Left Wrist Pain Case Study

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

O: Inspection of the right shoulder, no redness or edema noted; palpation of the right shoulder there was no warmth noted; on deep palpation TM reports in some tenderness

Heart: Rhythm regular, no murmurs. Normal S1 and S2. No S3, S4 or murmurs. No peripheral edema, cyanosis or pallor. Extremities are warm and well perfused. No carotid bruits.

O: Inspection of right elbow - No edema, discoloration, or swelling noted; tenderness with palpation near the lateral elbow when the wrist is bent forward; right hand Grip strength: Right +4, Left +5

Pain in the wrist, hand, or fingers is generally caused by repetitive motions, overuse, or underlying conditions like arthritis or tendonitis.

O: Right Shoulder: no edema; no discoloration; no warmth present to her right shoulder; full ROM; no neurovascular impairment; radial and ulna pulse +3; no impairment of the wrist joint or finger joints; all sensation intact; grip strength +5.

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.

\DOI: 3/11/2016. Patient is a 52-year old male supervisor who sustained a work related injury to his right elbow and tore his muscle when he tries to grab a falling 'A' frame. As per medical report dated 5/3/16, patient suffered biceps tendon tear. It was noted that the patient had surgery performed on 3/25 and he is in the process of going through physical therapy. He continues to have limitations in range of motion of the elbow. He also has developed fluid and edema over the right elbow into the olecranon bursa. He has an extension lag of about 15 degrees. He can flex his elbow, but not fully. There is about 5-6 inches between his fingertips and his shoulder. He also cannot perform full supination and pronation. It is in the moderate range at this time.

O: Right Lower Leg: Mild edema and erythema present; superficial abrasion (Lateral Shin) 86mm X 52mm without bleeding; tender with palpation; surrounding skin intact; able to bear full body weight; pedal pulse +2;

Carolyn had concerns about a throbbing pain in her neck, shoulders and upper/lower back. She also had concerns about a slight pain in her wrist. Carolyn has had a previous history of multiple musculo-skeletal surgeries.

O: Left middle finger bruising on dorsal palmar between distal and mild phalanx, mild edema, Full active and passive ROM. X- ray no abnormality found; fingers warm, brisk capillary refills.

Ulnar wrist pain is pain on the side of your wrist opposite the thumb. The pain is often mild at first, but can become severe enough to prevent you from doing simple tasks. (1)

O: on inspection of the right shoulder, no redness or edema noted; on palpation warmth noted; on deep palpation TM reports increased pain; .Pain with abduction at 70 degrees.

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

Musculoskeletal: No muscular asymmetry noted. No edema or tenderness of joints, no bone deformity, or contraction. ROM, strength grossly intact.