Dr. Willis Transcription Rules, Guidelines, and TipsGeneral Template Guidelines

1. Chief Complaint: When Dr. Willis dictates multiple chief complaints or assessments for multiple diagnoses, each one should be on a separate numbered (not bulleted) line. When Dr. Willis dictates additional information in the chief complaint (usually about a referring doctor or to state that the patient is coming for a second opinion), put that info on a separate line in order to leave the chief complaint by itself.For followup reports, the easiest is to refer to the previous report and copy/paste the chief complaint from that report and edit in the current report as necessary. Sometimes there is just a different time period that the patient is postop and all the rest stays the same. Sometimes he adjusts parts of the procedure that was performed, but it will help in understanding how he says the various procedures by simply referring to the previous report.

Chief Complaint: 1. …

2. …

Otherwise just put them on the same line:

Chief Complaint: …

2. Review of Systems, Allergies, History…: Dr. Willis is still in the habit of saying a line to the effect “insert past medical history, review of systems from the medical records”. This is a throwback to the old method of doing his reports and is simply to be ignored.

3. Previous Note Copying: Very often Dr. Willis will request that you copy entire sections from previous reports. Now that he is using dictation markers, this requires that you add “Encounter Note” to the list of document types each time you click “Insert Transcription” to locate a previous report. Be sure you are copying from the report on the date he specifies. On rare occasions, the date he requests will have been entered into the system a day or two (at the most) after the date he is requesting. In that case, use good judgement in determining which report to pull the information from.

When he does this, if there is a range of motion chart, then an entry needs to be made for the date of the current examination that is identical to the exam from which the data is being taken.

When copying xrays from a previous report, if the original says “xrays were taken today on 01/01/2001”, be sure to remove the word “today”.

Note: To have it copy/paste in correct format, try copying from the top of the exam, including the header until all the way at the end of the report . Then after pasting, remove all extra info that is not necessary.

4. Physical Exam Section: The physical exam section needs to be typed as a bulleted list, with one finding per line. Even though Dr. Willis generally does not speak in complete sentences in this section, each line needs to be transcribed as a complete sentence. Therefore, you may need to add a word or two to make each one a complete thought. (For instance, dictated as “Alert and oriented x 3.” should be typed “He is alert and oriented x 3.”) Formatting is as follows:

Physical Examination: … … …

5. ROM Reports: Any time Dr. Willis dictates a report for a shoulder or knee injury, he wants a complete chart of range of motion measurements (including every visit since the last “new patient” or “old patient/new problem” report). This requires that you go back to the previous report (regardless of whether he dictates any new ROM measurements or not) and copy the existing chart. If there is no chart, it is necessary to back again to the next-oldest report until you find a complete chart to put into the current report. If the chart is incomplete or does not exist, you will need to go back and make one from the available reports. Note again that this pertains to knees and shoulders only. Empty charts should be deleted from the report. In the chart, type out "Left" and "Right" (do not use "L" and "R"), and in the chart. Always put the injured or painful shoulder or knee last (because that is the side he will want to

keep track of and compare with future measurements).  If he dictates the opposite side, put it first.

6. X-Rays/Imaging Tests: When Dr. Willis dictates imaging studies, you should use the following formatting, regardless of how he calls the header.

Diagnostic Studies: Radiographs: …

Radiographs: …

MRI: …

EMG: …

7. Assessment: Leave the heading “Assessment:” regardless of whether he says “assessment” or “impression.” (Note that in a Worker’s Compensation or motor vehicle accident report, he will almost always include the sections “Prescriptions:”, “Work Status:”, and “Followup:”, and in the initial-visit report he will generally include “Causality:” as a separate section.)

8. Risks and Benefits/Surgery Teaching: The “risks and benefits of surgery and teaching protocol provided by me” templates are always inserted when Dr. Willis discusses surgery with a patient. Both templates should always be put in together. (You may want to make autotexts for this) The templates are as follows:

The risks and benefits of the surgery including neurovascular injury, infection, retear rate, chronic pain, contracture and loss of motion were discussed.  Rehab protocol, precautions and return to work guidelines and time frame were all discussed.

Preoperative education with the use of video, pictures, and PowerPoint presentations was performed by me.  Extensive time was utilized to educate the patient on their condition, the proposed surgical intervention, and the postoperative course.  All questions and concerns were answered. 

9. Narrative Report Signature: When Dr. Willis dictates a letter or narrative report, he wants a formal signature line to be used in closing the letter, as follows:

Andrew A. Willis, M.D., F.A.A.O.S.Board-Certified Orthopaedic SurgeonCertificate of Added Qualifications in Sports MedicineCertificate of Added Qualifications in Hand SurgeryDouble Fellowship Trained in Surgery of the Shoulder, Knee, Hand, and ElbowTeam Orthopaedic Surgeon:  New York Jets FootballHead Team Physician:  Drew University and Delbarton School

Assorted Terms/Phrases/Rules1. Right/Left Handed: Dr. Willis nearly always dictates whether a patient is left-hand or right-

hand-dominant at the beginning of the history section. He says it very, very quickly, so listen carefully. He never says just “left/right handed: It should be hyphenated as “right-hand-dominant”.

2. Followup: On a returning patient, Dr. Willis always says "[Name] returns today for followup evaluation."  The word "followup" can be hard to hear, but it's always there.

3. Arthroscopy: In the “Chief Complaint:” and “Plan:” sections, when Dr. Willis dictates about an arthroscopy, keep in mind that an arthroscopy is not a stand-alone procedure. It must be for something. You cannot have an arthroscopy, a subacromial decompression, and an AC joint resection, as if the arthroscopy were a separate procedure. Rather, the arthroscopy is the means by which all of the other procedures are performed. Therefore, you should type “arthroscopy for subacromial decompression, AC joint resection, etc.” and not simply as the first item in the list.

4. Surgical Components: You will need to learn the surgical components (screws, plates, prostheses, etc.) that Dr. Willis uses. Please research them online or in a surgical dictionary for proper spelling and formatting. Many times they will include a capital letter in the middle of the word. Some examples:Arthrex EndoButton or cortical EndoButtonBiomet ToggleLocBio-PushLockCayenne AperFix systemFasT-FixFiberWire suturesJuggerKnot anchorsPEEK screws and washers (PEEK is a type of plastic)Smith & Nephew (not Smith & Nephews or Smith & Nephew’s, even though he dictates this)

5. Complete Sentences: Always try to type complete sentences (with both subject and verb), whether they are dictated that way or not.  If necessary, add a word or two to make a complete sentence. Exception: Height x feet y inches. Weight xyz pounds.

6. Dates: Please format dates as MM/DD/YY (two digits per number, including the year).  This includes dates that are fully spoken (e.g., if he says "June 11th of this year", type the date as "06/11/14")

7. Narrative Reports Dr. Willis wants the following standard first paragraph template for his narratives. Name and date will need to be changed:

This is narrative report outlining my evaluation, treatment and care rendered to pt name for an injury that she suffered to her left shoulder, by her report, as a result of a fall on the date of 01/01/01. This narrative report is based on a review of my office notes, x-rays and advanced

imaging findings, including MRI and CT scans. This narrative report is being provided to you upon your request.

8. Dr. Willis often dictates sports terminology. You will need to pay extra attention to these and do some extra research when needed to get the correct words.

9. Dr. Willis often refers to specific people, medical facilities, schools, colleges, etc.: He is generally very specific & will not just say generally “here in high school”.Examples:111 Madison AvenueDelbarton SchoolDrew UniversityNew Jersey Imaging Network Cedar Knolls Kara at Professional (Pro) Physical TherapyTobey at ARMACThis is by no means a complete list, but these are the most common.

10. Dr. Willis dictates many abbreviations and acronyms. When he dictates “trap”, “pec”, “subpec”, etc., type these as dictated. When he dictates the whole word (trapezius, pectoralis, subpectoral), then type the whole word. Some of his common and easily-confused acronyms are:GIRD (glenohumeral internal rotation deficit; do not confuse with GERD)GLAD lesion (glenolabral articular disruption)HAGL lesion (humeral avulsion of the glenohumeral ligaments; not Haglund)HSS (Hospital for Special Surgery in New York City)OATS procedure (osteochondral autograft transfer system)PASTA lesion (partial articular supraspinatus tendon avulsion)SLAP tear (superior labrum anterior and posterior)TFCC (triangular fibrocartilage complex)VISI/DISI deformity (volar/dorsal intercalated segment instability)Semi-T (semitendinosus[a muscle with a strong tendon attached, often used for ACL reconstructions.])

He also abbreviates many muscles and tendons, especially of the wrist and forearm (FDS, FDP, EHL, EPL, etc.) These can be hard to differentiate. Look up the abbreviation and verify that you have the correct anatomy before typing it.

11. The following lines are often said very quickly in the physical examination and are the same every time. You may want to make autotexts for them:He/she is a pleasant male/female.He/She is alert and oriented x 3.His/Her mood and affect are appropriate.Motion of the cervical spine is full.He/she has full motion of the elbow, wrist, and digits.Liftoff, belly-press, and bear hug tests are negative.He/she is neurovascularly intact.He/she has a fair amount of trapezial muscle spasm. There is no opening to varus/valgus stress testing at 0 or 30 degrees.

His/her history is well-outlined in my report from [date].Another common test: "load and shift He/She understands the nature of his/her injury, the procedure that was performed, the rehabilitation, and the outcomes.

(Note the spaces and hyphens in these words: Liftoff, belly-press, and bear hug. Look them up in a dictionary. These are the correct forms.)

12. His most common radiograph views are:AP internal and external rotation, scapular-Y, and axillary (shoulder)AP-standing, PA-45-degree, lateral, and sunrise views (knee)

13. In shoulder x-ray reports, he often dictates “type 2 Bigliani acromion.” Bigliani is not found in many dictionaries but is correct. In general, when Dr. Willis spells something for you (such as "Tsuge"), it is usually correct.  Verify it either online or with a dictionary and use it.

14. Be careful with numbers and dates. He says them very quickly. Where possible, use the Intergy system to verify birth dates, dates of procedures, etc. Also be aware of when to use Arabic versus Roman numerals. (For instance, type 5 SLAP tear should be type V SLAP tear.)

15. When used as a noun or adjective, "followup" should be typed as one word. As a verb, it is two words (follow up). Do not use a hyphen in either case. (Note that this is per the doctor’s preference.) Also Dr. Willis wants the word “anti-inflammatory” to be typed hyphenated as shown, regardless of how your dictionary shows it.

16. Type facility names exactly as Dr. Willis dictates them.  If he says "Professional Physical Therapy" then type that, but if he only says "Pro Physical Therapy" then type only that.  The same thing goes for all other words.  If he says "rehab", "subpec", "subscap", etc., type exactly that.  Do not expand his abbreviations into full words.

17.Dr. Willis says "period" at the end of most sentences.

18.Sometimes Dr. Willis will overuse the word "paragraph."  If he dictates a paragraph that is only one short sentence, just include either at the end of the previous paragraph or the beginning of the next paragraph.

19. Because he speaks so quickly, listen carefully between words.

20. Dr. Willis often refers to other TCO doctors in his dictations. You can learn all the other TCO doctor’s names at: http://www.tri-countyortho.com/our-experts

21. It's very helpful to study and learn the bones, muscles, and ligaments of the wrist, as he dictates these often and usually very quickly (such as "lunotriquetral", another wrist joint “DRUJ" (distal radioulnar joint).).  I would suggest looking for a good image on Yahoo or Google with the names labeled and print it out for reference.  I like to hang them on the wall near my desk so I can see them easily.

22. "Carpal arcs" refers to the shape of the fingers as seen on x-ray.  The "carpal arch" is a blood vessel.  Dr. Willis will likely never dictate about that.

23. When typing an x-ray report, always include "left" or "right", based on which side is indicated in the chief complaint.  (For example, where he just dictates "x-ray of the shoulder," type "x-ray of the left shoulder" if that is the injured side.)

24. In the injection template, when you type LEFT/RIGHT inside the parentheses, make it all caps.

25. He will dictate the details of the surgery at the first postoperative visit but then he will dictate the procedure again almost word for word in subsequent postoperative visits.  It is not necessary to figure out what he is saying for each report, just refer back to the first postop (or the previous one) and match up what he is saying with that.  (It is usually necessary to pull up the report in Intergy anyway because of having to use the range of motion chart from the previous visit in any case, so this is just one helpful shortcut to get his stuff done more easily.)

26. Type out the word “pounds”

27. In the ROM chart, where he says "glute", just type "glute".  Really, as a general rule, you should not expand any of the abbreviated words Dr. Willis likes to use (glute, subscap, trap, etc.; just type as dictated and even add to your spellchecker if necessary).

28. Dr. Willis's four views of the shoulder are "AP internal and external rotation, scapular-Y, and axillary", just like that, no extra commas anywhere.

29. In the ROM chart, as with other dates, use the format MM/DD/YY (two digits each).

30. Write out words under 10, again unless part of a medication dosage or other measurement.

31. Some explanation for rotator cuff strength measurements: There are only two types of measurements, but he uses different names for them.  One measurement is either "supraspinatus" or "forward elevation in the scapular plane".  The second measurement is either "infraspinatus" or "external rotation strength against resistance".  Sometimes he dictates both names for both tests.  In that case, separate with a slash.  (Example: "Rotator cuff strength of the supraspinatus/forward elevation in the scapular plane is ___.  Infraspinatus/external rotation strength against resistance is ___." )  He always dictates this part very fast, and you really have to know what he's saying in order to make any kind of sense of out it, always adding words as needed. Also usually after giving a general strength measurement, he will give another measurement after performing "repetitive strength testing".

32. There should be no special characters, like 1/2 or th or st, that word automatically puts into a superscript or fraction, etc.  Intergy cannot read those properly, so that should be put back to regular characters.  You can set up Word to not automatically correct that formatting, or else manually do that.  It is not a frequent occurrence, but happens a lot when he talks about kids in grade school.  In those cases can also spell out - seventh or 7th.

33. Make sure that it says X-rays (plural) in the Diagnostic Studies section.

34. In ROM chart, always have the affected side on the right side of the chart, preferably AROM as the outermost column.

35. When you get a separate x-ray dictation by Dr. Willis it should be incorporated into the original report. (If he forgot to dictate the x-ray findings in a previous dictation, the secretary will give him the file back to dictate the x-ray findings in a separate dictation)..  The secretary has no way to put a marker file (the thing we upload our reports to) for a previous dictation that was supposed to have been finished, so this should be put in the system using the EHR. 

36. ROM Charts: The columns should be a fixed standard width to keep the charts looking uniform.  It’s ok to expand a column slightly to fit one of his more descriptive boxes (150 with slight hike takes more than a regular size box, but should not be the whole thing on one line nor on 3 lines).

37.

Some other common terms used by Dr. Willis:

Biomet Copeland shoulder prosthesis for hemiarthroplastybone-tendon-bone repairimpact-loading (exercise program)bony Bankart lesion (shoulder)bounce testBristow-Latarjet shoulder procedure with bone blockcapsulolabral tear (shoulder)CMC arthritis, Eaton stage I, II, etc.cock-up wrist splintCodman and pendulum exercises for shouldercomplex regional pain syndrome (CRPS) Copeland humeral head resurfacingcounterforce bracecubital tunnelDBX putty for bone graft with cancellous bone chipsdebridement of the subscapularisdelta sign (river delta sign)Biomet Comprehensive systemdial testDISI or VISI deformity, sometimes VISI/DISI or DISI/VISIDirectly and causally relateddistal clavicle excision.long head of the biceps soft-tissue tenodesisdorsal Watson shift test of wristdorsal Watson wrist signdouble-loaded anchor (suture anchor)drawer testextraarticularDRUJ instability (distal radioulnar joint)Durkan carpal tunnel compression testdynamic external rotation shear test (Mayo test)Exparel local anestheticextensor wad of the elbow/forearmFastin anchors (not Fasten)functional ACL braceglenohumeral joint resurfacinghamate bone, hook of the hamate (wrist)Hawkins impingement sign/testHeelbo elbow padHill-Sachs lesion or deformityhook of the hamatehumeral head resurfacinghyper-ligamentous laxityiliotibial band (ITB) friction syndrome (IT band syndrome)

in situ ulnar nerve decompression procedureindwelling Q-pump catheterinterval throwing programJobe test (may be Jobe valgus stress test)EMG nerve studies(always plural)Kim lesion related to posterior labral tear of shoulder (Kim, not KIM)KT1000 arthrometerLachman testlateral impingement signstraumatic injurieslateral-row anchorsliftoff test (Gerber liftoff test)Pictures from surgery were reviewed with him/her in detail.load-and-shift testmanipulation under anesthesiaMcMurray test (knee) – sometimes McMurray and Steinmann testsMedial-row anchorsMitek G4 suture anchorMRI arthrogram (measured as 3T, 1.5T, etc.; Telsas are a measurement of magnet strength)multidirectional instabilitymultidirectional laxityNeer, Hawkins, and lateral impingement signsOber test to assess tightness of the iliotibial bandO’Brien active compression testOrthovisc injection (viscosupplementation)Ossur hinged or locking elbow braceosteochondral lesion of kneeoveruse syndromeoveruse patellofemoral chondromalaciaP90X exercise programPA-45-degree view on x-rays of knee.pants-over-vest techniquepatella alta/bajapendulum exercisespiano-key signpivot-shift testpolyethylene glenoid (in total shoulder replacement)Popeye deformity of biceps rupturepress-fit stem (in arthroplasty)proximal row carpectomypronator mass of forearm at elbowQ-Pump indwelling anesthetic catheterrecurvatum testreflex sympathetic dystrophy (RSD)Remplissage procedure (shoulder)repetitive activities

resisted wrist extension testreverse shoulder arthroplastyriver delta sign.Sarmiento bracescapholunate (wrist)shuck testsleeper stretches (for posterior capsule of shoulder)snuffbox of the wrist/handSpeed test (capital S)spinoglenoid notch cyst (not spine of the glenoid)subaponeurotic space of handsyndesmosisSynvisc (series of injections) or Synvisc-One (single injection)tip-to-palm lagtrapezial muscle spasmtriquetrumvalgus extension overload test or syndrome (elbow)varus/valgus stress testweightlifter’s shoulderWhale wrap or Whale Neoprene wrap by Hely-WeberAC joint is nontenderanterior joint line tendernessglobal rotator cuff strengthsphericity of the humeral headhigh-riding humeral headinferior beard osteophyteacromiohumeral spaceHe/She is alert and oriented x 3His/Her mood and affect are appropriateMotion of the cervical spine is full" (it's very hard to hear "cervical", but he always says it)He/She has full motion of the elbow, wrist, and digitstip-to-palm lagsymmetrical (should be used even when he dictates symmetric which isn’t a word)neurological(should be used even when he dictates neurologic which isn’t a word)skeletally immature male/femaleregional and general anesthesiaupper border of the subscapsubdeltoid bursitisproceed as indicatedCausally and directly related Endurance fatigue (not endurance, fatigues)Bigliani acromion - Type 1, 2, or 3 - he might say "type 1 slash) 2 Bigliani acromion, which would be 1/2 but not do not let Word change it to a fraction, regular-sized numbers.hyperligamentous laxity (sometimes he will say only ligamentous laxity, but often with hyper as prefix).Medial or lateral (not mediolateral) 

Dr. Willis Injection Templates (as of 05/19/14)

Often Dr. Willis will request an injection template. These templates can be found here, and you will want to make autotexts (also called building blocks) for many, if not all, of them. To make an autotext (at least in Word 2007), highlight the intended text and press ALT-F3. Enter a name for the autotext and save it. To recall the autotext when you need it, type the name you gave it (or just the first few letters) and press F3. An autotext name is suggested for each template shown here.

After inserting the template, be sure to use F11 to enter the side (left or right) and, for finger injections, to enter the correct digit as well (first, second, third, fourth, or fifth, OR he may dictate it as thumb, index, middle, ring, or pinky). Also if he dictates a pain medication for the injection, enter it at the end of the injection paragraph (replacing the text “analgesic medications” with the medication name and dosage, if included). If he dictates multiple injections, insert separate templates for each one. (Sometimes he will accidentally dictate the same injection template later in the report. In that case, do not insert anything for the second reference to the injection).

Insert injection templates exactly where directed to do so in the dictation, and insert the entire template (including the bold underlined heading).  The F11 inside the parentheses in the bold underlined description should be all caps (LEFT/RIGHT).  Any F11s inside the paragraph should be normal text (left/right).

AC Joint Injection – acji

AC Joint Injection ( F11 )

Procedure: Due to the patient's medical condition, a corticosteroid injection was recommended. Risks of this procedure were discussed with the patient, including but not limited to infection, adverse medication reaction, pain at the injection site, and failure of the injection to provide relief of symptoms. The patient was verbally consented to the injection. The correct anatomic site and side for the procedure were marked and confirmed. The F11 shoulder was prepped with Betadine. Under sterile conditions, 40 mg of Depo-Medrol, 2 cc of 1% lidocaine, and 2 cc of 0.5% Marcaine were injected with a 25-gauge needle in and around the AC joint of the F11 shoulder. The procedure was tolerated without complication. The patient was given written post-injection instructions and protocol as well as analgesic medications.

Glenohumeral Joint Injection – ijg(Note that this often dictated as “Intraarticular Injection”)

Glenohumeral Joint Injection ( F11 )

Procedure: Due to the patient's medical condition, a corticosteroid injection was recommended. Risks of this procedure were discussed with the patient, including but not limited to infection, adverse medication reaction, pain at the injection site, and failure of the injection to provide relief of symptoms. The patient was verbally consented for the injection, and the correct anatomic site and side for the

procedure were marked and confirmed. Under sterile conditions, 80 mg of Depo-Medrol, 1% lidocaine (6 cc), and 0.25% Marcaine (2 cc) were injected into the anterior glenohumeral joint of the F11 shoulder. The patient tolerated the procedure without complication and was given a written post-injection instruction protocol as well as analgesic medications.

Subacromial Injection – isub

Subacromial Injection ( F11 )

Procedure:  Due to the patient's medical condition, a corticosteroid injection was recommended.  Risks of this procedure were discussed with the patient, including but not limited to infection, adverse medication reaction, pain at the injection site, and failure of the injection to provide relief of symptoms.  The patient was verbally consented for the injection, and the correct anatomic site and side for the procedure were marked and confirmed. Under sterile conditions, 80 mg of Depo-Medrol, 1% lidocaine (6 cc), and 0.25% Marcaine (2 cc) were injected posteriorly into the subacromial space of the right shoulder.  The patient tolerated the procedure without complication and was given a written postinjection instruction protocol as well as analgesic medications.

Lateral Epicondyle Injection – ile(Also sometimes dictated as “ECRB Injection)

Lateral Epicondyle Injection ( F11 )

Procedure: Due to the patient's medical condition, a corticosteroid injection was recommended. Risks of this procedure were discussed with the patient, including but not limited to infection, adverse medication reaction, pain at the injection site, and failure of the injection to provide relief of symptoms. The patient was verbally consented for the injection, and the correct anatomic site and side for the procedure were marked and confirmed. Under sterile conditions, 80 mg of Depo-Medrol, 1% lidocaine (2 cc), and 0.25% Marcaine (2 cc) were injected in and around the lateral epicondyle of the F11 elbow. A needling technique was used in an attempt to stimulate a healing response. The patient tolerated the procedure without complication and was given a written post-injection instruction protocol as well as analgesic medications.

Medial Epicondyle Injection – ime

Medial Epicondyle Injection ( F11 )

Procedure: Due to the patient's medical condition, a corticosteroid injection was recommended. Risks of this procedure were discussed with the patient, including but not limited to infection, adverse medication reaction, pain at the injection site, and failure of the injection to provide relief of symptoms. The patient was verbally consented for the injection, and the correct anatomic site and side for the procedure were marked and confirmed. Under sterile conditions, 80 mg of Depo-Medrol, 1% lidocaine (2 cc), and 0.25% Marcaine (2 cc) were injected in and around the medial epicondyle of the F11 elbow.

A needling technique was used in an attempt to stimulate a healing response. The patient tolerated the procedure without complication and was given a written post-injection instruction protocol as well as analgesic medications.

CMC Joint Injection - icj

CMC Joint Injection ( F11 )

Procedure: Due to the patient's medical condition, a corticosteroid injection was recommended. Risks of this procedure were discussed with the patient, including but not limited to infection, adverse medication reaction, pain at the injection site, and failure of the injection to provide relief of symptoms. The patient was verbally consented for the injection, and the correct anatomic site and side for the procedure were marked and confirmed. Under sterile conditions, 40 mg of Depo-Medrol, 1% lidocaine (2 cc), and 0.25% Marcaine (2 cc) were injected into the F11 thumb CMC joint. The patient tolerated the procedure without complication and was given a written post-injection instruction protocol as well as analgesic medications.

Trigger Finger Injection - itf(Include side and finger)

Trigger Finger Injection ( F11 F11 )

Procedure: Due to the patient's medical condition, a corticosteroid injection was recommended. Risks of this procedure were discussed with the patient, including but not limited to infection, adverse medication reaction, pain at the injection site, and failure of the injection to provide relief of symptoms. The patient was verbally consented for the injection, and the correct anatomic site and side for the procedure were marked and confirmed. Under sterile conditions, 20 mg of Depo-Medrol and 1% lidocaine (0.5 cc) were injected into the flexor tendon sheath of the F11F11 at the level of the A1 pulley. The patient tolerated the procedure without complication and was given a written post-injection instruction protocol as well as analgesic medications.

de Quervain’s Injection – dqi (Include side and finger)

de Quervain’s Injection ( F11 F11 )

Procedure: Due to the patient's medical condition, a corticosteroid injection was recommended. Risks of this procedure were discussed with the patient, including but not limited to infection, adverse medication reaction, pain at the injection site, and failure of the injection to provide relief of symptoms. The patient was verbally consented for the injection, and the correct anatomic site and side for the procedure were marked and confirmed. Under sterile conditions, 40 mg of Depo-Medrol and 1% lidocaine (0.5 cc) were injected into the extensor tendon sheath of the F11F11 first dorsal compartment.

The patient tolerated the procedure without complication and was given a written post-injection instruction protocol as well as analgesic medications and other medications.

Knee Corticosteroid Injection – ikc

Knee Corticosteroid Injection ( F11 )

Procedure: Due to the patient's medical condition, a corticosteroid injection was recommended. Risks of this procedure were discussed with the patient, including but not limited to infection, adverse medication reaction, pain at the injection site, and failure of the injection to provide relief of symptoms. The patient was verbally consented for the injection, and the correct anatomic site and side for the procedure were marked and confirmed. Under sterile conditions, 80 mg of Depo-Medrol, 1% lidocaine (6 cc), and 0.25% Marcaine (2 cc) were injected into the F11 knee joint. The patient tolerated the procedure without complication and was given a written post-injection instruction protocol as well as analgesic medications.

Knee Synvisc Injection – iks

Knee Synvisc Injection ( F11 )

Procedure: Due to the patient's medical condition, a Synvisc injection was recommended. Risks of this procedure were discussed with the patient, including but not limited to infection, adverse medication reaction, pain at the injection site, and failure of the injection to provide relief of symptoms. The patient was verbally consented for the injection, and the correct anatomic site and side for the procedure were marked and confirmed. Under sterile conditions, one vial (pre-packaged sterile syringe) of Synvisc-One was injected into the F11 knee joint. The patient tolerated the procedure without complication and was given a written post-injection instruction protocol as well as analgesic medications.

Short Arm Cast ( F11 ) Distal Radius Fracture

Procedure: A short-arm cast was applied using Webril padding over a stockinette. A fiberglass cast was then fashioned using two three-inch and one two-inch fiberglass casting rolls. This was then contoured to stabilize the fracture site using a 3-point manual molding technique to establish appropriate fracture buttressing. The cast was allowed to fully harden in the examination room. The cast extended from the forearm to the hand metacarpal flexion crease. The patient tolerated the procedure without complication. Cast precautions and potential cast complications were discussed. The patient was advised to call and follow up in the office or present to the emergency room immediately if increasing pain or significantly increased swelling occurs.

Short Arm Cast ( F11 ) Metacarpal Fracture

Procedure: A short-arm cast was applied using Webril padding over a stockinette. A fiberglass cast was then fashioned using two three-inch and one two-inch fiberglass casting rolls. This was then

contoured to stabilize the fracture site using a 3-point manual molding technique to establish appropriate fracture buttressing. The cast was allowed to fully harden in the examination room. The cast extended from the forearm to the hand, extending above the metacarpophalangeal joint, fifth and fourth metacarpals, and then digital buddy-taping was used to control metacarpal fracture rotation using two buddy loops between digits. The patient tolerated the procedure without complication. Cast precautions and potential cast complications were discussed. The patient was advised to call and follow up in the office or present to the emergency room immediately if increasing pain or significantly increased swelling occurs.

Short Arm Cast ( F11 ) Scaphoid Fracture

Procedure: A short-arm cast was applied using Webril padding over a stockinette. A fiberglass cast was then fashioned using two three-inch and one two-inch fiberglass casting rolls. This was then contoured to stabilize the fracture site using a 3-point manual molding technique to establish appropriate fracture buttressing. The cast was allowed to fully harden in the examination room. The cast extended from the forearm to the hand metacarpal flexion crease with the thumb spica component. The patient tolerated the procedure without complication. Cast precautions and potential cast complications were discussed. The patient was advised to call and follow up in the office or present to the emergency room immediately if increasing pain or significantly increased swelling occurs.

Procedure, corticosteroid injection, left elbow .    Due to the patient's medical condition, a corticosteroid injection was recommended. Risks of this procedure were discussed with the patient, including but not limited to, infection, adverse medication reaction, pain at the injection site, and failure of the injection to provide relief of symptoms. The patient verbally consented to the injection.  The correct anatomic site and side for the procedure was marked and confirmed. Under sterile conditions using a Betadine swab, injection of 6 cc of 1% Lidocaine, 2 cc of 0.25% Marcaine, 80 mg of Depo Medrol was injected into the soft spot of the elbow.  She tolerated this without complication.