DOI: 8/30/2010. Patient is a 66-year-old female cleaner who sustained a work-related injury while taking out a recycling bin when she fell down. She underwent a right knee arthroscopy, partial medial meniscectomy, suprapatellar synovectomy, manipulation under anesthesia and post-operative injection per operative report dated 05/31/12 and a left shoulder arthroscopy on 07/16/13. The patient underwent a left knee arthroscopy with synovectomy and meniscectomy per operative report dated 07/31/14.
Per IME report dated 09/16/14, it was noted that the patient has undergone a left knee arthroscopy with Dr. Dayan, who is now recommending PT. She reports that she has continued use of a continuous passive motion (CPM) machine and does home exercises. She reported of intermittent right knee pain,
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She reports numbness of the foot, bilaterally.
Pain increases with prolonged sitting, standing, bending, lifting, negotiating stairs, and walking 4-5 blocks.
On examination of the knees, there is tenderness noted bilaterally. Active range of motion (ROM) is painful bilaterally. ROM is -5-90 degrees on both sides.
Gait is slow. She uses a shopping cart for support. IW was diagnosed with bilateral knee sprain to rule out internal derangement.
Treatment plan includes PT and rehabilitation 3 times per week for 6 weeks, follow-up in 6 weeks, soft cervical collar, cervical pillow, knee brace, lumbar support, and Tylenol/Motrin.
On the statement of medical necessity on the MG2 form dated 06/25/15, the patient had no PT more than 6 months. Recently, her knee pain has worsened, stiffness increased and she can’t walk as much as before. Goals are to return to pre-exacerbation level and increase range of motion by 5-10 degrees and decrease pain by 1-2 levels.
Per OMNI payment screen, the patient has completed approximately 60 PT visits for the knees from 06/04/13 through
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
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.
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.
Abraham said his appointment with Dr. Yacisen has been moved to 9/12/16 by Dr. Yacisen’s office. Mr. Abraham arrived to the appointment on 9/12/16 with his Mother. He walks stiff legged to the right knee. He reports his pain in the right knee is about a 2 to 3 with twisting. Examination showed the knee to be slightly swollen but stable. Dr. Yacisen still feels he may need to have a scope done. With discussion on the length he will be working and the type of work he does Dr. Yacsien may still do an ACL repair. Mr. Abraham said he is very apprehensive about going back to work. Much discussion was given to restrictions and when he would go back. Dr. Yacisen would like physical therapy to continue and added a work conditioning also. He wants Mr. Abraham to have a custom ACL brace and must be wearing it to return to work. The brace was measured but would take about 3 weeks to come in. The left shoulder has good range of motion. Mr. Abraham said he has slight pain in the shoulder, he declined a injection. He was given a home exercise program to do by Dr. Yacisen in conjunction with formal physical therapy. Mr. Abraham said he is also driving
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 the medical report dated 05/17/16, the patient reported bilateral hand pain with numbness and tingling for the past 7 years or so, worsening, right greater than the left side. There is some degree of numbness/tingling on the right hand at all times. She has difficulty sleeping at night due to pain and driving, doing her hair/make up or holding objects worsen her symptoms. She has tried wearing splints that they worsened the discomfort. She denies any history of steroid injections. On examination, Tinel’s, Durkan’s and Phalen’s tests are positive bilaterally. There is bilateral thenar weakness.
Are you experiencing stiffness, or swelling, or unbearable pain in the knee joint? Is it affecting your movement?
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.
S: TM reports Acute Left Knee Pain. According to the TM, she was stepping into cell down the stairs and sudden pain shot though her left knee to mid tight. Reports the initial pain was sharp shooting like pain; 10/10. After Ice X 20 minutes helped to decreased her pain to 8-9/10. Now TM describes her pain as pulsation, located in her lateral and back of her knee. TM denies previous injury to the left knee. TM denies numbness, tingling, or loss of movement in her left leg.
According to the agreed panel QME report on 5/28/14, analgesic and anti-inflammatory medications should be made available to the patient, but otherwise no additional care is indicated as the patient states that none of the treatment that she has received over the past years has helped her and in fact she states that her condition has actually worsened. The examiner notes that any additional physical medicine treatment is not going to be helpful. Patient was deemed P & S on 02/2011.
Resident maintained functional ROM /strength in the in key upper and lower extremity joints and muscle groups. Bilateral knee extension lag approximately -10 degrees. Bilateral hamstrings and calf muscle tightness noted. Right shoulder muscle strength maintained at 3+/5, Rest of the muscle groups in the upper extremity maintained strength 4/5 and 4-/5 in the bilateral lower extremities. She has good sitting balance, decreased standing and walking balance. Resident transfers safely with 2 person assist (pivot) using walker. Resident able to walk short distances with
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.
On 12/12/16 I met Mr. McClellan and his step dad at the office of Dr. Nzoma. The MRI was reviewed. There is a partial tear of the ACL. There is some popping but examination showed good strength and stability. Dr. Nzoma would like physical therapy to continue to help him wean out of the brace and to work on the popping. We discussed a return to work and restrictions were written.
Expert proportion of clearance was calculated and represented in table 2. Index of content validity was calculated and it was found that scale index of content validity (S-CVI) equals 97.14% and scale index of content validity universal agreements (S-CVI/UA) equals 71% as shown in table 3. Also Expert proportion of relevance was calculated and represented in table 4. Patients were of both genders (female:52, male:17) and 46 of them had unilateral knee OA while 23 had bilateral knee OA also 42 patients made retest while 27 patient didn’t, descriptive statistics of patient general characteristics (age, eeight, height and BMI) were represented in table 5, descriptive statistics of sheets general characteristics were represented in table 6 and descriptive statistics of sheets results were represented in table 7, internal consistency calculations were made and it was found that Cronbach's alpha equals 0.848 with lower bound 0.789 and upper bound 0.896 at 95% confidence interval., test versus retest calculations were made as shown in table 8 and Spearman’s correlations coefficients were calculated and represented in table
It was just in time for another surgery to remove the screws and plates that were correcting my knees. I went through the exact same process of healing and pain as before. This time the surgeon becoming more and more encouraging than the time before. After a year of healing, I returned to the same place I was a year before. However, a sudden growth spurt caused my knees to revert. The doctor was just as baffled as I was; he seemed to cringe at the thought at putting me through the excruciating operation once more.