48 yr old man presents to ER stating my “left lower leg is killing me.” Patient has been in pain for two days. When asked when the pain started PT states “while I was playing water Volleyball, I felt a pop in my leg, I thought maybe I just strained a muscle but it feels like someone hit me in the back of the leg with a bat, I can’t even walk on my leg.”
Upon visual evaluation the leg is swollen and blue in color. Nurse is observing swelling, bruising, and alignment of the two legs. A Thompson test can be used to the severity of the injury.
The tender area felt boggy to palpation and a gap was found. Both feet and ankles felt normal, although a non-tender calcaneus was found. The patient ...view middle of the document...
Mrs. Jones presents to her primary care office with complaints of sharp pains in her wrists, forearms and fingers. The physician diagnoses her with carpal tunnel syndrome.
ASSESSMENT: I would ask the patient to describe why she came to the office and how long she has been having these symptoms. I would ask what the pain feels like (burning, cramping, sharp, etc), if it is continuous or intermittent, if it is radiating and if there is anything that makes it better or worse. I would ask a thorough health history as well as any medications or supplements she takes. Her occupation and hobbies are important to note.
HISTORY: A history of injuries or continuous stress on her muscles (a job where she types on a computer every day for example) might be associated with this symptom.
RISK FACTORS: Risk factors for carpal tunnel syndrome can be any of the following: Past wrist fracture or injury, female, diabetes, alcoholism, nerve damage, rheumatoid arthritis, pregnancy, menopause, obesity, thyroid disorders, kidney failure, occupational hazards (working with vibrating tools or in assembly line,repetitive flexing, computer work).
EXAM: For Mrs. Jones' physical exam, I would explore the 5 "P"s related to her symptoms (pain, pulse, pallor, paresthesia and paralysis.) I would also use the technique of inspection (inspecting all skin surfaces and muscles), palpation, range of motion (on both upper and lower extremities) and muscle strength. I would mostly focus on the feeling and pain sensations she is experiencing in her forearms, wrists and fingers. It is also a good idea to ask about any pain in her elbows (ulnar nerve) during the assessment.
EDUCATION: I would teach Mrs. Jones about any medications she is being started on (sometimes NSAIDs or corticosteroids are prescribed), how to take them and when to take them. If wrist splinting is being...