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GSG11245_4d89c3d7-e0d3-4ea8-93a9-006d1129cde4_0
| 1,754,909,288
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Now dictating follow-up note on Christopher M. Chervenyak 07/01/2025. Mr. Chervenyak comes to the office today. I performed surgery on his right shoulder five days ago, on June 26, 2025, when he had an evaluation under anesthesia, manipulation under anesthesia, operative arthroscopy of the right shoulder, abrasion arthroplasty of the humeral head, extensive debridement, subacromial decompression, excision of the distal clavicle, mini arthrotomy, and rotator cuff repair. operative arthroscopy of the right shoulder, abrasion arthroplasty of the humeral head, extensive debridement, subacromial decompression, excision of the distal clavicle, mini arthrotomy, and rotator cuff repair. I gave him a copy of the pictures. Everything went fine. He has not a lot of pain. There is a little achiness. The block worked great. He had no troubles with anesthesia. He finished the antibiotics.
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00:00:00.000
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00:00:34.440
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GSG11245_4d89c3d7-e0d3-4ea8-93a9-006d1129cde4_1
| 1,754,909,288
|
He is not taking any pain medications He was able to drive today PHYSICAL EXAMINATION: Mr. Chervenyak is a pleasant and cooperative male. Examination of his right shoulder revealed nicely healed incision. Staples were removed and wound was Steri-Striped. His temperature in the office is 97.7. Staples were removed and wound was Steri-Striped. His temperature in the office is 97.7. He could abduct and forward flex to about 45 degrees and passively about 120 degrees. He had about 30 degrees of active internal and external rotation and passively about 40 degrees. I did not do a drop test or an impingement test because he just had a rotator cuff repair. period.
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00:00:34.640
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00:01:04.760
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GSG11245_4d89c3d7-e0d3-4ea8-93a9-006d1129cde4_2
| 1,754,909,288
|
I took out all the original stitches that were present. It was a small tear, so I think we can push him a little bit more gently on regaining active range of motion period. Neurologically, he's normal. Pre-depregative x-rays, apilator x-rays, right shoulder, demonstrated he's down to both subocro and deep compression. Existed My impression is that Mr. Christopher Chervenyak had surgery five days ago on June 26, 2025, when I did an evaluation under anesthesia, manipulation under anesthesia, operative arthroscopy of the right shoulder, abrasion arthroplasty of the humeral head, extensive debridement,
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00:01:04.760
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00:01:32.380
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GSG11245_4d89c3d7-e0d3-4ea8-93a9-006d1129cde4_3
| 1,754,909,288
|
he also had a subacromial decompression, excision of distal clavicle, mini arthrotomy, and a rotator cuff repair. I think everything went well. The rotator cuff tear was small. I was able to repair the rotator cuff, so I think we can treat him more like a bad arthroscopy rather than six weeks of passive range of motion. He is completely fine with this. He is already working on active range of motion. He is just being careful. So, at this point, Mr. Chervenyak will start his physical therapy. For the first three weeks, let us work on passive range of motion, then come to see me in three weeks and we will work on active range of motion, but it is going to take a few months for him to rehab and build his strength back up to normal.
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00:01:32.480
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00:02:03.760
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GSG11245_4d89c3d7-e0d3-4ea8-93a9-006d1129cde4_4
| 1,754,909,288
|
So, I gave him a note for out of work. He will do the rehab. Medication wise, he is not taking anything, which is fine and I will see him back in my office in three weeks.
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00:02:04.220
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00:02:11.200
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GSG11241_641d500d-fd36-4fc9-8a40-9490719bfcc8_0
| 1,754,909,742
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JEANETTE ESPOSITO – 07/01/2025 Ms. Esposito comes to the office today with her companion, Faith. I had seen her almost three weeks ago on June 10, 2025. She had a recurrent dislocation of her right shoulder. I had done her rotator cuff repair years ago and she is feeling much better, though she does not have much pain. does not have much pain. She is a little stiff. She has been wearing the sling because we told her in her rotator cuff repair years ago, and she is feeling much better. does not have much pain. She is a little stiff. She has been wearing the sling. because we told her in her age group 72 years old after one dislocation, likelihood of recurrent dislocation is small,
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00:00:00.000
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00:00:30.980
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GSG11241_641d500d-fd36-4fc9-8a40-9490719bfcc8_1
| 1,754,909,742
|
but after two dislocations, the likelihood of a third dislocation significantly increases. Also with two dislocations, she has the potential of re-tearing the rotator cuff and damage the axillary nerve, though she does not have any numbness. PHYSICAL EXAMINATION:
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00:00:31.060
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00:00:44.640
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GSG11241_641d500d-fd36-4fc9-8a40-9490719bfcc8_2
| 1,754,909,742
|
Ms. Esposito is a pleasant, cooperative woman. Her temperature in the office is 97.4. Examination of her right shoulder reveals no numbness. She has a nicely healed scar from prior surgery. It is not hot or red. There is really no tenderness. She could forward flex about 65 degrees without any problems. I did not really want to externally rotate her. I did not really want her to abduct. I did not want to put her at any risk of recurrent dislocation. Actually, I really could not do a drop test. I could not do an impingement test. Her biceps looks okay. Neurologically, she is intact.
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00:00:44.760
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00:01:14.200
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GSG11241_641d500d-fd36-4fc9-8a40-9490719bfcc8_3
| 1,754,909,742
|
IMPRESSION: My impression is that Jeanette Esposito suffered two dislocations, first on April 18, 2025 as a result of fall and the second one while killing a bug on June 4, 2025. while killing a bug on June 4, 2025. Now, it has just been about four weeks since the second dislocation. She looks okay at this point, but I told her to wear the sling when she goes to sleep at night, wear the sling when she goes out to go to a party, but otherwise, take the sling off, and do some gentle forward flexion exercises. I would avoid external rotation. I would avoid any abduction and just be really careful. She is going South Carolina in a few days.
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00:01:14.200
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00:01:43.400
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GSG11241_641d500d-fd36-4fc9-8a40-9490719bfcc8_4
| 1,754,909,742
|
She is going to be back at the end of July. So, she will come see me in end of July. We will check on her. And at that point, we will put her through a little bit more range of motion exercises. I probably would not recommend therapy because I am nervous she is going to re-dislocate her shoulder. She is also going to do a cruise in September. Hopefully, she will be okay at that point. But if over the next few weeks she has poor abduction, then this could represent a recurrent tear of the road to the coffin. She may need an MRI, though she's really not interested in any type of surgery, period. So if she's fine with this, let's be nice and gentle,
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00:01:43.440
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00:02:12.000
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GSG11241_641d500d-fd36-4fc9-8a40-9490719bfcc8_5
| 1,754,909,742
|
so it may decrease the risk of any type of recurrent dislocation and I will see her back in my office in next four weeks or so once she is back from South Carolina.
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00:02:12.000
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00:02:19.500
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GSG11241_26b69396-672e-4e1c-843a-c4e031fba3d2_0
| 1,754,910,607
|
Jeanette Esposito July 1st, 2025. Ms. Esposito comes to the office today with her companion, Faith. I had seen her almost three weeks ago on June 10, 2025. She had a recurrent dislocation of her right shoulder. I had done her rotator cuff repair years ago and she is feeling much better, though she does not have much pain. Doesn't have much pain, just a little stiff. She's been wearing the sling because he told her in her ageator cuff repair years ago, and she's feeling much better. Doesn't have much pain, just a little stiff. She's been wearing the sling. Because we told her in her age group, 72 years old, after one dislocation, likely her recurrent dislocation is small,
|
00:00:00.000
|
00:00:30.980
|
|
GSG11241_26b69396-672e-4e1c-843a-c4e031fba3d2_1
| 1,754,910,607
|
but after two dislocations, the likelihood of a third dislocation significantly increases. Also with two dislocations, she has the potential of re-tearing the rotator cuff and damage the axillary nerve, though she does not have any numbness. PHYSICAL EXAMINATION:
|
00:00:31.060
|
00:00:44.640
|
|
GSG11241_26b69396-672e-4e1c-843a-c4e031fba3d2_2
| 1,754,910,607
|
Ms. Esposito is a pleasant, cooperative woman. Her temperature in the office is 97.4. Examination of her right shoulder reveals no numbness. She has a nicely healed scar from prior surgery. It is not hot or red. There is really no tenderness. She could forward flex about 65 degrees without any problems. I did not really want to externally rotate her. I did not really want her to abduct. I did not want to put her at any risk of recurrent dislocation. Actually, I really could not do a drop test. I could not do an impingement test. Her biceps looks okay. Neurologically, she is intact.
|
00:00:44.760
|
00:01:14.200
|
|
GSG11241_26b69396-672e-4e1c-843a-c4e031fba3d2_3
| 1,754,910,607
|
two dislocations, first on April 18, 2025 as a result of fall and the second one while killing a bug on June 4, 2025. Now, it has just been about four weeks since the second dislocation. She looks okay at this point, but I told her to wear the sling when she goes to sleep at night, wear the sling when she goes out to go to a party, but otherwise, take the sling off and do some gentle forward flexion exercises. I would avoid external rotation. I would avoid any abduction and just be really careful. She is going South Carolina in a few days. She is going to be back at the end of July. So, she will come see me in end of July.
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00:01:15.700
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00:01:47.400
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GSG11241_26b69396-672e-4e1c-843a-c4e031fba3d2_4
| 1,754,910,607
|
We will check on her. And at that point, we will put her through a little bit more range of motion exercises. I probably would not recommend therapy because I am nervous she is going to re-dislocate her shoulder. She is also going to do a cruise in September. Hopefully she will be okay at that point. but if over the next few weeks, she has poor abduction, then this could represent a recurrent tear of the rotator cuff. She may need an MRI, though she is really not interested in any type of surgery. So if she is fine with this, let's be nice and gentle, so it may decrease the risk of any type of recurrent dislocation, and I will see her back in my office in next four weeks
|
00:01:47.400
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00:02:17.000
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GSG11241_26b69396-672e-4e1c-843a-c4e031fba3d2_5
| 1,754,910,607
|
or so once she is back from South Carolina.
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00:02:17.000
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00:02:19.500
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