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1 401 Second Avenue South, Suite 110 Seattle, WA Telephone: Toll Free: Fax: Medical Examination of Employer: : of Exam: of Birth: of Injury: Location of Exam: Examining Physician: Brian Tallerico, DO Dictated by: Dr. Tallerico T hank you for requesting OMAC to schedule an independent medical examination on. The following is a report of an orthopedic examination performed 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: Clinic Locations throughout the Northwest 1

2 of Exam INTRODUCTION The history of present injury and record review was performed in the presence of the examinee so could add information or make corrections he 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 confirms, as noted in the cover letter, he injured his head while working at on, when he hit his head going up a ladder, jamming his neck backwards. He was wearing a hard hat that slightly obstructed his view overhead as he was going up the ladder. A PVC pipe holding sprinkler heads was projecting down from the ceiling. This blocked his view enough that a sprinkler pipe struck him in the front of the hard hat, snapping his head backwards. He had medications and a course of physical therapy, and an MRI. The MRI showed a broad-based C5-6 disk protrusion with minimal C4-5 left-sided smaller slight disk bulge and possible questionable focal syrinx C6 to C7. He saw a neurosurgeon, who felt no surgery was indicated. X-rays were interpreted by, MD. Mild dextroscoliotic curvature was present with no fractures or subluxations. The examinee was seen by, FNP, and had continued care through. The accident report indicated the date of injury was On, the examinee was seen for an independent medical evaluation (IME) through Objective Medical Assessments Corporation (OMAC) by, MD, orthopedic surgeon. The reader is referred to that report for a history of the injury and subsequent treatment. 2

3 of Exam Dr. felt the examinee had a neck sprain with muscle guarding, related to his industrial injury of. There was MRI evidence (the cervical MRI of )of a broad-based C5-6 disk protrusion, minimal disk bulge at C4-5, and possible syrinx at C6-7, likely pre-existing on a more-probable-than-not basis. He had not reached maximum medical improvement as of that evaluation. He recommended physical therapy and a bone scan. A SPECT bone scan was read by, MD, on, as showing a normal SPECT scan of the cervical spine. The examinee had an initial physical therapy evaluation at. Physical therapy notes followed through. The examinee saw, ARNP, on. She recommended ongoing physical therapy. There was an evaluation by, MD, on. Impression was history of cervical injury, treated conservatively, with some degenerative disk disease noted on MRI. He noted no evidence of focal weakness or restriction of motion. He had some discomfort with range of motion of his neck. Neurologic examination appeared to be normal. He then went back to see Ms. on. He had intermittent muscle spasms and cervical spine pain. He was doing home traction daily. Medications were recommended. Prior Records: We have an entire section of prior medical records, including unrelated knee conditions, for which he eventually underwent surgery in. There are other notes regarding unrelated medical conditions. CHIEF COMPLAINTS He has neck pain. 3

4 of Exam HISTORY OF PRESENT INJURY is a -year-old, left-hand dominant male who was working as an electrician for when he was going up a ladder and struck his head on a piece of PVC pipe. His head was snapped backwards. He went to see a couple of different physicians and providers. He was sent to physical therapy. He had a bone scan, MRI, and x-rays performed. He was sent to a neurosurgeon, who did not feel surgery was an option for him. He has not worked since the date of injury. CURRENT COMPLAINTS The examinee states that most of the muscle soreness and tightness is gone, but he still has what he describes as bone-on-bone sensation in the left side of his neck with grating, popping, and snapping whenever he turns his head a certain way. Also, when he is just sitting still he sometimes will feel sharp stabbing pain in his neck, and he has radiation of pain and numbness to the middle of his back and back of his left shoulder blade. He is not aware of any radicular-type symptoms radiating down his right or left arm or into his legs. He has no bowel or bladder dysfunction and no difficulty with ambulating or stumbling or tripping and falling. Alleviating factors include taking a hydrocodone and occasionally Lodine and muscle relaxants. He tries to do some stretching and traction exercises at home, but does not do them as much as he did when he was having therapy. PAST MEDICAL HISTORY Past/Recent illnesses: Depression, gastroesophageal reflux disease (GERD), and anxiety. Surgeries: Varicocele ligation, tonsillectomy, and bilateral knee arthroscopy. Allergies: Sulfa. 4

5 of Exam Medications: Prozac, Wellbutrin, Acyclovir, Protonix, Levoxyl, and hydrocodone (up to five a day). REVIEW OF SYSTEMS The review of systems is historical, based upon the medical documentation provided and an interview with the examinee. Other than the information noted above, he also has neck pain and back pain. SOCIAL AND FAMILY HISTORY Information in the Social and Family History section of this report was obtained from a form completed by the examinee and an interview with the examiner. Education level: He has had some college. Habits: Tobacco None. Alcohol One to two drinks per week. Illicit drugs None. Hobbies and activities: He enjoys poker and painting. Exercise: He does not exercise. Military history: None. Personal history: He is single with two dependents. Familial history: Positive for prostate cancer. Work history: He was working for at the time of the injury. ORTHOPEDIC EXAMINATION Height: Weight: Dominant hand: The examinee is reminded not to participate in any painful activities during today s examination. This is a well-developed, well-nourished male in no acute distress. He is pleasant and cooperative with the examination. 5

6 of Exam He appears his stated age with height of feet, inches, and weight of pounds. He ambulates with a normal gait without ataxia or antalgia. On seated examination, he has no obvious atrophy, asymmetry, or deformity in the upper extremities. Upper extremity circumferences are 30 centimeters for the bilateral forearms and 33 centimeters for the bilateral upper arms. Manual motor testing is 5/5 in all groups tested symmetrically in the upper extremities, including rotator cuff and hand intrinsics. Sensory examination is intact to light touch and pinprick throughout the upper extremities. Deep tendon reflexes are 2/4 and symmetric in the upper and lower extremities. Hoffman reflex and finger escape sign are both negative. Spurling maneuver is not attempted due to anticipated examinee discomfort. Cervical range of motion using single inclinometer technique reveals forward flexion is 45 degrees, extension is 40 degrees, right side bending is 35 degrees, left side bending is 38 degrees, right rotation is 50 degrees, and left rotation is 60 degrees. Tenderness examination of the cervical spine shows no tenderness along the midline or paraspinal musculature of the cervical or thoracic regions. He states that it would take greater pressure to reproduce his pain, and this is not attempted. No myospasm is appreciated. Upper extremity range of motion is full and symmetric for the shoulders with 170 degrees of abduction, 170 degrees of flexion, 45 degrees extension, and 45 degrees of adduction. External rotation and internal rotation are both 90 degrees with arms abducted. Elbow range of motion is zero to 140 degrees bilaterally. 6

7 7 Claimants Name of Exam IMAGING STUDIES There are plain films of the cervical spine dated, at. These show mild straightening of the cervical lordosis with good maintenance of disk spaces, no spondylolisthesis, and perhaps some mild facet arthrosis at a few levels. The neural foramina appear to be widely patent on the oblique views. DIAGNOSES Cervical strain/sprain, related to the industrial injury of, on a moreprobable-than-not basis. 2. MRI evidence of mild disk abnormalities with degenerative changes and possible syrinx at C6-7, all pre-existing on a more-probable-than-not basis and not permanently aggravated by the industrial injury of. RECOMMENDATIONS AND DISCUSSION Has reached maximum medical improvement from his, injury? If so, has he sustained a permanent partial impairment according to the AMA Guides to the Evaluation of Permanent Impairment? Would there be any apportionment for pre-existing degenerative conditions or prior injuries? It is my opinion that he has reached a fixed and stable state and is at maximum medical improvement. According to the AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition, he has no permanent impairment. His MRI findings are all pre-existent and do not warrant a rating related to this claim. 2. If has not reached maximum medical improvement, what further curative treatment would you recommend and for what time period? Will he be at maximum medical improvement after the recommended treatment is completed? Not applicable. 3. Is any further medication medically necessary for his, injury? Does have any restrictions due to his, injury and if so are they

8 of Exam temporary or permanent in nature? No further medication is needed for the industrial injury of. There are no restrictions related to the industrial injury of. OMAC/cb 8

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