Bone Marrow Incident Report

HPI: Ms. Smith presents to the office with bilateral shoulder stiffness and lateral elbow pain in right arm. The patient has been suffering shoulder stiffness for over 2 years. The symptom developed gradually after she started using her computer more at her work place; she had to hold her telephone between her shoulder and head while typing information on computer. The pain in right elbow stated about 8 months ago with gradual onset. The patient does not recall any trauma to the shoulder and elbow. She has been diagnosed as tennis

2. During inspection of the patient’s affected shoulder, name at least three key clinical aspects that you need to observe on both shoulders that would suggest any pathology or abnormality on the shoulders. From the three clinical aspects that you observed, explain what each of the findings would indicate concerning the pathology of the shoulder. For example if the shoulder is

DOI: 7/20/2015. The patient is a 56-year-old male elementary school worker who sustained a work-related injury while moving tool and materials in a milk crate between floors.

Inspection of the right shoulder joint reveals atrophy. Movements are restricted with flexion to 90 degrees limited by pain and abduction to 75 degrees limited by pain. Hawkin’s test, Neer’s test, Shoulder crossover test, Empty Cans test, Lift-off test, and Apprehension test is positive. On palpation, tenderness is noted in the acromioclavicular joint and subdeltoid

The patient wants to also update me as far as the arm pain he mentioned last time. He says his left arm is feeling better now. He is noticing that his right shoulder is hurting at times, especially in certain positons such as while he is sleeping and if he has his arm raised over his head while he is lying down. He had no specific injury or trauma. He is not aware of anything that makes it better or worse. He is not using any medication for it thus far. He would be interested in having

Manual muscle testing of the left glenohumeral joint with flexion, abduction and external rotation is 4/5. Patient is with limited use of the left upper extremity and has slow progress noted with precautions of pacemaker limiting aggressive stretching. Plan is to progress with ROM and mobility strength.

DOI: 2/24/2016. Patient is a 46-year-old male production technician who sustained injury while he was lifting a heavy door when he felt immediate pain in his right shoulder. Per OMNI, he was initially diagnosed with right shoulder strain.

Please allow me to make some correction to the rating of Dr. Miner’s report. It appears Dr. Miner used the range of motion measurement from the right shoulder [uninvolved joint] as a baseline to determine the impairment to the left shoulder as a result of a

A physical therapy evaluation dated 08/07/2017 indicated that the claimant had a right shoulder pain after a fall onto her elbow and knee at work on 06/28/2017. She stated that she will have a surgical intervention on her right shoulder. She rated the pain at 6-8/10. She was unable to reach above her right with the right upper extremity. Objective findings showed reduced right arm swing. It was noted that the claimant was unable to place the right hand behind the head or the ear. There was a noted atrophy of the right forearm. Therapeutic exercises, moist heat, TENS, cryotherapy, and patient

Barta reports his pain level was a 8 with any movement. Since the last appointment with Wesley Fischer PA the pain level has decreased to a /34 with movements. He was instructed on a home exercise program to avoid the shoulder becoming frozen. Mr. Barta’s examination showed an improvement with range of motion, and strength. Work restrictions were discussed. Per Mr. Barta he was told that he needs to be full duty to come back to work. I advised that the restrictions need to reflect what he can and cannot do with the right arm since that is the injured part. If the employer has the ability to bring him back to work then they must follow the restrictions. I asked that the restrictions reflect

The first was a questionnaire for symptoms, disability, and the SF36 health survey. The second assessment was performed by a blinded orthopaedic specialist and third an ultrasound and MRI of the shoulder. In the first stage the subjects took a Nordic- style questionnaire that focused on pain in the upper limb. The second stage was performed by an experienced orthopaedic specialist. The specialist assessed both shoulders by determining the range of motion and pull force at a 90 degrees of abduction in the scapular plane. A constant score was calculated for both shoulders. If the constant score was below normal female values, their shoulder was considered abnormal. Third a blinded musculoskeletal radiologist performed an ultrasonography of both shoulders in all subjects. If they had an inconclusive finding they completed the assessment with an MRI. The subjects were not allowed to report any pain they were having during the

Normal muscle tone noted bilateral (B/L) wrist and hand limited range of motion (ROM) to right thumb. Inspection: No joint deformity and swelling noted. No bogginess, or tenderness noted during palpation over the distal radius, and the ulua on the lateral medial surfaces of B/L hands. Denies tenderness over the radial styloid bone (snuffbox) during palpation. C/o of tinging during the Tinel’s sign test. Weakness was noted in the thumb abduction test and the hand grip test. Patient c/o discomfort during thumb movement test, but no ulnar deviation noted.

\DOI: 3/11/2016. Patient is a 52-year old male supervisor who sustained a work related injury to his right elbow and tore his muscle when he tries to grab a falling 'A' frame. As per medical report dated 5/3/16, patient suffered biceps tendon tear. It was noted that the patient had surgery performed on 3/25 and he is in the process of going through physical therapy. He continues to have limitations in range of motion of the elbow. He also has developed fluid and edema over the right elbow into the olecranon bursa. He has an extension lag of about 15 degrees. He can flex his elbow, but not fully. There is about 5-6 inches between his fingertips and his shoulder. He also cannot perform full supination and pronation. It is in the moderate range at this time.

DOI: 01/23/2016. This is a case of a 42-year-old female separation baker who sustained a work-related injury when one of the metal rack slipped off injuring her right arm. As per office notes dated 7/20/16, the patient complains of right shoulder pain, right wrist and hand pain as well as right elbow pain. The right shoulder pain is described as constant moderate pain in nature. It is described also by burning and weakness. The right wrist and hand pain is constant moderate to severe that is sharp and numb. The right elbow pain is constant moderate that is described as sharp and tingling. Objective findings revealed 2 + spasm and tenderness to the right rotator cuff muscles. Spuraspinatus test was positive on the right. The elbow revealed 2+spasm

The case reports showed that the differential diagnosis of SSN is difficult because of the overlap in the clinical presentation to other shoulder pathologies and cervical spine. However, in these studies is shows that symptoms of cervical radiculopathy of impaired sensation, impaired muscle stretch reflexes, and myotomal weakness is usually more extensive than what would be seen in the SSN. However, dermatomal testing should be used with caution for differential diagnosis due to the close overlap between the C5 dermatome and the suprascapular nerve cutaneous that is seen in a small percentage of people. Reflexes testing of the biceps brachii and brachioradialis muscles may be abnormal in indiviuals with radiculopathy but not in SSN. Evidence from this study suggests that the drop arm test may be helpful in discriminating between full-thickness rotator cuff tear and SSN, due to the high specificity for full thickness rotator cuff tear. An MRI or electrophysiologic testing may be helpful to distinguish between full-thickness rotator cuff tear, and SSN. Patients who may have an injury to the suprascapular nerve, weakness or atrophy of infraspinatus muscle with or without the involvement of the supraspinatus muscle, and posterior shoulder pain are the key factors to consider for the differential diagnosis of SNN. Disorders such as C5-C6 radiculopathy, upper trunk brachial