EXERCISE 1

History:
Mary-Jane, 45 year old nurse, presents with intermittent tingling and pain the thumb,
index and middle finger of her right hand for the last 2 days that started while at work.
The pain is described as 4/10 ‘pins and needles’. The pain is made worse with
computer work and is relieved by shaking her hands. She has been awaken by ‘8/10
pain, tingling and numbness’ in the middle of the night for the last 2 nights and
hanging her hand over the side of the bed or getting up to shake her hands helps to
alleviate it enough to get back to sleep. She has been taking 500g paracetomol with
no symptom relief. She denies any trauma or recent fall.
No fever, fatigue, weight gain/loss, fever, chills or sweating
No headaches, dizziness, nausea, visual changes, hearing loss
No recent illnesses
Unremarkable family history
Unremarkable systems - no GI/ GU/ CardioRespiratory complaints
No rash or other integumentary changes
No history of allergies
Social history good
Exam:
Good posture, no gait abnormality, adequate nutritional state, adequate emotional
state, good communication, no acute distress
Neck – no masses, no lymphadenopathy, thyroid good, no visual deformity, mild
restriction on right active and passive rotation; orthopaedic exam normal; UE DTRs
2+ and muscle strength normal, 5+
Shoulder exam – unremarkable
UE – Positive Tinnel’s sign over the volar wrist, positive Phalen’s test; minor muscle
atrophy at the base of the thumb; muscle strength normal. No swelling or tenderness
to joints

Based on the above history:

• Identify the components of LODCTRAPPA
• L – right hand, tingling and pain thumb, index and middle finger
• O – At work as nurse
• D – 2 days (Acute)
• C – worse at night 8/10 and with computer work
• T – pins and needles during day, tingling and numbness at night
• R – nil
• R – shaking her hands or hanging hand over bed at night
• A – computer work
• P – no previous episode
• P – no previous treatment
• A – no associated signs or symptoms

• Identify the components of GORPOMNICS

• G – nothing remarkable
• O – minor atrophy at base of thumb right side, no swelling or tenderness
• R – slight restriction to right rotation both AROM and PROM
• P – nothing remarkable
• O – normal exam (neck, shoulder), +ve Tinnel’s – volar wrist, Phalen’s
• M – 5+ muscle test (neck),
• N – 2+ DTR’s (neck),
• I
• C
• S – systems unremarkable

• Is any further investigation warranted? If yes, what might this be?

• MRI investigation to the neck, shoulder, elbow and wrist following the
distribution of the median nerve for Carpal Tunnel Syndrome.
EXERCISE 2

Short Case Histories:

39 year old male presents with a burning sensation at the bottom of his right foot. This has been
present for two weeks since he has started jogging to get fit again. He doesn’t feel like he’s
overdoing the training and can’t figure out why his foot hurts. Nothing makes it better or worse. He
has no history of system disorders or illness. He is generally well. Past history is only significant for
fracture of the proximal tibia when he was 25 yo. On examination on the right, the foot is normal
colour. Pulses are strong. There is decreased sensation at the posterior lateral ankle and on the
plantar aspect of his foot. He is unable to flex his toes. Ankle jerk is normal. Eversion is normal,
inversion is 3+. Examination of the left foot is normal

What is your most likely diagnosis?

Tibial nerve entrapment from past fracture to the proximal tibia 14 years prior which is presenting
with Tarsal tunnel syndrome of Medial Plantar nerve.

29 year old female; 28 weeks pregnant, presents to your office with a burning type pain over her
lateral upper leg of 4 weeks duration, 5-7/10 on NRS (numeric rating). She cannot identify a specific
onset, it came on gradually. She has aching in her low back and SI joint but that comes and goes. No
pain in her leg except the area mentioned. The pain is worse when she’s walking and sitting down
helps to relieve the pain. She is unable to take medications at this time. She has seen another
Chiropractor who adjusted her lower back and SI joint a few times but this did not help. On
examination, gait is normal, lumbar spine and hip ROM is normal. Significant discomfort is elicited on
palpation below the greater trochanter. Orthopaedic testing is generally unrewarding however when
you tap or press firmly over the inguinal region she winces. LE neurologic evaluation is normal. She is
otherwise fit and healthy.

What is your most likely diagnosis?

Meralgia Paresthetica

EXERCISE 3

Develop a table that includes the common entrapment syndromes of the UE and similar table that
includes the common entrapments of the LE (lower extremity). Include the following components.

Name of the entrapment

Nerve or branch entrapped

Common and any outstanding symptoms

Test used for that entrapment

Please find attached as an excel doc to weebly. Thanks.