Case Summary: What´s Multiple Muscle Pain?

Because of the potential displacement of bone fragments there was the possibility that the wrist would not look normal on the x-rays and that it may not have been possible to get a perfect lateral wrist. This was potentially problematic because it meant that the doctor may not have been able to measure the amount of displacement or the degree of angulation accurately. The doctor not being able to measure displacement and angulation properly may cause a problem when they are considering treatment options. Another thing that would be a potential problem while the x-rays were being taken is that the patient was in a lot of pain around the distal area of the radius and ulna. The pain in her wrist meant that she was not able to move it into the ideal positions without either her wrist hurting more or the potential to displace bone fragments even more. The patient had known osteoporosis which is a decrease in bone density (or bony tissue) (Knipe & Prasad Pant, 2015, para. 4). Because of the decrease in bone density the pathology was more likely to be a fracture because the bones would not be able to

On Exam:  BP today was 140/86. Head and neck exam was all clear. She had no oral or nasal ulcers. She had no lymphadenopathy or bruits. Heart sounds were normal and the chest seemed clear, as did the abdominal exam. Musculoskeletal exam disclosed widespread Heberden's and Bouchard's nodes. She had no swelling or stress pain at the MCPs. She was not tender at the CMC joints. She had no swelling in the wrist, elbows or shoulders. She had no soft tissue tender points. She has bilateral knee crepitus but only slight instability and no effusions. She had actually good range of movement of both hips. She was tender in the lumber spine and has a scar at the lower lumbar spine from her previous operations. Her feet are somewhat flat with tenderness across the

Raney was experiencing any pain to the area and Mrs. Raney replied that the only pain is in the right shoulder. Mrs. Raney was able to supinate and pronate her right wrist 30-40 degrees. Her skin was dry. Dr. Mendelson replied that at this time Mrs. Raney no longer required to wear the wrist brace and she can use the extremity. Dr. Mendelson obtained x-rays of her right shoulder as Mrs. Rainey has limited range of motion. After reviewing this, Dr. Mendelson replied that Mrs. Rainey as tremendous arthritis in her shoulder. I inquired if it was traumatic arthritis and the result of the accident. Dr. Mendelson replied that it was not related directly to the accident necessarily but her shoulder was aggravated from the accident. Dr. Mendelson continued to state that symptomatically it will get better and at some point Mrs. Raney did have a glenoral crack. Dr. Mendelson inquired about how Mrs. Raney’s shoulder was prior to the accident and she stated that it was fine and she could raise her arm above her shoulder and head but now she can’t and has had limited movement since the accident. Dr. Mendelson assessed and evaluated her lower extremity and replied that Mrs. Raney’s left incision is now healed. Her right ankle is still healing, the wound is dry and her skin is consolidating over the area. Mrs. Raney has an avagus external rotation of her foot.

Per medical report dated 01/23/15, the patient reported of middle and lower back pain and bilateral leg pain with tingling. He was diagnosed with thoracic compression fracture and lumbar spondylolisthesis.

Overall, Dr. Scharf’s report is quite concise. He documented the applicant’s current complaint as neck pain, radiating pain to both arms, and occasional headaches, as

The patient is a 50 year old male construction worker who sustained a work-related injury while lifting heavy boxes of metals. In an office visit dated 12/14/13, patient complaints of intermittent severe low back pain which radiates to bilateral lower extremities. The claimant had an epidural injection, which significantly alleviated right leg pain for a short period of time. Unfortunately pain has returned. It is in the right leg as well as severe pain in the lower back. The claimant wishes to consider surgical intervention due to severity of pain. Objective examination reveals weakness in the right extensor halucis longus and anterior tibialis which are 4+/5. The claimant has diminished sensation along the dorsum of right foot. The claimant has a positive straight leg raise.

DOI: 8/6/2015. Patient is a 51-year-old female licensed vocational nurse who sustained a work-related injury to her back and hips while moving a client. As per OMNI, she was diagnosed with muscle spasm, pain over the low back and thoracic region. She is status post right carpal tunnel release on 02/26/16.

S: TM missed 3 days of her ESI visit, related holidays, but she did continue with ice and plan of care as instructed at home. The TM reports her pain is 4/10, and the pain is described as aching type pain; the pain is intermittent. TM is currently taking Ibuprofen 800 mg tab, 1 tab 2 times a day and Acetaminophen 500 mg tab 2 tabs as needed for shoulder pain to manage her pain and it does help to decrease her pain to 2-3/10. TM denies any loss of ROM or sensation of the right arm; denies any tingling or numbness.

Based on the progress report dated 09/12/16, the patient reports more frequent pain with activity since the last

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

On 11/21/16 I met Mr. and Mrs. Messing at the office of Dr. Adams. Ms. Messing said she has not made any other follow up appointment. She wanted to wait until she saw Dr. Adams and spoke with him. There was a long wait for Dr. Adam. Ms. Messing arrived in a wheelchair, her neck was still in the Miami j collar but her chin was towards her chest, head was sinking down in the collar. This was not how the collar fit her when I saw her at the rehab unit. She continually pulls on the collar due to a skin break down under her chin. The wound to her chin is almost completely healed. Ms. Messing rates her pain at a 4 to a 10. She reports having a jolting tingling burning pain to the top of her head. She is alert and oriented. Family brought the MRI disc from test ran while in rehab unit at St. Joseph Mercy. Family also brought the entire cervical collar that have been tried to

Exam was 5/5 in the upper extremity and right lower extremity. She had 5-/5 of her left quadriceps. Tone was normal. Sensation was intact to primary modalities.

The x-rays of Plaintiff’s spine showed normal alignment, no swelling, no fracture or dislocation and normal lordosis of the cervical and lumbar spine. Plaintiff’s left knee x-ray also showed no fracture or dislocation, but moderate decrease in the meduial articular joint space. Plaintiff was given a general diagnosis of neck pain, back pain, low back pain and left knee pain. Plaintiff was prescribed 3 sessions per week for 6 weeks of physical therapy.

Allana saw Dr. Mullins six times during the month of March on 03/03/16, 03/07/16, 03/10/16, 03/14/16, 03/21/16 and on 03/28/16. On 03/07/16, Allana told him that her ultimate goal would be to run longer than 20 minutes without her back “buckling”. She also explained to him that high intensity workouts were her favorite. Throughout the month of March, she continued to have spasms and pain in her upper back, lower back, and in her neck. Her ribs also continued to be very sore. Her diagnoses on 03/21/16 was pain in the lower back, and muscle spasms in her back, neck and mid back. Her diagnosis also included segmental and somatic dysfunction of the head, cervical, thoracic and lumbar spine, her sacrum and sprain of her ribs.

We started by adjusting her chair to help encourage blood flow throughout her legs. We also adjusted the computer monitors and raised the height to bring the primary working area of the screen within her natural line of sight. The monitor was previously raised; Dorothy wears progressive bifocals and this may contribute to awkward neck postures if the dual monitors are at an elevated inclination.