Reason for Visit: Bruising and pain in the right index Finger
S: TM was pulling on a bumper when he felt a sudden pressure to his right index finger. TM rates his right index finger at 4/10. TM states his is not in pain and it’s more like a discomfort. TM was offed ESI but refused, stating that he will do ICE at home himself. TM denies previous injury to the location. Denies any tingling, numbness, or loss of movement to his right hand.
O: Right index finger: bruising of finger, mild edema, Full Active and passive ROM, Tender to palpation, no warmth. Brisk capillary refills; right radial and ulnar pulse +3
A: Right Index Finger Pain/Bruising
P:
Ice X 20 minutes
X-ray of right hand/fingers – unable to perform – X-ray not working
Ibuprofen
Heart: Rhythm regular, no murmurs. Normal S1 and S2. No S3, S4 or murmurs. No peripheral edema, cyanosis or pallor. Extremities are warm and well perfused. No carotid bruits.
On examination of the right hand, the middle finger shows scarring, pale color, contracture and unable to straighten.
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.
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,
S: TM completed total of 4 ESI visits for her right elbow Strain. TM reports ESI’s heat treatment is helping her with symptom’s management. TM reports her pain 5/10. Her pain starts at her elbow and radiates to her forearm, and reports weakness in her grip strength in her right hand. TM also reports her right elbow pain radiates up to her right shoulder (?) TM denies her right arm pain wakes her up at night.
O: No discoloration or edema noted in his right shoulder or right bicep and antecubital.
No redness, cyanosis or edema present. No tenderness. All peripheral pulses are 3+ and equal bilaterally. Legs symmetric.
A 48-year-old female with numbness and tingling in the right hand. Positive electromyography. Failed conservative treatment care including bracing and/or injection.
The patient reports no complaints. No pain. No numbness or other problems. He does notice that the left thumb continues to be somewhat swollen although significantly better with the release of the soft tissue at his last visit on July 7, 2015.
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.
Pain is severe with profound limitations, and described as aching, sharp and stabbing. There is radiation of pain to the hand and fingers. Pain is aggravated by lying down, sleeping on involved side, and use of the extremity. Associated symptoms include numbness, waking up at night, tingling, pins and needles. Condition is getting worse with time. He is unable to return to work due to physical limitations.
Pain in right arm and left shoulder. During clinical presentation patient was not distressed or anything blood pressure 114/76 mmHg, heart rate 96 beats per minute, respiratory rate 20 beats per minute and saturation of 100%. General signs were pallor, weight loss, fever (Hammer & McPhee, 2014, pp. 69-72). Patient reports a history of difficult with regular bowel movements, which has been an ongoing issue during her hospital stay.
S: TM reports bilateral hand numbness, denies any pain, but his hand goes numb at times. He has previous case going back to 2011. Currently his current job doesn’t requires physical involvement, but he wants have he’s case open incase his current bilateral hand numbness gets worse. His hand goes numb while he has his elbows are bent and maintain a passion and sometimes he wakes up with numbness in his hands, but never pain. TM denies lost grip or movement of his hands.
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