Medical & Surgical Nursing

WHAT WENT WRONG?
The median nerve that passes through the carpal tunnel in the anterior wrist is
compressed, resulting in pain and a numb sensation in the thumb, index finger,
middle finger, and lateral aspect of the fourth finger in the hand. This is often the
result of repetitive hand motions and may be work- or hobby-related. Carpal tunnel
syndrome tends to be more common in women.

PROGNOSIS
Some patients respond to conservative treatments including nonsteroidal anti-
inflammatory medications and rest of the affected area. A wrist brace may help to
keep the wrist in a neutral position during this time. If this conservative treat-
ment fails, the patient may need surgery to decompress the carpal tunnel area to
relieve pressure on the nerve as it passes through the wrist into the hand. Long-
term presence of carpal tunnel syndrome can lead to atrophy of muscles in the
palm of the hand. Hand grip strength may be affected. After treatment, carpal tun-
nel syndrome may recur in the future.

SIGNS AND SYMPTOMS

• Tingling, numbness, or burning sensation (paresthesia) in the hand due to
nerve compression
• Weakness in the hand due to nerve compression and, eventually, muscle
wasting
• Pain in the hand due to nerve compression
• Tapping over the carpal tunnel area will cause tingling, numbness, or pain
through the palm and affected fingers (Tinnel’s sign)
• Pain, tingling, and burning sensation in the wrist and hand as a result of the
blood pressure cuff being inflated on the upper arm to the level of the patient’s
systolic blood pressure

TEST RESULTS

• Electromyography (EMG) or nerve conduction studies will show nerve dys-
function.
• Magnetic resonance imaging (MRI) will show swelling of the median nerve
within the carpal tunnel.

TREATMENT
• Splint the wrist for 2 weeks to keep the wrist in a neutral position or slightly
extended and decrease compression on the carpal tunnel area.
• Administer NSAID (nonsteroidal anti-inflammatory drugs) to decrease
inflammation:

• diclofenac, diflunisal, etodolac, fenoprofen, flurbiprofen, ibuprofen, indo-
methacin, ketoprofen, ketorolac, meloxicam, nabumetone, naproxen, oxa-
prozin, piroxicam, salsalate, sulindac, tolmetin
• Administer corticosteroids to decrease inflammation:
• hydrocortisone, dexamethasone, methylprednisolone, prednisolone, pre-
dnisone
• Some are given orally.
• Some may be injected into the carpal tunnel area.
• Surgery when decompression of the carpal tunnel is necessary to relieve pres-
sure on the median nerve.

NURSING DIAGNOSES
• Pain
• Impaired mobility
• Disturbed sensory perception: tactile

NURSING INTERVENTION
• Assist the patient with hygiene if necessary before surgical correction and
with postoperative dressings after surgery.
• Patients wearing wrist splints may need assistance with certain activities of
daily living (ADLs).
• Assist the patient in exercising the hand; encourage performance of activi-
ties through physical therapy.
• Monitor the motion and sensation in the hand following surgery—check cap-
illary refill, color, and sensation of fingers.
• Encourage movement of fingers after surgery.
• Monitor postoperative dressing for drainage.
• Explain to the patient:
• Use, interactions, and side effects of anti-inflammatory medications.
• Proper use of wrist splints.
• Encourage appropriate exercises.
• Use of ergonomic devices, such as wrist rests or keyboard trays for com-
puter work.