HomeMy WebLinkAbout0920 . w.....?
.
•
.
CIOFFI, PETER M. 129-74
9/13/77: This is a 2S yr. old ~:~:i:c rale who states tnat ne wur~cu
. . a job from rchruary 2fi,= 1977 until July. 30, 1977. His job
. wa+'onc of in~tallin~ c•nbines ii~ a Yact~t Y~rd an~ on a Friuay morning
late in Juty cloesn't remcmhcr ex:ict]y thc ~au.c~ hut develo~~cJ tisck
p:iin a~et s?rM pain. 11uc: to thi, injury ltie r~is~ecl most of ihw ke~~k at
' work and sub~equently was laid oEf a~ ,oon a:+ tl~is war mentioncd to his
boss.
• After applying for anotiier job he found that something.was wrong with thc .
low back and therefore he was se~it to me for evaluation by Vocational
~ Rehabilitation for the rossibility of re-education and continuation of
~ college. tle has had one year of college and would~ like to go back.
; He likes beinA a diesel mechanic and likes the work, but if his problem
~ is ono in whirh h~ will b~ incap0u:itatcd '.n this rosition, then he wa?~td
j liko to ~ct into anutl~~r voc:?tion. . ~ • -
' OP~ 1: Ri (:IIT SIIQUI.I11iK •
2: IIPPtik RACK .
On oxsiiain:~i inn ~~f t~hr pat i~~nt', +huui~lrr 1?r w:i+ ~~atr~i tu h~v~~ a ~iormz~l
J ItUM. Thr ~~:~t iunt hr:i rd ~•r:~~k 1; ft=1 t wl?r~~ 1~~• u•rd i t lit~ fr ! t 1 i ti 14
bit of pain ~ecl~ ;~ntrri~rly. [ 1'ccl this w;~~ ~no~t likcly ~c~ran~l.iry tc~
, developiacnt of bursitis or a tandinitis. '1'his sccros to bc resolving anJ,,
. ~ no pain o r discomfort could he clicited in thc movcmcnt of the arat. fle ;
did have some crackin~, but this was felt to hc fairly normal and did not ;
, seea~ to bc a significant I~roblcm to hira at this time. ~3
On evaluation of thc back he demonstrated he had a full to normal ROM ~
' of his. hack for bcndin~; and exrension. Ilc h:~d a l ittic bi t of pain at _ '
~ full cxtensian oC iiis t~;~~:k. Also un latt•r.il hruJin~ it w~s a tittlt ~~ainful'
' ~ He hasi no pain down his leg~ or radiating up to l~is shoulders. I~e had -
+ no muscle spasm demonstrable. He could walk on his toes heels without
' any problem. The deep tendon reflexes of the anhles $ knees were intact
` bilaterally. Thcrc r+crc no pathological reflexc~.
~ OX: On orthopccii~ x-r:~ys o~ evaluation of his lumhar •~ine demonstr~tacl
; a narrowing of Lhe disc at L1. The end plates sccmcd to be irrefiular
at their antsrior ma?rgin a:~d the:e see~:;,~d to be some i:.de;.:zLio:~ of th.e
t disc area. I fcel the patient has clegcnerativc disc disc~~c at L1,L2
~ with some narrowing. l fcel mo~t I ikely thc ~~roblem t~e is 1~avin~ i~ with
~ the facet joini~ ro~tcriorly :~n~l thi ~ i. whcrr- his h~rk pain is coa~in~ fro~u. ~
~ Wl~cn r+e h:~~ h i m du 3I1 ~ i t• ups ;~nc! i n rhr n~i dJl c of tht• s i t-u~is i t wa~ notcd
that ha was having pain localiaed to thc uppar lumbar srine, althoubh it ~
: was only mild in degrce:. I fcel at this age I would recommend the following;
RECO,~E~DATIO~iS: I woi~ld recommend for his degenerasi3cs proce'ss in the
~ ~ lumbar spine ~etween L1 ~ L2 which would potentially
. lead to a£acet joint prob2eair:hich w~li prob.zbly in the future preclude
any h~avy l~~~or ~uch ;z• hc: w~~ enr~loyr.tl in. Thc;reC~re. M~~ x~uld recommend
• consultation and traininb through Vocational Itchabilitation for a morc
~ sadentary type of work.
,
~
• FRA.~IK D. MI3RP~iY,I?i.D./lp
~
~ , , .
!
~ ' i~~l1~CiE C~N~~f F~~.
RQQER PO~tlIA'~
!:?fPt C1~WO CQ R'
~ p~c 1 12 29PN'1~ .
~$6?5~4 -
~J~ ~ IO flAGf ~~8
. :