Carpectomy Case Studies

Decent Essays
DOI: 9/13/2013. Patient is a 66-year-old right-hand dominant female security officer who sustained a work-related injury when she tripped on a piece of metal while she was on patrol. Patient had a right wrist proximal row carpectomy and arthroscopy with debridement 12/9/14.
Per PT progress note dated 3/27/15, patient has attended 18 PT as of 3/27/15.

Per the AME report dated 07/23/15, the patient has reached MMI and has a whole person impairment rating of 26% for her right shoulder/wrist and chronic pain. Future medical treatment includes access to orthopedic treatment on an as needed basis, cock-up wrist brace replaced semi-annually, 3-4 physician re-evaluations and 6-12 PT visits on an annual basis, prescription medication refills
…show more content…
Mack, patient is still having pain in her right wrist. Weather change bothers her, and she finds herself needing to wear the splint most of the time. She is now 4 plus months post proximal row carpectomy. Diagnoses include traumatic arthritis of right wrist, closed fracture of distal end of right radius with malunion. She is having greater than expected pain following proximal row carpectomy. This may be due to the position of the capitate, which appears to be resting on the ridge between the scaphoid and lunate fossae. Recommendation was made for tapering program of strengthening and exercises for the wrist, once a week for 4 weeks (total 4 sessions). Long term considerations for wrist pain include fusion versus …show more content…
Mack, the patient complains of right wrist pain. She continues to note “quite a bit of pain” of her right wrist. She wears a splint full time. She is not working.
On examination of the right wrist, range of motion shows flexion of 25 degrees, extension of 45 degrees, radial deviation of 5 degrees and ulnar deviation of 25 degrees. Grip strength testing shows 15/10/14 on the right and 35/35/35 on the left.
As of this report, X-ray of the right wrist with 2 views shows proximal row carpectomy with capitate resting on the distal radius. There is increased sclerosis of distal radius beneath the capitate.
Current medications include Tylenol with codeine and ibuprofen.
Assessments include right wrist traumatic arthritis and closed fracture of the distal end of the right radius with malunion. It was noted that it has been a year since the patient was found P & S, with considerable time for her proximal row carpectomy. She is functionally compromised, noting pain with any flexion or extension of the wrist. Her motion remains limited as expected, but there is crepitus on examination and X-rays show loss of joint space.
He was given a prescription for Tylenol-codeine. A Titan wrist splint was dispensed.
Recommendation was made for a right wrist arthrodesis with

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