S: TM Completed total of 32 ESI visit since 3/15/2016. ESI’s heat treatment is helping her to minimize her pain for several hours, but symptoms management only. TM reports her bilateral hand pain is 5/10; the pain is constant, aching and cramping type pain, when she is working. TM states her right middle and ring fingers are stiff, particularly in the morning and makes a clicking sensation as she move her fingers. At time those fingers get locked and she has to full them to strait them out. Also she has intermittent numbness and tingling sensations in most of her fingertips.
Right and left inter pharyngeal joints enlarged, tenderness with palpation, warmth present in Joints, Tenderness in the palm at