Ms. Mary Donohue is not currently employed, and last worked as a line cook in the Lindenwood College cafeteria. Ms. Donohue worked in the grill and pasta bar area, cooking and stocking fried foods such as French fries. The claimant would spend as much as two and one half to three hours a day cooking French fries in a fry basket. On or about 4/15/02 the claimant suffered pain into her left wrist and arm while lifting and turning fry baskets.
Claimant treated with Dr. Covert that same day at SSM Corporate Health Services (See Employer and Insurer's Exhibit No. 2). Claimant was provided pain medication, a splint to wear on the affected hand, and was to begin physical therapy for what was diagnosed as an acute tenosynovitis. Claimant continued to work restricted duty, using the left hand only as a helper hand with a lifting restriction. Claimant had several follow up appointments with Dr. Covert. On 5/7/02 Dr. Covert performed an examination of the left wrist and forearm; concluded that a strain of the left forearm had resolved; and released the claimant to full duty.
Thereafter Ms. Donohue continued to work in the same area of the cafeteria, performing the same duties, and received no further treatment for left upper extremity complaints until such time as she suffered a second injury by accident on or about 12/03/02. Claimant was pulling open a box of french fries, and while tugging on the box flap, suffered severe pain from the tip of her fingers in her left hand to her shoulder, and with a burning sensation in her left arm and shoulder.
Ms. Donohue was returned to Dr. Covert for evaluation and treatment of her complaints. On 12/4/02, Dr. Covert notes, in part, the following history:
She has similar symptoms with regard to the left wrist about six to seven months ago. At that time, she was seen here and treated for acute tenosynovitis. She was referred for physical therapy and made a nice recovery. Her pain today in the wrist is similar to what she had back then.
The shoulder, however, is a new complaint. (See Employer and Insurer's Exhibit No. 3)
Dr. Covert diagnosed the claimant as suffering from an acute strain of the left shoulder, wrist, and forearm. Claimant was provided with a thumb spica splint, a prescription for Vioxx, and was instructed not to use the left arm for any lifting while undergoing physical therapy.
The physical therapist noted that the claimant complained of "excruciating pain in her left thumb, shoulder, and upper trap region". (See Employer and Insurer's Exhibit No. 4). The therapist suspected a possible rotator cuff tear and an acute tenosynovitis of the $1^{\text {st }}$ digit extensor tendons. On 12/11/02 Dr. Covert noted the physical therapist's concerns, performed a physical examination of the shoulder, and ordered an MRI scan. An MRI taken at St. Joseph Health Center on 12/20/02 was interpreted as showing a rotator cuff tear (See Employer and Insurer's Exhibit No. 5).
Dr. Covert referred the claimant to Dr. Bradbury with a diagnosis of de Quervain's tenosynovitis and left rotator cuff tear. Dr. Bradbury performed his initial examination of Ms. Donohue on 1/09/03, and on 1/21/03 performed an open left rotator cuff repair, and a de Quervain's release of the left first dorsal compartment. Ms. Donohue had follow up appointments with Dr. Bradbury, and on 1/29/03 Dr. Bradbury released the claimant for a return to work effective 2/17/03, limited to sedentary work with the right hand only. Claimant returned to work at the cafeteria, and worked a sedentary duty, checking student passes at the door.
Ms. Donohue was prescribed further physical therapy at SSM Rehab. On 3/7/03 the physical therapist reported that the claimant had attended 6 visits post her surgeries, and noted "She is experiencing pain along the superior border of the left shoulder and is only having mild tenderness in the left thumb and wrist with gripping". Claimant was further noted to experience "excruciating pain with end range PROM of the left shoulder."
Ms. Donohue met with Dr. Bradbury on 3/07/03. Dr. Bradbury notes, in part, "She is doing well. She denies any numbness or tingling. No fever or chills. She has been doing formal therapy. She says the shoulder is making progress. She still continues to complain of some weakness with overhead activity but overall she says she is doing okay". Claimant was advised at that time to continue with sedentary duty, physical therapy, and her home exercise program.
On 4/4/03 Dr. Bradbury performed an examination of the shoulder and wrist, and determined that the claimant should continue with physical therapy while returning to work with a restriction of no work above chest height.
On 5/2/03 the physical therapist noted that the claimant had been seen for a total of 18 visits post surgery, and noted, in part, as follows: "Ms. Donohue has met all PT goals. Her left shoulder and wrist ROM are normalizing and equal to the right. Her strength is improving within the left shoulder. She is independent with her HEP and can continue on