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NYU Medical Grand Rounds Clinical Vignette

NYU Medical Grand Rounds Clinical Vignette. Catherine Constable, M.D. PGY2 1/10/2012. U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS. Chief Complaint. U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.

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NYU Medical Grand Rounds Clinical Vignette

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  1. NYU Medical Grand Rounds Clinical Vignette Catherine Constable, M.D. PGY2 1/10/2012 UNITED STATES DEPARTMENT OF VETERANS AFFAIRS

  2. Chief Complaint UNITED STATES DEPARTMENT OF VETERANS AFFAIRS 36-year-old male artist and torture survivor with the near inability to use his hands to paint for over ten years.

  3. History of Present Illness UNITED STATES DEPARTMENT OF VETERANS AFFAIRS • This is a 36-year-old Tibetan male who initially presented to the Bellevue/NYU Program for Survivors of Torture in 2003, shortly after immigrating to the United States. As a teenager in Tibet, he was arrested and tortured in prison for painting traditional Tibetan images banned by the Chinese government. During his months of detention, he endured beatings, electrocution, and hanging by his handcuffed wrists. Lastly, as punishment for his poetry-writing, his attackers thrust his hands into a coal-burning oven, telling him, “you’re not doing anything useful with your hands.”

  4. History of Present Illness UNITED STATES DEPARTMENT OF VETERANS AFFAIRS • Burn scars left him unable to hold a pencil or paintbrush without pain. • Symptoms of PTSD included nightmares, insomnia, hypervigilance, and debilitating flashbacks every time he tried to hold a pencil or paintbrush.

  5. Additional History UNITED STATES DEPARTMENT OF VETERANS AFFAIRS • Social History: • Born in Tibet. • As a child, he studied art at a Tibetan monastery. • In his adolescence, he was commissioned by the Chinese government to create state-sanctioned art. • After he began creating traditional Tibetan art as a means of protest, he was arrested. • He fled over the Himalayas with his hands still in bandages into Nepal, and ultimately arrived in the U.S. in 2003.

  6. Physical Examination UNITED STATES DEPARTMENT OF VETERANS AFFAIRS • Left hand flexion contracture bands of 2nd and 3rd digits and radial side of thumb; right hand flexion bands from thumb to 3rd and 4th digits. Well-healed burn scars to palms bilaterally. Flexion intact, extension of fingers limited due to contractures. • Shoulders with decreased range of motion bilaterally, left more than right.

  7. Photo credit: Jonathan R. Tan UNITED STATES DEPARTMENT OF VETERANS AFFAIRS Physical Examination

  8. UNITED STATES DEPARTMENT OF VETERANS AFFAIRS Hospital Course/Outpatient Follow-up • Pain management • Management of severe symptoms of depression and PTSD with individual and group counseling with other Tibetan survivors of torture, as well as with medication • 4/1/2004: Z-plasty of right palm for release of contractures, which enabled him to hold a paintbrush again • Physical therapy for shoulder pain with improvement in his range of motion Photo credit: Jonathan R. Tan

  9. UNITED STATES DEPARTMENT OF VETERANS AFFAIRS The Present Photo credit: Jonathan R. Tan

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