Diagnosis : Impingement Syndrome, Right Shoulder

This is a chronic pain patient and has been on pain medication. However, the exact duration of use of opioids is unknown. In addition, there is no documentation of VAS pain levels with or without the use of medication. There is no opioid agreement of file. There is no reported functional benefit and pain relief from the medication. Furthermore, there is no mention of the absence of aberrant behaviors and absence of side effects of Tramadol. In addition, there is no mention of compliance and continued efficacy of the medication. There were no UDS or CURES reports available for review. Medical necessity of Tramadol has not been substantiated. Recommend non-certification. Non-certification here does not imply an abrupt cessation for a patient who may be at risk for withdrawal symptoms. Discontinuance should include a tapering prior to discontinuation to avoid withdrawal

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.

RCT is a common disease. According to general population surveys, the prevalence of rotator cuff tear is 25 % in those older than 50 years of age and 20 % in those older than 20 years of age (1). The rotator cuff is a group of 4 muscles and their tendons supraspinatus, infraspinatus, teres minor, and subscapularis (2). These muscles connect the upper-arm bone, or humerus, to the shoulder blade. The important job of the rotator cuff is to keep the shoulder joint stable. RCT can be caused by degenerative changes, repetitive micro-traumas, severe traumatic injuries, and secondary dysfunctions. Falling on an outstretched hand, unexpected force when pushing or pulling or during shoulder dislocation can cause traumatic injury to the rotator cuff.

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.

The patient notes that the injury happen when he was lifting some metal trash trays into a trash bin when he felt a sharp pain in his shoulders. Treatment history notes that the treatment to date has consisted of medications. Of note, the MRI done showed a large full thickness tear with retraction of the tendon. Physical examination of the left shoulder revealed that the range of motion has forward flexion of 0-175 degrees, external rotation of 0-40 degrees, and internal rotation to T12. There is positive Hawkins’ and Neer’s sign for impingement. There is weakness with abduction testing. Treatment plan notes recommendation, surgical intervention in the form of a left shoulder, subacromial decompression, rotator cuff repair surgery as necessary. A follow up of 2 to 3 weeks if surgery is authorized. As per medical summary and work status dated 6/14/16, it was noted that the patient has not improved significantly and would be needing surgery. The patient’s return to work date is 6/14/16 with no lifting over 10 pounds and no overhead reach. Follow up to clinic date is on

DOI: 11/26/2012. The patient is a 66-year old male janitor who sustained a work-related injury as a result of his job duties over the past 2 years.

DOI: 1/19/2015. Patient is a 44-year-old female machine operator who sustained injury while lifting pieces of cardboard into the machine when she felt pain to both sides of her shoulders and neck. Per OMNI, she was diagnosed with cervical and shoulder sprain/strain.

*insert article *attachedBesides being able to see the inside of a shoulder, doctors use different physical tests to evaluate the shoulder in order to determine what type of injury and how severe an injury may be. One such test was recently developed by Dr. Carl J. Basamania at the Womack Army Medical center in Fort Bragg, N.C. The test was developed to evaluate shoulder instability in a patient. During the test the Dr. or examiner stands next to the patient who is to lay flat on his/her back. The hand of the examined should is held firmly by the examiner. The examiner then pushes against the clavicle to stabilize th scapula, while they also gently hold the pectoral muscle with their thumb in order to be able to assess relaxation. The examiner then rotates the arm form neutral to full external rotation. If the patient has AIGHL incompetence there is a lack of tightening as the arm reaches full external rotation. The test has appeared to be highly accurate and may be of value to Dr.'s and surgeons alike. After doctors have determined what type and what degree of injury a patient has sustained using various tests it is on to the next step, rehabilitation.

Rotator cuff tendons are prone to degeneration leading to swelling with sub-luxation due to continuous active and passive forces. Rotator cuff pathology includes tendinopathy, tendinosis and bursitis, as well as rotator cuff tears. Most common indication for rotator cuff tears include increasing age and traumatic shoulder injury. Clinical symptoms for rotator cuff injuries include shoulder pain, weakness and loss of range of motion. However, these symptoms are common in various diseases; differential diagnosis includes labral tears, glenohumeral ligament tears or sprains, coracoacromial and arcomioclavicular ligament tears and sprains, osteoarthritis, adhesive capsulitis, proximal peripheral neuropathies and cervical radiculopathy. Hence,

Impingement syndrome: As indicated by Shahabpour, Kichouh, Laridon, Gielen, & De Mey (2008, p. 194), magnetic resonance imaging is the imaging tool of choice for evaluation of articular structure and soft tissue of the shoulder; it can aid in the detection of soft tissue anomalies linked to shoulder impingement. Similarly, Wise et al. (2011, p. 605) acknowledge the importance of MRI as an instrument in identifying osseous and soft tissue irregularities that may lead to or be the consequence of shoulder impingement.

On 12/06/2017, the reported occasional soreness in the elbow. The physical examination was unremarkable. An x-ray of the elbow showed a good position of the implant and the tunnel in the proximal radius. A functional capacity evaluation was recommended to determine if he can return to his regular

On 3/15/17 due to a schedule conflict Laurie Wawrzyniak met Mr. Rife at the office of Dr. Wines. Mr. Rife has made positive gain in range of motion with physical therapy. He still reports pain when raising the left arm. A cortisone injection was recommended along with a MRI. The injection was done under ultra sound in the office. While performing the injection under ultra sound Dr. Wines noted the rotator cuff was thinning and he was concerned there was a tear. Dr. Wines recommended a MRI of the shoulder. Physical therapy will continue and treatment options will be. The MRI will be done on 3/15/17. I have advised Mr. Rife to obtain a copy of the MRI CD to bring to the appointment on 3/23/17 with Dr. Wines.

The patient is a 64-year-old gentleman who tells me nine or 10 days ago he started having pain in his right shoulder which started in the morning. He states that prior to this he has been doing increased amount of work at his horse farm. He has had to not only bale hay, he has needed to lift 15 car batteries up onto a platform. He also tells me he caught a heavy "I beam" and felt a jerk of his shoulder several days prior to onset of pain. He states the day after the onset of the pain, he had such back pain, he had a difficult time sleeping. He was taking Advil every six hours, but this was not helping the pain. At that point, the pain was gone up not only in his right shoulder but going up his neck and down his arm. He tells me that he then switched to Aleve, two tablets twice a day and started using ice alternating with heat. He states the ice seems to work magic for him and one week after the pain started he woke in the morning and had no pain. He states that he still gets an occasional twinge, but it is almost completely resolved. He does worry because he works on a horse farm and does not want to have any sort of intervention if not needed. He does occasionally get aches and pains in his shoulders and at this point, this is the state he is in.

The shoulder is the most complex joint in the body. It is capable of moving in more than 16,000 positions. Many of its ailments, including the most common ones, involve biomechanical mechanisms that are unique to the shoulder. The most common shoulder problem for which professional help is sought out for is shoulder impingement (Haig 1996). Shoulder impingement is primarily an overuse injury that involves a mechanical compression of the supraspinatus tendon, subacromial bursa, and the long head of the biceps tendon, all of which are located under the coracoacromial arch (Prentice 2001). Impingement has been described as a continuum during which repetitive compression eventually leads to irritation and inflammation that progresses to

O: on inspection of the right shoulder, no redness or edema noted; on palpation warmth noted; on deep palpation TM reports increased pain; .Pain with abduction at 70 degrees.