General Exam Light

GEN: WDWN, NAD

CV: intact and equal pulses in the extremities bilaterally.

LUNG: normal respiratory effort.

NEURO: sensation is intact and equal in the extremities bilaterally. Normal and equal reflexes throught.

DERM: no rashes, bruising or skin lesions in the area of concern.

PYSCH: normal affect.

MSK:

General Exam

GEN: WDWN, NAD

CV: intact and equal pulses in the extremities bilaterally. Normal S1/S2, no m/r/g

HEENT: erythematous pharynx with no tonsilar exudates

LUNG: normal respiratory effort. CTABL

NEURO: sensation is intact and equal in the extremities bilaterally. Normal and equal reflexes through
out.

DERM: no rashes, bruising or skin lesions in the area of concern.

PYSCH: normal affect.

MSK: 5/5 strength

Knee Exam

special testing performed bilaterally and found to be within normal limits including McMurray's,
Lachman's, Varus/Valgus stress testing, ant/post drawer testing, and Apley's testing.

Shoulder Exam

shoulder exam within normal limits including empty can, full can, dropping sign, Hawkins/Kennedy,
Neer's, as well as Obrien's test.

Sports Physical History

He denies any family history of sudden cardiac death or unexplained deaths. He denies any chest pain,
shortness of breath, dizziness, pre-syncope/syncope during rest or exertion.

Clearance

Normal ECG and negative SC:

- cleared for football today
- see form

Concussion Normal

Patient suffered hit to head while playing football:

- no previous history of concussions
- no risk factors identified today
- educated on physical and cognitive rest for next 24-48 hrs
- will RTC in 2-3 days for re-evaluation

URI Plan

Patient suffering from viral URI:

- eating/drinking well
- will treat symptomatically
- educated on signs of bacterial conversion and will report back to clinic if they arise

Sickle Cell Disease

Patient educated on importance of being aware of symptoms related to sickle cell related illness including
sickle cell crises:
- educated on stopping physical activity and seek medical attention immediately if any of these symptoms
arise
- educated on importance of maintaining good fluid hydration as well as relation to heat illness
- patient is aware of the above and acknowledges receipt of educational material along with todays visit.

Dry Needling with Stim Procedure Note

Procedure: Patient had guasha performed with Eucrin cream after identifying injured muscle group.
Patient had accupuncture needles placed. She had TENS unit attched and adjusted to tolerable level.
Patient had heat lamp applied and placed for treatment for 15 minutes with no complications.

Visco Documentation

Patient had xray and steroid injection at Emerge Ortho 12 weeks ago with minimal improvement. Records
from that office visit have been reviewed. Severe medial compartment arthritis, mild lateral and moderate
patellofemoral arthritis was noted.
- He has been performing HEP to work on knee strengthening.
- He has been working on weight loss
- continue with Aleve prn.

Patient has symptomatic arthritis of the knee that is affecting activities of daily living. The patient has had
inadequate response, contraindicatoin per FDA label, documented intolerance, or is not a candidate for:
- exercise, weight loss, physical therapy
-NSAIDs
- analgesics
- intra-articular corticosteroid injection.

We will request authorization from the patients insurance for viscosupplementation.

Joint Injection Procedure Note

PROCEDURE NOTE: Ultrasound Guided Corticosteroid Injection - Right Knee

Indication: Knee Pain with failed conservative treatment.

Written consent was obtained after the risks, benefits, and questions were explained and answered.
Under ultrasound guidance the Left Supra-patellar space was identified. The injection site was marked
and prepped using sterile technique with Hibaclence and 70% Isopropyl Alchohol x3.

The marked area was anesthetized using a 0.5cc bleb in a 1:1 mixture of 1% Lidocaine and 4.2% Sodium
Bicarbonate solution on a 27G 0.5 inch needle. Approximatley 4 cc of a 1:1 mixture of Kenalog-40 and
1% Lidocaine was injected using a 25G 3" needle under Ultrasound Guidance using a Left Lateral
Suprapatellar approach. Patient tolereated the procedure well with minimal bleeding. The injection site
was bandaged and there were no obvious neuro or vascular deficits after the procedure. Patient was told
to keep the bandage on for the remainder of the day and follow up if there are signs of infection,
continued bleeding, or any other concerning problems. Patient agreed to the plan and is to follow up in
1 week to re-evaluate, sooner if symptoms worsen. Patient was instructed to call if she experienced any
problems before then and that there was a physician on call after hours if needed.

PRP Procedure Note

PROCEDURE NOTE: Platelet Rich Plasma Injection - Right Biceps Attachment

Written consent was obtained after the risks, benefits, and questions were explained and answered. The
area of pain was localized to the muscle tendon junction of the Right Biceps Tendon. This area was
marked and prepped using sterile technique with Hibaclence and 70% Isopropyl Alchohol x 3.

The three marked areas were first anesthetized using ~ 0.5cc blebs in a 1:1 mixture of 1% Lidocaine and
4.2% Sodium Bicarbonate solution on a 27G 0.5 inch needle. Approximatley 27 cc of autologous blood
was obtained through venipuncture and processed using a Harvest SmartPReP2 system. The sites were
then injected using a 25G 2" needle and a total of 4cc of concentrated PRP. Approximatley 0.5-1 cc of
PRP was used for each injection along the tendon sheath.

Patient tolereated the procedure well with minimal bleeding. Area was bandaged with tefla padding and
adhesive. There were no obvious neuro or vascular deficits after the procedure. Patient was told to keep
the bandage on for the remainder of the day and follow up if there are signs of infection, continued
bleeding, or any other concerning problems. Patient agreed to the plan and is to follow up in 3-4 weeks
to re-evaluate. Patient was instructed to avoid anti-inflammatories and use Tylenol for pain as needed.
Patient is to avoid painfull activity. No lower limb stretching or impact exercise until re-evaluation.
PRP Procedure Note

PROCEDURE NOTE: Platelet Rich Plasma Injection - Left Achilles Tendon

Written consent was obtained after the risks, benefits, and questions were explained and answered. The
area of pain was localized to the insertion of the Left Achilles Tendon. This area was marked and
prepped using sterile technique with Hibaclence and 70% Isopropyl Alcohol x 3.

The five marked areas were first anesthetized using ~ 0.5cc blebs in a 1:1 mixture of 1% Lidocaine and
4.2% Sodium Bicarbonate solution on a 27G 0.5 inch needle. Approximately 27 cc of autologous blood
was obtained through venipuncture and processed using a Harvest SmartPReP2 system. The sites were
then injected using a 25G 1" needle and a total of 4cc of concentrated PRP. Approximately 0.5-1 cc of
PRP was used for each injection along the tendon attachment.

There was minimal bleeding. Area was bandaged with tefla padding and adhesive. There were no
obvious neuro or vascular deficits after the procedure. Patient was told to keep the bandage on for the
remainder of the day and follow up if there are signs of infection, continued bleeding, or any other
concerning problems. Patient placed in Cam Walker for 2 weeks while wt. bearing. Patient agreed to
the plan and is to follow up in 2 weeks to re-evaluate. Patient was instructed to avoid anti-
inflammatories and use Tylenol for pain as needed. Patient is to avoid painful activity. No lower limb
stretching or impact exercise until re-evaluation.

Abscess I&D Procedure Note

PROCEDURE NOTE: Left Anterior Shoulder Abcess

Written consent was obtained after the risks, benefits, and questions were explained and answered.
Area of abcess (~2 cm x 1 cm) was prepped in sterile manner with Hibaclense and Etoh x 3. An #11
blade scapel was used to make a 1cm incision along the middle third of the abcess. Drainage was
expressed and sample was obtained for C&S. Further serosanguinous discharge was expressed. Patient
tolereated the procedure well with minimal bleeding. Area was bandaged with tefla pad and cobane.
Patient was told to keep bandage on for the remainder of the day and follow up if there are signs of
increased infection or continued bleeding. Patient agreed to the plan and is to follow up in 4-5 days to
re-evaluate, sooner if symptoms worsen.

Ankle Sprain Plan

- Rest, elevate
- Brace as needed
- Ice TID x 48 hours
- Tylenol prn pain
- F/U 2 weeks for recheck.

Short Leg Cast Procedure Note

PROCEDURE NOTE: Casting Left Short Leg

Examination revealed minimal swelling of the Left Leg. Casting stocking was cut to the appropriate
length and rolled onto the injured leg. 3" Cast padding was added with reinforcement padding placed.
3" Synthetic casting was added and allowed to set for ~5 minutes while hand molded. Pt reported the
cast was comfortable and questions were answered. Cast care handout was given and follow up x-ray
was arranged to evaluate alignment post-casting.

Contact Dermatitis Plan

- Keep area clean, air dry at night
- Benadryl PRN itching
- Steroid Cream BID x 1 week
- Follow up 1 week if symptoms not improving, sooner if symptoms are worse.

Epicondylitis Plan

Ice TID 15 min x 48 hours

Universal Surround Elbow Brace
Rest, avoid painful activity
Follow up 2 weeks for recheck, sooner if symptoms worsen

Gastritis Plan

- Pt did not want Promethazine at this time, felt symptoms were improving.
- Bland Diet
- Increase Fluids (1/2 Body Wt in Fluid oz per day) and Electrolytes
- Increase Rest
- Follow up 3-5 days if not improving, sooner if symptoms worsen.

Herpes Plan

- Herpes Galaditorum Recurrence

- Acyclovir 400mg TID x 5 days.
- Keep clean and look for signs of secondary infection, discussed.
- Avoid wrestling until 120 hours after treatment.
- Follow up if not continuing to improve in 2-3 days, sooner if symptoms worsen.

Plantar Wart Cryo Procedure Note

- Signs and symptoms are consistent with a common wart.

- Pt has tried OTC therapies with little relief over last month.
- Discussed treatment plans, including cryotherapy.
- Pt interested in moving ahead with cryo (see procedure note below)

PROCEDURE NOTE: Cryotherapy of Verrruca on Right Knee

Area was prepped in sterile manner with Hibaclense and Etoh x 3. A #10 blade was used to pare callous
skin. 3 treatments of cryotherapy were completed using a cryo pen. Patient tolerated the procedure well
with minimal bleeding. Suggested Salicylic Acid treatment QHS between cryotherapy. Patient agreed to
the plan and is to follow up in 1 week to re-evaluate, sooner if symptoms worsen. Re-evaluate, sooner if
symptoms worsen.
Sinusitis Plan

- Increase Rest
- Zpak
- Tylenol PRN Fever/Pain
- OTC Decongestant prn congestion
- Follow up 5-7 days if not improving, sooner if symptoms worsen.

Suture Removal Procedure Note

Laceration is healing well with good approximation of the wound edges and granulation tissue growth.
There are no signs of secondary infection at this time. Patient has minimal pain at the site of injury. A
total of 1 suture was removed without bleeding or separation. Patient tolerated the procedure well.
Discussed signs of secondary infection and reasons to follow up, along with wound care.

URI Plan

- Increase Rest
- Tylenol PRN Fever/Pain
- OTC Decongestant prn congestion
- Follow up 5-7 days if not improving, sooner if symptoms worsen.

US Complete Exam Knee

ULTRASOUND : Right Knee

Date: 8/14/13

History:Right Knee Pain x 1 month. Pt reports constant knee pain for the last month. Denies any specific
trauma. Denies any history of previous trauma, fever, chills, or night sweats. Able to wt bear without
difficulty. Wearing neoprene knee brace for comfort.

Site: Left Knee

Area was examined using at 12L linear probe in both the Longitudinal and Transverse planes. There was
medium joint effusion noted in the R suprepatellar recess.

LCL, MCL, Quadriceps tendon, and Patella tendon appear intact. No evidence of a popliteal cyst and
hamstring insertion appears normal. Recommend xray/MRI for further evaluation of meniscus with MCL
involvement.

PROCEDURE NOTE: Right Knee Aspiration and Injection

Informed consent was obtained from the patient. The right knee was prepped in the usual sterile fashion
with hibaclense and alcohol and ultrasound guidance was used to aspirate the right knee. 15 cc of straw
yellow fluid was obtained. Steroid was then injected into the knee. Patient tolerated the procedure well.
She was able to walk with minimal pain in her right knee afterwards. She was then placed in a right knee
brace. Patient was given instructions on post procedure care. She will also have x-rays done of both of
her knees as well as an MRI of her right knee to rule out any internal derangement. Patient will return to
the clinic after MRI results are obtained.

UTI Plan

-Increase fluid intake

-Bactrim DS BID x 5 days
-Follow up 3-5 days if not improving, sooner if symptoms worsen.

Hamstring Stain Plan and Dry Needling with PENS Treatment Procedure Note

- Signs and symptoms are consistent with Left Hamstring strain.

- Discussed treatment options and pt would like to move forward with acupuncture. (see note below)

Questions were answered in regards to treatment with PENS acupuncture and patient is interested in
moving ahead with the procedure at this time (see procedure note below).

PROCEDURE NOTE: PENS - Left Hamstring

Written consent was obtained after the risks, benefits, and questions were explained and answered. The
area of pain and muscle tightness was localized to the lateral and medial distal attachment of the Left
Hamstring. A PENS treatment was placed using (8) sterile 60 mm acupuncture needles at the
attachment sites of the Left Hamstring. E-stim was applied using 4 Hz and 30 Hz respectively and left
on for 15 min. A heat lamp was positioned for comfort. Pt tolerated the procedure well. Patient was
instructed to increase hydration and rest over the next 24 hours. Patient is to avoid painful activity.
Patient agreed to the follow up in 1 week, sooner if symptoms worsen.

Acupuncture Neck Procedure Note

- Questions were answered in regards to treatment with acupuncture and patient is interested in moving
- Questions were answered in regards to treatment with acupuncture and patient is interested in moving
ahead with the procedure at this time (see procedure note below).

PROCEDURE NOTE: Acupuncture Neck

Written consent was obtained after the risks, benefits, and questions were explained and answered. The
area of pain was localized to the Left SCM and Upper Trapezius. Indirect treatment of the upper back
and neck was treated with OMM and Gua Sha. 11 40mm acupuncture needles were placed along
palpable tender points of the Upper Trapezius and SCM, and left in for 15 min. Pt tolerated the
procedure well. Patient was instructed to increase hydration and rest over the next 24 hours. Patient is
to avoid painful activity. Patient agreed to the follow up in 1 week, sooner if symptoms worsen.

Allergic Rhinitis Plan

- Pt has history of seasonal allergies, responded well to antihistamines in the past.
- Zyrtec 10 mg daily prn symptoms.
- F/U 3-5 days if symptoms not improving, sooner if symptoms worsen.

Knee Aspiration/Injection Procedure Note

PROCEDURE NOTE: Ultrasound Guided Aspiration and Corticosteroid Injection - Left Knee

Written consent was obtained after the risks, benefits, and questions were explained and answered.
Under ultrasound guidance the Left anterior lateral cyst measuring ~ 2 cm x 2 cm in diameter was
visualized under Ultrasound. The aspiration/injection site was marked and prepped using sterile technique
with Hibaclence and 70% Isopropyl Alchohol x 3.

The marked injection site was anesthetized using ~ 2cc blebs in a 1:1 mixture of 1% Lidocaine and 4.2%
Sodium Bicarbonate solution on a 27G 0.5 inch needle. The site was then aspirated with ~ 2cc of
serosanquinous fluid and then injected using the same 18G 1" needle with 2cc of the Corticosteroid
Solution.
Patient tolereated the procedure well with minimal bleeding. The injection site was bandaged and there
were no obvious neuro or vascular deficits after the procedure. Patient was told to keep the bandage on
for the remainder of the day and follow up if there are signs of infection, continued bleeding, or any
other concerning problems. Patient agreed to the plan and is to follow up in 1 week to re-evaluate,
sooner if symptoms worsen. Patient was instructed to call if she experienced any problems before then
and that there was a physician on call after hours if needed.

Auricular Hematoma Procedure Note

PROCEDURE NOTE: Left Auricular Hematoma

Written consent was obtained after the risks, benefits, and questions were explained and answered.
Area of hematoma was prepped in sterile manner with Hibaclense and Etoh x 3. An 18G 1" needle with
10 cc Syringe was used to drain hematoma ~ 1.5 cc. Patient tolereated the procedure well with minimal
bleeding. Area was packed and pressure bandage was place on head. Patient was told to keep bandage
on for 3 days and follow up if there are signs of infection or continued bleeding. Patient agreed to the
plan and is to follow up in 1 week to re-evaluate, sooner if symptoms worsen.

Back Pain Plan

- Much improved, pain from 7/10 to 3/10 today with increase ROM and less pain.
- No longer needing analgesics
- Avoid painful movements and lifting
- Heat TID as needed.
- Tylenol and Cyclobenxaprine prn pain
- F/U if not continuing to improve.

Cervical PENS Procedure Note

PROCEDURE NOTE: Acupuncture Cervical PENS

Written consent was obtained after the risks, benefits, and questions were explained and answered. The
area of pain was localized to the Left SCM and Upper Trapezius. Indirect treatment of the upper back
and neck was treated with OMM and Gua Sha. 14 40mm acupuncture needles were placed along
palpable tender points of the Upper Trapezius using the Cervical PENS protocol of C2/C5, T2/T4, T8/T10,
and GB 21, and left in for 15 min with e-stim at 4Hz and 15 Hz. Pt tolerated the procedure well. Patient
was instructed to increase hydration and rest over the next 24 hours. Patient is to avoid painfull activity.
Patient agreed to the follow up in 4-5 days, sooner if symptoms worsen.

Concussion Plan
- Impact reviewed.
- Physical exam including balance and memory testing appropriate.
- Discussed with trainer, completed RTP protocol without symptoms.
- Pt cleared for full RTP, f/u if symptoms return.

Conjunctivitis Plan
- Keep hands clean and away from eyes
- Clean contact solutions and dispose of old contacts.
- Glasses until symptoms resolve
- Tobradex for up to 1 day after symptoms resolve
- Follow up 2-3 days if not improving, sooner if symptoms worsen.

Foreign Body Removal Procedure Note

PROCEDURE NOTE: Foreign Body Removal

Verbal consent was obtained from parent and patient, and risks/benefits were explained. Area was
prepped in sterile manner with Povidine and Etoh x 3. 1% lidocaine was injected with 27G 1/2" needle ~
1cc into area of the lesion. A #11 blade was used to make a 5mm incision along the location of the
foreign body. Straight sterile tweezers were used to excise the foreign body, small black object 1mm in
diameter, further exploration revealed no other objects. Area was cleaned and laceration was closed with
one steri strip. Area was covered. Patient to keep clean and covered, follow up if not improving in 2-3
days. Signs of bleeding and secondary infection were explained.

Ganglion Cyst Aspiration Procedure Note

PROCEDURE NOTE: Aspiration and Steroid Injection Left Ganglion Cyst

Written consent was obtained after the risks, benefits, and questions were explained and answered.
Area of cyst (~ 1 cm in diameter) was prepped in sterile manner with Hibaclense and Etoh x 3. An 25G 1
inch needle was used to aspirate the cyst which minimal fluid was obtained < 1cc. The syringe was
changed and ~ 1cc of a 1:1 mixture of 1% Lidocaine and Kenalog 40 mg was injected into the ares of
the cyst. Patient tolereated the procedure well with minimal bleeding. Area was bandaged with tefla pad
and cobane. Patient was told to keep bandage on for the remainder of the day and follow up if there are
signs of increased infection or continued bleeding. Patient agreed to the plan and is to follow up in 7
days to re-evaluate, sooner if symptoms worsen.

Viscosupplementation Procedure Note

PROCEDURE NOTE: Ultrasound Guided Orthoviscnjection - Left Knee
Indication: Knee Osteoarthritis with failed conservative treatment.
Written consent was obtained after the risks, benefits, and questions were explained and answered.
Under ultrasound guidance the Left Supra-patellar space was identified. The injection site was marked
and prepped using sterile technique with Hibaclence and 70% Isopropyl Alchohol x 3.

The marked injection site was anesthetized using ~ 2cc blebs in a 1:1 mixture of 1% Lidocaine and 4.2%
Sodium Bicarbonate solution on a 27G 0.5 inch needle. The site was then injected using a 25G 3" needle
with 2cc of the Orthovisc Product. Patient tolereated the procedure well with minimal bleeding. The
injection site was bandaged and there were no obvious neuro or vascular deficits after the procedure.
Patient was told to keep the bandage on for the remainder of the day and follow up if there are signs of
infection, continued bleeding, or any other concerning problems. Patient agreed to the plan and is to
follow up in 4 weeks to re-evaluate, sooner if symptoms worsen. Patient was instructed to

Lumbar PENS Procedure Note

Questions were answered in regards to treatment with PENS acupuncture and patient is interested in
moving ahead with the procedure at this time (see procedure note below).

PROCEDURE NOTE: Lumbar PENS

Written consent was obtained after the risks, benefits, and questions were explained and answered. The
area of pain and muscle tightness was localized to the low back R>L. A Lumbar PENS was placed using
(10) sterile 40 mm acupuncture needles at the L2 and L4 Spinal levels, S2 and S4, PSIS, and (2) sterile
60 mm acupuncture needles were place at functional Bladder points 54 bilaterally. E-stim was applied
using 4 Hz and 30 Hz respectively and left on for 15 min. A heat lamp was positioned for comfort. Pt
tolerated the procedure well. Patient was instructed to increase hydration and rest over the next 24
hours. Patient is to avoid painfull activity. Patient agreed to the follow up in 1 week, sooner if symptoms
worsen.

OMM Procedure Note

Osteopathic Manual Medicine (Cervical, Thoracic, Lumbar and Sacral regions)

Began with cervical traction followed by ME to the cervical spine as patient was restricted in R ROM. ME
was applied to the back and along with HVLA to the thoracic spione T4-T7. Lower limb adductors and
abductors were treated with ME , followed by sacral rocking and HVLA to L3-L5 Region. Gua Sha was
completed to the Left SI/Glut. Pt tolerated OMM well. Asked to rest over next 24 hours and then resume
normal activities.

Prolotherapy Procedure Note

PROCEDURE NOTE: Prolotherapy - Right Knee

Written consent was obtained after the risks, benefits, and questions were explained and answered. The
area of pain was localized to the insertion of the Right LCL and lateral patella retinaculum.L. These areas
were marked and prepped using sterile technique with Hibaclence and 70% Isopropyl Alchohol x 3.

The 16 marked areas were first anesthetized using ~ 0.5cc blebs in a 1:1 mixture of 1% Lidocaine and
4.2% Sodium Bicarbonate solution on a 27G 0.5 inch needle. A 15% dextrose prolotherapy solution was
used. The sites were then injected using a 25G 2" needle and a total of 15 cc. Approximatley 0.5-1 cc of
PRP was used for each injection along the ligament/tendon enthesis.
Patient tolereated the procedure well with minimal bleeding. Area was bandaged with tefla padding and
adhesive. There were no obvious neuro or vascular deficits after the procedure. Patient was told to keep
the bandage on for the remainder of the day and follow up if there are signs of infection, continued
bleeding, or any other concerning problems. Patient agreed to the plan and is to follow up in 3-4 weeks
to re-evaluate. Patient was instructed to avoid anti-inflammatories and use Tylenol for pain as needed.
Patient is to avoid painfull activity. No lower limb stretching or impact exercise until re-evaluation.

Prolotherapy Lower Back Procedure Note

- Pt continues to have chronic low back pain with little improvement with conservative treatment.
- Questions were answered in regards to treatment with prolotherapy and patient is interested in moving
ahead with the procedure at this time (see procedure note below).

PROCEDURE NOTE: Prolotherapy Low Back Right Side

Written consent was obtained after the risks, benefits, and questions were explained and answered. The
area of pain was localized to the Right PSIS and attachments of the Posterior Sacral Iliac Ligament
complex (Hackett's points A,B,and C), which was marked and prepped using sterile technique with
Hibaclence and 70% Isopropyl Alchohol x 3.

The four marked areas along the attachment of the Right Sacral Iliac Ligaments Enthesis were first
anesthetized using ~ 2cc blebs in a 1:1 mixture of 1% Lidocaine and 4.2% Sodium Bicarbonate solution
on a 27G 0.5 inch needle. The sites were then injected using a 25G 2" needle and 15% Dextrose
Solution with ~ 1-2 cc of solution for each injection along the ligament enthesis. Patient tolereated the
procedure well with minimal bleeding. Area was bandaged with tefla padding and adhesive. There were
no obvious neuro or vascular deficits after the procedure. Patient was told to keep the bandage on for
the remainder of the day and follow up if there are signs of infection, continued bleeding, or any other
concerning problems. Patient agreed to the plan and is to follow up in 3-4 weeks to re-evaluate.
Patient was instructed to avoid anti-inflammatories and use Tylenol for pain as needed. Patient is to
avoid painfull activity. No lower limb stretching or impact exercise until re-evaluation. Remain in the
back brace during active back movement.

Prolotherapy Shin Splints Procedure Note

- Discussed treatment options and patient would like to continue with prolotherapy.
- Discussed risk and benefits of prolotherapy and patient is wanting to move ahead with treatment today.
(see Procedure Note below)

PROCEDURE NOTE: Prolotherapy - Right/Left Tibia

- Questions were answered in regards to treatment with prolotherapy and patient is interested in moving
ahead with the procedure at this time (see procedure note below).

The area of pain was localized to the Right and Left Anterior/Medial Tibia, which was marked and
prepped using sterile technique with Hibaclence and 70% Isopropyl Alchohol x 3. The 5 marked areas
on the Left leg and 6 on the Right along the anterior medial tibia were injected using a 27G 1" needle
and 15% Dextrose Solution with ~ 1-2 cc of solution for each injection along the ligament enthesis.
Patient tolereated the procedure well with minimal bleeding. Area was bandaged with tefla padding and
adhesive. There were no obvious neuro or vascular deficits after the procedure. Patient was told to keep
the bandage on for the remainder of the day and follow up if there are signs of infection, continued
bleeding, or any other concerning problems. Patient agreed to the plan and is to follow up in 2 weeks
to re-evaluate. Patient was instructed to avoid anti-inflammatories and use Tylenol for pain as needed.
Patient is to avoid painfull activity. No lower limb stretching or impact exercise until re-evaluation.

PRP Plantar Fasciitis Procedure Note

PROCEDURE NOTE: Platelet Rich Plasma Injection - Left Foot Plantar Fascia

Written consent was obtained after the risks, benefits, and questions were explained and answered. The
area of pain was localized to the origin of the Plantar Fascia. These areas were marked and prepped
using sterile technique with Hibaclence and 70% Isopropyl Alchohol x 3.

The three marked areas were first anesthetized using ~ 0.5cc blebs in a 1:1 mixture of 1% Lidocaine and
4.2% Sodium Bicarbonate solution on a 27G 0.5 inch needle. Approximatley 27 cc of autologous blood
was obtained through venipuncture and processed using a Harvest SmartPReP2 system. The sites were
then injected using a 25G 1" needle and a total of 4cc of concentrated PRP. Approximatley 0.5-1 cc of
PRP was used for each injection along the ligament enthesis.

Patient tolereated the procedure well with minimal bleeding. Area was bandaged with tefla padding and
adhesive. There were no obvious neuro or vascular deficits after the procedure. Patient was told to keep
the bandage on for the remainder of the day and follow up if there are signs of infection, continued
bleeding, or any other concerning problems. Patient agreed to the plan and is to follow up in 3-4 weeks
to re-evaluate. Patient was instructed to avoid anti-inflammatories and use Tylenol for pain as needed.
Patient is to avoid painfull activity. No lower limb stretching or impact exercise until re-evaluation.

Diagnostic ultrasound was performed in the sagittal and transverse planes on the plantar
aspect of XYZ. Results of diagnostic ultrasound were compared to that of a control, the
plantar fascia of the examiner, Dr. [insert your name here].

Vertical thickness of the plantar fascia was measured in the sagittal and transverse plane
and recorded at XYZ millimeters in thickness inferior to the calcaneal tuberosity, XYZ
millimeters in thickness at the distal end of the calcaneal tuberosity, and XYZ millimeters in
thickness 1.5 - 2cm distal to the leading edge of the calcaneal tuberosity in the patient.
This is in contrast to the control, which was measured and recorded at XYZ mm, XYZ mm,
and XYZ mm, respectively.

OPT/ALT: A significant amount of subcutaneous edema and hyperechoic signal within the
substance of the plantar fascia was noted, in contrast to that of the control, which showed
the control's plantar fascia substance to have a signal intensity isoechoic with tendon and
connective tissue.

OPT/ALT: The plantar fascia was inspected from its insertion on the calcaneal tuberosity in
the medial, central, and lateral bands, extending into the medial arch approximately XYZ
cm, and no evidence of plantar fascia rupture was noted.

OPT/ALT: No evidence of subcutaneous bursa or space occupying mass or plantar fibroma

was identified in the study.

OPT/ALT: Range of motion of the metatarsal phalangeal joints was performed during
simultaneous observations of the insertion of the plantar fascia on the medial, central, and
lateral bands.

OPT/ALT: Inspection of the entire plantar fascia, encompassing all three bands from
calcaneal origin throughout the medial arch was performed, and no evidence of plantar
fascia rupture or disruption was noted at the insertion or throughout the substance of the
plantar fascia on all three bands.

OPT/ALT: Palpation of the insertion of the medial and central bands of the plantar fascia
was performed with direct ultrasonic visualization of areas of discomfort during this
examination, confirming insertional plantar fasciitis of the medial and central bands of the
plantar fascia.

Assessment: Plantar Fasciitis confirmed using Diagnostic Ultrasound.

PRP Foot Procedure Note

- Pt continues to have pain with activity in the Right foot. Conservative treatment with rest, NSAIDs, and
PT has made little improvement.
- Pt wanting to move ahead with trial of PRP, questions regarding the procedure were answered (see
procedure note below).

PROCEDURE NOTE: Platelet Rich Plasma Injection - Right Foot

Written consent was obtained after the risks, benefits, and questions were explained and answered. The
area of pain was localized to the insertion of the Right Peroneus Brevis Tendon, Dorsal Calcaneocuboid
Ligament, and Bifurcate Ligament. These areas were marked and prepped using sterile technique with
Hibaclence and 70% Isopropyl Alchohol x 3.

The three marked areas were first anesthetized using ~ 0.5cc blebs in a 1:1 mixture of 1% Lidocaine and
4.2% Sodium Bicarbonate solution on a 27G 0.5 inch needle. Approximatley 27 cc of autologous blood
was obtained through venipuncture and processed using a Harvest SmartPReP2 system. The sites were
then injected using a 25G 1" needle and a total of 4cc of concentrated PRP. Approximatley 0.5-1 cc of
PRP was used for each injection along the ligament/tendon enthesis.

Patient tolereated the procedure well with minimal bleeding. Area was bandaged with tefla padding and
adhesive. There were no obvious neuro or vascular deficits after the procedure. Patient was told to keep
the bandage on for the remainder of the day and follow up if there are signs of infection, continued
bleeding, or any other concerning problems. Patient agreed to the plan and is to follow up in 3-4 weeks
to re-evaluate. Patient was instructed to avoid anti-inflammatories and use Tylenol for pain as needed.
Patient is to avoid painfull activity. No lower limb stretching or impact exercise until re-evaluation.

PRP Achilles Procedure Note

- Pt wanting to move ahead with trial of PRP, questions regarding the procedure were answered (see
procedure note below).

PROCEDURE NOTE: Platelet Rich Plasma Injection - Right Achilles Tendon

Written consent was obtained after the risks, benefits, and questions were explained and answered. The
area of pain was localized to the insertion of the Right Achilles Tendon. This area was marked and
prepped using sterile technique with Hibaclence and 70% Isopropyl Alchohol x 3.
The five marked areas were first anesthetized using ~ 0.5cc blebs in a 1:1 mixture of 1% Lidocaine and
4.2% Sodium Bicarbonate solution on a 27G 0.5 inch needle. Approximatley 27 cc of autologous blood
was obtained through venipuncture and processed using a Harvest SmartPReP2 system. The sites were
then injected using a 25G 1" needle and a total of 4cc of concentrated PRP. Approximatley 0.5-1 cc of
PRP was used for each injection along the tendon attachment.

Patient experienced a vagal response after the procedure and was awoken within seconds with a cool
towel and elevated legs. There was minimal bleeding. Area was bandaged with tefla padding and
adhesive. There were no obvious neuro or vascular deficits after the procedure. Patient was told to keep
the bandage on for the remainder of the day and follow up if there are signs of infection, continued
bleeding, or any other concerning problems. Patient agreed to the plan and is to follow up in 3-4 weeks
to re-evaluate. Patient was instructed to avoid anti-inflammatories and use Tylenol for pain as needed.
Patient is to avoid painfull activity. No lower limb stretching or impact exercise until re-evaluation.

PRP Biceps Procedure Note

PROCEDURE NOTE: Platelet Rich Plasma Injection - Right Biceps Attachment

Written consent was obtained after the risks, benefits, and questions were explained and answered. The
area of pain was localized to the muscle tendon junction of the Right Biceps Tendon. This area was
marked and prepped using sterile technique with Hibaclence and 70% Isopropyl Alchohol x 3.

The three marked areas were first anesthetized using ~ 0.5cc blebs in a 1:1 mixture of 1% Lidocaine and
4.2% Sodium Bicarbonate solution on a 27G 0.5 inch needle. Approximatley 27 cc of autologous blood
was obtained through venipuncture and processed using a Harvest SmartPReP2 system. The sites were
then injected using a 25G 2" needle and a total of 4cc of concentrated PRP. Approximatley 0.5-1 cc of
PRP was used for each injection along the tendon sheath.

Patient tolereated the procedure well with minimal bleeding. Area was bandaged with tefla padding and
adhesive. There were no obvious neuro or vascular deficits after the procedure. Patient was told to keep
the bandage on for the remainder of the day and follow up if there are signs of infection, continued
bleeding, or any other concerning problems. Patient agreed to the plan and is to follow up in 3-4 weeks
to re-evaluate. Patient was instructed to avoid anti-inflammatories and use Tylenol for pain as needed.
Patient is to avoid painfull activity. No lower limb stretching or impact exercise until re-evaluation.

PRP MCL Procedure Note

- Pt continues to have pain with activity in the Right Knee.
- Pt wanting to move ahead with trial of PRP, questions regarding the procedure were answered (see
procedure note below).

PROCEDURE NOTE: Platelet Rich Plasma Injection - Right Knee

Written consent was obtained after the risks, benefits, and questions were explained and answered. The
area of pain was localized to the insertion of the Right MCL. These areas were marked and prepped
using sterile technique with Hibaclence and 70% Isopropyl Alchohol x 3.

The 6 marked areas were first anesthetized using ~ 0.5cc blebs in a 1:1 mixture of 1% Lidocaine and
4.2% Sodium Bicarbonate solution on a 27G 0.5 inch needle. Approximatley 27 cc of autologous blood
was obtained through venipuncture and processed using a Harvest SmartPReP2 system. The sites were
then injected using a 25G 2" needle and a total of 4cc of concentrated PRP. Approximatley 0.5-1 cc of
PRP was used for each injection along the ligament/tendon enthesis.
Patient tolereated the procedure well with minimal bleeding. Area was bandaged with tefla padding and
adhesive. There were no obvious neuro or vascular deficits after the procedure. Patient was told to keep
the bandage on for the remainder of the day and follow up if there are signs of infection, continued
bleeding, or any other concerning problems. Patient agreed to the plan and is to follow up in 3-4 weeks
to re-evaluate. Patient was instructed to avoid anti-inflammatories and use Tylenol for pain as needed.
Patient is to avoid painfull activity. No lower limb stretching or impact exercise until re-evaluation.

Orthovisc Knee Injection Procedure Note

PROCEDURE NOTE: Orthovisc Injection - 2/3 Right Knee

Written consent was obtained after the risks, benefits, and questions were explained and answered.
Under ultrasound guidance the Right prepatellar bursa was identified with mild effusion. The Injection
Site was marked and prepped using sterile technique with Hibaclence and 70% Isopropyl Alchohol x 3.

The injection site was anesthetized using ~ 2cc blebs in a 1:1 mixture of 1% Lidocaine and 4.2% Sodium
Bicarbonate solution on a 27G 0.5 inch needle. The site was then injected using a 25G 3" needle with
2cc of the Orthovisc Product. Patient tolereated the procedure well with minimal bleeding. The injection
site was bandaged and there were no obvious neuro or vascular deficits after the procedure. Patient was
told to keep the bandage on for the remainder of the day and follow up if there are signs of infection,
continued bleeding, or any other concerning problems. Patient agreed to the plan and is to follow up in
1 week to re-evaluate, sooner if symptoms worsen. Patient was instructed to avoid anti-inflammatories
and use Tylenol for pain as needed.

Splint Finger Procedure Note

PROCEDURE NOTE: Splinting Left Index Finger

Examination revealed mild swelling of the Left Index PIP. Stack splint was placed with finger in extension
at the PIP joint. Coban adhesive was used to secure the finger splint. Pt instructed on the importance
of keeping the finger in slight extension at all times with the splint on. Pt to follow up for bandage re-
taping as needed. Next appointment in 2 weeks, sooner if symptoms worsen.

Steroid Plantar Fasciitis Injection Procedure Note

- Pt continues to struggle with Right heal pain after a course of conservative treatment including rest
from running, ice, Tyelenol prn, shoe fitting and stretches.
- Discussed risks and benefits of corticosteroid injection and the patient would like to move ahead with
the treatment at this time. (see procedure note for details)

PROCEDURE NOTE: Corticosteroid Injection - Right Foot Plantar Fasciitis

Written consent was obtained after the risks, benefits, and questions were explained and answered. The
area of pain was localized to the origin of the Right Plantar Fascia attachment on the Calcaneous. This
area was marked and prepped using sterile technique with Hibaclence and 70% Isopropyl Alchohol x 3.

The marked area was anesthetized using a 0.5cc bleb in a 1:1 mixture of 1% Lidocaine and 4.2% Sodium
Bicarbonate solution on a 27G 0.5 inch needle. Approximatley 2-3 cc of a 1:1 mixture of Kenalog-40 and
1% Lidocaine was injected using a 25G 2" needle.
Patient tolereated the procedure well with minimal bleeding. Area was bandaged with tefla padding and
coban adhesive. There were no obvious neuro or vascular deficits after the procedure. Patient was told
to keep the bandage on for the remainder of the day and follow up if there are signs of infection,
continued bleeding, or any other concerning problems. Patient agreed to the plan and is to follow up in
3-4 weeks to re-evaluate. Continue home stretches BID.

Steroid Plantar Fasciitis Steroid Injection Procedure Note

- Pt continues to struggle with Left heal pain after a course of conservative treatment including rest from
running, ice, Tyelenol prn, shoe fitting and stretches.
- Discussed risks and benefits of corticosteroid injection and the patient would like to move ahead with
the treatment at this time. (see procedure note for details)

PROCEDURE NOTE: Corticosteroid Injection - Left Foot Plantar Fasciitis

Written consent was obtained after the risks, benefits, and questions were explained and answered. The
area of pain was localized to the origin of the Left Plantar Fascia attachment on the Calcaneous. This
area was marked and prepped using sterile technique with Hibaclence and 70% Isopropyl Alchohol x 3.

The marked area was anesthetized using a 0.5cc bleb in a 1:1 mixture of 1% Lidocaine and 4.2% Sodium
Bicarbonate solution on a 27G 0.5 inch needle. Approximatley 2-3 cc of a 1:1 mixture of Kenalog-40 and
1% Lidocaine was injected using a 25G 2" needle.

Patient tolereated the procedure well with minimal bleeding. Area was bandaged with tefla padding and
coban adhesive. There were no obvious neuro or vascular deficits after the procedure. Patient was told
to keep the bandage on for the remainder of the day and follow up if there are signs of infection,
continued bleeding, or any other concerning problems. Patient agreed to the plan and is to follow up in
3-4 weeks to re-evaluate. Continue home stretches BID.

Steroid Glenohumeral Joint Injection Procedure Note

PROCEDURE NOTE: Corticosteroid Injection - Left Shoulder Glenohumeral Joint Injection

Written consent was obtained after the risks, benefits, and questions were explained and answered. The
area of pain was localized to the origin of the Left Supraspinatus. The area below the acromiom was
marked and prepped using sterile technique with Hibaclence and 70% Isopropyl Alchohol x 3.

The marked area was then anesthetized using a 0.5cc bleb in a 1:1 mixture of 1% Lidocaine and 4.2%
Sodium Bicarbonate solution on a 27G 0.5 inch needle. Approximatley 3-4 cc of a 1:1 mixture of
Kenalog-40 and 1% Lidocaine was injected using a 25G 2" needle. US was used to identify the joint
space and for needle guidance.

Patient tolereated the procedure well with minimal bleeding. Area was bandaged with an adhesive pad.
There were no obvious neuro or vascular deficits after the procedure. Patient was told to keep the
bandage on for the remainder of the day and follow up if there are signs of infection, continued
bleeding, or any other concerning problems. Patient agreed to the plan and is to follow up in 1 weeks
to re-evaluate and continued treatment of upper neck/back pain. Continue home stretches BID.

Steroid Lateral Epicodylitis Joint Injection Procedure note

PROCEDURE NOTE: Corticosteroid Injection - Left Lateral Elbow - Extensor Wad
Written consent was obtained after the risks, benefits, and questions were explained and answered. The
area of pain was localized to the origin of the Left Wrist Extensor Origin. This area was marked and
prepped using sterile technique with Hibaclence and 70% Isopropyl Alchohol x 3.

The marked area was anesthetized using a 0.5cc bleb in a 1:1 mixture of 1% Lidocaine and 4.2% Sodium
Bicarbonate solution on a 27G 0.5 inch needle. Approximatley 2-3 cc of a 1:1 mixture of Kenalog-40 and
1% Lidocaine was injected using a 25G 2" needle.

Patient tolereated the procedure well with minimal bleeding. Area was bandaged with tefla padding and
coban adhesive. There were no obvious neuro or vascular deficits after the procedure. Patient was told
to keep the bandage on for the remainder of the day and follow up if there are signs of infection,
continued bleeding, or any other concerning problems. Patient agreed to the plan and is to follow up in
2 weeks to re-evaluate, soner if symptoms worsen. Continue with chopat bracing.

Steroid 1st MTP Joint Injection Procedure Note

- Pt here for corticosteroid injection of Right MTP joint of 1st toe
- Reports minimal improvement with boot.
- Wear carbon fiber insert while playing.
- Discussed risks and benefits of corticosteroid injection and the patient would like to move ahead with
the treatment at this time. (see procedure note for details)

PROCEDURE NOTE: Corticosteroid Injection -Right 1st MTP Joint

Written consent was obtained after the risks, benefits, and questions were explained and answered. The
area of pain was localized to the origin of the Right 1st MTP Joint. This area was marked and prepped
using sterile technique with Hibaclence and 70% Isopropyl Alchohol x 3.

The marked area was anesthetized using a 0.5cc bleb in a 1:1 mixture of 1% Lidocaine and 4.2% Sodium
Bicarbonate solution on a 27G 0.5 inch needle. Approximatley 1-2 cc of a 1:1 mixture of Kenalog-40 and
1% Lidocaine was injected using a 25G 2" needle.

Patient tolereated the procedure well with minimal bleeding. Area was bandaged with tefla padding and
coban adhesive. There were no obvious neuro or vascular deficits after the procedure. Patient was told
to keep the bandage on for the remainder of the day and follow up if there are signs of infection,
continued bleeding, or any other concerning problems. Patient agreed to the plan and is to follow up in
1 week to re-evaluate. Continue home stretches BID.

Steroid SI Joint Injection Procedure Note

PROCEDURE NOTE: Ultrasound Guided Corticosteroid Injection - Right SI Joint

Indication: Right SI Joint Pain with failed conservative treatment.

Written consent was obtained after the risks, benefits, and questions were explained and answered.
Coumadin INR discussed as well as risks and benefits of being on this medication during the procedure.
The area of pain was localized to the Right SI Joint. This area was marked and prepped using sterile
technique with Hibaclence and 70% Isopropyl Alchohol x 3.
The marked area was anesthetized using a 0.5cc bleb in a 1:1 mixture of 1% Lidocaine and 4.2% Sodium
Bicarbonate solution on a 27G 0.5 inch needle. Approximatley 5 cc of a 1:1 mixture of Kenalog-40 and
1% Lidocaine was injected using a 25G 4" needle under Ultrasound Guidance with a Curvilinear Probe
and an Superior approach.

Patient tolereated the procedure well with minimal bleeding. The injection site was bandaged and there
were no obvious neuro or vascular deficits after the procedure. Patient was told to keep the bandage on
for the remainder of the day and follow up if there are signs of infection, continued bleeding, or any
other concerning problems. Patient agreed to the plan and is to follow up in 1 week to re-evaluate,
sooner if symptoms worsen. Patient was instructed to call if she experienced any problems before then
and that there was a physician on call after hours if needed.

Steroid Subacromial Injection Procedure Note

PROCEDURE NOTE: Corticosteroid Injection - Left Shoulder Subacromial Injection

Written consent was obtained after the risks, benefits, and questions were explained and answered. The
area of pain was localized to the origin of the Left Supraspinatus. The area below the acromiom was
marked and prepped using sterile technique with Hibaclence and 70% Isopropyl Alchohol x 3.

The marked area was then anesthetized using a 0.5cc bleb in a 1:1 mixture of 1% Lidocaine and 4.2%
Sodium Bicarbonate solution on a 27G 0.5 inch needle. Approximatley 3-4 cc of a 1:1 mixture of
Kenalog-40 and 1% Lidocaine was injected using a 25G 2" needle.

Patient tolereated the procedure well with minimal bleeding. Area was bandaged with an adhesive pad.
There were no obvious neuro or vascular deficits after the procedure. Patient was told to keep the
bandage on for the remainder of the day and follow up if there are signs of infection, continued
bleeding, or any other concerning problems. Patient agreed to the plan and is to follow up in 1 weeks
to re-evaluate and continued treatment of upper neck/back pain. Continue home stretches BID.

Steroid Tibiotalar Joint Injection Procedure Note

- Steroid injection (see note below)
- Brace as needed
- Tylenol prn pain
- F/U in 2 days for recheck.

PROCEDURE NOTE: Corticosteroid Injection - Left Tibiotalar Joint

Written consent was obtained after the risks, benefits, and questions were explained and answered. The
area of pain was localized to the origin of the ATF and Ankle Joint. The Left Anterior Joint Recess was
marked and prepped using sterile technique with Hibaclence and 70% Isopropyl Alchohol x 3.

The marked area was then anesthetized using a 0.5cc bleb in a 1:1 mixture of 1% Lidocaine and 4.2%
Sodium Bicarbonate solution on a 27G 0.5 inch needle. Approximatley 3-4 cc of a 1:1 mixture of
Kenalog-40 and 1% Lidocaine was injected using a 25G 2" needle. US was used to identify the joint
space, neurovascular structures, and for needle guidance.

Patient tolereated the procedure well with minimal bleeding. Area was bandaged with an adhesive pad.
There were no obvious neuro or vascular deficits after the procedure. Patient was told to keep the
bandage on for the remainder of the day and follow up if there are signs of infection, continued
bleeding, or any other concerning problems. Patient agreed to the plan and is to follow up in 2 days to
re-evaluate and continued treatment of upper neck/back pain. Continue home stretches BID.
Steroid Trigger Finger Injection Procedure Note
- Risks and benefits of injection explained and discussed.
- Would like to move ahead with injection today.

PROCEDURE NOTE: Ultrasound Guided Corticosteroid Injection -Right Middle Finger Flexor Tendon

Indication: Tigger finger with failed conservative treatment.

Written consent was obtained after the risks, benefits, and questions were explained and answered.
Under ultrasound guidance the Right middle finger flexor tendon was identified. The injection site was
marked and prepped using sterile technique with Hibaclence and 70% Isopropyl Alchohol x 3.

The marked injection site was anesthetized using ~ 2cc blebs in a 1:1 mixture of 1% Lidocaine and 4.2%
Sodium Bicarbonate solution on a 27G 0.5 inch needle. The site was then injected using a 27G 1" needle
with 1 cc of the Corticosteroid Injection - Rt. middle finger Flexor Tendon.

Patient tolereated the procedure well with minimal bleeding. The injection site was bandaged and there
were no obvious neuro or vascular deficits after the procedure. Patient was told to keep the bandage on
for the remainder of the day and follow up if there are signs of infection, continued bleeding, or any
other concerning problems. Patient agreed to the plan and is to follow up in 1 week to re-evaluate,
sooner if symptoms worsen. Patient was instructed to call if she experienced any problems before then
and that there was a physician on call after hours if needed.

Suture Placement Procedure Note

PROCEDURE NOTE: Left Index Finger Laceration Suture Repair

Written consent was obtained after the risks, benefits, and questions were explained and answered.
Laceration on the distal dorsal aspect of the Left INdex Finger was prepped in a sterile manner with
Hibaclense and Etoh x 3. Anesthesia was administered using ~2cc of 1% Lidocaine and a 27G 0.5 inch
needle. Five interupted sutures of 6.0 Prolene were placed in a sterile environment. Patient tolereated
the procedure well and the bleeding was controlled with sutures. The area was bandaged with tefla pad
and cobane. Patient was told to keep bandage on for the remainder of the day and follow up if there are
signs of infection or continued bleeding. Told to keep convered during the day with topical antibiotics
and air dry at night. Patient agreed to the plan and is to follow up in 7-10 days for suture removal,
sooner if symptoms worsen.

Tinea Corpus Plan

- Ketoconazole 2% crm apply to affected area every 12 hours
- Keep clean
- Avoid wrestling until 72 hours after treatment
- Follow up if not continuing to improve in 2-3 days, sooner if symptom

Trigger Point Injection Thoracic Procedure Note

PROCEDURE NOTE: Tigger Point Injections - Thoracic Region

Written consent was obtained and the Risks and Benifits of the procedure were explained. The patient
agreed to have the procedure done today. Trigger points were marked in the area of the Left Upper
Trapezius 5 points. The area was prepped in sterile manner with Hibaclense and 70% Isopropyl Alcohol
x 3. A 1:1 mixture of 1% lidocaine and 4.2% Sodium Bicarbonate was injected with 27G 1/2" needle ~
0.5 cc into each lesion for a total of 2.5 cc. Patient tolerated the procedure well with minimal bleeding.
Area was cleaned and bandages. Pt denied any breathing difficulties and signs to call and return were
discussed. Pt felt relief of the area after injection therapy.

US Aspiration Knee Procedure Note

PROCEDURE NOTE: Ultrasound Guided Aspiration - Left Knee

Written consent was obtained after the risks, benefits, and questions were explained and answered.
Under ultrasound guidance the Left anterior lateral cyst measuring ~ 2 cm x 2 cm in diameter was
visualized under Ultrasound. The aspiration/injection site was marked and prepped using sterile technique
with Hibaclence and 70% Isopropyl Alchohol x 3.

The marked injection site was anesthetized using ~ 2cc blebs in a 1:1 mixture of 1% Lidocaine and 4.2%
Sodium Bicarbonate solution on a 27G 0.5 inch needle. The site was then aspirated with ~ 35 cc of
bloody fluid.

Patient tolereated the procedure well with minimal bleeding. The apsiration site was bandaged and
there were no obvious neuro or vascular deficits after the procedure. Patient was told to keep the
bandage on for the remainder of the day and follow up if there are signs of infection, continued
bleeding, or any other concerning problems. Patient agreed to the plan and is to follow up after MRI
complete to re-evaluate, sooner if symptoms worsen. Patient was instructed to call if she experienced
any problems before then and that there was a physician on call after hours if needed.

US Aspiration Elbow Procedure Note

PROCEDURE: Ultrasound Guided Left Elbow I&D

Date: 7/7/14

History: Left Elbow Swelling x 4 days. Pt reports hurting his elbow while doing carpentry work. Was
placed in abx 3 days ago, not improving.

Procedure was explained to the patient and questions were answered and risk/benefits discussed. Pt
signed consent to continue with procedure.

Area was marked under Ultrasound using a 12L probe. The Left olecranon bursa was identified and
needle insertion point marked on the superiormedial aspect of the elbow. Area was cleaned with
Hibaclense and Etoh x3. An 18G 2 inch needle on a 60 cc syringe was used to aspirate the fluid under
ultrasound guidance. Fluid appeared innocluated and 15 cc were obtain which was straw colored. Pt
tolerated the procedure and is to follow up in 1 day for re-evaluation and begin antibiotics.

US Aspiration Anterior Tibial Cyst Procedure Note

PROCEDURE: Ultrasound Guided Right Anterior Tibial Cyst Aspiration

Date: 5/16/14

History:Right Knee Cyst x 4 days. History of soft tissue contusion and fasciotomy.
Procedure was explained to the patient and questions were answered and risk/benefits discussed. Pt
signed consent to continue with procedure.

Area was marked under Ultrasound using a 12L probe. The Right suprapatellar bursa was identified and
needle insertion point marked on the superior lateral aspect of the knee. Area was cleaned with
Hibaclense and Etoh x3. An 18G 2 inch needle on a 60 cc syringe was used to aspirate the fluid under
ultrasound guidance. Fluid appeared serosanguinous and 10 cc were obtain. Fluid sent to lab for
aspiration. Pt tolerated the procedure and is to follow up at home with PCP.

US Hamstring
ULTRASOUND : Right Hamstring

Date: 1/1/18

History: Right hamstring pain x ~ 1 month. Has improved, but remains painfull when running.
Treatment with heat and NSAIDs.

Site: Right Lateral Biceps Femoris.

Area was examined using at 12L linear probe in both the Longitudinal and Transverse planes. There was
no fluid detected near the site of pain. There was a 1.5 cm void seen on ultrasound in the middle 1/3 of
the lateral aspect of the biceps femoris, suggestive of a small longitudinal tear.

US Knee Aspiration Procedure Note

PROCEDURE: Ultrasound Guided Right Knee Aspiration

Date: 5/7/14

History:Right Knee Pain x 4 days. Pt reports hurting his knee while jumping and landing sideways while
running an obstacle race. Felt Left medial knee pain after incident. Able to wt bear without difficulty.
Wearing Hinged Ligament knee brace for comfort.

Procedure was explained to the patient and questions were answered and risk/benefits discussed. Pt
signed consent to continue with procedure.

Area was marked under Ultrasound using a 12L probe. The Right suprapatellar bursa was identified and
needle insertion point marked on the superior lateral aspect of the knee. Area was cleaned with
Hibaclense and Etoh x3. An 18G 2 inch needle on a 60 cc syringe was used to aspirate the fluid under
ultrasound guidance. Fluid appeared innocluated and only 1-2 cc were obtain which was bloody. Pt
tolerated the procedure and is to follow up in 1-2 weeks for re-evaluation

US Knee Procedure Note

ULTRASOUND : Left Knee

Date: 2/1/13

History:Left Knee Pain x 1 day. Pt reports hurting his knee while sliding into first base during practice.
Felt Left medial knee pain after incident. Reports h/o of ACL repair in highschool on same knee. Able to
wt bear without difficulty. Wearing Hinged Ligament knee brace for comfort.
Site: Left Knee

Area was examined using at 12L linear probe in both the Longitudinal and Transverse planes. There was
small joint effusion noted in the L suprepatellar recess. There was a 1.5 cm void seen on ultrasound in
the middle 1/3 of the Left MCL suggestive of a small longitudinal tear seen in the long axis view small
longitudinal tear. Trasverse view showed further tissue void without evidence of a full thickness tear.

LCL, Quadriceps tendon, and Patella tendon appear intact. No evidence of a popliteal cyst and hamstring
insertion appears normal. Recommend MRI for further evaluation of meniscus with MCL involvement.

US Left Foot and Ankle Procedure Note

ULTRASOUND : Left foot and ankle

Date: 1/16/14

History: Left foot pain x ~ 3 days. Painfull when running. Treatment with heat and NSAIDs.

Site: Left foot and ankle.

Area was examined using at 12L linear probe in both the Longitudinal and Transverse planes. There was
trace fluid detected near the site of pain, base of 5th metatarsal. There was a 1.0 cm void seen on
ultrasound in the distal left peroneous brevis tendon, suggestive of a small longitudinal tear. Corticol
bone at abse of 5th appears intact.

US Ankle ATF Procedure Note

ULTRASOUND : Left Ankle

Date: 4/14/14

History: Left foot pain x ~ 15 days secondary to twisting injury while playing soccer.

Site: Left foot and ankle.

Area was examined using at 12L linear probe in both the Longitudinal and Transverse planes. There was
trace fluid detected near the site of pain, Left ATF. There was a 1.0 cm void seen on ultrasound in the
inferior back of the ATF, suggestive of a small horizontal tear. CFL appears intact. No cortical irregularity
seen on the Talar Dome. No joint fluid seen in the anterior recess.

IMPRESSION:

Second degree tear on the Left Anterior Talarfibula Ligament.

US Biceps Tear Procedure Note

Examination: Ultrasound of the Right Shoulder

Date: 4/17/14

Patient Name:

History: Chronic right shoulder pain that is getting worse.

Area was examined using at 12L linear probe in both the Longitudinal and Transverse planes. There is a
focal anechoic Examination: Ultrasound of the Right Shoulder

Date: 4/17/14

Patient Name:

History: Chronic right shoulder pain that is getting worse.

Area was examined using at 12L linear probe in both the Longitudinal and Transverse planes. There is a
focal anechoic trear of the proximal aspect of the right long head of the biceps tendon measuring 0.5 cm
short axis by 1.0 cm long axis along with a small joint effusion distending the biceps brachii tendon
sheath and mild distension of the subacromial-subdeltoid bursa. There is no involvement of hte short
head of the biceps tendon. The supraspinatus, subscapularis, and infraspinatus, and rotator cuff interval
appear normal. A moderate amount of infraspinatus and supraspinatus fatty degeneration is present.
Mild osteoarthrits of the acromioclavicluar joint. Additional focused evaluation at the sited of maximal
symptoms was unrevealing.

IMPRESSION: Focal incomplete partial-thickness tear of the right proximal biceps tendon with
infraspinatus and supraspinatus muscle atrophy.

US Steroid Hip Injection Procedure Note

PROCEDURE NOTE: Ultrasound Guided Corticosteroid Injection - Right Hip

Indication: Hip Pain with failed conservative treatment.

Written consent was obtained after the risks, benefits, and questions were explained and answered. The
area of pain was localized to the Right Hip Joint. This area was marked and prepped using sterile
technique with Hibaclence and 70% Isopropyl Alchohol x 3.

The marked area was anesthetized using a 0.5cc bleb in a 1:1 mixture of 1% Lidocaine and 4.2% Sodium
Bicarbonate solution on a 27G 0.5 inch needle. Approximatley 4 cc of a 1:1 mixture of Kenalog-40 and
1% Lidocaine was injected using a 25G 3" needle under Ultrasound Guidance with a Curvilinea Probe and
an Anterior approach. The Femoral Nerve, Artery and Vein were visualized prior to needle insertion.

Patient tolereated the procedure well with minimal bleeding. The injection site was bandaged and there
were no obvious neuro or vascular deficits after the procedure. Patient was told to keep the bandage on
for the remainder of the day and follow up if there are signs of infection, continued bleeding, or any
other concerning problems. Patient agreed to the plan and is to follow up in 1 week to re-evaluate,
sooner if symptoms worsen. Patient was instructed to call if she experienced any problems before then
and that there was a physician on call after hours if needed.

US Steroid Knee Injection Procedure Note

PROCEDURE NOTE: Ultrasound Guided Corticosteroid Injection - Right Knee

Indication: Knee Pain with failed conservative treatment.

Written consent was obtained after the risks, benefits, and questions were explained and answered.
Under ultrasound guidance the Left Supra-patellar space was identified. The injection site was marked
and prepped using sterile technique with Hibaclence and 70% Isopropyl Alchohol x3.
The marked area was anesthetized using a 0.5cc bleb in a 1:1 mixture of 1% Lidocaine and 4.2% Sodium
Bicarbonate solution on a 27G 0.5 inch needle. Approximatley 4 cc of a 1:1 mixture of Kenalog-40 and
1% Lidocaine was injected using a 25G 3" needle under Ultrasound Guidance using a Left Lateral
Suprapatellar approach. Patient tolereated the procedure well with minimal bleeding. The injection site
was bandaged and there were no obvious neuro or vascular deficits after the procedure. Patient was told
to keep the bandage on for the remainder of the day and follow up if there are signs of infection,
continued bleeding, or any other concerning problems. Patient agreed to the plan and is to follow up in
1 week to re-evaluate, sooner if symptoms worsen. Patient was instructed to call if she experienced any
problems before then and that there was a physician on call after hours if needed.

US steroid MP Injection Procedure Note

- Discussed other options including repeating PRP vs intraarticluar steroid injection.
- Pt would like to try steroid injection, has been > 3 mo since last foot injection.

PROCEDURE NOTE: Ultrasound Guided Corticosteroid Injection - Left 2nd MTP

Indication: Toe Pain with failed conservative treatment.

Written consent was obtained after the risks, benefits, and questions were explained and answered.
Under ultrasound guidance the2nd toe MCP joint space was identified. The injection site was marked and
prepped using sterile technique with Hibaclence and 70% Isopropyl Alchohol x 3.

The marked injection site was anesthetized using ~ 2cc blebs in a 1:1 mixture of 1% Lidocaine and 4.2%
Sodium Bicarbonate solution on a 27G 0.5 inch needle. The site was then injected using a 27G 1" needle
with 1 cc of the Corticosteroid Injection - Left 2nd toe MTP joint.

Patient tolereated the procedure well with minimal bleeding. The injection site was bandaged and there
were no obvious neuro or vascular deficits after the procedure. Patient was told to keep the bandage on
for the remainder of the day and follow up if there are signs of infection, continued bleeding, or any
other concerning problems. Patient agreed to the plan and is to follow up in 1 week to re-evaluate,
sooner if symptoms worsen. Patient was instructed to call if she experienced any problems before then
and that there was a physician on call after hours if needed.

US Steroid Subacromial Injection Procedure Note

PROCEDURE NOTE: Ultrasound Guided Corticosteroid Injection - Right Subacromial bursae

Indication: Right shoulder Pain with failed conservative treatment.

Written consent was obtained after the risks, benefits, and questions were explained and answered.
Under ultrasound guidance the Right subacromial bursae was identified. The injection site was marked
and prepped using sterile technique with Hibaclence and 70% Isopropyl Alchohol x 3.

The marked injection site was anesthetized using ~ 2cc blebs in a 1:1 mixture of 1% Lidocaine and 4.2%
Sodium Bicarbonate solution on a 27G 0.5 inch needle. The site was then injected using a 25G 2" needle
with 2 cc of the Corticosteroid and 2 cc of 1% Lidocaine.

Patient tolereated the procedure well with minimal bleeding. The injection site was bandaged and there
were no obvious neuro or vascular deficits after the procedure. Patient was told to keep the bandage on
for the remainder of the day and follow up if there are signs of infection, continued bleeding, or any
other concerning problems. Patient agreed to the plan and is to follow up in 1 week to re-evaluate,
sooner if symptoms worsen. Patient was instructed to call if she experienced any problems before then
and that there was a physician on call after hours if needed.