Muscular System

Use the words below to fill in the referral letter:

• CTS
• tingling
• numbness
• osteoarthritis
• clumsiness
• metacarpal
• atrophy
• arthrodesis
• flexion
• tenorrhaphy
• median
• ligament

PATIENT NAME: Mrs. Anna JONES
AGE: 65
SEX: Female
DOB: June 29

REASON FOR REFERRAL: Evaluation and consideration for surgery for treating carpal tunnel syndrome.

Dear Dr. Porter

I am referring Mrs. Jones for evaluation and consideration for surgery for treating _______[Blank 1]. Mrs. Jones is 65 years old. She has moved to this area 2 years ago and I have been her primary care physician since then. Recently she has been complaining of _________[Blank 2], tingling, burning, and pain in her right hand, primarily in the thumb, index, and middle fingers. Occasionally the pain and _________[Blank 3] travel up the forearm toward her shoulder. The patient reports that the pain and unusual sensations have started gradually and worsened over the past couple of years.

The patient has worked as a data entry clerk at a pharmaceutical company for 35 years. Her work involved sitting at her desk and typing on a computer for an average of 7 hours on each workday. She is retired now. The patient reports that during the past few months she has also felt weakness and _________[Blank 4] in her hand, and this has made her everyday life difficult. She can tell that her grip is not as strong as before since she frequently drops things. Now she is finding the simple tasks such as buttoning her clothes, cutting vegetables, and brushing her teeth challenging. The x-ray of the right hand and wrist shows clear signs of ________[Blank 5] and osteoporosis of carpal and _______[Blank 6] bones. On visual examination there is no muscle . The wrist has limited _________[Blank 7] and extension range of motion.

It is important to note that the patient had been in a car accident in her teenage years and had suffered from a compact fracture of her left wrist bones. Multiple surgeries, including arthroplasty and __________[Blank 8], were done to restore the functionality of the left wrist and hand. Eventually, her orthopedic surgeon performed a subtotal ___________[Blank 9] of the wrist to provide a stable and pain-free joint with a limited useful range of motion.

Based on the aforementioned observations and findings I have determined that Mrs. Jones is a fit candidate for CTS surgery. A proper cut in the transverse carpal __________[Blank 10] would release the pressure off the  ________[Blank 11] nerve and relieve the symptoms.

Thank you for seeing Mrs. Jones. Please do not hesitate to contact me directly with any questions or comments you may have concerning her care. Also, please keep me updated on her progress and kindly refer her back to my care once her condition resolves.

__________________________________
Trevor Sharpe, MD, Family Medicine

Check your answers: ^[1]