Age: 51.0
Sex: M
Vaccine: TD
Symptoms: Neck pain, Neuralgic amyotrophy, Nuclear magnetic resonance imaging, Pain, Pain in extremity
Clinical narrative: Before injury of 7-22-2009, I was healthy and productive as a construction site manager. My job was to turn contracts into buildings. I routinely climbed scaffolding and ladders as well as operated boom and scissors lifts to inspect and direct work of sub contractors. I was in charge of job safety and overall site conditions. I had not missed a day of work due to illness for over two years. My weight was high at the time about 265 lbs. and has now gone over 300 lbs. because of my limited ability to do anything physical with my right arm. I routinely performed long days of manual labor on my projects building temporary stairs and rails to keep work moving. In the months hat proceeded the injury, I performed three heavy projects by hand with heavy gauge steel and plywood sheathing. My sex life with my wife was normal at least once a week normally. I had energy and drive coupled with physical ability to do anything construction. I often worked 12 to 16 hour days. 7-22-2009 I was working for a construction company installing equipment when a co-worker drilled through my hand; I sought medical attention at local emergency room. The wound was cleaned and dressed as well as an X-ray taken. the doctor insisted I take tetanus shot in spite of me protesting I had just had one. At this time I tired to get in contact with my ex-employer to find out what date the previous shot was given. I could not get any answer from him. The Doctor told me you could not get to much tetanus protection and that if I had ever seen what some one goes through with  tetanus infection I would not be to hesitating to take another shot. The puncture wound healed up quickly and all seemed well at this point. 8-08-2009, 17 days, First effects after the shot was injected into right arm were the shoulder blade area began to hurt. it was a dull ache and did not concern me too much as I have broken my back before and have also had back surgery, and experienced pain at different levels. I live with soreness all the time and have creams and a tens unit to help with evening pains. I just asked the wife to rub the stuff on the shoulder blade and kept on living and working. 8-15-2009, 24 days, the shoulder still was tender the next symptom to appear was soreness in back side of right arm in upper area. Along with this symptom, I noticed that I was waking several times a night with  one or more hangs tingling. 8-18-2009, 27 days, I started to have a pain in my upper right chest area when coughing it was between the collarbone and shoulder blade felt like at top of lung. 9-01-2009, 41 days, While performing my work duties my right hand started to cramp in the forearm, seemingly the muscles that controlled the fingers. I thought I was sufficient in some mineral causing the symptom. I did not draw all theses symptoms together at this point, I thought I was having  a neck problem and had the wife do a couple of adjustments to my neck and changed my pillow to one for neck problems. 9-07-2009, 47 days, What finally drove me to seek medical attention was right hand went numb and my right arm was severely painful to move or set down anywhere at all. the ER took an X-ray and an EKG sent me home with diagnosis of pulled muscle. 9-08-2009, Went to see my chiropractor who has helped me many times. He did dome nerve test and asked me get a MRI of the neck to verify source of numbness and pain. It came back negative for right side impingement of nerves. we decided on doing several treatments to try to help the nerve condition. 9-24-2009, The pain grew to where sleep was impossible. I sought pharmaceutical help for a neurologist. He told me the hand numbness was to do with hand injury. he prescribed steroid treatment as well as LYRICA. 9-30-2009, First visit with hand surgeon under Workers comp insurance. He sent me for an EMG. 10-05-2009, during EMG study the Dr. told me that this was severe and widespread affecting five nerves of just right arm and hand, he said it was out immune and based in the brachial area and not the hand. The Dr. did not have the following information at the time. 1. A tetanus shot was given at time of injury. 2. it was the second tetanus shot in less than three years. 3. My tetanus toxoid level would be shown to be 187 times protected level at 101 days post injection. His diagnosis at the time was" brachial plexopathy" caused by parsonage turner syndrome.