Scenario:

A 24-year-old man who loves gaming (playing everwing after his work) complains of insidious onset of right hand numbness and pain, which began about 1 month previously. Symptoms felt mainly in the right index finger, especially when gaming at his smartphone at home. The symptoms are also reported to be worse during the night and early morning. The man also noted a slight decrease in his grip strength, which prompted him to see a doctor, who diagnosed carpal tunnel syndrome and prescribed PT, ibuprofen, vitamin B6 and short course of diuretics.

The patient is a full time call center agent at a prestigious institution for 3 years now until present. The patient was recently promoted which has meant an increase in computer work. The patient has an unremarkable medical and surgical history and has had no previous episodes.

Based on the history and systems review do you agree with the physician’s diagnosis for this patient?

CARPAL TUNNEL SYNDROME

It occurs when the median nerve at the wrist is compressed by thickened flexor sheath , edema or soft tissue mass. It is commonly due to repetitive hand activities.

The symptoms are:

• Pain from the wrist to the shoulders
• Numbness
• Thumb, index and middle fingers are affected.
• (+) Tinels sign (tingling sensation on percussion of inner wrist).
  
• (+) Phalen's sign (tingling sensation on holding the wrist in flexion for few minutes.
  
• Weak grip of hands

The treatment for carpal tunnel syndrome is based on the cause of the condition.

1. Application of wrist splints to prevent hyperextension and prolonged flexion of the wrist.
   2.Must remember to avoid repetitive flexion of the wrist.
2. NSAIDs, diuretics and vitamin B6 are prescribed.
3. Carpal canal cortisone injections
4. Surgical release of transverse carpal ligament.

Traditional open nerve release or endoscopic laser surgery are the two most common surgical management options for treatment of carpal tunnel syndrome. Both of these procedures are performed under local anesthesia and involve making small incisions into the affected wrist, cutting the carpal ligament so that the carpal tunnel is widened.

Here's a video about Endoscopic Carpal Tunnel Surgery by Dr. Stephen Helgemo

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Sources:

1. Medical Sugical Nursing
   By: Brunner & Suddarth's
2. http://www.webmd.com/pain-management/carpal-tunnel/carpal-tunnel-syndrome-topic

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