AAPM&R National Grand Rounds: Disability Evaluation: Essentials of Reviews and Determinations (enduring)-Case Study A

Case Study A

Pdf Summary

The document is a Case Presentation detailing the medical examination and history of Mr. Earnest Hurtman, a 35-year-old electrician at GE, whose right shoulder injury occurred on March 1, 2021. Referred by his attorney for an Independent Medical Examination (IME), the evaluation was conducted to understand his physical impairment post-injury.<br /><br />Mr. Hurtman's job involved medium-heavy lifting, including carrying wire spools. His injury happened while exiting a confined space, where he tripped and fell on his right side, immediately experiencing sharp pain in his right shoulder. Initial medical evaluations showed no fractures, but he was diagnosed with right shoulder strain and treated conservatively. Despite six weeks of restricted duty and medication, his condition did not improve, leading him to see an orthopedic specialist, Dr. Carver, who diagnosed a full-thickness rotator cuff tear.<br /><br />A subsequent arthroscopic surgery involved rotator cuff repair, subacromial decompression, and distal clavicular excision. Post-surgery, Mr. Hurtman underwent physical therapy and was gradually returned to work, ultimately reaching maximum medical improvement (MMI) by October 15, 2021, with a 1%-2% impairment rating.<br /><br />Currently, Mr. Hurtman experiences intermittent sharp pain, particularly sensitive to weather changes, with moderate-to-severe episodes up to 7-8/10 in intensity, affecting his ability to work overhead or at shoulder level. The Upper Extremity Functional Scale (UEFS) assessment showed a 42% perceived functional disability compared to his baseline. He is significantly limited in activities he previously enjoyed and faces challenges in his job due to focal weakness and fatigue.<br /><br />His social history includes a supportive family, cessation of smoking, and minimal alcohol use. His goals are to maintain his job despite concerns about job security due to his physical limitations. The physical exam showed no severe abnormalities and negative Waddell’s signs, indicating consistent effort and no exaggerated pain behavior.

Keywords

Mr. Earnest Hurtman

right shoulder injury

Independent Medical Examination

rotator cuff tear

arthroscopic surgery

physical therapy

maximum medical improvement

Upper Extremity Functional Scale

physical impairment

job limitations