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STEBBINS JR, RICHARD L Scan on 9/3/2013 by Jennifer Dixon [998058] of TRANSFER RECORDS
08-28-'13 10:03 FROM-PSSP 4137323623 T-530 P0002/0029 F-560
70139543
08/14/13 PIONEER SPINE AND SPORTS PHYSICIANS PC Acct#: 140653
Richard Stebbins DOB: 10/08/1978 Sex: M Age: 34 years
Subjective
CLINICAL INFORMATION:
Mr. Stebbins is a 34 year old male who previously was seen in the office with Dr. Skerker for TPІ
of the right UT and levator scapulae. He notes that after the last set of TPI of July 31, 2013 he
had good relief of his symptoms until he rode his bike longer than usual 5 days ago. He notes that
since the bike ride his pain has been significantly increased and he has not been able to rest due to
the pain. He notes that the pain is sharp in nature and does not radiate to the arms. He notes that
the pain is located of the right vertebral border of the scapula. He notes pain in the right levator
scap region as well. He denies left sided pain.
Aggravating factors include turning his head to right, moving in bed, riding his bike, deep breathing.
relaxing. Alleviating factors include ice. He notes that he has trialed Ibuprofen without relief. He
has had PT at Bicentennial HWY and in our EL office without significant relief.
He denies nausea, vomiting, fever, chills, bowel or bladder changes.
MRI of the cervical spíne notes mild broad based posterior disc bulge at the C6-7 level with
marginal osteophytes and minimal indentation of the thecal sac ventrally and with mild right and no
left sided neuroforaminal narrowing. Full report in chart and reviewed.
Problem List: Spondylosis Cervical W/O Myelopathy, Pain in Limb, Intervertebral Disc
Displacement Cervical W/O Myelopathy, Myalgia & Myositis Unspec
Medication List PSSP Provider: Lidoderm 5% Patch 2 daily to painful area on r
shoulder/neck and r Rhomboids area of back, Voltaren apply 4 grams to affected joints bid
Medication List Other:
Allergies: NKDA
PMH:
Medical Problems:
Not Indicated
Accidents:
Not Indicated
Surgical Hx:
Not Indicated
Hospitalizations:
Not Indicated
Assistive Devices: None
Reviewed, no changes.
FH:
Negative For Cancer, Diabetes, Heart Disease, Spine Problems.
Father: Alive.
Mother: Alive.
Children:None
Siblings:2.
Reviewed, no changes.
SH:
&
Marital: Married.Lives With: Spouse.Education: Highest level completed, 12th
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Richard Stebbins DOB 10/08/1978
T-530 P0003/0029 F-560
7013954
Page #2
grade.Occupation: Reset Specíalist.Hand Dominance: Right-handed:
Personal Habits: Cigarette Use: Never Smoked Cigarettes.Alcohol: None. Drug Use:
None. Exercise Type: Few Times A Week.
Reviewed, no changes.
Date: 08/14/2013
Was the patient queried about smoking behavior? ☑ Yes No
Does the patient currently smoke? Smoking: Does Not Smoke.
ROS:
Const: Reports fatigue, but denies fever and weight loss. General health stated as excellent.
Eyes: Denies blurred vision and double vision. Does not wear corrective lenses.
ENMT: Denies hearing loss and ringing in the ears. Denies sinusitis. Denies hoarseness/voice
change and difficulty swallowing.
CV: Denies chest discomfort, pain and irregular heartbeat.
Resp: Denies cough, coughing up blood, SOB and wheezing.
GI: Denies abdominal pain, loss of appetite, change in bowel habits, constipation, diarrhea and
bloody stools.
GU: Úrinary: Denies difficulty voiding, burning with urination and frequent UTI's.
Musculo: Reports stiffness, but denies arthritis and swelling.
Skin: Denies birthmarks, lumps, masses, rash, sores and ulcers.
Neuro: Denies difficulty with balance, dizziness, memory lapses and memory loss.
Psych: Denies anxiety, claustrophobia, depression, hallucinations and sleep pattern disturbance.
Endocrine: Denies increased appetite, hair loss or excessive thirst.
Hema/Lymph: Denies anemia, easy bruising and enlarged lymph nodes.
Allergy/Immuno: Denies frequent colds, frequent infections and itching.
Reviewed, no changes.
Objective
Vital Signs: Ht: 72" Wt: 210lb BMI: 28,5 Ht cm: 182.9 Wt kg: 95.256
Exam:
General: Wellappearing-muscular individual, appears stated age. No acute distress. Pleasant and
cooperative. He is a reliable historian.
Cervical: No midline cervical spine tenderness to palpation. No left sided tenderness to palpation.
Tenderness to palpation of the right lower cervical spine facet joint region and the musculature
overlaying the region with radiation in his typical pattern of complaint.
ROM physiologic with increased pain in extension and right rotation. Pain decreased with flexion.
Facet loading increases right sided pain. Modified Spurling's negative bilaterally.
shoulder: Full passive and active range of motion. No weakness. Empty can increases right sided
pain. Lift off and belly press negative bilaterally.
Musculoskeletal: Increased tight taught bands of the right UT and levator scap, rhomboids.
Neuro: Sensátion intact to light touch. Motor strength 5/5 bilaterally. Drop foot absent with
ambulation. Hoffman's absent. DTRs 2+ bilaterally.
Gait: appropriate and nonantalgic.
Assessment #1: 729.1 Myalgia & Myositis Unspeс
Care Plan:
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Richard Stebbins DOB 10/08/1978 Page #3
Med Current ... Lidoderm 5% Patch
2 daily to painful area on r
shoulder/neck and r Rhomboids area of back
Voltaren 1% apply 4 grams to affected joints bid
Assessment #2: 722.0 Intervertebral Disc Displacement Cervical W/O Myelopathy
Care Plan:
Assessment #3: 722.4 Intervertebral Disc Degeneration Cervical
Care Plan:
Assessment #4: 724.1 Pain Thoracic Spine
Care Plan:
Assessment #5: 721.0 Spondylosis Gervical W/O Myelopathy
Comments : Mr. Stebbins' history and physical exam most consistent with right sided lower
cervical spine facet joint mediated pain with a strong myofascially mediated
component that has responded to TPI for short duration and then return of
symptoms after activity.
Care Plan:
Order
Discussed with patient further treatment options including the risks and
benefits of injection therapy and he wishes to proceed with right C5-6, C6-7
facet joint injections. He denies allergy to iodine or hardware present. Follow
up 2 weeks after injection to monitor his symptoms. At that time if his
symptoms remain persistent of the proximal thoracic and distal cervical spine
consider imaging of the thoracic spine to rule out ddd, arthropathy, stenosis.
Discussed with patient the signs of worsening neuromuscular involvement and
he understood to contact the office if theyoccur. All questions answered to
patient's satísfaction at the time of visit
Cervical Facet Right
Leamus Vellee PA-C
Leanne Vallee, PA-C
pochalf
Michael J., Woods, D.O.
08/14/2013 2:10 pm
08/23/2013 10:56 pm
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STEBBINS JR, RICHARD L Scan on 9/3/2013 by Jennifer Dixon [998058] of TRANSFER RECORDS
08-28-'13 10:04 FROM-PSSP 4137323623 T-530 P0005/0029 F-560
70139543
07/31/13 PIONEER SPINE AND SPORTS PHYSICIANS-PCAcct#: 140653
Richard Stebbins DOB: 10/08/1978 Sex: M Age: 34 yrs
FOLLOW-UP OFFICE NOTE
CLINICAL INFORMATION:
Mr. Stebbins returns again for clinical followup regarding right upper trapezius/levator scapulae
muscle trigger point and rhomboid trigger points. He reports that the last set of injections done on
his prior visit helped a lot but he feels that I should do more spots on todays visit.
Last seen two weeks ago. Presents specifically for TP injections stating that they are the only thing
that helps. He made a comment that his Lawyer wants a letter from me. I explained that we would
require formal communications first.
Pain on analog scale of 0-10 averages approximately 5/10
FUNCTIONAL STATUS:
Patient currently using an Anti-Inflammatory or Analgesic OTC medication: ☐yes ☐no
Medication List PSSP Provider: Lidoderm 5% Patch 2 daily to painful area on r
shoulder/neck and r Rhomboids area of back, Voltaren apply 4 grams to affected joints bid
Medication List Other:
Allergies: NKDA
Problem List: Pain in Limb, Intervertebral Disc Displacement Cervical W/O Myelopathy,
Myalgia & Myositis Unspec
PHYSICAL EXAM:
Ht: 72" Wt: 210lb BMI: 28.5 Ht cm: 182,9 Wt kg: 95.256
Exam:
General: Well nо muscular individual. No acute distress. Pleasant and cooperative. He is requesting
repeat trigger point injections as I had recently done 2 weeks ago.
Cervical: Normal range of motion.
shoulder. Full passive and active range of motion. No weakness.
Musculoskeletal: + TP in R upper Trap and R Levator and R rhomboid in exactly same spots as
prior assessment.
Neuro: Not formally completed but informally intact.
Gait: nrl
DATA REVIEWED:
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70139543
Richard Stebbins DOB 10/08/1978 Page #2
Assessment #1: 729.1 Myalgia & Myositis Unspec
Care Plan:
Comments
Assessment #2:
Care Plan:
Comments
: TP injection done at R Levator and R upper trapezius at two sites with 5 cc of
50/50combo 2% Lidocaine and 0.25% Marcaine; under sterile technique.
Tolerated well. No complications encountered. Band aid applied. Spray and
stretch done.
TP injectionR Rhomboids with:
5 cc of 50/50combo 2% Lidocaine and 0.25% Marcaine; under sterile
technique. Tolerated well. No complications encountered. Band aid applied.
Spray and stretch done.
He reports good relief of symptoms before leaving office.
No SOB.
729.5 Рain in Limb
:If he calls for repeat trigger point injections, I would like him to see Leeanne
vailey. She has a different approach which may be very successful in his case.
She talk to me about a series of trigger point injections and physical therapy
and combination. I think that is reasonable and appropriate in his particular
circumstances.
If he needs any formal letters for attorneys, then they must communicate with
the office by letter and then we would have to communicate back with a formal
response.
Assessment #3; 722.0 Intervertebral Disc Displacement Cervical W/O Myelopathy
.Care Plan:
Rolet Shle M.D
Robert Skerker, M.D.
Seen by:
cc: Mark Skalski MD
07/31/2013 2:54 pm
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STEBBINS JR,RICHARDL Scan on 9/3/2013 by Jennifer Dixon [998058] of TRANSFER RECORDS
08-28-'13 10:04 FROM-PSSP 4137323623 T-530 P0007/0029 F-560
70139543
7/17/13- PIONEER SPINE AND SPORTS PHYSICIANS PC Acct#: 140653
Richard Stebbins DOB: 10/08/1978 Sex: M Age: 34 yrs
FOLLOW-UP OFFICE NOTE
CLINICAL INFORMATION:
Mr. Stebbins returns for clinical followup regarding right upper trapezius/levator scapulae muscle
trigger point and rhomboid trigger points. He reports that the last set of injections done on his prior
visit helped a lot but he feels that I should do more spots on todays visít.
He rode his bike to todays visit~7.5 mile and states that the shoulder and arm feel OK in that they
are not worse with biking. No helmet!!!
INTERVAL HISTORY: He describes these areas as knots. Please see copy of FCE done here about
4 weeks ago. No longer in PT but does HEP., Still not working and it has been a year since his
injury. He states that Lidoderm Patches and Voltaren gel have not been of much help.
He reports completing a 2 year program at the Bradford Hall in Springfield for a medical assistance
program. He passed all coursework about 2 or 3 weeks ago and is very pleased. He hopes to go
with this area full time, and is looking at employment at BMC.
FUNCTIONAL STATUS: Independent
Patient currently using an Anti-Inflammatory or Analgesic OTC medication: ☑yes ☐no
Medication List PSSP Provider: Lidoderm 5% Patch 2 daily to painful area on.r
shoulder/neck and r Rhomboids area of back, Voltaren apply 4 grams to affected joints bid
Medication List Other:
Allergies: NKDA
PMH:
Medical Problems:
Not Indicated
Accidents:
Not Indicated
Surgical Hx:
Not Indicated
Hospitalizations:
Not Indicated
Assistive Devices: None
Reviewed, no changes.
Problem List Pain in Limb, Intervertebral Disc Displacement Cervical W/O Myelopathy,
Myalgia & Myositis Unspec
PHYSICAL EXAM:
Ht: 72" Wt: 210lb BMI: 28.5 Ht cm: 182.9 Wt kg: 95.256
Exam:
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STEBBINS JR,RICHARD L Scan on 9/3/2013 by Jennifer Dixon [998058] of TRANSFER RECORDS
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Richard Stebbins DOB 10/08/1978
70139543
Page #2
General: Well-developed heavily muscled young male with multiple tattoos. Pleasant. Cooperative.
No distress.
Neurological: No evidence of weakness or sensory loss or reflex loss.
Cervical: Full pain-free range of motion.
shoulder: Fullactive and passive range of motion. No impingement. Tender points at the junction
of the shoulder and neck on the right. Anatomically this is just posterior to Erb's point. This could
be the scalenes word the levator scapulae or the upper trapezius muscles. In addition, there is
another tender area just medial to the medíal scapular border in the region of the rhomboid muscles.
Gait: Normal
DATA REVIEWED: FCE report
Assessment #1: 729.1 Myalgia & Myositis Unspec
Care Plan:
Comments
Med New
Order
Correspond's
Follow Up
: TP injection done at R Levator and R upper trapezius at two sites with 5 cc of
50/50combo 2% Lidocaine and 0.25% Marcaine; under sterile technique.
Tolerated well, No complications encountered. Band aid applied. Spray and
stretch done.
TP injectionR Rhomboids with:
5 cc of 50/50combo 2% Lidocaine and 0.25% Marcaine; under sterile
technique. Tolerated well. No complications encountered. Band aid applied.
Spray and stretch done.
I told patient that he has reached MMI and that I would no longer keep him out
of work. He may return prn.
To come back and see me for repeat TP injections as he feels necessary. No
limitations with any activity.
Lidoderm 5% Patch
2 daily to painful area on r
shoulder/neck and r Rhomboids area of back
Fce to assess his capabilities to return to work
Excuse From Work
f/u in 2 weeks
Assessment #2: 729.5 Pain in Limb
Care Plan:
Seen by:
Rolt ShleM.D
Robert Skerker, M.D.
07/17/2013 2:29 pm
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STEBBINS JR,RICHARD L Scan on 9/3/2013 by Jennifer Dixon [998058] of TRANSFER RECORDS
08-28-'13 10:04 FROM-PSSP 4137323623
Richard Stebbins DOB 10/08/1978
cc: Mark Skalski MD
T-530 P0009/0029 F-560
70139543
Page #3
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STEBBINS JR, RICHARD L Scan on 9/3/2013 by Jennifer Dixon [998058] of TRANSFER RECORDS
08-28-'13 10:04 FROM-PSSP 4137323623 T-530 P0010/0029 F-560
70139543
05/29/13 PIONEER SPINE AND SPORTS PHYSICIANS PC Acct#: 140653
Richard Stebbins DOB: 10/08/1978 Sex: M Age: 34 yrs
FOLLOW-UP OFFICE NOTE
CLINICAL INFORMATION:
Mr. Stebbins returns for clinical followup regarding right upper trapezius/levator scapulae muscle
trigger point and rhomboid trigger point. He reports that the injections done on his prior visit did not
help some much
INTERVAL HISTORY: He describes these areas as knots. He has been seeing Bill here at the East
Longmeadow office for physical therapy. Deep tissue massage and myofascial treatments are being
done. Patient does not report whole lot of success. He describes the pain as exhausting. He takes
'no narcotic analgesics. He states that insurance company denied Voltaren gel and denied
acupuncture treatments.
He reports completing a 2 year program at the Bradford Hall in Springfield for a medical assistance
program. He passed all coursework about 2 or 3 weeks ago and is very pleased. He hopes to go
with this area full time. He admits that he probably will not be able to returm to the Big Y. to do his
prior job because of the heavy physical demand.
He reports that his day is spent doing exercises. He does home exercises 3 times a day he cannot
do any right arm exercises but admits that he lifts waist was left arm. He cannot jog because the
pinching in his shoulder is painful he can ride the stationary bike but he cannot ride a bike outdoors
because he hits a hole his neck and shoulder hurt. He walks. And he occasionally goes to the
gymnasium.
FUNCTIONAL STATUS: Independent
Patient currently using an Anti-Inflammatory or Analgesic OTC medication: yes no
Medication List PSSP Provider: Lidoderm 5% Patch 2 daily to painful area on r
shoulder/neck and r Rhomboids area of back, Voltaren apply 4 grams to affected joints bid
Medication List Other:
Allergles: NKDA
PMH:
Medical Problems:
Not Indicated
Accidents:
Not Indicated
Surgical Hx:
Not Indicated
Hospitalizations:
Not Indicated
Assistive Devices: None
Reviewed, no changes.
Problem List: Paín in Limb, Intervertebral Disc Displacement Cervical W/O Myelopathy,
Myalgia & Myositis Unspec
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Richard Stebbins DOB 10/08/1978 Page #2
PHYSICAL EXAM:
Ht: 72" Wt: 210lb BMI: 28.5 Ht cm: 182.9 Wt kg: 95.256
Exam:
General: Well-developed heavily muscled young male with multiple tattoos. Pleasant. Cooperative.
No dístress.
Neurological: No evidence of weakness or sensory loss or reflex loss.
Cervical: Full pain-free range of motion.
shoulder: Full active and passive range of motion. No impingement. Tender points at the junction
of the shoulder and neck on the right. Anatomically this is just posterior to Erb's point. This could
be the scalenes word the levator scapulae or the upper trapezius muscles, In addition, there is
another tender area just medial to the medial scapular border in the region of the rhomboid muscles.
Gait: Normal
DATA REVIEWED:
Asşeşsment #1: 729.1 Myalgia & Myositis Unspec
Care Plan:
Comments
Med New
Order
Correspond's
Follow Up
TP injection done at R Levator and R Rhomboids with:
2.5 cc of 50/50combo 2% Lidocaine and 0.25% Marcaine; under sterile
technique. Tolerated well. No complications encountered.
Will order FCE to eval his capacity to returtn to work.
Lidoderm Patches ordered for pain control.
F/U after completing therapy sessions and FCE.
Out of work note written.
: Lidoderm 5% Patch
2 daily to painful area on r
shoulder/neck and r Rhomboids area of back
Fce to assess hís capabilities to return to work
Excuse From Work
f/u in 2 weeks
Assessment #2: 729.5 Pain in Limb
Care Plan:
Seen by:
RoltSluln M.D
Robert Skerker, M.D.
07/02/2013 12:47 pm
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Richard Stebbins DOB 10/08/1978 Page #3
cc: Mark Skalski MD
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STEBBINS JR,RICHARDL Scan on 9/3/2013 by Jennifer Dixon [998058] of TRANSFER RECORDS
08-28-'13 10:05 FROM-PSSP 4137323623 T-530 P0013/0029 F-560
70139543
04/24/13 PIONEER SPINE AND SPORTS PHYSICIANS PC Acct#: 140653
Richard Stebbins DOB: 10/08/1978 Sex: M Age: 34 yrs
INITIAL OFFICE VISIT
Date of Work Related Injury: July 10, 2012
Subjective
CC: R upper trapezius pain and R rhomboid pain. Referred by NEOS for TP injection. Question
cervical epidural injection in the future
HISTORY OF PRESENT ILLNESS:
The patient is a 34 - year-old Patient Declined/Unknown male who presents today with history of
work related injury 7/10/12 at Big Y while changing out products on shelves. He is a patient of
NEOS as he has had many surgeries by them in the past. In 2010 he had a right shoulder surgery
and and acromium plasty and decompression of the subacromial space.
He is a body builder and active exerciser and is very active and many regards. He works for big Y.
changing out shelves, It is very labor intensive and high-energy demand job. Apparently he was
injured on the job on July 10, 2012 when he went to move a box of heavy food across a shelf but
it didn't budge and he hurt his shoulder. He has been following with NEOS ever since. He saw Dr.
Somner Karras and others in the group. Cervical MRI scan done in December showed a C6-C7 mild
broad-based disc herniation with mild marginal osteophytes and right and left foraminal narrowing.
Patient states he is incapacitating by knots in his shoulders. His surgeon states that there is no
actual shoulder pathology and feel that the issue is really coming from his neck. He did have
physical therapy for about a month after the injury and they did do myofascial release techniques
but unfortunately they didn't help. The patient reports knots in the right upper trapezius at the
junction of the shoulder and the neck area. The area is just posterior to Erb's point. A second area
in question is just medial to the medial border of the right scapula in the region of the rhomboid
muscle group.
He denies numbness or tingling. He deníes weakness. He states that mostly the problem occurs if
he lifts his arm out to the side, it becomes painful. The pain is described as burning. He has tried
Lidoderm patches with no success. His exercises have not helped and he is very religious about
doing them. However he cannot do strength training with his right upper extremity because of his
symptoms.
He could not participate in the St. Patrick's Day road race or the Westriedl canoe races or the
Boston Marathon because of his symptoms.
FUNCTIONAL STATUS: Independent
Patient currently using an Anti-Inflammatory or Analgesic OTC medication: ☐yes ☐no
Medication List PSSP Provider: Voltaren apply 4 grams to affected joints bid
Medication List Other:
Allergies: NKDA
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T-530 P0014/0029 F-560
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Richard Stebbins DOB 10/08/1978 Page #2
PMH:
Medical Problems:
Not Indicated
Accidents:
Not Indicated
Surgical Hx:
Not Indicated
Hospitalizations:
Not Indicated
Assistive Devices: None
Reviewed and updated.
FH:
Negative For Cancer, Diabetes, Heart Disease, Spine Problems.
Father: Alive.
Mother: Alive.
Children:None
Siblings:2.
Reviewed and updated.
SH:
Marital: Married.Lives With: Spouse.Educatíon: Highest level completed, 12th
grade.Occupation: Reset Specialist. Hand Dominance: Right-handed.
Personal Habits: Cigarette Use: Never Smoked Cigarettes.Alcohol: None.Drug Use:
None.Exercise Type: Few Times A Week.
Reviewed and updated.
Date: 04/24/2013
Was the patient queried about smoking behavior? ☑ YesNo
Does the patient currently smoke? Smoking: Does Not Smoke.
ROS:
Const: Reports fatigue, but denies fever and weight loss. General health stated as excellent.
Eyes: Denies blurred vision and double vision. Does not wear corrective lenses.
ENMT: Denies hearing loss and ringing in the ears. Denies sinusitis. Denies hoarseness/voice
change and difficulty swallowing.
CV: Denies chest discomfort, pain and irregular heartbeat.
Resp: Denies cough, coughing up blood, SOB and wheezing.
Gl: Deníes abdominal pain, loss of appetite, change in bowel habits, constipation, diarrhea and
bloody stools.
GU: Urinary: Denies difficulty voiding, burning with urination and frequent UTI's.
Musculo: Reports stiffness, but denies arthritis and swelling.
Skin: Denies birthmarks, lumps, masses, rash, sores and ulcers.
Neuro: Denies difficulty with balance, dizziness, memory lapses and memory loss.
Psych: Denies anxiety, claustrophobia, depression, hallucinations and sleep pattern disturbance.
Endocrine: Denies increased appetite, hair loss or excessive thirst.
Hema/Lymph: Denies anemia, easy bruising and enlarged lymph nodes.
Allergy/Immuno: Denies frequent colds, frequent infections and itching.
Reviewed and updated.
Problem List:
Physical Exam:
Ht: 72" Wt: 210lb BMI: 28.5 Ht cm: 182.9 Wt kg: 95.256
Exam:
General: Well built frame who obviously does body building. Multiple tattoos.
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Richard Stebbins DOB 10/08/1978
Page 14 of 28
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Page #3
Cervical: Full range of motion nonpainful. Thick neck: No palpable tenderness except where the
right trapezius comes into the neck area at the range of the shoulder, Tenderness located there.
Patient reports that he feels knots in this area this examiner however has a hard time feeling the
same knots.
Shoulder: Full active and passive range of motion right shoulder. Good strength with abduction,
forward flexion, extension, and scaption maneuver.
Thoracic: Trigger point noted just medial to the medial border of the right scapula in the region of
the rhomboid muscles. Area is slightly tender and I do feel any palpable trigger point or tight
muscle band.
Musculoskeletal: No atrophy. Several scars at the elbows from prior surgeries and healed
laceration right calf. No calf atrophy.
Neuro: Detailed exam of the upper extremity shows no sensory loss or motor loss or reflex
abnormality. Reflexes at the knees are slightly brisk.
Gait: Normal. No spasticity appreciated.
IMAGING STUDIES: Reports of cervical MRI scan and right shoulder x-ray available. I tried to look
at the films on disc but had difficulty viewing the images.
DATA REVIEWED:
Dx Studies:
ASSESSMENT/PLAN:
Mr. Stebbins
Assessment #1; 729.1 Myalgia & Myositis Unspес
Care Plan:
Comments : ACCUPUNCTURE REFERRAL
F/U W NEOS IN 3-4 WKS
NOTE FOR OUT OF WORK
I firmly believe that this patient has myofascial pain syndrome, He of course
thinks her something more serious.
After verbal consent, I injected the 2 trigger points noted with a combination of
2% lidocaine and 0.75% Marcaine and a 50/50 mixture. About 3 cc injected it
each point. Sterile technique used. No complications encountered. Band-Aids
applied after injections performed. Patient denies use ice and injection sites and
also ply Lidoderm patches and injection sites when he goes home.
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Richard Stebbins DOB 10/08/1978 Page #4
Med New
Order
Unfortunately, he did not find either injection helpful towards improving hís
symptoms.
Voltaren 1% apply 4 grams to affected joints bid
PT Eval & Rx Neck
Correspond's: Excuse From Work
Assessment #2: 722.0 Intervertebral Disc Displacement Cervical W/O Myelopathy
Care Plan:
Assessment #3: 729.5 Pain in Limb
Care Plan:
Rolut Slil M.D
Robert Skerker, M.D.
Seen by: 05/29/2013 12:56 pm
Printed on 11/13/2013 12:02 PM Page 16 of 28
STEBBINS JR,RICHARD L Scan on 9/3/2013 by Jennifer Dixon [998058] of TRANSFER RECORDS
08-28-'13 10:05 FROM-PSSP 4137323623 T-530 P0017/0029 F-560
BAYSTATE
MRI & IMAGING CENTER
BAYSTATE MRI - SPRINGFIELD
ACCESBION NUMBER : 4230158:1
PATIENT NAME Stebbins, Richard Jr
MEDICAL RECORD NUMBER 43381581
DATE OF BIRTH 10/08/1978
DATR OF EXAM 1 12/14/2012
REPERRING PHYSICIAN
RESULTS PREFERENCE
only).
BXAM
Final Neport
:
70139543 Toll Froe: 1-800-258-4674
Гах: 1-800-253-7569
wwww.shields.com
KARAS, SUMNER E
300 Birhie Ave/Ste 201
Att: Pater Michaud PA
Springfleld, MA 01107
Reporta via Pax te 413-746-2700.
Images on None (repert only) via None (report
secure aссевв to reports and images at
WWW.SHIRLDS.COM for medical professional0.
MR- CERVICAL SPINE (C-) CPT 72141
HISTORY: Degenerative diec discase cervical spine, Right-sided back
pain and muscle spasm. Pain extending down the right arm.
COMPARI,SON: No prior studies ars available for comparison at Baystate
MRI and Imaging Center.
FINDINGS: The cervical apine is subtly convex to the left, and
etraightening of che cervical spine is 'noted without subluxation. The
cervical vertebral bodies are normal in height and aignal. Subtle lons
of cervical disc space height is seen, and this is most pronounced at
C6-C7. Minimal marginal spurring is neted at this level.
The visualized posterior cranial fosaa structures are unremarkable. No
cord compreesion or cord signal abnormality la seen.
The paraspinal soft tissues ere unromarkable.
C2-C3: No central canal or foraminal stenosia..
To:85254396 From: 12/25 FEB-19-2013
Printed on 11/13/2013 12:02 PM Page 17 of 28
STEBBINS JR,RICHARD L Scan on 9/3/2013 by Jennifer Dixon [998058] of TRANSFER RECORDS
08-28-'13 10:05 FROM-PSSP 4137323623 T-530 P0018/0029 F-560
C3 C4: No cantral canal or foraminal stenosis. 70139543
C4-CS: No central canal or foraminal stenoais.
CS-C6: No central canal or foraminal etenosis.
C6-C7: Mild broad-based posterior dise bulge with marginal osteophytes. Minimal indentation of the ventral thecal sac, Mild righe and no left foraminal narrowing!
C7-Tl: No central canal or foraminal stenosis.
IMPRESSIONI
1. Mild spondylotic and degenerative dise changes of the cervical spine are present at C6-C7 with mild right-sided foraminal narrowing. No cord compression is seen.
2. Straightening of the cervical spine which may be secondary to positioning or muecle apasm.
PHYSICIAN KANG, ÉUGENE MD
(Signature on file) 12/17/2012
The decuments socompanying this tranamiasion contain conidanlial heelth Informetion thet te legalty privlieged This information ls intended onlyfor the use of the individual or entily named ebove.The authorized reciplent of this Infermatien is prohibiced from dlacicaing enis intarmation to any other perty unless requlred le da co by lew or regulation and is required to desiray the infomalion ater is amted need hes been luifited. Ifyou ane not the Inisnded reciplant, you are hereby notiled that any dlecfosure, copying, dlautoution, of ection lalcan in reliance p
the contents of these dacumenta le stricily propibled, If you have rseelved thie lnformation in eror,pleese noly the sender immediately and arrange for the return of deatruction of these documente.
From: 18:26 FEB-19-013 To:85254396
Printed on 11/13/2013 12:02 PM
STEBBINS JR,RICHARD L Scan on 9/3/2013 by Jennifer Dixon [998058] of TRANSFER RECORDS
08-28-'13 10:05 FROM-PSSP 4137323623
05/24/13 PIONEER SPINE AND SPORTS PHYSICIANS PC Acct#: 140653
Richard Stebbins DOB: 10/08/1978 Sex: M Age: 34 years
Page 18 of 28
T-530 P0019/0029
70139543
F-560
Daily Note
Referring Physician: Peter Michaud PAC
Diagnosis: 729.1 - Myalgia & Myositis Unspec, 722.0 - Intervertebral Disc Displacement
Cervical W/O Myelopathy, 729.5 - Pain In Limb
Subjective
Reports no change in symptoms since initial visit.
Objective
Treatment
Therapeutic Procedure
METs/mobs T-spine, ribs
Trigger point therapy to R periscap region
Assessment
Patient Tolerated treatment well.
Patient continues with myofascial restríctions.
Patient continues with muscle imbalances.
Plan
Continue per Physical Therapist plan of care.
Dx:729.1 Myalgia & Myositis Unspec
Problem #1 Pain
STG:Minimize pain to 2/10 @ worst
Achieve by:05/22/13
Comment:
Status: 05/01/13
LTG:Tolerate bed mobility/sleep with no restrictions
Achieve by:06/12/13 Status: 05/01/13
Comment:
Problem #2 Range of motion
STG:Increase cervical ROM to full and painfree
Achieve by:05/22/13 Status: 05/01/13
Comment:
LTG:Pt will be able to lift during household chores with no restrictions
Achieve by:06/12/13 Status: 05/01/13
Printed on 11/13/2013 12:02 PM Page 19 of 28
STEBBINS JR,RICHARD L Scan on 9/3/2013 by Jennifer Dixon [998058] of TRANSFER RECORDS
08-28-'13 10:05 FROM-PSSP 4137323623 T-530 P0020/0029 F-560
Richard Stebbins DOB 10/08/1978
Comment:
Problem #3 Weakness
STG:Increase R trapezius strength to 5/5 throughout
Achieve by:05/22/13 Status: 05/01/13
Comment:
LTG:Return to ADL performance without restrictions or symptoms
Achieve by:06/12/13 Status: 05/01/13
Comment:
Total time of patient visit: 30 min.
WlilliamOsgorlPT
William Osgood, PT
Seen by: 05/24/2013 8:34 am
70139543
Page #2
Printed on 11/13/2013 12:02 PM Page 20 of 28
STEBBINS JR,RICHARD L Scan on 9/3/2013 by Jennifer Dixon [998058] of TRANSFER RECORDs
08-28-'13 10:05 FROM-PSSP 4137323623 T-530 P0021/0029 F-560
70139543
05/21/13 PIONEER SPINE AND SPORTS PHYSICIANS PC Acct#:-140653
Richard Stebbins DOB: 10/08/1978 Sex: M Age: 34 years
Daily Note
Referring Physician: Peter Michaud PAC
Diagnosis: 729.1 - Myalgia & Myositis Unspec, 722.0 - Intervertebral Disc Displacement
Cervical W/O Myelopathy, 729.5 - Pain In Limb
Subjective
Patient reports right UT pinching is gone. Knot, tightness/discomfort still in right UT and right
rhomboids. Patient-reports doing HEP dally.
Objective
Treatment
Therapeutic Procedure
Performed HEP of.
2# Ys', T's 2 x 15 in prone
T-Roll long and cros8 axis x 4 min
UT stretch 3 x 30 sec
rhomboid stretch 3 x 30 sec
Manual Therapy
DTM/SCS Right UT and Rhomboid, Voltarn 1% to same.
S/L right scapula mobs and stretching
OA release
Modalities
Ice and TENS x 15 min to right rhomboid / middle trap
US 1.5 Wcm2 x 6 min to R UT
US 1.5 Wcm2 x 6 min to R rhomboid / middle trap
Assessment
Patient continues with myofascial restrictions.
Patient continues with muscle imbalances.
Plan
Continue per Physical Therapist plan of care.
Dx:729.1 Myalgia & Myositis Unspeс
Problem #1 Pain
STG:Minimize pain to 2/10 @ worst
Achieve by:05/22/13 Status: 05/01/13
Comment:
Printed on 11/13/2013 12:02 PM Page 21 of 28
STEBBINS JR,RICHARD L Scan on 9/3/2013 by Jennifer Dixon [998058] of TRANSFER RECORDS
08-28-'13 10:06 FROM-PSSP 4137323623 T-530 P0022/0029 F-560
70139543
Richard Stebbins DOB 10/08/1978
LTG:Tolerate bed mobility/sleep with no restrictions
Achieve by:06/12/13 Status: 05/01/13
Comment:
Problem #2 Range of motion
STG:Increase cervical ROM to full and painfree
Achieve by:05/22/13
Comment:
Status: 05/01/13
LTG:Pt will be able to lift during household chores with no restrictions
Achieve by:06/12/13 Status: 05/01/13
Comment:
Problem #3 Weakness
STG:Increase R trapezius strength to 5/5 throughout
Achieve by:05/22/13 Status: 05/01/13
Comment:
LTG:Return to ADL performance without restrictions or symptoms
Achieve by:06/12/13 Status: 05/01/13
Comment:
Total time of patient visit: 60 min
Seen by: Oveiitapthen P,PIA
WillianOsgrrlft
William Osgood, PT
05/30/2013 8:08 am
06/03/2013 1:55 pm
Page #2
Printed on 11/13/2013 12:02 PM Page 22 of 28
STEBBINS JR,RICHARD L Scan on 9/3/2013 by Jennifer Dixon [998058] of TRANSFER RECORDS
08-28-'13 10:06 FROM-PSSP 4137323623 T-530 Р0023/0029 F-560
70139543
-05/16/13 PIONEER SPINE AND SPORTS PHYSICIANS PC Acct#: 140653 .
Richard Stebbins DOB: 10/08/1978 Sex: M Age: 34 years
Daily Note
Referring Physician: Peter Michaud PAC
Diagnosis: 729.1 - Myalgia & Myositis Unspec, 722.0 - Intervertebral Disc Displacement
Cervical W/O Myelopathy, 729.5 - Pain In Limb
Subiective
chief complaint of right UT anterior pinching.
Objective
Treatment
Therapeutic Procedure
review HEP of.
2# Ys', T's 2 x 10 in prone
T-Roll long and cross axis x 4 min
UT stretch 3 x 30 sec
rhomboid stretch 3 x 30 seс
patient states doing at home
Manual Therapy
DTM/SCS Right UT and Rhomboid
S/L right scapula mobs and stretching
OA release
Modalities
Ice and TENS x 10 min to right rhomboid / middle trap
Assessment
Patient continues with myofascial restrictions.
Plan
Continue per Physical Therapist plan of care.
Dx:729.1 Myalgia & Myositis Unspec
Problem #1 Pain
STG:Minimize pain to 2/10 @ worst
Achieve by:05/22/13 Status: 05/01/13
Comment:
Printed on 11/13/2013 12:02 PM Page 23 of 28
STEBBINS JR, RICHARD L Scan on 9/3/2013 by Jennifer Dixon [998058] of TRANSFER RECORDS
08-28-'13 10:06 FROM-PSSP 4137323623 T-530 P0024/0029 F-560
70139543
Richard Stebbins DOB 10/08/1978 Page #2
LTG:Tolerate bed mobility/sleep with no restrictions
Achieve by:06/12/13 Status: 05/01/13
Comment:
Problem #2 Range of motion
STG:Increase cervical ROM to full and painfree
Achieve by:05/22/13
Comment:
Status: 05/01/13
LTG:Pt will be able to lift during household chores with no restrictions
Achieve by:06/12/13 Status: 05/01/13
Comment:
Problem #3 Weakness
STG:Increase R trapezius strength to 5/5 throughout
Achieve by:05/22/13 Status: 05/01/13
Comment:
LTG:Return to ADL performance without restrictions or symptoms
Achieve by:06/12/13 Status: 05/01/13
Comment:
Total time of patient visit: 45 min
Seon by: Ouciatape PoPTA 05/16/2013 6:50 pm
EiMand-fut DPT
05/21/2013 7:29 am
Printed on 11/13/2013 12:02 PM Page 24 of 28
STEBBINS JR,RICHARD L Scan on 9/3/2013 by Jennifer Dixon [998058] of TRANSFER RECORDS
08-28-'13 10:06 FROM-PSSP 4137323623 T-530 P0025/0029 F-560
05/14/13- PIONEER SPINE AND SPORTS-PHYSICIANS PC Acct#: 140653
Richard Stebbins DOB: 10/08/1978 Sex: M Age: 34 years
Daily Note
Referring Physician: Peter Michaud РAС
70139543
Diagnosis: 729.1 - Myalgia & Myositis Unspec, 722.0 - Intervertebral Disc Displacement
Cervical W/O Myelopathy, 729.5 - Pain In Limb
Subjective
"I have constant knots in my right UT and right shoulder blade."
Obiective
Treatment
Therapeutic Procedure
2#Ys', T's 2 x 10 in prone
T-Roll long and cross axis x 4 min
UT stretch 3 x 30 sec
rhomboid stretch 3 x 30 sec
Manual Therapy
DTM/SCS Right UT and Rhomboid
S/L right scapula mobs and stretching
Modalities
US 2.0 Wcm2 x 6 min to right UT
US 2.0 Wcm2 x 6 min to right rhomboid / middle trap
Ice x 10 min to same
Voltaren to same
Assessment
Patient continues with myofascial restrictions.
Patient continues with muscle imbalances.
Plan
Continue per Physical Therapist plan of care.
Dx:729.1 Myalgia & Myositis Unspec
Problem #1 Pain
STG:Minimize pain to 2/10 @ worst
Achieve by:05/22/13 Status: 05/01/13
Comment:
LTG:Tolerate bed mobility/sleep with no restrictions.
Achieve by:06/12/13 Status: 05/01/13
Comment:
Printed on 11/13/2013 12:02 PM Page 25 of 28
STEBBINS JR, RICHARD L Scan on 9/3/2013 by Jennifer Dixon [998058] of TRANSFER RECORDS
08-28-'13 10:06 FROM-PSSP 4137323623 T-530 P0026/0029 F-560
70139543
Richard Stebbins DOB 10/08/1978 Page #2
Problem #2 Range of motion
STG:Increase cervical ROM to full and painfree
Achieve by:05/22/13 Status: 05/01/13
Comment:
LTG:Pt will be able to lift during household chores with no restrictions
Achieve by:06/12/13
Comment:
Status: 05/01/13.
Problem #3 Weakness
STG:Increase R trapezius strength to 5/5 throughout
Achieve by:05/22/13 Status: 05/01/13
Comment:
LTG:Return to ADL performance without restrictions or symptoms
Achieve by:06/12/13 Status: 05/01/13
Comment:
Total time of patient visit: 55 min
Seen by: Ociatopher PPIA
WillcamsgorrlPT
William Osgood, PT
05/30/2013 8:08 am
06/03/2013 1:55 pm
Printed on 11/13/2013 12:02 PM Page 26 of 28
STEBBINS JR,RICHARD L Scan on 9/3/2013 by Jennifer Dixon [998058] of TRANSFER RECORDS
08-28-'13 10:06 FROM-PSSP 4137323623 T-530 P0027/0029 F-560
7013954E
05/01/13 PIONEER SPINE AND SPORTS PHYSICIANS PC Acct#: 140653
Richard Stebbins DOB: 10/08/1978 Sex: M Age: 34 years
Initial Evaluation
Referring Physician: Peter Michaud PAC
Diagnosis: 729.1 - Myalgia & Myositis Unspec, 722.0- Intervertebral Disc Displacement
Cervical W/O Myelopathy, 729.5 - Pain In Limb
Subjective
Mechanism of injury: repetitive motion while working 7/10/2012. Precautions:.
CC: Patient presents with neck pain, right upper back pain.
HPI: Current Symptoms: cervical spine pain and upper back pain.
Cervícal spine pain: Rated as 9/10 in severity at its worst and 2/10 in severity at its least.
Located on the right side. Does not radiate. Reports aching and burning pain. Sx disturbs
sleep. Aggravated by carrying, lifting, raising arms over head and turning. Alleviated by rest.
Diagnostic studies include: MRI and X-ray.
Treatment to Date: Consulted with a physiatrist. Physical therapy. No prior functional limitations.
No functional limitations.
Occupation: Reset Specialist
Previous work status: Full-time full duty.
Current work status: Not working secondary to injury
Patient Goals: Eliminate pain.
Objective
Inspection: Cervical Spine: Forward head and neck posture. Thoracic Spine: Unremarkable.
Palpation: Cervical Spine: Tenderness of the right levator scapulae, tenderness of the right
rhomboid muscle, scalene muscles and tenderness of the upper trapezius region bilaterally.
Joint Mobility: Cervical: left side is normal. Right side is hypomobile. Thoracic: Left side is normal.
Right side is hypomobile. Costovertebral: Left side is normal. Right side is hypomobile.
Strength:
Spinal Innervation:
C4 shoulder shrug 5/5 bilaterally.
C5 elbow flexion 5/5 bilaterally.
C6 wrist extension 5/5 bilaterally.
C7 elbow extension 5/5 bilaterally.
C8 thumb extension 5/5 bilaterally.
T1 finger abduction 5/5 bilaterally.
VE:
Shoulder:
Middle trapezius 5/5 on the left, 4+/5 on the right.
Printed on 11/13/2013 12:02 PM Page 27 of 28
STEBBINS JR, RICHARD L Scan on 9/3/2013 by Jennifer Dixon [998058] of TRANSFER RECORDS
08-28-'13 10:06 FROM-PSSP 4137323623
Richard Stebbins DOB 10/08/1978
T-530 P0028/0029 F-560
70139543
Page #2
Lower trapezius 5/5 on the left, 4/5 on the right.
Special Tests: Cervical compression deferred bilaterally. Distraction test deferred bilaterally.
Facet loading is negative on the left, Facet loading is positive on the right Shoulder depression
test deferred bilaterally. Adson maneuver deferred bilaterally.
Neurologic: All reflexes are intact. No sensory deficit.
ROM:
Cervical
AROM
Forward Flexion: 60°.
Extension: 45*, end range pain.
L Rotation: Within functional limits.
R Rotation: 60°, end range pain.
L Sidebending: 35°, end range tightness
R Sidebending: 30°, end range pain.
Treatment
Therapeutic Procedure
SCS R paracervicals, R UT
Trigger point therapy to R periscap region
C/T joint mobs
R post rib mobs
Assessment:
Presentation: Pt. is a 34 y/o male with c/o neck pain and upper back pain. Presents with decreased
strength, decreased ROM, decreased soft tissue and joint mobility, and decreased functional status.
Pt. would benefit from PT to improve functional mobility.
Rehab Potential: Rehab potential is good.
Patient Understanding: Client understanding assessed is good.
Impairments: Decreased ADL's, spinal asymmetries, rib asymmetries, decreased muscle
performance, faulty posture, decreased flexibility, increased pain, decreased joint mobility/integrity,
decreased range of motion and decreased soft tissue mobility.
Treatment Emphasis to focus on: Biomechanical normalization, maximizing function, muscle
function improvements, relieving pain, postural improvements and range of motion/mobility
improvements.
Functional Outcome Assessment Reviewed: ☐ Yes No
Plan:
Expected therapeutic contents to be utilized: Patient education, a home exercise program, joint
mobilization techniques, modalities as needed/appropriate, neuromuscular re-education, postural
stabilization training, soft tissue mobilization techniques, stabilization exercises, stretching/flexibility
activities and therapeutic exercises.
Consult with: Client's physician.
Frequency & Duration: Frequency & Duration: 2 times a week for 4-6 weeks.
The treatment plan was developed and discussed with the patient and the patient is in agreement
with the treatment plan.
Dx:729.1 Myalgia & Myositis Unspec
Problem #1 Pain
STG:Minimize pain to 2/10 @ worst
Printed on 11/13/2013 12:02 PM Page 28 of 28
STEBBINS JR, RICHARD L Scan on 9/3/2013 by Jennifer Dixon [998058] of TRANSFER RECORDS
08-28-'13 10:06 FROM-PSSP 4137323623 T-530 P0029/0029 F-560
70133543
Richard Stebbins DOB 10/08/1978
Achieve by:05/22/13
Comment:
Status:05/01/13
LTG:Tolerate bed mobility/sleep with no restrictions
Achieve by:06/12/13 Status: 05/01/13
Comment:
Problem #2 Range of motion
STG:Increase cervical ROM to full and painfree
Achieve by:05/22/13 Status: 05/01/13
Comment:
LTG:Pt will be able to lift during household chores with no restrictions
Achieve by:06/12/13 Status: 05/01/13
Comment:
Problem #3 Weakness
STG:Increase R trapezius strength to 5/5 throughout
Achieve by:05/22/13 Status: 05/01/13
Comment:
LTG:Return to ADL performance without restrictions or symptoms
Achieve by:06/12/13 Status: 05/01/13
Comment:
Total time of patient visit 45 min. Wlllianbgrler
Seen by:
William Osgood, PT
05/02/2013 2:49 pm
Page #3
