what's next?

by Sharon
(Indiana )

I took a fall last Oct. 2007.

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Here is Sharon's original post and comments *Bart @ SII*
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To date, I’ve been to my own PCP, had PT, then was seen by an Ortho doctor, then had MRI, got the results for more PT, if that didn’t work, then possibly surgery, which more than likey wouldn’t work.

I’ve talked to my employer, who sent me to get a second opinion, I’ve now got the
Results from the 2nd doctor. They wanted me to do more PT, for 4 weeks, then evaluated again. I was told there were 2 tendon tears, that COULD NOT be repaired by surgery.

One they felt could be an old tear, where the muscles etc. had atrophied to much. They did think that it was very possible that the old tear was made worse or at least made symptomatic by my fall.
The 2nd tear also, couldn’t be repaired.

My employer refused to pay for any more PT, so I’ve been trying to do things at home.

I’ve done research on my local states website and I'm still lost.

SO SOMEONE PLEASE HELP!

Translate this into everyday English!


What the doctor wrote is this.

Exam: ROM is 170/60/T12

Strength is normal to resisted flexion with mild discomfort and is a 4 to resisted external rotation with minimal pain.

Assessment/plan she's been told at this stage her only good option is to continue a home exercise program on a chronic basis.

She will likely have to accept some symptoms of residual pain and mild dysfunction as a result of her condition.

Once again, I think there is a example of an acute on chronic type of injury where she may have had a chronic rotator cuff tear that was exacerbated by her work related injury.
At this point she has reached MMI.

She has residual permanent partial impairment equivalent to 5% of the upper extremity. /size
1.

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Nov 10, 2015
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good post NEW
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I'm not a doctor and don't have similar injury. So, I don't able to give you suggestion about your problem. I think you're suffering from long time with this kind of injury. Sorry to say i just pray to God that you get rid of this injury as soon as possible. You continue your effort and hope you will get your desire result from this effort.

Oct 20, 2015
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Oct 12, 2015
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Oct 23, 2008
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thanks
by: Bart - SII

Best of luck with everything - please do post again if you have more questions.

I hope you find a resolution to all of this, or at least a balance in life with your activities and shoulder.

Oct 23, 2008
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Follow up
by: Sharon

Sorry,

didn't mean to make you think that I doubted what you said.

I tend to forget that you're a professional in this field.

To many don't know and then I have to explain even more.

Hopefully when the information is sent to the insurnace carrier or workers compensation, there will be more information.

Yet, if it isn't, I guess I could get a lawyer,

oh bother, who wants to really stretch this out for a long time?

What can be done, is being done, so I have to learn to live with it.

Maybe I talk to them about what you suggested, about doing a look see, and at least cleaning it up a bit. Smoothing things out.

I can't remember the exact word you used, but isn't this what you meant?



I agree with you, it seems like there is more than 5% loss.

Yet, whatever I'm going to get in a settlement, is probably more than what the employer is was orginally going to give me.

I just wish, there was more to be done with my shoulder.

I'm doing the exercise at home, though you and I both know, that most people don't do at home as well as they'd do with a physical therapist.

big thanks again,

for translating the numbers for me.


Oct 22, 2008
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follow up
by: Bart - SII

I am sure that your doctor is very much in the know about rotator cuff tears. I apologize if I came off otherwise. I am sure he went through a thorough exam, probably only documented the items that were relevant to your specific case.

It is hard to say what another opinion might give you. You may be able to find a balance with your activities and some relief with a diligent home exercise program. It will be an adjustment for sure, but it is possible. You will likely have good days and bad, but hopefully more good ones.

I wish I could give you more insight or other options, but it does sound like you are in good hands, and obviously, they know you and your case better than I.

Please post back if you have other questions, and good luck!

Bart

Oct 22, 2008
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what's next?
by: Sharon

I forgot to add,

that from what I understand,

the doctor went by the well accepted scale to evaluate my arm.

Does that help any?

I've tried to typ everything in my paper work exactly as written, only leaving out personal information.

I know this is information that was sent to my PCP.

I'm not sure if this is the exact same information that will be sent to the IC.


Oct 22, 2008
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what's next?
by: Sharon

Big thanks for you help,

the second doctor is a local sports doctor for the Indianapolis Colts.

So I'm thinking he's in the know, of torn rotator cuffs.


Something I forgot to mention,

I am a 50 year old female, overweight. So I guess that means I'm out of shape.

I did have the ability of liftig from the floor with one hand between 30-40 pound, then again, with one hand lifting it slightly above waist high sitting it onto a counter or table.

Due to my restrictions I'm no longer allowed to do this.

The doctor has me on 15 pound weight restrictions, no reaching or lifting over head, I'm only to do light wait level activities.

Doctor was calling this a Chronic Rotator Cuff Tear.

Everything has been sent to the Insurance Carrier, so I guess I could ask for an evaluation by someeone else, but would it really do any good?




Oct 22, 2008
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exam translation
by: Bart - SII

You have had a rough go over the last year - my heart goes out to you and all you have been dealing with.

"Exam: ROM is 170/60/T12"

This is your range of motion (ROM) the first number is likely in flexion, or lifting your arm out in front of your body - normal is 180. The second number is probably external rotation, or how far you can rotate your shoulder away from your body - normal is 90, and the T12 refers to your 12th thoracic vertebra - that is a measure of how high you can lift your arm out to the side - equal to your 12th thoracic vertebra. That is roughly equivalent to 70-80 degrees - normal is 180.

"Strength is normal to resisted flexion with mild discomfort and is a 4 to resisted external rotation with minimal pain."

He is grading strength based on a 5 point scale - so you are normal strength lifting out in front, 4/5 rotating outwards. It seems strange that he doesn't give a value for either abduction (lifting to the side) or internal rotation. I would guess, given a rotator cuff injury that your abduction is weak, likely 3-4/5.


Assessment/plan she's been told at this stage her only good option is to continue a home exercise program on a chronic basis.

She will likely have to accept some symptoms of residual pain and mild dysfunction as a result of her condition.

Once again, I think there is a example of an acute on chronic type of injury where she may have had a chronic rotator cuff tear that was exacerbated by her work related injury.
At this point she has reached MMI.


MMI stands for maximal medical improvement.

She has residual permanent partial impairment equivalent to 5% of the upper extremity.

This is just stating that he feels you have a permanent impairment equivalent to 5% of your normal shoulder function. I am not familiar with how these numbers are reached, but I would think that with your motion restrictions it would be greater than 5%.

I can understand if the rotator cuff tears are too old to be successfully repaired - that happens. However, I would think that an arthroscopic procedure to debride the shoulder would be of benefit. I don't know the whole story, or your full medical history, so I could be off base.

I know this is your second opinion, but it might be worth starting over with a new doctor and seeing what they have to say.

Hope this helps - bookmark this page and keep us updated on how you progress.

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