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Maria Carmela L. Domocmat, RN, MSN
InstructorNorthern Luzon Adventist College
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Part 1: Degenerative & Metabolic bonedisorders:
Part 2: Bone infections Part 3: Muscular disorders
a : so e s o e a Carpal tunnel syndrome
Dupuytrens contracture
Ganglion Part 5: Spinal column deformities Part 6 : Disorders of foot Part 7: Sports Injuries
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Carpal Tunnel Syndrome Dupuytrens Contracture
Ganglion
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common condition in which the mediannerve in the wrist becomes compressed,
causin ain and numbness
most common repetitive strain injury
(RSI) the fastest growing type of
occupational injury
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o
a rigid canal lying between the carpalbones and a fibrous tissue sheet called the
flexor retinaculum
o a group of nine tendons enveloped by
synovium share space with the median
nerve in the carpal tunnel
owhen the synovium becomes swollen or
thickened, the nerve is compressed
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median nerveo supplies motor, sensory, and autonomic
function for the 1st three digits of the hand
and the palmar aspect of the 4th digito bcoz of its proximity to other structures
wrist flexion causes nerve impingement against
the flexor retinaculum
extension causes increased pressure in distal
portion of carpal tunnel
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o
Causes of Acute CTS rare excessive hand exercise
edema or hemorrhage into carpal tunnel
thrombosis of median artery
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o
common complication of certain metabolicand connective tissue diseases
ex: synovitis in RA hypertrophied
synovium compresses median nerve DM inadequate blood supply can cause
median nerve neuropathy, or dysfunction,
resulting in CTS
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o repetitive strain injuryjob requiring repetitive hand activities
involving pinch or grasp during wrist flexion(factory workers, computer operators,
jackhammer operators)o overuse in sports activities
golf, tennis, racquetball
o familial or congenital, manifesting inadulthood
o space-occupying lesions (ganglia, tophi,lipomas)
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o peaks between 30 and 60 yrs
o but children are adolescents are getting
common due to use of computer
owomen 5 times more commono affects dominant hand, but can occur both
hands simultaneously
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o if use computer regularly
use appropriate ergonomically designed
work stations
take regular breaks
if beginning symptoms tell medical
attention
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o numbness and pain on hand
o pain
worse at night as result of flexion or direct
pressure ur ng s eep may radiate to arm, shoulder and neck, or
chest
o
paresthesia (painful tingling)o sensory changes usually precedes motor
manifestations by weeks or months
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o (+) Phalens wrist test or Phalens maneuver
ask client to relax wrist into flexion
or place he back of hands together and flex
both wrists simultaneously (+) paresthesia in median nerve
distribution (palmar side of thumb, index,
and middle finger, radial half of ring finger)
within 60 secs
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o Tinels sign
tap lightly over the area of median nerve in
wrist
if test is unsuccessful a BP cuff can beplaced on upper arm and inflated to
clients systolic pressure;
result pain and tingling
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o motor changes
weak pinch, clumsiness, difficulty with fine
movements
progress to muscle weakness and wasting(muscle atrophy)
assess task performance
assess pinching ability by asking client to
perform a fine-movement task (ex:
threading a needle)
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o strenuous hand activity worsens the
subjective complaints
owrist swelling
o autonomic changes skin discoloration
nail changes (e.g., brittleness)
increased or decreased palmar sweating
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o routine x-rays
to visualize bone changes, space-occupying
lesions, synovitis
o for uncertain definitive dx: EMG reveals nerve dysfunction b4 muscle
atrophy
MRI enlarged median nerve within carpal
tunnel
UTZ newest technique
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o nonsurgical mgmt
drug therapy
NSAIDs
inject corticosteroid directly into carpaltunnel weekly or monthly
immobilization
splint to immobilize wrist during day orduring night, or both
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o surgical mgmt
to relieve pressure on median artery by
providing nerve decompression
Endoscopic Carpal Tunnel Release (ECTR)
synovectomy when synovitis is caused by
RA
removal of excess synovium thru a small
inner-wrist incision
removal of space-occupying lesions
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postop care
ECTR less invasive but pain and
numbness longer time postop
monitor VS check dressing carefully for drainage and
tightness
elevate above the heart for several days
postop reduce swelling from surgery
check neurovascular status of digits q hr
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postop care
hand movements including lifting heavy
objects restricted for 4 to 6 wks postop
encourage t o move all fingers of affectedhand frequently
teach client to expect weakness and
discomfort for weeks or perhaps months
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postop care
offer pain meds
multiple operations and other treatments
common may need assistance with routine daily
tasks or even self-care activities
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slowly progressive contracture of the
palmar fascia, resulting in flexion of 4th or
5th di it of hand
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common problem
can be bilateral
cause:
unknown
incidence:
older men, tend to occur in families
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Treatment
owhen function becomes impaired, surgical
release is required
o partial or selective fasciectomyo splint application - post removal of dressing
and drain
nursing careo same with carpal tunnel repair
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a round, cystlike lesions
often overlying wrist joint or tendon
s novium surroundin the tendon
degenerates, allow tendon sheath tissue
to become weak and distended
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painless on palpation, but can cause joint
discomfort after prolonged joint use or
minor trauma ex: strain
can disappear and then recur
common: 15 to 50 yrs old
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treatment:
although fluid within lesion can be aspirated,
total excision is preferred
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Ignatavicius and Workman (2006). Medical
surgical nursing [5th ed]. Singapore: Elsevier. http://www.epodiatry.com/corns-callus.htm http://www.ncbi.nlm.nih.gov/pubmedhealth/PM
00044 http://www.bupa.co.uk/individuals/health-
information/directory/c/corns http://www.ncbi.nlm.nih.gov/pubmedhealth/PM
H0002217/ http://orthoinfo.aaos.org/topic.cfm?topic=a00154
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