Nursing Case Study Of Carpal Shock

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: 6/12/2014. Patient is a 59-year-old right-handed male machine operator who sustained work-related injuries to his right arm, shoulder and neck when his right hand got caught in a mixer. As per office notes dated 9/6/16, the patient returns complains of continued neck pain with burning hot pain extending into the forearm down to the hand along the C6 and C7 distribution with numbness and tingling in the hand. The patient has undergone multiple medications, physical therapy, TEN both in physical therapy and home use. It was also noted that the pateint denies having cognitive behavioral therapy. The provider notes, that it would be appropriate as based on the history including postoperative right forearm fracture repair and forearm open reduction and internal fixation of the right distal radius that an additional surgery to the right arm and continue physical therapy, yet continues to have swelling

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.

The symptoms of pain, numbness, tingling or weakness are the result of the inflammatory process within the carpal tunnel that leads to compression of the median nerve. The compression and resulting impingement of the median nerve results in ischemia. The ischemia leads to the symptoms of numbness, tingling, pain and weakness of the hand and/or forearm. The FNP should inspect the wrist and hands of the patient with symptoms of CTS, looking for skin color and temperature changes, deformities and muscle wasting. The active and passive range of motion (ROM) of the neck, shoulders, elbows, wrists and fingers should be accessed. Muscle strength should be assessed at the shoulder, elbow, wrist and fingers. Spurling’s test for cervical radiculopathy should be performed. A plain x-ray can be ordered by the FNP if ROM of the wrist is limited. The FNP should also assess capillary refill of the fingers (Dunphy, Winland-Brown, Porter, & Thomas,

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

A physical therapy evaluation dated 08/07/2017 indicated that the claimant had a right shoulder pain after a fall onto her elbow and knee at work on 06/28/2017. She stated that she will have a surgical intervention on her right shoulder. She rated the pain at 6-8/10. She was unable to reach above her right with the right upper extremity. Objective findings showed reduced right arm swing. It was noted that the claimant was unable to place the right hand behind the head or the ear. There was a noted atrophy of the right forearm. Therapeutic exercises, moist heat, TENS, cryotherapy, and patient

A 50 year old male presented to the Out-patient department with a two month history of worsening pain in the right upper limb, extending to the middle finger. This pain was not improving with analgesia prescribed by his general practitioner. He also complained of weakness in the affected limb for the preceding two weeks. He denied any lower limb symptoms, had no difficulty with micturition or defecation and no gait disturbance. His examination was significant for grade four weakness in right elbow extension and an absent tricep jerk on the ipsilateral side. A clinical diagnosis of a C7 radiculopathy was made. Magnetic

DOI: 4/17/2013. Patient is a 61-year old male senior quality assurance manager who sustained a work-related injury to his right hand from repetitive use of keyboard and mouse. As per OMNI entry, he was initially diagnosed with right thumb and wrist tendonitis. The patient is subsequently diagnosed with radial styloid tenosynovitis [de quervain]; periarthritis, unspecified wrist; osteophyte, unspecified elbow; and lesion of ulnar nerve, unspecified upper limb. As per progress report dated 6/29/16, the patient complains of pain at the cervical spine, right shoulder, right elbow, and right wrist/hand with stiffness, weakness and numbness. Physical examination revealed tenderness to palpation, spasms, and decrease range of motion, strength, and

DOI: 3/5/2015. Patient is a 53-year old male coordinator who sustained injury to his right shoulder and right arm, when he slipped and fell while walking into work. Per OMNI, he was initially diagnosed with fracture of the right humerus and contusion of the right elbow. This claim is established only for the right shoulder and elbow.

DOI: 12/1/2003. The patient is a 58-year-old female book keeper who is experiencing pain in her right arm and wrist due to performing her usual and customary job duties. Per OMNI, the patient is diagnosed with neck pain and bilateral upper extremity pain. The patient is subsequently diagnosed with lateral epicondylitis, right elbow; lateral epicondylitis, left elbow; radial styloid tenosynovitis; and enthesopathy, unspecified. As per medical report dated 6/23/16, the patient walks in due to worsening of symptom. She has worsening pain in the right upper arm, forearm, medial, and lateral elbows, and left upper arm, forearm, medial, and lateral elbow, right more than left. Pain is burning in nature and constant. Any gripping/grasping activity

01/26/16 Progress Report noted that the patient presented with left shoulder pain. The pain was gradual in onset and is constant. The pain is characterized as burning, sharp, shooting, and throbbing. It radiates to the neck. She described her pain as moderate to severe. Her condition is associated with numbness in her left fingertips and weakness in her upper extremities. Any activity, movement and reaching aggravate the pain. Stretching and hot showers relieve the pain. The level of sleep has been decreased due to difficulty falling asleep. The quality of sleep is poor. She has difficulty performing her ADLs. Current medications: Meloxicam, Naproxen, and Spironolactone. Review of Systems was positive for weakness and nausea. The patient also has anxiety and depression. She has had psychiatric, psychological, or social work evaluations or treatments for problems. The physical exam of the cervical spine revealed that the ROM is restricted. There were spasms and tenderness of the paravertebral muscles bilaterally. There was also spinous process tenderness noted on C6 and C7. Tenderness is noted at the paracervical muscles and trapezius. Spurling’s maneuver produces no pain in the neck muscles or radicular symptoms in the arm. Adson’s test is negative. No signs of meningism. Cervical facet loading is negative on both sides. The exam of the right shoulder was

Based on the medical report dated 06/27/16, the patient developed bilateral carpal tunnel syndrome over the past year and also some left lateral elbow soreness. Symptoms have progressed. She continues to perform regular work; some adjustments have been made to her work site and she takes short breaks. She takes ibuprofen tablets as needed. Her symptoms wake her from sleep despite night splinting. Of note, electrodiagnostic testing was consistent with moderate to severe bilateral carpal tunnel syndrome. The right side is equal

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.

He is status post 3rd cervical ESI with catheter up to C4-5 towards the left. Pain prior is 9/10 and lowest at 4/10. There is improvement with radiating pain. Patient is demonstrating and detailing improvement along the C4 and C5 dermatomal region. He states that he has continued radiating pain through the medial aspect of the left upper extremity, through the elbow, left medial forearm and 4th-5th digits. Relief from the last ESI has begun to subside. He has increased pain through the neck radiating to the left hand and fingers. Pain is rated as 7-10/10. He also reports weakness, numbness and tingling into the upper extremities, left greater than the right. Pain is also extending through to the upper thoracic spine and left greater than right paravertebral regions. Pain is worsened with prolonged standing, sitting, walking, bending, holding head and neck in one position for too long, driving, bending head and neck back and forward and abrupt cervical movements. Ice, rest, heat, therapy and medications provide modest short term relief. He contionues to have difficulty with activities of daily living as well as work/professional activities of daily living, personal and