642 Study Notes on Carpal Tunnel Syndrome (CTS) Assessment and Management

PERFECT STUDENT SCRIPT – Carpal Tunnel Syndrome (CTS) – NURS 642 OSCE Aligned to PACE PRIME Rubric

1. PROFESSIONALISM – OPENING

• Student Introduction:

  • Student: "Hello, my name is Jaq, and I’m the Family Nurse Practitioner student working with you today."

  • Verification of Patient Information:

  • Request for full name and date of birth.

  • Acknowledgment: "Great, thank you."

• Outline of Patient Interaction:

  • Assessment Focus:

  • Asking questions about hand and wrist symptoms.

  • Performing a focused examination.

  • Discussing findings and next steps.

  • Patient Comfort:

  • Request: "Please let me know if anything is uncomfortable."

2. CHIEF COMPLAINT

• Inquiry: "What brings you in today?"

• Patient Response:

  • SP: "My right hand has been feeling numb and tingly."

3. HPI – OLDCARTS (History of Present Illness)

• Detailed Examination of Symptoms:

  • O – Onset:

  • Inquiry: "When did these symptoms start?"

  • SP Response: "A few weeks ago."

  • L – Location:

  • Inquiry: "Can you point with one finger to exactly where you feel the numbness?"

  • SP Response: "In my thumb, index, and middle fingers."

  • D – Duration:

  • Inquiry: "Does it come and go, or is it constantly there?"

  • SP Response: "It comes and goes."

  • C – Characteristics:

  • Inquiry: "How would you describe the sensation?"

  • SP Response: "Tingling, numbness, sometimes burning."

  • A – Aggravating Factors:

  • Inquiry: "What activities make it worse?"

  • SP Response: "Typing, holding the wheel, using my phone."

  • R – Relieving Factors:

  • Inquiry: "What helps it?"

  • SP Response: "Shaking my hand out."

  • T – Timing:

  • Inquiry: "Is it worse at certain times?"

  • SP Response: "At night and in the morning."

  • S – Severity:

  • Inquiry: "Rate it 0–10."

  • SP Response: "About a 5."

• Associated Symptoms Inquiry:

  • Weakness or dropping items?

  • SP: "Sometimes."

  • Numbness in pinky?

  • SP: "No."

  • Neck pain?

  • SP: "No."

  • Swelling or redness?

  • SP: "No."

  • Fever or weight loss?

  • SP: "No."

4. HISTORY

• Past Medical History (PMH):

  • Inquiries include: Diabetes, thyroid issues?

• Past Surgical History (PSH):

  • Inquiries include: Wrist, elbow, neck surgeries?

• Medications and Allergies:

• Family History (FH):

  • History of Carpal Tunnel Syndrome (CTS) or arthritis?

• Social History (SH):

  • Smoking status, repetitive work, occupation details:

  • Typing or repetitive hand work?

  • Hobbies:

  • Crafting, lifting?

5. REVIEW OF SYSTEMS

• Neuro:

  • Symptoms: Numbness, tingling, weakness.

• Musculoskeletal (MSK):

  • Symptoms: Wrist pain, elbow pain.

• Constitutional:

  • Symptoms: Fever, chills, weight loss.

• Skin:

  • Symptoms: Rash, swelling.

• Endocrine:

  • Issues: Diabetes, thyroid problems.

6. TRANSITION

• Statement: "I’d like to examine your hand and wrist now."

7. PHYSICAL EXAM

• General:

  • Observation of hand use and positioning.

• Inspection:

  • Findings: No swelling or deformity, possible mild thenar flattening.

• Palpation:

  • Tenderness noted over the carpal tunnel area.

• Range of Motion (ROM):

  • Finding: Full ROM, discomfort at extremes.

• Strength Assessment:

  • Finding: Thumb abduction mildly weak.

• Sensation Assessment:

  • Finding: Reduced sensation over thumb, index, and middle fingers.

• Special Tests:

  • Phalen’s Test: Tingling reproduced.

  • Tinel’s Sign: Shooting tingling elicited.

  • Durkan’s Test: Tingling triggered.

  • Cervical Screen: Negative result.

  • Elbow Exam: Normal results.

• Vascular Assessment:

  • Findings: Capillary refill normal, pulses intact.

8. ASSESSMENT

• Working Diagnosis:

  • Carpal Tunnel Syndrome (CTS).

• Differential Diagnoses:

  1. Cervical radiculopathy:

  • Reasoning: No neck pain, normal cervical examination results.

  1. Ulnar neuropathy:

  • Reasoning: Pinky not involved, indicating alternative diagnosis.

  1. Diabetic neuropathy:

  • Reasoning: Symptoms not focal and typically bilateral.

9. PLAN

• Diagnostics:

  • Recommendation: No imaging at the moment.

  • Action: Electromyography (EMG) and Nerve Conduction Studies (NCS) if symptoms persist.

• Non-Pharmacologic Interventions:

  • Recommendations include:

  • Night wrist splint.

  • Activity modifications.

  • Ergonomics adjustments.

  • Stretching exercises.

• Medications:

  • Recommendation: NSAIDs as needed.

  • Consideration: Corticosteroid injection if appropriate.

• Referral:

  • Suggestion for referral to a hand specialist if no improvement after 6-12 weeks.

• Education + Teach-back:

  • Inquiry: “Can you repeat the most important things you'll do to help your symptoms?”

• Follow-up:

  • Recommendation: Return in 2–4 weeks or sooner if weakness or numbness worsens.

10. CLOSING

• Inquiry: "Do you have any questions or concerns before we finish today?"

• Expression of Gratitude: "Thank you for coming in."