Presenting Complaints:
A 45-year-old male presents with complaints of numbness, tingling, and pain in both hands, which worsen during and after work hours. He works as a heavy machinery operator and has been experiencing these symptoms for the past six months.
History of Presenting Complaints:
The patient describes the symptoms as initially intermittent, primarily occurring after prolonged exposure to vibrating machinery. However, over the past few months, the symptoms have become persistent, affecting his daily activities and sleep.
Chief Complaints:
Numbness and tingling in both hands.
Pain and discomfort in both hands.
Symptoms worsen during and after work hours.
Past Medical and Surgical History:
The patient has a history of smoking for 20 years, but he quit smoking two years ago. There is no significant surgical history.
Family History:
There is no family history of similar symptoms or neurological disorders.
Socioeconomic Status:
The patient is employed as a heavy machinery operator and belongs to the middle-income socioeconomic group.
Present and Pre-Morbid Functional Status:
Prior to the onset of symptoms, the patient had a fully functional status with no known medical conditions. However, his current symptoms have limited his ability to perform tasks both at work and in daily life.
General Health Status:
Overall, the patient is in good health except for the symptoms related to his hands.
Vitals:
Blood Pressure: 130/80 mmHg
Heart Rate: 75 bpm
Respiratory Rate: 16 breaths/minute
Temperature: 98.6°F (37°C)
Aggravating Factors:
Prolonged exposure to vibrating machinery.
Repetitive hand movements during work.
Easing Factors:
Resting the hands.
Avoiding exposure to vibration.
Examination:
On physical examination, the patient has no visible deformities in the hands.
Tinel’s sign and Phalen’s test are positive, indicating possible nerve compression.
Reduced sensation and strength in both hands, particularly in the thumb, index, and middle fingers.
Sleep and 24-hour Pattern:
The patient reports disrupted sleep due to hand pain and discomfort. Symptoms tend to worsen at night.
Duration of Current Symptoms:
Symptoms have been present for six months and have progressively worsened.
Mechanism of Injury/Current Symptoms:
The patient’s symptoms are consistent with vibration syndrome, likely caused by prolonged exposure to vibrating machinery at work.
Progression Since the Current Episode:
Symptoms have worsened over the past six months, impacting the patient’s quality of life.
Significant Prior History:
No significant prior medical history related to the current symptoms.
Previous Treatment:
The patient has not received any prior treatment for these symptoms.
Diagnostic Test/Imaging:
Electromyography (EMG) and nerve conduction studies confirm nerve compression in both hands.
X-rays of the hands reveal no fractures or deformities.
Differential Diagnosis:
Carpal Tunnel Syndrome
Cubital Tunnel Syndrome
Peripheral Neuropathy
Rheumatoid Arthritis
Postural Observation:
No significant postural abnormalities noted.
Precaution and Contraindications:
The patient should avoid prolonged exposure to vibrating machinery and repetitive hand movements.
Functional Movement Analysis (Sign):
Reduced fine motor skills in both hands, difficulty gripping objects.
Quick Screening Tests/Clearing of Additional Joint Structures:
No signs of joint involvement.
Range of Motion (ROM):
Limited range of motion in the wrists and fingers due to pain and discomfort.
Special Tests:
Positive Tinel’s sign and Phalen’s test.
Positive EMG and nerve conduction studies.
Assessment:
The patient presents with vibration syndrome, likely due to occupational exposure. This has resulted in nerve compression in both hands, leading to numbness, tingling, and pain.
Problem List/Complaints:
Numbness and tingling in both hands.
Pain and discomfort in both hands.
Reduced sensation and strength in thumb, index, and middle fingers.
Sleep disruption.
Impaired fine motor skills.
Treatment:
Rest: Advise the patient to rest his hands whenever possible.
Splinting: Provide wrist splints for nighttime wear.
Ergonomic Assessment: Evaluate and improve workplace ergonomics.
NSAIDs: Prescribe non-steroidal anti-inflammatory drugs for pain relief.
Physical Therapy: Recommend hand and wrist exercises.
Occupational Therapy: Assist with adapting to daily tasks.
Lifestyle Modifications: Encourage smoking cessation and overall healthy lifestyle changes.
Prognosis:
With appropriate treatment and workplace modifications, the patient’s symptoms should improve. However, long-term exposure to vibrating machinery may necessitate ongoing management.
Goals:
Alleviate pain and discomfort.
Improve hand strength and sensation.
Enhance sleep quality.
Enable the patient to return to work with reduced symptoms.
Interventions:
Regular follow-up to assess treatment progress.
Collaboration with the workplace to implement ergonomic improvements.
Education on symptom management and lifestyle modifications.
Patient Education:
Educate the patient on the importance of hand and wrist exercises.
Stress the need for smoking cessation.
Discuss workplace modifications to reduce vibration exposure.
Patient/Family Education:
Educate the patient’s family on how to support the patient in daily activities and lifestyle changes.
Explain the importance of adhering to the treatment plan.
Discharge Plan:
The patient will be discharged with a treatment plan, including medications, splints, exercise instructions, and ergonomic recommendations. Follow-up appointments will be scheduled to monitor progress and adjust treatment as needed. The patient will also receive resources on smoking cessation and workplace safety.