Carpal tunnel release surgery: A nursing case study on post-operative care

Suganya

Charge Nurse, Kauvery Hospital, Alwarpet, Chennai, Tamil Nadu

Introduction

Carpal tunnel syndrome (CTS) is a common condition that affects millions of people worldwide. It occurs when the median nerve, which runs from the forearm into the palm, becomes pressed or squeezed at the wrist. This case study presents a 55-year-old female patient who underwent left open carpal tunnel release surgery.

Case Presentation

A 55-years-aged female, presented with complaints of left-hand weakness. She had a history of diabetes mellitus, systemic hypertension, and coronary artery disease. The patient underwent necessary investigations and was cleared for surgery.

Assessment

Progressive sensory changes including paresthesia and numbness of the thumb, index finger, and ring finger of the involved hand; leads to pain, waking the patient up at night.

Diagnostic Evaluation

  • Electromyogram showed weakened response to median nerve stimulation.
  • Motor changes beginning with clumsiness and progressing to weakness; edema and thenar atrophy may develop.
  • Positive Tinel’s sign: Increased paranesthesia on tapping of tendon sheath (ventral surface of central wrist).
  • Positive Phalen test: Increased symptoms with acute palmar flexion for 1 minute.

Diagnosis and Management

The patient was diagnosed with left carpal tunnel syndrome. She underwent left open carpal tunnel release surgery; her post-operative care included IV fluids, antibiotics, analgesics, and other supportive measures.

Therapeutic and Pharmacological Interventions

  1. Wrist splint in slight extension (cock-up splint) to relieve pressure aggravated by wrist flexion: worn at night, and during day if symptomatic.
  2. Avoidance of flexion and twisting motion of the wrist.
  3. Work or activity modification to relieve repetitive strain.
  4. Non-steroidal anti-inflammatory drugs (NSAIDs) such as Tab. Ibuprofen 600 to 800 mg TID to relieve inflammation and pain.
  5. Corticosteroid injection into tendon sheath to relieve inflammation.

Surgical Interventions

Surgery is indicated when conservative measures fail to relieve symptoms.

Procedure: Release of carpal ligament and tendon to relieve pressure on median nerve.

Nursing Interventions

  • Monitor level of pain, numbness, paresthesia, and functioning.
  • Monitor for adverse effects of NSAID therapy, especially in elderly. GI distress or bleeding, dizziness, or increased serum creatinine.
  • After surgery, monitor neurovascular status of affected extremity: pulses, color, swelling, movement, sensation, or warmth.
  • Apply wrist splint so, wrist is in neutral position, with slight extension of wrist and slight abduction of thumb; make sure that it fits correctly without constriction.
  • Administer NSAIDs and assist with tendon sheath injections as required.
  • Apply ice or cold compress to relieve inflammation and pain.
  • Teach patient the cause of condition and ways to alter activity to prevent flexion of wrists; refer to an occupational therapist if indicated.
  • Advise patient NSAID therapy, dosage, schedule and potential adverse effects; instruct patient to report GI pain and bleeding.
  • Teach patient gentle range-of-motion exercises; refer to a physical therapist as indicated.

Nursing Implications

Pain management: Effective pain management is crucial to prevent complications and promote recovery.

Wound care: Proper wound care and dressing are essential to prevent infection and promote healing.

Mobility and exercise: Encouraging mobility and exercise can help prevent stiffness and promote recovery.

Patient education: Educating the patient on post-operative care, wound management, and follow-up appointment is vital.

Discharge and Home Healthcare Guidelines

  • Therapy: Be sure that patient understands and implements appropriate range-of-motion exercises. Emphasize the need to use the hands as often as possible and the value of warm water exercising.
  • Equipment: Teach the patient proper techniques for applying and removing splints and/or slings.
  • Vocational Counseling:  Arrange for consultation with a vocational rehabilitation counselor about returning to work and any modifications that must be made on the job.

Heartfelt Gratitude and Feedback from Patient/Family

The patient and her family expressed gratitude for the nursing care provided and reported satisfaction with the treatment outcome.

Conclusion

This case study highlights the importance of effective nursing care in promoting recovery and preventing complications in patients undergoing carpal tunnel release surgery. The nursing interventions implemented in this case study demonstrate the crucial role nurses play in ensuring optimal patient outcomes.

Reference

Marilyn Sawyer Sommers, RN, PhD, FAAN, Susan A. Johnson, RN, PhD, Theresa A. Beery, PhD, RN , Diseases and Disorders A Nursing Therapeutics Manual, 2007 3rd ed

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