Description
§ Is an entrapment syndrome resulting from
compression of the median nerve in the tendon sheath within the ventral surface
of the wrist.
§ Similarly, tarsal tunnel syndrome is a group
of symptoms caused by pressure on the posterior tibial nerve in the medial
aspect of the ankle and cubital tunnel syndrome is caused by pressure on the
ulnar nerve at the medial epicondyle of the elbow.
§ Compression symptoms due to entrapment include
paresthesias, numbness, pain, weakness, and muscle atrophy.
§ Compression results from repetitive motion of
the wrist, trauma, local tenosynovitis, and mass, such as ganglion or neuroma.
§ Repetitive motion causing carpal tunnel
include the use of computer, typing, and use of a jackhammer. Nursing Path
§ Carpal tunnel syndrome is more common in those
over age 50, in women, in pregnant women in the first trimester, and in those
with rheumatoid arthritis.
§ Complications include chronic pain and loss of
function of the extremities.
Assessment
§ Progressive sensory changes including
paresthesias and numbness of the thumb, index finger, and ring finger of the
involved hand; leads to pain waking the patient up at night.
§ Motor changes beginning with clumsiness and
progressing to weakness; edema and thenar atrophy may be noted.
§ Positive Tinel’s sign: Increased paresthesias
on tapping of tendon sheath (ventral surface of central wrist).
§ Positive Phalen test: Increased symptoms with
acute palmar flexion for 1 minute.
Diagnostic
Evaluation
§ Electromyogram shows weakened response to
median nerve stimulation.
Primary Nursing
Diagnosis
§ Risk for injury
Therapeutic and
Pharmacological Interventions:
1. Wrist splint in slight extension (cock-up
splint) to relieve pressure aggravated by wrist flexion: worn at night, and
during day if symptomatic.
3. Work or activity modification to relieve
repetitive strain.
4. Non-steroidal anti-inflammatory drugs (NSAIDs)
such as ibuprofen 600 to 800 mg tid to relieve inflammation and pain.
5. Corticosteroid injection into tendon sheath to
relieve inflammation.
Surgical Interventions
1. Surgery is indicated when conservative
measures fail to relieve symptoms.
2. Procedure is release of carpal ligament and
tendon to relieve pressure on median nerve.
1. Monitor level of pain, numbness, paresthesias,
and functioning.
2. Monitor for adverse effects of NSAID therapy,
especially in elderly. GI distress or bleeding, dizziness, or increased serum
creatinine.
3. After surgery, monitor neurovascular status of
affected extremity: pulses, color, swelling, movement, sensation, or warmth.
4. Apply wrist splint so wrist is in neutral
position, with slight extension of wrist and slight abduction of thumb; make
sure that it fits correctly without constriction.
5. Administer NSAIDs and assist with tendon
sheath injections as required.
6. Apply ice or cold compress to relieve
inflammation and pain.
7. Teach patient the cause of condition and ways
to alter activity to prevent flexion of wrists; refer to an occupational
therapist as indicated.
8. Advise patient of NSAID therapy dosage
schedule and potential adverse effects; instruct patient to report GI pain and
bleeding.
9. Teach patient to gentle range-of-motion
exercises; refer to a physical therapist as indicated.
§ Physical findings: Hand, wrist,thumb,finger
pain; numbness; tingling; burning
§ Response to conservative or surgical treatment
§ Attendance and response to physical therapy
§ Ability to cope with immobility and inability
to return to work
Discharge and Home
Healthcare Guidelines
§ THERAPY. Be sure the patient understands and implements appropriate
range-of-motion exercises. Emphasize the need to use the hands as often as
possible and the value of warm water exercising.
§ EQUIPMENT. Teach the patient proper techniques for applying and removing splints
and/or slings.
§ VOCATIONAL COUNSELING. Arrange for the patient to consult with a
vocational rehabilitation counselor about returning to work and any
modifications that must be made on the job.
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