Right Hand Pain Case Study

He also says and demonstrates that if he supports the wrist that the tip of the ulna "goes back in place" and if he holds it the pain goes away. He reports that he has a laxity in the wrist. The PA Ms. Becker went over the MRI, x-ray and the ultrasound. She said he was born with the ulna being longer, that it is not acute. The MRI did show some fluid which could be from inflammation. She said she would recommend he go to a hand specialist. Mr. Naranjo was not aware of the results of the MRI other than they were normal because he opted not to follow up with Dr. Branch. He said he did not like Dr. Branch, that he did not feel a connection. Ms. Becker would also recommend a MRI of the wrist done at Sparrow so the previous radiologist could compare it to the prior forearm MRI, She suggested Dr. Stevens a hand specialist, and she also ordered Occupational therapy to continue. Mr. Naranjo asked if she would order some pain medication since he has

O: Inspection of the right shoulder, no redness or edema noted; palpation of the right shoulder there was no warmth noted; on deep palpation TM reports in some tenderness

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

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.

S: TM was working in Welding when he injured his left middle finger. TM states he was putting in part fixtures in Elanta when his left middle finger scrapped the car door and suffered a laceration. According to TM, he was wearing gloves at the time of injury. TM reports the initial pain was 4/10 but now his pain is 1/10, a minimal irritation. TM denies previous injury to his left hand or fingers. TM denies any tingling, numbness, or impairment of movement to his left hand or finger. TM reports he had his tetanus last September 2015.

A 50 year old male presented to the Out-patient department with a two month history of worsening pain in the right upper limb, extending to the middle finger. This pain was not improving with analgesia prescribed by his general practitioner. He also complained of weakness in the affected limb for the preceding two weeks. He denied any lower limb symptoms, had no difficulty with micturition or defecation and no gait disturbance. His examination was significant for grade four weakness in right elbow extension and an absent tricep jerk on the ipsilateral side. A clinical diagnosis of a C7 radiculopathy was made. Magnetic

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

O: No discoloration or edema noted in his right shoulder or right bicep and antecubital.

The patient has a Carpal Tunnel Syndrome if there is pain in palm, thumb, index and middle fingers, sometimes pain in wrist, forearm and upper arm.

O: Right Lower Leg: Mild edema and erythema present; superficial abrasion (Lateral Shin) 86mm X 52mm without bleeding; tender with palpation; surrounding skin intact; able to bear full body weight; pedal pulse +2;

As you recall she had been hospitalized on September 13 2014 at Chambers Hospital with severe right groin pain of 4-5 hours duration. She was a gravida 4 para four who, during her pregnancies, had had large painful veins in the right leg. She gave no history of previous superficial or deep phlebitis.

Ms. bogart is a 50-year old healthy women with a work history as a typist, who presents with a chief complaint of tingling in her left hand’s fingers (thumb and 2 adjacent) over the last 25 hours. The patient’s symptoms began last night while watching television with her arm in a “funny position”. She than shook it out to cease the pain temporally, however it reoccurred. This morning when waking up and driving to the clinic (2 hours away) she describe her pain as worsening. There is no radiation, thus the pain is localized to her three fingers. She appears to have no swelling, redness, or immobility, as well as no fever.

You did an excellent job on your discussion this week! You identified some fundamental health promotion interventions for both cases. For the leg pain case, you mention an important key intervention: reducing fat intake. Clair (2015) came up with the following total dietary recommendations based on the American Heart Association guidelines:

This examination is consistent with a mild left median nerve entrapment at the wrist, or carpal tunnel syndrome.

No edema or discoloration of bilateral upper extremities; full ROM; Radial and ulnar pulse +3;Tinel's, Phalen, Durkan compression test were all negative