Carpal Tunnel Syndrome

Last Name and Page # to the right I/2 from the top. Everything double spaced. Student Name Instructor Name Class Course Date Diagnosis of Carpal Tunnel Syndrome Paula is a 38 year old administrative assistant. She has visited the medical assistant at Heald College Medical Clinic. During the interview with the assistant, Paula explains she was waking up at night with pain in both wrists, Paula also states the wrist pain becomes worse after she has been working on the computer. Paula says she has been using wrist supports but they do not appear to help. The medical assistant refers Paula to the physician. The physician diagnosis is carpal tunnel syndrome. Diabetes, arthritis, is it the underlying cause of Carpal Tunnel Syndrome. Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist. The median nerve controls sensations to the palm side of the thumb and fingers (although not the little finger), as well as impulses to some small muscles in the hand that allow the fingers and thumb to move. The carpal tunnel, a narrow rigid passageway of ligament and bones at the base of the hand houses the median nerve and tendons. Thickening from irritated tendons or other swelling narrows the tunnel and causes the median nerve to be compressed. The result may be pain, weakness, or numbness in the hand and wrist radiating up the arm. Although painful sensations may indicate other conditions, carpal tunnel syndrome is the most common and widely known of the entrapping neuropathies in which the bodys peripheral nerves are compressed or traumatized. However test will need to be done in order to confirm the diagnosis of carpal tunnel syndrome: Early diagnosis and treatment are important to avoid permanent damage to the median nerve. A physical examination of the hands, arms, shoulders, and neck can help determine if the patients complaints are related to daily activities or an underlying disorder which can be used as a tool to rule out other painful conditions that mimic carpal tunnel syndrome. The wrist is examined for tenderness, swelling, warmth, and discoloration. Each finger should be tested for sensation, and the muscles at the base of the hand should be examined for strength and signs of atrophy. Routine laboratory tests and X-rays can reveal diabetes, arthritis, and fractures. Physicians can use specific tests to try to produce the symptoms of carpal tunnel syndrome. In the tendon test, the doctor taps on or presses on the median nerve in the patients wrist. The test is positive when tingling in the fingers or a resultant shock like sensation occurs. The Phalanges, or wrist-flexion, test involves having the patient hold his or her forearms upright by pointing the fingers down and pressing the backs of the hands together. The presence of carpal tunnel syndrome is suggested if one or more symptoms, such as tingling or increasing numbness, are felt in the fingers within 1 minute. Doctors may also ask patients to try to make a movement that brings on symptoms. Often it is necessary to confirm the diagnosis by use of electro diagnostic tests. In a nerve conduction study, electrodes are placed on the hand and wrist. Small electric shocks are applied and the speed with which nerves transmit impulses is measured. In electromyography, a fine needle is inserted into a muscle? Electrical activity viewed on a screen can determine the severity of damage to the median nerve. Ultrasound imaging can show impaired movement of the median nerve. Magnetic resonance imaging (MRI) can show the anatomy of the wrist but to date has not been especially useful in diagnosing carpal tunnel syndrome. Describe the symptoms that occur in carpal tunnel syndrome. Symptoms usually start gradually, with frequent burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers. Some carpal tunnel sufferers say their fingers feel useless and swollen, even though little or no swelling is apparent. The symptoms often first appear in one or both hands during the night, since many people sleep with flexed wrists. A person with carpal tunnel syndrome may wake up feeling the need to shake out the hand or wrist. As symptoms worsen, people might feel tingling during the day. Decreased grip strength may make it difficult to form a fist, grasp small objects, or perform other manual tasks. In chronic and/or untreated cases, the muscles at the base of the thumb may waste away. Some people are unable to tell between hot and cold by touch. Treatments for carpal tunnel syndrome should begin as early as possible, under a doctors direction. Underlying causes such as diabetes or arthritis should be treated first. Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms, and immobilizing the wrist in a splint to avoid further damage from twisting or bending. If there is inflammation, applying cool packs can help reduce swelling. Nonsurgical treatments are drugs in special circumstances; various drugs can ease the pain and swelling associated with carpal tunnel syndrome. Non steroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and other nonprescription pain relievers, may ease symptoms that have been present for a short time or have been caused by strenuous activity. Orally administered diuretics (water pills) can decrease swelling. Corticosteroids (such as prednisone) or the drug lidocaine can be injected directly into the wrist or taken by mouth (in the case of prednisone) to relieve pressure on the median nerve and provide immediate, temporary relief to persons with mild or intermittent symptoms. (Caution: persons with diabetes and those who may be predisposed to diabetes should note that prolonged use of corticosteroids can make it difficult to regulate insulin levels. Corticosteroids’ should not be taken without a doctors prescription. Additionally, some studies show that vitamin B6 (pyridoxine) supplements may ease the symptoms of carpal tunnel syndrome. Exercise Stretching and strengthening exercises can be helpful in people whose symptoms have abated. These exercises may be supervised by a physical therapist, which is trained to use exercises to treat physical impairments, or an occupational therapist, which is trained in evaluating people with physical impairments and helping them build skills to improve their health and wellbeing. Alternative therapies Acupuncture and chiropractic care have benefited some patients but their effectiveness remains unproved. An exception is yoga, which has been shown to reduce pain and improve grip strength among patients with carpal tunnel syndrome. Surgery of carpal tunnel release is one of the most common surgical procedures in the United States. Generally recommended if symptoms last for 6 months, surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve. Surgery is done under local anesthesia and does not require an overnight hospital stay.

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