
and hand might also be helpful to identify abnormalities of the bones and joints of the wrist.
DE LA SALLE HEALTH SCIENCES INSTITUTE
DASMARIŇAS, CAVITE
SUBMITTED BY:
Ellex John F. Benipayo
BSN 45 group 4