01/24/____   JANE DOE         #00-00-0-0

  Jane is seen in consultation from Dr. Long with pain in her left elbow area.  She is right-handed.  She states that just before Christmas she was carrying a vacuum sweeper up the stairs in her left arm and hand, it started to drop and she grabbed really hard for it.  She had sharp pain in her left elbow area. It has bothered her since that time.  She has tenderness over the lateral epicondyle.

  On EXAMINATION, she has full range of motion.  The elbow flexion, extension, pronation, supination, circulation, and sensation are intact.

  X-rays are completely normal of the left elbow.

  My feeling is she has evidence of lateral epicondylitis.

  In an attempt to give her relief, the left elbow is injected with 9 mg of Celestone under sterile fashion.  She is advised to put ice on it tonight.  She is to recheck in a month's time. If it has not improved, we will go further.  If it has improved, she will cancel her appointment.

Doctor Jones/ht:___

01/00/____   JEN DOE         

#00-00-00-3

  Jen comes in because of pain in her right hip area.  Pain radiates from her low back down the lateral right thigh, down into the lower leg area into the calf region.  She was concerned about her hip.  X-rays of her hip show the left hip to be in good position, no sign of loosening.  The right hip shows mild to moderate degenerative change but it is unchanged from 2-1/2 years ago. Hip range of motion is really quite good without discomfort. She is tender at the right SI joint and the right trochanteric area.

  My impression is her symptoms are related to her spinal stenosis. She has had right leg pain with dysesthesias and radicular pain before.  This would correspond to our current findings but are not related to the hip joint.  She has no groin pain, etc.  In an attempt to give her relief, the low back area and the right SI joint is injected with 80 mg of Kenalog.  The right posterior trochanteric area is injected with 80 mg of Depo-Medrol.  She will return to the clinic p.r.n. no relief of her symptoms.

Doctor Jones/ht:___

12/10/____   RON DOE          #00-00-00-8

  Ron Doe returns with continued discomfort in his right shoulder area.  He uses the cane in the right hand.  He pushes himself up.  New x-rays show severe degenerative change of the shoulder. The humeral head rides up under the chromium and I am sure with walking with a cane and pushing up and down from a sitting position, this puts pressure and irritates the shoulder area as well.  He is advised to use a cane in the left hand to avoid trying to push himself up with the right arm as much as he can.  He has pretty much had resolution of the ecchymosis about the shoulder area.  He is instructed in circumduction exercises. 

 

  In an attempt to give him relief, 80 mg of Depo-Medrol is injected

  into the biceps tendon sheath and 80 mg in the glenohumeral

  joint.  He will use ice on it for pain.  He will return to the

  clinic p.r.n. no relief of his symptoms.

Doctor Jones/ht:___

12/22/____   JANEY DOE        #09-09-06-22

  Janey Doe is seen in consultation from John Smith ofState Center because of radicular pain down the right leg with complaints of right foot numbness. 

  She has had some therapy without significant relief.

  She has had x-rays done and an MRI.  They show normal hip films. They show marked degenerative change of the lumbosacral spine area on her plane films and her MRI shows severe spinal stenosis at L3-4, L4-5 with moderate to severe at L2-3 and L1-S2.

  These findings would be consistent with her symptoms of pain down the leg.  There is no evidence of cancer or tumor in the MRI studies or plane films.  This was her main concern that she is worried about cancer.  She states she feels a 1000% better when she has been reassured that she does not have cancer in the bones.  She has enough reason for discomfort based on her spinal stenosis symptoms.  She was accompanied by her daughter and problems of doing such activities as bed making, vacuuming, and pushing snow all increase her problems with her low back area.  She is advised to avoid these if she wants to have continued relief.  She is doing a little bit better at this time.  Straight-leg raising is negative bilaterally.  Gross sensation shows no significant numbness in the right foot at this time. Circulation is good to the lower extremities.

  She weighs 217 pounds.  She is a nonsmoker.  Pulse is 80.  Blood pressure is 158/100.  She is advised to continue with her Aleve. She is advised to restrict these heavy activities as we discussed in terms of bed making, vacuuming, and snow shoveling.  And if her pain flares up or does not continue to resolve, she could be considered for referral to the Pain Clinic for a trial at epidural injections.

Doctor Jones/ht:___

01/24/____   JENNY DOE        #07-07-07-7

07/24/____  CINDY DOE         #07-07-07-7

  Cindy is seen in consultation from Dr. Baughman with pain and discomfort in her right shoulder.  She has a history that she is a 35-year-old woman who has worked at Frigidaire since May 1999.  She is right-handed.  She states she was lifting some top panels off an overhead and she felt like a snap in her shoulder in early summer.  She has had pain since July in the shoulder area.  She says the panels weighed 10 to 20 pounds and she would do about 3000 a shift.  She also has symptoms of right carpal tunnel syndrome in the right wrist and hand but this preceded her job at Frigidaire.

  She complains that she wakes up with a dull ache in the morning over the anterolateral aspect of the shoulder.  That it is tender to touch in this area.  She has been taking Relafen 750 mg twice a day.  She is working tearing some bags open and setting up some mail things but this involves reaching up overhead as well. She has seen the company doctor who has told her that she has had some tendonitis and been treated with therapy in Fort Dodge and not had much relief.  She has been at light duty at work and was on sickness and accident leave for three weeks.  She has been told as well as the tendonitis that she has a deltoid strain.

  On EXAMINATION, she has normal appearing right shoulder.  She has excellent range of motion of the right shoulder equal to the left with no restriction.  She has very good strength and flexion, abduction in internal and external rotation.  Her main finding is positive tenderness and pain over the biceps tendon sheath and a small catching and pain in the subacromial area with full abduction. 

  X-rays which were taken are normal.  They show no

abnormalities in the glenohumeral joint or any calcification

  or degenerative changes around the greater tuberosity.

  My feeling is she has symptoms of acute and chronic bicipital tendonitis of the right shoulder as well as the subacromial bursitis which has irritated the rotator cuff tendon to a slight degree, causing tendonitis here.  She has no tear or weakness that I can identify.

  In an attempt to give her relief, the biceps tendon sheath, the subacromial area are each injected with 60 mg of Depo-Medrol. She is given a work restriction to not do any overhead work for activities for the next six weeks.  She will return to the clinic in a month's time, p.r.n. no relief of her symptoms.

Doctor Jones/ht:___