Summary: Hip Osteoarthritis

Per medical report dated 01/23/15, the patient reported of middle and lower back pain and bilateral leg pain with tingling. He was diagnosed with thoracic compression fracture and lumbar spondylolisthesis.

DOI: 7/7/2015. The patient is a 48-year-old male cleaner who sustained a work-related injury to his back while moving a heavy bookcase. As per OMNI, the patient was diagnosed with lumbar degeneration, thoracic or lumbosacral neuritis and myofascial pain.

Physical therapy saw the patient, and the result of the examination are as follows; 6/10 left knee pain at rest and during activity (0 no pain, 10 worst pain), manual muscle testing for both upper and lower extremities were 4/5 except left knee flexion/extension 3+/5 due to pain, sensation on both UE/LE were intact to light touch, Stephen requires a moderate assistance of one person for both functional mobility and gait activity. He uses a front wheeled walker up to 35 feet due to decreased balance and antalgic gait from the left knee

Per medical report dated 11/24/15 by Dr. Cano, the patient is complaining of severe numbness in the right hand, tightness around the right worse than left hand. She also associates this with dropping items. She is unable to button her shirts or raise her arms up to her elbows. This is continuous all day long. Also, associated is severe low back pain with numbness, radiation, and muscle spasm in the thoracic area, and numbness and radiation down the right sciatic nerve with severe low back pain. She continued to work, sixteen-hour shifts, seven days a week. At this time, she is unable to function. She states that she has had 24 sessions of physical therapy that has definitely helped her.

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

The patient notes that the injury happen when he was lifting some metal trash trays into a trash bin when he felt a sharp pain in his shoulders. Treatment history notes that the treatment to date has consisted of medications. Of note, the MRI done showed a large full thickness tear with retraction of the tendon. Physical examination of the left shoulder revealed that the range of motion has forward flexion of 0-175 degrees, external rotation of 0-40 degrees, and internal rotation to T12. There is positive Hawkins’ and Neer’s sign for impingement. There is weakness with abduction testing. Treatment plan notes recommendation, surgical intervention in the form of a left shoulder, subacromial decompression, rotator cuff repair surgery as necessary. A follow up of 2 to 3 weeks if surgery is authorized. As per medical summary and work status dated 6/14/16, it was noted that the patient has not improved significantly and would be needing surgery. The patient’s return to work date is 6/14/16 with no lifting over 10 pounds and no overhead reach. Follow up to clinic date is on

DOI: 12/23/2013. The patient is a 64-year-old male foreman who sustained injury when he was involved in a motor vehicular accident. Per OMNI, he has had multiple injuries to the right shoulder, right knee, back and right arm/elbow. He is status post arthroscopic surgery for the right shoulder on 05/30/2014.

Per the IME report on 4/28/16 by Dr. Pierce Ferriter, the patient reports that he is actively treating with physical therapy and chiropractic treatment at a frequency of 3 to 4 times per week. The patient’s diagnoses include resolved lumbar strain, resolved cervical strain, resolved left shoulder strain and resolved right knee strain. There is no medical necessity for further physical therapy, orthopedic treatment of diagnostic testing based on examination.

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.

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.

On 11/21/2017, the claimant presented for a follow-up for his right shoulder. He reported right shoulder pain rated at 3/10. He stated that the range of motion had returned to normal. On examination of the right shoulder, a full range of motion was noted with resolved tenderness. The impingement sign was positive. X-ray of the right shoulder on 10/20/2017 was negative for fracture or dislocation. He was diagnosed with a traumatic arthropathy of the right shoulder. Continued physical therapy was recommended.

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

Hip osteoarthritis is a cause of severe pain and disability but it can be treated well with total hip arthroplasty surgery. Short term THA studies have reported a great improvement in the general health and quality of life and functionality of the hip in subjects with OA. Patient who undergo total hip arthroplasty may have impaired long-term self-reported physical quality of life and hip functionality, but still, they perform physically in a better condition than the ones who are untreated with advanced hip

OA is a musculoskeletal disease that causes chronic joint pain and reduced physical functioning (Laba, brien, Fransen, & jan, 2013). Osteoarthritis (OA) is a non-inflammatory disorder of synovial joints that results in loss of hyaline cartilage and remodeling of surrounding bone. OA is the single most common joint disease, with an estimated prevalence of 60% in men and 70% in women later in life after the age of 65 years, affecting an estimated 40 million people in the United States (Goodman & Fuller, 2009). Women are more commonly affected after the age of 55, almost everyone has some symptoms by the age of 70 (Tan, Zahara, Colburn & Hawkins, 2013, p.78). Osteoarthritis can be described radiological, clinical, or subjective.