Transcript Journal Club

NYU Medical Grand Rounds
Clinical Vignette
Catherine Constable, M.D.
PGY2
1/10/2012
UNITED STATES
DEPARTMENT OF VETERANS AFFAIRS
Chief Complaint
36-year-old male artist and torture survivor
with the near inability to use his hands to
paint for over ten years.
UNITED STATES
DEPARTMENT OF VETERANS AFFAIRS
History of Present Illness
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.”
UNITED STATES
DEPARTMENT OF VETERANS AFFAIRS
History of Present Illness
•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.
UNITED STATES
DEPARTMENT OF VETERANS AFFAIRS
Additional History
•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.
UNITED STATES
DEPARTMENT OF VETERANS AFFAIRS
Physical Examination
•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.
UNITED STATES
DEPARTMENT OF VETERANS AFFAIRS
Physical Examination
Photo credit: Jonathan R. Tan
UNITED STATES
DEPARTMENT OF VETERANS AFFAIRS
Hospital Course/Outpatient Follow-up
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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
UNITED STATES
DEPARTMENT OF VETERANS AFFAIRS
The Present
Photo credit: Jonathan R. Tan
UNITED STATES
DEPARTMENT OF VETERANS AFFAIRS