Left Knee Case Summary

This is a 63-year-old male with a 10/06/1978 date of injury. He fell between two walls and injured his left knee.

DIAGNOSIS: Pain in left knee

12/28/15 Progress Report stated that the patient remains off work. Current meds included Suboxone, morphine, amlodipine, maxzide, ecotrin, halfprin, testosterone injection, Norco, and dyazide. He likes his meds and denies craving. He is not receiving PT and is doing HEP. He stated that he is no longer with Kaiser but MediCal. The patient reported constant aching pain in the left knee and has difficulty doing his job. The patient stated that pain is relieved by medications and aggravated by sitting and standing. He rates the pain 4/10 at its best and 10/10 at worst. UDS and CURES report showed that

The patient is taking Norco, Morphine and Xanax. He reported 90 % relief with opioids and ability to do his ADL. There were no signs of abuse or diversion. He is on the lowest dose and denies any side effects. He has failed more conservative treatments, including NSAIDs. He is weaning off his medications. CURES report was reviewed. The patient stated that pain is relieved by medications and aggravated by sitting and standing. Current meds included morphine, amlodipine, maxzide, ecotrin, halfprin, testosterone injection, Suboxone, Norco, dyazide and alprazolam. The exam revealed normal gait. There were scars noted on both knees. He can flex knees to about 120 degrees. Treatment plan: Suboxone and UDS/CURES. Discussion: The first step would be to decrease the pain in the knee. The physician requested cooled RFA of the genicular nerves on the left. He is aware that the ODG does not recommend this. However, he is asking a trial of it in order to help wean off meds and to avoid any opioids. Follow-up was in 2

The patient has been on Ultram, chronically. The patient had a primary total knee arthroplasty in 1993, a first revision in 1998, and a third revision in 2001. The patient stated that his pain has been gradually worsening for a year to the point that he can no longer do his job. He cannot sit, stand, jog or jump. He not only has knee complaints but also problems in his lower back, bilateral feet and his lefts shoulder. He has difficulty walking a distance because of diffuse soreness in the legs, L>R and difficulty walking upstairs. Objective findings showed left knee ROM is 0 to 120 degrees. Treatment plan: The patient’s knee function is essentially unchanged. He has generalized skeletal complaints, which, in part relate to his coming off of narcotics. The patient has been advised to attend his pain management appointment for Ultram management. He was also advised to follow-up with his Kaiser physician. Work status: TTD until 09/30/15.

Treatment to date includes medication, PT, acupuncture, 9 knee operations and 3 total knee replacements.

The request is for Injection- Coolief Left