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I Do Not Know What This Means?

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vistagirl81

Question

Hello everyone,

I have been on here from time to time and my husband had a C&P exam om the 29th of June and the ortho dr. said that ... He is flexed forwaed 30 degrees. He cannot stand or walk on the heel or toes. he cannot squat.

Low back pain

Range of motion is 40 degrees flexxed, he lacks 30 degrees of extension, 5 degrees right lateral bend, 5 degrees left lateral bend, 5 degrees rotation to the rigth and left. After the final range of motion there is pain, fatigability, weakness, lack of endurance, but no incoordination throughout the entire range of motion.

Diagnosis : Lumbar strain

Right Knee tendonopathy

Range of motion rigth knee lacks 15 degrees full extension and flexes to 80 degrees whrn he is sitting and trying to extend against gravity, but when supine the right knee comes to full extension of 0... which one are they going to use?

Diagnosis Patellar Tendon Contusion right knee

Thank you.

Edited by vistagirl81
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This is what is says:

C-file and service medical record was reviewed. The Veteran served in the military from 2000to 2008. Just prior to his seperation there was a right knee injury and a fall abord ship, which has been diagnosed as patellofemoral pain syndrome.

There was low back pain reported during his military service. The veteran also had a lumbar puncture to rule out meningitis and he has complained of pain in the lumbar puncture site since.

Low back:

in aug 05 there are reports in the service medical record of the vet. having occasional low back pain with radiation to the buttocks. Diagnosis was made of lumbar strain and motrin was perscribed.

The vet. has obvious pain getting outof the chair. He limps favoring the right knee over the few steps he takes without his cane, but this is only a few steps.He uses the cane and he is flexed forward 30 degrees. He cannot stand or walk on the heels or toes. He cannotdo a tandemgait. He cannot squat.

There is no scoliosis, but there is a flattened lumbar lordosisand the vet stands forward flexed 30 degrees. There is no muscle spasm and the pelvis islevel.

R.O.M 40 degrees flexed, he lacks 30 degrees of extension. 5 degrees rigth lateral bend,5 degrees left lateral bend,5 degrees rotation to the right and the left. After the final range ofmotion there is pain,fatigability,weakness,lackodendurance, but no incoordination throughout the entire range of motion. There is bilateral paravertebral muscle tenerness, but no scarsand sitting posture is normal. Deep tendon reflexes trace right knee and right ankle and 2/4 left knee and leftankle with no pathologic reflexes and intact sensation.

Straight leg raise sitting 90 degree on the left, but straight leg rise cannot be doneon the right because the vet. resists because of right knee pain.Supine straight leg raise is 20 degrees right, 30 degrees left and is actively resisted by veteran.

The veteran sits up slowly from supine to sitting with pain and facial grimicing. He does needhelp in dressing for putting on his shoes and socks.

Diagnosis:lumbar strain

Discussion: The verteran's symptoms and finding on examination, which are under the direct control of the veteran ( R.O.M and movements) seem quite out odporportion withe the history provided. The vet has PTSD and i would consider that it is atleast as likley not that there is some psychological imapact upon his somatic complaints.

The service records does indicate the vet. was seen on occasion forback pain, but i would consider that the condition for which he was seen in the service would be causing his current subjective complaints.

Right Knee:

The vets. service medicalrecords indicates that in sep 08 the vet tripped and feel on his right knee while on board a ship.His diagnosis was soft tissue injury.

The vet stands with normal alignment of the right knee, but there is antalgic gait on the right with the cane. R.O.M right knee lacks 15 degree fulll extension and flexesto 80 degrees when he is sitting and trying to extend to gravity, but when supine the right knee comes to full extension of 0. The vet complaines of pain duringextension of the knee. The leftknee extends full to 0 degrees, flexes 125 degrees. After the final R.O.M there was no change of motion , but there was pain, fatigability, weakness and lackofendurance.

Diagnosis: Patellar tendon contusion right knee.

An MRI of the right knee was done in October 09, which showed thickening and signal alteration in the proximl portion of the patellar tendon, whick the radiologist states was consistant with a tendonopathy.

Discussion: Based upon the nature of the veteran's injury while in the military in 08 with the fall, the pain in the anterior aspect of the knee. However, the extent of the vet's subjective pain and the physical observation of the knee is quite in excess of what one would expect given the time interval between the injury and current examination and the nature of the findings in the MRI.

As was stated in my discussion of the lower back, the vet' PTSDmay well have an impact upon the somatic complaints.

A psychological examination would be necessary, however, to specifically relate to his psychiateic diagnosis with his somatic complaints.

This is beyond the scope of an orthopedic surgeon, although suggestion of a relationship has been made.

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In a nut shell, they are saying that it is all in his mind. While there may be pain there is no physcial condition to compare it to. Sort of like a paper cut. It hurts like the devil, however, it looks like a scratch. Thus, they are saying that that it is symptomatic of his PTSD.

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That is what i figured. Since he gotout of the military they haev said that. From his knee pain to his aches in his stomach.. When he ends up in the emergency room that is when they find out he has high blood pressure and diabetes. I called the va today and they sent his C&P exam back because they said everything was contradictory. How could a MRI detect something but it be in his head. If it is his ptsd then why isnt he 100%.. Thank you for your help.

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I called the V. A today and they said that the C&P exam was sent back to the examiner because it was contradictory to the evidence. Will my husband need another exam? Is this normal in dealing with the V.A. I knew what they were trying to say and now i am confused. Thank you

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