January 19^th , 2009

Law Offices of Jones and Jones, LLC            

The following is in regards to your client, John Doe, who presented to our office on January 19, 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.

HISTORY AND MECHANISM:

John Doe presented with ongoing complaints of right hip 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 slipped on a wet kitchen floor, falling onto his right hip.  The first doctor she saw after the accident was Dr. Kumler at Mt. Carmel, whose care he is still under.

CURRENT COMPLAINTS AND STATUS:

John Doe explained that he no longer works for the above-mentioned employer. The patient states that he missed three months of work.  Mr. Doe states that the pain is constant and that his condition is progressively getting worse.  He describes the pain as a dull, throbbing, cramping, numbness, stiffness, and aching sensation.  The patient states that he has limited mobility of his right hip.  He states that this injury interferes with his work, sleep, daily routine, and recreation.  With limited use of his right hip, 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, sitting too long, lying down, playing sports, playing with kids, lifting weights, exercising, running, jogging, sleeping, standing, shopping, grocery shopping, and shopping with spouse. Mr. Doe explains that as the weather gets cold and damp his pain increases.

All of the above mentioned complications fall under the chronic pain category where up to 3% impairment is given/added to this claim based on the ongoing burden of illness disrupting activities of daily living.  John is given 1% WPI today.  Reference AMA guides, 5^th edition, Chapter 18, Tables 18-1, 18-3, 18-4, 18-5, 18-6 and page 584 item 5b.

Deep tendon reflexes were +2 and symmetrical of the patella and Achilles.  Eli’s, Nachlas, and Hibbs were positive on the right.  Dermatome hyposensitivity was noted over the L3 dermatome in the right.  Muscles hypertonicity was palpated all throughout the right hip region and primarily in the gluteus maximus, hamstrings and tensor fascia lata muscles.  X-rays analysis revealed fixation surgery of the right proximal femur.  Findings included 4 surgical screws and steel rod placed in the neck and shaft of right femur.  Muscle testing of the right hip during flexion, extension, and abduction revealed a 25%, grade 4/5, decrease in muscular strength when compared to the left.

A.)  Flexion = 10% impairment.
B.)  Extension = 0% impairment.
C.)  Right Abduction = 5% impairment.
D.)  Right Adduction = 0% impairment.
E.)  Right Internal Rotation = 0% impairment.
F.)  Right External Rotation = 5% impairment.

Right lower extremity impairment = 20% LEI, based on AMA Guides, 5^th Edition, Chapter 17, Table 17-9, page 537.  

Intertrochanter Fracture, Closed, Right = 25% LEI.

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 19, 2009:  It is my professional opinion that Mr. Doe has sustained a 17% 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.