Right Finger Contusion

O: Left Pointer Finger Nail: A Blue colored discoloration, tender to palpation; Left pointer Finger distal phalanx 1 cm in length purple discoloration, small, pin tip size open area, bleeding has stopped. mild edema

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

S: TM just finished working on a car in the back step off platform into pit, wielding AN Car, and fell back on pipes on his left lateral side. The initial pain was 10 out of 10 and it was difficult to breath related to pain. Now, he rates his pain at 5 to 6 out of 10, aching paint to his left shoulder and his left lateral rib cage. Denies any headache, blurred vision, N/V. Ice X 20 minutes now did helped him with symptoms management.

Patient is diagnosed with bilateral carpal tunnel syndrome, bilateral elbow pain, lesion of the ulnar nerve of the bilateral upper limb.

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.

The patient is a 48-year-old individual who sustained an injury on 09/20/16. During that time, he was running food on a plastic tray plate at work when the plates suddenly jammed to his left hand.

The patient c/o ganglion cyst to right top of hand near the wrist. limited movement and pain x 6month. However the patient c/o of increased pain x 2 days .She denies injuies but states when she opened the door she move "her hand some type of way causing her immediate pain." The pt currently rates 4/10 dull pain that radiates to finger and elbow with occassional numbness to the forearm and elbow. The patient states that she was being seen by othropedic and was referrrd to a hand speciialist but was never nofitied. Per Major Blount the patient was advised to called othropedic and schedule and appt. Take Tylenol or Motrin as need for pain.The patient agrees and verbalized understanding to the POC.

Some of the injuries that can occur in the hand are Cubital Tunnel Syndrome and Carpal Tunnel Syndrome along with many more. Cubital Tunnel Syndrome causes pain or numbness in the ring and little fingers, but could also go to the arm (Types of RSI, 2010). Occurs when the ulnar nerve is pinched along the elbow’s edge (“funny bone”), and has tingling or painful feeling (Types of RSI, 2010). Cubital Tunnel Syndrome can be treated by avoiding putting pressure on the “funny bone” (Types of RSI, 2010). Cubital could lead to surgery if the nerve needs to be relieved. Carpal Tunnel Syndrome is similar to Cubital but occurs in the three first fingers. A major nerve is compressed which passes over the carpal bones through the front of the wrist (ASSH, 2015). When the nerve is compressed it causes painful, tingling and numbness in the first three fingers (ASSH, 2015). Carpal Tunnel Syndrome can be treated without surgery by changing the patterns of hand use and/or wearing wrist splints at night (ASSH, 2015). If severe then surgery can take place to make the nerve have more

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

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.

DI 24510.006 indicates the RFC must be based on all of the available medical evidence, including medical history, medical signs and laboratory findings and effects of symptoms including pain that are reasonably attributed to a medically determinable impairment. There is insufficient medical evidence in file to assess the claimant’s current level of function. DI 24515.001B.3 states evidence of a claimant's functional limitation is “sufficient” to permit an assessment of impairment severity when it is both consistent and complete enough to evaluate and assess the function. In this case, the evidence in file is not sufficient to fully assess the claimant’s hand impairment. X-ray imaging of both hands, and knees is needed.

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,

A _____(43 or 42)-year-old female [Place] Police Officer with 2 issues. She has noticed, for about 5 weeks numbness in all the fingers of her right hand. Present most of the time. She notes that by holding her arm bent at an angle and up it seems to resolve it. She can recall no neck trauma or neck injury. Neck is not bothering her. No car wrecks. She fashioned some sort of splint herself, but it did not seem to help that much. No other numbness, or tingling, or other neurological symptoms. Feels well overall. Did have her thyroid ablated about a month ago, and she is due to check her TSH again. In addition she has chronic sinus problems, we went through that. There is a seasonal variation. Zyrtec-D seems to work the best. Flonase

Acute idiopathic blue finger is a benign and rare condition. It is characterised by an acute bluish discoloration of fingers which may be accompanied by pain4. The acute blue finger appears to occur in all age groups, predominately affecting the female, middle-aged population1. Spontaneous acute blue finger syndrome is an entity different from ischemia or vasospasm. The mechanism of subcutaneous bruising has been offered. Lesions usually disappear without the stages of ecchymosis resorption. The patients presenting with acute blue fingers should be rapidly clinically evaluated. The absence of any thromboembolic disorders or systemic diseases indicates a benign clinical course2. In a prospective follow-up of 22 patients who had presented with

Observing the old blood on his finger could have shown that it had occurred earlier in the day, but he had left it to clot up on his skin. Upon asking my dad what he had done today during work, he had told me that he had been lifting a pool heater during the day to do an installation job and one of the metal pieces near the heater itself had cut through a piece of his shirt. Upon asking him about his finger, he had stated that he had been using a very sharp knife to cut through the heater box and it had slipped a small amount, piercing his skin and going into it. He had said this injury had occurred in the morning, which had also shown that the job was completed from the morning until the evening which could easily explain why the blood was seen to be old and the bandage looked as if it hadn’t been replaced all