NR 603 Week 6 Assignment_Clinical Education Associates CEA Pre-Diagnostic Case Study - Part 2

with repetitive wrist use. Ulnar neuropathy has fewer occurrences, and is often related to elbow flexion, low BMI or prior elbow trauma. Cervical radiculopathy is less common, occurs more often in men than women. • Comparison and contrast of pathophysiology: Carpal tunnel syndrome, ulnar neuropathy and cervical radiculopathy all involve nerve dysfunction, but differ on where and how the nerve is injured. Carpal Tunnel Syndrome involves the median nerve and occurs when the nerve is compressed due to increased fluid and structural narrowing. Ulnar neuropathy occurs at the cubital tunnel of the elbow due to flexion that tightens the tunnel and causes compression and stretches the nerve. Cervical radiculopathy is caused by damage at the nerve root due to disc herniation or foraminal narrowing, causing compression and inflammation. • Comparison and contrast of presentation: Carpal tunnel syndrome, ulnar neuropathy and cervical radiculopathy often have overlapping symptoms. Carpal tunnel syndrome usually causes numbness and tingling in the thumb, index, and middle finger, and the radial half of the ring finger. The symptoms often worsen at night and with activities that involve repetitive wrist motions. Ulnar neuropathy occurs at the elbow and causes numbness and tingling in the ring and little fingers and is often caused by elbow flexion. Cervical radiculopathy can cause neck pain that radiates to the arm and is accompanied by weakness and reduced reflexes. Diagnostic Testing, Guidelines, and Expected Results (Describe the necessary tests to diagnose and assess the severity of the three differential diagnoses. Discuss the relevant clinical practice guidelines (CPGs) for diagnosing and conducting diagnostic tests for each condition. Include expected diagnostic results consistent with the client’s chief complaint, HPI, and physical exam findings.) • Diagnostic testing for diagnosis 1 (including relevant CPG): Diagnostic tests for carpal tunnel syndrome include a clinical history, a physical exam with Phalen’s test, Tinel’s sign, Carpal compression test, and hand elevation test. Nerve conduction studies are the gold standard when confirmation of diagnosis is needed prior to surgery (Wipperman & Penny, 2024). o Expected results: Nerve conduction studies would show slowed median nerve conduction across the carpal tunnel. Phalen’s test, Tinel’s sign, Carpal compression test and hand elevation would all elicit numbness and tingling. • Diagnostic testing for diagnosis 2 (including relevant CPG): Cervical radiculopathy is diagnosed with a clinical history and physical exam that shows. Dermatomal sensory changes, myotomal weakness and diminished reflexes. Provocative tests include spurling’s test, and upper limb tension test. An MRI of the cervical spine should be ordered if symptoms persist for more than 4-6 weeks or with progressive neurologic deficit (Thoomes et al., 2021). o Expected results: MRI would show disc herniation, foraminal stenosis and nerve root impingement, degenerative changes and edema or inflammation around the nerve © 2024. Chamberlain University LLC. All rights reserved. • Diagnostic testing for diagnosis 3 (including relevant CPG): Diagnostic testing for ulnar neuropathy starts with a clinical history and physical exam that shows sensory symptoms in th th the 4 and 5 fingers, and a weakened grip strength.