an 'i Orthoped Associates GaryE Amerson,MD - JohnW Anderson, M.0. . Jack] Beller,MD. Steven P.3rantley,M,D - Stephen R, Davenport, MD, . Davldl.FleSher,M.D. i . Greg . MichaelE.Klehfl,M,D. AndrewE Parkinson,M.D. - Richard 3301N.w.50"' street - Oklahomaoty, UK73H25691 tel: 405900911 seesaw-0911 i fax1405-947r1341 Patient Name: McGahey Bradley Physician: in, IE or Date of Servic 03/29/20i2 Type of Service. we Followup (L Hand/Wrist) AIG/Chartis PO Box 25974 Shawnee Mission, KS 66225 Attn: Latisha Snorn, Adjustor (Fax: 86673976983) Claim: 710-690993 Court: This is an orthopedic report on the above named patient, CURRENT Followup lefl hand and wrist. No evidence of self-mutilation 0r self-manipulation of the hand and wrist by physical examination or by direct questioning. MRI: MRI studies performed today, 03/29/2012, reviewed carerully by me, The wrist shows there to be some tenosynowtis of the extensor carpi radialis brevis and extensor digitorum. These are relatively nonspecific findings and do not Show any edema in the bones, joints, or ligaments or otherwise in the soft tissue. PHYSICAL EXAM: further examination of the hand reveals Swelling, limited range of motion, and also very tentative range Of motion, possibly some contractures 0r adhesions, which are nut identifiable by MRI. He also may benefit from a tenolysis of the dorsum of the left wrist. DIAGNOSIS: Status post injury to the left hand and wrist with persistent pain, swelling, limited range or motion, and paresthesias. MRI findings are equivocal, but do not rule out a significant ligamentous injury, contracture, and/or adheslonsl PLAN: Recommendations may include manipulation under anesthesia of the left hand and wrist with possible arthroscopy and/or tenolysis. Treatment is not authurlzed this time, according to my notes, The patient be seen on a pm. or preop basis depending upon the wishes of the interested Dames. WORK SYATUS: At this time, he has restrictions of no use of the left hand except for attempted range of motion on his own accord. ANTICIPATED If surgery is performed, anticipated is in the range of three to four months postop. All opinions in this report are based upon a reasonable degree of medical certainty. i declare under penalty or penury that I have examined this report and all statements contained herein, and to the best of my knowledge and belief, they are true, correct, and complete Richard A. Ruffin, cc: Craig Dawkins, Attorney at Law (Fax: 843-1246) Jennifer Sloan, Attorney at Law (Fax: 91838271499) sip, C19 Electronically signed on 04/24/2012 by RICHARD RUFFIN MD RECEIVED mm DAWKINS LAW FIRM Orthopedic Associates -Gary -Jdtinw,Andeim Mn and]. seller, n, - Steven verandey, D.- sephen R. Mi: ~er E. Helm, M.D.- rmchad E. idem, m. - Andrew a Philemon, m) . mderd m. 30le slamstraei newsman Pauent Maine: McGahe Bradley in, a Date or serihce: tum/2012 Type or Sennce: wic initial (L Hand/Wrist) Ale/charts po Box 25974 Shawnee Mission, KS 56225 Amt: Laflsha Sham, Adjuster (Fax: 866-739-5983) claiiri: 710690993 Court: 2010-0339834 This is an orthopedic repnrt on the above named patient. REASON FOR insn': Bradley McGahey was seen in the offite today for evaluation and treatment of the lefl hand and wrist. HISTORY: Mr. Mtcahey is 25 years old and rEpons he is right hand dominant. He got his hand caught in a chicken grinding machine sustaining a crushan Injury on 05/27/2010, He states since alter his injury he had marked swelling and he went to the lntegris sieve Hospital, had evaiuatiniis, and subsequently saw a physician harried Di. Biian 099, None of these records are available, but the patient apparently had marked swelling of his hand They mind never determine whether he had a frame, but the swelling ws so severe it took several weeks, it not marina, tor the swelling to the resolve or at least get better. He states he has no strength as a result or his injury. He cannot do his work and he also annct do his hobbies such as pertorming rodeo aaivitias. He has not strength and he says his hand hurts all the time, MEDICAL may: Past hisiery revlened and part of the medical rem. it does not appear to he otherwise remarkable. He had a prior head irriirry. Previous disc surgery, He dos not smoke or drink There is a comment regarding a 11/09/2011 Injury in which he adually wettl he the Mercy riuspital pt rshemingo and had x-mys taken of left hand. There were no new iniuries detected, apparently the patient did have a tall, but he says he actually harely hit his lett hand, it just stand hurting even more alter this Injury. He states his hand has always been hurting even before what apparently was a faifly trivial tall according to the patient. PHYSICAL EXAM: Examination reveals the patient to be fully copper--alive. He dots not appear to magnify his He is approximately 5 reet9 ind-s and 200 pounds aaminafian ufthe left hand reveals swelling oithe artire hand with limited harm of all digits. He has a hexiari deformity of all the digits as well. He a very tender RECEIVED 82/29/2812 81:47 4858431246 DAWKINS LAW FIRM E:\data\patients\05 2\l 77\52l 77\\Transcriptl him throughout the thenar and hypothenar musculature. He has very limited opposition of the thumb to the adjacent digits. He has multiple points of tenderness, which were poorly localized. I Radiographs of the lelt hand, multiple views, show soft tissue swelling, no instability patterns, and no evidence of dislocation or fracture that I can identify on these views. DIAGNOSIS: Left hand and wrist injury with subsequent pain and recent aggravation. PLAN: MRI studies are recommended for the left hand and wrist to rule significant ?uid collection or other abnormality. I discussed the ?ndings with the patient. He does have a signi?cant swelling of the hand, which is ongoing and persistent and by report at least has not changed signi?cantly since 2010. His intervening injury of 2011 does not appear to have worsened or magni?ed his condition. He will followup after these studies. WORK STATUS: The patient certainly has limitations of 10 pound lift limit and limited use of the left hand. As noted, I believe all these problems are a consequence and result of his injury of 05/27/2010 while employed with Christian Prescription Alcohol Addicts Recovery. ANTICIPATED MMI: I have not been able to estimate his MMI status at this time. I -. f? All opinions in this report are based upon a reasonable degree of medical certainty. I declare under penalty of perjury that I have examined this report and all statements contained herein, and to the best of my knowledge and belief, they are true, correct, and complete. Richard A. Ruf?n, M.D. cc: Craig Dawkins, Attomey at Law (Fax: 843-1246) 9- Jennifer Sloan, Attorney at Law (Fax: 918-382-1499) l. RAR/cig {3 Electronically signed on 02/27/2012 by RICHARD RUFFIN MD i}