Patient Case Study

She still had some loss in her sensory neurons, but they showed some slight improvement from the initial evaluation. A follow-up MRI also showed a “…decrease in the brachial plexus thickening and hyperintensity.” (Gazioglu) The patient in this case study experienced rare symptoms. Patients who are usually diagnosed with brachial neuritis have severe pain in the shoulder and some even have localized pain. Only a small number of patients have pain that subsides to the fingers of the affected side. This case study supports the signs and symptoms along with the treatment that our team doctor prescribed.

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

From the scenario I have identified two nursing priorities that I feel are necessary to address, in order to improve Mrs Jones health status. They are her pain,

DOI: 7/2/2010. The patient is a 57-year old female claims examiner who sustained a work-related cumulative trauma injury to multiple body parts that include head/cervical spine, shoulders, arms knees, and left hip. As per progress report dated 7/11/16, the patient reports neck and low back pain. IT was noted that the pain is associated with left lower extremity numbness, tingling, and weakness. The patient has tried and failed multiple anti-inflammatories, which causes gastrointestinal upset, except for Celebrex. Her psychiatrist, Dr. Nehoryan has recommended her current regimen including Cymbalta and Restoril intermittently for sleep. It was mentioned that the patient had a fall in early 2/2016 due to left lower extremity numbness and is continuing

The patient has been diagnosed with bilateral peripheral neuropathy. She has been seeing Kishori Somyreddy, MD. Dr. Somyreddy recommended physical therapy, which she is not sure it helped with the neuropathy, but she does think it helps with her chronic back pain and she is feeling better from that standpoint. She has not been able to stick with the physical therapy exercises as much of late, but does plan on getting back to that now that she is settled and feeling less stress with all that she needs to do.

Clinical Scenario: Adult female accountant complaints of right-sided lateral upper extremity numbness and tingling, pain, weakness, and dropping things held in right hand.

He also recommended at some point when her physical therapist feels she is ready to join the adapted therapeutic yoga program that meets weekly. They have found that yoga, mindful breathing along with a Tia Chi program help with pain control. Ms. Bambricks private health insurance has given approval for an extended number of physical therapy session so that is decreasing her stress and worry regarding that. Her being able to attend physical therapy consistently has helped to improve the range of motion of her cervical spine and upper body strength. She continues to use a walker for the right drop foot and the left ankle weakness. The numbness she has to the left side of her body continues, along with the right wrist pain and weakness. The attendant care and transportation services have made a great impact on her attendance to her therapy and medical appointments. Our next appointment will be with Neurologist Dr. Hakim on 5/24/18. We will address the coldness to her hand and foot along with the numbness in her

Use special exercises, stretches, hands on therapy, and other equipment to try to lessen the pain of the patient.

The most relevant findings from the objective exam lead me to diagnosis the patient with a left sided C5 disc pathology causing secondary radiculopathy symptoms. Nerve roots should normally be able to withstand relative mechanical insults such as compression and stretching.4 Nerve roots can become injured in a multitude of ways including decreased space in the intervertebral foramina or spinal canal secondary to osteophytes or other degenerative changes from nearby structures such as facets or uncovertebral joints which can cause compression on the nerve root in “closing” type movements4. Other methods include herniated discs, synovial cysts or alterations in the chemical environment around the disc.5 Damage to the nerve root can cause sensitivity changes, hyporeflexia and motor weakness in the segment supplied by that specific nerve root. In this patient’s case the C5 nerve root was most indicated because it supplies the anterior shoulder dermatome, motor strength for shoulder abduction and biceps reflex. I believe the peripheralization of the patient’s symptoms laterally down the left shoulder and upper arm is caused by an increase in mechanosensitivity in which “pressure and/or stretch on a nerve produces immediate symptoms.6” When the patient decreases space and potentially compresses the nerves ie., cervical extension, lateral flexion to the left side and rotation to the left side his symptoms are peripheralized and the pain increases. The pain generators at the nerve root with increased sensitivity to these closing movements are referred to as

Assist the patient in movement. This helps to decrease the patient’s pain by taking some of the weight off her (Unbound Medicine, 2014).

The benefits of orthotic intervention are not documented objectively, therefore the functionality should always determine whether an orthosis is prescribed, noting that the upper limb requires a broad range of fine motor skills which the use of long-term splints can inhibit. If orthotic intervention is to be attempted, practitioners must:

The therapist will start by introducing herself and the purpose of performing ROM on the child to the mother. The therapist will build a rapport with both the child and the mother so the child can feel comfortable. The therapist will ask John if he is in pain and then check for swelling. If there is no pain, the therapist will continue with the activity; however, if there is pain or swelling, the therapist will stop the treatment than apply a cold pack in the area to reduce edema. The patient will then be seated in a small chair with support at a 90 degree angle, while both legs flat on the floor to perform the activity. The chair will not have any arm rest. The therapist will begin by doing PROM on the right elbow with gentle guidance then the child will continue to perform the activity actively towards the end. The therapist will stabilize the humerus, while passively flexing the forearm starting from extension to flexion. The patient will actively perform 4 repetitions of ROM on the right elbow from extension to flexion. The therapist will passively perform 6 repetitions of ROM on the right elbow of the patient to increase the level of function in that extremity. Between the active and passive ROM, the patient is required to take a 5 minute rest for joint protection. Before moving to the next activity, the patient will need to take another 5 minute break to avoid fatigue in the affected

A 48-year-old female with numbness and tingling in the right hand. Positive electromyography. Failed conservative treatment care including bracing and/or injection.

Interventions – none, assistive devices, breathing treatment, cold therapy, deep breathing, distraction, eating, elevation, exercise, holding, immobilization, massage, medications, moist heat, music, repositioning, rest, rice bag heated, splinting, other:

S: TM works in GA FS/3L when she injured her right hand fingers. TM was propping engines and pulling back the pallets, and the other TM, who was working with her, didn’t see her hand causing right hand finger contusion, index, middle, and ring finger tips. The initially the pain was 10/10 and the pain was pulsation, now the pain is at 4/10. TM denies any numbness, tingling, or loss of movement in her right hand fingers. After the 20 minutes of ice, TM rates her pain was at 1/10 in her ring finger tip and her index finger tip, but she rates her middle finger tip pain at 3/10 and describes her pain as aching.