Left Broker Injury: A Case Study

S.P. is admitted to the orthopedic ward. She has fallen at home and she has sustained an intracapsular fracture of the hip at the femoral neck. The following history is obtained from her: She is a 75-year-old widow with three children living nearby. Her father died of cancer at age 62; mother died of heart failure at age 79. Her height is 5’3 and weighs 118 pounds. She has a 50 pack year smoking history and denies alcohol use. She has severe Rheumatoid Arthritis (RA) and had an upper GI bleed in 1993 and had Coronary Artery Disease with CABG 9 months ago. Since that time, she has engaged in “very mild exercise at home.” Vital signs are 128/60, 98, 14, 99 degree farenheight (32.7 degrees C) SAO2 94%

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.

DOI: 1/23/2014. This is a 36- year old male relief driver who sustained injury while he was putting away the automatic tarper when he was struck on the right shoulder and got driven into the ground and twisted his right foot. Per OMNI, he was diagnosed with right shoulder strain, and back/neck/right foot fracture. As per office notes dated 6/3/16, the patient is complaining of numbness in all extremities specifically the bilateral feet, arms and bilateral elbows. He has had a flare-up of pain that past couple of weeks around lateral column of the right foot made worse with walking and standing. He has been taking Neurontin 300 mg thrice a day which is helping control his symptoms. He apparently had a bilateral upper extremity upper extremity

R.P. is a 74-year-old married Caucasian female that is a homemaker that lives at home with her husband. Reason for her care is due to a recent fractured left hip and left wrist. She stated that she slipped on a rug in her home and landed on her left side. R.P. reports pain being 10/10 and sharp and radiates all over body stating, “even the slightest touch of skin hurts so much”. It all began a few minutes after the fall. Pain is alleviated with narcotics (hydromorphone and morphine) and immobilization.

Medical Diagnosis: Client was diagnosed with a fractured right tibia bone, and fractured right radial bone. Client has diabetes mellitus type one. Client has history of hypertension and was admitted with chest pain following accident. The client fell off her bicycle while walking her dog.

Patient came into the hospital as an outpatient claiming that they were experiencing tenderness and stiffness in their left shoulder. Upon reading the requisition as well as asking the patient more questions I discovered that the patient had slipped and fell onto the ice 3 days previous. This patient explained that they were reluctant to go to the doctors as they already had stiffness in the left shoulder and they were convinced it was nothing serious. After taking the first image (the AP) it became clear that there was a comminuted fracture of the proximal humerus. A

12/31/15 Progress Report described that the patient has cervical spine, right shoulder, and right wrist pain. She rates her cervical spine at 8/10-scale level and frequent; right shoulder pain at 8/10-scale level; and bilateral wrist pain at 6/10-scale level. The pain is frequent and improved since last visit. Rest and medications make the pain better. Weather

The patient was a 41-year-old male who failed conservative treatment of a SLAP tear and full thickness glenoid and humeral head articular

~Chief Complaint: The patient c/o bulging to the right shoulder possible dislocation with 7/10 localized pain x2 day. The patient states that when she woke up Tuesday she had right shoulder pain with mild swelling and bulging that appear to be her bone. The pain states that she is able to move he arm but it is extremely pain. The patient states that she has been taking Advil and icing her shoulder with very little improvement. She denies possible injury or numbness and tingling in the right arm or hands

On 10/02/2017, the claimant presented with right wrist pain. She reported that the pain interferes with daily activities. She had a weakness, joint stiffness, and joint pain. Objective findings showed swelling, deformity, tenderness, and limited range of motion of the right wrist/hand. She was diagnosed with a pain in the right wrist and Colles' fracture of the right radius (closed fracture). A forearm cast and x-ray of the right wrist/hand were recommended.

PHYSICAL EXAM: Examination shows comparing the right hand to the left, including the hand and wrist region, that there are skin scratches, very superficial, from activity. There is no tenderness. There is no soft tissue swelling. There is normal alignment. No deep tenderness to palpation over the fractures. No crepitus. No instability. Active range of motion is about 85% of the contralateral left side.

Per the medical report dated 02/24/16, the patient had some left knee pain and swelling. On examination, there was some mild swelling along the anterior proximal tibia. He can flex to about 110 degrees and extend to 10 degrees. Of note, X-rays demonstrated plateau fracture fixed with plate and screws in good alignment with early callus. Medications include amlodipine; cefadroxil; diazepam; meloxicam; oxycodone/acetaminophen; rivaroxaban; and sertraline. Diagnoses include status post open reduction

It is crucial to rule out other differential diagnoses such as lateral collateral ligament injury , osteochondritis dessicans, posterior interossesus nerve syndrome , radial head fracture , capitellum fracture and synovitis. (1)

Diagnoses are cervical radiculopathy, right shoulder pain, nondisplaced fracture of the greater tuberosity of the right humerus and right shoulder bursitis. He has reached maximal recovery for his right shoulder. MD is concerned that the elbow and hand pain are related more to his neck as he has a history of cervical radiculopathy and his symptoms are more of tightness than pain that can be localized. He has had epidural injections in the past for left sided radiculopathy. An updated MRI is requested. If there are right-sided findings, he will be sent for possible injection for the upper extremity pain. Otherwise, he will be sent for a second opinion for his continued

HISTORY OF PRESENT ILLNESS: Roger is here to follow up with right proximal humerus fracture. He is a month and a week out. He has previously seen Jake Heiney, MD on July 15th, where he prescribed physical therapy, but patient has been noncompliant and has not done any therapy. His is understandably a little stiff now because of that.