DOI: 6/25/2007. Patient is a 37-year-old female store manager who sustained injury when a tote slipped off shelf and struck her left side of the body. Per OMNI, she is status post ulnar nerve decompression on 03/11/08, left De Quervain’s release on 09/08/09, spinal cord stimulator implant on 08/03/11 and shoulder surgery on 01/19/15. Per the PT attendance report dated 05/07/15, the IW has attended a total of 30 sessions for the left shoulder from 02/05/15 through 05/01/15. Based on the medical report dated 06/24/16 by Dr. Angermeier, the patient presents for evaluation of left hand numbness and tingling. She has history of left ulnar nerve decompression approximately 6 years ago. She also has history of both left upper and lower …show more content…
She has elbow range of motion actively from 15 to 150 degrees. She is exquisitely tender to touch throughout the medial elbow and distal forearm. There are some trophic skin changes consistent with her diagnosis of complex regional pain syndrome. She has subtle weakness of the intrinsic function in her hand. There is a 2 point discrimination of 8mm and ulnar nerve distribution, 4 mm in the median nerve distribution. Current medications include Xanax, Symmetrel, Amrix, Flexeril, Relpax, Duragesic patch, Fentanyl, Prevacid, Movantik, Zofran, Roxicidone, Prevident, Trezix, Chantix, Zorvolex and Vitamin …show more content…
She continues to have active symptoms of complex regional pain syndrome in the left upper extremity, which at this point may never resolve. Recommendation was made for continued conservative treatment, although IW was counseled that she may well have progression of ulnar neuropathy over time which could also have significant consequences for her with respect to pain, numbness, tingling, and weakness or deformity of the hand. Unfortunately, MD thinks that the IW’s risk of complications with revision surgery probably outweigh the risk of progression of her ulnar
Click here to unlock this and over one million essaysShow More
DOI: 4/16/2012. Patient is a 29-year-old male technician who sustained injury when he was 25-feet up on a ladder when the ladder slid and he fell onto the pavement. He had an open reduction internal fixation (ORIF x 2) for a compound tibia fibula fracture and had hardware removal in 4/25/2013. MRI of the lumbar spine performed on 3/24/2016 revealed L5-S1 small right paracentral disc protrusion without significant spinal canal stenosis or neuroforaminal narrowing.
She was unable to abduct (move her arms away from the middle of her body) her arms so we were concerned there was a dislocation in the shoulder joints since they have a shallow articulation (movement). She could pronate (turn her palms up) and supinate (turn her palms down) her palms, but her grip strength is
Jimmie Bowman was seen in followup for CIDP, causing previous weakness and numbness of his distal lower extremities. He states that the strength of his distal lower extremities [____] continues improved and is staying normal. He has occasional mild feeling of numbness of his feet, but states this is staying down to what he can tolerate. He is not having pain of his feet. He is no longer on Imuran.
DOI: 5/19/2010. Patient is a 57-year-old male electrician who sustained injury when he was struck in the back by a car in a parking lot. He underwent a L5 laminectomy and decompression of the neutral elements 2011. Per the progress report dated 5/18/16, the patient complained of low back and left leg pain.
Activities at home and work worsen the pain. Numbness, tingling, and burning sensation are reported with increased pain throughout the week. The patient is requesting medication refills and reports limitations with gripping, grasping, pushing, pulling, and lifting 10 pounds. Activities of daily living are limited due to pain, as
Client has pain when extending the neck towards the sternum, lateral extension of the right side, and reduced range of motion in rotation of the neck towards the left side of the body. Patient explains that prior to her injury she could touch her chin to her sternum area, easily rotate her head from right to left and look over her shoulder. She complains of lack of sleep due to pain, headaches, problems with driving and inability to bend neck to read, eat, and engage in office/school work. Client loves to take long drives, put together puzzles, and play video
Jean Russell of Michigan Insurance Company referred this file for medical case management. Instructions were given to meet with Flavia Tocco and assist with coordination of appropriate and related medical care, and identify needs to facilitate recovery. INTERVIEW SETTING I met Ms. Tocco at the St. John’s physical therapy department. Ms. Tocco was open to providing me information on her current and prior medical history.
The report notes a prior shoulder surgery in 2002, on the right shoulder. An X-ray was done of the left shoulder, which did reveal degenerative changes in the acromioclavicular joint, as well as post-surgical changes, and degenerative changes on the right side in the acromioclavicular joint. The applicant was subsequently referred to an orthopedic surgeon, Dr. Peter Simonian. An MRI of the right shoulder was conducted on April 10, 2015, which noted tendinopathy of the supraspinatus and infraspinatus tendons. No tear of the rotator cuff, but a superior labrum anterior to posterior tear extending to the posterior labrum, as well as post-surgical changes.
She completed all activities that were assigned to her WNL. (A) Assessment Pt is doing extremely well for the number of visits that she has received. This is because of her hard work at home which has contributed to her fast recovery. Her ulnar/radial deviation lacks because of the muscle tightness which could be loosened
DOI: 6/10/2014. The patient is a 38-year-old male assistant lead who sustained a work-related injury to his low back after lifting a 50-pound bag of soy crisp. Based on the progress report dated 03/03/16, the patient complains of pain from the lumbar spine radiating into the left leg and foot. Pain level is 7/10.
DOI: 1/23/2016. Patient is a 21-year-old female housekeeper who sustained injuries to her head, neck and back when the elevator from the third floor dropped to the first floor. Per OMNI, she was initially diagnosed with neck and back sprain and headache. Based on the progress report dated 03/29/16, the patient presents for follow-up of her cervical and lumbar strain. She feels slightly better.
DOI: 06/10/2004. Patient is a female store manager who sustained a work related injury while she was stocking and cashing at a thrift store over a period of time. Based on progress report dated 08/24/15, the patient was seen for re-assessment of chronic mechanical and myofascial pain in the lumbar region. She has undergone two lumbar surgeries, as well as a left abdominal hernia repair and a revision of the ventral hernia repair.
Minor Brachial plexus injury can lead to transient sensory impairment on the medial side of the upper limb. The more severe affection of the upper roots can (C5, C6) classically leads to Erb’s palsy syndrome (Waiter’s tip hand). The injury of the lower roots (C8 and T1) classically causes Klumpke’s paralysis syndrome (Claw hand) (8, 17). Horner’s syndrome (ipsilateral ptosis, miosis and anhydrosis) may accompany brachial plexus injuries particularly with the injury of (T1) nerve root due to involvement of the nearby cervical chain (17). The radial nerve neuropathy can be manifested by paresthesia in the lateral 3.5 fingers and loss of the function of extensor muscles in the wrist and the figers (wrist drop).
With forearm and elbow injuries being so common, the resources to diagnose such conditions are readily available in today’s society. However, because radial tunnel syndrome and lateral epicondylitis have such similar symptoms, it is not uncommon for one to be under looked. For clinicians, the easiest way to differentiate between the two is to pinpoint the exact location of discomfort. Specific testing, such as the EMG, will test to see if the forearm muscles are intact and functioning normally. Assistive passive range of motion will also help the therapist determine the patients end feel.