Carpal Tunnel Syndrome Case Summary

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

It was noted that the random urinary drug screen dated 6/14/16 (no official report) is consistent with medications. Controlled Substance Utilization Review and Evaluation System (CURES) dated 8/1/16 from department of Justice (no official report) found to be consistent with the medications. The pateint also has opioid agreement signed 7/14/16 and a grade of 3 on opioid risk assessment. The 4 A’s of opioid monitoring notes that Norco and Neurontin notes that were not prescribed in the past and do not have significant documentation to provide functional improvement.

DOI: 9/30/2014. Patient is a 28-year-old female research assistant who alleges pain and weakness in her hands/wrist as a result of repetitive scooping dirt from soil barrels. As per OMNI entry, the patient was diagnosed with cervicobrachial syndrome (diffuse), right carpal tunnel syndrome and insomnia. She is status post endoscopic carpal tunnel release (CTR) on 09/24/2015 for the right and on 06/02/2015 for the left side.

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

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

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.

If you suspect you or someone you know is showing symptoms of Carpal Tunnel, we advise you see a

At today's visit, she is awake, alert and oriented times 3. . She complains of back pain that radiates to her abdomen and down her legs. She describes the pain as deep ache that is aggravated with movements with a severity of 8/10. She states that her pain has worsened and that her current pain regimen is not effective. She states she has been taking her Dilaudid every 4 hours. She stated that she had fentanyl 50 mcg patches from what she uses to take previously. She states that she used her 50mcg patch and her pain had

12/22/15 Progress Report described that the patient has improved substantially in her left hand following her carpal tunnel surgery in 2014. She expresses a strong desire to proceed with right carpal tunnel surgery, given the degree of residual symptoms that have not adequately responded to conservative measure. ROS: The patient has dyspepsia with some episodic epigastric pain treated with antacids and H2 blockers. The physical exam revealed moderate tenderness over the right carpal tunnel. There were positive Tinel’s and Phalen’s signs. The Katz hand diagram was consistent with

She weighs 159 pounds, oxygen saturation is 97% in room air. Patient is sitting comfortably in no apparent distress. Eyes: Pupils are equal, regular, reacting to light with intact extraocular movements. Oropharynx is normal. Ears: Normal, external auditory canal, and tympanic membrane. Neck: Supple. Chest: Clear to auscultation. Left thumb mild tenderness. Good range of motion.

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).

Patient Opioid Misuse Index score shows 0/6, indicating the patient is not a potential misuser of opioid. Graded Chronic Pain Scale score reveals current pain level of 7. Average pain is 7/10 and worst pain is 9/10, for the last 30 days.

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

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,

A very strong ligament called the transverse carpal ligament connects the arch of bones, which makes a complete “tunnel”. The transverse carpal ligament is a heavy band of fibers which runs between the hamate and pisiform medially to the scaphoid and trapezium laterally, and forms a fibrous sheath which contains the carpal tunnel. These bones and this ligament form a circle Carpal Tunnel Syndrome -5- from which tendons and major nerves travel. This complete circle is called the Carpal Tunnel, hence the name of this disease “Carpal Tunnel Syndrome”.