Carpal tunnel syndrome (CTS) is a common complaint in patients seen by the Family Nurse Practitioner (FNP). Patients that complain of numbness, tingling or pain to the first three fingers and part of the ring finger of the hand are describing CTS. The patient may also complain of weakness to the affected hand. In patients that have experiences these symptoms chronically, there may also be muscle wasting to the thenar eminence near the base of the thumb (Dunphy, Winland-Brown, Porter, & Thomas, 2015). The typical patient that has symptoms of CTS is a pregnant or middle aged female as women are more likely than men to for CTS. Typically, the symptoms worsen at night and the patient may be wakened from sleep by wrist or
DOI: 2/7/2004. The patient is a 57-year-old male fuel tank driver for over 3 years who sustained cumulative trauma due to repetitive movement caused by delivering fuel. Per OMNI, the patient was diagnosed with cervical spondylosis, myalgia, testicular dysfunction and depression. The patient is status post right shoulder surgeries on 7/26/04 and on 7/06/06 and left elbow surgery on 01/05/10 as per OMNI notes.
Carpal Tunnel Syndrome (CTS) is numbness, tingling, weakness, and other problems in the hand caused by pressure on the median nerve in the wrist. The median nerve along with tendons run along the forearm to the hand into a small space in the wrist. Adding pressure along the median nerve causes the carpal tunnel to become smaller. Additional causes for this disease is injury or trauma to the wrist such as a sprain or a fracture. Medical problems such as an enlarged pituitary gland, hypothyroidism, and fluid retention during menopause can all cause this disease. According to the National Institute of Neurological Disorders and strokes states that women are more likely to have this disorder compared to men because a women’s carpel tunnel is smaller.
Patient is a 57-year-old male fuel tank driver who sustained cumulative trauma on 2/7/2004 due to repetitive movement caused by delivering fuel. As per QME dated 1/25/14, the patient has numbness in the fingers and the patient is diagnoses that he has carpal tunnel syndrome. The left wrist had undergone carpal tunnel surgery; however, he gets numbness from the wrist up into his forearm and numbness in the fingertips. It was also noted that on 12/5/13, the patient complains of shoulder pain bilaterally at 7/10. It is constant and goes into noth arms, along with weakness with numbness in the hands, decreased ability to perform activities of daily living, and impared grip. The pain in the bilateral shoulders is constant and aching with intermittent
DOI: 10/6/2015. Patient is a 40-year-old right hand dominant female production employee who sustained a work-related injury to her neck, left shoulder and right hand from packaging work.
DOI: 8/6/2015. Patient is a 51-year-old female licensed vocational nurse who sustained a work-related injury to her back and hips while moving a client. As per OMNI, she was diagnosed with muscle spasm, pain over the low back and thoracic region. She is status post right carpal tunnel release on 02/26/16.
An article by Aslani et al., “Comparison of carpal tunnel release with three different techniques” compared the open release, endoscopic release and mid-palmar release. It was a clinical trial study that was done over a period of one year on patients who were surgical candidates for carpal tunnel syndrome (Aslani et al., 2012). Patients were diagnosed based on clinical symptoms and electro-diagnostic studies (Aslani et al., 2012). The clinical diagnosis was made based on the presence of three or more of the following: history of recurrent or persistence paresthesias in the median nerve distribution, nocturnal awaking with paresthesia, worsening of symptoms with any hand activity, positive Tinel’s and Phalen’s sign on physical exam (Aslani et al., 2012). Total of 105 patients were diagnosed and were studied over a course of one year (Aslani et al., 2012). Patients who entered the study had not responded to non-surgical treatments for 6 months (Aslani et al., 2012).
DOI: 12/21/2012. Patient is a 51-year-old female government collections supervisor who complained of right hand numbness and tingling to the left hand. Pere OMNI entry, she was initially diagnosed with cervical spine stenosis, bilateral spinal enthesopathy, right cervical radiculitis and right carpal tunnel syndrome. Patient was deemed maximum medical improvement on 12/17/13 with 0% permanent disability. Future medical care includes doctor visits, PT, injections and surgery.
IW was diagnosed with cervical strain with right arm dysesthesia with what appears lo he chronic regional pain syndrome of her right arm, right shoulder biceps tendonitis and subacromial bursitis with associated impingement, status post subacromial injection x 1, mild medial and lateral epicondylitis of her right elbow, carpal tunnel syndrome by EMG/nerve conduction velocity and reactive depression.
DOI: 05/11/2015. Patient is a 56-year-old female indirect credit card officer who sustained a work-related injury to her right hand due to repetitive motion. The patient is subsequently diagnosed with right hand carpal tunnel syndrome; and carpometacarpal degenerative joint disease.
It was noted that functional levels are not very well improved, however, patient is recovering from neck surgery. He has bilateral shoulder complaints which severely limits his ability to do a lot of household type chores. Despite these numbers, he will continue his same opioid medications. He is only on a low-dose opioid medication and does not want to increase