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…
Severe dysesthesias are also noted to the left hand and palm. There is severe pain radiation from the hand up towards to the left upper extremity with involvement of shoulder and lower neck. She characterizes her pain as severe, shooting, annoying, sharp, numbing, and constant. Exacerbation occurs with everything. The patient also notes sleep disturbance. Medication includes Clonazepam.
Physical examination of the cervical spine revealed that there are tenderness in bilateral C5-6 and C6-7 facet joint lines.
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
extremity.
As per discussion, the patient has definite signs of complex regional pain syndrome in the left upper extremity. The provider believes that this is secondary consequence of the crushed injury despite healing of the initial injury. There are 2 pain major generators (Crush Nerve Injury to Finger and CRPS) that are complicated by Psychological Disturbance. The patient will require extensive treatment with pain management, stellate ganglion injections, physical therapy and psychological treatment. As per provider's recommendation, clonazepam 1 mg, amitriptyline 25 mg, 6 physical therapy, psychiatric consultation, left cervical sympathetic stellate ganglion injection x 3 would be needed for the patient.
Future medical includes medical evaluations, medications, physical therapy and/or chiropractic treatment, pain management, and possible surgical intervention, if required.
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…
Severe dysesthesias are also noted to the left hand and palm. There is severe pain radiation from the hand up towards to the left upper extremity with involvement of shoulder and lower neck. She characterizes her pain as severe, shooting, annoying, sharp, numbing, and constant. Exacerbation occurs with everything. The patient also notes sleep disturbance. Medication includes Clonazepam.
Physical examination of the cervical spine revealed that there are tenderness in bilateral C5-6 and C6-7 facet joint lines.
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
extremity.
As per discussion, the patient has definite signs of complex regional pain syndrome in the left upper extremity. The provider believes that this is secondary consequence of the crushed injury despite healing of the initial injury. There are 2 pain major generators (Crush Nerve Injury to Finger and CRPS) that are complicated by Psychological Disturbance. The patient will require extensive treatment with pain management, stellate ganglion injections, physical therapy and psychological treatment. As per provider's recommendation, clonazepam 1 mg, amitriptyline 25 mg, 6 physical therapy, psychiatric consultation, left cervical sympathetic stellate ganglion injection x 3 would be needed for the patient.
Future medical includes medical evaluations, medications, physical therapy and/or chiropractic treatment, pain management, and possible surgical intervention, if required.