Bilateral knee pain and lower extremity pain

The patient presents today for his first follow-up visit since I consulted with him back on April 15, 2013 for his bilateral knee pain and lower extremity pain. He states today that his primary complaint is his knee pain. He did not move forward with the physical therapy that I have recommended at this last visit and he did not receive a topical cream that I had ordered for him. He has no new complaints today, just his primary complaint being his knee pain. He has neurogenic claudication symptoms by history and is unable to stand or walk without weakness for any significant time. He is chronically anticoagulated with Plavix secondary to paracardiac stenting.

IMPRESSION:
1. Bilateral knee pain; no recent imaging available for assessment – patient has not had recent imaging.
2. Chronic low back pain and buttock and hamstring discomfort; most likely referred pain from lumbar facet syndrome versus lumbar radicular pain; I only have the MRI report and did not see the images.
3. Bilateral distal lower extremity pain; most likely peripheral neuropathy; patient did not obtain the EMG nor move forward with physical therapy as requested.

PLAN:
He states his primary issues today are weakness in the lower extremities in addition to his bilateral knee pain. At this time, I have recommended that he move forward with aggressive physical therapy over the next few weeks. He already has braces at home. So, we did not move forward with consideration of further bracing. Should he not obtain any results with regards to his knee pain and low back issues, consideration of genicular nerve block and possibly future radiofrequency ablation may be appropriate. We will see how he does over the next few weeks and I will follow up with him next month. He is in agreement with this plan and I will look forward to work with him.

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