Repeat carpal tunnel surgery is recommended, along with a possible cubital tunnel surgical procedure. Williams determines the patient has left ulnar neuropathy, at the cubital tunnel region, as well as an ongoing carpal tunnel syndrome. He is married with children and smokes one pack of cigarettes/day.Ī detailed exam is performed of the mental status, cranial nerves, motor nerves, DTRs, sensory nerves, and head and neck.Īfter performing an EMG and nerve conduction study, Dr. He has a family history of hypertension, heart disease, and stroke. His past medical history is negative for significant diseases. He has no swelling in his hand, no neck pain, or radiating pain. He is limited in his job as a machinist for a mining company due to the pain and numbness. He still has significant, sharp, burning wrist pain and reports the problems are continuing to get worse. The pain started last year after rocks fell on him while mining. Williams, at the request of his family physician to evaluate complaints of weakness, numbness, and pain in his left hand and arm. There is no cyanosis, clubbing or edema to the digits.Ī 45 year-old patient is seeing the neurologist, Dr. Strength and tone to the upper and lower extremities are normal for age with no evidence of atrophy. MUSCULOSKELETAL: Gait and station are normal. LYMPHATIC: There are no palpable pathologic lymph nodes in the neck or axilla. Gross sensation is intact to all extremities. The patient moves all 4 extremities symmetrically. NEUROLOGIC: Cranial nerves appear intact.
SKIN: The skin is pale and slightly diaphoretic.
There is no tenderness, rebound or guarding noted. GASTROINTESTINAL: The abdomen is soft and nondistended.
There is no significant edema to the lower extremities. CARDIOVASCULAR: The chest wall is normal in appearance. RESPIRATORY: The lungs reveal transmitted upper airway signs and bilateral rales, wheezes and rhonchi.
The thyroid gland has no appreciable goiter. There are no masses, crepitus or tenderness of the neck. NECK: The neck is supple and the trachea is midline. Oxygen saturation 90% GENERAL APPEARANCE: The patient reveals profound mental retardation.