Case Study: Numbness And Pain In A 47-Year-Old Female ✓ Solved

Case Study Numbness And Painpatient Informationck 47 Female

CASE STUDY: Numbness and Pain Patient Information: CK, 47, Female, Caucasian S. CC: numbness and pain in the right wrist HPI: 47-year-old Caucasian obese female presents to the clinic with reports of right wrist pain, 6/10 with tingling and numbness in the thumb, index, and middle finger for 2 weeks. The patient reports she is a hairdresser for the last 20 years and expressed frustration because the pain causes her to drop her work tools. The patient denies associated signs and symptoms. The patient stated she was at work when the pain, tingling, and numbness occurred, and the pain often wakes her up at night.

The patient reports that she usually “shakes out” her hand and wears a splint she got over the counter to relieve symptoms. Reports doing several activities with her hand at work causes more pain. Current Medications: DM type 2, metformin 500mg BID for two years but self-discontinued one year ago, “I didn’t feel I had diabetes.” Multivitamin daily for 20 years. Allergies: denies medication, food, and environmental allergies. PMHx: immunization up to date, last tetanus five years ago when she stepped on a nail at work. Diagnosed in 2010 with diabetes type 2. Hospitalized last year for pneumonia for three days.

No major surgeries, past major illnesses, and surgeries. Soc Hx: works at a salon as a hairdresser for 20 years, enjoys reading and watching television. Married with one adult child. Denies tobacco use and reports drinking wine with dinner or weekends to relax. Denies any other drug use.

Patient reports wearing a safety belt while driving, denies exercise and described diet as “steak and potatoes.” Fam Hx: Mother died three years ago from DM. Father died in a car accident at age 59 ten years ago. Grandparents both deceased before the patient was born. One brother who is healthy with no known illnesses. Adult child is obese with borderline diabetes.

ROS: GENERAL: Denies weight loss, fever, chills, fatigue, +weakness in the right hand. SKIN: denies rash or itching, denies open sores or wounds. CARDIOVASCULAR: denies chest pain, chest pressure or chest discomfort; denies palpitations, edema. RESPIRATORY: denies shortness of breath, cough or sputum, dyspnea on exertion, night sweats, exposure to TB. NEUROLOGICAL: reports numbness and tingling to thumb index and middle fingers on the right hand. Denies headache, dizziness, syncope, paralysis, ataxia, or change in bowel or bladder control. MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.

Physical exam: Vitals 132/80, 76, 16, 37.6c, 98%. General: alert and oriented x4, cooperative, does not appear to be in acute distress, good posture while sitting, steady gait when ambulating, good historian. Skin: warm, dry, and intact. Respiratory: symmetric, no visible abnormal findings, no use of accessory muscles in breathing, breath sounds CTA in all lobes. Cardiovascular: Heart rate regular rate and rhythm, S1 and S2 heard, no extra heart sounds, distal pulses are 2+ bilaterally, no edema noted, normal hair distribution in legs.

Musculoskeletal: full ROM in the left upper extremity, limited range of motion in the right upper extremity. Right weakened thumb abduction, hypalgesia. Neurological: alert, attentive, oriented; speech clear & fluent with reasonable comprehension. Motor: normal bulk, tone, and strength 5/5 left 4/5 right hand. Sensory: vibration felt in toes and fingers bilaterally; pinprick intact in feet and hands bilaterally. Superficial pain sensation is not intact in right fingers. Reflexes: 2+ and symmetric at biceps, triceps, knees, and ankles; plantar responses flexor bilaterally. Coordination: normal fine finger movements, finger-nose-finger, and heel-knee-shin.

Diagnostic results: - X-ray to r/o broken bone or sprain, A1C lab d/t p.t having DM which can damage nerves over time, + Phalen, +Tinel, manual carpal compression, and hand elevation tests. A. Differential Diagnoses: Carpal tunnel: is caused by compression of the median nerve, with obesity, gender, and repetitive motions being significant factors (Kothari, 2019).

Diabetes: Diabetic neuropathy is due to nerve ischemia from hyperglycemia, resulting in pain and numbness (Brutsaert, 2019). The patient exhibits symptoms consistent with diabetic neuropathy. C6 radiculopathy: shows severe neck pain associated with specific finger symptoms (Rainville et al., 2017). Radial nerve compression syndrome: affects the radial nerve and is more common in premenopausal women (Moradi, Ebrahimzadeh, & Jupiter, 2015). Anterior Interosseous Nerve Syndrome: affects hand function and could present similar symptoms (Aljawder et al., 2016).

Paper For Above Instructions

In this case study, we will analyze the symptoms reported by CK, a 47-year-old Caucasian female with concern for numbness and pain in her right wrist. Understanding her history and symptoms is pivotal for arriving at an accurate diagnosis and potential treatment approaches.

History of Present Illness (HPI): CK is a 47-year-old Caucasian female and has worked as a hairdresser for 20 years. She presents with right wrist pain rated at 6/10, alongside tingling and numbness in her thumb, index, and middle fingers for the past two weeks. The symptoms have worsened during certain work activities, resulting in dropped tools and interrupted sleep. Her tendency to use an over-the-counter splint suggests a degree of self-management while also indicating heightened concern about her symptoms.

Current Medications: CK had been diagnosed with Type 2 diabetes in 2010, managed previously with Metformin, but discontinued it a year ago under the belief that her diabetes was resolved. This highlights a critical point for consideration—a thorough understanding of diabetes management is crucial to her overall health, especially in the context of her current symptoms which may indicate diabetic neuropathy.

Physical Exam Findings: On physical examination, notable findings include full range of movement in the left upper extremity but restricted range of motion in the right, reflecting a possible neurological deficit. The numbness and tingling in specific digit distributions and variability in sensory response suggest compromised median nerve function, consistent with carpal tunnel syndrome.

Differential Diagnosis: The differential diagnoses include carpal tunnel syndrome, diabetic neuropathy, C6 radiculopathy, radial nerve compression syndrome, and anterior interosseous nerve syndrome. Carpal tunnel syndrome is likely given CK's occupational demand and symptoms (Kothari, 2019), and diabetes could amplify nerve-related complications (Brutsaert, 2019). Further examinations, such as nerve conduction studies, will aid in confirming potential diagnoses and guide appropriate interventions.

In conclusion, CK exemplifies a patient within a demographic prone to conditions exacerbated by occupation, metabolic health, and lifestyle factors. Comprehensive assessments and interventions are warranted to enhance her functional outcomes and manage her symptoms effectively.

References

• Aljawder, A., Faqi, M. K., Mohamed, A., & Alkhalifa, F. (2016). Anterior interosseous nerve syndrome diagnosis and intraoperative findings: A case report. International Journal of Surgery Case Reports, 21, 44–47. doi:10.1016/j.ijscr.2016.02.021
• Brutsaert, E.F. (2019). Complications of Diabetes Mellitus - Endocrine and Metabolic Disorders. Retrieved from neuropathy
• Kothari, M. J. (2019). Carpal tunnel syndrome: Etiology and epidemiology. Retrieved from [source]
• Moradi, A., Ebrahimzadeh, M. H., & Jupiter, J. B. (2015). Radial Tunnel Syndrome, Diagnostic and Treatment Dilemma. The Archives of Bone and Joint Surgery, 3(3), 156–162.
• Rainville, J., Joyce, A. A., Laxer, E., Pena, E., Kim, D., Milam, R. A., & Carkner, E. (2017). Comparison of Symptoms from C6 and C7 Radiculopathy. [source]