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.

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

Electromyography report dated 01/05/2016 (no official report) revealed mild carpal tunnel syndrome on the right and moderate on the left.

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.

S: TM works in Front sub, he was lifting pipes when he experiencing pain in his left wrist. Most pain wit extension of his wrist. 3 to 4/10. TM denies previous injury to his left 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.

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 most common injuries that many adolescents receive are contusions and strains (Adirim & Cheng, 2003). The ankle and the knee are the most commonly injured areas followed by less common injuries of the hand, wrist, elbow, shin, calve, clavicle, head, and neck (Adirim & Cheng, 2003). Sever’s disease is an injury to the heel whereas Little League elbow affects the elbow joint. Contact sports such as hockey and football report more contusion injuries due to the collisions that happen during the game (Adirim & Cheng, 2003). In contrast, non-contact sports such as running, soccer, and basketball report more muscle strain injuries. When an athlete is repetitively using their elbow, an injury called, Little League elbow may occur.

Carpal Tunnel syndrome (CTS). The rationale for choosing CTS as the most likely differential diagnosis is based on the subjective, objective data and T.R occupation. Evidence: CTS are caused by excessive used and repetitive movements of the wrist, which cause a loss of space and impingement of the median nerve. A type of activity that is associated with CTS, is computer use (Goolsby & Grubbs, 2011). CTS is a common musculoskeletal disorder affects approximately 1.5% to 2.8% Americans. The yearly costs estimated at $2 billion. The most common involve joints are the first (thumb), second (index finger), third (middle finger), and fourth (ring finger) metacarpophalangeal. CTS symptoms include: tingling, numbness, burning, or pain usually affects the anterior part of the wrist, medial palm and the first three digits on the hand (Thiese, Gerr, Hegmann, Harris-Adamson, Dale, Evanoff, & Rempel, 2014).

Suppose I was working in an urgent care clinic with approximately 20-25 staff members. Presuming there to be four midlevel providers, two Family Nurse Practitioners, and two Physicians Assistant. There will be one physician covering the facility and the rest of the faculty includes the medical assistants and secretaries. Understanding that each provider would divide and see the same amount of patients throughout the day. Assume I started my day with a patient presenting with a laceration distal portion of the index finger. This patient states that he was cutting wood with a table saw and accidentally skimmed the saw with his finger. As a practitioner, I would examine the finger for any possible tendon involvement as

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

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

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