Medical Case Study Of Finkelstein's Case Summary Of Stomach

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

He was given a refill prescription for gabapentin 600 mg, 1 tablet orally, 3 times a day for 30 days, # 120 and hydrocodone/APAP tablet, 10/325 mg 1 tablet 4 times a day for 30 days #120. The patient continues on stable doses of medications in a responsible and compliant fashion.

Per the Request for Authorization form dated 09/19/16, IW was prescribed with Naprosyn 500 mg 1 tablet three times daily #90, omeprazole 20 mg 1 capsule daily #30 and Elavil 25 mg a t bedtime #30.

On examination of the right hand, the middle finger shows scarring, pale color, contracture and unable to straighten.

Based on the medical report dated 03/31/16 by Dr. Schonwald, the patient reports pain in his low back, left lower extremity, right lower extremity, as well as in his left hand that originates at his left elbow and to his fingertips.

On Primary Treating Physician’s Progress Report (PR-2) dated 08/11/2017, the patient presented with unchanged symptoms. His left-hand pain was rated at 8/10. and was described as constant and sharp. The pain was aggravated with certain movements and gripping. The

O:Left Wrist: no edema, no discoloration, full ROM, no impairment of the NVS, radial and ulnar pulses +3, pea-sized bump palpated in the dorsal radial border that is firm and stationed and causes pain with pushing on it or extension of the wrist.

There is tenderness with motion of the wrist. Strength is 4/5. She is tender over the first dorsal extensor compartment and has a positive Finkelstein’s test. Assessment includes internal derangement of the right wrist, status post right wrist arthroscopy and De Quervain’s tendinitis of the right wrist/thumb. Patient will benefit from an additional course of PT to enhance and restore strength and function of her right wrist. She will benefit from a thumb spica splint to allow her tendinitis to resolve. She will continue applying her Voltaren gel.

Moreover, Tinel’s sign is positive bilaterally and Jamar grip strength is measured to be 10/10/10 bilaterally. Diagnoses include continuous trauma; cervical strain with radicular complaints; bilateral shoulder rotator cuff tendinitis with rotator cuff tear, status post left shoulder arthroscopy with rotator cuff repair; and bilateral wrist strain with carpal tunnel syndrome and degenerative arthritis of the index/long distal interphalangeal joint, triggering of the bilateral

DIAGNOSIS: Strain of muscle, fascia, and tendon at neck level; Carpal tunnel syndrome, unspecified right limb,;Carpal tunnel syndrome, unspecified left limb; Status post left carpal tunnel release; and Adhesive capsulitis of right shoulder (M75.01).

Per IME report dated 9/27/2013 by Dr. Philip D’Ambrosio, the patient has reached MMI to the right shoulder, right ankle, right elbow, and right knee. At this time, he requires no further treatment other than for documented exacerbation.

DE Quervain’s Tenosynovitis. The rationale for choosing this condition as a differential diagnosis as the other is likely is based on the decreased sensation and the inability to grasp objects tightly. Evidence: De quervain’s tenosynovitis disease, also called gamer's thumb or mother's thumb, is a common pathological condition of the wrist. Even though the exact etiology is unknown, the cause of de quervain's disease is thought to be due to thickening of the synovial sheath containing the extensor pollicis brevis (EPB) and abductor pollicis longus (APL) tendons. This disease can cause irritation of the muscles, pain and swelling over the radial side of the wrist in patients along with an increased difficulty in gripping objects. Signs and symptoms of de quervain’s tenosynovitis include mild pain, limited ROM, swelling, and decreased sensation and locking with thumb motion (Patel, Tadisina, & Gonzalez,

Based on the progress report dated 02/09/16, the patient presents for follow-up. He describes ongoing difficulty with pain in both shoulders, wrists, low back and the bilateral lower extremities from the knees to the calves. His symptoms include pain, spasms, numbness and tingling. He rates his pain level as a 9/10 in intensity, but it is reduced to a 7/10 with use of his medications. He reports that morphine is helping, but he is still taking 5-6 Norco a day. He is also taking a stool softener three times a day as well as Linzess. However, he continues to have significant constipation.

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

On examination, there is decreased range of motion with pain with flexion/extension. There is positive tenderness