Carpal Tunnel Syndrome in Older Adults: A Nursing Case Study on a 68-Year-Old Tailor
Carpal tunnel syndrome develops when the median nerve becomes compressed as it passes through the narrow carpal tunnel in the wrist, and it is most often caused by repetitive hand and wrist motion, joint swelling, or prolonged gripping. In this case, a 68-year-old male tailor developed progressive right-hand weakness, wrist pain, and a declining grip over three months, a pattern that lines up almost exactly with classic median nerve compression. His history, physical exam findings, and lab results all point to the same diagnosis, and his case is a useful teaching example of how nurses and other clinicians work through the assessment, differential diagnosis, and treatment of this common nerve disorder.
What Is Carpal Tunnel Syndrome and Why Does It Matter?
Carpal tunnel syndrome (CTS) is one of the most frequently diagnosed nerve compression disorders of the hand and wrist, and it disproportionately affects people whose jobs involve repetitive fine motor movement. Left untreated, ongoing pressure on the median nerve can lead to permanent nerve damage, muscle wasting at the base of the thumb, and a lasting loss of hand function. Because the condition tends to develop gradually, many patients don’t seek care until weakness or dropped objects start interfering with daily life, which is exactly what happened in this case.
Patient Snapshot
The patient, referred to here as Mr. Sinclair, is a 68-year-old man who was seen for a follow-up evaluation on June 28, 2025. He works as a tailor, a profession built around constant fine motor activity, and this occupational detail turns out to be central to understanding how his symptoms developed.
Chief Complaint and History of Present Illness
Mr. Sinclair came in because of worsening weakness in his right wrist and hand. He described frequently dropping objects and noticing that his hand strength had declined steadily over roughly three months. He rated his discomfort as a 6 out of 10 on a standard pain scale, describing it as a dull ache in the wrist and hand that intensifies during repetitive tasks like sewing or sustained gripping.
Several features of his history pointed toward median nerve involvement rather than a more general musculoskeletal problem:
- Gradual, progressive loss of grip strength rather than a sudden injury
- Pain that worsens specifically with repetitive hand movement
- Temporary relief from rest, gentle massage, and over-the-counter acetaminophen
- No history of trauma, fracture, or acute injury to explain the symptoms
Because his job requires hours of repetitive wrist motion, occupational strain stood out early as the most likely underlying cause.
Medications, Allergies, and Medical Background
For pain relief, Mr. Sinclair had been using extra-strength acetaminophen and had not taken any other prescription medications. He has no known drug allergies, though ibuprofen causes him stomach upset, which is an important detail when choosing anti-inflammatory therapy going forward. His past medical history is otherwise unremarkable, with no prior hospitalizations, surgeries, or chronic illnesses.
His family history includes type 2 diabetes in his father and a stroke in his mother roughly a decade earlier. Neither condition directly explains his wrist symptoms, but both remain relevant to his broader preventive care.
Social and Occupational Factors
Mr. Sinclair lives with his wife and reports feeling safe and independent at home. He does not use tobacco or recreational drugs and drinks about one glass of wine with dinner. The most clinically significant piece of his social history, though, is his work as a tailor, which involves continuous gripping, fine hand coordination, and repetitive wrist flexion and extension — all recognized risk factors for carpal tunnel syndrome.
Review of Systems: What Stood Out
A full review of systems was largely negative, which helped rule out broader systemic illness as the cause of his symptoms. He denied fever, fatigue, chest pain, shortness of breath, skin changes, vision changes, gastrointestinal symptoms, and hearing problems.
The musculoskeletal and neurological findings, however, told a different story. On exam, he had right wrist pain, limited wrist mobility, reduced pinch strength, a positive Phalen’s test, and a positive Tinel’s sign — all classic bedside indicators of median nerve compression. Outside of the affected hand, his neurological exam was normal, with no seizures, numbness elsewhere, or loss of balance.
Physical Examination Findings
Overall, Mr. Sinclair presented as a healthy, well-groomed older adult in no acute distress, with vital signs within normal limits and a body mass index in the overweight range. His cardiovascular, respiratory, gastrointestinal, and neurological exams were all essentially normal.
The musculoskeletal exam is where the diagnosis became clear. Beyond the limited range of motion in the right wrist, the combination of a positive Phalen’s test (which reproduces symptoms by flexing the wrist) and a positive Tinel’s sign (tingling produced by tapping over the median nerve) provided strong bedside evidence of nerve compression at the wrist rather than a joint or muscular problem.
Laboratory Results
Routine labs were ordered to rule out systemic conditions, like diabetes, that are known to contribute to nerve damage. His hemoglobin A1c came back at 4.9%, which reflects normal glucose control, and his cholesterol panel, vitamin D level, PSA, and HIV panel were all within normal or desirable ranges. These normal results made it far less likely that a metabolic or systemic disease was driving his symptoms, which strengthened the case for a mechanical, occupation-related cause instead.
Differential Diagnosis: Ruling Out Other Causes
Before settling on carpal tunnel syndrome, a few other conditions had to be considered and reasonably excluded.
- Osteoarthritis of the wrist was considered but was made less likely by the absence of joint swelling, deformity, or crepitus, along with exam findings pointing specifically to nerve compression rather than joint degeneration.
- Wrist sprain or ligament overuse injury was also considered, but the gradual three-month symptom onset, lack of recent trauma, and positive nerve compression tests argued against a purely ligamentous injury.
Final Diagnosis: Carpal Tunnel Syndrome
Taken together, the occupational history, the positive Phalen’s and Tinel’s tests, the progressive weakness, and the normal lab work all point to carpal tunnel syndrome as the most likely diagnosis. The median nerve runs through a tight anatomical space in the wrist alongside several tendons, and repetitive strain or tissue swelling in that space can gradually compress the nerve, reducing blood flow and triggering the pain, weakness, and clumsiness Mr. Sinclair described. Without treatment, this kind of ongoing compression can lead to permanent nerve damage and muscle wasting near the base of the thumb.
Treatment Plan
Medication Management
Because ibuprofen upsets his stomach, naproxen 220 mg once daily was recommended instead to help control pain and inflammation. If he doesn’t tolerate naproxen well, corticosteroid therapy would be the next option to discuss. Given his prior reaction to NSAIDs, he’ll need to be monitored for gastrointestinal side effects while on this medication.
Conservative, Non-Drug Interventions
For mild to moderate carpal tunnel syndrome, conservative treatment is usually the first line of defense before considering anything more invasive. Recommended steps include:
- Resting the affected hand as much as possible
- Applying ice to reduce swelling and inflammation
- Wearing a neutral-position wrist splint, especially overnight
- Elevating the wrist to help minimize swelling
- Reducing repetitive wrist motion at work and adjusting workstation ergonomics
Additional Testing to Confirm the Diagnosis
While the clinical picture is already strongly suggestive of CTS, further testing can confirm the diagnosis and rule out other structural issues. A wrist X-ray can exclude fractures or arthritis, and a musculoskeletal ultrasound can directly assess nerve compression and tendon health. If symptoms don’t improve, nerve conduction studies and electromyography are considered the gold standard for confirming median nerve dysfunction.
Patient Education
Patient education plays a major role in how well someone recovers from carpal tunnel syndrome, especially when a job requires the same repetitive movements that caused the problem in the first place.
Mr. Sinclair was advised to take naproxen with food and avoid combining it with other NSAIDs, and to report any signs of gastrointestinal bleeding, such as black stools, vomiting blood, or severe stomach pain. For his wrist splint, he was instructed to wear it during sleep, use it during repetitive tasks if symptoms flare, and avoid overtightening it while still moving his fingers gently. On the job, taking frequent breaks, stretching his wrist and fingers, and maintaining proper posture while sewing can all help slow symptom progression.
Preventive Care and Referrals
Beyond his wrist symptoms, this visit was also an opportunity to flag age-appropriate preventive screenings, including colorectal cancer screening, a routine prostate exam, blood pressure checks, and diabetes screening. Two referrals were recommended: physical therapy to rebuild wrist strength and improve ergonomics, and an orthopedic specialist evaluation if conservative treatment doesn’t resolve his symptoms or if surgery becomes necessary down the line.
Key Takeaways for Clinicians
- Progressive hand weakness paired with reduced grip strength is a hallmark presentation of median nerve compression.
- Phalen’s and Tinel’s tests remain reliable, low-cost bedside tools for identifying carpal tunnel syndrome.
- Repetitive occupational hand movement, as seen in tailoring, sewing, and similar trades, is a major and often underrecognized risk factor.
- Conservative management — splinting, activity modification, NSAIDs, and physical therapy — is effective for many patients before surgery is ever considered.
- Catching and treating carpal tunnel syndrome early can prevent irreversible nerve damage and preserve long-term hand function.
References
American Academy of Orthopaedic Surgeons. (n.d.). Carpal tunnel syndrome. OrthoInfo. https://orthoinfo.aaos.org/en/diseases–conditions/carpal-tunnel-syndrome/
National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2025, June 6). Carpal tunnel syndrome. https://www.niams.nih.gov/health-topics/carpal-tunnel-syndrome
National Institute of Diabetes and Digestive and Kidney Diseases. (2025, February 18). Prostate tests. https://www.niddk.nih.gov/health-information/diagnostic-tests/prostate
U.S. Preventive Services Task Force. (2021, April 27). Hypertension in adults: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/hypertension-in-adults-screening
U.S. Preventive Services Task Force. (2021, May 18). Colorectal cancer: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening
U.S. Preventive Services Task Force. (2021, August 24). Prediabetes and type 2 diabetes: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-for-prediabetes-and-type-2-diabetes