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 patient wants to also update me as far as the arm pain he mentioned last time. He says his left arm is feeling better now. He is noticing that his right shoulder is hurting at times, especially in certain positons such as while he is sleeping and if he has his arm raised over his head while he is lying down. He had no specific injury or trauma. He is not aware of anything that makes it better or worse. He is not using any medication for it thus far. He would be interested in having

Electrodiagnostic consultation report dated 10/02/15 revealed normal study of both upper limbs and cervical paraspinals. No evidence of cervical radiculopathy. No median or ulnar neuropathy.

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.

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

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

Diagnoses are cervical radiculopathy, right shoulder pain, nondisplaced fracture of the greater tuberosity of the right humerus and right shoulder bursitis. He has reached maximal recovery for his right shoulder. MD is concerned that the elbow and hand pain are related more to his neck as he has a history of cervical radiculopathy and his symptoms are more of tightness than pain that can be localized. He has had epidural injections in the past for left sided radiculopathy. An updated MRI is requested. If there are right-sided findings, he will be sent for possible injection for the upper extremity pain. Otherwise, he will be sent for a second opinion for his continued

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

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

\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.

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,

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

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

S: TM is here for s/p ESI X 9 visit follow up for his right hand and wrist pain and also for RUE Neurometrix test. TM reports his current pain is at 7/10. During the Shutdown his pain has improved some, but still waking him up at night with pain and numbness in his right hand and arm, relieved by shaking or rubbing the hands. TM also reports, numbness and the pain occurs during waking hours, when he is driving, talking on the phone, and occasionally when he is using the hands for repetitive maneuvers. When the heat was applied to his