January 8^th, 2009

The following is in regards to your client, John Doe, who presented to our office on January 8, 2009, for examination in regards to the above-mentioned industrial related incident in reference to percentage of Whole Person Permanent Partial Impairment, utilizing AMA Guides, 5^th Edition.

John Doe presented with ongoing complaints of bilateral hand/wrist pain.  He states that these complaints have been present since being involved in an industrial related accident that occurred on the above-mentioned date.  He described the mechanism of the injury as when he was lifting a post pounder to drive base post, the pounder was off balance causing both hands to be twisted and turned causing sharp pain in both hands.  The first doctor he saw after the accident was Clemency, where he received a prescription and wrist braces.

CURRENT COMPLAINTS AND STATUS:

John Doe explained that he still works for the above-mentioned employer. The patient states that he did not miss any work due to the injury.  Mr. Doe states that the pain comes and goes.  He describes the pain as a   sharp, tingling, throbbing, stiffness, and aching sensation.  The patient states that he has limited mobility of his hands and wrists.  He states that this injury interferes with his work, sleep, daily routine, and recreation.  With limited use of his hands and wrists, it is difficult or impossible for him to perform the following activities:  climbing stairs, doing laundry, doing dishes, running sweeper, cutting lawn, shoveling snow, raking leaves, gardening, driving a car, lifting weights, fishing, and grocery shopping, grasping small objects, and using your hands.  Mr. Doe explains that as the weather gets colder his pain increases. 

Deep tendon reflexes were +2 and symmetrical of the biceps, triceps, and were elicited bilaterally and equally of the brachial radialis.  Finkelesteins test was positive bilaterally indicating tenosynovitis.  Altered sensations to hot and cold during sensory testing.  Grip strength was 50 lbs right and 55 lbs left.  Patient is right hand dominant.  Wrist circumference measured 21cm left and 21 cm right.  The patient was unable to discern between two sharp points of contact within 55mm (<5mm is normal) over the C6 dermatome in the left and right wrists. 

Left Wrist Range of Motion

LEFT WRIST RANGE OF MOTION IMPRESSION:

A.)  Flexion = 5% impairment.

Total left wrist impairment = 12% UEI according to AMA Guides, 5^th Edition, Chapter 16, pages 467-470. 

A 12% UEI equals a 7% WPI.  Table 16-3, page 439.

Right Wrist Range of Motion

RIGHT WRIST RANGE OF MOTION IMPRESSION:

A.)  Flexion = 6% impairment.

Total right wrist impairment = 13% UEI according to AMA Guides, 5^th Edition, Chapter 16, pages 467-470. 

A 13% UEI equals an 8% WPI.  Table 16-3, page 439.

DISCUSSION AND OPINION: 

The following impairment rating has been given to John Doe after a thorough history, orthopedics, neurological, muscle testing, and range of motion examinations were performed on January 8^th, 2009:  It is my professional opinion that Mr. Doe has sustained a 14% Whole Person Impairment.

This impairment rating falls into the Range of Motion category, November 2000, 5^th Edition AMA Guides to the Evaluation of Permanent Impairment.