Carpometacarpal Joint Case

HPI: Ms. Smith presents to the office with bilateral shoulder stiffness and lateral elbow pain in right arm. The patient has been suffering shoulder stiffness for over 2 years. The symptom developed gradually after she started using her computer more at her work place; she had to hold her telephone between her shoulder and head while typing information on computer. The pain in right elbow stated about 8 months ago with gradual onset. The patient does not recall any trauma to the shoulder and elbow. She has been diagnosed as tennis

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: 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.

Based on the progress report dated 10/07/16, the patient presents for evaluation of carpal tunnel syndrome on the right shoulder.

DOI: 9/30/2014. Patient is a 28-year-old female research assistant who alleges pain and weakness in her hands/wrist as a result of repetitive scooping dirt from soil barrels. As per OMNI entry, the patient was diagnosed with cervicobrachial syndrome (diffuse), right carpal tunnel syndrome and insomnia. She is status post endoscopic carpal tunnel release (CTR) on 09/24/2015 for the right and on 06/02/2015 for the left side.

If you suspect you or someone you know is showing symptoms of Carpal Tunnel, we advise you see a

Carpal Tunnel syndrome (CTS). The rationale for choosing CTS as the most likely differential diagnosis is based on the subjective, objective data and T.R occupation. Evidence: CTS are caused by excessive used and repetitive movements of the wrist, which cause a loss of space and impingement of the median nerve. A type of activity that is associated with CTS, is computer use (Goolsby & Grubbs, 2011). CTS is a common musculoskeletal disorder affects approximately 1.5% to 2.8% Americans. The yearly costs estimated at $2 billion. The most common involve joints are the first (thumb), second (index finger), third (middle finger), and fourth (ring finger) metacarpophalangeal. CTS symptoms include: tingling, numbness, burning, or pain usually affects the anterior part of the wrist, medial palm and the first three digits on the hand (Thiese, Gerr, Hegmann, Harris-Adamson, Dale, Evanoff, & Rempel, 2014).

On 01/03/2018, the claimant presented for a follow-up for the right wrist. She complained of pain and weakness in her right wrist/hand. The associated symptoms include joint pain, joint stiffness, weakness, pain, and decreased strength. Objective findings showed healed pin sites. There was less swelling, deformity, tenderness, and limited range of motion. She had a full range of motion in the fingers with popping in the wrist. She lacked full supination and pronation. Physical therapy was

Due to a schedule conflict my co-worker Chris Callahan attended the appointment with Mr. Price and Dr. Werner on 6/15/16. Mr. Price said that he has difficulty gripping with the right hand. He also reports numbness and tingling to the first three fingers. He stated this has been consistent since the injury. Dr. Werner reviewed the EMG report. Grip test showed that his right hand is weaker than the left. Dr. Werner did tapping and repositioning of the hands and wrist which resulted in numbness to the first four fingers of the right hand. Tapping to the elbow also caused the fifth finger to go numb. Ms. Callahan asked for clarification on the cause of the Carpal Tunnel (CTS) diagnosis. Dr. Werner stated that changes in the right shoulder

Electrodiagnostic study of the bilateral upper extremities performed on 05/27/15 revealed moderate bilateral carpal tunnel syndrome.

DOI: 9/18/2008. The patient is a 62-year-old male cashier who sustained a work-related injury due to repetitive work load.

The use of ultrasound therapy prior to client engagement in functional activity will increase tissue extensibility, increase collagen deposition, increase blood flow, increase sensory/motor nerve conduction velocity, and decrease muscle spasms. The use of paraffin therapy prior to client engagement in functional activity will decrease pain, joint stiffness and increase range of motion in the hands. Both of these modalities have a great impact on clinical practice to more efficiently and effectively treat clinical conditions.

Normal muscle tone noted bilateral (B/L) wrist and hand limited range of motion (ROM) to right thumb. Inspection: No joint deformity and swelling noted. No bogginess, or tenderness noted during palpation over the distal radius, and the ulua on the lateral medial surfaces of B/L hands. Denies tenderness over the radial styloid bone (snuffbox) during palpation. C/o of tinging during the Tinel’s sign test. Weakness was noted in the thumb abduction test and the hand grip test. Patient c/o discomfort during thumb movement test, but no ulnar deviation noted.

The thumb, with its designated capability to touch the opposite fingers, is infrequently observed by us except we have now some form of difficulty with it. That's when we notice its versatility and usability. One of the most long-established complaints of the thumb is carpometacarpal joint suffering. To put it in layman's terms, it's arthritis of the thumb joint. It causes soreness on the base of the thumb when you pinch or grip some thing. The joint at the base of the thumb enables for it to be swiveled and pivoted and it's referred to as the basal joint, or the carpometacarpal joint. This variety of arthritis of the thumb joint, is normal with those who are inclined to osteoarthritis. This crisis can afflict just about any person; nevertheless,

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.