Bilateral Hand Numbness

Patient is a 50-year-old-year-old left-handed white male who presents with his wife for evaluation of multiple symptoms that have been present since an MVA in 02/2013. At that time, he was T. boned and his car was totaled. He has amnesia for the event and is unaware whether or not he hit his head. The airbag did deploy. Afterwards, he was confused and noted significant pain in his neck and upper back. Since then, he has had multiple symptoms. He does have involuntary twitching on the right, more than left, both hands, legs, and sometimes feet. He demonstrates one of these twitches and it looks like a focal myoclonic jerk of a limb. These occur on a daily basis. He also has problems with his left thumb and index finger locking up. When he is fatigued, especially when his neck gets tight, he has some problems with word finding, paraphasic errors, and syntax errors. He did see Anthony P. Knox,

On Exam:  BP today was 140/86. Head and neck exam was all clear. She had no oral or nasal ulcers. She had no lymphadenopathy or bruits. Heart sounds were normal and the chest seemed clear, as did the abdominal exam. Musculoskeletal exam disclosed widespread Heberden's and Bouchard's nodes. She had no swelling or stress pain at the MCPs. She was not tender at the CMC joints. She had no swelling in the wrist, elbows or shoulders. She had no soft tissue tender points. She has bilateral knee crepitus but only slight instability and no effusions. She had actually good range of movement of both hips. She was tender in the lumber spine and has a scar at the lower lumbar spine from her previous operations. Her feet are somewhat flat with tenderness across the

Range of motion shows flexion of 85 degrees, extension of 30 degrees, and lateral tilt of 25 degrees bilaterally. Straight leg raise is positive on the right at 90 degrees for low back pain. Bechterew's test is positive on the right. The patient has diminished sensation in the right L4, L5 and S1 dermatomes. Deep tendon reflexes are absent in the right knee and right ankle.

Cardiovascular Assessment: No visible pulsations, no heaves or lifts. Apical pulse present in the fifth intercostal space at the left midclavicular line. Auscultation of apical rate 62 beats per minute, normal rhythm regular S1 - S2 heart sounds present. Pulsations present when supine and disappear at a 45 degree angle position. Extremities are brown color without redness, cyanosis, lesions or varicosities bilaterally. Temperature warm bilaterally, Allen test was negative. Homan’s sign negative. Carotids: +2 and present bilaterally. Right Radial +2, left radial +1 , Right Brachial: +2

Discuss what the letters in STROKE stand for and correlate them with what she experienced during the stroke.

Per medical report dated 11/24/15 by Dr. Cano, the patient is complaining of severe numbness in the right hand, tightness around the right worse than left hand. She also associates this with dropping items. She is unable to button her shirts or raise her arms up to her elbows. This is continuous all day long. Also, associated is severe low back pain with numbness, radiation, and muscle spasm in the thoracic area, and numbness and radiation down the right sciatic nerve with severe low back pain. She continued to work, sixteen-hour shifts, seven days a week. At this time, she is unable to function. She states that she has had 24 sessions of physical therapy that has definitely helped her.

FD performed a focused trauma assessment to find no noticeable abnormalities, limited range of motion, and restricted circulation w/ pale acrocyanosis.

I did receive a significant amount of records from this patient's PCP, as well as neurology consult in followup and infectious disease notes. In short, he is a 67-year-old right-handed white male who while living in Alaska developed some hip pain, as well as medial right hand numbness. He did have an EMG on 10/2000 that showed ulnar neuropathy with cubital tunnel syndrome on the right. Ulnar nerve transposition was considered, but the patient deferred this. He did have an MRI of the cervical spine, which revealed most significantly C3-4, moderate bilateral neuroforaminal narrowing, C4-5 severe left and moderate right neuroforaminal narrowing, C5-6 severe bilateral neuroforaminal narrowing. He did

O: A & O X 3, in no acute distress, no edema of left lateral rib cage, some redness to 1 inch below clavicle. Full ROM, bilateral lung sounds clear, full lung expansion, full active and passive ROM of left arm. Able to deep breath and cough with

Clinical Scenario: Adult female accountant complaints of right-sided lateral upper extremity numbness and tingling, pain, weakness, and dropping things held in right hand.

Electrodiagnostic consultation report dated 10/02/15 revealed normal study of both upper limbs and cervical paraspinals. No evidence of cervical radiculopathy. No median or ulnar neuropathy.

O: Right index finger: bruising of finger, mild edema, Full Active and passive ROM, Tender to palpation, no warmth. Brisk capillary refills; right radial and ulnar pulse +3

Per the medical report dated 12/15/16 by Dr. Vohra, it was noted that a left upper extremity EMG and nerve conduction studies obtained on this date showed normal. Patient is still pending myelogram.

Denies arm, neck, or leg pain, cramping, weakness, joint swelling. Denies weakness, numbness and tingling in the extremities

O: Right index; minimal bleeding, small laceration present at the dorsal DIP joint, Full ROM, tender with palpation; erythema and edema present, clean, minimal tension, minimal bleeding, NO FB, Surrounding intact skin