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| "text": "Hi. Good to see you today. Just want to get a little information about what's going on. So can you tell me what's bothering you? Yeah, it's my hands and feet. They tend to hurt mostly in the morning and get better as the day goes on, but. Yeah. Is it an aching pain, sharp pain? An aching pain, yeah. And how long has this been going on? For [DURATION] [DURATION] [DURATION]. Have you been doing anything to treat it? [DRUG] [DRUG] or just some [DRUG] every once in a while and that tends to help. It does help. Yeah. Have you noticed any swelling [MEDICAL_CONDITION] [MEDICAL_CONDITION] hands? Any redness? Yeah, a little bit of swelling. Take a look at that. And same thing with [MEDICAL_CONDITION] [MEDICAL_CONDITION] is a similar feeling. Yeah, it's a similar feeling. Okay. Is it preventing you from doing daily activities like running, walking, cooking, that kind of thing? Not really, but it is pretty painful in the morning. Okay. And on a scale from 1 to 10, 1 being no pain and 10 being the most excruciating pain you've ever experienced, how would you rank it? Maybe a five. And the zapple for your hands and [MEDICAL_CONDITION] [MEDICAL_CONDITION]? Yeah. All right, [PERSON_NAME], so what I want to do today is take a full look at both your hands and [MEDICAL_CONDITION] [MEDICAL_CONDITION], do a series of tests that's just basically just going to make sure we test for a bunch of different problems that could be going on and be able to give you a way to move forward and sort of help relieve that pain, we hope. Thank you. Just want to start with a quick [MEDICAL_PROCESS] [MEDICAL_PROCESS]. I'm going to give you a pillow here to rest your hands on. Go ahead and lift those up and just rest comfortably there. Is that okay? Yeah. Firstly, just looking visually, and it's both hands equally, the most part. And you don't remember falling or having any sort of impact? No. Okay. Doesn't look like there's any major [INJURY], [INJURY] [INJURY] [INJURY] [INJURY], [INJURY]. Could you put your hands over for me, please? Thank you. I can already see some of that swelling there, especially in the knuckles. All right, I'm gonna feel the hands now, and I want you to just tell me if there's any extreme pain. Is there tenderness in the knuckles? Mm, yeah. Is it shooting pain anywhere else? No, not at the hand or anything. Okay. Okay. Just let handle this for me, please. Thank you. Any pain on the muscle here? No. Okay. And same thing. Any pain in the joints and the fingers? Just a little bit. It was more on those knuckles. Relax that hand. I'm going to do the same thing to this side. It looks like there's [DURATION] [DURATION] of calluses there. Do you work with your hands a lot? Do a lot of computer work or anything physical with your hands like that? I do work on the computer. Work on the computer. Do [DURATION] [DURATION] tests with your wrist then as well. And yeah, I can see. I saw you wince a little bit there. Was that tender? It's a little tender. Okay, Be gentle. All right, now let's go ahead and get some baseline measurements of these hands. What I'm also doing is comparing side to side. So start out. Just look at the circumference to see what the swelling might be. Okay. Let me check that against the other side. Now, actually have more swelling in the left thumb, finger and the right. I can feel that as well. Okay. Actually, more swelling on the right side there. Those look even. Okay. No significant change. So I just have those. Just get around the knuckles here. There's definitely more swelling in this hand there. Let's get your wrists lasting. Okay, I'm gonna do [DURATION] [DURATION] of tests here. I'm gonna squeeze right here. I want you to tell me if there's pain a little bit. Yeah. Okay. How about right here? Spread your fingers apart. Any pain when I squeeze like this? Not really. Okay, so sideways. Okay. I'm just gonna pull on the fingers a little bit here. And I want you to tell me if there's any shooting pain. No. Okay. Same thing on this side. Any shooting pain? No, just a little bit of discomfort with the. Okay. Relax those hands. Going to get a temperature check on both of them. Okay. Okay. Pretty even temperature sealing up the arm a little bit. Definitely. The hands feel a little bit warmer. We are manipulating them now, so that could play a role. But that heat could also be an indication of some swelling. I'm gonna have you make some motions for me. I just want to see the [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [INJURY] [INJURY] hand. I'm gonna hold this against you here. So I just want you to move your wrist up as far as you can go. Okay, Very good. And same thing on this side. Relax up as far as you can go. A little more [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] on that side. I want you to move your wrist side to side and the other way. Okay. Felt a little bit of cracking in there. Same thing here. One way. Other way. You spread your fingers as wide as they can go and put them together into a fist. Is there any pain with this motion here? A little bit, yeah. Okay. And relax them again. I. I just want you to put your hands up like this. Can you pull these thumbs back and push them forward into your Hands. All right, I'm gonna have you touch each one [INJURY] [INJURY] fingers like that. Any pain with that? Not really, no. Okay. Can you put your thumb all the way across here? Any pain with that? No. Okay. So it seems like the discomfort is mostly centralized to knees, knuckles, and beginning [INJURY] [INJURY] fingers here. The knuckles here on the fingers. But the thumb doesn't feel as affected. I'm going to do all of that again against resistance. So put your hands up. Both your hands up. And don't let me pull you. And push me away as far as you can. Both hands. Okay. A little more weakness in the left side. Fingers up like that. Don't let me pull it down. And same thing. Push me away. Good. Fingers out as wide as you can. Don't let me pull you through. Fingers closed. Don't let me pull them apart. I'm going to give you a bit of a tissue here. I want you to just open up your fingers and slide it in here. I want you to grasp it and don't let me pull it away. Good. Same thing on the other side. Grasp it with your fingers. Don't let me pull it. Okay, very good. So strength about 4.5 out of 5. Definitely a little bit of weakness on that left hand there or that. More swelling is we noticed. So it's not too surprising. While I have this, I'm going to test some sensation. So again, just lay your hands out and relax them and close your eyes for me. Just say yes when you feel something. Yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes, yes. Good. Keep your eyes closed. I'm going to have you flip your hands over. Do the same thing on the other side in [DURATION] [DURATION] spots. Yes, yes, yes. Good. Yes, yes, yes. Okay, back to the other side there. Didn't have any problems with the light touch sensation. I'm just going to touch part [INJURY] [INJURY] hand and I want you to tell me right, left or both. So either way is fine. Keep your eyes closed and tell me right, left or both. Left. Right. Both. Right. Left. Left. Both. Right. And flip your hands for me. Same thing. Both, Both. Right, left. Okay. Do the same thing just with a sharp or dull sensation. And just close your eyes and tell me sharp or dull. So I'm just going to test it here. That's going to be dull and that's sharp. You feel the difference? Okay. Dull, dull. Sharp. Dull, Dull. Sharp. Sharp. Do flip your hands for me. Do, do. Sharp, Sharp. Do, do. Sharp. Do do. Sharp, Sharp. Okay, I'm just gonna have you relax your hand. Fully just on the outside like that. And I'm just gonna run it over the swelling here and I'll be very gentle. But I just want you to tell me if it feels the same sharp across your knuckles. Does that feel the same? Any numbness when I go across there? That feels the same. Okay. Same thing here. Does that feel the same? Yeah. And do it just on your fingers here. Feel the same on every finger. Just do [DURATION] [DURATION] other here just to be sure. I'm going to knock this and you'll feel either a little bit of vibration or it'll just be pressure. Okay. Vibration, Vibration. Pressure. Pressure. Good. Vibration, Vibration. Vibration. Up the hands for me, please. Vibration, Vibration. Pressure. Pressure. Pressure. Vibration. Vibration. Okay. Does this feel cold [MEDICAL_CONDITION] [MEDICAL_CONDITION] hands? Does that feel cold there? Yeah, it does. Feels the same coldness? Yeah, same. And flip the hands for me. Still cold? Yeah, all along these knuckles cold? Yeah. I'm going to give you [DURATION] [DURATION] of objects to hold and use, and I just want to see how you're able to grasp things. So could you hold these for me, please, with one [INJURY] [INJURY] hands or both? And then could you place them on your face? Any discomfort while doing those motions? Not really. Okay. Now, I noticed later in the day you say that bothers you more in the morning. Go ahead and remove those for me. So it sounds like, you know, those small movements with the hands were okay for you just now. Mm, great. I'm gonna have you grasp this and show me how you would use it. I want you to make that motion. Any pain with that? Not really. Can you try it in the other hand? A little bit? A little bit more on that side. Last thing I want is for you to do some squeezing. So I've got this little tube here that you would squeeze. I want you to squeeze it on the outside [INJURY] [INJURY] hand. Any pain at the wrist here like this? No. Can you squeeze it on the other side? Any pain? Just a little. Just a little. I'm gonna draw some things [MEDICAL_CONDITION] [MEDICAL_CONDITION] hands. Close your eyes and tell me what you're feeling. Three. Okay. And on this side is gonna be a letter X. Okay. Flipping your hands over, I'm just gonna move it up and down at the knuckle. Is that too, too uncomfortable for you? No. Okay, I want you to tell me if I'm moving it upwards or downwards. Okay. Up, up, down. I'm just gonna do one here. Down, down. Okay. Last finger. Up, down. Great. Down, down, up, down, up, up. Wonderful. So I think that's everything I want to do for sen Just want to take a closer look at the hands themselves. Again. Just relax. And what I'm looking for here is really any other fine detail or indication, rashes or issues with [INJURY] [INJURY] that could reflect that it's something other than what I think it is. Check [INJURY] [INJURY] turgor while I'm here and looks like you're well hydrated. That's good. Any unusual hair distribution that you've noticed? No, no hair loss on the hands. And could you flip the hands over for me? Good. I'm not seeing anything super critical. Let me [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] here, nice and quick. So, [PERSON_NAME], I think we're experiencing what you're experiencing with some [MEDICAL_CONDITION] tendencies, especially it coming on in the morning. Does it feel better after you've been moving around for a while? Maybe breaking up a little bit of that swelling, scar tissue. So have you ever dealt with [MEDICAL_CONDITION] before? No. Okay. It's, you know, it's not. It's not uncommon by any means, but you are pretty young, so you might want to look into some further testing, see if there's. We have a sort of [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION] or something else going on. But I do want to take a look at those feet as well because I want to just double check. There's nothing to be worried about there. All right, I'll go ahead and have you lay down on the table and then I'll claim [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION]. All right. Thank you. So, [PERSON_NAME], now that I have you down here, I'm going to do the same thing. You just start out with inspecting. Just going to put on some gloves for this. Is the discomfort mostly in the toes or is it other parts [INJURY] [INJURY] feet? Mostly in the toes and the front [INJURY] [INJURY] feet. Okay, take a look. So in the toes and the front. You said it. I'm going to press on this. I want you to tell me, is this painful? No. About right here. A little bit. Okay. About right here. That's okay. That's this. These joints here. Same thing. Taking a look at the other side. Feet are very symmetrical, which is good. Same thing. No difference in the hair distribution. That's good. That's even side to side. Squeezing again in that. Pain painful there? Yeah. How about the toes? Just a little bit. Just a little. Any pain when I press on your heels like that? Just gonna move [MEDICAL_CONDITION] [MEDICAL_CONDITION] a little. Just relax for me. Checking in between the toes here, making sure we're not missing anything. Get some temperature. Greetings here. Feet are actually a little cooler than the hands. Do you ever feel like, you get [MEDICAL_CONDITION] issues with your coldness in the feet when they're hurting at all? I'm not sure. Okay. Something maybe to pay attention to. Your feet aren't unusually cool, but they are significantly cooler than the hands. So could be an unrelated problem or just could be because it's a little bit cool in here and you don't have your socks on. And what type of socks are you normally wearing? I think they're wool. Okay. And any compression to them? A little bit. I'm going to do the same thing. I'm just going to get some comparison measurements from foot to foot. More swelling in this left side around the toes, even there. Okay. Toes aren't too swollen. You said the pain was manageable in the toes, right? Yeah. It's a little bit worse in the hand. Okay. All right. Just get the ankles here. Another side. Look for me, please. Any discomfort in this ankle bone? Just a little. Yeah. Okay. Yeah, there's a little bit of swelling there, too. I want to have you do the same [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] [MEDICAL_PROCESS] here. So pull [MEDICAL_CONDITION] [MEDICAL_CONDITION] back as far as they can go and pull them forward as far as you can go. Relax. And just this toe, can you push it down? And the toes, push them down. Okay. Can you flail out your toes as far as they can go, Moving this side to side. Okay, one side. Have you push against me as hard as you can. Pull back as far as you can. Push me with your toe. Okay, pull back. All right, Push against my hand here and here. Very good. This side, this side. Strength seems great in the feet. Definitely no weakness the way that there was in the hands. Let's go ahead and do those same sensation tests. So just close your eyes and say yes when you feel it. Yeah. Yes. Yes. Yeah, yeah, yeah. Yes. Yes, yes. Yes. Any history of [MEDICAL_CONDITION] in the family? No. Okay, same thing. Left, right or both left? Left. Both. Right. Both. Both. Left, left, right. Move on to sharp or dull again. This is dull and this is sharp. I'm going to press just a smidge harder now because there's a bit of, you know, callousing on [INJURY] [INJURY] [INJURY] [INJURY] [MEDICAL_CONDITION]. So let me know if it's too painful. Okay. Dull shirt. Dull shirt, shirt. Sure, same thing. I just want to know if it feels sharp all the way across this swollen area here. Does that feel same way, sharpness across? Yeah. Cane on the top here. Same way. And just on the toes here. Same and same here. And just on the heel here. About that same coldness. Is that cold all the way down [INJURY] [INJURY]? Yeah, Cold and cold all the way up. I'm gonna hit this and I'm gonna have you tell me. Vibration or pressure? Pressure, Vibration. Vibration. Pressure. Vibration. Pressure, Pressure, vibration. Same thing down here. There's really no sensation loss that I can tell. I'm going to move [INJURY] [INJURY], your toe up or down and just tell me which direction it's going to. Down, up, Down. Okay. Up, up, up. And the pinky toe. Up, down, up, up. Okay, let me just take a really close look here. My feet are very smooth. The color is normal for ethnicity. No excessive dryness or excessive callousing. Just normal. So this doesn't interrupt your ability to walk, right? No. Do you have to walk with any assistance, a cane or walker? No. Okay, I'm going to quickly test the reflexes in the foot here, so just relax for me. Give me the full weight [INJURY] [INJURY] [INJURY]. Good. Same thing on this side. Give me the full weight. Okay, just cross your leg here, unlock the knee and just lay it down to the side. Relax like that. Perfect. I'm just going to [INJURY] [INJURY] [INJURY] [INJURY] [INJURY] [INJURY]. It's going to be a little uncomfortable. All right. Negative [PERSON_NAME]. So that's wonderful, [PERSON_NAME]. The feet look good. Definitely can see some of that swelling that may get worse. Go ahead and swing your legs back around and just. I want to take a look at the shoes that you wore in here today. Okay? Okay, [PERSON_NAME], so we've got the shoes that you wore in today. Look at them. I'm just looking for any unusual step patterns, indentations. Do you have any insoles that you ever wear? On my normal shoes, I do have some insoles, like your sneakers, I would say. Just keep wearing those as much as you can. These are not bad either because you can see they have pretty good arch support there and a place for all [INJURY] [INJURY] [MEDICAL_CONDITION] to go. But sometimes with the open toe shoes like this, you can slip around a little bit. You're tensing [MEDICAL_CONDITION] [MEDICAL_CONDITION]. When you're not realizing it can cause some additional pain and swelling if you're already experiencing that [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION] [MEDICAL_CONDITION]. So, [PERSON_NAME], that concludes our exam. I'm just going to take [DURATION] [DURATION] of notes and we'll be good to go. So I want to keep an eye on that pain. I think for now, you know, if you're able to get through the day without taking lots of medication, then that's good. Definitely work on some stretching in the morning, help break up some of that swelling right away. It could just prevent the prolonged experience that you may have. And if it gets worse, though, I think we should look into doing some [MEDICAL_PROCESS] [MEDICAL_PROCESS], seeing if there's anything else going on. You work on the computer a lot, and if you are on [MEDICAL_CONDITION] [MEDICAL_CONDITION], do you walk a lot? Do you have a dog or anything? Mm, yeah. Okay, so you may just have these aches and pains. Yoga, stretching, making sure that you're wearing your inserts and your shoes is going to be really important. But if it gets worse, definitely come back and we can do some [MEDICAL_PROCESS] [MEDICAL_PROCESS] and see if there's anything else going on. Sounds great. All right, well, [PERSON_NAME], you're all set to go, and I hope you have a great day. Thank you so much. Thank you.", |
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