Title Exhibit 4: Orthopedics Record.pdf ✅

PLEASE PRINT OR TYPE APPROVED OMB-0938-1197 FORM 1500 (02-12)
PAUL ELIOT HUGHES, M.D. Orthopaedic Surgery/Sports Medicine 100 South Ellsworth Ave, Ste 504 San Mateo, CA 94401 Phone: (650) 343-5633 Fax: (650) 343-3122 November 29, 2022 RE: DOB: 07/09/1979 Date of Injury: 10/18/2022 ORTHOPEDIC TELEMEDICINE FOLLOW-UP CHIEF COMPLAINT Right shoulder pain, right elbow pain, bilateral knee pain, low back pain, and right ankle pain. HISTORY OF PRESENT ILLNESS is a 43-year-old male who has had his MRI of his right shoulder recently. The patient continues to have discomfort in his right elbow, both knees, low back and right ankle. The patient states that at his medial side of his right leg, he still has numbness and has tenderness on the inside part of the right ankle and leg. The patient has not had MRIs of the other extremities. The patient states that he is not able to work due to pains and discomforts that have happened to him from this collision that occurred when he was struck on his E-bike. The patient's MRI of his right shoulder from 11/22/2022, shows complete separation of the AC joint with a high-riding clavicle with disruption of coracoclavicular ligaments completely. This is consistent and read as a complete AC joint separation with an elevation of clavicle. The patient has some slight tendinosis of the infraspinatus with no evidence of rotator cuff tear. ASSESSMENT 1. Right shoulder AC joint separation with complete disruption of the coracoclavicular ligaments and elevated clavicle. 2. Right elbow strain. 3. Bilateral knee strain. 4. Low back strain. 5. Right ankle strain. TREATMENT LAN In discussion with the patient, he would like to get his acromioclavicular joint reconstructed so that he does not have a high-riding clavicle. He continues to have discomfort in this area and is interested in getting surgery. We discussed that surgery would include an open AC joint reconstruction and repair with augmentation with allograft. The patient understands this. We
RE: Page 2 of 2 would also do a right shoulder arthroscopy at that time and treat any intra-articular pathology that we see. The patient needs to be in a sling for 4 weeks, will be unable to work in any significant capacity for 3 months. The patient will need postop physical therapy and progress his strength over that time. The patient understands this and wishes to proceed with the procedure. We will await for the results of the other extremities and back from MRIs. The patient is continuing to take pain medications, which were provided to him, which included cyclobenzaprine, ibuprofen, and tramadol, which he says give him some moderate relief. DISCLOSURE The above report is for medical/legal assessment of injuries and is not to be construed as a complete physical examination for general health purposes. Only those symptoms which are believed to have been involved in the injury or that might relate to the injury have been assessed. Regarding the general health of this patient, the patient has the right to obtain a physical examination for general purposes with a personal physician. Notice is hereby given that pursuant to the patient's authorization and California Civil Code Section 2882.1, the undersigned claims a lien for all medical services rendered to patients on any sums that may be recovered by the patient by reason of accident of occurrence. Paul Eliot Hughes, M.D. PEH:TDY:hon.HFP