DOI: 2/19/2013. Patient is a 44-year-old female home attendant who sustained a work-related injury when her client fell on her while she was changing the client’s diaper. As per OMNI, she underwent right knee surgery on 6/7/13, left knee arthroscopy on 12/10/13 and bilateral L4-5 laminotomy on 11/12/14. Per the IME report on 12/14/15 by Dr. Alvin Bregman, there is a medical necessity for further treatment from an orthopedic standpoint. The examiner notes that an evaluation with a pain management specialist is indicated, as well as an orthopedic follow up. Per medical report dated 1/22/16 by Dr. Islam, the patient continued to complain of pain in the lower back, with numbness and tingling sensation radiating to the lower extremities. The pain is aggravated by bending, lifting, walking, climbing and standing. She rates her pain as 6-7/10 in intensity with intermittent burning and aching. Limping gait, tightness, muscle spasm, swelling or edema and tenderness to the lumbar spine are noted on examination. The patient has difficulty on stair ambulation, sitting to standing, squatting, and prolonged sitting and standing. She also reports difficulties with activities of daily living. Lumbar range of …show more content…
Based on the medical report dated 12/07/16 by Dr. Sunadresan, the patient presents with increasing back pain, radiating to both knees. Past medical history is significant also for hypertension, for which she takes lisinopril. She also takes Tylenol with codeine. On examination, she is markedly overweight at 245 pounds. Patient is ambulatory with a walker. Review of the studies shows that she has a herniated disc at L4-5. She does require an anterior lumbar interbody fusion at this level. Because of the laminectomy, she may require a second-stage posterior pedicle screw fixation. She is anxious to have surgery. She had some abnormal hematological
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
Based on the initial pain medicine evaluation report dated 06/22/15, the patient complains of constant neck pain which radiates down to the bilateral upper extremity, fingers and hands. Pain is accompanied by intermittent tingling and numbness in the bilateral upper extremities to the level of the fingers and muscle weakness. The neck pain is associated with occipital, temporal and frontal headaches and muscle spasms in the neck area. The patient describes the pain as aching, burning, pins and needles, sharp, and stabbing. The pain is aggravated by activity, flexion/extension, prolonged sitting, pulling, pushing, repetitive head motions and standing. She also reports severe difficulty in sleep.
She was having pain in her neck and soreness in her thigh and back. she claimed that she felt continuous pain because of this
The lumbar region of the human spine is a location that is very susceptible to injury and trauma. A majority of the population experience back pain at some time during their life, and although in most cases the pain subsides after a time of rest, there is an enormous need for treatment of this malady. The various types of treatment for lumbar disc herniations include a more conservative method of rest, physical therapy, and anti-inflammatory or non-steroidal drugs. A more extreme condition would require surgery to try to alleviate the symptoms. The older, more traditional surgery is a posterior laminotomy, however, newer less invasive microscopic and endoscopic surgeries been implemented to increase success and recovery time as well. Although most of these operations are performed on the posterior, anterior surgeries are also performed, depending upon the nature of the injury. While these surgeries partially remove disc material affecting the spinal cord, another type of surgery is used to remove the disc entirely and replace it with prosthetics. Still, there are alternative treatments including chiropractic care, acupuncture, and physical therapy that are increasing in popularity. Due to the sensitivity and vulnerability of the spinal cord, the diagnosis and treatments have a moderate risk of failure, and force a patient to explore numerous options to relieve pain.
It was noted that the patient has had increase range of motion and decrease in allodynia due to injection. The patient’s injection has worn off and is in more pain as well as decrease in range of motion noted due to not having the injection performed. It was also mentioned that the patient is doing self-therapy. Currently, the pain is rated as 6 with medication and as 8 if without medications. The pain is located at left knee and ankle. The patient describes it as aching and increased. Physical examination revealed that on palpation of the lumbar facet revealed pain on both the sides at L3-S1 region. There is palpable twitch positive trigger points are noted in the lumbar paraspinous muscles. Motor strength is grossly normal except pain inhibited 4/5 on the left foot eversion and plantar flexion. Examination of the extremity revealed mild increase swelling in ankle and in the 3rd/4th metatarsals. Left ankle reveals increase allodynia and hyperalgesia. Dorsiflexion is 10 degrees. Plantarflexion is 30 degrees. Subtalar joint inversion is 4 degrees secondary to pain. Inversion is 5 degrees, forefoot abduction is 10 degrees, abduction of 20
On admission, a complete physical assessment was performed along with a blood and metabolic panel. The assessment revealed many positive and negative findings. J.P. was positive for dyspnea and a productive cough. She also was positive for dysuria and hematuria, but negative for flank pain. After close examination of her integumentary and musculoskeletal system, the examiner discovered a shiny firm shin on the right lower extremity with +2 edema complemented by severe pain. A set of baseline vitals were also performed revealing a blood pressure of 124/80, pulse of 87 beats per minute, oxygen saturation of 99%, temperature of 97.3 degrees Fahrenheit, and respiration of 12 breaths per minute. The blood and metabolic panel exposed several abnormal labs. A red blood cell count of 3.99, white blood cell count of 22.5, hemoglobin of 10.9, hematocrit of 33.7%, sodium level of 13, potassium level of 3.1, carbon dioxide level of 10, creatinine level of 3.24, glucose level of 200, and a BUN level of 33 were the abnormal labs.
An emergency department note dated 11/02/2017 indicated that the claimant presented with a low back pain and right hip pain. His back pain started a month ago and had been worse the past 2 weeks. He stated that pain is aggravated by sitting and slightly relieved by standing. His BMI was 31.92. A lumbar spine x-ray was ordered and medications were provided.
My patient was a twenty-two year old female and she suffers from bunions on both of her feet. Only the left foot was treated, because the severity level was higher. After her diagnosis, she was taken to surgery and had the first metatarsal operated on. Type of surgery that was performed is called a bunionectomy. This surgery requires a small piece of bone to be removed and repositioned by a piece of hardware (UPMC, 2014). My patient had a screw inserted from the lateral border of her first metatarsal. After the surgery, she came to x-ray to get post operation images. The order called for a left foot series, which includes the anterior posterior (AP), oblique, and lateral views. After the surgery she had a cast on, which meant techniques were increased on each view accordingly. The AP view was done with the tube angled about ten degrees cephalic with a technique set at 65 kVp and 3.2 mAs. Next the oblique was done by rolling her foot medially about thirty degrees with no angle on and using the same technique as the AP. After she was placed in a lateral position and increasing the mAs to 4.
"Chapter 37." Operative Techniques in Orthopaedic Surgery. Ed. Sam Wiesel. 4th ed. Vol. 2. Lippincott Williams & Wilkins, 2011. eBook.
Based on the progress report dated 06/15/16, the patient continues to slowly improve, but complains of left shoulder pain. He has pain with overhead activities and reaching behind his back. Pain is mostly anteriorly and laterally. He is doing his exercises and PT.
Based on the progress report dated 09/07/16 by Dr. Morris, the patient rates her pain as 7/10 at average with medications and 8/10 without medications. She has pain in the lumbar spine with radiation to the feet, left greater than right. She has functional benefits of medication. Response to therapy is unchanged from prior
She also had stiffness in her upper back and neck due to two motor vehicle accidents in 2010 and 2012, though the pain in the buttocks and legs was the pain she wished to have focused on. The patient had previously had Bell’s palsy in 1989 and 1994, as well as two c-sections in October 2000 and February 2002. Her activity level as described as moderate to low. She had also broken 3 fingers, one during the treatment term, and a broken toe. The only supplement or medication the patient reported taking was vitamin d. The patient did not see a doctor in regards to the pain in her gluteal region, nor had she had any formal treatments done to help alleviate the pain, though she had had her husband massage the
Mrs. D. was admitted to the unit in 2011. She is 84 years old widow who was diagnosed with dementia, diabetes mellitus type II, hypertension, high cholesterol
Participants were recruited from Stanford University Medical Center and referred by that same physician. The study concluded only individuals with a resent onset of low back pain (duration of ˂3 months) and the following signs and symptoms: localized low back pain (above the waist), decreased lumbar extension while standing and increased pain with lumbar extension while
Orthopedic surgery covers a wide area of expertise. Depending on age and condition, a certain surgery might be