On June first of 2014, Mr. Lane continued to have numbness and pain in the right arm. He had a nerve conduction velocity test to determine the source of his numbness and tingling nerves in neck or arm.
Nerve conduction study (NCS) and Electromyography (EMG) testing results revealed cubital tunnel compression and surgery was recommended to decompress the cubital tunnel.
Mr. Lane returned to the tertiary care center for outpatient surgery for right cubital tunnel decompression.
Medical History
Recommendations:
Discharge instructions: Begin therapy in 3 weeks; UE splint
Medications
- Atorvastatin 10 mg PO daily
- Lisinopril 10 mg PO daily
- Amlodipine 5 mg PO daily
- Senna-S 2 tablets twice daily
- Doxepin 25 mg HS PRN sleep
- Gabapentin 300 mg PO three times a day
- Duloxetine 60 mg PO daily
- ADJUSTED Oxycodone extended-release 40 mg PO twice daily
- NEW Naproxen 500 mg PO twice daily
Psychosocial
No change.
Work History
No change.
Interventions
Nursing: Discharge Instructions - Follow-up Care:
- See your family physician/nurse practitioner in 5 days for an appointment. Do not shower until after the doctor visit. They will change your dressing and give you more instructions.
- You have an appointment with your surgeon in 10 days for suture removal.
- Activity Restrictions:
-
- No driving; No use of the right arm; use sling for right arm; no working
- Wound Care Instructions
- Caring for your incisions:
-
- Wash your hands before caring for your incision.
- Do not apply any creams, salves, ointments or powders unless you have been told to do so.
- You may take a shower. Remove the dressing before your shower after your doctor appointment in 3 days. After your shower, pat the incision site dry with a clean towel. Put on a new dressing.
Additional Info
- Pharmacy cost: $1285.00, Insurance paid $771.00, Out of pocket $514.00
- Social Work cost: $150.00 x 2 visits= $300.00
- Physical Therapy cost: 12 visits with $75.00 copay
General Cubital Tunnel Recovery Timeline
| Recovery Milestones | Time After Surgical Decompression |
|---|---|
| Heavy pain | 2-3 days |
| Require strong painkillers | 3-10 days |
| Return to work; no use of arm | 5-7 days |
| Arm immobilized in bandage/splint | 2-3 weeks |
| Light use of arm | 2-4 weeks |
| Require non-opioid analgesics (i.e., ibuprofen) | 1-2 months |
| Normal use of arm | 3-4 months |
| Complete recovery (no symptoms) | 4-6 months |
Activity Event
Assume a Role:
You could be a nurse practitioner or pharmacist in this situation.
Situation:
Mr. Lane has chronic pain in his right arm and now has an acute on chronic pain situation with the decompression surgery.
As his nurse practitioner and pharmacist, you might consider the following as barriers for monitoring his opioid use in each of the following options:
Short term opioid prescription:
- Barriers to consider for short term opioid prescription include limited pain control and increased risk for addiction
Clinical visit required for additional prescriptions:
- Barriers to consider for clinic visits are increased transportation difficulties, increased insurance cost for billing and possible delays in receiving medication.
Urine sampling monitoring:
- Barriers which may impact the use of urine sample monitoring include transportation difficulties to the clinic for testing and cost for testing.
Lock box for medication:
- Barriers which may impact the use of lock box for medications include entrusting a person to monitor the box and coercion or manipulation by the patient to the person who monitors the box.
