Rule out partial rotator cuff tear

The patient is here for initial evaluation for pain in both knees and right shoulder. The patient has had this pain since last several years when he himself injured while working on a cruise ship. He had a more severe and it was left at the time of surgery, but since then the pain has never gone. His complaint of pain in both knees is much more severe on the left as compared to the right and also for the last few months started to feel significant pain in the left shoulder. He complains of off and on burning and numbness in the feet. He denies any significant back pain. He describes the pain as burning and stabbing, and numbness. Pain is constant. Walking and working a lot makes it worse. Sitting on the leg makes it better and is interfering and he finds continued to difficult to work. Pain is about 8 to 9/10. He has taken oxycodone and alprazolam on as needed basis to help in pain for the last but now he is not taking anything.

DIAGNOSES:
Bilateral knee DJD.
Left shoulder adhesive capsulitis.
Shoulder impingement syndrome.
Rule out partial rotator cuff tear.
Chronic pain syndrome.

RECOMMENDATIONS:
I will do x-ray of both knees and left shoulder, and start physical therapy three times a week for four weeks. I will give the patient Percocet 5/325 mg one tablet two to three times a day p.r.n. for pain. A prescription for 40 tablets were given. Hopefully once we start the patient on treatment, the patient will need opioids; however, if the patient may need opioid medication on a long-term basis, the patient will sign an opioid agreement with us. I will start patient on Mobic 50 mg one p.o. q.daily with food and Ultram 50 mg one tablet four times a day p.r.n. for pain. We will see the patient back in followup in two weeks.

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