Southern Discomfort Case Study

Patient reports left knee pain history of MVA in 2009 and injured left knee. Patient also reports tooth ache 4/10.

The patient stated that overall the symptoms have decreased. Antalgic gait has improved. The pain is decreased but it increases in the morning. The patient reported pain 3/10-scale level. Rom and Muscle strength remained the same. Swelling has decreased. Tenderness to palpation in the lateral and medial malleolus decreased. Muscle testing plantar flexion remains weak. Dorsiflexion remains weak. Review of Systems revealed joint swelling and loss of bladder/bowel control. Treatment plan included PT

Health History: A 25-year-old male injured his left knee in a recent skiing accident. The patient stated that he lost his balance because the inner edge of his right ski got caught while skiing. This resulted in the right leg being externally rotated followed by and audible “pop” as he lost footing. By evening, the right knee joint had become swollen, causing intense pain. The primary care physician referred the case to an orthopedist.

DOI: 7/18/1999. Patient is a 63-year-old male crew leader who sustained a work-related injury when he tripped over a mat at work. As per OMNI, the patient is status post left knee arthroscopy in 2001, knee replacement in 2004 and gastric bypass surgery in 5/2013.

Based on the progress report dated 04/05/16 by Dr. Fieser, the patient complains of pain in the left knee, left ankle and left foot, associated with numbness and tingling in the left leg/foot, as well as weakness in the left leg. He describes the pain as sharp, cutting, throbbing, dull, aching, pressure-like, cramping, shooting and shocking with muscle pain and pins-and-needles sensation.

DOI: 10/17/2012. Patient is a 54-year-old male janitor who sustained injury while emptying water out of bucket after mopping when he struck his right knee on a metal mop ringer. Per OMNI, he was initially diagnosed with right knee contusion.

DOI: 12/13/2012. Patient is a 64-year-old male security officer who sustained a work-related injury to the right knee when he missed a step and fell down the stairs. As per Omni, the patient had a right knee meniscus tear. The patient had right knee replacement on 11/19/14. Per QME Dr. Murphy on 08/11/15, the patient has a 20% whole person impairment rating. Future medical care includes 4-6 visits per year for recurrent symptoms, narcotic/nonsteroidal anti-inflammatory drugs (NSAIDS) in addition to gastrointestinal stabilizing medications, pain management specialist monitoring, office visit with an orthopedic surgeon once a year with X-ray, revision surgery in the future and bone scan.

DOI: 05/13/2012. Patient is a 45-year-old male home attendant who sustained bilateral knees injury when he tripped and fell while he was pushing a client in a wheelchair. As per OMNI, he has undergone right knee surgery on 09/19/2012, 11/01/2013 and 12/10/2014. Patient is status post left knee arthroscopy, partial and lateral meniscectomy, synovectomy and shrinkage of the anterior cruciate ligament (ACL) graft on 12/11/15.

Southern Comfort is often thought of as a whisky, however it is actually a liqueur made from a neutral flavoured spirit with whisky, fruit and spice flavourings.

This is a 58-year-old male with a 5/27/2010 date of injury. He was working in an awkward position underneath a machine on the bottling line when he heard and felt a painful pop in his left knee, as well as a "funny" sensation in his right knee.

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.

Patient has no joint pain .No crepitus assessed in both knees. No limitations in range of motion lower extremities verbalized and observed. Patient has no noted problem with gait

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.

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

OVERVIEW: This case deals with a manufacturer of women’s shoes that purposely changes styles frequently to take advantage of the flexibility of a small organization. However, decision making in the organization follows such a convoluted pattern that conflict is a given. Work flow needs to be re-examined, and adjusted for efficiency.