Case Study: Mankoski Injury

DOI: 12/10/2015. The patient is a 38-year-old male tractor driver who sustained a work related injury when he tripped on an edge while walking backwards. The patient underwent a right 4th metacarpal comminuted displaced fracture surgery on 03/16/13. Based on a progress report dated 02/23/16, the patient had persistent pain in his right forearm and right wrist. He has been taking Anaprox DS and Flexeril. Based on the progress report dated 05/03/16 by Dr. Cho, the patient presents for follow-up of his right rib contusion, thoracic spine strain/contusion, lumbosacral spine strain/contusion, right forearm contusion and right wrist contusion. With regard to his right rib cage, the patient states that the pain has never resolved since his injury
The patient’s initial x-ray to the right ribs was negative for fractures. However, he is persisting with unresolved pain. He is requesting for his Motrin, which he has now run out. The patient persists with pain in the upper back and lower back. He rates the pain in these areas at 8/10 on the Mankoski pain scale. He has been going to physical therapy and has not had any improvement. With regard to his right forearm and right wrist, the patient rates the pain in his right wrist and right forearm at 6/10 on the Mankoski pain scale. He states he has not had any relief since he sustained the injury. The pain starts in the volar aspect of the right wrist and radiates proximally to the right forearm. There is also pain over the extensor surfaces of his right forearm. The patient states that his wrist and hand had been improving; however, he states that right shoulder pain has not improved significantly since his initial injury. Examination of the right rib cage shows exquisite tenderness over the right mid to lower rib cage. Examination of the thoracic spine shows tenderness over the thoracic paraspinal muscles. Range of motion (ROM) is 80% of
Examination of the right forearm shows full pronation and supination. The right forearm musculature is supple. There is tenderness along the volar as well as extensor surfaces especially over the ulnar side. Examination of the right wrist shows tenderness over the volar, as well as extensor surfaces. As of this report, repeat right rib x-rays done 02/23/16 showed no evidence of rib fracture. Thoracic spine MRI on 02/03/16 revealed straightening of the normal lower thoracic kyphosis. Otherwise, unremarkable. Lumbar spine MRI on 02/03/16 showed compression of the descending right S1 nerve root at L5-S1. Mild impingement of the descending left S1 nerve root is noted. Findings are on the basis of a broad based 4.3 mm subligamentous disc protrusion. X-rays of the thoracic spine, right forearm, right wrist and right tibial/fibula are unremarkable. Lumbar spine X-ray on 12/10/15 showed mild degenerative disc disease at L3-L4. Current medications include diclofenac, gabapentin and tramadol. Patient was diagnosed with strain of the thoracic and lumbosacral spine and contusion of the lumbosacral spine, right rib, right forearm and right wrist. He was given a prescription for