Work Related Injury
DOI: 5/5/13. This is a 52-year-old female assembler who incurred a work-related injury when her finger got caught in while she was trying to unjam a machine.
The patient was subsequently diagnosed with traumatic middle finger, arthropathy, myofascial pain, cervicalgia, and chronic pain syndrome.
As per pain management consultation report dated 5/10/16, the patient complains of left hand and finger pain radiating up to the upper extremity, shoulder and cervical spine. She rates her pain as 9. Her left middle finger has severe intractable dysesthesias. There is middle finger digital neuritis. She is able to bend fingers and grasp but only with severe pain consequences. She has severe sensitivity to light touch and cold air, wind, and pressure. …show more content…
There is diffuse muscle spasm on the left lower cervical spine and paravertebral musculature. There is pain in the rhomboids, teres, triceps, and biceps of the left upper extremity. The pain originates distally and travels upward through her left upper extremity to her neck. Full cervical ranges of motion are noted with pain. It was also observed that the patient has avoidance symptoms on examination of upper extremities. She holds her hand in a protective manner. There is diffuse muscle spasm. Examination of the formally crushed middle finger revealed severe dysesthesias but healed contusion. There is severe diffuse pain and dysesthesia in the entire left upper extremity, worse in the finger and hand but extending upward into the forearm and upper arm and shoulder regions. The limb is cold and clammy with a mottled appearance to the left hand, wrist, and forearm. Sympathetic exam of the left upper extremity revealed remarkable for ab abnormal appearing left hand and wrist. Neurological evaluation of upper extremities revealed that pain is corresponding to the left median nerve distribution from the crushed area of the distal middle finger to the palm and upward. There is hyperalgesia throughout the left upper extremity. Deep tendon reflexes are 2/4 at the bilateral biceps, brachioradialis, and triceps tendons. Motor strength is 3/5 throughout the left upper
The patient was subsequently diagnosed with traumatic middle finger, arthropathy, myofascial pain, cervicalgia, and chronic pain syndrome.
As per pain management consultation report dated 5/10/16, the patient complains of left hand and finger pain radiating up to the upper extremity, shoulder and cervical spine. She rates her pain as 9. Her left middle finger has severe intractable dysesthesias. There is middle finger digital neuritis. She is able to bend fingers and grasp but only with severe pain consequences. She has severe sensitivity to light touch and cold air, wind, and pressure. …show more content…
There is diffuse muscle spasm on the left lower cervical spine and paravertebral musculature. There is pain in the rhomboids, teres, triceps, and biceps of the left upper extremity. The pain originates distally and travels upward through her left upper extremity to her neck. Full cervical ranges of motion are noted with pain. It was also observed that the patient has avoidance symptoms on examination of upper extremities. She holds her hand in a protective manner. There is diffuse muscle spasm. Examination of the formally crushed middle finger revealed severe dysesthesias but healed contusion. There is severe diffuse pain and dysesthesia in the entire left upper extremity, worse in the finger and hand but extending upward into the forearm and upper arm and shoulder regions. The limb is cold and clammy with a mottled appearance to the left hand, wrist, and forearm. Sympathetic exam of the left upper extremity revealed remarkable for ab abnormal appearing left hand and wrist. Neurological evaluation of upper extremities revealed that pain is corresponding to the left median nerve distribution from the crushed area of the distal middle finger to the palm and upward. There is hyperalgesia throughout the left upper extremity. Deep tendon reflexes are 2/4 at the bilateral biceps, brachioradialis, and triceps tendons. Motor strength is 3/5 throughout the left upper