Skin Injury Paper

On 1/16/17 I met Mr. Anderson at the office of Dr. Rampersaud. Mr. Anderson drove to the appointment. He uses 2 canes to walk. He reports that he and his wife drove to Florida on 1/4/17 to 1/15/17. He said they walked everyday while he was there. He reports his pain is a 9. The pain is in the left Si and caudal along with the low back. Mr. Anderson is scheduled for several injections today after we meet with Dr. Rampersaud. Mr. Anderson’s current medications were discussed. I remind Dr. Rampersaud that we are on a tapering process with the medications. Mr. Anderson was instructed to decrease the Dilaudid to 3 times per day from 4; the

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

Based on the progress report dated 08/23/16, the patient complains left knee pain upon walking. Discomfort was described as aching, tingling, intense, severe, continuous, pain, discomfort, increasing with movement and varying with activity. Pain is rated as 5/10 without medications and 4/10 with medications.

DOI: 9/3/2014. The patient is a 30 -year-old male ironworker who sustained a work-related injury when he was struck by a moving rebar. As per operative report dated 9/3/15, the patient underwent retrograde intramedullary nail fixation, right femur and had an implant of a 380 x 11 mm nail with proximal and distal interlock screws. As per physician’s notes on 12/28/15, the patient complains of continued right knee pain. The patient also reports new pain on the side of the knee. On examination of the right knee, there is tenderness to palpation of the lateral joint line. Range of motion of the knee is 0-130 degrees. MRI of his right knee dated 1/28/16 revealed that there is a partial revisualized intramedullary nail in the right femur locked distally.

Treatment rendered to date included medications and physical therapy (PT). The pain was relieved by 50% due to medication use. Surgical history and diagnostics were not provided in the report.

The patient is a 66-year -old retired black male. The purpose of the visit was to determine medication compliance, evaluate functional and mental status and perform a complete physical evaluation. His chief complaint is left knee and foot and calf soreness and ankle swelling without any injury for approximately seven days. He states that he has pain in his left knee, soreness to his calf increases with swelling and redness to his left ankle but no temperature changes to his left leg or foot. He states that his calf pain increases with dorsiflexion of his left foot. He describes the pain in his knee as pressure and rates the pain as 4/10. The pain does not radiate to anywhere other than his calf and knee.

DOI: 8/4/2014. The patient is a 37 -year-old male climber who sustained a work-related injury from repetitive climbing. According to the QME report on 5/27/15, future medical care provisions includes physician visits, medication refills, physical therapy, access for independent aquatic exercise as part of home exercise program, possible additional attempts at injection pain management and surgery.

DOI: 11/15/2010. The patient is a 56-year-old male sales representative who sustained a work-related injury when he tripped on a pallet. As per OMNI, the patient is diagnosed with strain to right knee, right leg and right shoulder and is status post right shoulder diagnostic and operative arthroscopy on 8/10/12.

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

Based on the progress report dated 05/09/16, the patient complains of pain present in the plantar anterior right heel at insertion of plantar fascia into the calcaneus and is present immediately when standing upon first arising in the morning or after sitting for awhile and then standing.

Per the progress report dated 8/4/2016, patient returns with improving symptoms to her left knee and has been undergoing post-operative physical therapy times seven visits and has been utilizing Transcutaneous Electrical Nerve Stimulation (TENS) unit as well. She does still experience significant intermittent post-operative pain which she currently rates as 6/10 in intensity. Patient remains on her current oral analgesic mediations

DOI: 8/26/2007. Patient is a 46 year-old male general production worker who sustained a work-related injury to his left ankle as a result of walking over an uneven driveway. The patient was subsequently diagnosed with tendonitis and degenerative joint disease. As per SOAP notes dated 7/6/16, the patient complains of ankle pain and that he is out of medications. Objective findings reve3aled pain with motion and while in cast. It was further noted that it seems to cycle and stable. Motion in the “STJ” residual from failure of fusion pain producing relative to time on it, in cast/out. Plan notes that left ankle lateral aspect is the area of tenderness. Current medications are Norco and

Findings showed difficulty dorsi flexing her left lower extremity, she had a healed surgical incision on her lateral left calf that measured approximately 7 cm in length, with some dried scabbing on it but no signs of erythema and drainage at the site. On her medical-surgical incision from her fasciotomy, she had a 7 1/2 cm long wound with a 2 cm open part that had some scant bleeding and yellowish granulation tissue present. She stated that she changes her bandages daily and noted that when she pulls the bandage from the scabbing it rebleeds again that was controlled. She was also concerned about being on her feet all day during her recovery. A review of systems was pertinent for gait problem. Physical therapy referral was

10/22/15 Pain management report by Dr. Saidov reported the patient has knee pain. The pain radiates up and down the left leg. The patient describes the pain as burning, aching and dull. The patient reports that the pain is 9/10-scale level on her worst day and 3/10-scale level on her best day. Bending forward, sitting, standing, and walking aggravate the pain. Medications relieve the pain. She has been previously treated with pain medications and PT. The PT was ineffective in controlling the pain. Tramadol was effective. The patient reports no side effects to the medications and states that her functional status improves and her pain is controlled with the medication. The patient is afraid to proceed with the SCS trial secondary to the fear of getting RSD in her spine. The patient admits having sleeping problems. Exam of the left lower extremity revealed decreased temperature in the left knee. There were parasthesias and signs of allodynia in the left leg. Knee stability was decreased on maneuvers and there was severe restricted ROM in all planes. Treatment plan included medication refill for gabapentin, tramadol, clonidine, lidocaine topical and pamelor oral. Follow-up in 1 month.

Pain was controlled initially with multimodal pain therapy with the support of the anesthesia pain service team. The patient was started on deep vein thrombosis prophylaxis with sequential compression devices and lovenox. On post-operative day 0, the patient began working with physical and occupational therapy on progressive mobilization. The patient was transitioned to oral analgesics. By the day of discharge, the pain is well-controlled. The patient is neurologically intact. The patient is ready for discharge from a medical, surgical, and rehabilitation standpoint. Treatment recommendations include continuation of IV vancomycin, start IV ceftriaxone 2 g every 24 hours and continue through 5/27/16, aspirate joint after 2 weeks off antibiotics and await culture results prior to new prosthetic implantation. Recommend “ID” followup in 5 weeks prior to end of therapy. Patient was given activity, diet, and incision/wound care instructions. It was noted that the wound must be kept clean and dry for 14 days. It was noted as well that staples will be removed in 10-14 days after date of the surgery. Removable sutures will also be removed in 10-14 days after