Document Type: Primary Care OP Provider Note   Document Subject: hand pain/carpal tunnel? - AMB Primary Care Progress Note   Performed By: NP on July 26, 2022 11:40 EDT   Verified By: NP on July 26, 2022 11:40 EDT   Encounter Info: Clinic, 07/26/22 - 07/26/22    * Final Report *        Chief Complaint   Patient is here today to follow up on Right shoulder pain and right hand numbness.  Was seen at Walk in clinic on 7/23/22.  Given Prednisone with some relief.  History of Present Illness/Subjective     Patient is here to f/u on above c/o.   Past couple of months his right hand has been getting numb when he was using elliptical. Was able to stop, shake it out and resolve it. No new exercises, but has been using ellipitical for over 2 years.  No numbness any other time of day until recently.   Friday night he woke with hand numb and it lasted most of day.  Next night it occurred again and was so painful, it made him sick to stomach.  Pain radiated to elbow and caused his hand to "seize up". He couldn't move it or grip. Was swollen.   Was so bad it made him sick from 3-7am  He tried ice on elbow and wrist.  Swelling gradually went down a little  He went to walk in about 10am  but it was some better by then.   He was given toradol injection as well as 50mg prednisone x 5 days.  He is on day 4 of that.  Now pain is essentially gone. Has not occurred again. He is wrapping his arm at night to keep it straight as he is afraid it will recur.  He is a policeman. Right handed.   He also would like to proceed with colonoscopy screening.      Review of Systems     Constitutional: No fever, No chills, No weakness, No weight changes Eye: No vision changes Head/ Neck: No headache, No neck pain Respiratory: No shortness of breath, No cough, No wheezing Cardiovascular: No chest pain, No palpitations, No peripheral edema Gastrointestinal: No bowel changes, No abdominal pain Genitourinary: No dysuria Hematology/Lymphatics: No abnormal bleeding or bruising Endocrine: Negative Musculoskeletal: see  hpi Neurologic: Alert and oriented X3, No headache, No confusion     Health Status     Depression Screening  Depression Screen PHQ9 Total: 0 (07/26/22 11:02:00)  Initial Depression Screen Score: 0 (07/26/22 11:02:00)  PHQ2 Total: 0 (07/23/22 14:02:00)    Physical Exam/Objective  Vitals & Measurements last 24 hours  VITAL SIGNS  Heart Rate:       75 bpm  Resp Rate:       16 br/min  BP #1:       112 / 62 mmHg  SpO2 (%):       99 %     Height CM: 188 cm  Weight KG: 97.8 kg  BSAM2 Weight in kg: 2.26 m2  BMI Weight in kg: 27.7 kg/m2  Ideal Body Weight: 82.24 kg      General:  Alert and oriented, No acute distress.   Eye:  Normal conjunctiva.   Integumentary:  Warm, Dry, Intact.   Neurologic:  Alert, Oriented, Normal sensory, Normal motor function, No focal defects, Cranial Nerves II-XII are grossly intact.   Psychiatric:  Cooperative, Appropriate mood & affect.   Musculoskeletal:  Normal range of motion, Normal strength.  Neg tinel's, phalens today.  No decrease in grip strength. No epicondyle pain.                  Assessment/Plan       1. Carpal tunnel syndrome on right   G56.01  He would like to proceed with EMG and ortho hand specialist.  Will order EMG today and plan hand specialist once EMG scheduled.  He will continue ace wraps at HS in meantime.  Avoid activities that aggravate symptoms.   Ordered:   CHARGE OV Est Intermed 20-29 min  Outside Electromyography 1 Extremity     Screen for colon cancer   Z12.11    Ordered:   Outside Colonoscopy SCREENING       Chronic Problem List    Hyperlipemia  Wellness examination  Procedure/Surgical History  ?back surgery ?Tonsillectomy ?Vasectomy     Medications  Home Medications (2) Active predniSONE 50 mg oral tablet 50 mg = 1 Tablet, Orally, Daily, with food or milk rosuvastatin 10 mg oral tablet 10 mg = 1 Tablet, Orally, Daily  Allergies   NKA  Social History    Alcohol   Denies   Electronic Cigarette/Vaping   E-Cigarette Use Never.   Employment/School   Employed, Work/School description: POLICE OFFICER.   Home/Environment   MARRIED, 2 CHILDREN   Substance Abuse   Denies   Tobacco   Tobacco Use: Never (less than 100 in lifetime).  Family History   Family history is negative  Review Management   Lab Results     WBC: 5.8 k/cumm (05/02/22)  RBC: 5.54 million/cumm High (05/02/22)  Hgb: 16 GM/dL (05/02/22)  Hct: 48 % (05/02/22)  MCV: 87 fL (05/02/22)  MCH: 28.9 pg (05/02/22)  MCHC: 33.4 GM/dL (05/02/22)  RDW: 13.3 % (05/02/22)  Platelet: 231 k/cumm (05/02/22)  MPV: 7.9 fL (05/02/22)  Neutrophils %: 52 % (05/02/22)  Lymphocytes %: 34 % (05/02/22)  Monocytes %: 10 % (05/02/22)  Eosinophils %: 3 % (05/02/22)  Basophils %: 1 % (05/02/22)  Absolute Neutrophil: 3 k/cumm (05/02/22)  Absolute Lymphocyte: 2 k/cumm (05/02/22)  Absolute Monocyte: 0.6 k/cumm (05/02/22)  Absolute Eosinophil: 0.2 k/cumm (05/02/22)  Absolute Basophil: 0.1 k/cumm (05/02/22)  Sodium SerPl QN: 140 mmol/L (05/02/22)  Potassium SerPl QN: 4.2 mmol/L (05/02/22)  Chloride SerPl QN: 104 mmol/L (05/02/22)  Carbon Dioxide SerPl QN: 27 mmol/L (05/02/22)  Anion Gap: 9 mmol/L (05/02/22)  BUN SerPl QN: 15 mg/dL (05/02/22)  Creatinine SerPl QN: 0.89 mg/dL (05/02/22)  Estimated GFR (CKD-EPI): >90 (05/02/22)  Estimated CRCL (CG): >120 (05/02/22)  Glucose SerPl QN: 86 mg/dL (05/02/22)  Calcium Total SerPl QN: 9.3 mg/dL (05/02/22)  Alkaline Phos SerPl QN: 62 Units/L (05/02/22)  ALT SerPl QN: 22 Units/L (05/02/22)  AST SerPl QN: 19 Units/L (05/02/22)  Bilirubin Total SerPl QN: 0.6 mg/dL (05/02/22)  Total Protein SerPl QN: 6.4 GM/dL (05/02/22)  Albumin SerPl QN: 4.4 GM/dL (05/02/22)  Cholesterol SerPl QN: 154 mg/dL (05/02/22)  Triglyceride SerPl QN: 129 mg/dL (05/02/22)  HDL SerPl QN: 37 mg/dL Low (05/02/22)  LDL Calculated QN: 91 mg/dL (05/02/22)  Hemoglobin A1C HPLC Bld QN: 5.6 % (05/02/22)  Est Average Glucose mg/dL: 114 mg/dL (05/02/22)  Est Average Glucose mmol/L: 6.31 mmol/L High (05/02/22)         Signature Line Electronically Signed on 07/26/22 11:40 EDT ________________________________________________________ NP