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- Apr 5, 2012
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Hi there guys
Here is a case Im having some issues with
PC = Bilateral shoulder pain (R++) with associated pain at sternoclavicular joint and bilateral peri scapula
Onset - approx. 10yrs, from someone falling on top of him while lateral recumbent – couldn't move for 3/7
Pain getting worse
Pain = Sharp 8/10
Bilateral P&N arms and hands
Numbness in both thumbs and forearms
Headaches
PC add= Bilateral P&N in legs and numbness in large toes
Had visited GP after initial trauma= Analgesics, NASAD's, imaging chest and shoulders NAD
Chronic Alcoholism from age 16-36 (Approx. 2-3L of fortified wine per day)
Chronic Cannabis use from age 16-36 (up to 3g per day)
Smoker from age 18-37 (15-20 per day)
No alcohol or drug use for last 3.5 yrs.
Has Hypertension Dx and is taking Avapro
Has been prescribed analgesics which he uses when pain is severe
DDx
Have been
Alcoholic Polyneuropathy = Bilateral P&N arms & legs, numbness, Chronic Alcoholism
Diabetic Polyneuropathy= Bilateral P&N arms & legs, numbness, prevalent in family
Space occupying leision METS or (osteochondroma)
Cx Central disk protrusion
Ms -ve = Male, age
Now have Cx CT
There are significant posterior disk prolapses at C6 + 7
Now thinking C6 Disk in conjunction with Lx disk (has low back pain but NAD in clinical provocation)
Or possible METS
The Patient lives 7 hours away on a indigenous reserve and I cant see him for a month and he has no access to further imaging until then.
Any thoughts as it's the the Occam's razor Vs Hickam's dictum debate
Cheers
Here is a case Im having some issues with
PC = Bilateral shoulder pain (R++) with associated pain at sternoclavicular joint and bilateral peri scapula
Onset - approx. 10yrs, from someone falling on top of him while lateral recumbent – couldn't move for 3/7
Pain getting worse
Pain = Sharp 8/10
Bilateral P&N arms and hands
Numbness in both thumbs and forearms
Headaches
PC add= Bilateral P&N in legs and numbness in large toes
Had visited GP after initial trauma= Analgesics, NASAD's, imaging chest and shoulders NAD
Chronic Alcoholism from age 16-36 (Approx. 2-3L of fortified wine per day)
Chronic Cannabis use from age 16-36 (up to 3g per day)
Smoker from age 18-37 (15-20 per day)
No alcohol or drug use for last 3.5 yrs.
Has Hypertension Dx and is taking Avapro
Has been prescribed analgesics which he uses when pain is severe
DDx
Have been
Alcoholic Polyneuropathy = Bilateral P&N arms & legs, numbness, Chronic Alcoholism
Diabetic Polyneuropathy= Bilateral P&N arms & legs, numbness, prevalent in family
Space occupying leision METS or (osteochondroma)
Cx Central disk protrusion
Ms -ve = Male, age
Now have Cx CT
There are significant posterior disk prolapses at C6 + 7
Now thinking C6 Disk in conjunction with Lx disk (has low back pain but NAD in clinical provocation)
Or possible METS
The Patient lives 7 hours away on a indigenous reserve and I cant see him for a month and he has no access to further imaging until then.
Any thoughts as it's the the Occam's razor Vs Hickam's dictum debate
Cheers
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