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GSG11241_eddfa15c-9d37-4ac4-81ff-b20e00fd58d3_0
| 1,754,916,393 |
Jeanette Esposito July 1st, 2025 Ms. Esposito comes to the office today with her companion, Faith. I had seen her almost three weeks ago on June 10, 2025. She had a recurrent dislocation of her right shoulder. I had done her rotator cuff repair years ago and she is feeling much better, though she does not have much pain. She does not have much pain. She is a little stiff. She has been wearing the sling. because we told her in her age group 72 years old, after one dislocation, likelihood of recurrent dislocation is small,
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00:00:00.000
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00:00:30.980
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GSG11241_eddfa15c-9d37-4ac4-81ff-b20e00fd58d3_1
| 1,754,916,393 |
but after two dislocations, the likelihood of a third dislocation significantly increases. Also with two dislocations, she has the potential of re-tearing the rotator cuff and damage the axillary nerve, though she does not have any numbness. PHYSICAL EXAMINATION:
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00:00:31.060
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00:00:44.640
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GSG11241_eddfa15c-9d37-4ac4-81ff-b20e00fd58d3_2
| 1,754,916,393 |
Ms. Esposito is a pleasant, cooperative woman. Her temperature in the office is 97.4. Examination of her right shoulder reveals no numbness. She has a nicely healed scar from prior surgery. It is not hot or red. There is really no tenderness. She could forward flex about 65 degrees without any problems. I did not really want to externally rotate her. I did not really want her to abduct. I did not want to put her at any risk of recurrent dislocation. Actually, I really could not do a drop test. I could not do an impingement test. Her biceps looks okay. Neurologically, she is intact.
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00:00:44.760
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00:01:14.200
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GSG11241_eddfa15c-9d37-4ac4-81ff-b20e00fd58d3_3
| 1,754,916,393 |
Can be better than pressure myopathy or genitis. suffered two dislocations, first on April 18, 2025 as a result of fall and the second one while killing a bug on June 4, 2025. Now, it has just been about four weeks since the second dislocation. She looks okay at this point, but I told her to wear the sling when she goes to sleep at night, wear the sling when she goes out to go to a party, but otherwise, take the sling off, and do some gentle forward flexion exercises. I would avoid external rotation. I would avoid any abduction and just be really careful. She is going South Carolina in a few days.
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00:01:14.200
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00:01:43.400
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GSG11241_eddfa15c-9d37-4ac4-81ff-b20e00fd58d3_4
| 1,754,916,393 |
She is going to be back at the end of July. So, she will come see me in end of July. We will check on her. and at that point, we will put her through a little bit more range of motion exercises, but I would not recommend therapy because I am nervous she is going to re-dislocate her shoulder. She is also going to do a cruise in September. Hopefully, she will be okay at that point, But if over the next few weeks, she has poor abduction, then this could represent a recurrent tear of the rotator cuff. She may need an MRI, though she is really not interested in any type of surgery. So, she is fine with this. She must be nice and gentle,
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00:01:43.440
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00:02:12.000
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GSG11241_eddfa15c-9d37-4ac4-81ff-b20e00fd58d3_5
| 1,754,916,393 |
so it may decrease the risk of any type of recurrent dislocation and I will see her back in my office in next four weeks or so once she is back from South Carolina.
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00:02:12.000
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00:02:19.500
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GSG11242_0e5a1ce6-fe88-45f9-9588-a9c3f2abf764_0
| 1,754,916,990 |
Candida Marques, dated July 1st, 2025. Ms. Marques comes to the office today. She has primary degenerative joint disease of both knees. She is here because her right knee is bothering the most. She wants to know if we can do an aspiration and cortisone shot. The last one was multiple months ago and I told her I can. It helps her makes her feel better. She is also going to Portugal in the very end of September. So, I told her if she wants to do it again, we could do that again. PHYSICAL EXAMINATION: Ms. Marques is a pleasant and cooperative woman. Examination of the right knee reveals moderate joint effusion present. She cannot fully extend or flex. She has some minimal diffuse tenderness. No gross evidence of instability. She walked with a mildly abnormal gait.
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00:00:00.000
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00:00:32.840
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GSG11242_0e5a1ce6-fe88-45f9-9588-a9c3f2abf764_1
| 1,754,916,990 |
CANDIDA MARQUES – 07/01/2025 CONTINUED IMPRESSION: My impression is that Candida Marques Marquez has got primitive joint fluency both knees which the right knee is much more significantly uncomfortable period. She wants me to do an aspiration cortisone shot which I find completely acceptable period. New paragraph. I want to thank the NECI. Aspirated 18 cc school shell fluid. Gave the injection 1 cc of 0.125% Marcaine without epinephrine along with 6 mg of betamethasone acetate, 6 mg of betamethasone sodium phosphate, Macro four cortisone shot. Ice it, take it easy, come to see me a few days before she goes to Portugal.
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00:00:32.840
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00:01:02.000
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GSG11242_0e5a1ce6-fe88-45f9-9588-a9c3f2abf764_2
| 1,754,916,990 |
We can always do this again for her right knee and possibly her left knee also. Possibly, when she comes in to see me the next time, maybe repeating x-rays of both knees would be appropriate.
|
00:01:02.000
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00:01:10.320
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|
GSG11244_a5d52e41-e400-4554-a1ac-1532e2b320b0_0
| 1,754,923,430 |
Now dictating JOAN DABON, 07/01/2025 Ms. Dabon comes to the office today. Five days ago, on June 26, 2025, I did release of the right first dorsal extensor compartment of her wrist, and she states she is doing great. No pain, no discomfort, happy about the results, no troubles with anesthesia, and she took a couple of Tylenol and she already went back to regular duty tomorrow. PHYSICAL EXAMINATION: Ms. Dabon is a pleasant, cooperative woman. Her temperature in the office is 97.2. Examination of the right wrist revealed nicely healed incision.
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00:00:00.000
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00:00:32.740
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|
GSG11244_a5d52e41-e400-4554-a1ac-1532e2b320b0_1
| 1,754,923,430 |
The sutures were removed. Wound was Steri-Striped. She had good range of motion. No localized tenderness. No triggering of the A1 pulleys. No subluxation of the extensor tendons. Negative Finkelstein test and neurologically normal. My impression is The bond released at the right first dorsal extensor compartment on June 26, 2025, five days ago, for which her outcome has been excellent. She has no pain, no problems. Her incision looks good. The sutures were removed and she is happy about the results. So, I told Ms. Dabon in a couple of weeks, she is going to get a little bit of scar tissue. Work on some deep friction massage, otherwise her outcome has been excellent. otherwise her outcome has been excellent.
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00:00:33.260
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00:01:07.680
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GSG11244_a5d52e41-e400-4554-a1ac-1532e2b320b0_2
| 1,754,923,430 |
I sometimes send people to therapy, but her motion is full. She does not really look like she has any problems at all. So, if it bothers or if she has any difficulties, then she is obviously welcome back for repeat evaluation.
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00:01:07.680
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00:01:18.040
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GSG11245_14095c0b-2c45-48e9-bcac-6666b1946100_0
| 1,754,924,591 |
now dictating follow-up note on CHRISTOPHER M. CHERVENYAK 07/01/2025 Mr. Chervenyak comes to the office today. I performed surgery on his right shoulder five days ago, on June 26, 2025, when he had an evaluation under anesthesia, manipulation under anesthesia, operative arthroscopy of the right shoulder, abrasion arthroplasty of the humeral head, extensive debridement, subacromial decompression, excision of the distal clavicle, mini arthrotomy, rotator cuff repair. I gave him a copy of the pictures. Everything went fine. He has not a lot of pain. There is a little achiness. The block worked great. He had no troubles with anesthesia. He finished the antibiotics.
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00:00:00.000
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00:00:34.440
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GSG11245_14095c0b-2c45-48e9-bcac-6666b1946100_1
| 1,754,924,591 |
he's not taking any pain medications, period. He was able to drive today, period, and break a physical examination. Giovene, he was supposed to go out with a male, an examination of his right shoulder, he healed nicely, he healed incisions, the state of the wound, the wound was stereotyped, Temperature in the mail, examination of his right shoulder, nicely healed incision, Staples were removed and wound was Steri-Striped. His temperature in the office is 97.7. He could abduct and forward flex to about 45 degrees and passively about 120 degrees. He had about 30 degrees of active internal and external rotation and passively about 40 degrees. I did not do a drop test or an impingement test because he just had a rotator cuff repair.
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00:00:34.640
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00:01:03.760
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GSG11245_14095c0b-2c45-48e9-bcac-6666b1946100_2
| 1,754,924,591 |
I took out all the original stitches that were present. It was a small tear, so I think we can push him a little bit more gently on regaining active range of motion. Neurologically, he is normal. X-RAYS: AP and lateral x-rays of the right shoulder demonstrate he is status post subacromial decompression and excision of distal clavicle. Mr. Christopher Chervenyak had surgery five days ago on June 26, 2025, when I did an evaluation under anesthesia, manipulation under anesthesia, operative arthroscopy of the right shoulder, abrasion arthroplasty of the humeral head, extensive debridement,
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00:01:04.760
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00:01:32.380
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GSG11245_14095c0b-2c45-48e9-bcac-6666b1946100_3
| 1,754,924,591 |
he also had a subacromial decompression, excision of distal clavicle, mini arthrotomy, and a rotator cuff repair. repair period. I think everything went well. The rotator cuff tear was small. I was able to repair the rotator cuff, so I think we can treat him more like a bad arthroscopy rather than six weeks of passive range of motion. He is completely fine with this. He is already working on active range of motion. He is just being careful. So, at this point, Mr. Chervenyak will start his physical therapy. For the first three weeks, let us work on passive range of motion, then come to see me in three weeks and we will work on active range of motion, but it is going to take a few months for him to rehab and build his strength back up to normal.
|
00:01:32.480
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00:02:03.760
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GSG11245_14095c0b-2c45-48e9-bcac-6666b1946100_4
| 1,754,924,591 |
So, I gave him a note for out of work. He will do the rehab. Medication wise, he is not taking anything, which is fine. And I will see him back in my office in three weeks.
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00:02:04.220
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00:02:11.200
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GSG11248_d09dba7e-2122-4f80-8839-ecccc7d0e896_0
| 1,754,911,729 |
now dictating follow-up note on RODRIGO ORTEGA-OLIVO three and a half months ago, where he sustained a minor compression fracture of the superior endplate of T11 and L2 along with a little bit of a right frozen shoulder. He is doing much better. He does not really have back pain.
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00:00:00.000
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00:00:29.540
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|
GSG11248_d09dba7e-2122-4f80-8839-ecccc7d0e896_1
| 1,754,911,729 |
He does not really have shoulder pain. He still notices reaching behind his back, he is little bit stiff, but otherwise he has finished his therapy. He is not taking any pain medications. He is happy about the outcome. I've been giving him notes for light duty but as far as he is concerned he can go back to regular duty tomorrow. He has no other complaints. He can stand, bend, walk, squat, push, pull, lift, carry, and sleep. PHYSICAL EXAMINATION: Mr. Ortega-Olivo is a pleasant and cooperative male. His temperature in the office is 97.0. Period. Examination of the right shoulder. no muscle spasm, no trigger points, no ecchymosis, erythema, abrasion, discoloration, edema, or localized tenderness. Period. He has full abduction, full forward flexion full external rotation.
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00:00:30.040
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00:01:04.880
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GSG11248_d09dba7e-2122-4f80-8839-ecccc7d0e896_2
| 1,754,911,729 |
He lacks a little bit of internal rotation of his right shoulder. Negative Neer test, negative Speed test, negative O’Brien test, negative belly press test, negative lift-off test. No deformity of the biceps. Examination of the patient's lumbar spine revealed there was no swelling. X-RAYS: AP and lateral x-rays of the thoracic spine demonstrate completely healed barely visible superior endplate fracture of T11 X-rays of the lumbar spine AP and lateral showed healed minimal compression deformity of the superior endplate of the body of L2.
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00:01:04.880
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00:01:34.000
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|
GSG11248_d09dba7e-2122-4f80-8839-ecccc7d0e896_3
| 1,754,911,729 |
My impression is that Rodrigo Ortega-Olivo was involved in a work-related accident three-and-a-half months ago on March 16, 2025, sustaining minor compression fracture of superior endplate of T11 and L2 and a minor right frozen shoulder. At this point, other than lacking a couple of degrees of internal rotation of the right shoulder, he has no other complaints. At this point, other than lacking a couple of degrees of internal rotation of the right shoulder, he has no other complaints. His examination was normal. His x-rays show excellent healing of the fracture of the thoracic and lumbar spine, and he has finished his therapy. He has been instructed on home exercises. He is not taking any pain medication. He takes calcium and vitamin D per my recommendation. and as far as work goes, he would like to go back to regular duty tomorrow.
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00:01:34.000
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00:02:06.180
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GSG11248_d09dba7e-2122-4f80-8839-ecccc7d0e896_4
| 1,754,911,729 |
So, at this point, Mr. Ortega-Olivo can return to regular duty as of July 2, 2025 without restrictions. as of July 2, 2025 without restrictions. I will consider him to be MMI. I answered all of his questions for him and he was discharged from the office. Complaint goes to Great American Strategic Compost. This is Fox 4080, Clinton, Iowa. 52733, Attention, H-U-G-H, Spiegelman, S-P-I-E-G-E-L-M-A-N. Clemens A. Zanartho, 00703618. For his S-U-P-R-E-M-O, Foods, Common, LLC. Fox Capital Rosa Stagnitta, Genex. It's 877-883-4947. Thank you.
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00:02:06.360
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00:02:38.400
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GSG11248_8414f902-02eb-4281-9063-bda83e0b0e2f_0
| 1,754,912,276 |
now dictating follow-up note on RODRIGO ORTEGA-OLIVO – 07/01/2025 Mr. Ortega-Olivo had been involved in a work-related accident on March 16, 2025, three-and-a-half months ago, where he sustained a minor compression fracture of the superior endplate of T11 and L2 along with a little bit of a right frozen shoulder. He is doing much better. He does not really have back pain.
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00:00:00.000
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00:00:29.540
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GSG11248_8414f902-02eb-4281-9063-bda83e0b0e2f_1
| 1,754,912,276 |
He does not really have shoulder pain. He still notices reaching behind his back, he is little bit stiff but otherwise, he has finished his therapy. He is not taking any pain medication. He is happy about the outcome. I have been giving him notes for light duty, but as far as he is concerned, he can go back to regular duty tomorrow. He can stand, bend, walk, squat, push, pull, lift, carry, and sleep. PHYSICAL EXAMINATION: Mr. Ortega-Olivo is a pleasant and cooperative male. His temperature in the office is 97.0. Period. Examination of the right shoulder. Don't know muscle spasms, trigger points, no achy most, erythema, braids, discoloration, femur, localized tenderness. Period. He's got forward flexion, full forward flexion. Full external rotation.
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00:00:30.040
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00:01:04.880
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GSG11248_8414f902-02eb-4281-9063-bda83e0b0e2f_2
| 1,754,912,276 |
He lacks a little bit of internal rotation of his right shoulder. Negative near test, negative Speed test, negative O’Brien test, negative belly press test, negative lift-off test. No deformity of the biceps. Examination of the patient's lumbar spine revealed there was no swelling. New paragraph x-rays. APLX lateral extrapastic spine demonstrate completely healed, barely visible superior end plate fracture of T11. x-rays of the lumbar spine AP and lateral showed healed minimal compression deformity of the superior endplate of the body of L2.
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00:01:04.880
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00:01:34.000
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GSG11248_8414f902-02eb-4281-9063-bda83e0b0e2f_3
| 1,754,912,276 |
My impression is that Rodrigo Ortega-Olivo was involved in a work-related accident three-and-a-half months ago on March 16, 2025, sustaining minor compression fracture of superior endplate of T11 and L2 and a minor right frozen shoulder. At this point, other than lacking a couple of degrees of internal rotation of the right shoulder, he has no other complaints. At this point, other than lacking a couple degrees of internal rotation of the right shoulder, he has no other complaints. His examination is normal. His x-rays show excellent healing of the fractures of the thoracic lumbar spine. And he's finished his therapy. He has been instructed on home exercises. He is not taking any pain medication. He takes calcium and vitamin D per my recommendation. and as far as work goes, he would like to go back to regular duty tomorrow.
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00:01:34.000
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00:02:06.180
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GSG11248_8414f902-02eb-4281-9063-bda83e0b0e2f_4
| 1,754,912,276 |
At this point, Mr. Ortega-Olivo can return to regular duty as of July 2. 2025 without restrictions. I will consider him to be MMI. I answered all of his questions for him and he was discharged from the office. Complaint goes to Great American Strategic Compost. This is Fox 4080, Clinton, Iowa. 52733, Attention, H-U-G-H, Spiegelman, S-P-I-E-G-E-L-M-A-N. Clemens A. Zanartho, 00703618. For his S-U-P-R-E-M-O, Foods, Common, LLC. Rosa Stagnitta, RN, nurse case manager from Genex. It's 877-883-4947. Thank you.
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00:02:06.360
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00:02:38.400
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GSG11249_24cf4bdb-e5c9-4244-a9b0-292f74ce4a66_0
| 1,754,912,643 |
Now dictating follow-up note on Rosa Velez – 07/01/2025. This is an office visit of this 54-year-old right-hand dominant woman, who I had seen back in September of 2024 with regards to calcific tendinitis and bursitis of her right shoulder. I gave her a cortisone shot. Recently over the last couple of months, it has been bothering her. She has some pain, some pain with rotation, pain with overhead activities. There has been no new injury and it does not hurt as much as it hurt when I had seen her almost a year ago. PHYSICAL EXAMINATION:
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00:00:00.000
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00:00:30.360
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GSG11249_24cf4bdb-e5c9-4244-a9b0-292f74ce4a66_1
| 1,754,912,643 |
Ms. Velez is a pleasant and cooperative woman. Her temperature in the office is 97.9. Examination of the right shoulder. reveals some very minimal tenderness over the anterolateral aspect. She lacks about the last 5-10 degrees of abduction and forward flexion, 10 degrees of internal rotation, and about 5 degrees of external rotation. Very weakly positive impingement test, negative drop test, negative sulcus sign, no subluxation, negative belly press test, negative lift-off test, negative Speed test, negative O’Brien test. AP and lateral x-rays of the right shoulder demonstrate a huge amount of multiple calcifications over the area of the greater tuberosity. I reviewed her x-rays done previously back on September 23, 2024. They were pretty similar.
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00:00:30.520
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00:01:03.220
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GSG11249_24cf4bdb-e5c9-4244-a9b0-292f74ce4a66_2
| 1,754,912,643 |
My impression is that Rosa Velez She has very significant calcific tendinitis/bursitis of her right shoulder. She had a similar problem about a year ago. I gave her a cortisone shot. It got better. The problem came back in the last month or so. I told her I can give her another cortisone shot. Hopefully, that will resolve the problem. If it does, that is great. If it does not and it keeps coming back frequently, then we talked about MRIs. We talked about operations, but hopefully that can be avoided. She was fine with that. So, under sterile technique, into the maximum tenderness in the anterolateral aspect of the right shoulder, gave her an injection of 1 cc of 0.5% Marcaine without epinephrine,
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00:01:03.380
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00:01:35.240
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GSG11249_24cf4bdb-e5c9-4244-a9b0-292f74ce4a66_3
| 1,754,912,643 |
6 mg of betamethasone acetate and 6 mg of betamethasone sodium phosphate. I told her to ice it, take it a little bit easy, be gentle. If she wants to take an Advil, that is fine. And if the pain gets worse or bothers more in the future, to let me know. Sometimes, one cortisone shot may not be adequate. So, if she needs another cortisone shot in the near future, considering how large the calcification is, just give me a call and I will set her up for that.
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00:01:35.240
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00:01:57.020
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GSG11250_7b0f6299-20a1-4c1e-9626-0f6303f85f50_0
| 1,754,913,322 |
now dictating follow-up note on Hernan Lucero Date is July 1, 2025. Mr. Lucero comes to the office today accompanied by Rosa Stagnitta, his nurse case manager. His English is good, but Rosa helped to translate along with Jose in my office between Spanish and English. Mr. Lucero had injured his right shoulder at work on January 31, 2025. He has undergone conservative treatment, cortisone shots, physical therapy, ice, Motrin,
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00:00:00.000
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00:00:32.000
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GSG11250_7b0f6299-20a1-4c1e-9626-0f6303f85f50_1
| 1,754,913,322 |
and because he was still having pain, I sent him for an MRI of his right shoulder that was done at University Radiology at Trinitas on June 12, 2025, which was interpreted as full thickness tear of the supraspinatus tendon and infraspinatus tendon, low grade partial tear of the subscapularis tendon, reactive subdeltoid bursitis, AC joint moderate osteoarthritis. I reviewed an aged MRI report, and it commented on full thickness tear of the rotator cuff and some degenerative arthritis
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00:00:32.000
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00:01:01.740
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GSG11250_7b0f6299-20a1-4c1e-9626-0f6303f85f50_2
| 1,754,913,322 |
in the glenohumeral joint. There is also arthritis in the AC joint. The interpretation is a chronic tear of the rotator cuff. Mr. Lucero states he is better. He has less pain and discomfort, period. He's doing his regular job. He's been doing home exercises and he definitely has less pain as compared to previously. He has no trouble sleeping, period. He broke a physical examination. Mr. Lucero is a pleasant and cooperative male. His temperature in the office is 98.5. Examination of the right shoulder.
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00:01:01.740
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00:01:31.000
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GSG11250_7b0f6299-20a1-4c1e-9626-0f6303f85f50_3
| 1,754,913,322 |
revealed some minimal tenderness present anterolaterally. He has good range of motion at this point. Maybe lacks a couple of degrees of internal rotation. very weakly positive impingement test, negative drop test, negative sulcus sign, negative lift-off test, negative Speed test, negative belly press test, negative Neer test, negative drop test. I went over Mr. Lucero’s actual MRI of his right shoulder done at University Radiology at Trinitas on
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00:01:31.000
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00:01:56.240
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GSG11250_7b0f6299-20a1-4c1e-9626-0f6303f85f50_4
| 1,754,913,322 |
June 12, 2025. It shows tear of both the supraspinatus and infraspinatus tendons with about greater than 10 mm of separation. There is no significant atrophy. There is hypertrophic change of the AC joint. There was a small amount of bursitis present. There was some inflammation around the biceps. Hernan Lucero was involved in a work-related accident on January 31, 2025, where he injured his right shoulder.
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00:01:58.240
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00:02:24.880
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GSG11250_7b0f6299-20a1-4c1e-9626-0f6303f85f50_5
| 1,754,913,322 |
shoulder. His MRI of his right shoulder does show complete tear of the rotator cuff. The age report comments that this appeared to be a chronic problem, but considering his MRI, injury of January 31, 2025, more than four-and-a-half months ago, this could be interpreted as a chronic tear of the rotator cuff. In turn, he does not have significant atrophy. He does not have a large retracted rotator cuff tear and he has no elevation of the humeral head and the glenoid.
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00:02:24.880
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00:02:54.300
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GSG11250_7b0f6299-20a1-4c1e-9626-0f6303f85f50_6
| 1,754,913,322 |
In turn, though Mr. Lucero does have evidence of a torn rotator cuff of his right shoulder, he is not overly symptomatic. He has minimal discomfort. I explained to Mr. Lucero the options for torn rotator cuff were conservative versus surgical. He has already had conservative treatment with regards to anti inflammatory medication, medication, cortisone shot, physical therapy and he feels much better. At this point, he does not want any type of operation. He wants to know if he changes mind in the future, is that possible that he could that, and I told him he can. In turn, he is happy about the results. So, I told him if he is happy about the results, then I would live with this problem. If it gets worse
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00:02:54.300
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00:03:23.860
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GSG11250_7b0f6299-20a1-4c1e-9626-0f6303f85f50_7
| 1,754,913,322 |
in the future, you can always consider additional treatment in the future. So, at this point, he can continue with regular duty. I will consider him to be MMI. I discussed all the options with regards to surgery versus conservative care and he wants to go conservatively. I do not need to see him unless there are further problems or difficulties. Compensation letter goes to Gray America Strategic Compost, box 4080. Clinton, Iowa, 52733. Attention, Mary Mouton, M-U-N-T-O-N-E. Claim is A.S. Northwood, 00691850. Closed Brown, Beardimian Integrated Logistics.
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00:03:23.860
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00:03:53.060
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GSG11250_7b0f6299-20a1-4c1e-9626-0f6303f85f50_8
| 1,754,913,322 |
Fax capital rose is standing at GenX at 877-883-4947. Thank you.
|
00:03:53.160
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00:03:58.020
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|
GSG21245_afb4ff0d-023c-4361-97f9-9de0a2500faa_0
| 1,754,916,121 |
now dictating follow-up note on CRISTIANE COLOMBO July 1st, 2025. Ms. Colombo comes to the office today. Her date of injury goes back to February 18, 2025, where she injured her right shoulder at work. I operated on her right shoulder on May 29, 2025, four-and-a-half weeks ago when she had an evaluation under anesthesia, I operated on her right shoulder. Debridement of the partial tear of the rotator cuff. Extensive debridement, subpectoralis biceps tenodesis. And she is doing way better. Motion is improved. She has less pain. She drove today. She is not taking any pain medication and she is happy about the results.
|
00:00:00.000
|
00:00:32.240
|
|
GSG21245_afb4ff0d-023c-4361-97f9-9de0a2500faa_1
| 1,754,916,121 |
All the exercises they gave her to do in therapy, she has been doing on her own at home. I have reviewed her therapy notes from Total Care Physical Therapy. Ms. Colombo is a pleasant and cooperative woman. Her temperature in the office is 97.8. Examination of the right shoulder revealed nicely healed arthroscopic portals. She has a nicely healed subpectoralis incision. It is either not hot or red. There is no drainage. Her range of motion is way better as compared to previously. She has about 130 degrees of active abduction and forward flexion, passively a little bit better.
|
00:00:32.900
|
00:01:04.000
|
|
GSG21245_afb4ff0d-023c-4361-97f9-9de0a2500faa_2
| 1,754,916,121 |
She has about 50 degrees of internal and external rotation actively, passively a little bit better. Negative impingement test, negative drop test, no deformity of the biceps. Neurologically, she is intact. IMPRESSION: My impression is that Cristiane Colombo was involved in a work-related accident on February 18, 2025, where she injured her right shoulder. where she injured her right shoulder at work. This was over failed conservative treatment. I operated on her right shoulder approximately four-and-a-half weeks ago on May 29, 2025, when she had an evaluation under anesthesia, operative arthroscopy of the right shoulder,
|
00:01:04.000
|
00:01:35.960
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GSG21245_afb4ff0d-023c-4361-97f9-9de0a2500faa_3
| 1,754,916,121 |
debridement of the partial thickness tear of the rotator cuff, extensive debridement, and then through a separate subpectoralis approach a biceps tenodesis. and then through a separate subpectoralis approach a biceps tenodesis. I think she is doing very well. She has good passive range of motion, good active range of motion, no deformity of the biceps, and she is neurologically intact. She has been out of work. She has been going to therapy and the exercises they gave her to do in therapy she has been doing on her own at home. So, at this point, Ms. Colombo will continue with the physical therapy. Again, I would tell her that she could move her biceps but do not do any forceful lifting for at least two more weeks, Give herself six-and-a-half weeks after the surgery. As far as work goes, I gave her a note for out of work
|
00:01:36.480
|
00:02:09.200
|
|
GSG21245_afb4ff0d-023c-4361-97f9-9de0a2500faa_4
| 1,754,916,121 |
and an appointment to see me in two weeks for repeat evaluation. I usually send people back to light duty somewhere between 8 and 12 weeks postoperatively and regular duty somewhere between 4 and 4-1/2 months postoperatively. Make sure all the exercises they gave her to do in therapy, to do on her own at home, she is doing that already. Completed goes Walmart claim services. Post this at 14731 Lexington, Kentucky, 40512. Attention Bellum, B-E-L-E-M, Torres, T-R-E-S. Number 25049046. For Walmart.
|
00:02:09.300
|
00:02:35.260
|
|
GSG21245_afb4ff0d-023c-4361-97f9-9de0a2500faa_5
| 1,754,916,121 |
Press the number to Donna, D-O-N-A, Viviani, V-I-V-I-N-I at FMCO at 973-257-2284. Thank you.
|
00:02:36.300
|
00:02:42.560
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|
GSG21246_1a967a5d-20ac-4040-affc-a5a2068fa9ec_0
| 1,754,916,451 |
now dictating follow-up note on RICHARD OLIVA – 07/01/2025 Mr. Oliva comes to the office today. His date of injury goes back to June 6, 2025, where he sustained a strain of his right shoulder. I put him on Naprosyn and he thinks that really did not help very much. I put him on Naprosyn and he thinks that really did not help very much. I gave him a cortisone shot back on June 17, 2025. He is not sure if it helped very much. I had recommended therapy. He is on three sessions of therapy and he is still pretty miserable. and he is still pretty miserable. He has pain with rotation, pain with activity, pain with sleeping at nighttime.
|
00:00:00.000
|
00:00:28.180
|
|
GSG21246_1a967a5d-20ac-4040-affc-a5a2068fa9ec_1
| 1,754,916,451 |
He is driving. He is going to work light duty, but he thinks they are pushing him too hard at work. I did review his physical therapy notes from GIG Physical Therapy. They thought he was doing okay. PHYSICAL EXAMINATION: Mr. Oliva is a pleasant and cooperative male. Examination of the right shoulder revealed most of his tenderness is over the anterior aspect, little tenderness over the AC joint. He has some tenderness posteriorly. He has a positive impingement test, positive Neer test. He still has limited range of motion, 8 to about 105 degrees of abduction and forward flexion, maybe about 45 degrees of external rotation, 40 degrees of internal rotation, questionably positive Speed test, questionably positive
|
00:00:28.240
|
00:00:58.720
|
|
GSG21246_1a967a5d-20ac-4040-affc-a5a2068fa9ec_2
| 1,754,916,451 |
O'Brien test, negative drop test. Neurologically, his examination was completely normal. The person I present at Richard Levo was involved in a work-lead accident in June 6, 2025. Three and a half weeks ago, he was seen as estranged of his right shoulder. He's had a cortisone shot, naproxen, physical therapy rehab. He's still pretty miserable, period. He had a history of a problem with his left shoulder years ago, labral pathology. So, considering the mechanism of injury, it's possible he may have damaged his labrum based on this accident in June 6, 2025. We'll rotate the cuff. The, is it possible he may have damaged his labrum based on this accident in June 6, 2025, or rotator cuff? The answer is it's possible, period. Period of plans, so I'll explain to him. So, leave him at my recommendation. Continue with the therapy.
|
00:00:58.720
|
00:01:31.600
|
|
GSG21246_1a967a5d-20ac-4040-affc-a5a2068fa9ec_3
| 1,754,916,451 |
will continue with the light duty. he can take the Naprosyn as needed. At this point, an MR arthrogram of the right shoulder would be appropriate to make a determination whether there is evidence of rotator cuff or labral pathology and then treat him appropriately. Period. He was fine with this. He'll get the MRI, make sure when he goes for the MRI, he gets the actual disc, brings it to my office. I gave him an appointment to see me in a couple weeks. We will go over the MRI to determine the need for appropriate treatment in the future.
|
00:01:31.600
|
00:02:00.060
|
|
GSG21246_1a967a5d-20ac-4040-affc-a5a2068fa9ec_4
| 1,754,916,451 |
The company goes to PMA, post this box 5231, Jamesville, Wisconsin, 53547. Attention, Marion, M-A-R-I-O-N, Anderson, A-N-D-E-R-S-O-N, from Subway's Water 004606-445, Florida's County of Essex Corrections, That's Governor Marion Anderson at 800-432-9762. Thank you.
|
00:02:00.060
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00:02:17.540
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|
GSG21247_7a3cc4f5-59b1-4e33-b4d2-9acf2a6538c6_0
| 1,754,917,046 |
now dictating follow up note on JAMES GERTMAN – 07/01/2025 Mr. Gertman comes to the office today. His date of injury goes back to May 27, 2025. He injured his right knee at work. That was approximately five weeks ago. He had an aspiration and cortisone shot for his right knee. He has high blood pressure, therefore I told him to avoid the anti-inflammatory medications. Though he has been taking ibuprofen 600 mg. He has been going to therapy, though he does not think it has really helped him.
|
00:00:00.000
|
00:00:31.720
|
|
GSG21247_7a3cc4f5-59b1-4e33-b4d2-9acf2a6538c6_1
| 1,754,917,046 |
I have been giving him notes for light duty, but he states there is no light duty available. When I had seen Mr. Gertman in the past, he was also complaining about pain in his left knee, but it was my opinion that I did not think any problems with the left knee were causally related to the accident of May 27, 2025. So, he complains of more pain in his left knee today, a lot of swelling, difficulty walking, he comes with a crutch. He states his right knee is little bit better, but the left knee is miserable. PHYSICAL EXAMINATION: Examination of his right knee reveals a very small
|
00:00:31.720
|
00:00:59.020
|
|
GSG21247_7a3cc4f5-59b1-4e33-b4d2-9acf2a6538c6_2
| 1,754,917,046 |
joint effusion present. There was no significant tenderness. Range of motion was 3 to about 135 degrees. He had a negative Lachman, negative pivot shift, negative anterior drawer, negative posterior sag, no medial or lateral instability in 10 and 30 degrees of flexion with valgus and varus stress. Examination of the left knee revealed a huge joint effusion present. His temperature in the office is 97.3. He had significantly decreased range of motion. just moving the knee gave him agonizing pain. It was a little warm, but not hot. and he was afebrile. His range of motion was severely limited in his left
|
00:00:59.020
|
00:01:29.080
|
|
GSG21247_7a3cc4f5-59b1-4e33-b4d2-9acf2a6538c6_3
| 1,754,917,046 |
knee. It was tender everywhere. No gross evidence of instability, but his range of motion was 10 to about 30 degrees. It was hard to evaluate him ligamentously. IMPRESSION: My impression is that James Gertman was involved in a work-related accident on May 27, 2025 2025, five weeks ago, where he sustained a strain/contusion of his right knee. The right knee is doing much better at this point.
|
00:01:29.080
|
00:01:55.860
|
|
GSG21247_7a3cc4f5-59b1-4e33-b4d2-9acf2a6538c6_4
| 1,754,917,046 |
I also was able to obtain the synovial fluid results of his right knee that I had aspirated when I had seen him in my office initially on June 10, 2025 and it came back as monosodium urate crystals observed by polarized light microscopy, which is consistent with gout. microscopy, which is consistent with gout. I asked him if he had gout in the past. He states never in his knee, but he had it in his left right toe. So, I told him this is gout.
|
00:01:55.940
|
00:02:25.140
|
|
GSG21247_7a3cc4f5-59b1-4e33-b4d2-9acf2a6538c6_5
| 1,754,917,046 |
His problems with his knees are gout, though it does not appear to be specifically related to the accident of May 27, 2025. accident of May 27, 2025. I do not consider this pain in his left knee to be specifically causally related to the accident of May 27, 2025. related to the accident of May 27, 2025. He is in excellent physical condition. I understand if a 75-year-old out-of-shape, overweight individual having an injury to the right knee, is putting more weight on the left knee may bother the left knee, but he is a young individual who looks like he is in good physical condition.
|
00:02:25.440
|
00:02:51.460
|
|
GSG21247_7a3cc4f5-59b1-4e33-b4d2-9acf2a6538c6_6
| 1,754,917,046 |
So my impression at this point is Mr. Gertman's examination of both knees as a result of gouty arthritis in both knees and not specifically causally related to the accident of May 27, 2025. PLAN: So, I told Mr. Gertman, considering the amount of pain he has in his left knee, He'll do an aspiration cortisone shot. So I took out 105 cc's of cloudy fluid from the left knee, gave him an injection of 1 cc of 0.125% more campyloctin, 6 milligrams of metastatic, 6 milligrams of metastatic and 75 of spain, put down a macro four cortisone shot period.
|
00:02:51.660
|
00:03:22.340
|
|
GSG21247_7a3cc4f5-59b1-4e33-b4d2-9acf2a6538c6_7
| 1,754,917,046 |
I told him to ice it, comma. He needs to now go to see his family doctor with regard to this pain in both knees knees because this is a gouty problem, not a work-related problem. problem. So, as far as work goes, I gave him a note for light duty. I gave him an appointment to see me in a week, what he needs to do is take colchicine 0.6 mg two pills once and then one pill couple of hours later. once and then one pill couple of hours later. Then, after the gout has slowly resolved, he can go on allopurinol,
|
00:03:22.340
|
00:03:52.320
|
|
GSG21247_7a3cc4f5-59b1-4e33-b4d2-9acf2a6538c6_8
| 1,754,917,046 |
which will decrease the likelihood of recurrence of the gout. I told him that treatment needs to go through his private health insurance. So, when I see him in a week at that point he would be MMI with regards to the accident May 27, 2025 and any residual pain in either knee as a result of gout, would need to go through his private health insurance and not through Worker's Compensation. A couple of cases abroad. Spire Post is Fox 14645. Lexington, Kentucky 40512. now dictating follow up note on JAMES GERTMAN – 07/01/2025 Mr. Gertman comes to the office today. His date of injury goes back to May 27, 2025, where he injured his right knee at work.
|
00:03:52.400
|
00:04:21.420
|
|
GSG21247_7a3cc4f5-59b1-4e33-b4d2-9acf2a6538c6_9
| 1,754,917,046 |
That was approximately five weeks ago. He had an aspiration and cortisone shot for his right knee.
|
00:04:21.820
|
00:04:24.920
|
|
GSG21249_3c2c65b3-ad83-4476-af03-581c6af8e184_0
| 1,754,917,452 |
now dictating follow up note on CARMELINO JUAREZ-HERNANDEZ 07/01/2025 Mr. Juarez-Hernandez comes to the office today. Jose in my office helped translate between Spanish and English. His date of injury goes back to August 19, 2024, injured in his right shoulder. and had just operated on his right shoulder five days ago on June 26, 2025, when he had an evaluation under anesthesia. operative arthroscopy of the right shoulder. debridement in the partial exterior of the right calf, debridement of partial fixative carotid debridement of the calcification, subacromial decompression, excision of the distal clavicle, and then through a separate subpectoralis approach,
|
00:00:00.000
|
00:00:30.940
|
|
GSG21249_3c2c65b3-ad83-4476-af03-581c6af8e184_1
| 1,754,917,452 |
also biceps tenodesis. He is doing okay. One of his friends drove him today to the office. He is a little bit uncomfortable. He finished the antibiotics. He is not taking the Percocet. He took the Motrin, but it made him feel funny, so he does not want to take it. I told him, if he does not want to take it, then take some Tylenol instead. He did the block, which worked fine, and he has a little achiness, but nothing terrible. Mr. Juarez-Hernandez is a pleasant, cooperative male. His temperature in the office is 98.3.
|
00:00:30.940
|
00:00:58.500
|
|
GSG21249_3c2c65b3-ad83-4476-af03-581c6af8e184_2
| 1,754,917,452 |
Examination of the right shoulder reveals nicely healed arthroscopic portals. They are all clean and dry. They are all clean and dry. The Steri-Strips were changed. He had a subpectoralis incision. The staples movement when the Steri-Strips appeared. He had no deformity of the biceps. He had a little bit of ecchymosis. Neurologically intact. He had about 40 degrees of abduction, 40 degrees of abduction before flexion, passively about 70. He had about 25 degrees of
|
00:00:58.500
|
00:01:22.040
|
|
GSG21249_3c2c65b3-ad83-4476-af03-581c6af8e184_3
| 1,754,917,452 |
active internal rotation, passively it may be about 30 degrees. We did not do an impingement test or a drop test or a sulcus sign or a belly press test or a lift-off test because of his limited range of motion. Neurologic examination was normal. AP and lateral x-rays of the right shoulder demonstrates he is status post subacromial decompression, excision of the distal clavicle and just about complete removal of the calcification that was there previously. Carmelino Juarez-Hernandez was involved in a work-related accident on August 19, 2024, where he injured his right shoulder. He did not improve with conservative treatment.
|
00:01:22.040
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00:01:51.780
|
|
GSG21249_3c2c65b3-ad83-4476-af03-581c6af8e184_4
| 1,754,917,452 |
Therefore, I operated on his right shoulder five days ago. On June 26, 2025, when he had an evaluation under anesthesia, operative arthroscopy of the right shoulder. I debrided the partial tear of his rotator cuff, a small tear, extensive debridement, debridement of the calcification. I did a subacromial decompression, excision of the distal clavicle, and then through a separate subpectoralis approach, also biceps tenodesis. I think he is doing okay. He cannot take the Motrin because it makes him feel funny, so I told him, just take some Tylenol. He finished the antibiotics. His incisions looked good. He has pretty good passive and active range of motion, and we just need to work on improving that. He had no trouble from anesthesia.
|
00:01:51.900
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00:02:25.060
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|
GSG21249_3c2c65b3-ad83-4476-af03-581c6af8e184_5
| 1,754,917,452 |
So at this point Mr. Juarez-Hernandez will start his physical therapy. He was again instructed on ice units, T-bar and pulley system and explained how to use that, which he has been using already. I gave him a note for out-of-work and appointment to see me in two weeks. As far as therapy goes, we want to work on range of motion exercises for his shoulder to improve that and you want to avoid any type of forceful biceps exercise. We do not put him at risk of any type of recurrence. I usually start biceps exercises about six weeks postoperatively. I usually send people back to light duty 8 to 12 weeks postoperatively. and regular duty usually somewhere between four and four-and-a-half months postoperatively.
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00:02:25.060
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00:02:55.960
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|
GSG21249_3c2c65b3-ad83-4476-af03-581c6af8e184_6
| 1,754,917,452 |
Obviously, if there are any problems or difficulties, to let me know. Otherwise, we will see him back in my office in two weeks for repeat evaluation. Comp letter goes to Travelers Insurance, Postal Spikes 4614, Buffalo, NY 14240, Attention Edna, EDA, and Palazzo, P-E-L-A-E-Z, F-E-R-A-N-G-5-T-S-N-T-O-M-4-6-5-8-4-F-A-B-U-W-O-D-C-A-B-A-N-T-R-Y, I think he is doing okay. He cannot take the Motrin because it makes him
|
00:02:56.480
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00:03:26.820
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|
GSG21250_6f8d8d1b-dfdb-4e61-99ce-ea3fd52591ae_0
| 1,754,917,875 |
now dictating follow up note on TRACEY ATTERBERRY – 07/01/2025 Ms. Atterberry comes to the office today. Her date of injury goes back to March 19, 2025, approximately 15 weeks ago where she sustained a contusion of her right knee. I had seen her last week in my office on June 25, 2025. I had seen her last week in my office on June 25, 2025. I gave her a cortisone shot and resolved all of her pain. I sent her back to regular duty. She is doing regular duty and she is happy about the results. She can stand, bend, walk, and squat. She uses a walker because of the stroke,
|
00:00:00.000
|
00:00:29.980
|
|
GSG21250_6f8d8d1b-dfdb-4e61-99ce-ea3fd52591ae_1
| 1,754,917,875 |
but that has nothing to do with the accident of March 19, 2025. PHYSICAL EXAMINATION: Ms. Atterberry is a pleasant cooperative woman. Her temperature in the office is 98.4. Examination of the right knee revealed no tenderness, swelling, abrasion, discoloration, edema, muscle spasm, trigger points, or erythema. no tenderness, swelling, abrasion, edema, muscle spasm, trigger points, or erythema. She had full range of motion, 0 to 140 degrees. Negative Lachman, negative pivot shift. No medial or lateral instability was noted 30 degrees of flexion with valgus and varus stress and her motion was quite good at this point
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00:00:30.360
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00:00:57.100
|
|
GSG21250_6f8d8d1b-dfdb-4e61-99ce-ea3fd52591ae_2
| 1,754,917,875 |
being 3 to about 115 degrees. But, genu varus deformity present bilaterally. IMPRESSION: Tracey Atterberry was involved in a work-related accident on March 19, 2025, 15 weeks ago, where she sustained a contusion of her right knee, which at this point has resolved to its pre-injury state. Obviously, she has a significant arthritic condition of her right knee having nothing to do with the accident of March 19, 2025, 2025, and when I gave her the cortisone shot last week on June 25, 2025, that resolved the contusion. She is back to the pre-injury state, she is happy about the results, and she is doing regular duty without restrictions.
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00:00:57.100
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00:01:27.680
|
|
GSG21250_6f8d8d1b-dfdb-4e61-99ce-ea3fd52591ae_3
| 1,754,917,875 |
restrictions. PLAN: So, at this point, Ms. Atterberry can continue with normal work without restrictions. She is at maximum medical benefits from treatment. Any additional problems with regard to her knees based on the arthritic condition, will need to go through her private health insurance, and she was aware of this. I answered all of her questions, I gave her a note for regular duty, and she was discharged from the office. She is MMI at this time. Public goes to Walmart Claim Services. The post is 14731 Lexington, Kentucky, 40512. Attention, Lindell, L-I-N-D-E-L-L-M-O-R-E, and the 25076894. The post is Walmart in Bayonne.
|
00:01:27.680
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00:01:59.020
|
|
GSG21250_6f8d8d1b-dfdb-4e61-99ce-ea3fd52591ae_4
| 1,754,917,875 |
The fax is up at Danielle, D-A-N-Y-E-L, freeze, F-R-E-S-E, at FMCO at 973-257-2284. Thank you.
|
00:01:59.420
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00:02:06.740
|
|
GSG21251_24f970f4-7ab9-4a09-8ae9-850fbf32d748_0
| 1,754,918,036 |
now dictating follow up note on KHONDAKER FAQRUL HASAN – 07/01/2025 Mr. Faqrul Hasan comes to the office today. His son helped translate. Mr. Faqrul Hasan continues to complain of some pain in his low back, occasional pain down the right lower extremity. He complains about a little bit of atrophy in his right thigh I had seen him previously on October 7, 2024. I recommended a few weeks of therapy,
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00:00:00.000
|
00:00:30.280
|
|
GSG21251_24f970f4-7ab9-4a09-8ae9-850fbf32d748_1
| 1,754,918,036 |
and he states he has continued to go since I saw him back in October 2024. He thinks it has been for ___ more time. The therapists are recommending more therapy. He states it has helped him, but it has not resolved all of his pain and he has already been instructed on all of the home exercises that he can do on his own at home. PHYSICAL EXAMINATION: Mr. Faqrul Hasan is a pleasant, cooperative male. His temperature in the office is 98.5. Examination of low back reveals no tenderness, swelling, abrasions, discoloration. Straight leg raise is negative. He may have 1 cm atrophy of the right thigh
|
00:00:30.280
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00:00:59.940
|
|
GSG21251_24f970f4-7ab9-4a09-8ae9-850fbf32d748_2
| 1,754,918,036 |
as compared to the left. Sensory, motor, and reflexes are normal. Babinski’s were downward going. He had good range of motion of his hip, good range of motion of his hip, good range of motion of his knee, no evidence of instability. He walked with an entirely normal gait. New record brush by brush. Khondaker Faqrul Hasan has been complaining about back pain, some right lower extremity radiculopathy drop. It looks like he may have a little bit of atrophy of his right thigh. He complains about this pain going down his right leg. His x-rays that were done previously in my office on October 7, 2024, involving his lumbar spine, right hip, and knee were all pretty much normal.
|
00:00:59.940
|
00:01:29.780
|
|
GSG21251_24f970f4-7ab9-4a09-8ae9-850fbf32d748_3
| 1,754,918,036 |
Minimal arthritic changes. Simply, this represents some sciatica. It is possible. He has been through physical therapy, home exercises, He has been icing this, He has tried different medications, none of which have helped him. He is not a great candidate for anti-inflammatory medication because he takes Plavix because of heart surgery. So, at this point, I explained to Mr. Faqrul Hasan, why do not we send him for an EMG nerve conduction study of his back to see if he has lumbar radiculopathy. If he does, then potentially a more aggressive treatment program may be indicated to include epidurals, But considering he has these cardiac problems,
|
00:01:30.180
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00:02:00.220
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|
GSG21251_24f970f4-7ab9-4a09-8ae9-850fbf32d748_4
| 1,754,918,036 |
I am not sure he is a great candidate for epidurals either. So, get the EMG, come back and see me. We will sit down, We will look at the results, and make a determination of what can be done.
|
00:02:00.220
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00:02:08.820
|
|
GSG11255_3ad71057-1379-45eb-aeed-0ea26feaf06e_0
| 1,754,976,250 |
now dictating follow-up note on GIANELLA ZAVALA-VILLALTA – 07/02/2025 Ms. Zavala-Villalta comes to the office today. She had been involved in a work-related accident on June 3, 2025 injuring her right shoulder and right wrist. I had seen her previously in my office. She had been taking some Advil and Tylenol. She still takes Tylenol. I recommended some therapy. She is back to regular duty. She states she completed one session of therapy. There was a little bit of delay but at this point she does feel better. She has less pain in the right shoulder and right wrist. She still gets a little achiness in the thumb and long finger. She gets a little achiness in the right shoulder. She notes when she reaches behind her back she cannot reach as far as she could previously, but she definitely feels better. No numbness or weakness. She is able to sleep. PHYSICAL EXAMINATION:
|
00:00:00.000
|
00:00:33.000
|
|
GSG11255_3ad71057-1379-45eb-aeed-0ea26feaf06e_1
| 1,754,976,250 |
Her temperature in the office is 97.5. Examination of the right shoulder reveals maybe a little tiny tenderness anteriorly. She is able to sleep. She is able to sleep. She is able to sleep. She is able to sleep. She is able to sleep. She is able to sleep. She is able to sleep. She is able to sleep. She is able to sleep. PHYSICAL EXAMINATION: Ms. Zavala-Villalta is a pleasant and cooperative woman. Her temperature in the office is 97.5. Examination of the right shoulder reveals maybe a little tiny tenderness anteriorly. She lacks couple of degrees of internal rotation, otherwise her motion is good.
|
00:00:33.000
|
00:00:59.900
|
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GSG11255_3ad71057-1379-45eb-aeed-0ea26feaf06e_2
| 1,754,976,250 |
She has a negative impingement test, negative drop test, negative lift-off test, negative belly press test, negative speed test, and negative O’Brien test. She has a negative Neer test. No deformity of the biceps. Examination of the right hand and wrist She points to the thumb and long finger that bother her a little bit. She points to the right wrist that bothers her a little bit, but there is no swelling, no tenderness, full range of motion, no triggering of the A1 pulley, no subluxation of the extensor tendons.
|
00:01:00.340
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00:01:22.480
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GSG11255_3ad71057-1379-45eb-aeed-0ea26feaf06e_3
| 1,754,976,250 |
no evidence of active Boutonnière, swan neck or mallet finger deformities. Neurologically, she is intact. She has done one session of therapy and she would like to continue, which I find acceptable. So, at this point, Ms. Zavala-Villalta will continue with the therapy for two more weeks. She will continue with the regular duty. The exercises they gave her to do in therapy she
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00:01:22.480
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00:01:49.680
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GSG11255_3ad71057-1379-45eb-aeed-0ea26feaf06e_4
| 1,754,976,250 |
can do on her own at home. Pain wise she will take occasional Tylenol that is okay. I gave her an appointment to see me in two weeks. We will check on her. If she is doing If she is doing okay at that point she will be MMI and discharged. If she still has some pain in the right shoulder then possibly a cortisone shot may be indicated.
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00:01:49.680
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00:02:00.900
|
|
GSG11256_slow_879f281e-e022-41e3-8e60-fdea5093bf10_0
| 1,754,977,207 |
now dictating follow-up note on Francisco Gonzalez July 2, 2025 Mr. Gonzalez comes to the office today. I had seen him previously. He was having back pain. right lower extremity radiculopathy. I put him on a Medrol Dosepak and Naprosyn. It has helped, but he still has some back pain. He gets some radicular pain down the right leg towards his foot. He has done the rehab session. He has been doing home exercises. He had an MRI of his back years ago, back on May 10, 2017,
|
00:00:00.000
|
00:00:30.860
|
|
GSG11256_slow_879f281e-e022-41e3-8e60-fdea5093bf10_1
| 1,754,977,207 |
which showed disc herniations right-sided component. He is a little concerned that this might have gotten worse. I told him it probably has gotten worse. He is just not happy with the way it is and he would be interested in doing additional diagnostic tests. He has done the rehab. He has taken the anti-inflammatory medications. He has altered his work status. He's also going away to Puerto Rico and the Dominican Republic between July 9th and July
|
00:00:30.860
|
00:00:58.720
|
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GSG11256_slow_879f281e-e022-41e3-8e60-fdea5093bf10_2
| 1,754,977,207 |
27th, 2025. He also has arthritis in his knee and he'd like to come in prior to going away to get a cortisone shot in his knee, which I've done in the past, which has helped him significantly for the right knee. PHYSICAL EXAMINATION Mr. Gonzalez is a pleasant and cooperative male. Examination of his lumbar spine revealed some mild tenderness present. He has some tenderness in the right sciatic notch. He has some tenderness over the right sacroiliac joint.
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00:00:58.720
|
00:01:25.140
|
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GSG11256_slow_879f281e-e022-41e3-8e60-fdea5093bf10_3
| 1,754,977,207 |
Range of motion is mildly decreased. Neurologic status including sensory, motor, and reflex were normal. normal, maybe questionably positive straight leg raise on the right and negative on the left, Babinski’s were downward going. No clonus was present. He walked with a grossly normal gait. IMPRESSION: My impression is that Francisco Gonzalez has low back pain, right lower extremity radiculopathy that has come and gone. He has gotten progressively worse. He had an MRI back in 2017 which showed disc herniations on the right side.
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00:01:25.140
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00:01:54.760
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GSG11256_slow_879f281e-e022-41e3-8e60-fdea5093bf10_4
| 1,754,977,207 |
He has taken the Naprosyn. He has done Tylenol and Advil. He has been icing his back. He went to therapy. He has changed some of his work status, but he is still pretty uncomfortable with regard to his low back with some radiation of pain down the right lower extremity. I think doing an MRI of his lumbar spine would be appropriate. I will continue with the Naprosyn p.r.n. and he is aware of the side effects. I will continue with the home exercises. He will get the MRI of his lumbar spine. He will get the MRI of his lumbar spine. He is going away on July 9, 2025,
|
00:01:56.360
|
00:02:29.180
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|
GSG11256_slow_879f281e-e022-41e3-8e60-fdea5093bf10_5
| 1,754,977,207 |
so I am not sure he is going to be able to get the MRI by then. He is coming back on July 27, 2025. So, when he comes back, bring the MRI and the disk with him. We will go over the results to determine what additional treatment may be indicated I will also see him next week for a cortisone shot for his knee prior to going away
|
00:02:29.180
|
00:02:46.180
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|
GSG11257_b0fa0988-3246-4e0e-9676-93446055f9f5_0
| 1,754,977,696 |
now dictating follow-up note on DOUGLAS B. LAMONT 07/02/2025 Mr. Lamont comes to the office today. He still complains about back pain. He has lower extremity radiculopathy. He is pretty miserable. He had a hip replacement, which helped him. but he is just uncomfortable. I told him there is not much else I can do. I had seen him recently. He went to see a spine surgeon. who told him there was nothing else they could do. He went to see a pain management doctor. They put him on Lyrica. He has been on that for about two weeks. I told him two weeks is not enough. I would give it a little bit more time and see what happens. If he gets better with the Lyrica that is great. He is going back to the pain management doctor in two weeks.
|
00:00:00.000
|
00:00:33.720
|
|
GSG11257_b0fa0988-3246-4e0e-9676-93446055f9f5_1
| 1,754,977,696 |
and if he is not, then they will talk about injections or a spinal cord stimulator. He had a spinal cord stimulator 20 years ago. He did not do well. But the electronics have improved, so I would give it some time and see what happens though I cannot guarantee it is going to resolve his complaints. PHYSICAL EXAMINATION: Mr. Lamont is a pleasant and cooperative male. He has nicely healed incision in his back. He has very decreased range of motion. He has diffuse numbness in both legs. He could not sit down because it was too uncomfortable. He had trouble toe and heel walking and trouble getting up and down off the examining table. He has diffuse weakness in both lower extremities.
|
00:00:33.740
|
00:01:03.280
|
|
GSG11257_b0fa0988-3246-4e0e-9676-93446055f9f5_2
| 1,754,977,696 |
Sensory a little bit decreased also and had difficulty getting reflexes. I could get him a little bit but not great. He walked with a hunched over gait utilizing a cane. My impression is that Douglas Lamont has chronic back problems. He has had surgery on his back, multiple surgeries. He has back pain. He has lower extremity radiculopathy. He has an MRI documenting a right-sided L3-L4 disc herniation. He has been seen by the spinal doctor. He did not think there was anything else that could be done. done.
|
00:01:03.760
|
00:01:32.240
|
|
GSG11257_b0fa0988-3246-4e0e-9676-93446055f9f5_3
| 1,754,977,696 |
He was seen by the pain management. They put him on Lyrica, but I do not think two weeks of Lyrica is enough. He wants to know if I can give him additional pain medication, but I told him he is under the care of a pain management doctor. They are going to have to treat him for the pain. So, I filled out a form for jury duty because he is not going to be able to go to jury duty because he cannot sit. Go see the pain management doctor and try a couple of injections and see if it helps. You can consider bone stimulator, but I again told him there is no guarantee that these problems are going to resolve and he understood that.
|
00:01:32.240
|
00:01:58.800
|
|
GSG11259_0223ea71-6fdd-4d04-b683-d19c8c30214f_0
| 1,754,978,856 |
Now dictating follow-up note on YOLANDA SMITH – 07/02/2025 Ms. Smith comes to the office today. She has primary degenerative joint disease of her right knee. She is here for the second Orthovisc injection. She is definitely better from the first injection. On July 4, 2025, she is going to a pool party and she is bringing in some elements of punch. PHYSICAL EXAMINATION: Ms. Smith is a pleasant and cooperative woman. She walks with a grossly normal gait, She has a small joint effusion in her right knee. She does not really have any tenderness at this point. Range of motion does lack a couple of degrees of both flexion, a couple of degrees of extension. She has a negative Lachman, negative pivot shift,
|
00:00:00.000
|
00:00:32.580
|
|
GSG11259_0223ea71-6fdd-4d04-b683-d19c8c30214f_1
| 1,754,978,856 |
negative anterior drawer, negative posterior sag, no medial or lateral instability in 10 and 30 degrees of flexion with valgus or varus stress. A little bit of patella crepitus. She has primary degenerative joint disease of her right knee. She is here for the second Orthovisc injection. She is feeling better from the first injection, which is great.
|
00:00:32.680
|
00:00:44.680
|
|
GSG11260_1020f074-3d13-4cd9-b9bb-3cf6fbb6be0d_0
| 1,754,979,276 |
now dictating follow-up note on SUSANA CASTIMORE – 07/02/2025 Ms. Castimore comes to the office today. Her date of accident goes back to December 30, 2024, when she was involved in a motor vehicle accident. She sustained multiple injuries including lumbar strain, some bilateral lower extremity radiculopathy, left shoulder strain, contusion/strain of both knees, and a fracture of the transverse process of L2. She failed her nuclear stress test.
|
00:00:00.000
|
00:00:29.460
|
|
GSG11260_1020f074-3d13-4cd9-b9bb-3cf6fbb6be0d_1
| 1,754,979,276 |
Therefore, I have not allowed her to go to therapy because I wanted to be cleared by the cardiologist before considering physical therapy which would then put her at risk. She states she had a calcium score, which came back as 0, which is a very good sign, but that does not clear her with regard to the cardiologist. She is going to see the cardiologist next week and if she clears with the cardiologist, I will allow her to start her therapy again, period, because of physical examination. New paragraph. I had also sent her for an EMG/nerve conduction study and it was not available when she was
|
00:00:29.780
|
00:01:00.040
|
|
GSG11260_1020f074-3d13-4cd9-b9bb-3cf6fbb6be0d_2
| 1,754,979,276 |
seen in the office, but she states she was seen by Dr. Choi and was told that the EMG was normal. I did not do this dictation until later that day. I was able to get the EMG result and it showed some reduced amplitude of the right sural nerve but no evidence of active radiculopathy or a neuropathic process, which is a good sign. I did contact her later and told her that the EMG came back as normal, which is good.
|
00:01:00.040
|
00:01:27.100
|
|
GSG11260_1020f074-3d13-4cd9-b9bb-3cf6fbb6be0d_3
| 1,754,979,276 |
that does not mean that she does not have a back issue. She has already had an MRI of her back performed on January 4, 2025, which showed disc desiccation, facet arthropathy at L4-L5, similar problems at L5-S1, and the fracture of the transverse spinous process at L2 is also going to give her some of her complaints of back pain, though at this point she does not clearly have evidence of any type of neurologic damage.
|
00:01:27.520
|
00:01:53.780
|
|
GSG11260_1020f074-3d13-4cd9-b9bb-3cf6fbb6be0d_4
| 1,754,979,276 |
I think once she is cleared by the cardiologist, we will send her back to physical therapy, which I think would help her significantly. Ms. Castimore is a pleasant and cooperative woman. Examination of the left shoulder revealed some mild tenderness over the anterolateral aspect. She has a weakly positive impingement test. She has some pain at the extremes of motion. She has a weakly positive Speed test. negative drop test, no deformity of the biceps. Neurologically, she was normal. Examination of the lumbosacral area continues to show some tenderness present.
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00:01:54.220
|
00:02:23.780
|
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