Case Study: Indium Bone Scan

Based on the progress report dated 03/28/16 by Dr. Bakhos, the patient presents for follow-up of his right knee

12/24/15 Progress Report describes that the patient has right knee pain. The pain is frequent. It is aching and burning in quality. The current pain level is 0/10 and worst pain is 4/10. Bending, squatting, walking, weight bearing, changing clothes and ROM aggravate the pain. Rest, ice,

Per the medical report dated 03/29/2016 by Dr. Waghmarae, the patient believes that her left buttock pain has increased over the last month. She describes her pain as aching, throbbing and stabbing. She rates her pain symptoms as 8/10. Pain is relieved by medication, heat, ice and use of a Transcutaneous Electrical Nerve Stimulator (TENS) unit, and is increased by movement and standing for long periods of time. She states that her bilateral legs have also increased in pain severity over the last month. She believes because she is doing a lot of standing and trying to clean up her house. She states that pain is increasing in her left buttock. She is not involved in physical therapy, chiropractic, massage therapy or acupuncture. Palpation of the lumbosacral spine reveals abnormalities along the bilateral facet joints. There is pain in her axial lower back in all planes of lumbar motion that is

Based on the progress report dated 08/23/16, the patient complains left knee pain upon walking. Discomfort was described as aching, tingling, intense, severe, continuous, pain, discomfort, increasing with movement and varying with activity. Pain is rated as 5/10 without medications and 4/10 with medications.

She reports tenderness to the posterior aspect of the cervical spine, trapezius region and scapular region with deep palpation.

Health History: A 25-year-old male injured his left knee in a recent skiing accident. The patient stated that he lost his balance because the inner edge of his right ski got caught while skiing. This resulted in the right leg being externally rotated followed by and audible “pop” as he lost footing. By evening, the right knee joint had become swollen, causing intense pain. The primary care physician referred the case to an orthopedist.

Impression includes chronic right knee pain status post anterior cruciate ligament repair and significant degenerative joint disease of the knee.

Diagnoses include right ankle sprain/strain, difficulty walking, lumbar sprain/strain, lumbosacral and thoracic spine multiple vertebral subluxation complex, lumbar ligament instability secondary to sprain/strain, bilateral L5 PARS Interarticularis fracture, traumatic or insidious sacroiliac joint pain, lumbosacral radiculopathy or radiculitis, and Grade 1 L5-S1 spondylolisthesis, thoracic sprain/strain.

Per the IME report on 4/28/16 by Dr. Pierce Ferriter, the patient reports that he is actively treating with physical therapy and chiropractic treatment at a frequency of 3 to 4 times per week. The patient’s diagnoses include resolved lumbar strain, resolved cervical strain, resolved left shoulder strain and resolved right knee strain. There is no medical necessity for further physical therapy, orthopedic treatment of diagnostic testing based on examination.

Per the AME report dated 07/08/15, the patient was deemed P & S with regard to her right knee and lumbar spine as of this date. Future medical care includes ongoing exercise program, occasional orthopedic visits, brief periods of PT, anti-inflammatory medications for flares, prescription medications and periodic injections.

DIAGNOSIS: Strain of muscle, fascia, and tendon at neck level; Carpal tunnel syndrome, unspecified right limb,;Carpal tunnel syndrome, unspecified left limb; Status post left carpal tunnel release; and Adhesive capsulitis of right shoulder (M75.01).

Based on the progress report dated 02/02/16, the patient presents for evaluation of his bilateral knee pain. He was last seen on 01/05/2016.

DOI: 12/13/2012. Patient is a 64-year-old male security officer who sustained a work-related injury to the right knee when he missed a step and fell down the stairs. As per Omni, the patient had a right knee meniscus tear. The patient had right knee replacement on 11/19/14. Per QME Dr. Murphy on 08/11/15, the patient has a 20% whole person impairment rating. Future medical care includes 4-6 visits per year for recurrent symptoms, narcotic/nonsteroidal anti-inflammatory drugs (NSAIDS) in addition to gastrointestinal stabilizing medications, pain management specialist monitoring, office visit with an orthopedic surgeon once a year with X-ray, revision surgery in the future and bone scan.

A total knee replacement is a surgical procedure in which the articular surfaces of the tibia, patella, and femur are replaced with prosthetic devices. It is performed to relieve pain from joints that have not been controlled by other methods of pain management. There are varieties of reasons a patient might need a knee replacement including rheumatoid arthritis, post traumatic arthritis, congenital knee deformity and in the case of my patient, osteoarthritis which is also the most common type of joint disease. Osteoarthritis happens when cartilage that covers the ends of the bones where they meet joints break down and deteriorate. When this happens, the bones and the joints now rub together. Sometimes the bone will grow causing bone spurs and make it very painful and stiff to move around.

DN is a 68 year old Caucasian male who lives in Pomona, Missouri. On September 14, 2009, DN underwent a scheduled left total knee arthroplasty at Baxter County Regional Medical Center. A consultation appointment about a total knee arthroplasty was scheduled when DN had increasing pain in his knees while doing chores and working on his dairy farm. The increasing pain DN was having been due to a history of osteoarthritis and the wear-and-tear on his joints throughout his life, no specific injury was noted. Depending on the outcome of the left knee, DN was consulted on having his right knee done in the future