WEEK 6 Case Study Chapter 24: Assessing Musculoskeletal System A 40-year-old cli
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WEEK 6 Case Study Chapter 24: Assessing Musculoskeletal System A 40-year-old client presents with complaints of pain, tingling sensation, and weakness of the right hand for the past 4 months. The client describes the pain as excruciating at times, so much so that work has become impossible to do. The client reports to the nurse that the pain started gradually and then the tingling and numbness began. The client has been controlling the pain by taking over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) for the past few weeks. The client now has complete loss of sensation in the fingers of the right hand. The client is right-handed but now has limited function of the right hand. The client is a middle school music teacher and plays the guitar on the weekends in a friend's local band. Due to the pain, the client has used up all of the sick days for the school year and has now started to take personal days off without pay. The health care provider is evaluating the client for possible carpal tunnel syndrome. Questions: a. Based on the preliminary interview, the health care provider determines that the client's symptoms are due to carpal tunnel syndrome. How will the diagnosis be confirmed? b. The health care provider conducts several musculoskeletal tests to assess if muscles are involved. Describe how this is performed. anyExplanation / Answer
Ans a. The diagnosis can be confirmed by physical examination, evaluating history and electrodiagnostic testing which involves nerves conduction test and electromyography.
Ans b. Musculoskeletal test involve the following:
- phalen's maneuver: it is performed by flexing the wrist as far as possible then hold at this position and wait for the symptoms. A numbness in the median nerve will indicate a positive test. Quicker the nubness start more severe the condition is.
- Tinel's sign: it is performed by lightly tapping the skin over flexor retinaculum to elicit a sensation of tingling in the median nerve distribution. If it is present the test is considered positive.
- Durkan test: it is performed by applying firm pressure at palm over nerve for approx 30 secs and eliciting symptoms.
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