The employee worked in the spiral line department which made hoses. On September 20, 1995, the employee was pulling a hose when he noticed a hot burning sensation which started at the top of his right shoulder and went down to his elbow. The employer sent the employee to Dr. Douglas on September 27. Dr. Douglas
noted bruising along the posterior aspect of the right shoulder, significant pain and loss of strength. He referred the employee to Dr. Knight, an orthopedic surgeon. Dr. Knight saw the employee on September 29, and noted that the employee had swelling, tenderness, and bruising to his right shoulder. Dr. Knight ordered an MRI. After the MRI was performed, Dr. Knight stated that there was not a rotator cuff tear. He diagnosed right shoulder pain with impingement and bursitis, gave an injection and ordered therapy. The therapist noted that the employee had loss of flexion and abduction in his right shoulder. In November, Dr. Knight's impression was right shoulder impingement with pain and bursitis with an intrasubstance cuff tear. Dr. Knight ordered an EMG and nerve conduction study due to numbness in the employee's right upper extremity. The studies performed by Dr. Tellow on November 15 were interpreted as normal.
On November 16, Dr. Knight noted that the bruising of the employee's shoulder occurred from muscle tearing at the time of the injury. Since the employee failed non-surgical treatment he recommended surgery which was performed on December 15. The operative report showed a post operative diagnosis of right shoulder pain with subacromial impingement with minimal synovitis in the glenohumeral joint. Dr. Knight performed a right shoulder arthroscopy with limited debridement in the glenohumeral joint, and a subacromial decompression and acromioplasty. It was noted that although the MRI showed intrasubstance tearing of the rotator cuff and no full thickness tear, the operative notes noted no evidence of a rotator cuff tear.
The employee received therapy in January and February of 2006. In February the employee had constant shoulder pain and trouble sleeping. Dr. Knight noted that the employee had made good progress with his range of motion and strength but still had pain. Dr. Knight stated that it was most likely due to the anterior superior portal due to the size of his musculature and that it was probably iatrogenic pain. Dr. Knight continued therapy and prescribed Vicodin for pain. The employee had a total of 28 physical therapy sessions. In March the employee had work conditioning but still continued to have pain.
At the end of March, it was Dr. Knight's opinion that the employee was at maximum medical improvement and ordered a functional capacity evaluation which was performed on March 29. The evaluation showed marked limitation in right shoulder internal rotation and moderate limitation in the other planes of movement. The range of motion was seventythree percent of normal flexion, eighty-one percent of normal extension, seventy-eight percent of normal abduction, twentyone percent of normal internal rotation and seventy percent of normal external rotation. There was a suggestion of capsular adhesions. There was moderately decreased right shoulder strength in all plans of movement particularly abduction. It was noted that there was a suggestion of a tendency to over-guard which may account in part for the continued range of motion deficit. The employee had an acceptable quality of effort. It was noted that the employee should be able to safely function in a job in the heavy work demand level on a full time basis with the restrictions of lifting up to seventy pounds occasionally and thirty-five pounds frequently and a limit of overhead lifting of thirty-five pounds occasionally and twenty pounds frequently.
The employee testified that the surgery helped and the physical therapy helped with his range of motion. He has swelling and tingling in his right shoulder which goes down into his hand and finger tips. The employee has pain in his shoulder everyday including when he moves his arm out to the side and if he lifts more than a gallon of milk. To help alleviate the pain, he takes over the counter ibuprofen 1-2 times a day and uses ice and heat. He has to stop doing laundry and vacuuming due to the pain. He has trouble sleeping on his right side and the pain in his shoulder wakes him up. The employee has limited range of motion which causes problems lifting over his shoulder level. He can reach out to the front to shoulder level but if he pushes up, he has pain. He has loss of motion behind his back and can only get his arm up to his beltline as opposed to the mid back area with his left arm. He has trouble pushing a lawnmower and cannot play basketball, cannot pitch, throw or bat due to his loss of range of motion. He has trouble lifting with his right arm due to the loss of strength and cannot change a tire or move furniture. The employee stated that his pain is now worse than when he was released at maximum medical improvement. While he was doing therapy his motion and strength was improved but since he stopped therapy it is not as good.
Although the employee is right handed, he has switched to his left hand when using hammers, wrenches and when he cooks. He believes he has a 50 % loss of use on his right side. He is no longer working at Gates Rubber and could not go back to work at Gates with the restrictions given by Dr. Knight. He has looked for but has not been able to find a job due to the limits with his right arm. Although the FCE said he could work in a heavy capacity, the employee testified that he cannot work at that level due to the pain, loss of strength and loss of range of motion.
Dr. Knight noted that the FCE showed that the employee did fairly well with his effort. Dr. Knight stated based on the FCE, the employee was clear to work at a heavy demand level. He gave the e