Cubital Tunnel Syndrome

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

Symptoms can vary from patient to patient depending on the severity of the compression (ACSN, 2015). Paresthesia, the ‘pins and needles’ feeling, in the fourth and fifth digit and pain at the elbow are the most common signs of cubital tunnel syndrome. Grip strength may also decrease as the condition worsens along with muscle atrophy in the hand. The patients might have a positive Tinel sign, which is tested by simply tapping on the ulnar nerve and seeing if the sensation of tingling or “pins and needles” is reproduced. The Wartenberg sign is positive if the patient is unable to abduct the fifth digit to the rest of the hand. This shows that there is weakness in the ulnar innervated intrinsic muscles of the hand (Guardia, Berman, & Lorenzo,

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.

Carpal Tunnel is a slight passageway positioned in the wrist. This tunnel allows for the median nerve, the nerve that ranges from your spine to your hand, to pass through. When pressure occurs on the median nerve in the wrist, it can result in swelling. Swelling in the wrist then results in Carpal Tunnel Syndrome, which has the potential to cut off or limit feeling in your hands. It can be caused by a number of things including illnesses, repetitive hand movements, and pregnancy.

Injecting medicine (steroids) into the tendon sheath to reduce swelling and irritation. Injections may need to be repeated.

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.

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

extend and lengthen them. The thumb plays an important part in the efficient working of the hand, it

Per progress report dated 02/26/2016, the patient had good response to corticosteroid injection; however, her symptoms have worsened now that she is working more. Examination reveals positive Tinel’s sign over the median nerve at the wrist. Carpometacarpal joint is also tender to palpation and has a positive passive flexion. Sensation testing to light touch reveals dysesthesias in the median nerve distribution. As per office notes dated 6/3/16, the patient

Carpal Tunnel Syndrome (CTS) occurs when the median nerve, that runs from the neck, under the armpit, along the forearm and into the palm of the hand, becomes compressed in the wrist. This compression is a result of the reduction in the space of the carpal tunnel, due to swelling of the surrounding tissue. This can cause numbness, tingling, burning, pin-and needle sensations and pain in the thumb, index, middle and half of the ring finger. The carpal tunnel is the area, where bones and ligament in the wrist provide a small, rigid passageway that houses the median nerve. The median nerve runs through the first 4 digits of the hand, excluding the little finger. It provides sensation and locomotion in the hand. And controls the thumb muscles.

These are parts that enable the hand and wrist to work together for an action like writing to happen. When these joints are affected by arthritis you will experience intense pain and daily small actions that were not a problem before, will become impossible. Arthritis of the hand needs to be treated immediately because over time if treatment is not administer then it causes inflammation and distortion of this bones they lose there original shape and this becomes very painful. Early symptoms include feeling a dull or burning sensation. The pain however is the most prevalent symptom and it occurs during lifting of heavy objects. With time because the cartilage wears off and there’s less material to provide shock absorption pain in the joint becomes more extreme. Experts and doctors recommend certain remedies to relieve this pain they include: 1. Splinting and injections These two methods are applied together in case one does not work or the patient ends up reacting to one. Doctors may advise the patient to use a specially designed splint. The splint supports the joints of the hand and in so doing prevents excess pressure from being exerted on it hence avert pain. However, this splint should be small enough to ensure that the user still uses the hand muscles and does not end up losing function of the muscles on the lower hand. Over time anti-inflammatory medicines may become ineffective as they contain

The patient has a Carpal Tunnel Syndrome if there is pain in palm, thumb, index and middle fingers, sometimes pain in wrist, forearm and upper arm.

The wrist is an anatomic linkage bridging the hand to the forearm. Eight bones of carpus and the distal radius and ulna form complex articulation that allow 3 degrees of movement. The hand, relative to the forearm, can flex and extend, pronate and supinate, and deviate ulnar and radial. [17]

Your hands contain lots of joints, joints at which two or more bones meet. Ligaments connect

Sensation is reduced to light touch over the radial aspect of the forearm and hand. Impression includes the following: right wrist sprain/strain injury, rule out triangular fibrocartilage tear; right de Quervain’s tenosynovitis; right lateral epicondylitis; right shoulder and cervical spine sprain/strain and myofasciitis; history of diabetes mellitus and hypertension; and heartburn and reflux with history of nonsteroidal anti-inflammatory medication use and controlled on proton pump inhibitor.