Discharge Case Studies

DOI: 8/27/2014. The patient is a 45-year-old male laborer who sustained a work-related injury when he stepped on a sharp foreign object which pierced his skin. As per OMNI, he was diagnosed with open wound on the foot.

DOI: 12/23/2013. The patient is a 64-year-old male foreman who sustained injury when he was involved in a motor vehicular accident. Per OMNI, he has had multiple injuries to the right shoulder, right knee, back and right arm/elbow. He is status post arthroscopic surgery for the right shoulder on 05/30/2014.

On 6/14/16 I met Mr. Blake at the U of M wound clinic, Midland location. Mr. Blake said over the weekend, the white end cap fell off his pin to the third toe. Since that time he reports an increase in pain to that toe. Mr. Blake reported that he called Dr. Biddinger’s office and he was told to come in on 6/15/16. Dr. Taylor examined the foot. He removed some calloused skin around the toes. Dr. Taylor stated the wound is completely healed now. He does not need to come back to the wound clinic.

The status of this case is that we are awaiting the applicant to undergo an EMG of the upper extremity as recommended by the Panel Qualified Medical Evaluator, Dr. Stephan Choi, in his evaluation report dated December 14, 2016. Please recall, Dr. Choi requested an EMG of the right upper extremity so he can rule out possible carpal tunnel release. He opined if the EMG of the right upper extremity were to come back normal, the applicant would be deemed permanent and stationary.

I suffered a laceration of my arm, which proceeded laterally from the medial aspect of my left wrist. The laceration only reached about halfway across this site, but that was enough to cause major physiopathology in my left hand (primarily). The laceration severed my left ulnar nerve, ulnar artery, and palmar interossei. I immediately lost sensation in the region described above (pinky and medial aspect of ring finger, as well as proximally down my entire hand). Table 14.4 in the textbook illustrates exactly the region affected (McKinley, O’Loughlin, & Bidle 556). I completely lost motor control of the affected region, as well. I received first aid, and eventually surgeons were able to repair the nerve, ligate the artery (“to tie,” as in “ligament” or “ligature”; the artery could not be repaired), and repair the palmar interossei. The reason that I still have a functioning left hand is that both the ulnar and radial arteries supply blood to the hand. As the textbook describes (as if the authors are describing my own situation), “If the left ulnar artery were cut, the left hand and fingers could still receive blood via the left radial artery, since both vessels contribute to the superficial and deep palmar arches” (McKinley, O’Loughlin, & Bidle

IMAGING: X-rays today, three views of the right hand, shows a good reduction with moderate callus on the long or middle finger metacarpal base and mild callus on the ring metacarpal base. Equivocal, whether there is a healed fracture, but not obvious callus, at the fifth metacarpal base. The alignment and position of the [3:31__] metacarpal joints appears benign.

On 11/1/17 Wendy Lavin attend ed the appointment with Mr. Naylor and Dr. Dass. Dr. Dass said he would not need any surgery or formal hand therapy. He showed Mr. Naylor some home exercise to increase the range of motion to the fingers. He agreed with the course of treatment outlined by Dr. Najjar.

Findings showed difficulty dorsi flexing her left lower extremity, she had a healed surgical incision on her lateral left calf that measured approximately 7 cm in length, with some dried scabbing on it but no signs of erythema and drainage at the site. On her medical-surgical incision from her fasciotomy, she had a 7 1/2 cm long wound with a 2 cm open part that had some scant bleeding and yellowish granulation tissue present. She stated that she changes her bandages daily and noted that when she pulls the bandage from the scabbing it rebleeds again that was controlled. She was also concerned about being on her feet all day during her recovery. A review of systems was pertinent for gait problem. Physical therapy referral was

Patient attends with increasing worsening discomfort in his right extremity as well as left lower extremity. The patient had a stenting done in 2010 he states of the right limb but they entered the left limb to stent the right limb. Fortunately, St. Cloud has sent off for his medical records and they have not arrived. Be that as it may, he has noticed over the past several months he has had increasing and worsening discomfort in his right calf with ambulation. Becomes rock-hard particularly if he is walking from his living unit to the dining hall. It is so hard that he has increasing and worsening discomfort while ambulating. When he finally reaches the dining hall where he can rest then it tends to improve. Walking back it is not as bad because it is a downhill walk. He does not have resting pain. The limb has not changed colors. He has not noticed dependency rubor. He states he also has a history of

DOI: 04/23/2015. Patient is a 33-year-old male detailer who sustained injury when he hopped over a barrier and strained his leg. Patient is diagnosed with septic arthritis of the right femoral head and acetabulum. He is status post right hip resection, irrigation and debridement, and placement of antibiotic spacer in 04/16/2016. Per medical report dated 03/08/16 by Dr. Disiere, the patient’s current medications include tramadol and cyclobenzaprine. Based on the progress report dated 07/06/16 by Dr. Disiere, the patient presents prior to leaving for his hip surgical procedure on 07/08/16. Patient has had aspiration of the infected area. On examination, the patient is now able to bear some partial weight and use assistive crutches. He continues

Per the medical report dated 09/14/15, the patient fell on 08/10/15 and sustained a wound to his right anterior tibia. The ulcer/wound has been resistant to healing despite numerous interventions.

On 7/13/17 Ms. Barnes met with Dr. Truluck. Due to a conflict in my schedule and the appointment being moved by the doctor’s office I was unable to attend. Ms. Bennett met Ms. Barnes. Ms. Barnes reports that for the last 3 weeks she has not had any occurrences of the dislocation of the 5th finger. She felt the injection did help. Dr. Truluck released her from care. Dr. Truluck said if the problem with the dislocation re-occurred she may need to have an A1 pulley release.

Upper extremity amputation is the result of a limb loss or an associated medical condition that varies, loss of a limb is normally allocated into two categories congenital and acquired (Early, 2012). The cause of an amputation can be the result of a “congenital amputation” which is usually the lack of a limb or part at birth, more or less is the result of flaw in development (2012). The acquired amputation is the direct result of a loss from all or part of an extremity due to trauma or surgery. Surgical amputations of the upper extremities are performed because of severe infections or to remove a cancerous growth, when there is a severe injury the upper

DOI: 10/8/2015. The patient is a 32-year-old male field technician who sustained a work-related injury to her stomach, groin and right leg from tripping and falling on wooden gate. As per OMNI notes, the patient is diagnosed with unilateral inguinal hernia. He had surgery for right inguinal hernia repair on 12/8/15.

In the United States, the majority of amputations are performed in order to treat complications of peripheral vascular disease; the greater numbers involve the lower limbs (Clawson, 2009). According to Bowker and Michael (1992), disease is the most frequent reason for amputation in adults age 50 or older, while trauma is the usual cause of amputation in younger individuals. Marshall and Stansby (2008) include malignant tumor, uncontrollable acute or chronic infection, congenital deformity, ‘useless’