Iw Treatment Plan

The patient underwent repeat MRI of his right knee on 1/28/16. As per office notes dated 7/25/16, review of system revealed that the patient has a history of weakness, shortness of breath, joint pain, muscular weakness, stiffness and muscular pain, headache and dizziness, as well as nervousness. The patient presents today stating that he would like to have his rod removed. He says that his right knee continues to give out on him and he wants to go on longer than 2 mile hikes without having knee pain and feeling instability. Examination of the right lower extremity revealed that the patient’s incisions are clean, dry, intact, and well-healed. The patient’s knee demonstrates discomfort with patellar grind-the symptoms are consistent with his last several exams, and are relatively unchanged. Knee is stable to varus and valgus stress, however, valgus stress does cause some discomfort on the lateral side. Distal neurovascular status is intact. Impression includes right displaced comminuted fracture of shaft of right femur, initial encounter for closed fracture; right chondromalacia patellae, right knee, and right sprain of other specified parts of right knee, initial

Per the AME report dated 07/08/15, the patient was deemed P & S with regard to her right knee and lumbar spine as of this date. Future medical care includes ongoing exercise program, occasional orthopedic visits, brief periods of PT, anti-inflammatory medications for flares, prescription medications and periodic injections.

Based on the progress report dated 02/02/16, the patient presents for evaluation of his bilateral knee pain. He was last seen on 01/05/2016.

Based on the latest medical report dated 03/08/16 by Dr. Tenuta, the patient presents for his right knee pain. He was seen for back pain approximately a year ago. He has had persistent issues with that. He feels that he has been favoring his knees. He has been having problems going up and down steps. On examination, he has crepitus with patellofemoral range of motion. As of this

Patient was diagnosed with left shoulder pain, status post rotator cuff repair on 07/12/2013, right thigh pain and chronic low back and right lower extremity pain.

Based on the latest medical report dated 12/23/16, the patient is noted to be approximately one year status most recent left knee arthroscopy. The patient is also status post anterior cruciate ligament reconstruction of the left knee, several years ago. The patient is now two years status post revision anterior cruciate ligament reconstruction of the right knee. The patient complains of some discomfort in the right knee.

Based on the progress report dated 08/17/16, the patient continues to have right knee pain without significant improvement, however, he does get some substantial relief when he wears a right knee brace. The medications give him functional improvement and pain relief.

Per medical report dated 12/23/15 by Dr. Ajay Kiri, the patient is developing left-sided knee pain as a consequence and is also developing right leg discomfort with gradual improvement in pain. There is numbness and tingling sensation radiating to the bilateral lower extremities. The pain is described to

DOI: 9/9/2008. The patient is a 50-year-old male security guard who sustained injury to his back, right wrist, and right shoulder when he tripped over a chair and landed on the floor.

Based on the latest medical report dated 12/21/15, the patient complains of persistent severe pain in the lower back radiating to the buttocks and legs, greater on the left side.

DOI: 1/31/2011. The patient is a 61-year-old female family service coordinator who sustained a work-related injury when she fell on the ground. As per OMNI, the patient is status post right shoulder surgery on 5/10/2013, left knee surgery on 11/12/2013 and anterior cervical decompression and fusion C5-7 on 7/11/2014.

12/18/15 Progress Report by Dr. Fuhrmeister described that the patient has right knee pain with radiation to the right leg. She is s/p right knee arthroscopy on 04/22/15. MRI of the right knee on 04/11/15 reported a lateral meniscal tear. It was recommended to have an MRI of a right knee and try PT, over her last visit on 11/16/15. The patient is requesting refills on medications. Her current medications include Opana 15 mg, Topamax 100 mg, Zofran 8 mg, Ambien 5 mg, Paroxetine HCL 20 mg, Omepreazole 40 mg, Baclofen 10 mg and Hydrocodone 5/200 mg. The patient is currently in pain at 5/10-scale level. The patient stated that hydrocodone for breakthrough pain provides inadequate pain relief. The note indicates that the patient is fully aware of risks of narcotics and potential side effects were discussed. There is constant burning and throbbing pain from the knee down laterally. Physical examination revealed an antalgic gait with a limp. She is wearing a brace on the right knee. ROM of the right knee is decreased. There was tenderness to palpation over the right knee. Treatment plan included medications, increase hydrocodone 7.5/325, PT 3 X 8, MRI, and follow-up with surgery. Follow-up is in 1 month.

11/30/15 Progress Report noted that the patient has right ankle pain. Objective findings: X-ray right ankle, osteoarthritis present. Treatment plan included medications.

Pula, the patient complains of right knee pain. She has attempted PT, injections and activity modification without any significant sustained relief. She states that the knee is giving out more and having more spasms than usual. She also states that her patella is feeling bruised, with no new injury. Her symptoms are persisting and actually worsening.

Per AME report dated 5/5/2014, future medical treatment should include MRI of the right hip and lumbar spine, EMG and nerve conduction study, use of oral and topical analgesics and home stretching exercise program. Per the supplemental report dated 9/19/2014, patient was declared permanent and stationary. Attached is another Supplemental to the AME report dated 03/11/15.