DOI: 09/14/2011. Patient is a 55-year-old female hospice licensed vocational nurse who sustained an injury when her car was struck by another car resulting in neck, upper/lower back, and left shoulder injuries. Patient is diagnosed with severe cervical degenerative disc disease, disc protrusions and stenosis of the cervical spine, and upper extremity radiculopathy. She is status post anterior cervical discectomy, partial corpectomy and fusion at C4 to C7 with placement of interbody cages and autologous iliac crest bone graft and anterior plating plus a posterior fusion from C4 to C7 in 02/08/2013.
Per office visit note dated 03/24/2016, patient was prescribed Robaxin 750mg and Motrin 800mg.
Based on the progress report dated 07/01/16, the
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There is tenderness to the acromioclavicular joint which is slightly enlarged especially at the distal clavicle where there is a sharp osteophyte palpable. There is moderate tenderness to the distal clavicle and the acromion process, subacromial space, rotator cuff and anterior shoulder capsule. There is very mild crepitus with the range of motion testing. The rotational and overhead impingement test is mildly positive. The cross arm test is minimally positive.
Review of systems is positive for occasional headaches, anxiety and depression.
IW was diagnosed with severe degenerative disc disease and spondylosis plus disc protrusions and stenosis of the cervical spine at C4-5, C5-6 and C6-7, left shoulder subacromial impingement syndrome, degeneration of cervical intervertebral disc, cervical spondylosis without myelopathy, displacement of cervical intervertebral disc without myelopathy, spinal stenosis of cervical region, brachial neuritis, postsurgical arthrodesis status, other specified disorders of bursae and tendons in shoulder region, osteoarthrosis of the shoulder region, traumatic arthropathy involving shoulder region, rotator cuff (capsule) sprain, and benign essential
On History- The patient was a 49-year-old Caucasian male with a chief complaint of pain and weakness in R shoulder abduction and external rotation (dominant shoulder). He was a retired baseball player. He has been a baseball pitcher for 12 years before he retired 5 years
In a 1973 case, Perin v. Hayne, the District Court System of Iowa addressed the question of whether a cervical fusion performed on a female patient resulted in a paralysis of a vocal chord. (Showalter 160.). In this particular case the plaintiff, Perin, began consulting Dr. Robert A. Hayne for a cervical fusion surgery. Perin underwent the cervical fusion surgery to eliminate the pain, weakness, and numbness in her back, neck, right arm, and hand, which was caused by two protruding cervical disks. Subsequently, Perin alleged she suffered paralysis of a vocal chord because of an injury to the right recurrent laryngeal nerve during the surgery. In a consultation in 1968, Dr. Hayne took on the cervical fusion surgery for the plaintiffs pain, weakness, and numbness in her back, neck, right arm, and hand. The results from this surgery had resolved the plaintiffs injuries. Soon after, the plaintiff admits that even though the surgery resolved her previous
When comparing rotator cuff tears from the common people and athletes, they are much more common when a person is physically active in sports. An injury in the rotator ...
Per AME report dated 05/02/12 by Dr. Perelman, the IW is P & S 8-12 months post injury. Future medical care includes orthopedic evaluations, PT, chiropractic care, and acupuncture to the cervical spine. The patient underwent a cervical ESI at C5-6 per procedure report dated 02/10/12 with no benefit.
The four progressive resistive exercises I chose are, Thera-band tubing shoulder flexion, Thera-band shoulder diagonal, Thera-band shoulder Extension, and Thera-band shoulder external rotation at 90 degrees.
Schlatter, and Rugby Knee (Dhar). “This can cause multiple sub-acute avulsion fractures along with inflammation of the tendon, leading to excess bone growth in the tuberosity and producing a visible lump which can be very painful when hit (Dhar). Activities such as kneeling may irritate the tendon further (Dhar).” “In 1903, Robert Osgood (1873-1956), a US orthopedic surgeon, and Carl Schlatter (1864-1934), a Swiss surgeon, concurrently described the disease that now bears their names (Sullivan). Osgood-Schlatter disease (OSD) is a common cause of knee pain in active adolescents (Sullivan).”
...the shoulder i.e. subscapularis, teres major, pectoralis major and latissimus dorsi. When this movement is viewed from the top the forearms can be seen rotating about the long axis of the humerus bone which cannot be seen when viewed from the sagittal plane and frontal plane. Thus, the movement in this exercise occurs in transverse plane.
There are several tests and measure that can be done in a physical therapy examination in order to rule out certain diagnoses, as well as come closer to a physical therapy diagnosis. First, an observation of the patient standing, walking, and sitting should be done in order to associate any visible deficits in the patient that could be associated to the ...
DOI: 5/26/2011. This a case of a 71 year-old male forklift driver who sustained a work-related injury to the lower back when he was stuck by another co-worker in the forklift. The patient was subsequently diagnosed with lumbar disc syndrome, spondylosis protrusion, multilevel, lumbar; annular phisher at the lumbar level, chronic lumbar pain, and chronic pain syndrome. MRI of the lumbar spine dated 03/26/2015 revealed mild to moderate multilevel degenerative changes of the lumbar spine most severe at the L4-L5 and L5-S1 levels. X-ray of the Lumbar spine dated 03/29/15 revealed mild to moderate multilevel degenerative disc disease but no fracture. As per physical therapy note dated 03/30/15, the patient completed 12 physical therapy visits. He
Spinal fusion stabilizes the spinal vertebra by fusing the disk spaces between the vertebra. The purpose of Lumbar fusion surgery is designed to help create solid bone between the adjoining vertebra. Classically Autograft bone has been used for fusion. This case study demonstrates the successful use of a synthetic bone graft called Signafuse. Signafuse is a moldable bone graft comprising a proprietary combination of patented bioactive glass particles and biphasic mineral granules suspended in a patented resorbable polymer carrier.
Patient returned the next day still complaining of pain. The PT applied heat, then initiated the exercise program, but the patient could not perform theem to same extent as previously, secondary to pain. Therefore, the PT told the patient to schedule an appointment with his physician. The patient was seen by the MD the next day and an arthrogram performed that revealed a reinjure to the repaired site. And a second surgery repaired the rotator cuff.
DOI: 11/14/2013. Patient is a 34-year-old male digital sales lead who sustained injury on while he was lifting a heavy box. MRI of the lumbar spine without contrast dated 1/2/14 revealed degenerative disc disease and facet arthropathy with grade 1 anterolisthesis L5-S1; canal stenosis include L4-5 mild to moderate canal stenosis; and neural foraminal narrowing includes L3-5 mild to moderate left, mild right neural foraminal narrowing. As per office notes dated 6/17/16, the patient pain level has decreased since the last visit He rates his pain with medications as 2.5 and 5 without medications. The patient is taking the medications as prescribed with no side effects reported. Current medications include ibuprofen and Skelaxin. Objective findings
When performing manual muscle testing for shoulder flexion and abduction, PTA’s typically place their hand at the wrist verses the mid-extremity because placing their hands at the wrist increases the length of the lever thus testing the muscles ability to resist externally applied force overtime and across the bone-joint lever arm system. Shorter lever arms will provide higher testing scores when compared to using longer lever arms, thus changing the point of force application affects the length of the lever arm and therefore the muscle torque.
Flexibility Sit and Reach test - The sit and reach test is a regular way of measuring flexibility. It tests how flexible your lower back and hamstring muscles are as it is an indirect measure of static flexibility. This test is important as tightness in the lower back and hamstring muscles can make you prone to back injuries. The way you test it is by sitting down with your legs straight and your heels against the border of the sit and reach box, you keep your legs flat on the floor and you slowly reach forward and drop you head in between your arms. You repeat this three times and and record your best measurement.
Wainner, S., Fritz, M. and Irrgang, J. 2003. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine, 28: 52-62.