Flare-Up Case Study

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

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.

Komblatt, the patient underwent extensive chiropractic treatment with 87 sessions from 10/07/11 through 07/11/12. It was opined that it does appear that the IW ha s undergone excessive passive-chiropractic treatment referable to both lumbar spine and right shoulder. It was further opined that the IW has reached MMI regarding the lumbosacral strain and contusion of the right shoulder within approximately 6-8 weeks post injury. Appropriate treatment would have consisted of aggressive right shoulder and low back rehabilitation to include aerobic conditioning, strengthening exercises involving the right upper extremity, lumbar spine and core, and resumption of normal recreational and work activities within 6-8

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: 6/23/2016. Patient is a 42-year-old female registered nurse who sustained injury to her neck/left shoulder when she twisted to keep the attachment from falling to the floor. Per OMNI, she was initially diagnosed with strain to multiple body parts.

DOI: 12/23/2013. The patient is a 64-year-old male foreman who sustained injury when he was involved in a motor vehicular accident. Per OMNI, he has had multiple injuries to the right shoulder, right knee, back and right arm/elbow. He is status post arthroscopic surgery for the right shoulder on 05/30/2014.

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.

Examination of the bilateral shoulder reveals tenderness to palpation about the anterior shoulders bilaterally. There is also restricted range of motion secondary to pain and her supraspinatus weakness and Hawkins’ impingement tests are both positive. In addition, Neer’s impingement and drop-arm tests are also positive.

DOI: 12/20/2008. The patient is a 42-year old female licensed vocational nurse who sustained a work-related injury when she slipped on ice. As per OMNI entry, she was initially diagnosed with right shoulder impingement and neck strain. She had an AME with Dr. Sanders who found her at MMI as of 03/01/2013. Her future medical care includes medications with no indications for surgery.

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

DOI: 10/20/2014. Patient is a 46-year-old male delivery driver who sustained injury while he was unloading fittings and flanges to job site. Per OMNI, he was initially diagnosed with lower back strain/sprain.

DOI: 6/9/2015. Patient is a 55-year-old right hand dominant male breakfast host employee who sustained injury when he picked up a box of milk when he felt pain on his right shoulder to neck and radiating to the right forearm. Per OMNI, he was initially diagnosed with right shoulder impingement, cervical train and benign hypertension.

DOI: 8/23/2012. Patient is a 59-year-old male longshoreman who sustained an injury when allegedly attempted to sway cables that were being lowered and hurt his left shoulder. As per OMNI, he sustained a left shoulder rotator cuff tear/superior labral anterior-posterior tear/impingement, acromioclavicular joint arthritis and bicipital tenosynovitis. On 11/21/2012, he underwent left shoulder rotator cuff repair, debridement of glenohumeral joint, distal clavicle resection and subacromial decompression via acromioplasty.

The patient is a 71-year-old male who sustained an injury on 11/20/14. He underwent a right shoulder arthroscopic subacromial decompression and rotator cuff repair on 02/17/2015. He still presented with some right arm weakness associated with functional