Dr. Tehrany: 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

Russell Carrington is a 25 year old right handed relief pitcher for the MLB team the Baltimore Orioles. Carrington has been playing baseball since he was seven years old and this was his third season in the Major Leagues. Carrington was at the mound and in the motion of throwing a fastball, when he felt a “pop” in his overhand motion. He dropped to his knees and clinched his right shoulder in pain. Athletic trainers came onto the field an upon examination Carrington stated his arm felt like it was “dead” and felt like it was “catching”. Carrington was seen by the team physician. She performed ROM exercises, strength, and stability tests on his shoulder and examined his neck and head to ensure pain wasn’t coming from a pinched nerve. She concluded that further testing and imaging was necessary. Carrington had an X-ray and MRI done on his shoulder and he was diagnosed with a type II SLAP (Superior Labrum Anterior and Posterior) lesion. He didn’t want surgery done because he would miss the remainder of the season and possibly the next, so doctors prescribed non-steroid anti-inflammatory medication and five months physical therapy to strengthen the shoulder capsule. After completion of physical therapy, the pain didn’t improve and arthroscopy surgery was recommended.

He also says and demonstrates that if he supports the wrist that the tip of the ulna "goes back in place" and if he holds it the pain goes away. He reports that he has a laxity in the wrist. The PA Ms. Becker went over the MRI, x-ray and the ultrasound. She said he was born with the ulna being longer, that it is not acute. The MRI did show some fluid which could be from inflammation. She said she would recommend he go to a hand specialist. Mr. Naranjo was not aware of the results of the MRI other than they were normal because he opted not to follow up with Dr. Branch. He said he did not like Dr. Branch, that he did not feel a connection. Ms. Becker would also recommend a MRI of the wrist done at Sparrow so the previous radiologist could compare it to the prior forearm MRI, She suggested Dr. Stevens a hand specialist, and she also ordered Occupational therapy to continue. Mr. Naranjo asked if she would order some pain medication since he has

Once again Dr. Armin Tehrany was asked to share his professional opinion, based on his decade’s long experience and profound orthopedic knowledge.

When I asked him about the situation, he said that he asked her if she had the flu recently because sometimes the brachial plexus can give off flu like symptoms such as a fever, fatigue, cough, and runny nose. He said this condition is called brachial neuritis. He said the majority of the time it affects one side of the shoulder and that’s why he asked the golfer is she had any of the symptoms or the flu during the break. He said that the muscles become weak and in some cases, paralyzed. For treatment, Dr. Wallace said he prescribes pain relievers so it won’t bother the patient as much. He said in severe cases, the patient will undergo surgery and then see a physical therapist to help regain strength in the shoulder. When I asked if he thought the golfer had had brachial neuritis he said most likely no since

I, Dr. Eric McDonald, MD am truly enthused about recommending Dhoha Alhashim for admission into medical school. It gives me immense pleasure, indeed, to suggest one of our emergency department's marvelous medical scribes, Ms. Alhashim, into your incoming class. I have known Dhoha Alhashim for the past six months in her capacity as a medical scribe. As a medical scribe, Ms. Alhashim had the opportunity to work side by side with some of the department's successful providers; her duties included documenting medical history, physical exam, procedures performed by providers, and transcribed lab and radiology test results on patients' charts. I, personally, had the opportunity to work with this intelligent young lady and observed the transformation of this incredible medical scribe over the past six months. Ms. Alhashim has been exposed to patients with a variety of symptoms and witnessed difficult patient encounters and critical cases, observing the proper ways to manage such situations. Ms. Alhashim has also become acquainted with our department's medical equipments. We have certainly been very pleased with the work performed by Dhoha Alhashim. Her intelligence, enthusiasm and curiosity for learning have enabled her to

Inspection of the right shoulder joint reveals atrophy. Movements are restricted with flexion to 90 degrees limited by pain and abduction to 75 degrees limited by pain. Hawkin’s test, Neer’s test, Shoulder crossover test, Empty Cans test, Lift-off test, and Apprehension test is positive. On palpation, tenderness is noted in the acromioclavicular joint and subdeltoid

Dr. Justin Clayton at the Mercy Clinic Orthopedic Surgery evaluated the claimant on April 6, 2018. Dr. Clayton stated the claimant may have rheumatoid disease and prescribe him Meloxicam. In addition, he reported the claimant would be referred for further arthritis evaluation (Ex. 23F).

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

DOI: 3/19/2015. Patient is a 63-year-old right hand dominant male janitor who sustained injury while he was mopping when he began having right shoulder pain. Per OMNI, he was initially diagnosed with right shoulder impingement syndrome, neck strain and right shoulder strain.

Based on the latest follow-up evaluation progress report dated 03/02/16, the patient complains of right shoulder pain and stiffness. He states that his shoulder feels sore. He states that his pain is aggravated by the cold weather and over activity. The patient has not attended physical therapy for some time due to travel outside of the country. He is using an analgesic cream.

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

Dr. Bruno Da Rocha is one of the top Sports and Family Chiropractors in Miami, and Hollywood, Florida. He has been serving the residents of South Florida for years. As a chiropractor, he is dedicated to helping his patients understand and address issues related to their musculoskeletal system. As a nutritionist, Dr. Da Rocha assists his patients in achieving optimal health by providing them with information related to proper nutrition as well as tips on living a healthy lifestyle.

There have been no major changes in Mr. Dawkins’s pain level. Rebecca Berner RN CCM attended the scheduled pain management appointment on November 1, 2017. Mrs. Berner arrived at the pain clinic this morning at 10:00 am. Mr. Dawkins got there at 10:40 am. He was ambulatory and said his pain was about the same-primarily in his left shoulder. He could raise his left arm about 110 degrees and said it was better than before, but said he could not reach around to wash his back. He also indicated he completed all the pre-requisite testing to move forward with the surgery and wanted to know what the delay was. After an hour and a half, we were placed in an exam room and the medical assistant asked him why he had filled a script for Tylenol #4's.

HPI: Ms. Smith presents to the office with bilateral shoulder stiffness and lateral elbow pain in right arm. The patient has been suffering shoulder stiffness for over 2 years. The symptom developed gradually after she started using her computer more at her work place; she had to hold her telephone between her shoulder and head while typing information on computer. The pain in right elbow stated about 8 months ago with gradual onset. The patient does not recall any trauma to the shoulder and elbow. She has been diagnosed as tennis