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By: John Emmanuel
Balido




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! 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.
! is a common disorder that is often associated with
repetitive actions of the hands and wrists. Carpal
tunnel syndrome is one type of repetitive stress
injury and can lead to pain, numbness and
sometimes disability of the hands
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! jumbness or tingling in the thumb and next two or

three fingers of one or both hands
! jumbness 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
! Weak grip or difficulty carrying bags (a common
complaint)
! Weakness in one or both hands
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! aome research suggests that carpal tunnel

syndrome can result from overuse or strain in certain
job tasks that require a combination of repetitive,
forceful, and awkward or stressed motions of your
hands and wrists. Examples of these include using
power tools ² such as chippers, grinders, chain
saws or jackhammers ² and heavy assembly line
work, such as occurs in a meatpacking plant.
Although repetitive computer use is commonly
assumed to cause carpal tunnel syndrome, the
scientific evidence for this association isn't definitive.
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! ÿ Women are three times as likely as

men are to develop carpal tunnel syndrome.

! 

ÿ ou may be significantly more
likely to develop carpal tunnel syndrome if
close relatives have had the condition.
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     Conditions including

some thyroid problems, diabetes, obesity and
rheumatoid arthritis can increase your risk. People
with endÿstage kidney disease also are more likely to
develop carpal tunnel syndrome. Women who are
pregnant, taking oral contraceptives or going through
menopause also are at increased risk, most likely
due to hormonal changes. Fluid retention may be a
cause of carpal tunnel syndrome during pregnancy.
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! „he pathophysiologic basis for carpal tunnel syndrome is, in most instances,
unknown. „he carpal canal normally contains only the median nerve, the flexor
tendons of the digits and the synovial lining of the tendons. „he median nerve
is compressed when the space available to it is decreased within the finite
volume of the carpal canal. Conditions that cause synovial swelling are known
to be associated with carpal tunnel syndrome. Pregnancy and rheumatoid
arthritis are two wellÿknown examples. Conditions like acromegaly and
hypothyroidism may also be associated with carpal tunnel syndrome but these
conditions are relatively rare, especially in the context of workÿrelated
symptoms of carpal tunnel syndrome.
! atudies of biopsy specimens taken from the flexor tendon synovium at the time
of surgery to perform a carpal tunnel release, show edema of this tissue even in
patients not known to have a condition which is associated with swelling. „his
observation suggests that flexor tendon synovial edema may be the cause of
median nerve compression but the immediate cause of the swelling in these
cases is not known.
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! Intrinsic abnormalities of the median nerve itself may also act to lower the threshold for symptomatic
compression. Pressures within the carpal canal that might not otherwise cause symptoms of carpal tunnel
syndrome may do so if the nerve is rendered particularly sensitive to pressure by some other disease or
condition. A common example of this is diabetes mellitus, which frequently affects peripheral nerve
function. Peripheral nerves, including the median nerve, are a target of diabetes and in individuals with this
condition, carpal tunnel syndrome may occur even where the pressure in the carpal canal is insufficient to
cause these symptoms in a nonÿdiabetic individual. In this sense, diabetes may be considered a preÿ
existing condition that predisposes the median nerve to symptoms of compression under circumstances
where this might not otherwise occur. Other diffuse peripheral nerve diseases may also play a role in the
development of symptoms of carpal tunnel syndrome but these are also very rare conditions which will
usually be known to be present in an individual before symptoms of hand numbness are attributed to
carpal tunnel syndrome.

! A much less clear, but related concept is that of "double crush". In the double crush syndrome it is thought
that subÿclinical compression of the median nerve at several points in its course between the spinal cord
and the carpal tunnel, lowers the threshold for symptomatic compression at level of the carpal canal. While
this idea fits in with some of what is known about peripheral nerve function, it is a largely unproven
hypothesis. Furthermore, it can rarely be shown to be present in clinical cases of carpal tunnel syndrome
and should seldom, if ever, play a role in the diagnosis or management of carpal tunnel syndrome.
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! 


 Electromyography
measures the tiny electrical discharges
produced in muscles. A thinÿneedle electrode
is inserted into the muscles your doctor
wants to study. An instrument records the
electrical activity in your muscle at rest and
as you contract the muscle. „his test can
help determine if muscle damage has
occurred.
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 In a variation of
electromyography, two electrodes are taped
to your skin. A small shock is passed through
the median nerve to see if electrical impulses
are slowed in the carpal tunnel.
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Oost people use
more force than needed to perform many tasks involving their
hands. If your work involves a cash register, for instance, hit the
keys softly. For prolonged handwriting, use a big pen with an
oversized, soft grip adapter and freeÿflowing ink. „his way you
won't have to grip the pen tightly or press as hard on the
paper.‡
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  ·ive your hands and wrists a break by
gently stretching and bending them periodically. Alternate tasks
when possible. If you use equipment that vibrates or that
requires you to exert a great amount of force, taking breaks is
even more important.
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! ë  


Avoid bending your wrist all the
way up or down. A relaxed middle position is best. If
you use a keyboard, keep it at elbow height or
slightly lower.‡
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Incorrect posture can cause
your shoulders to roll forward. When your shoulders
are in this position, your neck and shoulder muscles
are shortened, compressing nerves in your neck.
„his can affect your wrists, fingers and
hands.
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! !

 "
 ou're more likely
to develop hand pain and stiffness if you
work in a cold environment. If you can't
control the temperature at work, put on
fingerless gloves that keep your hands and
wrists warm

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! Administer mild analgesics as needed.

! Encourage the patient to express her concerns.
! Have her perform as much selfÿcare, as her
immobility and pain allow.
! Provide her adequate time to perform these
activities at her own pace.
! Oonitor the effectiveness of analgesics and other
forms of therapy used to relieve the patient¶s
discomfort.
! Regularly assess the patient¶s degree of physical
mobility.

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! „each the patient how to apply splint. Advise her not to make
it too tight.
! ahow her how to remove splint to perform gentle rangeÿofÿ
motion exercises.
! Advise the patient to occasionally exercise her hands in warm
water.
! If the patient is using a sling, tell her to move it several times
a day to exercise her elbow and shoulder.
! Review prescribed medication regimen. Emphasize that drug
therapy may require 2 to 4 weeks before maximum effect is
achieved.
 
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! Wrist splint in slight extension (cockÿup splint) to relieve

pressure aggravated by wrist flexion: worn at night, and
during day if symptomatic.
! Avoidance of flexion and twisting motion of the wrist.
! Work or activity modification to relieve repetitive strain.
! jonÿsteroidal antiÿinflammatory drugs (jaAIDs) such as
ibuprofen 600 to 800 mg tid to relieve inflammation and pain.
! Corticosteroid injection into tendon sheath to relieve
inflammation.
 
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! Carpal tunnel release is a surgical procedure

that cuts into the ligament that is pressing on
the nerve. aurgery is successful most of the
time, but it depends on how long the nerve
compression has been occurring and its
severity.
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! may allow faster functional recovery and less postoperative

discomfort than traditional open release surgery. „he surgeon
makes two incisions (about ½" each) in the wrist and palm,
inserts a camera
attached to a tube, observes the tissue on a screen, and cuts
the carpal ligament
(the tissue that holds joints together). „his twoÿportal
endoscopic surgery,
generally performed under local anesthesia, is effective and
minimizes scarring
and scar tenderness, if any. Oneÿportal endoscopic surgery for
carpal tunnel
syndrome is also available.

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! Acute pain
! Risk for injury
! Activity intolerance