In-depth Notes on Carpal Tunnel Syndrome, Fractions, Pediatric Disorders, and Muscular Dystrophy

Rheumatoid Arthritis (RA) and Carpal Tunnel Syndrome (CTS)

• Definition of Carpal Tunnel Syndrome: A disorder that affects the wrist and hand, associated with RA and repetitive motions.

Risk Factors for Carpal Tunnel Syndrome

• Common Occupations:
  • Construction workers
  • Hair stylists (e.g., blow drying, curling)
  • Secretaries (e.g., typing)
  • Weight lifters

Prevention Strategies

• Identifying Risk Factors: Important to recognize those at risk.
• Preventive Measures:
  • Use of wrist splints
  • Ergonomic workstations (mouse, desk, chair) for proper body alignment

Signs and Symptoms of Carpal Tunnel Syndrome

• Major Symptoms:
  • Weakness in the hands
  • Sharp pain
  • Numbness and tingling in the median fingers and hands
  • Difficulty grasping objects
• Important Note: Symptoms prompt visits to a physician.

Diagnostic Tests for Carpal Tunnel Syndrome

• Tinel's Sign: Tapping over the median nerve elicits pain or tingling.
• Phalen's Sign: Holding the wrists in flexion for one minute triggers numbness or tingling.

Treatment Options

• Non-Surgical:
  • Wrist braces
  • Ergonomic adjustments
• Surgical:
  • Carpal tunnel release surgery to relieve pressure on the median nerve

Fractures

Definition and Types of Fractures

• Fracture: A break in the continuity of a bone structure.
• Types:
  • Open Fracture: Bone breaks the skin
  • Closed Fracture: Bone remains within skin
  • Complete Fracture: Bone completely broken in half
  • Incomplete Fracture: Bone partially broken but not all the way through

Signs and Symptoms of Fractures

• Indicators:
  • Swelling or edema
  • Pain
  • Tenderness
  • Muscle spasms
  • Deformity and bruising (ecchymosis)
• Loss of Function: Possible loss of function at the fracture site.

Healing Process and Care

• Healing Factors: Requires good blood supply for healing.
• Treatment Methods:
  • Open Reduction Internal Fixation: Surgical alignment
  • Closed Reduction: Manual realignment without surgery (may require sedation)
• Traction: Applies pulling force to immobilize fractures when surgical repair is delayed.

Neurovascular Assessment (Post-Surgery)

• Six P's:
  • Pain
  • Pallor
  • Polar
  • Paresthesia
  • Paralysis
  • Pulse
  • Porkiothermia: Skin temperature matches the environment (distinguished from cool skin).

Nutrition for Healing

• Diet Recommendations: High in
  • Protein
  • Calcium
  • Vitamin D
  • Phosphorus
  • Magnesium
  • Vitamins B, C, D

Pediatric Disorder: Legg-Calvé-Perthes Disease

• Definition: An avascular event causing necrosis of the femoral head; considered a growth disorder.
• Symptoms:
  • Persistent unilateral hip pain exacerbated by activity
  • Inability to abduct the hip normally
• Age of Diagnosis: Typically between 2 to 12 years old.

Diagnosis and Treatment

• Diagnostic Methods:
  • X-ray
  • Bone scan
  • MRI
• Treatment Goals: Prevent hip deformity; may use a hip spica cast (24-hour wear).

Nursing Care for Legg-Calvé-Perthes Disease

• Monitoring: Assess skin integrity under the spica cast, reposition every two hours.
• Patient Education: Important to teach caregivers about prevention and assessment of complications.

Muscular Dystrophy: Duchenne's Muscular Dystrophy (DMD)

• Overview: A genetically inherited disorder leading to muscle degradation and weakness.
• Symptoms:
  • Waddling gait and loss of ability to walk by ages 9-12
  • Use of Gower's maneuver for rising from the floor
  • No loss of sensation despite muscle degeneration
• Diagnosis: Usually indicated by elevated serum creatinine kinase (CK) levels, EMG, and muscle biopsy.

Treatment for DMD

• Goals: Ensure independence, maintain ambulation, prevent contractures.
• Supportive Care:
  • Physical therapy for mobility
  • Nutritional support for long-term health
  • Emphasize socialization for affected children

Additional Notes

• Patient Care with Assistive Devices: Importance of correct usage, adjustment, and teaching of crutches and walkers as part of rehabilitation.
• Ongoing Learning: Review of best practices in patient care, including skin care and mobility aids, is essential for nursing education.