Pain or numbness and tingling that affect some part of the median nerve distribution of the hand (the palmar side of the thumb, the index finger, the radial half of the ring finger, and the radial half of the palm) and may radiate into the arm. Patients may have a history of cumulative trauma to the wrist, e.g., as a result of overuse in carpentry, rowing, typing, computing, or the operation of vibrating tools or machinery. In addition, the condition may occur after wrist fracture, in pregnancy, or as a consequence of systemic or metabolic disorders such as diabetes mellitus, hypothyroidism, acromegaly, and amyloidosis.
See: repetitive motion injury

TREATMENT
The patient should rest the extremity, avoiding anything that aggravates the symptoms. This may require splinting of the wrist for several weeks to relieve tension on the median nerve. The patient's job requirements should be analyzed and recommendations provided for modified tools or a change in job assignment. The patient is taught how to avoid tension on the median nerve. Other treatments may include yoga, corticosteroid injections, or surgery.

PATIENT CARE
The patient is evaluated for loss of sensation on the palmar surface of the fingertips and for atrophy of the thenar muscles—both of which indicate advanced median nerve injury. If they are present, a referral to a specialist is indicated. Physical assessments of the carpal tunnel (Phalen's and Tinel's signs) have poor accuracy but are generally performed.

Most patients with pain that is thought to come from the carpal tunnel are treated with modification of work, a wrist splint to hold the affected hand(s) in a neutral position, and an anti-inflammatory drug, such as ibuprofen. Occupational counseling is suggested if the syndrome necessitates a temporary or permanent job change.

The need for diagnostic studies, such as nerve conduction tests or electromyography, and expected sensations are explained. If surgery (carpal tunnel release) is required, the patient is prepared by explaining the procedure and expected sensations. Postoperatively, neurovascular status in the affected extremity is carefully assessed (patient and significant others should be taught this assessment), and the patient is encouraged to keep the hand elevated to reduce swelling and discomfort. The patient should perform prescribed wrist and finger exercises daily to improve circulation and to enhance muscle tone; he or she can perform these exercises in warm water if they are painful (wearing a surgical glove if dressings are still in place). He or she should avoid lifting anything weighing more than a few ounces. The patient should report severe, persistent pain or tenderness, which may point to tenosynovitis or hematoma formation. The incision should be kept clean and dry, and dressings changed daily until the incision has healed completely. Dressings should also be checked for bleeding; any unusual bleeding or drainage should be reported. The patient is encouraged to express any concerns, and support is offered.
See: Nursing Diagnoses Appendix