KING-GREENFIELD TEMPLATES - PART TWO
RISKS AND COMPLICATIONS PARAGRAPH (LG1):
A long discussion was carried out with the patient regarding the nature of the condition. It
was carried out with Dr. King. The patient was again given the choice of various
treatment alternatives, and surgical and non-surgical options that were available. The
patient's questions were answered, and with an expressed understanding of the risks and
benefits associated with both the surgical and non-surgical treatment alternatives that
were available.
Laurel Greenfield, P.A.
Warren King, M.D.
SUBACROMIAL INJECTION (KING-SIN):
Procedure:
Injection of the subacromial space.
Following an explanation of the details and risks of the procedure the skin was sterilely
prepped with alcohol and Betadine. The skin and subcutaneous tissue were then
infiltrated with 2% lidocaine solution utilizing a 27-gauge needle. The subacromial space
was then injected with 1 cc of Kenalog 4 cc of 1% lidocaine using a 22-gauge needle.
The needle was then withdrawn and the area was covered with a Band-Aid. The patient
tolerated this injection with minimal difficulty. The arm was then rotated in various
position to spread the medication throughout the subacromial bursal space. Neer and
Hawkins impingement tests were then performed and there was improvement with a
decrease in pain reported with these maneuvers indicating a positive impingement test.
ACROMIOCLAVICULAR INJECTION (KING-ACI):
Procedure:
Injection of the acromioclavicular joint.
Following an explanation of the details and risks of the procedure the skin was sterilely
prepped with alcohol and Betadine. The skin and subcutaneous tissue were then
infiltrated with 2% lidocaine solution utilizing a 27-gauge needle. The subacromial space
was then injected with 1 cc of Kenalog 4 cc of 1% lidocaine using a 22-gauge needle.
The needle was then withdrawn and the area was covered with a Band-Aid. The patient
tolerated this injection with minimal difficulty. The arm was then rotated in various
D:\308866768.doc
position to spread the medication throughout the subacromial bursal space. Neer and
Hawkins impingement tests were then performed and there was improvement with a
decrease in pain reported with these maneuvers indicating a positive impingement test.
KNEE JOINT ASPIRATION (KING-KJA):
Procedure: Aspiration of the knee.
Following an explanation of the details and risks of the procedure the peripatellar region
was sterilely prepped with alcohol and Betadine. The skin and subcutaneous tissue were
then infiltrated with 2% lidocaine solution utilizing a 27-gauge needle. A 16-gauge
needle was then introduced into the joint itself. The knee joint fluid was aspirated.
Approximately ?? cc of fluid was obtained. The fluid was ?? in appearance. The needles
were withdrawn and a Band-Aid was placed over the injection site. The patient tolerated
this with minimal difficulty.
HYALGAN INJECTION ANKLE (KING-HIA):
Procedure: Hyalgan ankle injection.
The skin in the anterior aspect of the ankle was sterilely prepped. The skin in the
anteromedial aspect of the ankle was injected with a 30-gauge needle with 2% lidocaine
with epinephrine. 2 cc of Hyalgan solution was then injected through the anesthetized
area with a 22-gauge needle into the tibiotalar joint. A Band-Aide was placed over the
injection site. He tolerated the procedure without difficulty.
SYNVISC INJECTION KNEE (KING-SIK):
Procedure: Synvisc injection knee.
Following an explanation of the details and risks of the procedure the knee was sterilely
prepped with alcohol and Betadine. The skin and subcutaneous tissue were then
infiltrated 1-2 cc of 2% lidocaine plain solution utilizing a 30-gauge needle. A 22-gauge
needle was then introduced into the joint itself, and the joint was injected with 20 mg of
Synvisc. A Band-Aid was placed over the injection site. The patient tolerated this
procedure without difficulty.
D:\308866768.doc
HYALGAN INJECTION KNEE (KING-HIK):
Procedure: Hyalgan injection knee.
Following an explanation of the details and risks of the procedure the knee was sterilely
prepped with alcohol and Betadine. The skin and subcutaneous tissue were then
infiltrated 1-2 cc of 2% lidocaine plain solution utilizing a 30-gauge needle. A 22-gauge
needle was then introduced into the joint itself, and the joint was injected with 20 mg of
Hyalgan. A Band-Aid was placed over the injection site. The patient tolerated this
procedure without difficulty.
LATERAL EPICONDYLE INJECTION (KING-LEI):
Procedure. Injection of the lateral epicondyle.
Following an explanation of the details and risks of the procedure the epicondylar region
was sterilely prepped. The lateral/medial epicondyle region was injected with 1 cc of 1%
lidocaine and a 0.5 cc of Celestone. A Band-Aid was placed over the injection site. The
patient tolerated the procedure without complications.
MEDIAL EPICONDYLE INJECTION (KING-MEI):
Procedure. Injection of the medial epicondyle.
Following an explanation of the details and risks of the procedure the epicondylar region
was sterilely prepped. The lateral/medial epicondyle region was injected with 1 cc of 1%
lidocaine and a 0.5 cc of Celestone. A Band-Aid was placed over the injection site. The
patient tolerated the procedure without complications.
TRIGGER FINGER INJECTION (KING-TFI):
The base of the affected finger in the metacarpophalangeal joint flexion crease was
carefully prepped with an alcohol swab. Lidocaine was used to anesthetize the skin.
Subsequently 0.5 cc of Celestone was injected into the tendon sheath. A Band-Aid was
placed over the skin. The patient tolerated this well. Patient states the symptoms and
pain in the finger were improved.
D:\308866768.doc
DE QUERVAIN’S INJECTION (KING-DQI):
PROCEDURE: Injection of the first dorsal compartment, right/left wrist.
Following an explanation of the details and risks of the procedure the skin was sterilely
prepped with alcohol and Betadine. The skin and subcutaneous tissue were then
infiltrated with 2% lidocaine solution utilizing a 27-gauge needle. The first dorsal
compartment was then injected with 1 cc of Celestone and 2 cc of 2% lidocaine using a
22-gauge needle. The needle was then withdrawn and the area was covered with a
Band-Aid. The patient tolerated this injection with minimal difficulty.
NEW PATIENT TEMPLATE (KING-NPT):
CHIEF COMPLAINT: ??
HISTORY OF PRESENT ILLNESS: The patient was seen in conjunction with Dr.
Warren King today.
CURRENT MEDICAL PROBLEMS: The patient denies any history of hypertension,
diabetes, cardiac, pulmonary, renal or gastrointestinal disorders.
CURRENT MEDICATIONS: Negative.
ALLERGIES: ??
PAST SURGICAL HISTORY: Negative.
FAMILY HISTORY: Noncontributory.
REVIEW OF SYSTEMS: Thirteen point review of systems is otherwise unremarkable
and noncontributory.
PHYSICAL EXAMINATION: ??
ASSESSMENT: ??
RECOMMENDATIONS: ??
D:\308866768.doc
SURGICAL CONSENT (KING-SC):
The patient was told of the diagnosis and was given a choice of the treatment options
available. The patient was told of the surgical and the nonsurgical treatment options as
well as the risks and benefits associated with each of the treatment options. Prior to the
patient giving consent the patient expressed an understanding of the diagnosis and the
treatment options, both surgical and nonsurgical. The patient's questions were answered.
With an expressed understanding of the diagnosis and the treatment alternatives the
patient requests surgical intervention.
SURGICAL CONSENT FOR A MINOR (KING-SCM):
The patient’s parents were told of the diagnosis and was given a choice of the treatment
options that are available. The patient’s parents were told of the surgical and nonsurgical
treatment options available along with the risks and benefits associated with both the
surgical and the nonsurgical options. Prior to the their consent the parents expressed their
understanding of the diagnosis, the associated treatment alternatives that were available
as well as the risks and benefits associated with each of those alternatives. With an
expressed understanding of the diagnosis and its treatment alternatives, risks and benefits
the patient’s parents request surgical intervention.
POSTOP ACL EQUIPMENT STATEMENT/DURABLE EQUIPMENT REQUEST
(KING-DER):
Postoperative Care: Postoperatively the patient will require a cryotherapy machine, a
CPM (continuous passive motion) machine and a range of motion brace. The CPM
machine is used to assist in the prevention of loss of range of motion and
thrombophlebitis postoperatively. The cryotherapy machine will help reduce discomfort
and pain as well as help with postoperative inflammation. The range of motion brace is
required for protection of any instability episodes that may occur postoperatively during
the course of the rehabilitation.
D:\308866768.doc