Summary Of Lisfranc Injury: A Case Study

~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

I met Mr. Eigner at the office of Dr. Taha. Mr. Eigner reports he is not taking any pain medications at this time. He reports he has a jolting shooting pain to the right and left legs only occasionally. He denied any pain to his right forearm. X-rays taken showed good alignment and healing of the fracture. The incisions are all healed except for a couple small spots on the right ankle. There is some swelling to the right ankle which Dr. Taha said is to be expected. The range of motion to the left ankle and toes was good. The range of motion to the right stores was limited. Dr. Taha said there is scar tissue at times from this type of repair and he would like physical therapy to start working on that. He is still going to be non-weight bearing for another 6 to 8 weeks on the right leg. He is now allowed full weight bearing as tolerated to the left leg. Dr. Taha ordered a rolling scooter to aid with ambulation and stop using the wheelchair. I have contacted Reverence physical therapy and faxed the new orders so the service can begin. I will process the rolled scooter with directions from the adjuster. The attendant care and replacement services will continue through to the next appointment.

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.

Chweyah, dated 08/11/2017, indicated that the claimant presented for a follow-up visit after his discharge from the hospital on 08/08/2017. He was admitted on 08/04/2017 due to normocytic anemia, pain in both knees, starvation ketoacidosis, hypertension, gout with tophus, and duodenitis. The esophagogastroduodenoscopy revealed erythematous duodenopathy, erythematous mucosa in the antrum, and small hiatal hernia. He had a colonoscopy which revealed internal hemorrhoids. Objective findings showed blood pressure of 112/86 with a pulse of 105. He was diagnosed with quadriceps weakness, pain in both knees, normocytic anemia, type 2 diabetes mellitus, hypertension, stable chronic kidney disease stage III, and bilateral impacted cerumen. It was noted that he can return to work on 08/16/2017 with limitations of not standing for more than 10 minutes at a time for 1

Indications: The patient is a 69 year old black female who fell landing on her right hip. She was seen in the Emergency Room where physical exam and x-ray revealed an intertrochanteric right femoral fracture. She was admitted to Dr. Loyd’s service .

The patient is a 50 year old male construction worker who sustained a work-related injury while lifting heavy boxes of metals. In an office visit dated 12/14/13, patient complaints of intermittent severe low back pain which radiates to bilateral lower extremities. The claimant had an epidural injection, which significantly alleviated right leg pain for a short period of time. Unfortunately pain has returned. It is in the right leg as well as severe pain in the lower back. The claimant wishes to consider surgical intervention due to severity of pain. Objective examination reveals weakness in the right extensor halucis longus and anterior tibialis which are 4+/5. The claimant has diminished sensation along the dorsum of right foot. The claimant has a positive straight leg raise.

Axel and skeleton frame injuries are something that are very common in the world of sports. The National Football Ledge(NFL) has a foundation of physical impact and is very strenuous on the axel and skeletal frame. Thoracic disc herniations in the one of the most common injuries the NFL and it requires the greatest amount of time to recover which is 189 days. Thou the injury is very high in football nearly 15 percent of American suffer from Thoracic Disc Herniation. Degeneration the most common cause of Thoracic disc herniation “As a disc's annulus ages, it tends to crack and tear. These injuries are repaired with scar tissue. Over time the annulus weakens, and the nucleus may squeeze (herniate) through the damaged annulus. Spine degeneration

Dr. Leonard diagnosis of Mr. Duszynski include Multi-trauma with rib fractures and bilateral closed ankle fractures. Mr. Duszynski lower extremities were splinted and he was admitted to trauma. Mr. Duszynski was placed on non-weight bearing status to his lower extremities and Dr. Edwards was also consulted.

The symptoms are described as dull and sharp. Weight bearing and putting pressure aggravate the pain. Current pain level is 6/10. The exam of the left lower extremity showed that the pin sites were completely healed. Skin was intact. Pulses were palpable. He was able to range his ankle comfortably. He virtually had no motion of the subtalar joint. His pain was over the lateral part if the subtalar joint. The foot was warm. Pulses were palpable. He was intact neurovasculay. There was no calf pain. Reported CT scan demonstrated that the calcaceus fracture was healed. The patient has post-traumatic subtalar joint arthritis and calcaneal cubital joint arthritis. Plan: steroid injection, shoe wear and activity modification. If conservative treatment fails, he will benefit from a subtalar joint

The patient wants to also update me as far as the arm pain he mentioned last time. He says his left arm is feeling better now. He is noticing that his right shoulder is hurting at times, especially in certain positons such as while he is sleeping and if he has his arm raised over his head while he is lying down. He had no specific injury or trauma. He is not aware of anything that makes it better or worse. He is not using any medication for it thus far. He would be interested in having

S: TM just finished working on a car in the back step off platform into pit, wielding AN Car, and fell back on pipes on his left lateral side. The initial pain was 10 out of 10 and it was difficult to breath related to pain. Now, he rates his pain at 5 to 6 out of 10, aching paint to his left shoulder and his left lateral rib cage. Denies any headache, blurred vision, N/V. Ice X 20 minutes now did helped him with symptoms management.

She said, she fell last night while playing volley ball. She landed on her right shoulder and heard a pop sound, too. She did not take any pain medicines. She applied icepack and felt burning pain. This was an interesting musculoskeletal assessment case. We assessed her right shoulder and compared with the left one. We found slight dislocation of the shoulder joint. She had good circulation in her right arm, no swelling noted in the right hand and the capillary refill was < 2 secs. Mary said, since she had burning pain, it could be a nerve injury, too. We also noted a slight swelling of her trapezius muscle on the right side. She complained of pain on palpation. Mary applied a sling to her right arm to keep it elevated. She may need an MRI to see the damage. Mary sent her to the urgent care. She told her that, since she heard the popped sound, the ER or Urgent care doctor can replace it. It will be a painful procedure, and she will need a strong pain medicine. She gave her the note for her teacher and asked her friend to drive her to the urgent

Majority of the patients that suffer with this injury have to have an open reduction internal fixation (ORIF) in order to correct the issue. The open reduction internal fixation is said to be less invasive on the bone, ligaments, muscles, and tendons, it also will relieve pain and prevent a reoccurring dislocation of the metatarsal.4 After surgery the patient is non-weight bearing for six weeks then will slowly progress to full weight bearing over a course of a couple of months. As for the rehabilitation process, the patient will most likely be in physical therapy for a long period of time. Part of the rehabilitation plan for an LFD consist of picking marbles up with the toes and placing them into a container, tracing the alphabet with the injured foot, balance exercises, and theraband exercises. One of the reason for the rehabilitation process is to regain most of the range of motion back in the ankle and foot. It also helps with rebuilding strength in the muscles of the foot and

If the separation between the base of the first and second metatarsals is less than two millimetres, the recommended treatment is to cast and immobilise the foot until healed. However, the most common form of treatment is surgical and known as open reduction and internal fixation (ORIF). In Figure 4, a radiographic image shows how a surgical screw has been positioned to stabilise and internally fixate the Lisfranc fracture-dislocation (Southerland, Boberg, Downey, Nakra & Rabjohn, 2012).

Upon inspection the contour of the patients abdomen was rounded, symmetric, color appropriate to genetic background, striae present, 6 to 8 round bruises from subcutaneous injections. No apparent pulsations, masses, lesions, rashes, wounds, ascites, scars, or hernias present. Auscultated bowel sounds in all four quadrants; hyperactive sounds heard in lower right quadrant, hyperactive sounds heard in upper right quadrant, normoactive bowel sounds in upper left quadrant, and hyperactive bowel sounds heard in lower left quadrant. Auscultated the aorta, renal arteries, and iliac arteries for vascular sounds, no bruits heard. Lightly palpated the abdomen in all four quadrants, patient felt tenderness on bruised areas, no masses present, abdomen distended. Percussed the abdomen in all four quadrants noting the predominately tympanic in all four quadrants and minimum dullness. The patient’s last bowel movement was around 0830, loose, with no pain. The patient stated having three to five loose bowel movements daily and that, “several bowel movements a day was common for her.” The patient describe the characteristics of her bowel movement as “watery, stinky, and not a large amount”. No prescription medication related to the abdomen. However, patient takes over the counter medication for frequent bowel movements at home. No surgeries related to the abdomen. No laboratory data related to the