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Tallerico-Hand, Wrist, Knee 401 Second Avenue South, Suite 110 Seattle, WA 98104 Telephone: 206.324.6622 Toll Free: 1.800.331.6622 Fax: 206.726.8605 Medical Examination of Employer: Claim Number: Date of Exam: Date of Birth: Date of Injury: Location of Exam: Examining Physician: Brian Tallerico, DO Dictated by: Dr. Tallerico hank you for requesting OMAC to schedule an independent medical examination on ____. The following is a report of an orthopedic examination Tperformed by Dr. Tallerico. This report is intended to provide you with a fair and objective review of the medical facts relating to the examinee's circumstance, including those particular issues presented for our consideration. The opinions expressed in the report are solely those of the physician performing the examination. A reminder letter was sent to the examinee that included an explanation of the purpose and procedures of the examination. The letter also informed the examinee that a written report will be sent to the agency requesting the examination. The examinee should contact that agency for information regarding the report. The dictated report is as follows: www.omacime.com Clinic Locations throughout the Northwest 1 Claimants Name Claim Number Date of Exam INTRODUCTION --------------------------------------------------------------------------- The history of present injury and record review was performed in the presence of the examinee so that Ms. ____ could add information or make corrections she felt necessary. Any records reviewed represent a summary of the available medical records and it is my recommendation they remain available for further consultation as needed. CHART REVIEW---------------------------------------------------------------------------- Per the cover letter from ____, the claim is ____. The examinee is ____. The employer is ____. Date of injury was ____. History of present injury: ____ was walking in the parking lot to report to work when she tripped and fell, and landed on the concrete sidewalk with a contusion of her face, left knee, and fracture of her right hand. The fracture healed, but she continued to have ongoing pain. She saw several hand specialists and finally underwent surgery with Dr. ____, and had a good outcome from the surgery. On ____, she was deemed to be at maximum medical improvement as a result of the hand injury, with no work restrictions. She also injured her left knee as a result of the fall, but no treatment occurred until several months after the injury. She continued to have left knee pain, and this was refractory to conservative treatment. She had knee surgery in ____ by ____, MD, which was a left knee arthroscopy, loose body removal and debridement of parameniscal cyst anteromedial meniscus, and was found to have significant chondromalacia of the patella, as well as medial femoral condyle that was débrided, but she continued to have pain postoperatively. She has had multiple cortisone injections, one in ____ and one in ____. The one in ____ eliminated most of her pain temporarily but it recurred. The second one did not help much. She underwent a series of Synvisc injections by ____, MD, without relief of her symptoms. Dr. ____ advised that the only option at this time would be a total knee replacement. Dr. ____ has indicated ____ is at maximum medical improvement. Date The emergency report, status post fall on ____. The impression was facial abrasion and contusion, left knee abrasion, and right fifth metacarpal fracture. X-rays of the right hand showed a mildly displaced fracture at the base of the fifth metacarpal. 2 Claimants Name Claim Number Date of Exam Date An evaluation by ____, MD, on ____, showed that she had ecchymosis, swelling, and tenderness in her hand. He reviewed the x-rays and recommended a short arm cast. Date She went to see ____, MD, for her hand after she came out of the cast. He stated that she apparently healed her fracture well, but had some pain at the fifth finger MP joint. He injected her tendon sheath at the A-1 pulley. Date On ____, Dr. ____ noted she was still having problems. The cortisone shot helped her somewhat. Dr. Jones recommended a bone scan. Date On the ____ visit, Dr. ____ felt that she had carpometacarpal arthritis of the fifth metacarpal joint, with separation of the extensor tendons at the metacarpophalangeal joint. He recommended a bone scan and discussed surgical options, but the examinee elected to proceed with conservative treatment. Date She saw ____, MD, on ____. An MRI was ordered. Date The MRI reported a healed fracture at the base of the fifth metacarpal, no evidence of edema, and no abnormality of the tendon or ligaments, by ____, MD. Date She was starting to have pinpricks along the ulnar dorsal right hand. Date Electrodiagnostics were carried out by Dr. Horan on ____, and reported as normal. Date An independent medical examination (IME) for the right hand condition was done on ____, by ____, MD, a plastic surgeon. The reader is directed to that report for details. He did note that Dr. ____ was supposed to be doing the exam regarding the knee portion of the claim. After reviewing a CT scan of the wrist as well as an MR arthrogram of the wrist, and repeat nerve conduction test, Dr. ____ opined that she had a non-displaced healed fracture at the base of the fifth metacarpal, work-related. She had degenerative arthritis at the joint of the fifth metacarpal base and hook of the hamate, secondary to diagnosis number 1, no treatment needed at this time, as well as perforation of the radial attachment triangular fibrocartilage complex, right wrist secondary to number 1, work- 3 Claimants Name Claim Number Date of Exam related, not fixed and stable, and recommended arthroscopy. He recommended no further treatment to the suspected tenosynovitis, right middle finger. Date Follow-up with Dr. ____ for the knee arthroscopy. He injected the interlateral portal and the joint with Marcaine and Kenalog. Date Visit with Dr. ____ for the left knee pain. He reviewed the most recent MRI of ____, showing small joint effusions, small cyst located posterior horn medial meniscus, widening of posterior capsule suggestive of a meniscal capsule separation but may represent a meniscal cyst rather than popliteal cyst, and mild chondromalacia of the patella. Arthroscopic photographs were also reviewed from ____, showing significant chondromalacia of the patella, at least grade 3, and significant chondromalacia of the medial femoral condyle at least grade 3, with loose chondral fragmentation and loose body. He felt that she had significant chondromalacia of the patella and medial femoral condyle, and that was where most of her symptoms were coming from. There was nothing that he felt could be treated successfully arthroscopically. He recommended viscosupplementation, possibly requiring a total knee replacement. Date She was seen by ____, MD, for the hand and wrist. Dr. ____, on ____, performed a local injection in the ulnar side of the wrist at the radiocarpal or ulnocarpal joint, and it seemed to alleviate her pain significantly suggesting that the pain generator was the triangular fibrocartilage complex, but the pain returned when she was being fitted with a new splint. They did discuss the possibility of diagnostic wrist arthroscopy and possible fusion of the fifth carpometacarpal joint. Date Dr. ____ saw her for the left knee on ____, and felt that the only surgery that would eliminate her symptoms would be a knee replacement. She did want to think about it and try to consider some weight loss. Date Surgery was eventually carried out by Dr. ____ on ____, that being a right wrist diagnostic arthroscopy and debridement of the central triangular fibrocartilage tear, and right fifth metacarpal corrective osteotomy. 4 Claimants Name Claim Number Date of Exam Date Follow-up on ____, with ____, PA, for Dr. ____: Impressions were right wrist status post diagnostic wrist arthroscopy, status post central triangular fibrocartilage complex debridement, and status post right fifth metacarpal corrective osteotomy. They felt she was doing very well following the surgery with significant relief of her pre-surgical symptoms. She was fitted with a splint, and was to follow-up with Dr. ____ in four weeks for additional radiographs and re-evaluation. HISTORY OF PRESENT ILLNESS ------------------------------------------------------------ ____ states that she was walking to work on the sidewalk, tripped and fell, and fell off the sidewalk onto the parking lot and landed hard with her right arm against her breastbone and scuffed the right side of her face, and landed hard on her knees. She sought treatment and ultimately saw several hand specialists, coming under the care of Dr. ____ who performed surgery in ____ of this year on her right hand and wrist. She also had arthroscopic surgery on her left knee, and has continued following with that including injections and activity modification. CURRENT COMPLAINTS------------------------------------------------------------------- In regard to her right wrist and hand, at the very minimal she is at least 80 or 90 percent better. She still has some sensitivity over the scar of her hand, and some self-imposed limitations as she is getting back into it slowly. In regard to her left knee, she still has swelling, catching, and symptoms of painful instability; in other words, the knee will suddenly give out on her after a sharp pain in the medial side. She also has some loss of motion, and her husband states that she limps. Alleviating factors include taking naproxen. When she does not take it, she definitely feels it more in her knee. The symptoms are there all the time, but worse if she is on her feet for extended periods of time. The injections did not help. The surgery really did not help much either. PAST MEDICAL HISTORY------------------------------------------------------------------ Past/Recent illnesses: Reflux and non-insulin diabetes.
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