Mr. John Richardson, 44 years old as of the date of hearing in this matter, comes from a family of General Motors workers. The claimant graduated from high school in O'Fallon, Illinois and began working off shore "mud logging", described by Mr. Richardson as a safety job that involved monitoring for sediment formation and for natural gas releases off shore while drilling for oil. Thereafter, the claimant worked as a driver for United Transports, a company that shipped General Motors vehicles from the assembly plant. After a year or so of driving, Mr. Richardson accepted a job offer from General Motors. Claimant began with G.M. in Oklahoma City on or about 10/24/83.
Mr. Richardson became an "Absentee Relief Operator" after his first six months with G.M. Claimant explains that an "ARO" was expected to perform a variety of different jobs after short term training. In 1997 Mr. Richardson was transferred to the G.M. plant in Wentzville, Missouri.
On 6/26/00 claimant suffered the work injury that was the subject of the companion claim in this matter, Injury Number 02-178923. On 6/26/00 Mr. Richardson was working in "the pit". Mr. Richardson agrees that the job he was performing was highly desired, and that he was able to bid for the job with his seniority. The pit is a recessed underground repair area, allowing vehicles to roll by overhead. Workers in the pit performed all manner of special repairs necessary before the vehicle could be shipped out.
Claimant was fixing a brake line, and as he attempted to climb out and exit the pit, his head struck the steel frame of a van. Claimant sought medical care at plant medical for a laceration on the top of his forehead at the hairline. The laceration was dura-bonded shut, and claimant suffered no immediate symptoms and was allowed to complete the rest of his shift. Claimant acknowledges that he sought no medical treatment outside of the plant following his injury. The claimant acknowledged that he suffered from migraine headaches prior to his head injury, and notes that after his head injury those
headache complaints worsened in severity and duration. Mr. Richardson also complained that use of his arms causes him to suffer swelling in both sides of his neck, with pockets of fluid, and with increased numbness in his arms.
Mr. Richardson recalled that he worked only a short time in the pit, and when a new man came on that job, claimant transferred to a job on the assembly line deck, working inside the cab, under the hood, and on trim items, requiring more use of his arms than was required when in the pit. Claimant related that strenuous use of his upper extremities caused him all manner of increased complaints as to pockets of swelling, arms and hands becoming numb, and a loss of grip strength that caused him to drop tools and parts. Claimant is alleging to have suffered an occupational injury relating to a cumulative trauma affecting him in his neck and upper extremities at work through 3/18/02. Claimant relates that his complaints became so severe that he ultimately was obliged to leave work, and has not been back to work at G.M or for any other employer since $4 / 15 / 02$.
Medical records reveal that on 3/25/02 the claimant met with his family physician, Dr. Mary Kiehl, "...in follow up for acute exacerbation of musculoskeletal complaints primarily involving shoulder pain, low back pain, wrist, and low back discomfort after a change in his work routine" (Claimant's Exhibit B). On 4/16/02 Mr. Richardson met with Dr. Robert A. Shively. Dr. Shively noted that the claimant had complaints as to eleven different body parts, and declined to evaluate all of the complaints, opting instead to suggest that the claimant seek a specialist in physical medicine. Dr. Shively did examine the right shoulder; had a diagnostic evaluation performed by Theodore Vandervelde, M.D. (See Claimant's Exhibit J); and concluded that claimant might have some relief by revision surgery following up on an earlier surgery involving the excision of the distal clavicle.
Claimant was then referred to Dr. Manish Suthar, Missouri Bone \& Joint Physical Medicine Center (Claimant's Exhibit D). On 4/17/02 Dr. Suthar elicited a history of chronic diffuse body pain; performed a physical examination; formed the impression that the claimant suffered from arthritis or possible fibromyalgia; and suggested a work up for a possible rheumatologic disorder.
On 5/10/02 Mr. Richardson met with Dr. Richard H. Gelberman, complaining of bilateral wrist and hand pain. Dr. Gelberman performed an examination of the upper extremities; concluded that x-rays were negative for arthritis; concluded that the claimant's symptoms were not classic for carpal tunnel on the right side; did not advise a repeat surgery; and recommended an injection, a splint, and nonsteroidals for tennis elbows.
On 5/17/02 Dr. Leesa M. Galatz performed an orthopedic evaluation of the shoulders, noting a chief complaint of bilateral shoulder pain right greater than left. X-ray of the shoulders was found to be negative, and upon physical examination Dr. Galatz noted that the claimant had scarring related to a resection to the left sternoclavicular joint, and scars over the right shoulder from a prior subacromial decompression, debridement of the rotator cuff, and distal clavicle resection. On examination, Dr. Galatz noted some crepitus over the right acromioclavicular joint, negative biceps signs, and an absence of scapular winging or muscular atrophy. Her diagnosis was shoulder pain of unknown etiology, and her recommendation was "Given the constellation of his symptoms, I think he is best managed by Pain Management. I don't think any further surgery would help him."
On 6/17/02 claimant was seen by Dr. John Clohisy for complaints of bilateral knee pain. Dr. Clohisy noted the history of prior arthroscopic debridement on the right, performed an examination of the knees, and reviewed x-rays showing no bony deformity; no major degenerative disease; and no fractu