Case Study: Work-Related Injury

DOI: 7/7/2015. The patient is a 48-year-old male cleaner who sustained a work-related injury to his back while moving a heavy bookcase. As per OMNI, the patient was diagnosed with lumbar degeneration, thoracic or lumbosacral neuritis and myofascial pain.

Per progress report dated 03/04/16, the patient complains of pain of pain in the neck and lower back. Current medication is for Norco and Gabapentin.

Patient was encouraged to continue with heat, followed by his home exercise program and ice. He will continue with his transcutaneous electrical nerve unit (TENS). Patient was given an ice pack to use, to reduce pain. He was given a 60 mg Toradol injection on this visit.

DOI: 6/29/2010. The patient is a 50-year-old female packager who sustained a work-related injury when she hit her head on machine door after bending over to pick up an item.

Per the Agreed Medical Re-Examination report dated 09/29/15, whole person impairment rating is 5%. Future medical care includes access to follow-up visits for monitoring of his condition for the next calendar year, with continued provision of pharmacological agents. Should patient experience a significant acute symptoms flare-up within the next calendar year, re-instatement of brief courses of traditional PT, acupuncture,

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

The patient has a history of discectomy to the left with temporary improvement of his lumbar pain and lower extremity symptoms. He has reherniation to the left correlating to the L4-L5. He has had transforaminal epidural steroid injections and facet injections with relief of his lumbar pain.

Per the medical report dated 08/12/16 by Dr. Gunderson, the patient had neck pain, as well as headaches, dizziness and blurred vision. The neck pain radiated into both shoulders, but more so on the right, and occasionally she had tingling in her upper extremities. She described the neck pain as severe and intermittent, and not related to any specific activity, and relieved with massage. The pain in her lower back was in the beltline and radiated into both lower extremities, more so on the left. She described the pain as moderately severe and constant, and not related to any activity, and only relieved with nerve medicines. On examination, the patient had tenderness in the lower cervical region about C5 to C7. Range of motion of her neck was 75% of normal. Motor, sensory, and reflex examinations in the upper extremities were normal. On examination of the lumbar spine, the patient could dress and undress without difficulty. She had a bent forward posture and gait. She had reduced lumbar motion and with maximum forward flexion, her fingertips were 12 inches from the floor. Lateral flexion was 50% of normal, and she had no active extension in the lumbar spine. Motor, sensory, and reflex examinations in the lower extremities were normal. There was paravertebral tenderness about L4-5 bilaterally, as well as in both sacroiliac and sciatic notch regions. Straight leg caused hip and thigh pain at 50 degrees bilaterally. Of note, X-rays of the cervical spine demonstrated disc degeneration at C5-6. X-rays of the lumbar spine were normal. Patient sustained

At today's visit she is found in her room sitting in her recliner. She reports chronic, intermittent, dull, achy, lower back pain. Her current pain regimen is effective for her pain according to the facility staff. The staff reports that the patient is sleeping more hours during the day. She has increased generalized weakness. No acute distress noted this visit.

Based on the latest medical report dated 02/10/16, the patient has undergone extensive PT. She was diagnosed with sprain/strain derangement of the cervical spine, cervical subluxation complex, and cervical brachial radiculopathy, sprain/strain derangement of the lumbar spine, lumbar subluxation complex and lumbar radiculopathy.

Based on the progress report dated 02/29/16 by Dr. Naraghi, the patient reports worsening of her right lower extremity with pain, numbness and weakness.

She presents with severe episodes of back pain and sometime extension in the lower extremity .Her problem started when she fell off a horse when she was 10 or 11 age . This pain aggravate during movement and walking . Additional she complains of often epigastric pain , probably combined with intake of different food components.

DOI: 10/12/2011. The patient is a 53 -year-old female laborer who sustained a work-related injury to her low back and left elbow when she slipped on cardboard.

The patient reported a 25-year history of intermittent low back pain since an initial fall in 1990 with exacerbation of symptoms upon aggravation of the patient’s comorbidities, or with an extreme decrease in activity. The patient’s medical history also included fibromyalgia, lumbar osteoarthritis, irritable bowel syndrome (IBS) and bilateral neuromas between metatarsals 2-3. The patient underwent an ileostomy 3 years prior, secondary to the IBS. The patient noticed onset of the bilateral lower extremity radicular symptoms after she slipped and fell on her wet garage floor, landing in a sitting position, 5 weeks prior to her physical therapy initial evaluation. As a result, she was experiencing constant sharp/shooting symptoms coupled with functional limitations including sitting, standing, walking, ascending/descending stairs, transfers, bending, and lying down, making it difficult for her to sustain any one position for any significant period of time. Consequently, the patient found herself significantly limited in her ability to complete her activities of daily living (ADLs). Using the Numeric Pain Rating Scale (NPRS), the patient rated her current pain level as 6/10 at best and 9/10 at worst. The patient stated that her physician had

DOI: 3/6/2009. Patient is a year old male maintenance technician who sustained injury when he had bent to lift a heavy box of pipe fittings and collapsed to the floor.