Carpal Tunnel Syndrome
Carpal tunnel syndrome (CTS) is a common complaint in patients seen by the Family Nurse Practitioner (FNP). Patients that complain of numbness, tingling or pain to the first three fingers and part of the ring finger of the hand are describing CTS. The patient may also complain of weakness to the affected hand. In patients that have experiences these symptoms chronically, there may also be muscle wasting to the thenar eminence near the base of the thumb (Dunphy, Winland-Brown, Porter, & Thomas, 2015). The typical patient that has symptoms of CTS is a pregnant or middle aged female as women are more likely than men to for CTS. Typically, the symptoms worsen at night and the patient may be wakened from sleep by wrist or
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Thus, CTS can be triggered by hormonal changes, underlying musculoskeletal disorders and diseases that cause fluid retention. Carpal tunnel syndrome also has a genetic predisposition as it runs in families. The transverse carpal ligament, also known as the flexor retinaculum, and the carpal bones of the wrist form the carpal tunnel. The structures that pass through the flexor retinaculum include the median nerve and nine flexor tendons from the forearm Carpal tunnel syndrome occurs when excess pressure to the median nerve occurs, causing entrapment and peripheral neuropathy (Dunphy, Winland-Brown, Porter, & Thomas, 2015). The resulting symptoms may occur in the hand and …show more content…
The symptoms of pain, numbness, tingling or weakness are the result of the inflammatory process within the carpal tunnel that leads to compression of the median nerve. The compression and resulting impingement of the median nerve results in ischemia. The ischemia leads to the symptoms of numbness, tingling, pain and weakness of the hand and/or forearm. The FNP should inspect the wrist and hands of the patient with symptoms of CTS, looking for skin color and temperature changes, deformities and muscle wasting. The active and passive range of motion (ROM) of the neck, shoulders, elbows, wrists and fingers should be accessed. Muscle strength should be assessed at the shoulder, elbow, wrist and fingers. Spurling’s test for cervical radiculopathy should be performed. A plain x-ray can be ordered by the FNP if ROM of the wrist is limited. The FNP should also assess capillary refill of the fingers (Dunphy, Winland-Brown, Porter, & Thomas,
She still had some loss in her sensory neurons, but they showed some slight improvement from the initial evaluation. A follow-up MRI also showed a “…decrease in the brachial plexus thickening and hyperintensity.” (Gazioglu) The patient in this case study experienced rare symptoms. Patients who are usually diagnosed with brachial neuritis have severe pain in the shoulder and some even have localized pain. Only a small number of patients have pain that subsides to the fingers of the affected side. This case study supports the signs and symptoms along with the treatment that our team doctor prescribed.
Carey reported that she experienced occasional numbness of the upper extremities and that she would occasionally drop objects from both hands. Upon physical examination, Dr. Abiera noted that Ms. Carey’s range of motion of the cervical spine was decreased on flexion and tenderness on palpation of posterior cervical muscles with spasms and trigger points was present. In addition, Dr. Abiera noted that the range of motion of lumbar spine was within normal range, however there was still some tenderness on palpation of thoracic paraspinals muscles.
• People who do repetitive motions with their hands, such as movements in sports or heavy labor.
I did receive a significant amount of records from this patient's PCP, as well as neurology consult in followup and infectious disease notes. In short, he is a 67-year-old right-handed white male who while living in Alaska developed some hip pain, as well as medial right hand numbness. He did have an EMG on 10/2000 that showed ulnar neuropathy with cubital tunnel syndrome on the right. Ulnar nerve transposition was considered, but the patient deferred this. He did have an MRI of the cervical spine, which revealed most significantly C3-4, moderate bilateral neuroforaminal narrowing, C4-5 severe left and moderate right neuroforaminal narrowing, C5-6 severe bilateral neuroforaminal narrowing. He did
Per medical report dated 10/26/15 by Dr. Parsioon, the patient was initially seen on 9/14/15 for evaluation and treatment of cervical pain. At that time, he had neck pain without radiculopathy and bilateral hand tingling. IW stated that physical therapy made his neck pain increase and he wanted to make sure that it is okay to continue this. His chief complaint is pain in his neck radiating to the right shoulder and arm. He states the only time he gets the tingling sensation in the hand is
DOI: 4/17/2013. Patient is a 61-year old male senior quality assurance manager who sustained a work-related injury to his right hand from repetitive use of keyboard and mouse. As per OMNI entry, he was initially diagnosed with right thumb and wrist tendonitis. The patient is subsequently diagnosed with radial styloid tenosynovitis [de quervain]; periarthritis, unspecified wrist; osteophyte, unspecified elbow; and lesion of ulnar nerve, unspecified upper limb. As per progress report dated 6/29/16, the patient complains of pain at the cervical spine, right shoulder, right elbow, and right wrist/hand with stiffness, weakness and numbness. Physical examination revealed tenderness to palpation, spasms, and decrease range of motion, strength, and
150 CRPS diagnosed patients over a period of 4 years at a Korean chronic pain center were observed in this case study. Some tests that were done include neuromuscular conduction, quantitative sensory, autonomic function tests, infrared thermography, 3-phase bone scan, along with pain scale questions (Choi, 2008). Based on the results of the case study, CRPS affects men and women at all ages. The most common causes linked to the condition within this study were injuries and surgeries. The majority of patients reported the condition occurred in one extremity. 76% reported that the most effective treatment was the sympathetic nerve block (Choi, 2008). This is one case study done, so little can be concluded based on the results. In the future more case studies should be done to compare
The conduction of the Apley’s Scratch Test and Gerber’s Lift off Test along with the MRI scans was to identify Rotator Cuff Tendonitis. These tests trial the movement of the rotator cuff to see how the limitations of movement correspond with the receptance of pain. With Rotator Cuff Tendonitis, the individual will experience uncomfortable pain during movement and at night. Occurrence will happen if the individual holds the arm at a certain position for long periods of time, such as working on the computer for continuous hours, branching with poor posture. Another contribution to the occurrence is the individual’s participation in activities that needs the arm to actively and continuously maneuver
By now you must be enjoying all the compliments coming your way about that coveted ‘glow’ and the ‘luscious’ locks. Of course you might be still coming to terms with your ever-increasing tummy, but it is a lot easier to feel better about yourself when you are wearing flattering maternity clothes.
video games have also a negative effect on the health of children like Carpal Tunnel Syndrome has long been related with computer use this caused when the main nerve between the forearm and hand is held or pressed. This occurs when the carpal tunnel the area of the wrist that contains the main nerve becomes irritated. Overuse of a computer mouse can cause such irritation, as can extreme use of a video game
Clinical signs and symptoms are often neurologic in early cases of CTS and progress to musculoskeletal signs and symptoms if the condition is untreated. 1 Hallmark signs and symptoms include pain, paresthesias, numbness and tingling in the distribution of the peripheral nerve that is present at night. 1,4 As the condition
01/12/16 Progress Report documented that the patient has persistent pain in the ulnar left arm and forearm, which radiates into the ulnar hand, ring, and small fingers. It was noted that the MRI performed on 02/15 was of the left WRIST. The left elbow, arm, and forearm have not been imaged. The nerve conductions study was consistent with persistent and worsening ulnar compression neuropathy, possibly secondary to compression at flexor fascia of proximal forearm and intermuscular septum of medial arm; following attempted
PROCEDURE: The patient was placed in the supine position on the operating room table, where her right hand and forearm were prepped with Betadine and draped in a sterile fashion. We infiltrated the thenar crease area with 1% Xylocaine, and once adequate anesthesia had been achieved, we exsanguinated the hand and forearm with an Esmarch bandage. We then created a longitudinal incision just at the ulnar aspect of the thenar crease and carried the dissection down through the subcutaneous tissue. We identified the transverse carpal ligament and incised this
Carpal Tunnel Syndrome Abstract The wrist is surrounded by a band of fibrous tissue, which normally functions as a support for the joint. The tight space between this fibrous band and the wrist bone is called the carpal tunnel (The Stay Well Company, 1999). The median nerve passes through the carpal tunnel to receive sensations from the thumb, index, and middle fingers of the hand.
A hypothesis that can be made from the patient’s report is that she is suffering from cervical radiculopathy, or a nerve root lesion. Symptoms that describe cervical radiculopathy include: arm pain in a