Baird Cenifled In Orlhoiulle Surgery Slnye Sm: ol'New JaneyDcpuruncm ofTreuuryDivinion of Pension and B=n:fluPO Box 295Tlenlnn, NJ 01625RE: JAMES PIEPERFILE NO.:DATE INJURY: 06115110DATE OF EVALUATION: Dear Mr. - Mr. Jnmes Plan: was seen at your request lb:-an lndependem Ofilwpedlc Medical Evnlunlun onin 111: Ridgewoorl nffuze of IMX SEWID6. Mr. Piepelxmdusxood than this was tn Independent Media! Evnluninn uni does nut rqnesml develwmenl ofa ealalionship or racnmmuldnliuns lor lrelumm.ACCIDENT AND TREATMENT HISTORYMr. Pieper is 3! year old, right-handed male who 011 he iujumd bad: and rightclhow an OGIZSIIO. He states he fell on his luck while Braking up I light between Iwninmates. Well! In nu mam nt Ruben Wand Hospital on Olliccr dam: him. Hr: hm] x- ken. xvhich were ncaznivu: for or hn.-uks.Hu was In.-um! with ml la sunes um: he was nun admillml. Aflcl Ike injury. Mr. Piepcr slums Ihnl he mccived prinmxy mm {mm Dr. 'fromJun: In July 2010. H: had MRI: nviewod and Wu mscribcd ain physicallhcrapy. He mnivad pain management can Dr. "from July or August lo Novemlxr ur Dzcemhcr zolo. incluxdcd lwa epidural and discogrunwas dun: HI: received can {mm July 2M0 Io Tmnummx innlnulml spinal fusion or L5-SI. H: nucn 1 mpy Ihm: limes a week I'mspam 0Jlmu -Iv April I2, 2012uppruximrnely live rnonlhs and this wa then discumlnutd. He reccived vzalmeulsas nzeded on and ufl't2>r three He Inok and which he isall! inking and look today. He h-d lwo spinal luiaclions in Ipptoxiulalely Auglm 2010 andSepmnber ZOID. He had LS-SI sp1n|H\5lnn on 03l09Ill. H: hurl 3-rays ulwn in Jun: 2010,March 20] l. Muy 2011, Ind lb: last cm: was on 03/05/12. H: (old mm the films wereuezllive for breaks or Ind is fined. He MRI: In appmxiynuely July2010 Ind Ihelnsxomwu lnocmbuzoll. He wnsuild drmhe L4-LS mild bulgeand annular mt. He Isndan EMG sxudy in 20! l. which was negative. Adiscugmn was done in Ippmrirnnely January 20ll ml for LS-S1.CURRENT Mr. Piepefls main ecmphinr is lnwu hunk pain going into his right and lefi legs causingweakness. 112 painkgrulerin uh: right leglnd luhuweakruuiuhtl feet withringling inhismas. Ho had buck and right leg pain to his Incl. At present. his Insomewhat better. He Ilul h: is no Iruuneni. H: raw: his law: buck andbullock: plin 1; Soul of 10 on pain scale.HISTORYWham me nccidam or.-curled. Mr. Pieper full lime, per week, as saninrCorrections Office for the Juvenile Justice Cavnminion. Ax sh: time at the irfiury. Ir: workedvlhale forapprux'unmIy9yeursInd4 mmuha. Heisnu nmliulnsignmion in Febnmy 20l2. His job required lining and carrying, H: spurt I0hour: sitting. IS llnlus minding and walking lb! hisjob. H: unis (lull he rninnd time fimnwink met in: way from approximualy on: year and eight months. he isno! uclively wanking H: is rruediully resigncd hccuuse of: 50 welgln rm:-icliun and In:been on ligln duly. He has ml menrpted to go to nuiv: duly us he nn'r run, rennin lninuel. orwalk hr I5 minuls.PAST MEDICAL HISIOI-IVHe allies he had a similu injury in lime 2009 II: injured his neck wlrilcnutrnining imnnm. At that time. 11: did not have Iukan and mums] in war]: In Ilnu: Infour shay: uflcr Ir resulved. slam (hnI.h= dun nur have P-sr Surgical Hismry: He mus nm In: had cv.-rvicnl rusinn surguy and C6-C7 onoomll um! ankle zoos.MEDICAL commonsnzukl 1June: Pleper April 11, N12SOCIAL HISTORYMEDICATIONSALLERGIEH: mm hf: us no known ullergles no modiulions.PHYSICAL EXAMINATIONA ID we used for idenfiliutionmd I chnpemnz wu pcesenl ln Ih: mm.Exam' I6-fool. 7J5 pound mil: is in no dlmux, ellmbed on exnm ubl: wilhom dil'I'u:ulIy Ind mnhulmd without a limp. A wn used (or rn-we ofmmlon mawmnenu.Cervical spine examination rung: at modon with Ilaxinn In 45 ulegtcsexlansinn 45 degrees lo Ill: Id! In deyaesand [Metal llexlan lo Ila: right and M11045 dzuees 'l'lle1swu no tcwdarnasslo palpation. no spam, and an min. The neumlogie exntninalion cl' oetvinl spine slmwudreflexes 2' ml nomul. The Inn was ungudve. Triceps, biceps. bnchimmllalls wmmd equal. Sulsnim was nunnal. The lvicopu, bicepl. foveaml muscles. IndInulnsle muscles nflhe hand were 1'homcolumlnr spin: alwwul I-inch unmior incision only. Then isno pain now. lull ha hu 3 conmnl well: in his lmver back. Emu-n dzmolulnled range nfmolionincluding fludcn to 90 dexrus exlcnaion lo 30 degnu lateral llaxion In Ill:and lull In 30 dzgrecs and lo the right and kn In J0 l'I?fll'IE? Thur: was nu spasm. nr In puipmlon. or pain on mug: of motion. Th: nemuloglcmum of lower exlwmilies dcnnanslnued dun lcrulml mums, pnlullnr Achilles. nu:nun-'mal. l3ahinsti': was normal. No scnsuinns nolcd. hxmulrings.llnlIu:is longu: wen bilaterally and cqull 5/5. Ii}:mixing aiuinu and supine wen: blluwrully with no rndivulopmhy noted. The mt wu Heel and we was nunnul. Wmldell Issting was not-ml. Righl and Ian imuldm rxuminnlinn forward to IE0 durees to 50 degree: (N=Slf'l. lo degrees udducliml la 50I 3PI EFERI2James Pieper -4- . April 12, 2012degrees internal rotation to 90 degrees and external rotation to 90 degreesThere was no pain on range of motion. There was no heat. swelling, erytherna, oreffusion. The impingement sign was negative and the apprehension test was negative.The circumference of the right upper arm at 4 inches above the olecranon measured 14 inchesand the left measured 13.5 inches with no atrophy. Right forearm circumference measured 11inches and the left measured ll inches with no atrophy.Right and left elbows examination demonstrated range of motion including flexion to I40degrees extension to 0 degrees supination to 80 ?degrees . andpronation to 80 degrees ?l'here was no pain with range of motion. ?there was notenderness, swelling. or e?itsion noted.Right and Ian wrists examination demonstrated flexion to 60 degrees extension to 60degrees radial deviation to 20 degrees and ulnar deviation to 30 degreesThere was no tenderness, pain, or ef?rsion and range of motion was pain free.Phalen?s test was negative and the Tinel's was negative.Right and left hands examination demonstrated range of motion: Proximal interphalangeal jointllexion to 100 degrees distal interphalangeal joint tlexion to 70 degrees andextension to 0 degrees There was full closing of the hands and no atrophy was presentof the'thenar or hypothenar musculature. There was no tenderness, swelling, erythema, orpresent. The Finklestein's test was negative. Sensation was normal.Jamar strength testing demonstrated 45 kg on the right and 45 kg on the left. Lateral pinch was 8kg on the right and 8 kg on the left. Hand grip was normal bilaterally.Right and left hips examination demonstrated forward flexion to [20 degrees extension to 30 degrees internal rotation to 40 degrees external rotation to 50degrees abduction to 40 degrees and adduction to 20 degrees Therewas no pain on range of motion. The Patricl:?s test was negative.Right and left knees examination demonstrated flexion to I50 degrees (N=l50?) and normal .extension to 0 degrees The Lachman. MeMurray's. and Drawer signs were negative.The patellofemoral inhibition test was negative. The knees were stable to vows and valgusstress. 'l'ltere was no tenderness. hcut. swelling. erythema. or el?l'usion. ?l'ltere was no pain onrange of motion.The circumference of the thigh l0 cm above the superior pole of the patella measured 20 incheson the right and 20 inches on the lcti with no atrophy. The circumference of the call? measured16.5 inches on the right and l6.5 inches on the lell with no atrophy.James Pleptr -5- April ll, Right and Len ankles and feel euxninalion dunilleximt In 20 degmea 052(7),plantar flnian to 40 degrees inversion to 30 degmea and aversion In 20degtees Thus was no swelling,' erythem or deformity yruenl. 'mmwas no pain on plantar flexion toe raises as 5 bilaterally. Tlteze was no pain with range ofmotion.'Leg length: were equal. The remainder om: examination was nonnal.MEDICAL RECORDS REVIEWED0 New Janey Division oFPensloa: and Benefits - Application Disability --OJIOII I2. New Jersey Division ufPevtliom and as-um: -- Medical Bum by Trailing rt-yssci-n-I New Jersey Division of Pemians and Benefit: - to Disclose Healthlnfonmtion - New Jury Juvunlle Calnxnissiun Vlolalions and Ineitlent Reports -06/25/] 0New Jersey Juvenile First Aid Repun.a--ll6IljIll)Job descriptions (2) - smlur Conutlon Olfioer. Juvenile JusticeVinuo It Work - Work Imus sttnunary Iuales-- IPain Management nnles-- 0ll05IIO--09/ll/I0hon inieetlnn - Ruben Wood Johnson Hosp IAI - Operollve Reports (1) - IRobert Wood Johnson Hospital - Consululiun - 03ll 2/1 IRobert Wood lolmxon Hnspilnl - Discharge summary - 03ll2IIlRobert Wood Johnson Harpitnl -- l!:wnls- -- MRI -- 07/20/10-09I07ll1- l/63/llDiIgnostiu-- Rlt'1iu|ogy- 1-03/09/1 IDlagttostic:-- Dist: Stimulation Report -- OIIDSII Iagnuniu-.5 -- Cardiology - 01l26lI 1cities -- Lab: I Dutgnustics - Pathology - 031091! ITherapy - physical therapy mm.-s -- DJII DII Immpy -- physical noles --a9mu/t IFunctlaml Capacity Evalua(ion- I ll29ll 1Employer Cnnupondence -PIBPER1 4Motnltev Cutwspundenca James Pieper -6- April 12, 2012DIAGNOSIS0 Lumbar disc derangement with excellent result post-operative lumbar spine fusion,resolved functionally0 Normal exam of the lumbar spine with no signi?cant subjective complaints or objective?ndingsCervical degenerative disc disease resolved post-operativelyDISCUSSIONMr. Pieper sustained the above mentioned lumbar spine injury which is now fully functionallyresolved with no clinical residuals. There were subjective complaints of pain without objective?ndings, except post-operative status. There was no atrophy of the upper or lower extremities,indicating normal usage. Grip and pinch testing demonstrated normal strength. Hand grip wasnormal. -Radiological studies: MRI of the lumbar spine on 07/20! 1 demonstrated bulging discsand herniated disc changes at L4-L5 and that pre-existed the incident and did not correlatewith the nonrral clinical examination. There is no evidence of radiculopathy radiologically orclinically with excellent post-operative fusion clinically and radiologically.EMG study on indicated a normal study of the lumbar spine with no radiculopathy.He can participate in all activities of daily living. He may work at his regular employment as aSenior Correction Officer, Juvenile Justice full time- without restrictions. The prognosis is goodfor continued stable function at the current level.The alleged injuries were the result of the accident and Mr. Pieper is fully recovered with noresiduals. From an orthopedic standpoint, he did not suffer a permanent injury and has nopermanent disability due to the accident of 06/25! 10. -A job description was reviewed and it is acceptable for this patient. The member is not totallyand permanently disabled for the duties of his occupation of Senior Correction Oliieer, JuvenileJustice Mr. Pieper left the exurn worn in the same condition he arrived. with no complaints or apparentsigns nl'dissatisl?aetinn regarding this examination.All the above is stored within a reasonable degree of medical certainty.pr apaais Jame: Plrper -7- April I2, 2012alTm-n under nu: pennllica of perjury. ml the (Ifunhmun oomninzd wirhln this document wasympurtd by and In Ihe wotk pmducl oflhe undersigned. is we to I11: bus! of my knowledgeand infommlimu."Respecmuly suhmilted,I-'ellnw, Ama-inn Aaduny nf Onhnpedi: