How To Avoid Tissue: A Case Study

O: Inspection of the right shoulder, no redness or edema noted; palpation of the right shoulder there was no warmth noted; on deep palpation TM reports in some tenderness

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

Based on the medical report dated 12/22/16, the patient was last seen on 10/13/16, and was recommended to have continued therapy. He has not had therapy secondary to insurance issues over the last month or so. He presents with ongoing right elbow pain status post cubital tunnel release and medial epicondylitis debridement, worsening with motion and activity, lifting, reaching, bending, upper extremity dressing, household

DOI: 3/19/2015. Patient is a 63-year-old right hand dominant male janitor who sustained injury while he was mopping when he began having right shoulder pain. Per OMNI, he was initially diagnosed with right shoulder impingement syndrome, neck strain and right shoulder strain.

On Primary Treating Physician’s Progress Report (PR-2) dated 08/11/2017, the patient presented with unchanged symptoms. His left-hand pain was rated at 8/10. and was described as constant and sharp. The pain was aggravated with certain movements and gripping. The

Are the requests for 1 Right Thumb Spica Splint; and 18 Physical Therapy Visits for the Right Wrist between 6/17/2016 and 8/16/2016 medically necessary?

Even with active assistance, the patient can only achieve approximately 140 degrees of forward elevation, 60 degrees of external rotation, and internal rotation barely to his upper sacrurn. He has 4/5 supraspinatus weakness and pain. Internal and external rotation strength seems to be normal. He has a nonspecifically painful Neer’s, Hawkins, and O’Brien’s test. His proximal biceps and acromioclavicular (AC) joint are both very tender to palpation.

Per the PT attendance report dated 09/11/15, the patient has had 8 sessions to bilateral shoulders from 07/27/15 through 08/19/15.

Based on progress report dated 03/09/15, the patient reported of persistent left shoulder pain. She has attended at least 12 PT sessions with non resolution of her symptoms. Due to left shoulder pain with positive impingement test despite 7 weeks of conservative care with NSAIDS, muscle relaxant and PT, left shoulder MRI for further evaluation is recommended. PT for 3 times a week for 4 weeks is also requested. She was advised to continue Anaprox and Flexeril.

Per IME report dated 9/27/2013 by Dr. Philip D’Ambrosio, the patient has reached MMI to the right shoulder, right ankle, right elbow, and right knee. At this time, he requires no further treatment other than for documented exacerbation.

On 08/07/2017, the claimant presented for a physical therapy initial examination. He had left arm pain. It was noted that he would return to work the day after the visit with restrictions of no lifting more than 10 pounds. Objective findings showed painful swelling and tenderness in the left distal biceps tendon. Physical therapy for 2-3 times a week for 8 weeks was recommended.

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.

Based on the medical report dated 12/15/16, the patient complains of pain to her neck and bilateral wrists. Patient has right sided cervical pain with numbness and tingling down the right arm,

Impressions are the following: cervical disc bulge and disc protrusion; left C6 radiculopathy; bilateral shoulder tendinitis impingement status post left shoulder arthroscopic procedure on 08/12/12; right shoulder arthroscopic procedure on 04/04/13; lumbar disc herniation; right L5 radiculopathy; lumbar discectomy on 07/17/13; lumbar fusion on 03/24/15; cervical and lumbar myofascial derangement; right elbow lateral epicondylitis; left wrist sprain status post left wrist carpal tunnel release; cervical and thoracic myofascial derangement; status post right carpal tunnel release and tenosynovectomy; status post cervical anterior cervical discectomy and fusion (ACDF); and status post recent right cubital tunnel release.

S: TM works in GA Final B; Door Sub. According to, TM, his right shoulder began to hurt on right Thursday, he thought, over the weekend with adequate rest, ice and some Advil will get him better, but his right shoulder didn’t get better but worse. That’s when he decided to come to HMMA Medical Clinic. TM reports his right shoulder pain is 7/10, he couldn’t even perform his ADL this morning because he couldn’t raise his right arm above his waist level because of the pain. TM reports his pain is in his AC, deltoid region, and pectorals major area. TM denies acute trauma or previous injury to the location. TM denies numbness or tingling sensation radiating down to his hand