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I. FACTS
On May 6, 1994, Plaintiff, Dawn Madia, was lawfully
a passenger in a motor vehicle on Route 11 north at or near
its intersection with Locust Point Road, Township of Silver
Spring, Cumberland county, Commonwealth of Pennsylvania, when
suddenly and without warning the motor vehicle owned and
operated by Defendant, Albert Lloyd Renn, made a left turn
from the right lane violently striking Plaintiff's motor
vehicle, causing serious injuries to Plaintiff hereinafter
referred to.
II. CONTENTIONS AS TO LIABILITY AND/OR LEGAL ISSUED PERTINENT
Defendant Albert Lloyd Renn failed to properly
operate and control his motor vehicle; driving at an excessive
rate of speed under the circumstances; failure to keep a
proper lookout; failure to keep constant vigilance of the
road, traffic weather, and road conditions; violation of the
Statutes of the Commonwealth of Pennsylvania, as well as the
Ordinances of Cumberland County governing the operations of
motor vehicles on the streets and highways; wanton and
reckless disregard for the rights and safety of the Plaintiff;
and Defendant Renn also violated MVC Section JJJ1(b) required
position and method of turning, failed to regard the point and
position of the Plaintiff's motor vehicle then and there being
lawfully operated upon said highway, and failed to avoid
striking Plaintiff's motor vehicle.
III. LIST OF REOUESTED STIPlJ1AT~ONS OF FACT OR AUTHENTICITY
1. Date, time and place of accident;
2. Medicals, necessity of treatment, amount and
reasonableness of charges.
IV. ESTIMATED TRIAL TIME
Two days.
V. LIST OF ALL DOCUMENTS OR EXHIBITS
1. Silver Spring Township Police Report, incident
number TA94-151, dated 5/6/94.
All medical records, bills, and reports in the
possession of:
2. Carlisle Hospital
246 Parker Street
Carlisle, PA 17013-0310
3. RWC Emergency Physicians
117 N. Hanover Street
P.O. Box 177
Carlisle, PA 17013
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4. Carlisle Imaging Associates
P.O. Box 100
Carlisle, PA 17013
5. Dr. Charles J. Zemo
Three Points Chiropractic Clinic
114 North Hanover Street
Carlisle, PA 17013
6. Dr. Philip K. Keats, M.D.
290 Madison Avenue, Bldg. 1
Morristown, NJ 07960
7. Parsippany Physical Therapy and Rehab
148 Parsippany Road
Parsippany, NJ 07054
8. Dr. Louis A. Lorenzo
359 North Beverwyck Road
Parsippany, NJ 07054
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9. Alan steiner, DMD
suite 208
35 W. Main Street
Denville, NJ 07834
10. Dr. Philip K. Keats, M.D.
290 Madison Avenue, Bldg. 1
Morristown, NJ 07960
11. Nicholas S. Federicki, P.T. or
Records Custodian
Parsippany Physical Therapy and Rehab
148 Parsippany Road
Parsippany, NJ 07054
Dr. Louis A. Lorenzo
359 North Beverwyck Road
Parsippany, NJ 07054
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Alan steiner, DMD
Suite 208
35 W. Main street
Denville, NJ 07834
Records Custodian
Carlisle Hospital and Health Services
246 Parker street
P.O. Box 310
Carlisle, PA 17013-0310
VII. A STA'fEMENT OF SETTLEMENT NEGOTIATIONS TO DATE,
INCLUDING THE PLAINTIFF'S MOST RECENT DEMAND AND
THE DEFENDANT'S MOST RECENT OFFER
On June 22, 2000 an arbitration hearing was held and
the arbitrators awarded Plaintiff $10,000.00. The Defendant
appealed. Plaintiff's demand is $10,000.00. Defendant has
offered $4,000.00.
VIII. ALL LEGAL ISSUES OR OTHER QUESTIONS WHICH COUNSEL
REASONABLY ANTICIPATE WILL ARISE DURING SELECTION OF
THE JURY OR DURING TRIAL
No unusual legal issues.
IX. PLAINTIFF'S CONTENTIONS AS TO INJURIES AND SPECIAL
DAMAGES
A. Plaintiff, Dawn Madia, has sustained various physical
illness and injuries including without limitation, cervical
and trapezius strain, cervical and thoracic myalgia
complicated by vertebral subluxations in the upper and lower
cervical spine an upper thoracic spine plus sprain/strain of
the posterior cervical musculature, muscular and ligamentous
sprain of cervical spine, bilateral paracervical muscle pain
with associated occipital headaches that are intense and very
defuse, cervical whiplash, acute traumatic cervical vertebral
subluxation complex, loss of motoricity of the vertebral units
due to subluxation of the cervical spine, hypolordosis/
kyphosis cervical spine, neck pain, and chronic TMJ with
headaches, as well as damage to her nerves and nervous system,
all of which are or may be permanent in nature.
B. The special damages are as follows:
.DAT.E
5/7 /94
5/7/94
5/7 /94
5/10/94-3/10/95
5/24/94 & 8/9/94
6/3/94-6/16/94
6/6/94-10/23/96
1/7/95-7/13/96
9/28/95
TREATING FACILITV/TREATMENT
Carlisle Hospital
RWC Emergency Physicians
Carlisle Imaging Associates
Dr. Charles J. Zemo
Philip K. Keats, M.D.
Parsippany Physical Therapy
Louis Lorenzo, D.C.
Alan steiner, D.M.D.
Carlisle Hosp. & Health Services
TOTAL MEDICALS TO DATE
AMOUNT
$ 268.30
66.00
50.00
280.00
210.00
560.00
2,834.00
424.00
727.00
$5,419.30
C. GENERAL DAMAGES
1. Pain and suffering, past, present and future.
2. Loss of life's pleasures.
3. Residual disability.
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MYCHAK GECKLm WELKER . THIROWAY,
By: Patrick G. Geckle
Attorneys at Law
Identification No. ~6718
11 th Floor
230 South Broad Street
Philadelphia, PA 19102
(215) 735-3326
P.c.
Attorneys for Plaintiff
DAWN MADIA
Dickerson College
HUB 1138
Carlisle, FA 17013-0927
COURT OF COMMON PLEAS
CUMBERLAND COUNTY
vs.
ALBERT LLOYD RENN
3335 South College Road
Wilmington, NC 28412
and
PE'fER MEN SKY
119 Cemetery Street
Jermyn, PA 18433
NO. f~ - {~v't
(1 t~~ ~ J u-..,.,....
CIVIL ACTION
NOTICE
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AS'Srl~CIA LAGAL
Court !\drninistrator
CUnberland ColU'lty COurt House
1 Courtl'xluse Square
Carlisle, PA 17013-3387
(717) 240-6200
Court Administrator
C1.Il1b!r1and County Court House
1 Courthouse Square
carlisle, FA 17013-3387
(717) 240-6200
COUNT I. DAWN MADIA VB. ALBERT LLOYD RENN AND PETER MENSKY
4. Plaintiff, DAWN MADIA, incorporates by reference
each and every paragraph from 1 through J inclusive as fully
as though they were herein set forth.
5. On or about May 6, 1994, plaintiff, DAWN MADIA,
was lawfully a passenger in the motor vehicle owned and
operated by Defendant, PETER MENSKY, on Route 11 north at or
near its intersection with Locust Point Road, Township of
Silver spring, County of Cumberland, Commonwealth of
Pennsylvania, when suddenly and without warning the motor
vehicle owned and operated by Defendant, ALBERT LLOYD RENN,
made a left hand turn from the right lane violently striking
Plaintiff's motor vehicle, causing serious injuries to
Plaintiff hereinafter referred to.
6. solely as a result of the aforesaid accident,
the Plaintiff, DAWN MADIA, suffered serious physical injuries,
including without limitation, cervical and trapezius strain,
cervical and thoracic myalgia complicated by vertebral
subluxations in the upper and lower cervical spine and upper
thoracic spine plus sprain/strain of the posterior cervical
musculature, muscular and ligamentous sprain of cervical
spine, bilateral paracervical muscle pain with associated
occipital headaches that are intense and very defuse, cervical
whiplash, acute traumatic cervical vertebral subluxation
complex, loss of motoricity of the vertebral units due to
subluation of the cervical spine, hypolordosis/ kyphosis
cervical spine and neck pain, all of which may be permanent in
nature, cause permanent disfigurement and/or loss of use of a
bodily function and may have aggravated pre-existing
conditions.
7. Further, Plaintiff incurred a severe shock to
her nerves and nervous system, great physical pain and mental
anguish and was prevented from attending to her usual duties,
activities, and avocations all of which may continue for an
indefinite time in the near future.
8. This action resulted solely from the negligence
and recklessness of the Defendants herein and was due in no
manner whatsoever to any act or failure to act on the part of
the Plaintiff.
9. The negligence and recklessness of the
Defendants consisted of the following:
a. Failure to properly operate and control
their motor vehicle;
b. Driving at an excessive rate of speed
under the circumstances;
c. Failure to keep a proper lookout;
d. Failure to keep constant vigilance of the
road, traffic, weather, and road
conditions;
e. Failure to regard the point and position
of Plaintiff's motor vehicle then and
there being lawfully operated upon said
highway;
f. Violation of the statutes of the
Commonwealth of Pennsylvania, as well as
the Ordinances of Cumberland County
governing the operations of motor
vehicles on the streets and highways;
g. Wanton and reckless disregard for the
rights and safety of the Plaintiff;
h. Failure to use due care under the
circumstances;
i. Negligence and recklessness at law.
10. As a result of this accident, the Plaintiff will
be obliged to receive and undergo medical attention and care
and to expend various sums of money or to incur various
expenses and she may be obliged to continue to expend such
sums and to incur such expenditures for an indefinite period
of time in the future.
11. As a further result of this accident, Plaintiff
has or may suffer a severe loss of her earnings, and
impairment of her earning capacity or power, which such loss
of income and/or impairment of her earning capacity or power.
12. As further result of this accident, Plaintiff has
suffered severe physical pain, mental anguish, and humiliation
and she may continue to suffer sane for an indefinite time in
the future.
13. As a direct and reasonable result of this
accident aforementioned, Plaintiff has or may hereafter incur
t i r:: h t, so r e n eke 1 s h 1 d s 1 u:: 'C l-:.1 "= \, '.{ 1 he:} d ;:J. C h ':! S r lot 0 r s c h" (\: t: res sur Ie:!
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f~(!tlrl(T f~irlv (~:~I~~nt ~in~~ l~:~t visit: hV~I~rtl~n~0 c'.'r':/~hl~/110C l.~,-"~
rrll~)r:'ul,1t\lrf;; lir.-:it~r} c(~rV po:! mrl::~tly r.lle to r.1l;l t~~r.:3ior.; tr:-nd.l-":t' tr.
n i lj F.) 1 U !) pc. ~ r v, II P P t h 0 r [; Fin.l 1 ,7t Ei (l J ~; ~l '1 F d 1 f i :, ;-t t i () n r; - C 1 , C 2 I 'r ,. J____
Ci.PR, c;~ASRP, T3PLS; r.crv-~/tj patient felt r~llch l:0tter uft(~r ;:1,~i\I:~~.
me n t;- ,. :.
..../i
patinn+. stnt,0:l th,"1t "hl~l1C h.:l~ ~p'l}n !(illinq hn.rtl last \':tJ1 d~y~: HI lot
of prn:=;~llrf~ in t~~r.1l)1'~ i1nG occicitill line arca~; le'" ~.;c~:/hips doinc
(jonrl; fl;jr,,-up OF ""lplash 'iymptoms; tre;)t s2m,,-C;ASRP, C2PR, T3rr,,;
cerv-d/t; patl~nt alv;)vs statu8 she feels imm~di&te rallef vh0n her
ntJc~o: is adiust~d ~ /.;;r.-,
~ .
patl2nt states conrlition as previous visit-started tuildina up sh0rtl
~ft~r last treatm8nt; ?r~atment samA;C h
.;
n:lti~nt St-..:!t:A'i th'1t-, !;h~ i~ rl."\plin(r Ml:~h bett-,er--sl~Acin(j hAt-,t0r,
less frequent & intcn$~ h~~d~ch~; orntinu~ treat's as previous:
patient status she is doin~ cerv/shld mm e~erciscs as instructad
usu2l1 y ;C:'? /
()
/
patient states that overall she is still feeling better wi less
intense and less fre uent headaches; ex eriencina some left lumb-
sac ~creness/tightness vi some difflr:ulty straighten ng spine from
zitttnc or bent forward position; treat same on cerv/upp thor areas;
ertha's ne0 for lumh-s;)c area root comoression-mostly hypertense
lunt-ilial nm's; ~loPal neC) for fi:<ation/su"lluxation; stretch/mass.':g'-'
is=h,comn, to lumh-ilial mm's; cati~nt felt much better after;
.atif'nt also statas that her TM 'oints have been noisv after T as~~(
h8t" ahout Iter ja~is; as Sh2 is as sha is going ho~e for Thanksgivvi~~
trea~ from school. T suaa'd she hava her dentist check her out for
any TM disorder plu bring back any x-r~ys with her from her primary
treatinc:; chiro rar:tnr-Louis LorenzoV""'?f
atient bac~ frnm schnol break-claims I 0 be feeling "not-tbo-bad~;
some lo~.j bile!": discrJr.1fort; head.2.ches have be':'n r.l1.nll'Tlal but has hed sr
stiffness feelinc in neck; di& not cet dental check-will do that ove
Christmas brea~; she brought in x-rays-hut not the ones taken at Car
1sle hosp1tal after 5/94 accident-sugg'd she do that ovur next trip
hnme; cerv spine still showing limited ROM in all directions; DigPal
tenderness in uoeer cerv & u~o thor soinal areas; muscular tension j
lumb-ilial mm's; tr~at sane; prognosis seems to be good at present;
eontinue treat's t';ir:<"? "reeklv if ossi'ole for nO''';L~
~ati~nt 5t~tes th~t ~h0 h~sn't h~cl one hea~ach~ sin last treat un'
this mornin~ after sha ah~ heen u~ f~r awhile-in~en5ity ahout hatE
Hl:.,"\f- i,.. h.:J.~ r~"n ;,,.. i."'~ 'f""'~'" rt"ljl:j'pn"'t'i~ ~l-q" "':~")~ri.~nt;inr";' sor,,~~
str"Jr1.1r;h cti!=i~()mF,01:'t-,: 1n'[ l;;:,,":,'~ ar~.:J~ h~f;n '1()"'~: tredt to c:erv and thnt
S;1r.1'? '.dth li0~t fnrrl-:: C0.r.t-G/t;I"'7"\'
I )
(c ,-, r - -, c,)
May 11. 1994
PATIENT. DAWN K, MADIA
DOB I 3/3/74
55#. 155.82-2600
The above named patient pre.ented here on May 10, 1994 vlth tightness
and general soreness In her posterior neck/shoulder muscles blleter-
ally, alledgedly as s result of an auto accident vhlch took place on
May 6. 1994. See patlent'a repor\ of accident.
Vlaual observatIon revealed no diSCOlorations. lacerations or othor
abnormalities In the head. neck or upper back areas or upper extrem~
ities, No obvious abnormal flexion. extension, or rotation vas noted
In the cervical or thoracic spine.
Digital palpation elicited significant tenderness in the cervical
paraBpinal musculature posteriorlY and over the spinous processes and
transverse processos of the upper and middle cervIcal spine and over
spinous processes of T3 through T5, Notable hyperthermia vas felt in
the cervical and upper thoracic regions,
Forvard flexion of the neck was restricted to about 45 degrees vlth
patient complaining of tightness and soreness dovn ,to the upp~r thoracic
region, Backvard bending of the neck vas normal but elicited some
soreness in the occiplto/atlanteal and cervico/thoracic areas, Side-
ways flexion of the neck vas normal vith tension, rotation of the neck
vas norm~l to the right and slightly restricted to the left, Hyper-
extension of the upper thoracic spine elicited pain betveen the shoulder
blades,
Motion palpation of the vertebrae revealed rotational fixations in the
upper and lover cervical spine and right lateral flexIon fixation
in the upper thoracic spine.
The pupil. bleeps and triceps reflexes vere normal. and the patient
Indicated no disruptions In vision. hearing. taste or smell. ,TheEe vas
no numbness or loss of strength In the upper extremities na vas there
any pain throughout the upper extremities.
X-rays taken at Carlisle Hospital-on 5/7/94 vere not vleved as yet and
no films vere taken here,
I.
~.
'Ghree CjJoirats Ghiropradic Glinic
'Dr, Ghar/e. /I, Zemo
114 N, Hlne.., SUitt
Clrlilll, PI, 17013
Phene: 249,1120
March 22. 1995
THE PRUDENTIAL
P.O. Box 2280
W. Caldwell, N.J. 07007-2280
REI DAWN K. MADIA
#38N14487-050
Attn: Cindy Coulbourne
Dear Mrs. Coulbourne.
This is an update and itemization of services rendered..to the above
named patient. Enclosed please find copies of data which was sent to
Mr. PatriCk G. Geckle after Miss Madia's visit here following her auto
accident in May of 1994.
The patient was seen here on 5/10/94 reporting that she had been in
an auto accident. She reported SUffering from neck and shoulder sore-
ness and tightness...the same presenting complaints she had been
getting periodic treatments for since 9/17/92 as a result of student
and self-imposed stresses. -
Miss Madia was examined briefly (see 5/11/94 work-Up letter), treated
with manual adjustments to her cervical and upper thoracic spinal
areas anft instructed to return on 5/13/94 for a follow-up and to bring
in insurance information whereupon she stated that her friend wouln
drop off the information on 5/11. She was also to sign an x-ray re-
lease form (so I could get her x-rays from the hospital), and a typed-
out version of her accident report. I never saw or heard from Miss
Madia after the 5/10/94 visit until she called in October of 1994
and wanted an appointment. She presented on 10/21/94 complaining of
soreness in her low back and neCk/shOUlder areas since recently wear-
ing a very tight corsette for a college play plus rehearsals. Asked
about her auto accident, she stated that she left this area after her
5/10/94 appointment and went home for the summer where she was seeing
her regular family Chiropractor who took x-rays and treated ~er through
the summer. When asked if these present complaints were part of her -
auto accident care she staten that she didn't think so but would check.
Her mother called me a few days rater and informed me that all bills
were to be sent to Dawn's insurance as part of her auto accident cover-
age.
See enclosed progress notes for Miss Madia's care through 3/10/95. AS
of 3/10 the patient has not had any bad headache problems since late
January. She still has flare-ups of neCk/shOUlder/upper back soreness
& tightness as previous to auto accident, It is my opinion that she
has reached MMI as regards her auto accident but another reportedlY
'?5hree q>oints Ghiropradic Glinic
q)" (!h4,I., ,!J. z'mo
114 N, H.no.., SI'..,
C.rti,lt, P., 17013
P"cno: 249,1120
August 6, 1996
MYCHAK GECKLE WELKER & THIROWAY, P.C.
230 S. 8road St.
Phila., PA. 19102-4190
REI DAWN K. MADIA
Attn: Mr. Patrick G. Geckle
Dear Mr. Geckle.
I am in receipt oE a letter Erom you dated 7/30/96 requesting inEorm-
ation relative to "continuing treatments" oE the above named patient
Eor auto accident injuries sustained on 5/6/94.
I sent you a letter on December 1, 1995 (copy enclosed) s~ating that
as oE March 10, 1995, I vas releasing Miss Madia from any further
care relative to the accident as I felt she had reached MMI and pre-
accident condition.
Miss Madia continued coming to me aEter that date for occassional
neCk/shoulder and h~ad aches as she had been doing before the auto
ac~~e~. I had informed the patient. her mother, and Aetna Insurance
Co. oE the release and that any further visits/treatments by Miss
Madia wou1..d be on a none accident basis. Recently', I sent an itemized
statement to Prudential Insurance Co. Eor services rendered to Miss
Madia since March 10, 1995. This was at the request oE the patient's
mother who was acain informed that the itemization to Prudential was
for services not-related to the auto accident in my opinion. 80th the
patient and her mcther understood and accepted this decision to release.
With the previous having been said, I don't understand the reason
Eor your request letter of 7/30/96. The patient ended all treatments
in May of this year as she has graduated Erom college and moved back
home to New Jersey.
IE I am mis-understanding something regarding this case. please Eeel
Eree to contact me and clarify...I will be happy to co-operate Eor
a valid reason.
'::~/7elY, '~_ ..
~ue.o' ~/4-c::.
Charles J.~ m D.C.
CJZ/cjz
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DR. LOUIS A. LORENZO
FAMILY CHIROPRACTIC CENTER
Wi N BEVERWW.K R(lAD . l'i\RSIPPM'~Y, 1") O;OH . 201.B,j.(,sr,s
July 11,1994
Patrick Geckle
Attorney at Law
11th Floor
230 South Broad street
Philadelphia, Pa J9102-4190
RE: Dawn Madia
D/A May 6, 1994
Dear Mr. Geckle:
At your request and with the permission of my patient,
Dawn Madia, I am submitting the following narrative report concerning
the injuries she sustained as a result of an accident on May 6, 1994.
HISTORY
The patient was ambulatory and presented herself for examination
and treatment at this office on May 25, 1994, at which time she
stated that on May 6, 1994 she sustained injuries as a result of an
auto accident. She relates that she was a passenger in a vehicle that
broadside~ another vehicle while attempting to turn. She doesn't
recall hitt.ing her head on the windshield, but does remember hitting
the headrest.
SUBJECTIVE FINDIN~
The patient stated that since the date of this accident she has
suffered from (symptoms uS li3ted). Dilateral ~a~acervical p~in
associated with occipital headaches that can become intense and
diffuse. Also involved are bilateral upper trapezius muscles,
upper-dorsal pain and shoulder pain.
OBJECTIVE FINDINGS
The patient is a SpaniSh/Italian female, 20 years of age and
weighs 130 pounds and is 5 feet 5 inches in height, mentally alert
and cooperative.
Palpation of cervical spine revealed muscle spasms of the
trapezius muscles bilaterally. Pain response was elicited upon
palpation of the shoulder muscle groups bilaterally.
"e atlas is right by 3 1/2. The body of the axis is right by 2
_nd the axis spinous is right by 5 1/2. The functional cervical
~ C-2 through C-7 is left with a compensated functional
cer,lco-dorsal spine of right 4.
C~r7ie.l Flexion view
Unusual stair stepping at the levels of C-4 - C-5 is observed.
C.'7ie.l Extension View
Unusual stair stepping at the levels of C-4 - C-5 is observed.
This patient suffered a moderately severe hyperflexion
hYr/~extension trauma to the cervical spine.
Soft tissue damage is usualiy more serious than bone injury.
~or~ heals with calcium which is one of the substances of bone,
wh.reas 50ft tissue heals with fibrous or near tis~ue. The latter is
dl'f~rent than the original soft tissue. Soft tissue takes longer to
he~1 than bone tissue and although bone tissue may actually be
atr~nger after the healing process has taken place, soft tissue is
USV~lly weaker after repair.
structurally the major area of concern is the upper cervical
Gpl~~ C-l and C-2 and the functional cervical spine C-2 through C-5.
'rh"l:~ areas are markedly displaced and resistant to our corrective
Cor~es and rehabilitative exercises.
Ill.tqnos i s I Cone 1 us iOD I B"""'.rv
On th& basis of the findings, it is evident that the patient has
Guttered the following injuries:
Acute traumatic cervical vertebral subluxation complex.
Loss'of motoricity of the vertebral units due to subluxation of
the, cervical spine.
cervical subluxation complex complicated by acquired kyphosis.
1.Uatllent
Fost tra~~atic rnanageme~t was both corrsctive and supportive.
Chiropractic treatment included:
Specific adjustment corrections of the subluxation
COnfigurations.
Specific corrective exercises.precisely for her subluxation
COnfiguration for mobilizing and strengthening the cervical spine
whiCh will establish a more normal mechanical and physiological
(unction of the entire spine.
motion
Normal Exam
Flexion
Extension
Left Lateral Flexion
Right Lateral Flexion
Left Rotation
Right Rotation
60
50
40
40
80
80
50 pain & restriction
40 pain & restriction
30 restriction
35 restriction
70 pain & restriction
75 restriction
The Foraminal Compression Test was positive bilaterally for pain
in the neck of the patient.
Foraminal encroachment was positive bilaterally for neck pain.
Biceps tendon reflexes were bilaterally diminished.
The brachio-radialis reflexes w~re diminished bilaterally.
Dermatomes tested by the pinwheel on both arms revealed a
hypoesthesi,a in the right ar.m.
The Soto-Hall test was positive for central Upper thoracic pain.
The Shoulder Depression test was positive unilaterally on the
right side.
The supine leg check revealed a functional short leg on the left
side by 1/2.
The dynamic prone leg check exhibited a right contracted leg,
short by 1/4. Upon flexion of the legs a right contracted leg, short
by 1/8 w~s exhibited.
Posture AnalYsis
Head tilt with high ear on the right side.
Shoulder tilt was evident with the high shoulder on the left
side. The shoulders were also rotated with the left shoulder
forward.
The hips were rotated anterior on the left side.
I=.rav Ana1.vsis
Lateral Cervical View
A 190% loss of the cervical curve, maintaining a state of
hypolordosis with the maximum point of stress at the level of C-4,
C-S.
Nasium (A-P) View
(All measurements relative to the center of the skull mass)
12/9/9.:1 p;:lti8nt: S~"l~.f~~:; t.h.lt ~~l~t~ ',;,1::; (,1,'1 ir~,: r,i,-:l~1- '-:':,j '~''''\r..
in h...'"lr h'1,lrl ,1M,'j n,...,--t,: 1';/ ~fl~f: ~,hrflhrin(: ir~ h'~,ld (fl:n~~r.:-:ll\'; C':',"t".111
has ccC!r. f(~I;;l ln0 Ct~ttc:r '''I In~)~ t, icht.nr~:3:i in n,?(.'1\' ;)nr. fl~'." h,.:l'-!.l(7hl'i'~;
upper C'erv jntCi 1'""2 fix;)t'C::/li.:elllX,ltcd-joint motiCln im[CrC:':'".::-hamper,
bv cer\'/shld mu,"clllar t.,n~i"n: ClASRf', C2cR, T3PLS - ,d t Jdjustm"n-t:'
wI liql~t forc0; r,ltil~~t InJ~irl';; fer l:llristm~~ trc~k ~'yxt \:00'~, 31~~
doctcr ll":.]':in.--; en ':.:ic,lt-.il']n-r~"'\~:;;uml_l C,:lrl." ~';:'~ o~ \JJt1u,]r':-'0: ,,'hl:n t::,":'!ti"":
L '2 t urn~: for c r:) 11 ": '.-:' ~ c t ,1 S :.; t: ~ ; ~'_;
0)
-- 1/24/95 tati8n~ rr~sl"'\ntlrl(: 'lith h~~ ~r,lri~rt:,::~ fnr c~~t. ~:~~~ ~rld ~ },~lf ~r~ro:
left u~!= nr::cJ~ e~:rQt:i<1l1V tir:ht ,]!ld snrf:-b:;t:-:rl Elner.:in.:,: in diff8rent
beds past cpl ~;ceks wtlile on t'~liday tre~~; lQ~ ~~ck b~en gODd;
orh~o's nee; ['Jr rO!lt compres~ion or extre~ity referral; ratation~l/
fle:nor' flxatior.'~ HI upp c'",; spln0: no f~,'~lat In'.'olv02tnents oth"rt:L
T~l io rs,' ill nol,",' n oCQnino/ctosi~',; (;"t\tl~t die not cl'lCC muclc)
mort to it oth"r th,1n tCl ~I:gqcst a o~sibte r0taianer in mOllthz-- I
Die?.)l soren'Jss.;.tiCC c~rv, C1c':ro.s~ ShOllld~~!'s, uee t,1C~: ~!oPal fix:::ticr,
Cl,C2, C6, T3; ClASRP, C2FR, C6FL, T3FL~: Cerv-,::/t: stretch/massace
l~",c::',"';,:r:., t-r;,>I'"',. ~r;~'pn.~ rr~c: ri'-1.+-~ n,-'~;~nt- f~1t, m':,"'r, rpl-t-pr 'lFt-F:::~;
follo',{-uC 2/3 and GO to \le,,:-:lv fotlo',{-ur.~: ( 1,
(J
2 / 3 n " t: i j::l n t-; ~ t- ,,",\ r ~ ~ fa- h;: -: ~ h ~ I ~ r, ~-. ~,.., f ,.~. 1 in r: It r, ('; I- - t: n () - t ,-~,-j II; h p ,-I r: ,;, r 1-: ~ :: i t: l: c ..
cetter(18ss often & 1058 inter150); G0n n~ck sorcne~s shifting bCt~;C0~
right & left sides; upp cor'l ROM much bctter; patient claims to be d'
her ncck/shld strengthening €:\~rcises; tre'3.t same; fcllo'",'-up 1 tleerr:..;.:
- '.
2/10
2/17
2/24
3/3
(
1...-/
patient states that c 1 morninGs aGO she ~oka up \lith nec~!shoulder
stiffness, as lIell as right LST soren',ss ,,;/ pain exten ing throL:gr.
\lhole-rt lo~er extremity t~~ mai~tv to k~ee area-no kno~n reason tor
onsetr (possible student [Costural & extra-curricular stresse5/strai~<
Gaensten + for Lumb/sac in':olvment, s',:oir,e del lee rais,?r . -at 15-20
decrees; scnstic lumb-ilj,al mnts, EC2Stic SC~{ and cost cerv mm's;
aGaravation of orevious con~ition in cerv/thClr; HoPal fdxation note~
Lumb-saiint: C2PR, C~PL, T3PLS. rT-rt Ilium: p"tlent felt much botts,
after; follO'.r-up 2/17; "'7-"
patient claims to h;'\v~ h~r: fpl(.l1 irrJ "bad" in neck/snlds c~c;t: iL." ti;3.Y~
some lo~., back disr:nmfor~: C;f~'H'~n 1l,.,t4j::l~ R ,,.,10 r)F c:"'I'"~~C:: since last vi$i~
performina in coll~aA clav 2nd h~vin0 r~'e~ivpc: vicf~fn~~ ~~C: "n~ ~~d
any headaches f()r [Cast .s;.Et \{ee,:s; Dicral soreness uoo/to'.er cerv,
upp thoro LST areas; tense mm's-cerv/shtd/llPP back and lumb-itiat
areas; ~!oPal fix;;,tions-IlDc c,:1rv, l:Cr,. t.hnr" ~r)in.;'\l ;1.rCJ:l~: r?op ('hPTC---'
T3PLS; Cerv-rl/t; Lllmh-<:/m; f.o1t- ,"',.-h 1"'''0" "qpr: f""""I-"r 1 "rob
patient generally feeling pretty good-has~~ had headaches since mont'
acro; today e:<ol:~rien~ina sor~--.?n0SS in rt ~hl'-~ l71t"l'S E. hr....,n sr:aDlltilf-:;
DloPaJ. sorF1ness-ur:D/lo~.rer c~rv, ucc/lrJ~fPr fa-.nnrar:ir. 5:Jin;:j.l ;}reCls..L-
Shld docr8ssor, foramln~ com~~~ss t~~ts nn~:t stnM~ch dis~omfort-DLot
due to 08n n0rvous/hvG~r nat~Jr8; ~!,)P21 fi~;!ti0n~-1]~n/lQ~~r c~r"l ucs:
" ., 1
tho r; C 2 P R, C t) r~" ~ 1 ? L;;; C '? ~.,. _,..l / 1-, ~ ,e;:- ~
head,1ches st i 11 m l n im3 t to non-e:d it" .t; p'Hsi st'ln t fl;J re-Ilrs of n.,c"
shld achin~s,s; stomach <:trl-::,) r~iSC0m~~rtt p,1tn p~:r~;tsts-shrry h,1S b~'~n
dla0'd wi e;(~0SS stGm,1ch Jlli~0S ~ spl~ti~ 01~tri~ v~1';0(whict\ on~-
( C ';,': )
3/3/95 (cont-,'d) unknol/n): nrnh m,I'1 hr> rill" t-n r"f.i.t-~nt- 11'''' t-hr'Jr ~~;n"'
soreno'!ss or c;JUSin,1 tt-shp.'s colno ham'" for sorine brea'{ soon-T Sllo'T-:;'
she talk to her reqular family chiropractor ;Jbout x-raylne her t~or;Jci,
spine for n(}S~1 diR~/I\nrV rnnt r:rnh:: ln~; b~r~ nnn~: nrthn'~ r~0 Fnr
cerv/thor root comprt)~~ion; nn ,~xtrem invclv; T~t rli~order persistsr-
DiaPal t0ndcrn"~ss-t:r;D/l(H/f;t" r."rv ,r., nee t:hnr ~~cin;11 flrf~15'; Fix.:lti()ri~:
upp/lc'icr 2',rV, "q' thor; c:'rp, C,-,PL, T"ccS; CI'!rv-d/t; f>Hlo'!nt Felt
much l:cttf2r ;Jft.err (..'-';
II
oatierlt statf~s th~t ~0r nt'r'!(/~h}rls h~vp b00n v~rv (lnnrl-hp~rlJr.h~9 nnly
occasslonll brlo'!f tesslon hr>ld~chr>s; main croblem Is stomach dlscomfcc
attAr A(lt:in<1-fll~ t:;lmp~ sP,'m-:: '{nr~::::p~ ~t-.t 11 ':""r'/ tpnripr tn Dl(1'P;;.1 'ht,;.rn
scapulae on spinp.; had dlsocmfort vlth rt lower extrem last nicht
ortho's and RO~1 test,; in LST and thlch if,t nO'Cl For o,ltholoc'" rt-, lr>c
short c.s has b0cn m2nv t,iml?s t)rpCi('l\l~ u/n\lt. ~vmt1t.l()m~-GrtVP hAr l/tfill r~'-,
11ft. f()r rt-. f('ot:~-lpar~ ni(fp~, "orpnpc:c:: llf'r' t},nr '1nn Il.pf' rp",v~ r?OR.
"'~1a.'1~ ~,..l;l]C:" ~ l:'r,p1c lp-1:vil"'l!"T .-:'n.... nnl""lP ?l"'I,..l c:rt"in'] 'h1"'r.l~1(' novr '..rAov-_~rr;:lir,
5tJca1rj shp r.l.nvp Dr. T,nrr:'ln'7,F) x-rrlV thnr2r-:-;r sctnp ann tnAn r.()~-=i.hlv Cf;:':
internal med exam of uooer GT:, '-'
3/10
4/10
4/14
4/21
I.
L./
oatiect presentine wi aeneral neck/shld soreness olano richt side-had
col minor hr>~dache~ since last visit: she h~d med check while hOffi0
reco'!ntl.v and was diaa'd v/ stomach ulcer--is on medication for it;_
DiaPal tenderness-uDo cerv, UDD thorlmuch elss tender than ~revious).
TST a"',,'~: ~r0Pal flxat-,10ns-llcc cr>rv, lIce thoro C2PR, 'I'3?LS; Cerv-d/t;
Lllmb-;' ;al mm ~t-rpt-rh/m"ssa'le: felt mlJ(,h HH tet.tr>r after; told oatle'
~h~~ , ~~~~r~A~ insl1ran~p como~nies and l~~;ver that r feel ShA has
reached a point odor to auto' accident; <:.....(/
. ..L\
cotient states that a:ter leavinc on 4/J,b..!later that da'! her 10'" bac',:
becam8 achy for a',{hi18 anc' then disaoc8?red., .thl'>n on 4/11 sr.e l:ecar.:'C
sore tetwean shoulder blades and her rt neck/shld area flared-uc(duri:
di.srllr.:eion shp rAmAm};pr~i! sh~ nad "r,ppn 1,.;restltna 1"ith bovfri~nd on
4/10, f0raMln~ rOMe tr>sts n"~ for rerv root c0moression/radlculooathy
no othp.r accidents/traumas; ROM limited in cerv spine due to tight
c~rv/thor mm's: DlcrPrtL tenderness UCD cerv, uop thor; hiDs/leas level
M,..,P;')' ~otldo f;~(~t;/"'I"'C::-_lll""\r" rprv, l1f"1r tn"r c:::r,;n.11 a.r~ris: C1'ASPO, '1'1?LS;
Cerv-d/t; carv/shld/uoo back mm stretch/m2ssaae; patient claimed to
feel Much better after; fo11o\<-uo on,4/14 lshe uants to be in cood sr,
fnr s;l1fJinrr t"prit'21 nirrnt: nf 4/ 4 /,,-
~
oatient states that she has boen fe{ Inc "real good" since last visit
uokp. un tH.s mornina III verY .sore rt n0c~'.:/shlr:l ar~)as-she had "reslles~
nlr:hl". ~10(.~l')ina, t:0c;,qin0 ar()l,ln(l, ~.()ssil")t'i u-nticht about her sincina
~i.I:rtl at colleCl" tonicTht, no h..,~~aches until sliaht one developed
rht~ ~"'rninl[: Di11'P'11 SOr"POAC:::O:-:-ll;)l') r~rv. rt-. r:r.}rv/~jhlrl mm's. uo:J thor
spine: sti 11. p.:<n~rifOnc-:ina S(Jr.l~ stom2~listress. osti 11 nn "ulrpr"
m~rlictnA: n~tl~nt finally Dres~ntA~ ;c-ravs from lat vear concerning
l-,~... ~"l-f"'I ~""r""iMorr(~;lm~ from Tll"'. T("\r~'1n'?n ~n"'l r;]rtis12 Hos::Jit:al):..l:!.!l~,:;
fl;<ation"-IJ'")'l rcrv, uno th0f seln"; lo,r 'crtr'</hiDS/l""s aood; C1ASRP,
T1PLS; Cerv-d/t; transvers,~/10nCjitll'lir,rtl fnctlon massa;e t-n t1-o0racir
,.r::, r-n -: ": s"~ 1 r! m 11 ~ r:-.!l1...::i.t..!..Lr 0: f ~ 1. ~ r111"" r r'" to r, r. r ;'1 f 1'. ~ r :
'e'
( r:- <-: 1-, Z-' ': '~~ _; )
5/5
e/2 9
8/30
9/4
--
I ~ I'
patient b,l~~ t-:"'\M f:~.......lin": ~-:t-"I"'II'-:~llr_lll\' ,.,...~~~~..;:" ',',".,::.,,1..1,",1-;1 ":-,1
days aco ,,,hen "all~t"qips nt<1rtr:>d l(ic'<in''T ur," ("";~Il~ir,"":' h'C'\,1~,1""rJ."\o::' ;"l"'~
1ft corv/shld soreness; stomJch discomfort mlnim~l-stlll on the medica
had flarD-up of low back pJln on0 eVDenina which w~s aone next morn-
Ing; DiqPJI tendp.rn'~ss-lJrp enrv, upp thorJeic sr.lnD; NoPJI E1xaitons-
occiput and u;:p thor spln'~; Occlp-Pl.. 33Pt,S; Cc't'v-li/t; Sintls/cr,1nlill-
massacre; ~,1ti(?nt fF~lt c0t:ter ;1ft(~r; ~'
II
U
patient's m~irl comclnints arc p0rsistant stom~cll sorenes~ and lo~{ t~c'
soreness; nec~/shld not too bild althouch they feel "tlaht and achY";
no traumas/med prob's or scholilstlc cressures this cast WAA~' r"odv to
00 home for slJmmer vocation; niaPal tenderness-uoc cerv. UOC thoro lSr
areas; NoPal E1~ations-upp cerv, upp thor, s-r jnts; C2PR, T3!"LS,
PI-rt. AS-1ft; Cp.rv-d/t; Lumb-s/m; (.~
pat i e n t pre s e r. t t n -: I.'; / so r C', t i q h t n p,c an (j, he", ri ;: ~ h j:I ~ 1'\ tl t r:> r ~, r:> ""' ... i " ''''':
post u res t res s - - m (1 i n pal n ::: t e m t:: 1 e a r,f';. S W / pre S 5 U rei n fro n t "l and
o c c i p L tal 1 i r. ear e as: cat i e n t 'c a c k (t" C r:t 5 '1 m m ~ r 1::: r e 1. ~ t () 1" 0::1 ~ It ~ g <: ~ ~ '0 r
year at colle~e: Thoracic cains anc stomach orb1::: under control(re-
diagnosed medically as stomach muscle spasms): no other ~~X2a~ trauma~/
med crab's sinc~ tast visit: OicP31 tencerness ute/lower ~ec~: C~rv ~C~
norm wI cerv/shld m~ tichtncss; ortho's nee for root comcression or
radicalopathy; MaPat fixations ucc/lc~~r cerv seine: Treat=adj C2PF,
C6PLi Stretch/mJ::sace ...c.orv/shld/upt: th.-::r m:nl 5; patient felt much loo::.(:~
and pain frE:!€ aL't,:ri ~
/ )
----
patient stated she felt good for about t~o hours last evening then
neck got sore and tight again-intensity not quite as bad, DigPal/~cFal
as yest~rday plUS soreness in T~ area esp rt masseter/te~poralis mT's
along ~I loud CliCking in T~ Jots en opening/closing of mouth, Treat
sam~ as yest plus adj T3?tS and m3ssaged/stretched masseter mmts,
assisted oral closinG, a~d massaGed sinusF.s and frontal/sagoital
sutures; patient felt much l:ett~, after: SU:Jg tdpatient may need oral
appliance to reduce T~J stressl~
^
patient presenting w/ bad headaCffe, sore neck; ~as easina uo ofter
8/30 treat then flared un aaaln evenin" of 9/11 friends told her tDat
she was walking as though she ~ere "drunk" (s~ayingl--has had episodes
of dizziness & equilibrium disturbance; Mouth/Jaw areas been OK;,
Pupil reflex norm. BP-I12/64, ortho's neg for root compression/
radlculooathv; Dia?al soreness-uDc n~ck(eso aton0 rt aceto/at/ax ~reas
lower rt neck, upp rt thor areas; Mopal fixations-upp/lo~er cer~ine
upp thor spine; Treat=licht tooele adju't w/ thumb/index finaer on
atlas trans proc's w/ patient in pror.e position, T3PLS, C6PL(prone pus
C2PL: catient felt mar~od imcrov after: su~~'d she 00 hom~ ~nd rplax 0
rall,ed-up to.....el undcr neck for 20 minutes: ....7
n
'/
patient pr@serltina wI aeneral neck/shld ach~ness/tightnes~: headaches
disappeared suddenly several day. ago-she had CT of neck at Ca~lisle
Hosp shortly after la$t visit a. headaches did not abate and they
neg !or osseous or soft tissue invotv: patient did obtain a c~rvical
sucin~action kit l3nd h3S us~d it to,{ice sto1ting th.lt it did m,jk'J h,,:,r
neck fe~l better-I sug~ld she continu~ using it r~gIJlarly; Di;PJl
( r.; '; '! r )
10/2/95
/lxxi.xl<
12/l
12/:
l!24/96
2/21
3/8
(c..,nt1d) tp.nd~rno"Ss found in '1~~/l"'''''P rolC" 0:1'\ np ,..A' ~ o::p
upp cerv mm'sr minor tendern~55 not~d in intra-s lnQUS race!! so~~e c
't' 3 / .1 rHo P <1 t ! i :< a t 10 n 5 f 0 U n d - u p P F. 10 'Ii erc.~ r v s p 1 ~~i...-!.:{ t. r I~ m i n v r) 1 v n e g ;
Hcadach~~1 other eve, e~r, no~~ or throJt lnvnlv ~b,pntl r~rv Q0~~
bk ext norm w/out paln, for flex norm wi ll~~ c~rv Jchln,!s5, tat (le~
nor m -~t 1 g h t m m f l1 e 1 i n q, rot .1 t 1. 0 n r t nor m I t f t .1 C c (? rj: for a m l n;) C l') m 'F
',I / r t 1 a t f t '0 x pro ,j U c e d "0 r,' n,' ,; " I n u e" n" c" -;--:r r.' a to" d i C 2 r R, C 6 ~
stretch/m,1ss,1o'0 corv/shld mm's, "hld/u.. thoL' mm's, 5. lum1:/111,,1 !"m"(
due to minor, 1:rlef low 1:.ck achlne"s), no fallow-UP .chcduled:C
10/26 patIent presentlnq ',1/ tlcht/achy neke/ohld/ue" 1:ac~ mm's, t ckll
throat, getting over head cotn ',1/ nasa~ngcst/ddp/ feel. "t("qht."
in chest: tu~g sounds norm: cerv ROM norm w/ mm tlnhtness: OLePal
tcndern~~5-UPp neck. upp that" splnc/mm's: MoFal fixation5-UP~ ce~vl
-;P;;-thcr spine: Terat~adj CHi', CLASH', TJrt.S, stretch/m"ssa>;o cerv!s[-,
/uPp~' mm's, sinus/cranial m1Ssago: su~ hot sho'.er, t:undlll1g-UF
5 'Ii eat i n g "J U t res t 0 f t 0 x ins; ~ -.>? //
- /)
0./
Patient ~esentinc ~I sare neck/shlds/ucc t~ck--has head. sinus c~n~~
-ion, has snee'zinq fit cpl days aqol Neq. felfile~ o~ or dist~~SSi H,1_5
been very good sInce 10/26 treat; Dlgpol soreness-upp/lo'./er neck._UPF
back splne/mm's/ MoPal tlxatlons-upp/lower cerv, upp thor seine;'
Treat~adjC2PR, T3PLS, stretch/massac. cerv/shld/UCo back mm's, olous/
cranial ma5s~gei felt much ectte~ a(teri ~~/
Patient ,resentlnn ',II .Qr~ n~c< 5. uce.r t:'c<-~ ad 1:.d nlcht 51eepln;,
atter seeing horror movie and woke 'j~ in hy~er fetal position wI netk
stiffneSsi Cerv ROM limited to ,15 dc;re~s rotation, 45 degrees {orw
fexlon, bkwrd ext abt 40 degreeS ',1/ pain, DlgP.l soreness up"/lower
neck & upp 1:ack: Mopal flxations-npp/lower cerv & upp thor spine;
T rea t ~a d j C 2 P R, C 6 P L, T 3 P L S, s t r e t c h / mas sa>; e c e r v / s h 1 d m m ' s :
Patient c~esentina wI soreness acrOSS shlds & in necK, ccass/h adach;
p.st few days; sllpced on Ice alst nloht landlnc on rt side
catching horself ',1/ rt hand/arm; Gen has been pretty good since last
visiti No other traumaos/med.l?rob's since alst visiti She claims her
TM Joint has been making louder noises recently ',1/ pain on "snapping"
Neq. oraaniclextrem involvi DioPal ~ao.ness-uco rt neCK scine/~m's. rt
lev.scap. mm, mid rt trap mm, upp thor spine; Mapal fixaions-uPP cory
upp thor spinal areas; Treat~adj e2PR, C6PL, T3PLS, stretch/massage
cerv/shld mm's, isch.comp.-lev.sca . & mid rt trap mmls; Aaain stress,
she should get T~J work done after graduating In May;c-2-
rJ
L/
be"ln "C'1r1"
m8'; . C l:"f1r: :;
l:"~~""n~tv.
I>c;tl"'l{
vie i r,
~(>nltnfj"...~""eo'int"! hp~"'"," n".".
r; i n r;A 1 '1 ~ 1-.
'1.'" -; .~~~:L-; I" ': .,1 'f'
rc;~l
"1 ,.. ,. n .. .... ......s.-.1l..r:-P
( n r~ :~ 10. r.; ,]'j ':! )
3/1,1
"" h 1 ~ '" 'n I ., 't... t' ~ l""l, " r i ... ,,,, /,...., I "'. r 1'1 r V
wi Qn!1Jstr~tch mm 50reneOEr M~FJt flx~tlcn9-uPP c~rv, laW,lr
c~rv, Upe I:h"t' f=r.in.ll ,1 t'fl.)S 1 Tre.Jr,tJ,lr!i C2PR, Cfirr_. T1PCS, TEPnS;
fI I; r (l ~ r; h / m ., ~i !3 .' 11 '" f' ~ r V / <t h 1 rf m m I ~ t"'''-;':7-
.. )
I--/"
p ,} tin n t: t: r 0 S r'! n tin'~ "Ii In>) c k s t iff n 1,1 s S .~ h ,'~ ,1 ! ~~ S " n 1 d i ( fie u t tv
i r. h .] 1 i n '1 - - .'" 0 k (l '2 d.) Y :3 tl:1 0 ~ c () n d i t i .: :1 - - r- ':' ~ :3 11: 1 (I s t I~ f'! t: i n 'J f: " 5 t u r p.
in', 0 1 v m ~ n t; N <] ~m.l:5 1m tl J . pre I: ; . s; :! t C::'l " c h f I) I~ t 0 1:..... t t ~ r t h., n 1 a 5 t
visit; ,Just wnnt throll~h h~r[l oxam ~e~k ~t cotloae prior to s~rinQ
"
I: r e " ~(: I A rl ., 1 :.: i s / 1'. r "! a I: m t-: n I: ;);, c r (l v i 0 \: ~ I
3/26
. - )
P.ltient prAsAnting wi sore, stiff nt:t:</~hl'~s r:llls "C;lC ehildaches";
Sh~ puts bl~me. on vory soft mlttr0~~ at m'1t~1 during sprin~ break
last wlC!ekr He'). extrF)mi~.'II(Jrr:1niC' ir.'/cl':: Cl;:~rv RO~'~ n~rm wi tir:ht mm
sorf?_n~ss
3/29
Orth0'5 n~~ fo~ di~C' cc~crQs~iont Di~Pat ~nrpn~~~ nee
:} ~ !'" 1 l) 0: .. J:l ~ ~ r n t: r.1 tJ n G I: ~ ~ l: .1 ('" p ~ ,.. 1'1"'" .. h..... 0: I" f n
ucc/lo~~t" c~rv ~l:in~1 u=c that" eQt~Aet scinp.t Treat=
~':;PL, lPLS, stretch/::!Jssaae cerv/shld mm'S1
l=',1.~i,:'>n" fnt.. ~n"' 'T1I"'l"A~ ""11"'11 hnt:t:pr ~'tpr:' c:-,
Patient presentin, w/ continein nec~/shld S~fEne5s. "oreness &
on/o(( he~d;)ch~5: Ani11Ysi~/Tre;Jtm'?nt ::a:ne as pr1!vious: Patient ~-
c 1 aim e d to fee 1 m u c h 1: e t t e r a ( t e ~ t rea t - - a 1 soh a tJ (r e ~ r, g rea t e r .R 0:\
Patient presentina wi mild neck tic::-.tnl?:::s/s:renes5 r.:ll~,: l,,~ ()~ O:"o'J~r.
distress (Eindin; it hard to keep fccd dewn, h.s not teen able to eat
pro erlv last wee:{ or so); Ne-::. hCJrtturr. s'lm.tom~1 ne':'. 1:o'l/et or
genito-urinary distress; Som~ C0CCY:< ::orness(she cl~ims ~oss brui~in;
(rem sittinc on hard sur(aee a lot r~centl'l; Orthc,'s np.~. !or radicul
itis o~ root com"ression symptomsr Cerv/LS RO~ norm w/ end-stage mm
cis c 0 mY 0 r t: Not raIl m o'l s 1m e d . t:: rot's ~ i r: eel:! s t vis it: Fe s sib 1 '/ (r 0 m
"nerves" as she's under lot cf scholastic and self-i~oossed stres~es;
DicPal soreness alona occi~ lin~~~~crv s~ine/mrn'sl uot:: to mid
thar 501no115 CI:'Or:~5S~~; NoP,:!l fixaticn:!-ur:c Cl'::!rv soi....!l...2...!.uct:: thol:'
spine; Tre.t=adj C2PR, ll:6PL, T3PLS, T6PPS. stretch/milssage cerv/shld
mm's; Friction mn.::1Saa8 to shtd/uPI= the!:' m;.,'s; She C'~aduates & leaves
this area in another mor.th--su~a'd ~h~ hav~ h~t hometo~n ryo~t:ors
check her thorou~hlY wh~n she Gets atck hcm8: '-(
/)
......
Fatient oresentincr wI ner.k/shtri/Iloc b.'.!("k s.2..rr:>np<::s/c:"ffl~n""<::c,' ::l"~ r""ese'
-lya headache; Stomach has beel' much 1:~tter since hElr medic l'JoL....her,
a new me d i cat ion r e c e n t 1 Y r She c 1 aim s nee k / s h 1 d / b a c II / h e a d il C hem a.in 1 y
due to sr.resses of college sonior e:<am ',;eek p~; No traumas/miCl.L...groJ:
otherwise: N':Jq. ora:}nil'::/extrem invot'l; She Cl<lim~ also th::t" c:h"" n:\d a
episode oE p.in i~ leEt T~ Joint, plu, rt T~J is still very noisvr
Ce~v ROM no~m wi mm stretch t::~in: Fcram.~~mo. ne~. for rn~ ~~mD~~ssi
Digpal soreness neck/ghtd mm's, uct::/lo~~r c~rv soine. vpry "~~~p~
along eccipital line. up" thor interspinous spacesr MoPal Eixations-
u Ilower cerv 50[n0," lJDO thnr ~cin~: T?E~T~~~ ClASPP ~~~_
C 6 FRS. 113 p t. S, Tj P P S, "i t: r.:.> t: ~ h 1:n..J ':; :i ,1 ,; >-, ;: ~-, r 'I I "; h 1 (1 m m ' os , ,..,,... .. i <"'l" m"~ 5 J r:;
to S hId 111 0 0 tho r m m ' ::;: A: ~ t l'II::"I ;\ 1 ;.; n m ,; - 3 1 ':' l"'! ~ .1 n (J T { ~ r. 10 , '/ 1..... <"'l ~..... I'f ..., ~ " E'
T ~ j 0 i n t "i; rr 0 (I") 1 1 r") ~" ... 'I'" r. ,.. j., " ,I " T ..... ,I. <~7
i~)
-/
4/ [9
--
5/2
DETAIL OF CURRE
AC ElO
60399
60102
26710
T CHARGE , PAYHENTS AND ADJUSTHENTS
05/07/94 ACETAHINOPHEN/COD 30HG TABLET X 6
05/06/94 ADDITIONAL VIEW
05/07/94 SPINE CERVICAL ROUTINE 5V
05/07/94 CLASS I VISIT EHERGENCY
PATIEN'fNAME
HADJ,A.'__QAWIl_K.
.- . .-- - --.-
-- ACCOUNTNO:-FDMi"T6ATe'-IDiScHAffbTDATErBiCCbATE ---rACCOlmfREP,
7662. 27-3L2..~1 O]l.9_~ ~UQU9.4.L051U/9_4u_ __ n.
--._..._.. .__._____._ n'o _ '. ___..______
....lIInlth,.:1'p Rillin" c;".'Am" P() Rn~ 177 (''1rllc;,ll~ PA 17nl.1.n177
1
1
1
1
NRV SUHMARY DE CRIPTION
250 PHARMACY
320 RADIOLOGY-
450 EMERGENCY
TOTALS
.______ .______~~ ,___ .. ..~---- A~;;D;~;~-ro05M~T:;~E9~-r~~C;::~~:ET~~7:;;~~TCccfUNT REP, ~C~~-~
B'I. 1'i,l,Vf. 1"'i':Il"\Jl-IllV'l
Heolthc8rO I IIno Systems, P,O. Box 177, Carlisle, PA 1701.1-017? ~"," [,\;II FlfCORDGl
, ,
S~"..; (lilt./,,( ,~
.
(711) 245.5500 EMERGENCY
REOISTRAnO~
'7"2273:? '~;,
. cItiste ~
. \jO .
24() p.,k.r Strv..t C.rllll1.., P^ 17013-0:"0
20Y FilS
03/03174
155-82-2600
'AllfNllorH 1 ,M't<1~. I
DSON STUDENT
I ( II) " C Ill)
(II II N ()!lRI l'tO~f. 1
NJ 07950
155-82 -2600
, ~ lON1SOC.5 c. 0 t.lEIl(,!;NCYNOII'Y
MADIA, FRANK
(201)539-7624
· 18
FRANK P.
18
097387761
MADIA, FRANK P.
017091 41 204
18
N
~
PT CIO INVOLVED IN MVA AT
1430 TODAY
ED I IIENI)INlI
KURLANTZICK, ROBERT L
&-10 9( SfHT-IN---
SHE DIDN'T KNOW WHAT CARRIER
BRIEF VISIT 25700 CAST ROll, PlAS TER 28075 ALL ADDlnONAL CHARGIS ' I"C"
CLASS I VISIT B/P MONITOR 28037 , , ,- ,
I II I
CLASS II VISIT 25720 PACER PADS 79084 I II I
I II I
CLASS III VISIT 25730 GASTRO/HEMO SLIDE 28080 \, .J I.. ./
CLASS IV VISIT 28740 KIDDE TOURNIOUET 28048 , , , ,
I II I
CLASS V VISIT 25750 OCl PER FOO r 79870 I I I I
EXTENDED OlARGE I I I I I
28750 F.SB.S, 80081 1..- .J 1.._ ./
EXTENDED CHARGE II 25770 TUBE: GAUZE PER FOOT 28074 , -, ,- ,
MINOR SUTURE EDSOI ED STAT ESTAT I II I
I II I
MEDIUM SUTURE EDS 02 PULSE OX POXED I I I I
I.. .J 1.._ ___.J
MAJOR SIJTURE EDS 03 ALL ADDlnONAL CHARGES , ,- ,
r , ,
INTUBATION IDS 04 I I I I I I
I I I II I
IV SET UP EDS 05 I I I II I
CARDIAC MONITOR EDS " I.. _./ 1..--- ____.JI..___ ---_./
, , , , ,- ,
PELVIC EXAM EDS 14 I I I II I
NITRO SET.UP .1 I I II I
EDS 18 I I I II I
--
CAST, SCOTCH SHORT ARM 25031 I.. - - - - -- - _ _ --_ _ _ _./ \. _ _ _ _ _ _ _ _.J I.. _ _ ,_ ._ _ _ _ _ .J
.. ..
CAST, SCOTCH LONG ARM 25032 , , , , ,- --,
I I I II I
CAST, SCOTCH SHORT lEG 25033 I I I I I I
I I I II I
CAST, SCOTCH LONG lEG 25034 I.. .J I.. ._.J 1.._ --.I
ER'050S (RaY. I ilia
_I, Madia, IlBwn
KR 'I 576619 ~I 05-07-54
IJIDlaIKlY JlOCM RIXXIm
CJaII' CXICPLMIft'I Neck pain after motor vehicle accident.
ImftatYI 'Ibis is a 20-year-old waran who is a student at Dickinson COllege.
S. _ a seat belted right front passenger in a motor vehicle which was
~....-ding forward in the left lane. A vehicle in front of them to the right
INIde a left han:i turn am cut her vehicle off. Her vehicle went forward into
the aide of the other vehicle am the patient sustainOO a flexion extension
injury of her neck. 1\s her neck drqlplld forward and then back, she struck the
head rest behind her. 'Ihere was no loss of consciousness. 'lbe patient had no
pain initially. She developed neck and upper shoulder pain bilaterally begin-
nin:J approximately two hours after the accident. 'Ihe injury occurred at 2:30
this afternoon. 'lbe patient has not previously had any neck pain problellE.
She reports no neurologic deficit.
PA8T Ml!DICAL HI~YI Bronchitis.
IIII)ICll/1'I<Hl1 None.
ALLDlGIESI Jlapirin
IlMlICAL I!IIIl\KINM'IClfI Afebrile. Pulse is 84. Respirations are 20. Blood
pi. -Jre is 126/84. 'lbe ratient is amb.1latory and in no distress tAlt guarding
all mr:MI1lIr\t of her neck. Head and neck exam shONS significant posterior
cervical and upper trapezius spasm. 'lbere is no bony deformity or bony ten-
.. Y-. 'lbe remairder of the facial scalp and skull exam is norrral. 'lbe
a-t a clear and nonterxil'.r. Cardiac: Norrral heart tones. 'lbe back shows
no VlIl1:.ebral or CVA tenderness. 'lbe abdanen is soft am nontender. 'lbe
nwrologic exam is norrral.
~ DIll'ARDIIltfl' CDJRBEI 'Ihe patient had cervical spine x-rays ordered
fran triage prior to my exam. 'Ihese sh~ sane straightening consistent with
8pI1SII. 'l1lere is flOOlB degenerative change rot no acute fracture or subluxa-
tim. 'lbe filJns are read by the emergency physician. 'Ihe patient was
clliIpeJ-S six tablets of Tylenol #3 for hare use.
DIJliIRl8I81 Cervical and trapezius strain. Acute status post motor vehicle
accident.
'l'RIlMJCDf1' PIMI 'lbe patient is disc.harged hare in good con::lition with advice
to rest and use ice packs for her neck for the next several days and to avoid
using heat. She will use Tylenol with Codeine two tablets every four to six
hoors if needed for pain. She should not drive while taking this. She may
switdl to regular Tylenol as her S}'I1lltans inprove. She will follcr,.,r up at the
DicY.lnson student Health Center for any persistent problems after three to
five daye. She may return to the flnergency Department as needed for worsening
synptam.
RU</~
0: 05-07-94 0300
T: 05-10-94
ROBER!' L.
ZIa<, M.D.
CARLISLE HOSPITAL
EMERGENCY ROOM RECORD
CARlISL.17013-0310
EMERG"V REGISTRATION
tJ~,
FOR NURSING ASSESSMENT
SEE NURSING DOCUMENTATION SHEET
IUhro~
PT CIO INVOLVED 'IN M A AT
1430 TOOAY
95026
NONie
0 0
TRANS ot~tER
,
o SAME
nMI "'IT, ..-
,/
~;"1\-
MADIA. DAWN Ie
,
05/07/94 01:23 20Y
I rj ~ '
MEDICAL RECORDS
iii
ER-osoe (REV, lll~'
I .
,...: ~ Carlisle IbpitaI
~ C"",.tgnll
EA 2010 we41
NURSING DOCUMENTATION - EMERGENCY / CONVENIENT
DEPARTMENT CARE CENTER I .
. '" ...~ . L) (A. ell :-.... TRIAGE NOTE: DIll: . . .5 /:!I9.i-
NAME - -~.'-~- b -- . Tlirtgo Status Mode of ArrivAl Ar..../cd Wllh.
ROOM' .--- AGE 4' ..... WT3'f '~ I' P"o"" I I I Al S I I BLS I I Police LI F"end
VITAL SIONS: ,,~ __,[I)-'."L....T. .. U ... II Prio"l, 11 ~AlI1b.lJln'OI' {I Pme,,1 [) Femily
P 8~_ R .;lO . Bp ..I.:J 4> 'il{ )""P"orlly 111 II Wheelchalt ~oll U Olher
.oJ r'd I I Fn" Tonck II Gnmed J (c1'
ALLEllOtES' -(.....1'--,4-:--- ".... --. Chie' COll1pl.,nl . tll : c.,O _ ..~~t"'!:, ._ -'-:~._._,_.
CURRENT MEDICATIONS,Jo-!?IVL.. - '. ,..n 1 fA. . -, ~'o.l..t ~''!-l:.. ~.
W~4Lti...f.o- ?;1,..fic1 1;.. /<'leI-
---- --- c_'l.<t or . <Mt.{)./ ~r)Y1:i .- v
0". 01 Symptom. ;-I.JD. J'{ .__.__ _" Q , .,~
----.--.-0-. NurSIng ACIIQrllComrnenls: C' - t..LJ/J.a..<.. c __ .. ~
.--..--- Childhood 100munllAhons: 11 UTO rJ Never n____.~ __
TETANUS STATUS, () Wllhln 5 Vear. T,earment P"o. to Am'n" (I .... ...__... _ _
[J 5,t 0 Years
(1 More than 10 'Vonrs
U Never
. GENERAL APPEARANCE
~PULSE:
.gulsr [) Irregular L I Other
ull [J Weak _...._..
11,!;.!lP: [) Shallow [J Aapld [J AlJd,blo
)!FNormal 0 Deep [J SlOW Wheelo
[) Labored [) Slrldor I.J Rel.aclion.
. T~~~~MENTD~~:~~~,RES~~~ ARRIVAiA: mln II MOnlto. -- Ahylhm _,.. _. ___ Ral.__
o Alrwey - 0 Ortl, 0 Ne.al __ 51'. _.., .... I I. ] O'ygen -- tJ MA.k, [ ] - LiMln ______
o AlM.Y. Endot,lch.lIl- SIze -..---.---- ._n.. -. ~f- C.) SplflallmmobUizallrt't:- --t<1----.----- ---
o Aifwey, NlIlo~eclltel - Sllt._ ____. . II MAS!,._. , " 'n___
o IV SoMk>n ~SUe __m_, ,__ _.... 51 _. U Pressure Oronlno ... _. _.. ___
LuNI.....~ RighI' 0 Ra... n Whit..,,, Mln'.1 A.....m.nl:
U ..... - - n ~ (I AbI.nl MOQd'^,,~
......... llfl 0 A.... (J WhHn D'~('Ipnpl"'"
CJ AhoneN U Abt.." (J B'uI'11l(j "'"
r)[)lI'~.....
{1 Arcw.f...,r...
r I n,.llft" Combft,,~.
11 Flushed
l J JAundiced
II Cool
f. ] Clammy
II Du'ky
U Cyanollc
lJ ~la,lbed.
rJ Circumoral
U Lacetltlon
[) Edeml
t.l Ecchymosis, _. __..
LI Rash,.. u_..~.___._. '_
"....,
1IigIlt,
Ihnught
1..o..~"~III"1fl()t...
~ J v~,. Ool("OMtC1fd
II ()lW"'lPf"tflld
r 1 Slow 10 M...,
t. .
4. .
,- .
.- .
r1 W,lhGllIss8S
Ll WlthoulQlasslIs
Sill _
~._--
SIll ___.
AOI"Ion__ ~. .
Loft '
c.g:JIIA
" .
VI,u,1 Activity;
00
OS
~
.
_n
,_rr~l'ftIl'C".,
"So.....
rl h",.I~
(1 ".ll1lv,
II f,4um~lng
110""""
...o.1nllCt
tJ Impll'~
o Rte.nl
o Oialanl/Paal
..
r
r.D<NIA
. INITIAL NURSING INTERVIEW: TIME
REASON FOR VISIT: d(TRAUMA [] MEDICAL U PSYCHO sac IAUE MOTIONAL
PAST MEDICAL HISTORY: __~T,.LiJ!. __ ~_ . '______.__.______________m.______ _.__.
LMP: _
..
SUBJECTiVE: CaUle or Injury/History ~, -Pr~.s~-nllllness (Whallhe pall.nt letlS-.;~~;:.~~.;~:6-_.~ ~~;.:_~.~..~_:_~;t;..:.=:=-~-Z=__~~
~----1.~4o---L-~~4.-o<-/~____L_.:....~__"_:_".''- __ f ~_e"_I_c_J"_~c:.&I~~/~---L-.-~:.~.u-c
'I F't
OBJECTIVE: Ph"lcallnformAllon (Whal you are able to seel ./.... .). ~O -"d..0 ,_._ ,.:. _.'" ._._
-..--!--:-J;~;...~...J.~_____c:.___:....c ~/~~L-::-._ _ /~:~.L.:__~~tU. r..:.d: .__1,-__
-a..c.---..I~iL'_roo./..z.~!i.k__...._.._ ,.__. _.__._. ... _____..._______...__.__. ,""_
PATIENT PROBLEM: NUlSlng DleQno.i.
__. NlJncornpllnnce
_ __ Sell Cn", Oftll!;11
:_~C"om'ort. AII"rtltWll1ln
__ n. Comr"unlCAllon hnpOlrfld
_ Coping. In""eCI!'.."
Fluid Volum". Allftr,111oM In
Gn~ f.r.hllnon, Impnlrltd
TI!I!lult Por1IJlMn.,A1I III
. __ Skin lntegllly hT1pallmenl
. ThOught PrOCe!lS6S, All I"
____ Hypnrthe,mln IFe.""r)
_.... In'er.Mn, PolonllAl
"",_ Injury, PotentiAl
I<nowlttdgl? O"Iir.I!
~!lhltlly lr"paUIlI1
OIM,
__ Airway Clearance, Ineffecllve
~_An.j'ly
____ Breathing Pall.mll, 1",lIl'CIIVe
_ _._ CllrdlllC Output, OecrOlllled
_.._ Other "____.._
fi[~!~.C;;;1'd
7. .,..,
-~-:;::.~~' #?...z,u// .....; /
t /lr;(/ ~(l~/
,//!(l((AII'
ON1 r(,SF. 'i 'jlf1NA TlJRf
o
PLAN OF CARE:
[l Maintain Pallgnt Airway
o Monilor Cardiovascular Status
U IV [J BP Monllor
U E KG [] CardiAc Monllor
U SA filly Measures
[] Restrainfs [J Suicide Precautions
(: ) Seizure Precautions
II Side AAil. Up
U Comlort Measures
L1 Pain Conlrol
[ PosUlon lor Com'ort
r re~are tor Exam
I E "plain Procedures
r ) E mollonal Support
[I Po"ml Teaching
( ) Di~r.harQe InSfructiOnG
) Olher _....~.._~___"-
IOlho'
) Olher
r I Olhor
'l5hree q>oints Ghiropracttc Glinic
'D,. GhA,/e. do Z.mo
114 N, H.no." Slltll
Carll.I" P,. 17013
Phon.: 249.1120
May II, 1994
PATIENT, DAWN R, MADIA
DOB I 3/3/74
55., 155-82-2600
The above named patient presented here on May 10. 1994 vith tightness
and general soreness in her posterior neck/shoulder muscles bilater-
ally, alledgedly as a result o! an auto accident vhich took place on
May 6. 1994, See patient's report o! accident.
Visual observation revealed no discolorations. lacerations or other
abnormalities in the head, neck or upper back areas or upper extrem-
ities. No obvious abnormal flexion. extension. or rotation vas noted
in the cervical or thoracic spine.
Digital palpation elicited significant tenderness in the cervical
paraspinal musculature posteriorly and over the spinous processes and
transverse processes o! the upper and middle cervical spine and over
spinous processes of T3 through T5, Notable hyperthermia vas felt in
the cervical and upper thoracic regions,
Forvard flexion o! the neck vas restricted to about 45 degrees vith
patient complaining o! tightness and soreness dovn to the upper thoracic
region. Backvard bending of the neck vas normal but elicited some
soreness in the occipito/atlanteal and cervico/thoracic areas, Side-
vays flexion of the neck was normal with tension. rotation o! the neck
vas normal to the right and slightly restricted to the left. Hyper-
extension of the upper thoracic spine elicited pain between the shoulder
blades,
Motion palpation o! the vertebrae revealed rotational fixations in the
upper and lower cervical spine and right lateral flexion fixation
in the upper thoracic spine.
The pupil, biceps and triceps reflexes were normal. and the patient
indicated no disruptions in vision. hearing. taste or smell, Thefe was
no numbness or loss o! strength in the upper extremities na was there
any pain throughout the upper extremities.
X-rays taken at Carlisle Hospital on 5/7/94 were not vieved as yet and
no fIlms were taken here.
1.
75hree Cj>otnts Ghtropractu; Glinic
'Dr, (!Jh.rl.. 3- .z.mo
114 N, Hlne'" Strllt
Clrlilll, PI, 17013
Phenl: 249,1120
March 22, 1995
THE PRUDENTIAL
P.O, Box 2280
W. Caldwell, N,J. 07007-2280
RE: DAWN K. MADIA
#38NI4487-050
Attn: Cindy Coulbourne
Dear Mrs. Coulbourne,
This is an update and itemization of services rendered to the above
named patient. Enclosed please find copies of data which was sent to
Mr. Patrick G. Geckle after Miss Madia's visit here following her auto
accident in May of 1994.
The patient was seen here on 5/10/94 reporting that she had been in
an auto acciden~. She reported SUffering from neck and shoulder sore-
ness and tightness.. .the same presenting complaints she had been
getting periodic tr~atments for since 9/17/92 as a result of student
and self-imposed stresses.
Miss Madia was examined briefly (see 5/11/94 work-up letter), treated
with manual adjustments to her cervical and upper thoracic spinal
areas and instructed to return on 5/13/94 for a follow-up and to bring
in insurance information whereupon she stated that her friend would
drop off the information on 5/11. She was also to sign an x-ray re-
lease form (so I could get her x-rays from the hospital), and a typed-
out version of her accident report, I never saw or heard from Miss
Madia after the 5/10/94 visit until she called in October of 1994
and wanted an appointment. She presented on 10/21/94 complaining of
soreness in her low back and neCk/shoulder areas since recently wear-
ing a very tight corsette for a college play plus rehearsals. Asked
about her auto accident, she stated that she left this area after her
5/10/94 appointment and went home for the summer where she was seeing
her regular family Chiropractor who took x-rays and treated her through
the summer, When asked if these present complaints were part of her
auto accident care she staten that she didn't think so but would check,
Her mother called me a few days later and informed me that all bills
were to be sent to Dawn's insurance as part of her auto accident cover-
age.
See enclosed progress notes for Miss Madia's care through 3/10/95, AS
of 3/10 the patient has not had any bad headache problems since late
January. She still has flare-ups of neck/shoulder/upper back soreness
& tightness as previous to auto accident. It is my opinion that she
has reached MMI as regards her auto accident but another reportedly
~n/:,I/')'
~~J-0-!....l~ ~~~~:!.!~
"I n~1I
( , )
IIIl
1111l
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11/16
11/18
12/2
12/6
(('/"HII.II'l) ,r, 'i-r jr'r .ir'l'.l" I~,rr~, ''i'(:^Il~_., I'r_rt, !\'~-t"t; Tllj","";/rli r.vr'
'l/~,; '.,
/ .
p.lt.l(lnt. :pr(1~~('ntinq \II sort::' nr::rk, l;dd hC',l(;,lf:,h(\~-:, P~"'tJI'(~i,111V tiqht,r1cll
~Jpr Iv:r~J.:/()r.ci plJt I ~-~()rt~ l-)(lt'.:00n Shr:)111dpr l)1,lrlf~~1' f-' ('~': hurt ., f(\(ll in',
prnr"slIrr in tprnpln:, rlrr"s; ff~p.l nq t l'~ \y.1Y .1'1nut 1,1~-it l) d,lys-prC?viol:
fn"llnCT f~lrly d"cr,nt Gln,-n 1.1St. vi."lt; hYflnrt,,,nsp c"rvlshl"/uPfl h~c'<
rrUGC111.,t.llrr!; lirnittlr] cpr.v RO~1 mnst,ly r.1.l(~ to r,1m tJ~liSion; t.,...,t\rh..r t.n
Dlqp'lJ upp cr'rv, llPP t.hnr spln'11 '1l1"~~'; MnP~1 fl;cdtlnnG-Cl,C:', T'i;
C2PH, r,1^SRP, 'l'3PLS; Ccrv-rl/t.; r~Hr>nt. f"1t milch l'Jr>tt.('r ~ft"r adjust.-
rH'nt.. - '
/t 1
p<1t.\r>n~ st~tr)s th'1t "h('~d "as h('rJn !d It Inq hr>r" li'l"t cpl ri~y" "I lot
of prr>ssllrn in t.'!mpl'! anrl occipital tin" are>as; 1011 11~r.k/hlrs doino
<]fJod; ftarr>-Ilp or ',hlpl~sh symptoms; tr('~t samp.-C1ASRP, C2DR, 'l'3PLS;
Cerv-d/t; patl~nt. alllays "t~t"s ~hn r""ls Immp.dlate rr>lief when her
nl~c!< i~ n.riiustr!d;t"~.,
./
atlp.nt. stat.as condition as previous vlslt-st~rted ~ulldln. UJ short.l
after last treatment; Tr~atm(!nt samn;
p~t.I"nt st.~t.es that sh" Is fr>"Ii.nn much better--sl""plno better.
less frequent & Inten"" hr>ad~che; ocntinup. treat's as previous;
patient states she is doln~ cerv/sl11d mm e~ercises as instructed
USUallY;O~.
patient states that overall she Is still feeling better w/ less
intense and less fre uent headaches; expnrlencinq some left lumb-
sac corennss tightnr?ss 111 some cliff cutty it'rilightening splnn from
sitt.ing or bent. forllard position; treat same on cerv/upp thor areas;
ortho's neg for luml'J-sac area root compression-mostly hypertense
lumb-Ilial mm's; MoPal neg for flxation/subluxation; stret.ch/massage
isch.comp. to lumh-Illal mm's; patient felt much better aft.er;
~atlent also states th~t her TM joints have be>en nfJisy aftnr r aske~
her about her jaws; as sh~ Is as she> is gain; ham a for 'l'hanksgivving
hrea~ from schaal, r suoc'_ she hav9 her dentist chnck her out for
any TM disorder plu brl~~ hack any x-r,ys with her from her primary
troatln' chiro ractor.-Louls Loron"o' ."
atlent hac~ from schofJl ~r"ak-clalms n h" feollng "not-tea-bad";
some lOl.j hilcl( d sCtJmFort; h~ad(H~hf:'s h.vr. been mln mal hut has
stiffnr>"s f('"llnn in n"ck: did not qfJt dr>nt~l chock-will do that ove
Chrlstm~s hr',,,:<;' sh" l'Jrollr;ht In :c-r'1ys-hllt not the fJnr>s t.al<en at Car
1s1(' hospltill <lft.('r ~/'Jr1 occlrlr>nt-slJ9,!'d sh(' do that over n",;<t trTp
home; cerv spln(' st.111 showing limited ROM In all dltoctions; Dig?al
tnnrlnrn~ss in llPP"r cnrv ~ lJPP tt10r ~pin~l areas; musc~lar tension i
lumb-llirll mm'8; tr-::oat'. '-:itlnr>; proqn()~;is !It:'Pr.'lS to bp good at prpsenti
(!nntinll'~ t.rp;,t's t,'-li.C(~ 11,,,('1{ty if pn'1:"'ill-J10 for no\tJiL
P.:1t.i0nr. gf:;'lf"J'IS t.n;lt Sh0 );(-,~;rllt. h,l(l onp hPlld;1c:h(~ ~iln..... lllst treat lint.
this morninq .1"tJ'r :-ill" il~rl hp....'Tl llt) For ;nrhiln-intt?nsity a11()lJt. halr
Fhdt it '1d'i l"r'nn at it<; "nl"'''~t' rf'6nnr.lu: il1:v) ~'::I'):~'ripnr:in"'; S'1r'lof~
.".;toM;'\r;h disenmfnrt:; ln~I' ':"r:"~ flr"(l~~ h0f.:n i(()()r1; t,r~',lf", to r:'r'rv llnn thnr
~i,lrl" ",j.t-'r] lir;ht. fnl"('('; rr'['.--d/tt,\
.T)
~
12/9/94
--- t/24/95
2/3
2/tO
2/17
2/24
J/l
CASE PROGHESS
patient. st~t09 th'1t veRd~~~ ynstrrriay sh" was F"C'tlna tight and sorD
In hC'r head i'lnri nn~k wi sam" thrnhhlna in h"'1d qC'nC'ratty; ovC'ratt
has bC'en feeting bC'tter wi t"ss ti .htnC'ss In nC'~k 'Inri few he,rla~ln9;
uppC!r cerv jnts tess fix~tcd 9t1btux;ltnrl-jnint motion improvf'd-h~mpcrl) ,
b~ cerv/shtd muscular tension; CI^SRP, C2PR, 'l'JPLS - alt ~dju9tments
w/ light force; p~tlent l"3ving for christmas brC'ak nf'xt week, atso
doctor leavinq on vacatlon-restlme care end of J~nuarY-'95 when patlC'n'
returns for college classes;-:-:;
)
patient presnnt.lna with h~d ftAadaches for p~st week and ~ half ~pprox.
left u neck es ecialt tiht and sorf'-b~en stee in in different
beds past cpl weeks while on h~l day bre~k; low b~ck bC!en good;
orhto's n~g for root compression or extremity referr~l; rotationall
flexion fixations in upp cerv spine; no facial involvements other that
TM joints still noisy on openinq/ctosinq; dentist did not place much
import to it other than to suggest a possible retaianer in mouth;
DiqPal soreness~upp Cnrv, accross shoulders, upp back; Mopal fixation,
~1.C2, C6, '1'3; C1ASRP, C2PR, C6PL, T3PLS; Cerv-d/t; stretch/massaqe
lev.scan" tr~n" scalnne mm's bllat: 9atient. felt much bntter after;
follow-u 2/3 and 0 to weeJ<l follow-u 9; 0
patient states that shn' s bnen fpelino "not-too-bad"; heil~uatl
better(less often & less intense); en neck soreness shifting between
r ght & left sides; upp cerv ROM much'better; patient claims to be do:
her neck/shld strengthening exercises; treat same; follow-up I wee{j'
patient states that c 1 mornin s a 0 she woke u with neck/shoulder
stiffness, as welt as right LST soreness w pa n extend ng through
whole rt lower extremity but mai~ty t.o knee area-no known reason ~or
onset; (possible student postural & extra-curricutar stresseslstrains
Gaenslen + for Lumb/sac involvment, supine dbl leq raiser + at t5-20
deqrees; spastic lumb-itial mm's, spastic SCM and post cerv mm's;
aqqravation of previous condition in cervlthor; MoPal fixation not~d
Lumb-sa~int; C2PR, C6PL, T3PLS, PT-rt ilium; patient fett much better
after; follow-u 2/17; ~
patient ctaims to hay'? neck d ys
some low back di ~o, 0 since last vi~it
performinq In colleoe nti'lv and having retativns visi.tinQ: has not had
any headaches for ast c 1 wenks; Di Pal soreness u lower cerv
upp tlor, LSI areas; tense mm's-cerv/shtd/upp back and lumb-itial
areas; MoPal fix~tions-unp cory, unn thor soina
T3PLS; Cerv-d/t; Lumb-s/m: Fel t mll("h b,'Hpr
patient generally feeting pretty good-hasn't had headaches since month
aqo; today exnerlencinq soreness in rt shtrl mm's & btwn scanulae;
DiqPat soronpss upp/tower C0rv, upn/tower thoracic soinal are~s;
Shtd deprnssor. foramin~ comprpss t~sts no~; stomach 1iscomfort-prob
clu') to q~n n8rvnus/hyp",r nl~,llr~; ;lnP'1l 1'i::,lr.lnnS-I1!?l?/tol;~r c"rv, UP!?
c'
thar i C2PR, CG P~. I ';l~}LS; ~: r,.'_-1 jr : ('"'*
hn~cl'1ch0s stilt mlnim~t tn nnn-0xiita t; !?0rsi.sti'lnt ft'1r~-u!?s of neck
shld a~hln0ss; stom~ct\ ar~l rlis~om t pain p0r~;lsts-shp has b~en
dir1rJ'd iff P;<:r.'f:SSi sr,nmdC'h j1Ji~0S ,I\, SP,--lsttr.' (l'l~,t-,ri(~ Vr)lvP(i<lhich on~-
(nvr r)
DRS KUMMEL & KEATS, P.A.
290 MADISON AVE, BLDG 1
MORRISTOWN NJ 07960
201-538-2222
TAX ID ~: 22-3212228
PATIENT: 011528 MADIA ,DAWN
01-23-95
PAT BAL:
INS BAL:
OTH BAL:
---------------------------------------------------------------------------. .
SERV C
DATE INV RP S DR PROC DESC
INS A
COMMENT CO C~A PL
LINE INVOICE RUNNING
AMOUNT BALANCE BALANCE
---------------------------------------
052494 1 3 1 2 99204 NEW COMPR
052494 1 3 1 CK CHECK 1501 1 0
071494 1 3 1
071494 1 3 1
080994 2 3 1 :l 9921~ EST PT EXP AETN 2Y 0
080994 2 3 1 CS CASH 2 0
090694 2 3 ~ ~-
090694 2 3
------------------------ -",.1.""1' H.l.b'l'UKY
... TOTALS ..., CHARGES: PAYMENTS.
-10.00
.00
-10.00
.00
ADJUSTS:
....~.......mm.....Q...~=~.=..======..aa.==a...=..~#.=..==.........~.
110994 3 15 2 2 99080 REPORT
110994 3 15 2 CK CHECK
------------------------ END OF
... TOTALS ..., CHARGES:
o
13794 0 .00 ~v
OTu~R HISTORY -------------___________________
PAYMENTS: ADJUSTS:
..~........................
_......=.............~...?...~.........
PARSIPPAHY PHYSICAL THBRAPY
NICHOLAS S. rBDBRICI, P.T.
(201) 884-2066
Name: DAWN MADIA
Address: 11 WINDSOR ROAD, MORRIS PLAINS, NJ 07950
phone:
~20
Doctor:
KEATS
539-7624
contraindications:
Coals:
Dia~rnosis: CERVICAL WHIPLASH
Evaluation and Pro9ress Notes:
6/3/94 INITIAL EVALUATION: This is a 20 year old female who is
complaining of bilateral cervical neck pain and surrounding
musculature as a result of injuries sustained in an auto accident
that occurred on or about 5/6/94. She relates that she was a
passenger in a vehicle that broadsided another vehicle while
attempting to turn. she does not recall hitting the head on the
wind shield, but does remember hitting the head rest. She was
seen at the local hospital for evaluation and subsequently
followed up with Dr. Philip Keats, an orthopedist in Morristown.
Atter x-rays and evaluation, Dr. Keats recommends physical
therapy treatments in the form of modalities as indicated. In
addition, she was recommended to this office by her chiropractor,
Dr. Louis Lorenzo, for evaluation and treatment as well.
More specifically, she is complaining of bilateral paracervical
muscle pain with associated occipital headaches that can become
intense and very defuse. Also involved are the bilateral upper
trapezius muscles and tho paraspina.Is in the dorsal spine and
levator scapulae muscle. She is denying complaints of upper
extremity symptoms at this time.
Physical examination shows a moderate forward head posture in
addition to a moderate degree of muscle tightness and tenderness
in the paracervicals, upper trapezius and levator muscles.
Cervical rotation to the left is approx 70. with resulting pain
at end range. other motions appear to be adequate.
Treatment will be in the form of modalities to the affected
musculature in addition to postural exercises to help re-
establish spinal alignment and reduce muscle spasm. Modalities
may include, heat, ultrasound and massage and auto traction will
be given as tolerated. Treatment will be on a 3xlweek basis
until re-evaluated by Dr. Keats.
-----------------------------------------------------------------------------~
DATE: 07/20/94
LOUIS A. LORENZO, D.C.
359 N. BEVERWYCK ROAD
PARSIPPANY, N.J. 07054
S.S. No. 146-36-4350
PATIENT: Dawn Madia
ATTENDING PHYSICIAN ATTACHMENT
------------------------------------------------------------------------------
97260 Office Visit (Adjustment/s)
06/06/94
06/08/94
06/13/94
06/15/94
06/27/94
07/06/94
07/08/94
07/13/94
07/19/94
9 @
90017 Extended Exam/New Patient 1 @
OS/25/94
90060 Intermediate-ROF with Adjust. 1 @
06/03/94
07202 xray CV (3' Views) 1 @ ,
OS/25/94
tQ)~V
Diaqnodsl
739.1 Aberrant Glob. Disp. Cerv. Spine737.10 Hypolordosis/Kyphosis
Cerv. Spine
723.1 Neck Pain
TOTAL CHARGES:
Doctor's Signature:
------------------------------------------------------------------------------
DATE: OS/25/95
LOUIS A. LORENZO, D.C.
359 N. BEVERWVCK ROAD
PARSIPPANV, N.J. 07054
S.S. No. 146-36-4350
PATIENT: Dawn Madia
ATTENDING PIIVSICIAN ATTACIIMENT
------------------------------------------------------------------------------
97260 Office visit (Adjustment/s)
05/17/95
OS/22/95
72050 Xray CV (4 Views) 1 l!
05/15/95
97012 Mechanical (Cerv. ) Traction
OS/22/95
2 l!
1 @
Dia9ftOahl
739.1 Aberrant Glob. Disp. Cerv. Spine737.10 Hypolor~osis/Kyphosis
Cerv. Spine
723.1 Neck Pain
TOTAL CHARGES:
Doctor's signature:
.
PLEASE
DO NOT
STAPLE
IN THIS
AREA
ATTN. Cindy WatBon
Prudential InBurBnce Company
P.O. BOH 2280
weet Caldwell, NJ 07007-2260
HEALTH INSURANCE CLAIM FORM
~Ef)lt''''O C.IAMPU/i C'.AMI'YA (illlll/f' 'feA or'41'11
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SIONED
U DATI or rUllnENT . IllN!"Pi (FIlM ftwmptoml OR
Mho! , 00 ' 'tV INJlJRY IAcr,ldlml~ on
. 0.619.L-.!!:~~~IL"~__
17 NAME 0' "F:FF.RnINQ PHV~IClIINon OTII!R ~OU"CE
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LOUIS A. LORENZO, D.C.
359 N. IIVIRWYCK ROAD
PARSIPPANY1 N,J. 07054
lZOl13.4.6868
I'INII
(,riP,
FtJIlMttrf^ 1','111
rom,lrWlff'I",II'l
II;'n,,\
r',Pt'IIIltll'.'''1
PLEASE
DO NOT
STAPLE
IN THIS
AREA
,,,,,
ATTN. cindy Wataon
Prudent ia! I naurance Company
P.O. Box 22BO
Weat Caldwell, NJ 07007~2280
,
Ip"'A HEALTH INSURANCE CLAIM FORM '" ^
MIUlC;Anl MFOICAIO CllAMPtlS (lIAMI'VA (,Il{Il!I' 'ICA Illllffll,1I'j'.I111111',llltIIIMllfll "'I.'."'I'M,I""II"'11
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359 N. IEVE~WYCK ~OAD
PA~9IPPANY< N,J. 07054
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f''U:ASE
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359 N. IIYIRwYCk ROAD
PARSIPPANT. N.J. 01054
(201) ,4-6868
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LOUIS A. LORENZO
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FAMILY CHIROPRACTIC CENTER
l~') N, IlI'VI'KWn,K I(();\[l . 1'A1ISII'I't\NY, Nlll/ll~1 . 1111 ll-!clHiJH
July 11,1994
Patrick Geckle
Attorney at Law
11th Floor
230 South Broad Street
Philadelphia, Pa 19102-4190
RE: Dawn Madia
D/A May 6, 1994
Dear Mr. Geckle:
At your request and with the permission of my patient,
Dawn Madia, ! am submitting the following narrative report concerning
the injuries she sustained as a result of an accident on May 6, 1994.
HISTORY
The patient was ambulatory and presented herself for examination
and treatment at this office on May 25, 1994, at which time she
stated that on May 6, 1994 she sustained injuries as a result of an
auto accident. She relates that she was a passenger in a vehicle that
broadsided another vehicle while attempting to turn. She doesn't
recall hitt1ng her head on the windshield, but does remember hitting
the headrest.
8UBJBCTIVB rINnINGS
The patient stated that since the date of this accident she has
suffered from (symptoms uS listed). Dilateral ~a.acarvical pain
associated with occipital headaches that can become intense and
diffuse. Also involved are bilateral upper trapezius muscles,
upper-dorsal pain and shoulder pain.
OBJBCTIVB rINDINGS
The patient is a Spanish/Italian female, 20 years of age and
weighs 130 pounds and is 5 feet 5 inches in height, mentally alert
and cooperative.
Palpation of cervical spine revealed muscle spasms of the
trapezius muscles bilaterally. Pain response was elicited upon
palpation of the shoulder muscle groups bilaterally.
The atlas is right by 3 1/2. The body of the axis is right by 2
1/2 and the axis spinous is right by 5 1/2. The functional cervical
spine C-2 throuqh C-7 is left with a compensated functional
cervico-dorsal spine of right 4.
Cervical r1exion Vie.
unusual stair stepping at the levels of C-4 - C-5 iE observed.
Cervical Ixtenaion Vie.
Unusual stair stepping at the levels of C-4 - C-5 is observed.
This patient suffered a moderately severe hyperflexion
hyperextension trauma to the cervical spine.
Soft tissue damage is usually more serious than bone injury.
Bone heals with calcium which is one of the substances of bone,
whereas soft tiBsue heals with fibrollfl or flear tis<Jue. 'rhe lattor is
different than the original soft tissue. Soft tissue takes longer to
heal than bone tissue and although bone tissue may actually be
stronger after the healing process has taken place, soft tissue is
usually weaker after repair.
Structurally the major area of concern is the upper cervical
spine C-1 and C-2 and the functional cervical spine C-2 through C-5.
These areas are markedly displaced and resistant to our corrective
forces and rehabilitative exercises.
DiaCJnoaiaJconcluaionJ8"mlllarv
the
On the basis of the findings, it is evident that the patient has
suffered the following injuries:
Acute traumatic cervical vertebral subluxation complex.
Loss of motoricity of the vertebral units due to subluxation of
cervical spine.
Cervical subluxation complex complicated by acquired kyphosis.
Treat.ent
FOGt trau~atic management was both corrective and supportive.
Chiropractic treatment included:
Specific adjustment corrections of the subluxation
configurations.
Specific corrective exercises precisely for her subluxation
configuration for mobilizing and strengthening the cervical spine
which will establish a more normal mechanical and physiological
function of the entire spine.
Cervical ranges of motion
Normal
Exam
Flexion
Extension
Left Lateral Flexion
Right Lateral Flexion
Left Rotation
Right Rotation
60
50
40
40
80
80
50 pain & restriction
40 pain & restriction
30 restriction
35 restriction
70 pain & restriction
75 restriction
The Foraminal Compression Test was positive bilaterally for pain
in the neck of the patient.
Foraminal encroachment was positive bilaterally for neck pain.
Biceps tendon reflexes were bilaterally diminished.
The brachio-radialis reflexes w~re dlml.nished bilaterally.
Dermatomes tested by the pinwheel on both arms revealed a
hypoesthesi~ in the right arm.
The Soto-Hall test was positive for central upper thoracic pain.
The Shoulder Depression test was positive unilaterally on the
right side.
The supine leg check revealed a functional short leg on the left
side by 1/2.
The dynamic prone leg check exhibited a right contracted leg,
short by 1/4. Upon flexion of the legs a right contracted leg, short
by 1/8 was exhibited.
poature Ana1vaia
Head tilt with high ear on the right side.
Shoulder tilt was evident with the hiqh shoulder on the left
side. The shoulders were also rotated with the left shoulder
forwllrd.
The hips were rotated anterior on the left side.
X-ray Ana1.vah
Lateral Cervical view
A 190% loss of the cervical curve, maintaining a state of
hypolordosis with the maximum point of stress at the level of C-4,
C-5.
Nasium (A-P) View
(All measurements relative to the center of the skull mass)
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---.. - -- ... -- - --~-- -- f-- - -.. --.-- --
- - - - -- .. ,- ---- ..-- nu_ f--- f-- _u
- - -- " _.-.- -.------ .---- - --- r-- -- - ------ -
.. ,- -- . -- --- .- .. ------ 0--'--- - ---. f---- -- -" .-- .. ------ - --
- ---- -.. --- - - .-.- ~. -.-.-- ,.. -- - - - , - - --- 1----
'.. _. -- -- - ,,- -- -- -- - -- -- -- I---
.. -- -, - --. -'. -- - -.--.-- ,. - - ,-" . - - I-- -, - +- -- - -- - --.
--.. - ..- . -- - .. ,.- - - .-.-.. --- - -, ,,- -- . ., - -- --,
- -- - . - , - -..- -- - . - - - ,. _..~._-_. - - 1- - - - .. --
.. - ,-- . - - -
-- " , - - ]
..- .
. , -
.. - -. , -.-. . -. -- ---- - ... ..--. - .------- -....... . ----- u_ ..
---~._-----...- ,--
-- ...---- -------..----
-- -- -----------.--.-------
-.----.---.-------.---.------ -. ..-----.
.
~
ITEMIZED LIST OF SPECIAL DAMAGES
DAWN MADIA
DATE OF ACCIDENT: 5/6/94
~ TREATMENT/TREATING FACILIIX
5/7/94 Carlisle Hospital
5/7/94 RWC Emergency Physicians
5/7/94 Carlisle Imaging Associates
5/10/94-3/10/95 Dr. Charles J. Zemo
5/24/94 , 8/9/94 Philip K. Keats, M.D.
6/3/94-6/16/94 Parsippany Physical Therapy
6/6/94-10/23/96 Louis Lorenzo, D.C.
1/7/9~-7/13/96 Alan Steiner, D.M.D.
9/28/95 Carlisle Hosp. & Health Services
TOTAL 20% CO-PAY DUE
20' CO-PAY DUE
$ 53.66
13.20
10.00
56.00
20.00
312.00
566.80
84.80
145.40
1,261.86
S -eH tll,,,,,, ~"
.
(717) 245.5500 EMERGENCY
REGISTRATlOII
'7642273:;: ::;,
. Gfliste ~
. ~\O .
201(, !'o.k.. St,..t Co.II.I., PA 17013,0310
.
o 1071t4 01: 23
" ,
111I1\ij"t1",\,:t. -~_._._--~.- -,i,(i.-liiitiiTi...irliw1
NY 05/06/94 14:30
I . 'DAWN I(
UI1' 3'~DSOH,ICOLEGE
. A"Llilfr~p~:'~;~!' 17013
.\,/' 'I' ..1
I , I I 0 1!)(K.nrCtiIJ
MADIA, DAWN k.
11 WINDSOR RD
70
017091 41 204
18
20Y F W S
03/03174
155-82-2600
''''I(p"j iOfl(' 1\11.11
DSON STUDENT
liU-.1ANltlllf>f ,,-mE 1
NJ 07950
155-82-2600
J l' 15QC.lilC.NO (MfnGlNt.vNOIlf'v
MADIA, FRANK
(201)539-7624
· 18
FRANk P.
097387761
MADIA, FRANk P.
18
.r
MOH 'OA VISIT
PT CIO INVOLVED IN MVA AT
1430 TODAY
f 'lIfN Nll
kURLANTZICK, ROBERT L
EN CAR&-1O-ee-SEfotl--IH
SHE DIDN'T KNOW WHAT CARRIER
" R
BRIEF VISIT 25700 CAST ROLL, PLASTER 25075 ALL AOOlnONAL CHARGES
CLASS I VISIT BIP MONI TOR 25037 r "'\ r
I II
CLASS II VISIT 25720 PACER PADS 79054 I II
I I I I
CLASS III VISIT 25730 GASTRO/HEMO SLIDE 25050 '- --___J'-________J
CLASS IV VISIT 25740 KIDDE TOURNIQUET 25048 r "'\ r "'\
I II I
CLASS V VISIT 25750 OCL PER rOOT 79870 I I I I
EXTENDED CHARGE I I II I
25750 rSBS 8008\ '---______J'-________J
EXTENDED CHARGE II 25770 TUBE GAUZE PER rOOT 25074 r "'\ r - -"'\
MINOR SUTURE EOSOI ED STAT UTAT I II I
I II I
MEDIUM SUTURE EOS 02 PULSE OX POXEO I II I
'- J \._ ./
MAJOR SUTURE EOS 03 ALL AOOlnONAL CHARGES "'\ r -....
r
INTUBATION EOS 04 I I II I
I I II I
IV SET UP EOS De I I I I I
CARDIAC MONITOR EOS \1 '----- ) '- J,- ./
r "'\ r-- "'\ r ....
PELVIC EXAM EOS \4 I I I II I
NITRO SET.UP EOS 15 I I I II I
I I I II I
CAST, SCOTCH SflORT ARM 25031 '- _ _ _ _ _ _ _ ___ _ __ _ J \. __J,- -_./
CAST, SCOTCH LONG ARM 25032 r "\ r "'\ r ---....
I I I II I
CAST, SCOTCH SHORT LEO 25033 I I I II I
I I I II I
CAST, SCOTCH LONG LeG 25034 '- __J'-________J'-________./
ER-OeOS IMY, lllUl
11IIII1. Madia, D8Wn
HR 'I 576619 ~I 05-07-94
.
DlDlI3IHnr ROCII IUXXIlD
CIIDr ClllPLADft'I Neck pain after motor vehicle a=ident.
IIIfttIlYI 'Ihis is a 20-year-old wanan who is a student at Dickinson College.
She WBII a seat belted right front passenger in a motor vehicle which was
~o.JlW!loU1lJ forward in the left lane. A vehicle in front of them 1:0 the right
JIIIde a left hand turn arxi cut her vehicle off. Her vehicle went forward into
the .ide of the other vehicle arxi the patient sustained a flexion extension
injury of her neck. As her neck ch~ foIWcU'd am then back, she struck the
t.ad rest behin1 her. 'Ihere was no loss of consciousness. 'Ihe patient had no
pain initially. She developed neck arxi upper shoulder pain bilaterally begin-
ning approximately two hours after the accident. 'Ihe injury ocx:urred at 2:30
this afternoon. '!he patient has not previously had any neck pain problenE.
She reports no neurologic deficit.
PMT IIIlDICAL RIIm:RYI Bronchitis.
IIIDICM'ICIIII None.
ALLmGIDlI Aspirin
IlMlICAL IIDKDIM'Ictl: Afebrile. Pulse is 84. Respirations are 20. Blood
pi. 'Nre is 126/84. 'Ihe patient is amb.llatory arxi in no distress b.1t guarding
all mtIII8lI8Jlt of her neck. Head am neck exam shC1NS significant posterior
oervieal and uwer trapezius spasm. 'Ihere is no lxmy deformity or bony ten-
_I U.. 'Ihe remainder of the facial scalp ard skull exam is normal. 'Ihe
m.t is clear ard nonte.rxier. Cardiac: Nonnal heart tones. 'Ihe back showB
no vwtelral or rNl\ te.rxie:rness. 'Ihe ab:Ianen is soft ard nonterder. '!he
na:rologic exam is nomal.
_ICY DIlPU'11IDft' OOORB!ll '!he patient had cervical spine x-rays ordered
fran triage prior to my exam. '!hese shCM sane straightenin;J consistent with
1pUIll. 'Ihere is sane degenerative cI1an1e b.1t no acute fracture or subluxa-
tion. 'Ihe fiJ.mg are read by the emergency physician. '!he patient was
di8perwed six tablets of Tylenol #3 for hane use.
DDGII08I8l Cervical am trapezius strain. Acute status post motor vehicle
aooident.
'1'RIINDII!:Ift PLANl '!he patient is discharged hane in good con1ition with advice
to rest and use ice packs for her neck for the next several days am to avoid
usin;J heat. She will use Tylenol with Codeine two tablets every four to six
hours if needed for pain. She should not drive while taking this. She may
switdl to regular 'lYlenol as her synptal'lS in'prove. She will follCM up at the
Dickinson student Health Center for any persistent problans after three to
five clays. She may return to the Emergency Department as needed for worsenin;J
synptans .
~
RIJ<'1l:ks
D: 05-07-94 0300
T: 05-10-94
CARLISLE HOSPITAL
!lM!lRG!lNCY ROOM RECORD
NONID
'T c/o INVOLVED'
1430 TODAY
~
o 0
TRANS OHlER
N.
T"'JIj"f;"!j
95026
~,!;
MADIA. DAWN K.
',,'''- "I ..
05/07/94 01:23 20Y W
MEDICAL RECORDS ER.O~08 (REV. 1111.11
I .
, -.i' Carlisle ~
({'J Copyrlglll'
.
.
.
.
fA 2010 1'/9'1
NunSINO DOCUMENTATION - EMERGENCY I CONVENIENT
DEPARTMF,NT CARE CENTER I .
. "'....:.. . /) fA. J/t'L . TRIAG~ NOTE: Dele: .5 /:! /9:1
t'~AME - -~~'-"" _J .' rtlogo Slnlus Mode of Arll\/QI Arrived With
ROOM. -.- AOE _~i) WT '~ I I Pm",ly I I I AI5 I I BL5 I I Pollco II frlond
VITALSIONS TllfE _tl~-'(;)_ __T 3'( Ci. I I P,lo"ly II )'f"f'A"'blllnIOry II Pn,onl [J Family
p 8~_ R .;10 . Bp 1.;1_4'> d'1 )'''''P''O'i1y III I I Whoelcha" ~ell 1I Olhor
.d (''d t I FRSI r,nck LI Gn",ed / (cI'
ALLEIIO/ES' -f'''~4::n~' - Chlol Complnlnl ,II, (j/O., ,"""<"~t'".t',. _."~__n___
CURRINT MEDICATIONS ~-. , htl A, . -:-',' "';: mt - ..,,'" j,=-<'i!!i.!:l
~=:~ w <.;",,~i ::"''{,JK:::J.~ .._
On, 01 Symplom" , I'MD, -J/ " , letv".., .~_ _ .,~
NurSing AcllonlCommenls: (' - LuILt.t.( M;s;Lu.., ~
----- --- ChHlIllood Immunlznllons: U UTO tJ Never rJ _____.. _
TETANUS STATUS: (J WithIn ~ Years Treatmenl Prior 10 Arrival: (I _________.._.
o 5.'0 Vea"
[J More than 10 Vo""
[J Neye,
. GENERAL APPEARANCE
~PULSE:
.gul.r 0 Irregular U Other
ull 0 Week _._, .
I1J;JlP: 0 Sh.llow 0 Aapld 0 Audible
~orm.1 0 Oeep 0 Slow Whee,o
o Laborad 0 St,ldor 0 Aol,aclion,
. T~~~~MENTo:,~:~~~RESS _O~ARR'V~~L: min [I MaMa, - Rhylhm ______ ,_ Aale
O A 0 Or I 0 N I 51 [J O.)'geo - f1 Mask, fl - l1Min ___
Irwa, - a, a,a - ,e _..o.".. I
o Airway, Endot,lchelll- SIze _.______ p__. f/..,'~- LI Spinal tmmoblljlall~ --~r.<1 ~__.__~_____.____
o """a" NalO~achtal- Size ..... _,. LJ MaSI, __....._.._,_. .{,,,\ ______
C IV SoIutr,n Sill.. ..__.._ SI u rJ Pressure OrOSSing J O1her ._
LUM ......1 ........ 0 Rtttt n WI'1..,. Menl., '.....m.nl:
U ... - - 0 AhoneN (I AbUnl Mood'^"Ni
c."."''' LtfI ::l-~ppI'f)()Il"'fP
(I etll"'~'l",
[J[)fo'.",.~
[1 App.n.n.,....
r I n.,'Iet.. Comb"!""1
U Cysnollc
[] Nailbeds
lJ Circumoral
o lace,alion
OEdema
r J Flushed
( J Jl.lundlCed
U f)u'ky
I J Cool
, ) Clammy
U Ecchymosls,_
U Rash, _.._
a R.... o Whfollr.
a_ u Abte"l
,.,... , ,. . 4. .
..... ' Slrl
R.tc1lon _ 2. . ,. .
ltfl. Sill
~A R.ICt~ __ , . . I. .
"",ogM
... p..et.., ~"f'ItKll"
(J'tI~..()otc"ONlfCtfld
r 1 ()1O'''''''fId
rJ~lo~
Mtt,f1Oty
'-'=>'"11Ct
o Impallld
a Flecenl
o OlslanVPssl
-"
.-""Not~L "C1e,r
nSrJont
(I ""'lflv,
n Flepoltltvl
r 1 Mumbllno
VISUI' 'c'I-wlty:
OQ.
OS
rl W,rh orlls!!e'
(I WilholJ! Glasses
rJXN/A
· INITIAL NURSING INTERVIEW: TIME LMP;
REASON FOR VISIT: (j(TFlAUMA [I MEOICAL U PSYCHOSOCIALJEMOTlONAL
PAST MEDICAL HISTOAV: '---:;'<' ~..R~, "- ~~ _____________.______.._.__________.__..
SUiJICTIVE: Cluse at ;jUrylHlslory.~I~P;;;~-n~..il1-ne5-~-fwh~l. the ~all.nllell;;~~-)--~_:;~.6=_::~~:;.~_~~___J~&:~ ~~t..~~~~_;._
,~ ~~~ ,#i '- ~4,..o_~__-L~.:'.,__~.'_ ~__._f ~~.._LC~1_~tr:l_....~_/.'/t.J~\. (<.::;,J~_L.?..t:-
OiJECTIYE: Phy~icallnto'mallon (Wh.;-;~~-,;;a-abl~.t~ ~el--L - _~_' ~;;;:L::2~L2'1,-_=
_~~k-,u --~_~.....J-."-j____ -.c_-----C:.,Cl_LLCLC.__....--.f ~--.!-.';:_____(...~ u_~_ll.-J~__ _ _n on
-.. D ~-.r-~'JJo..L7..~JL.....u_________,,_____________n_____.._______..
PLAN OF CARE;
-------~----~.._------------ -.-..----
[J Mainlain Palient Airway
o Manllar Cardiovas1;:ular Stalus
o IV [J BP Monitor
II EKO [J Cardiac Monllor
[J Safety Measures
1:.1 Restraints (] Suicide Precautions
LJ Seizure Precautions
LJ Side Aails Up
U Comfort Measures
o PAin Conlrol
t Position for Comfort
r repare for Exam
) Explain Procedure:}
( J Emollonal Support
II Plllenl TeAching
L) DIscharge Inslruclions
I Othar . _ .. ...._,
) Other
I Other_
flOlher
PATIENT PROBLEM: Nu"lng Dlagnosi'
__ NoncompliAnt'
._ .. Sell CAft! De1tC11
_~C"om'ot1. AU'ratlon! In
__ CommunlCAllon ImplIlred
_ Coping_ Inelfllcll"e
_ __ Fluid Volume_ Aftllt<1Hon! In
...._. Oil! IhchAngfl, It"pailed
. m __ Tlssll" Perluslrm. All In
___ Skin tnlllglily ImpRlfmenl
____ Thought Processes. All in
____ ~jyperlhetmiA (Fe"er)
_'H In1eellon, Poll!nllnl
_ Injury, F'rHenhal
_. ___ Knowl~gll Dellcl!
.~obili'V Impaired
__m.OthrH
_ Airway Clearance, Inellectt".
__Anlilly
__ Brtatnlng Pall.ml, Inltllechv.
___ Clrche OutpUI, Oeefused
__._._ Ofhe, ...~.____. . _0____. ______._
OUTCO'1,OOAl' "pecled by Discharge.. , ,_ "
u}rt::lJM~~.S~7t/~~~ _t!!2f.~-q'((~i_ "
_~~~':/~~;'~1~;;;'l '. )/[!a.6',~~"
'NURSES SIGNA rURE
..
..
r
N
,-
..
~hree CjJoints Ghiropractic Glinic
'D,. GIY,lel ,fJ. Z,,"o
114 N, Hlnover Sir...
C.,IIIII. PI. 17013
Phonl: 249.1120
May 11,1994
PATIENT, DAWN K. MADIA
DOB. 3/3/74
55#. 155-82-2600
The above named patient presented here on May la, 1994 with tightness
and general soreness in her posterior neck/shoulder muscles bilater-
ally, alledgedly as a result of an auto accident which took place on
May 6, 1994. See patient's report of accident.
Visual observation revealed no discolorations, lacerations or other
abnormalities in the head. neck or upper back areas or upper extrem-
ities. No obvious abnormal flexion, extension, or rotation vas noted
in the cervical or thoracic spine.
Digital palpation elicited significant tenderness in the cervical
paraspinal musculature posteriorly and over the spinous processes and
transverse processes of the upper and middle cervical spine and over
spinous processes of T3 through T5. Notable hyperthermia was felt in
the cervical and upper thoracic regions.
Forward flexion of the neck vas restricted to about 45 degrees with
patient complaining of tightness and soreness down to the upper thoracic
region. Backward bending of the neck was normal but elicited some
soreness in the occipito/atlanteal and cervico/thoracic area.. Side-
ways flexion of the neck was normal with tension. rotation of the neck
was normal to the right and slightly restricted to the left. Hyper-
extension of the upper thoracic spine elicited pain between the shoulder
blades.
Motion palpation of the vertebrae revealed rotational fixations in the
upper and lower cervical spine and right lateral flexion fixation
in the upper thoracic spine.
The pupil, biceps and triceps reflexes were normal. and the patient
indicated no disruptions in vision, hearing, taste or smell. The.e was
no numbness or loss of strength in the upper extremities nawas there
any pain throughout the upper extremities.
X-rays taken at Carlisle Hospital on 5/7/94 were not viewed as yet and
no films vere taken here.
1.
PATIENT, DAWN K. MADIA
DOB, 3/3/74
55.. 155-82-2600
Positive orthopedic tests Included Jackson's Compression Test.
Shoulder Depressor, snd Soto-Hall part I.
Didgnosls, Cervical & Thoracic Myalgia complicated by Vertebral
subluxatlons In the upper and lower cervical spine and upper thoracic
spine plus spralnlstraln o! the posterior cervical musculature.
Prognosis, The outlook !or a rapid recovery Is good.
Treatment, Manual spinal adjustments to the cervical and thoracic
spine along with muscle stretch/massage therapy.
Recommendations to patient, periodic cold compresses to posterior
neck/shoulder muscles along with light active posterior neck muscle
exercises,
D~e to patient's college student status as she Is leaving the area
shortly to return home !or the summer. she will receive limited attention
here, It is hoped she will continue at-home therapy and treatments
with her locsl Chiropractor to restore Integrity to her spine and
parasplnal mUSCUlature.
S;::JjOIY, {}7' 1O~
~~C:)!Y~
Charles J. Zemo D.C.
CJZ/cjz
encI, Itemization
2.
10
75hree fjJotnts Ghtropractic Gltnic
'1),. (JJ""i.. /J. Zcmo
114 N, Hlno... Str..t
elrl;,I., PI. 17013
Phon" 249.1120
March 22, 1995
'l'HE PRUDENTIAL
P.O. Box 2280
W. Caldwell, N,J. 07007-2280
REI DAWN K. MADIA
#38NI4487-050
Attnl Cindy Coulbourne
Dear Mrs. Coulbourne,
This is an update and itemization of services rendered to the above
named patient, Enclosed please find copies of data which was sent to
Mr. Patrick G. Geckle after Miss Madia's visit here following her auto
accident in May of 1994.
The patient was seen here on 5/10/94 reporting that she had been in
an auto accident. She reported sUffering from neck and shoulder sore-
ness and tightness. ..the same presenting complaints she had been
getting periodic treatments for since 9/17/92 as a result of student
and self-imposed stresses,
Miss Madia was examined briefly (see 5/11/94 work-up letter), treated
with manual adjustments to her cervical and upper thoracic spinal
areas and instructed to return on 5/13/94 for a follow-up and to bring
in insurance information whereupon she stated that her friend would
drop off the information on 5/11. She was also to sign an x-ray re-
lease form (so I could get her x-rays from the hospital), and a typed-
out version of her accident report. I never saw or heard from Miss
Madia after the 5/10/94 visit until she called in October of 1994
and wanted an appointment. She presented on 10/21/94 complaining of
soreness in her low back and neck/shoulder areas since recently wear-
ing a very tight corsette for a college play plus rehearsals. Asked
about her auto accident, she stated that she left this area after her
5/10/94 appointment and went home for the summer where she was seeing
her regular family Chiropractor who took x-rays and treated her through
the summer. When asked if these present complaints were part of her
auto accident care shp. stated that she didn't think so but would check.
Her mother called me a few days later and informed me that all bills
were to be sent to Dawn's insurance as part of her auto accident cover-
age.
See enclosed progress notes for Miss Madia's care through 3/10/95. AS
of 3/10 the patient has not had any bad headache problems since late
January. She still has flare-ups of neck/shoulder/upper back soreness
& tightness as previous to auto accident. It is my opinion that she
has reached MMI as regards her auto accident but another repor.tedly
! OJ:? II'!'
~:^..!l!...Ih_J:l~1.:-'t~
.'., ()nn
(' )
\ II?
l1/8
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11/lfL.
11/18
12/2
12/6
(cnrl~I(I)..... ";-1 jt~~ ilt""],, I'~l'-'f~, T(;^nt'.., "T--r"", .~'-;-l'-t'l rll,~'." ://'1; ~I't"'
'l/t,; "'-7
/ '
p.:.t-.1.c;nt ;pr('1r.;r"nt~inq HI fiOt"': n(:,('I-:, h,lr: ~lI:,l(~,-lf~hr:~1 '~~-;i:,('r.'i'lll''''' tiqht,')f,'!1
Up[J n.-'ck!ncr:iput, sor_,:, r,('t',:0nn shollldpr .)l,ld.-'r" r~yr'~': hurt., F. fortin"
p r (:' s 011 r ("l (n t o III P 1 ~~ S " r r~ " ~; f (~e 1 i n q t h i'~ \.,r.] Y i\1j n 1.I t I. il :-; t 'i "1., Y s - P r (I v i 01:
f0.r.lin'1 fair.lY rlD.cr'n"", ~inrl" 1;1St: vi.sit.: hYP('lrt~'tl,q("l ~'~rvlshl":/upn h,lC'{
rr.USClIt.,t.lIrr!i li"it.pr) crrv F.C~l mn:31:1y nllt:' to r,1nl tJ:>n:::;ion; t.'-"nril-~r to
Dlqpill l1pp c"rv, u[JP thor .C[,il1,l I ~Er,H'; Nn!'" I [I :(..UonG-C! ,C:" T~;
C/.PI\, r,\^SRP, 'l'3PLS; C','rv-rl/t.; pi'lH0nt. fplt. milch l'Jrtt,,,r ~~trr adjust.-
rlr1nt,j' ,
t;,1
pi'lti"nt stilt"s th,lt "hr"r! 1~S h,,"n i~i I I Inq hr>r" l~~t cpl r!;,y" "I lot
of pr(?SSIHC' in t(?mpl" anrl occlplti'll linl' i'lr",l~; In'.! ni1r~k/hirs <!nino
good; flar~-up o~ ~niplaRh "ymptnms; trpat s'1m,,-~I^SRp, C:'DR, T3PLS;
Cerv-d/t; pati"nt al\l~YS qt,lt<l~ "hC' [",,10 Immncllatf' r"liQf 1fhr>n her
n,'?c'( i" ~diust<ldlr'''/
patient statC's cnndltinn as prf'vious visit-st~rtecl nulldinG up shnrtl
~fter last treatm~nt; Tr~atm(lnt sam":~ h
:./
Dati~nt stntRfi that Rh0 is fp~lin(r mu~h 110ttnr--sl~pptnq b~tter,
less [reql1nnt & intC'nsn hc.cl~chC'; ocntinu" trn~t.s as provious;
patient. st.at.oR Rho iR doin~ c0rvlshlcl mm exercisC's aR instructed
US1JallY;(fj;
pationt states thi'lt overall she is still feeling better wi less
intense and less frn unnt headaches; experiencinq some left lumb-
sac coren<lss/tightnnss w snme difficulty straightening spine from
sitt.ing or hent foruard positlnn; trC'at samn on cervlupp thor areas;
orthn's nee for luml'J-s~c arei'l rnot com rnssion-mostl h ertense
lumb-ilial mm's; MoP~l neg for fixat.ion sUl'Jluxation; stretch/massage
isch,comp, to lumh-ilial mm's; patient felt much bettnr after;
~atient also states th~t hC'r TM inints h~ve boen noisy after r aske(
h~r ah01Jt tIer jaws; as sh~ is as sh(~ is going hom~ for Thanksgivving
crea!( from school. r suoo'lII sh0. have? hAr dpntist ch<lcl: hf!r out for
~ny TM clisord"r plu brins b~ck any ;c-rays with her from her primary
treatinc chirn ractor-Loui" Lor"n~o'
;]tif~nt hrlc1-,: from school l;r0alc-r.laims ..() hp. fp.elinq "not-too-had";
some lOT., hack d scor.tfort; hn.ao;.1c les hdV~ hn0n mlntrrlal hut has had so
stiffn<lss fC'elinn in nrc~; did not q0.t dent'll chock-will do that ovp
Christmas l'Jr"~k;'she l'Jrought in ;c r~ys-h1Jt not thC' ones taken at C~r
ls10. hOSplt~l after ~/9~ accicl"nt-sugg'd ah0. do that over next trip
-nome; cory spinC' sti tl shcJ\1inci I imitC'd ROM in alt directions; DigPi'll
tr.!nGCrn0SS in uppr:ar- c(1rv ~. upp t,hnt' :::;pf.n.11 ar-0as: muscular- tensfO'rl i
11Jmb-iliA! mm'8; tr-?~t s~nn; rr()qno~is 50(~mS tr) br good at present;
enntinIJ(:a tr0~t's t'lic0 'J0~!<].Y if pos~i~10 for nnw;{
nati~nt statps th~t Sh0 ~~~n't h~(l nnf~ h0nrl~(~ho sin 1~5t treat unt
thi" morninq ,1r-tr~r ,5)1" ilho l']Pn~ Fnr o1l-lhllc>-lntensity 2,l,nllc half
t. t: r (' '" n ,t- t <:: ' . r: I'" ':' t- f"l n tv. r :-"i () 0" I"):" r-' 1 C n r'; s n r" (1
. 'd' h I ~,r(l;l~. ~,n r.",rv ?n~t nr
fJl_On,lr:rl . tsC'omfnrt:: In'l r;;l",:'~ rlr0;"J':::; (l('n rrnnr: . "I 1 r..nf
~.j(H'p I,ft t-,h 1 ir;l"d: fnrrr; Cr'~\'-d/t._ t-\
. ()
12/9/94
--- 1124/95
2/3
2/10
2/17
2/24
3/1
C\SE PROGRESS
patiC'nt St'1te9 that YPRtiF~a yest"rday Rhe was frC'llnq tiGht ~n~ sorC'
in hpr hpa~ '1nd nnrk wi "o~e thrnbhlnG in he'1d generally; nV0r~11
has bC'en feeling better wi less ti htnC'ss in nC'ck i'lnd fr>w h0a~'1chps;
upper cC'rv jnts less fix'1tC'd sllbluxated-joint motion Imprnved-h~mpere
b cerv/shld muscular tension; Cl^SRP, C2PR, 'l'3PLS - '111 adjustments
wight force; p~t ent lpav ng for christ.mas bro~k next wC'ek, also
doctor leaving on vacat.lon-resllm~ care end of January-'9'i when patlC'n'
returns for collC'ge classes;:;
~
patient presentinq with barl fteadaches for Pi'lst weC'k and a half aporox.
left u neck es eclall ti ht. and sore-been Sleeping In different
beds past cpl wC'sks whlln on h~l day bre~k; low bi'lck been good;
orhto's neg for root compression or extremity referral; rotational/
flexion fixations in upp cerv spine; no facial involvements other that
'I'M joints still noisy on openinqlclosing; dentist did not place much
import to it other than to suggest a possible retaianer In mouth1--
Oiqpal soreness'upp cerv, accross shoulders, upp back; Mopal fixation.
Cl,C2. C6, '1'3; Cl^SRP, C2PR, C6PL, 'l'3PLS; Cerv-d/t.; stretch/massaqe
lev.scao., treo,. scalpne mm's hilat.: 9atient felt much better after;
fOllow-up 2/3 and go to weel<ly follow-ups; ~)
patient statps that shp's br>en fpC'lina "not-too-bad": headache situatl
better(less often & less intense}; (en neck soreness shlftin between
right & left sides; upp cerv ROM much better; pat ent claims to be do:
her neck/shld strengthening exercises; treat same; follow-up I wee r
atient states that c I mornin wi th neCk/shoulder
st ffness, as well as right LST soreness w pa n extend ng through
whole rt lower e;ctremity but mai&ly to knee area-no known reason for
onset; (possible st.udent. postural & extra-curricular stresses/strains
Gaenslen + for Lumb/sac involvment., supine dbl leq raiser + at 15-20
deqrees; spastic lumb-illal mm's. spastic SCM and post cerv mm's;
aqqravation of previous condition in cerv/thor; Mopal f1xation noted
Lumb-satint; C2PR, C6PL, T3PLS, PT-rt ilium; oatient felt much better
after; follO\{-up 2/17; ,-,
atient claims to "bad" in neck ys
some low back discomfQr.; bpen lIndE'" a lot of strE'lSB since last visit
performina in collE'qe olav and havina relativps vtatting: has not h~d
any headaches for past cpl weeks; Oiqpal soreness upp/lower cer~
upp thor, LST areas; tense mm's-cerv/shld/upp back and lumb-illal
areas; MoPal fixations-upp cerv llllll .t.l:lQ( ~oi al arpa C?EB ('fi~
'l'3PLS; Cerv d/~,; Lllmh-s/m: ;,'It'mIIr'h h,.t.-,pr ~~tPr' ;o~;nW_llp', lU> ~
p~tient genE'lr~tty f"eling pretty good-hasn't had he~dache'~ since month
ago; today experiencina soreness in rt shl~ mm's & btwn scapUlae;
OigPal sorenrs9-upp/lnwE'lr cerv, upo/lnwer thnri'lcic spinal areas;
Shld dC'pressor, foramina C0mpr0SS tr>sts na~; stonach discnmfort-oroh
rll10 tn ~0n ncrvnl,I~;/tlY]J0r nltllrn; ~r0P~1 fi:{~ti0ns-upp/law0r CArY, upp
c '
thori C~PH, CGP~" '~'J:-'L:;i r'r'! .-l/t.: /-
he,lcl.,chr,o sl:i.ll ~inim,'1 to t'nn-r>:d\it.Alt; pr>rsistant ft~r,,-ups of neck
shlrl ~chinnss: ~;tnm~r~\ ~r"l rlisrom~ t paln p~rslsts-shp has h0~n
rllvl'rl ",,"j P;{("f':iC; ~')t,()m,lr'll J~P:'l ,(. sp,lst-,ir: (r'lsl:rir; v,llve(l.;hir;h onf~-
( nver)
DRS KUMMEL & KEATS, P.A.
290 MADISON AVE, SLDG 1
MORRISTOWN NJ 07960
201-538-2222
TAX ID #: 22-3212228
PATIENT: 011528 MADIA ,DAWN
01-23-95
PAT BAL:
INS BAL:
OTH BAL:
---------------------------------------------------------------------------. -
SERV C
DATE INV RP S DR PROC DESC
INS A
COMMEN'l' CO C#A PL
LINE INVOICE RUNNING
AMOUNT BALANCE BALANCE
---------------------------------------
052494 1 3 1 2 99204 NEW COMPR
052494 1 3 1 CK CHECK 1501 1 0
071494 1 3 1
071494 1 3 1
080994 2 3 1 :t 9921~ EST PT EXP AE'l'N 2Y 0
080994 2 3 1 CS CASH 2 0
090694 2 3 r ~-
090694 2 3
------------------------ ""'1'\ 1 J.t..I~"1" Hl::''l'Ul<Y
*** TOTALS *** CHARGES: PAYMENTS.
,
-10.00
.00
-10.0n
.00
ADJUSTS:
.=.~=...a.=...=..~.=......==.==========CU========~~4==a.a..a...a.a.._
110994 3 15 2 2 99080 REPORT
110994 3 15 2 CK CHECK
------------------------ END OF
*** TOTALS ***, CHARGES:
o
13794 0 . 00 ~,J
nT~ER HISTORY --------------__________________
PAYMENTS: ADJUSTS:
........"..........~........
-.........~..=...a...aa.............u....
PARSIPPANY PHYSICAL THERAPY
NICHOLAS S. FEDERICI, P.T.
(201) 884-2066
Name: DAWN MADIA
Ad4ress: 11 WINDSOR ROAD, MORRIS PLAINS, NJ 07950
phone:
539-7624
MJJu.. 2 0
Doctor:
KEATS
contraindications:
Goals:
Diagnosis: CERVICAL WHIPLASH
Evaluation and progress Notes:
6/3/94 INITIAL EVALUATION: This is a 20 year old female who is
complaining of bilateral cervical neck pain and surrounding
musculature as a result of injuries sustained in an auto accident
that occurred on or about 5/6/94. She relates that she was a
passenger in a vehicle that broadsided another vehicle while
attempting to turn. She does not recall hitting the head on the
wind shield, but does remember hitting the head rest. She was
seen at the local hospital for evaluation and subsequently
followed up with Dr. Philip Keats, an orthopedist in Morristown.
Atter x-rays and evaluation, Dr. Keats recommends physical
therapy treatments in the form of modalities as indicated. In
addition, she was recommended to this office by her chiropractor,
Dr. Louis Lorenzo, for evaluation and treatment as well.
More specifically, she is complaining of bilateral paracervical
muscle pain with associated occipital headaches that can become
intense and very defuse. Also involved are the bilatera.Z upper
trapezius muscles and the paraspinals in the dorsal spine and
levator scapulae muscle. She is denying complaints of upper
extremity symptoms at this time.
Physical examination shows a moderate forward head posture in
addition to a moderate degree of muscle tightness and tenderness
in the paracervicals, upper trapezius and levator muscles.
Cervical rotation to the left is approx 70. with resu.Zting pain
at end range. Other motions appear to be adequate.
Treatment will be in the form of modalities to the affected
musculature in addition to postural exercises to help re-
establish spinal alignment and reduce muscle spasm. Modalities
may include, heat, ultrasound and massage and auto traction will
be given as tolerated. Treatment will be on a 3x/week basis
until re-evaluated by Dr. Keats.
------------------------------------------------------------------------------
DATE: 07/20/94
LOUIS A. LORENZO, D.C.
359 N. BEVERWYCK ROAD
PARSIPPANY, N.J. 07054
5.5. No. 146-36-4350
PATIENT: Dawn Madia
ATTENDING PHYSICIAN ATTACHMENT
------------------------------------------------------------------------------
97260 Office Visit (Adjustment/s) 9 @
06/06/94
06/08/94
06/13/94
06/15/94
06/27/94
07/06/94
07/08/94
07/13/94
07/19/94 tQ)~Y
90017 Extended Exam/New Patient 1 @
OS/25/94
90060 Intermediate-ROF with Adjust. 1 @
06/03/94
07202 Xray CV (3' Views) 1 @ ,
OS/25/94
Diaqnoabl
739.1 Aberrant Glob. Disp. Cerv. Spine737.10 Hypolordosis/Kyphosis
Cerv. Spine
723.1 Neck Pain
TOTAL CHARGES:
Doctor's Signature:
------------------------------------------------------------------------------
LOUIS A. LORENZO, D.C.
359 N. BEVERWYCK ROAD
PARSIPPANY, N.J. 07054
5.5. No. 146-36-4350
PATIENT: Dawn Madia
ATTENDING PHYSICIAN ATTACHMENT
DATE: OS/25/95
------------------------------------------------------------------------------
97260 Office visit (Adjustment/s)
05/17/95
OS/22/95
72050 Xray CV (4 Views) 1 @
05/15/95
97012 Mechanical (Cerv. ) Traction
OS/22/95
2 @
1 @
Diagnosia r
739.1 Aberrant Glob.
Cerv. Spine
723.1 Neck Pain
oisp. Cerv. Spine737.10 HYPolordosis/Kyphosis
TOTAL CHARGES:
Doctor's Signature:
.
PLEASE
DO NOT
STAPLE
IN TflIS
AREA
ATTN, cindy Watson
PrudentiaL Insurance Company
P.O. Box 2290
West caldwell, NJ 07007-2290
HEALTH INSURANCE CLAIM FORM
'JEOICAIO CH"MPUS CHM"PVA lillol!l' , f C^ OIHFJI
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SI(jNED
SIGNATURE ON rILE
DillE
01/02/96
U DATE or CUllRENI ~ III NI!'lS IFttM R\,"'plom) OR IS IF "IITtI::NT H^,i 11110 511,,4f' un <;IMll^,IIILN~ ~';
MM , 00 ' n INJURY 4Awrhmll 00 (jIvE Flfl'H OlifF "-'M Oil y'f
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17 NAME OF nEFE'RFUNQ PH'fSICIIINOR QrHfR !;OUnCE' .iJIl . 0 Nii~.llimi:ir-nFrF..ii;iltlll f.i~Ysti:it\N"- .
19 RESH1VEDFOAlOC^lUSE
21 DIAGNOSIS on Nil' URF. OF IUNE 55 OR 'NJI)flY IRE LA TEl rEMS I ;?.:ion4uiIlfM ;J4F n-;; I ~li)-=---=-l-~.'-
I L1J9.~ Aberrant Glob. Diep. C 1 L_,___
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359 N. 8rVERWYCK ROAD
PARSIPPANY. N.J, 07054
(2003.4.6868
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PL~ASE
DO NOT
STAPLE
IN THIS
AREA
Weet caldwell, NJ 07007-2280
HEALTH INSURANCE CLAIM FORM
I.'....
ATTN. Clndy Wateon
Prudentlal Inlurance Company
P.O. BOll 2280
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PANSIPPAN'. N.J. 07054
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FAMILY CHIROPRAC'l'IC CENTER
,1") N.IIEVI'IlWYCK IIOi\I). l''''ISII'I'ANY, NJ I)/ll~,l. Jlll,\H,(,H(IH
July 11,1994
Patrick Geckle
Attorney at Law
11th Floor
230 South Broad Street
Philadelphia, pa ]9102-4190
RE: Dawn Madia
D/A May 6, 1994
Dear Mr. Geckle:
At your request and with the permission ot my patient,
Dawn Madia, I am sUbmitting the tollowing narrative report concerning
the injuries she sustained as a result ot an accident on May 6, 1994.
HISTORY
The patient was ambulatory and presented herself for examination
and treatment at this office on May 25, 1994, at which time she
stated that on May 6, 1994 she sustained injuries as a result ot an
auto accident. She relates that she was a passenger in a vehicle that
broadsided another vehicle while attempting to turn. She doesn't
recall hitting her head on the windshield, but does remember hitting
the headrest.
SUBJlpTIVI .INDINGS
The patient stated that since the date of this accident she has
sutfered from (symptoms ~a listed). Bilateral paLacarvical pain
associated with occipital headaches that can become intense and
diffuse. Also involved are bilateral upper trapezius muscles,
upper-dorsal pain and shoulder pain.
OBJICTIVI .INDINGS
The patient is a Spanish/Italian female, 20 years of age and
weighs 130 pounds and is 5 feet 5 inches in height, mentally alert
and cooperative.
Palpation of cervical spine revealed muscle spasms of the
trapezius muscles bilaterally. Pain response was elicited upon
palpation of the shoulder muscle groups bilaterally.
The atlas is right br 3 1/2. The body of the axis is right by 2
1/2 and the axis spinous s right by 5 1/2. The functional cervical
spine C-2 through C-7 is left with a compensated functional
cervico-dorsal spine of right 4.
Cervical .le.ion Vie.
unusual stair stepping at the levels of C-4 - C-5 is observed.
Cervical ..teneion Vie.
Unusual stair stepping at the levels of C-4 - C-5 is observed.
This patient suffered a moderately severe hyperflexion
hyperextension traumd to the cervical spine.
Soft tissue damage is usually more serious than bone injury.
Bone heals with calcium which is one of the substances of bone,
whereas soft til3sue heals with tillrollfl or llear tisllLle. 'rhe lattol' is
different than the original soft tissue. Sott tissue takes longer to
heal than bone tissue and although bono tissue may actuallr be
stronger after the healing process has taken place, soft t nsue is
usually weaker after repair.
structurally the major area of concern is the upper cervical
spine C-l and C-2 and the functional cervical spine C-2 through C-5.
These areas are markedly displaced and resistant to our corrective
forces and rehabilitative exercises.
DiaanosisJconclusionJ8umaarv
On the basis of the findings, it is evident that the patient has
suffered the following injuries:
Acute traumatic cervical vertebral subluxation complex.
Loss of motoricity of the vertebral units due to subluxation of
the cervical spine.
Cervical subluxation complex complicated by acq~ired kyphosis.
Treat.ent
Fost tra\l:~atic management was both cor::-scti './0 and supportive.
Chiropractic treatment included:
Specific adjustment corrections of the subluxation
configurations.
Specific corrective exercises preciseIr for her subluxation
configuration for mobilizing and strengthen ng the cervical spine
which will estab1i.sh a more normal mechanical and physiological
function of the entire spine.
cervical ranges of motion
Normal
Exam
Flexion
Extension
Left Lateral Flexion
Right Lateral Flexion
Left Rotation
Right Rotation
60
50
40
40
80
80
50 pain & restrIction
40 pain & restriction
30 restriction
35 restriction
70 pain & restriction
75 restriction
The Foraminal Compression Test was positive bilaterally for pain
in the neck of the patient.
Foraminal encroachment was positive bilaterally for neck pain.
Biceps tendon reflexes were bilaterally diminished.
The brachio-radialis reflexes w~rc dIminished bilaterally.
Dermatomes tested by the pinwheel on both arms revealed a
hypoesthesia in the right arm.
The Soto-Hall test was positive for central upper thoracic pain.
The Shoulder Depression test was positive unilaterally on the
right side.
The supine leg check revealed a functional short 1.eg on the left
side by 1/2.
The dynamic prone leg check exhibited a right contracted leg,
short by 1/4. Upon flexion of the legs a right contracted leg, short
by 1/8 was exhibited.
Posture Analvs~
Head tilt with high ear on the right side.
Shoulder tilt was evident with the high shoulder on the left
side. The shoulders were also rotated with the left shoulder
forward.
The hips were rotated anterior on the left side.
X-rav AnaLvsis
Lateral Cervical view
A 190% loss of the cervical curve, maintaining a state of
hypolordosis with the maximum point of stress at the level of C-4,
C-5.
Nasium (A-P) View
(All measurements relative to the center of the skull mass)
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.. .. i ~ -I.... ........" ................
~ ~ ~ a ~ CD In IC:"''''U "'''H/''A
" ~ ,.. ..,....-,~~........,....,....
.... .,. rl.. ~ -' a -'ilia i'" ....i'...'
: ,,; .. ~IHI:;j ~~ ~:;~~ '" iR- il~ I~ss~ I
.... ~~3~ ~
... = Ql~:;~
~ ! .... ~ .... Q..... 0. a.
.. ..'" ~~f ~B,~2g~!.5,~Eg9~
.. wi",,'" ~~:3~
-' !;S~ .... N ........, ,-'I-...... ................~ ...................
'8 .. .....c .....~~N~N~ ~o~~~~
~ in 1!:1!::!1'8
... .... ~ " ~3~Sm~ OeD ~OO~~~~
iC .... ~ .. ....................... .......... ""~ "'''' ~~'" In 0
i! co.,_"" ..... ............... ..... ~............... ...........................
... ...... NNro"IO ~~~;~~.o~..~ro"I'^xx~~~
8 ~ ~:c ......................
.. :?;:?;:;2! =~~~=~~~:~~~~~~~~~i
.. ....
9/~7/_92
\0/'
'0/2 9
! \ / \ 7
21',1/93
2 1t8
4 /2 ~
9/14
10 It 2
10/28
1 1/5
-- 2/18/94
3/9
4/27
5 I 1 0 I 9 ,I
10/21
C.\SE I'lll)(jl{ES~
(! )
r:1'J11'?1'~ -'=1'1:,-1,1""" ~I""_" 't, ~h.) '-r",:-.I,.. 11.....;.... If........ h1t' "'.(",' .,.,......
'\ n: ,1 ~ j 11 -: 1':: n ': r. ~'~ ~ F I) r :' - !:' -; ',: " ,~r 1'. ~ tl I' ,- r I': ~ r:''',: t:? '= r. C ':: ~ L, - ": r-.
L 3 r: tiC I - t:' r., F:' - r 1'.; ,'} '; n m ~ ,~I. ': ': . I r.) r I! _ .t It: ~ ,1 1 t: '.~,~ t ... '':\ r :~ (f t ,.... r : (7
~:l 'S '1" 0 -! II n t i 1 : ,.t.1' "" oJ -: r) - .. ': rJ 1 ,l" ':'/:n -: t: f1 r.1'~; r-: '/., r .: ' 1 ~ t: r .'1 ';" t: "'!..:'....... ~ f1 ':1/~
C 2 P r., c 7 P t, r ~ D, L? t: t, p r - r, ii, ~ - 1: '1'~ n r.\ m ,1 In <!. ~ ': C -: r'/ - :il t : "I..~
^
t' t ::: i 1 e 0 f n'~ c 't' s rJ t':>: 5 Q r'~, t: I 'j"" t ,1'-: r: r (') ::; ~ t 'j ',,' ~.} <: '(: ~ i r fie t'H,~ '/ i n
l:r~,]t~in;: Cl,ll,C;F.!:', 'T'J1\nt" T.:", r.7_r, ,'':-1.fl:: Cer':-~/t: lum~-str...~t(''11
mlss.::lq"?: fell: bp.tter ;3;ft0t'; .c~".
, : 'Jf-:')s c
ta1 ~~a~a=~@5 l~t~ly: ~~t'1 lOll ~~r:~
~. a s ;:- e: n 0 K: C '? n L, C! AS;! t'l, ~ ~::"-;' T,? 1"'\, . ~1 - r t ,
Cerv-d/t: flp,t muc!" ):-ottl?r ,,~t:t.: ~
overall aC1.iness;~ tiqr-tr.'?:~ ~ue t~<."r.erl/''::u~ tF"!nsi~n: esr: ;:!C~... nec'<t/,'S!;1
areas; C2Pr" C::!J~, TJl\~e..; T.llml-:-sWC8rv-c/t: ff.~lt "'ctt~r after: )
/)
lot o~ mBnt~l/~~~tian~
Cl.\St.P, T5Pi Lu~l:-s/rn:
F. I} r- r:: t: \-, 0 [" ::' C i C 5 i \-. r F; ~ t \.,. f ;-, ::
~~-l'~: lum~-3trctc~/~~:~1
nec~/s~ld ti~~tnes1/sor~ness; Freq hea~~ch0Si
~5tresses lat~ly at scho~l: lc~ l:a~c O~: C2FL,
cerv-d/t: !F:?lt mu,:h cfl?tl:pr ~f'!'.t:;!:': (~
S C h 0 1 a s tic / e x ~ m ~ t r ''? 5 s; ,.. ~ '1 ..; a c "', ': s; t:.~ h t, 5 tJ r ~ r. '2 c ", s" 1 ~ ,
A 0 L s t r ass e 5 1st r a i n :s: C 2 ':) t, C:" t, ~~:~: c ~ r ',0 - ~ It:: '. I; ::\ "': - s / r.t :
1,; i= 9 >: ~ c',,::
~ Q 1 t mt:.-: \.;
t:ett~r ~(ter: "
bac~-I:o-school; u~ent/~:ct!:'J curricul~ ACt stresses/strains-~~inly
sore, t i q'" t n e . shIes, u r= p 1: a c l{; 1 0 ~j j. 0' k hilS 1: e ~ n ; 0 a d i () S rr. ~ hI'"'! il rj -
a f1' h e s; C 1 AS R p, C 2 ? t., C S P p., '~5 P: C e r 'f - -: It; t ~ 0 r - 5 lor t h Q I ~~ "::2"! - r:: ~ t i <: .
! e 1 t m u c h b P, t t III r ,,!' r, e r: n r') - ~ 0 1 1 0 'v - 11 t::' t r €1 t per f 1 'i r ~ - up; s:--:
(5
tiaht, sore nekc/shlds/u:::c 1::,1r::... '..;1 headaches; lot of SChO(I! creS5ure
plu$rehearsals for school play thl. w.e~; flxatlons-upp ~erv & mid
thor; ...ClASRP, C2PI, T5P; C~r'l-~/t; sin/cran m'1~s,: <;:i...
h"!! 3 d a c h e s, SO r l::!, t i g h t n e c k, 5 h 1 d s, u t: ~ i': ,1 C k: c ~ m i ;..;; I r) .:s s t r a s ~ h i g!'-,
at school; !iYatlons-upp/lo~ c~rv, mld-thor, C1KSI?'/C2PP, C:Fr~
T10PC;' c"r~,,("'1,/m1CC~"'Q !'iht.-i/"'h~" mm'c:: ro:)['v_~/~: (~tt: mlJCn b~".t~r 2~r
~ias good Itil 2 days aao-'..c''':t? t:p ';II stiffness in n~cK:-tj,ll1i".ed rOt'/,,;rior
bilat; fixations, tenderness-u~,/lo~-I c~rv & mid-thar are.)!3: orthO"1
n e;: u!? P e:< t rem I 5 goo d; C 2 ? L, C 5 ? R, T 4 Ant.: C'? r v - -1 It; f e 1 t m IJ c h " ~ ,t't .
just finished anocher schaal clav; e~Deriencina hearlaches, neck/s~l.
& low back soreness; student cnRtural ~ e~tracurricular stre"ses;
C2PR, T5P, TIO?LS, AIR sacru~; si~e costure stretch of 1ft O.L. mm's;
",prv-I'l/t, fpl~ (J()()n I',ftoor'O
sore, tiaht neck/shld arq~s, e;ccerienaina sare thrnat w/ lot of cough-
in recentl .. .getting over "colc"; 101'( hack been good; fixated u!"P C
cerv, mid-thor area; C2?R, T3PLS; Cerv-cl t; gen nm massage; felt bet';?
A. c h y, t i ~ '" t n e ~ 'J;; I '5 h 1 d :i / U ;J t= l:: '! ~ '(; lJ, 0 t I ::i t lj :! '? n t ~ t: t' "1 S '3 ~:5; non ~ a d ~ c h ~ :5 ; ,!)
fi:<ations-ucp/lower cerv & u~9 th0racic soin~; C2~L. C5PR, TSPRS; Catv
d/t:.; Felt milch better ~fti~r; ~-z--
p :.l t i ~ n t "":t sin aut 0 a '= c i C ~} n t U '5 1 t? I g.: ("1 '"! ~ r ~ po r t 0 f fin din -j :.; ~ ;
d]1r1vatlon/1mpli!icatio~ ~~ ~r~vi~IJs tl~r~-I:~ cQn~itlons: tOJ hac~ C
CIA~HI=, C~FR, TJ"tS: C~rv-~/~;~l'~'.,_,,,,,...., <::/11, C
!'JatiAnl: ~:~;J~t"il!nctn'J qnrer.~~~ i~ In'l l~;a~'" (-:n~ r:.~r'!I'E.~ ~ ~1rE:~~-V0t"y l:,~'
-:'t" to Ol'lP211!; 10~1~[" thnraC1CSi Si': '1.13 hl,?,J.rtnrj a tl~.:nt:. c()rs~:t:.tD rer.:':..'r:
1:' ~or cl'lll'2"'J~ ~l.].... plll~ r~~Al!r"",'l'l; fi'(,lr.inr.-:;-l;-;r, I>"r'r, lrrr(lr t-.~',nr,
(r,':.:, r )
~!".Dl-!~'.J~,i '11'
., I)""
) 'Jr'IJ '''1\1\' ~r r> ,'S-'o' "t,' LUiT1\~-s/n.' CIC~r.'
IO/21/'J) (,o"nt',' I. ';.( :r:1 .It"."., I' " ,;, ,... -..'L
_._~._-~._----... ....-- -.----.---
'I/t, ':1____.__
I)
p.l't- (71f\T~';r:_:'~;;ttr;y-") ~;Ilr" nl~I~I-: I l;,l(~ heac'aches, est:eciallY tiqht ,dch
1Ii:r: l\f-I"\<: Ill'l'l pllt. I ~lr\r,1 h't.'J'~0n uh0ulclcr sladcs, eye::: hurt 8. feel in6
i;r;!~'ii:-,:;-r~___.c-;-'I'l~: r'~:l ~ r.l.l"iJ f .'\l~ L i. n':! t.h i s tfa y a 00tl t la s t ~ "a ys- p reV11J11
o..0,'.....IJJ!.:!_.!.:0._UL_.:~~~~.... 1.1:, t v I si t; hvpert'lnse co! rv/shlc/Uoo cac',
mlJnr"lti\t.lltl!1 lir.,\t,I'rj r.'t.!rv pf)~t mrl:''itly r.l.1C to r.ua ter.sioni t~nrier to
---~I-iTl-j'"fil-~i-,-:;i-;-':"~'-r-v~--;I-~'i')-t,hr)r ripin;ll ;)lir?,l~j NDPal Ei;~ations-Cl,C2, T:::j
-- c 21'R:"('iX;:;rT;-;"'fl'j1[;';;, C', r v - d / t; p,Jt I en t f e I t much l-Je t t era f t~ r a c' j us t-
~f.)' ----.----.
-' ., .--.-,
"I'
11/n,~;ltl"n't';L\T,,:\ t.h,lt. "h".1'1 h,1:1 hn'!n !dllinc; her" last cpl days HI lot
nr rrp~~~~.!:.~!!..-~~:.!l:lp ;\nd n(:(:lnlt.ll line areas; lo'., back/hies doine
<lCJf}d; rl~..:!L_~" lilllpl.lnh "ymptnms; treat saml'?-C;ASRP, C2PR. T3PLS;
('"rv-d/t/ t''ltlpnt, .,IIIi1Y,O "t~t'!:, "he feels ir:lmediate relief t,/hen her
n fl r~ I": t ~t n d j II n ~. ',. rl F / tl'l"1
.. --,/
["1t,ll"~::,t."" "'Hlr!ltinn ~-; [Jr<1ViOllS visit-started "uildina up shortl
nf't-.f!r \'-I',t. t,rp,)t,r,lr.lnt,' '~'r01lt-,mpnt samp.;C ~)
./
p~tl"nt Bt~to~ that ove~all she is still feeling bette~ w/ less
IntenRe Hnr! 1'l59 (recuent headaches; ex eriencinu some left lumb-
9;"7 "r.rnn"';'l t 'Jhtn"ss \,' some difficulty straightening spine from
--.----;::-rt.t.lr,(: nr hJ>nt. ('HI/.1Id poslti<ln; treat same on cerv/upp tho~ a~eas;
"rthn~-'l'l.:.: rnr \lIml,-s~c are~ ~<lot c<lr:1oression-mostly hvpertense
l~,~~hoill"l mr:l'r'; H<lP,11 neq for fhation/su"lluxation; st~etch/massag€
1:';(lh"!.:',m[l, t,n IlImr.-!.llal mm'r;; patient felt much hetter after;
_L~,.!:.t~!:.. f) 1 '-:n nt'.:'j".~~-l th.lt. h~r T:'>.t ;oints have been noisy after I as1(eo:-"
h'lr tlhnllt:. hr~r j;:Hl.s; as shC? i5 as she is going hor.t~ for Thanksgivvir.~
r.r";l'~ (r'1m ,,(:h'1ol, I suna' Ii "h.) hav"! her f.entist checJ: he~ out for
Any TM dI9nrr!~r plU ~rlng bAck any x-r~ys vit~ her from her primary
_ t.rp,lt.ln'l ('II 1 ropr'l<::tnr-Louis r.orenzo~
vatl"nt. ha('~ rrnm Hchn<ll "lr'lak-claimsl <l he feeling "not-tbo-bad";
--,or;nmf' Ln'''' h.1c!~ rl i.~jr.nr.1t:Grt; h~ad~ciles aye be~n m1.nlMal but has ha se
I'ltlr(ni'"A '...."Ilnn in n'lck: did not cet dental check-viII do that avo
Chrlntmal'l hrea~; Hhn "lr<lught in X-~~ys-hut not the ones taken at Car
IsI" ho"pLt~1 after 5/94 accident-sugg'd she do that over next trip
11()"'.~; c"rv sp~ still sholdnc; limited RON. in all directions; DIgPal
t"ndnrnnsn in uponr cerv & uoo thor spinal areas; muscula~ tensio~ j
llimh-lll,,1 111m's; tr-:!at sar:le; p~ognosls se<!r.1S to be good at present;
r.nnt.in1J'~ t.rj.:;'\~.'5 ~.'"ir:~ U1=?~klv if os:;;i\;le for nO'ir;L
~'Itlent I'ltaten that she h~sn't had one headache sin. last treat unt
thl. mnrn!.n~ ~'t~r "hn ahd h~"!n UD for awhlle-in~ensity abollt half
ll..h...lt. it- h'J'J '!:r."l,Cln ,1.1- tl-<': "'11""<:1- r~pClnt-t'/: .q10:;1'") ,""!:~1')~rt~nrinG s()r,1t:ry
~;I'J)M,l(~h di"i(~nrnE()rt:; l()~r b,;]r;',: ar.:?.:}~ hpt=?n (1()('F~; r.reot to cerv and thor
';,Irl" '1ith lifj~lt f0r(:~;; Cerv~.d/tV'\
-..-.-..--....---...-..--... ! )
II/J
: I /1:
11 / I r,
11/18
J 2/}
12/fi
_.l2.:'lt..l.!l1.lt--LLtil.~~t, nhp iri E~\(~lino Mll~h b~tter--sl~~ninq b~tt~r,
lfl~l~-: rr(lf1\I..'nt F. int.(~n~..;F' h0;:d'-.c:h~; ocntinuCl treat'fj as previous:
[l,'t.lnnl: Ht..1t,,,:; :;hn Is <loin'; car'l/shld rcll'l exe~cises as instructp.d
IJ~III :~~ I E~li
( n-':: r. F'c S )
12/9/9.1
1/24/95
2/3
2/10
2/17
2/24
3/3
'.,\} ';:
._J.~
(3 )
C.\SE PROGRESS
patierlt stnt(~~ tll~t Y~)R~F~~ yesterday Sh0 ~:ns feelinc tiaht 2n~ snre
in har hp~~ ~n~ np~~ ~/ sn~e throhl::ina in head aenerallv; overall
has been feeling better w/ less tiahtness in neck and few he3daches;
upper cerv jnts less fixated/subluxate~-joint motion improved-hamper.
bv cerv/shld muscular tension; ClASRP, C2?R, T3PLS - all adjustmen-ts
\{llight force; patient lea'ring for christmas break next uee~.;, also
doctor leavina on vacation-resume care end of January-'95 uhen patie:
returns for colle9(~ classe2;~; /
i7
oatient nresl'!ntina \lith bad rl'eadaches for oast l{el'!k and a half aooro:'
left upp neck especially ticht anc sore-been sleepinc in different
beds past cpl ueeks while on h~liday break; low back been good;
orhto's neg for root compression or extremity referral; rotational/
fleXion fixations in upp carv spine; no faCial Involvements other the
TM joints still noisv on ocenina/closinc; dentist did not place much
import to it other than to suggest a possible retaianer in mouth;
Ciapal soreness.ueo cerv, accross shouldl'!rs, ueo back; MoPal fixatior
Cl,C2, C6. T3; C1ASRP, C2PR. C6PL, T3PLS; Cerv-d/t; stretch/massaae
lAv,~"'an., rr?l:')" sra.'~n~ rnrnls hi.1'li.~ n;:::t-lpnt:. fptt" mllcn bpt;"~r rlFt-er;
follo'l-ue 2/3 and co to l{ee:',lv follo,,-uos; (...,..1,
(J
oattAnt:. ~t:;:jt:P<:; t'h2~ ~hp's l-JnAn fp,:-ll ina "not.-too-badn: hA;"jdar":1~ situa:
better( less often & less intense); aen neck soreness shi ftine betlH,er
right & left sides; upp cerv ROM much better; patient claims to be de
her neck/shld strengthening exercises; treat same; follol{-UP 1 l'1eex.
J
atient states that c 1 mornines aao she woke uo with neck/shoulder
stif~ness, as well as right LSI soreness w pain extending through
whole-rt lower extrl'!mitv but mai~lv to knee are3-no known reason for
onset; (possible student postural & extra-curricular stresses/strain:
Gaenslen ... for Lumb/sac involvment, suoine dbl lea rais,:.I '..at 15-20
dearees; snastie lumb ilial mm's, soastic SC~ and oost cerv mm's;
aaaravation of previous condition in cerv/thor; MoPal f~xation noted
Lumb-sa~jnt; C2PR, C6PL, T3PLS. PI rt ilium; patient felt much better
after; folloll-U 2/17; <=
patient claims to havA "",,', "bad" in neck sh d. a r y,
some 10'. back discomfor ; l::Apn "","PI:" a '0' ()f ~rrp~~ since last vi:!;it
performina in collsae olav and havinn rpletivps vi~irlng: ~.~ nnr ~.d
any headaches for ast c 1 weeks; DiaPal soreness uoe lower cerv.
upp tor, LSI areas; tense mm's-cerv/shld/upp back and lumb-ilial
areas; Mapal fixations HOC cerv, lIDt') thot" sninC'l.l ar-~::l~~ r?pp
T3PLS; Cerv-d/t:.: Lllmb-g/m: fpl t- Mllrh l. I!-I-~r ~ff-P"'. ff"'l11nt.r_l1r 1 '.I~)Pk'
patient generally feel ing prl'!tty good-hasn't had headaches since manU
aqo; today experiencina soreness in rt shld mm's & btwn scaDula,,;
CiqPal soreness-uno/lower Cl'!rv, uco/lower thoracic soinal areas;
Shld deoressor, foramin~ comoress tpsts npo; stom3ch discomfort-orar.
due to gen nervous/hypl'!r nature; MoPal fixations-upo/low'lr cerv, uop
thor; C2PR, C6PL, ,3?LS: C'?r<r-A/t: .S-'
headaches still minimal to non-exi~ta t; persistant flare-ups of n'lcl
shld achiness; stcnach area discom t/pain persists-she has b'l"n
dlaa1d wi eXC8SS stomach juic8~ & sp~stic gastric valv~(which on~-
(o'rer)
MAnl~l_.D.'.l,!t.I.r: ,
:: l OqH
(<1 )
1/1/9~ (ennr.'d) IIni<nn"n), nrnh m,l'/ r,,, rlllo 1''1 r"'r~i~t~nt- linn t-.hnr s,,;,,'1
r5r)rl~n'~~,~s or C.lllsino it-she's aoina home fot" sorine breal{ sGon-T ..li.!.!.2..9"
shn talk to her rcqular family chiropractor about x-raying her thoraci'
Rplnl~ for no~~~ ~i~c/nprv ront crab:: In~ h~rk 0nnrl~ nr~hn'~ ~Q? Fnr
cnrv/thnr r00t cnmpression; no extrem involv; TN disorder persists;-
nlCIP;i 1 tl!nd,)rn",;s-uco/lo\/er cerv & uop thor soinal areas; Fixations-
upp/1Q~nr corvo upp thor; C2PR, C6PL, T3PLS; Cerv-d/t; patient felt
mlj(~'h h~ttrJr ;Jft~;ri
l/lO
ndt["nt. st"tp" that er nec'</shlds hav8 b"!"n verv aoorl headoches only
oGc.1R"ion"l brief tension headaches; main oroblem is stomach discomfor
.lftnr I"I,l..!Jnn-;'}f: ,,(mAs .sf=:!p.ms Horse: still v~rv tpnrtpr ~o niaP;tl b~wn
t;1:ap"l.1e on spine; had disocm:ort llith rt lo'.er extrem last nieht-
ortho''i."nrl RON tests in LST and thiah int n",a for patholooy, rt lee:
shnrt .15 h.1S b0.en many times nrecious II/Ollt svmotoms-eClve her 1/1fi" he
11,t', ff)r rt-. fnot-~1Pn.r: nlcrp.:ll ~(}rpnpc:;:c:: 11r'lt"l t-h()r .:lTlnllpr. rt=:lrv~ r?OR.
'r,\1\nt-. ~r1 1'10:;": 1 p~,,; 11...... ;:tnr4 c:pri n'1 'h1"~~1(' np"'<'r 'olPQ\r' ~7;:j ir,
~\ frr'rl vp r. ar'r sn e a d thAn Dossibtv oat
Intnrn~l mAd exam of
-1LLc-~"nt. nresentina 1// aeneral necl</shld soreness alone riaht side-had
__---rlLL-minnr heCldClches since last visit; sh"! hod med check while home
rncnntlY and WClS diae'd w/ stomach ulcer--is on medication for. it;
ninpal tenderness-uoo cerv, uoo thor(much elss tender than previous),
[~I arna~, ~0PClI f{XCltions-uoo cerv, ucC thor; C2PR, T3PLS; Cerv-d/t;
Lllmb-ilial mm ~trpt...h/MClssCla",; felt much 1!1I better after; to ld...E.!:!.t.ie,
.. , I' ~ . urCl c'l comoanies and la~ver that I feel she has
rnach'ld a point orior to auto' accident; / .
"'p~r {f'n: states that after IE'avine on 4/l'?lat.gr that day he::- 10'..r bac'.:
bC~Clmn achy for allhile an~ then disaooeared., .th",n on 4/11 she became
sore betwenn shoulder blades and her rt neck/shld area flared-up(duri:
disc'l~~ion shf' rpmemhero.d sh" hClrj bppn 'HGstlina Idth bOYfriend on
4/10, forClMina cOMO t"sts n",c for cp,rv root comoression/raciculooatry
no other accidents/traumas; ROM limited in cerv spine due to tight
cerv/thor mm's; DiaPal tenderness uon cerv. uOP thor; hios/lees level
MnP;:t1 kCl:ldl:::i 1!;~~;:lt-;fjnC:_l1?n r~rv, 11?P thfjl'" c:nin.:.3.t ar-PClS: Cl~SRP. T'3?LS;
Cerv-d/t; cerv/shld/uoo back mm stretch/m~ssaqe; patient claimed to
feel much hetter after; follow-un on 4/14 (she wants to be in ood Eh
"....r~' aht 0: 4 ,I /;
"/1 ,1
4/21
oatient stat~s that sh~ has been fe ine "real oodl' since last visit
lrok", UP this mornina 11/ very sore rt nec:,/shl'l areas-sIlO had "restless
nlcht sl",eolne, tossin0 around. ~ossihlv uotieht al::out her sincina
rpcital at colleae toniaht; no heo~ach'ls until sliGht one developed
thic; r.1r')rnin....,.~ 01'10,11 snr~n~~s-11~D rp["v, rt cerv/shlrl rnrrt's. UPO that"
spine; ~till exn~rien~ina 5o~e stomach distress, ~til1 an "ulrerll
mo.dicine, cati",nt finClllv ores",ntprj x-rays from lat year concernina
l,P'r" ,::lll~r"\ ~,....,...;..-:lprt(~i'l""!<::: 'rl'JCl. T"'lr. rr-.rAr.70 ;lnr. ('arlisl~ Hosnital); Mc!?a.
([xClti'Jns-u')'J c~rv, uoo tr.or soln,,; lGli bac'</hi:Js/lr>cs qood; C1ASRP,
T3PLS; cerv-d/t; trClnsversa/lan~iturlinal frIctIon massage ra thoracic
.& r.'''9~ sh'l"~ m11sr:l1t;)f-,11rp>: fplt' 1'T11jrn t;Al-l-nr ;:jFr.~r:
,.
(n>-~xr,;Jf1~~ )
4/28/95
5/5
8/2 9
8/30
9/4
1 rt /,
C\.SE PROGRESS
natient h,l::-': 'h:nn ~pOol;n'l c:!-nl,"'rllt'"11'... v.....!"'\' 'J"n"; r,"1C:!- '~""","lnlr ",..1-;1 "''''Tl
days acro ~..,hf::n "t)ll~rClil:~:; st,lrt0r1 kickinrr lltJ" r,111sinl"'! hn.l';,lrhn~ :'!.",,,
1ft cerv/shld soreness: stom3ch discomfort minim~1-5till on the ma1icJ
had flare-up of low back p3in one eV'lanina which W35 aone n'lxt mnrn-
ing; DiqPQl t"ndernass-up" cerv,' upp th()r~cic spine; NnP31 fixaitnns-
occiput ~nd upp thnr spine; Occip-PL,.-:rJPLS; Cerv-d/t; Sinlls/craniill
massacre; patient felt better aftar:~
patient's mQin =omolaints are parsistQnt stnm~ch snreness and low b~c
soreness; neck/shld not too tnd ~ltho!lah the v fA~l "tiaht an~ ~~hv~;
no traumils/med prole's 0r schnlilstic oraSSllres this C~f;f". """Ie r""dv to
00 home for summ':r vacation; DicrPa1. tenderness-Ilpo cerv, 1l0D thor, LSI
areQS; ~loPa1. fixations-upp cerv, upp thoro S-l jnts; C2PR, TJPLS,
PT-rt. AS-1ft; Cerv-d/t; Lumb-s/m; ( ~
patient presentin~ wi sore, tiaht n~~ and h~~~~ch~~ ~ t~ ~1~~~
posture stress--main pain=temple ar,~ ~ wI pressure i~ front!1 and
o c c i p L tal 1 i n ear: e i'l Slt.'1 tie n t be: c k (r 0 m 5'1 m m 8 r h r: ~;') '-( '" r') r'" ~ 'I m,:) co:) nil) r
year at colle~e; Thoracic pains and stomach prbb under conl:.rol(re-
diagnosed medically as stomach muscle spJsms); no other tXHmas traumasl
med pt"cbls sincoe 1.<151: vt~it~ Oiapal t~nrjern...~s~ uoc/lo',.,er nec'<~ Cl"!I:'V RO~
nor m l,f / c e r '/ / s h 1 d m m t i cr h t n e s s; 0 r l:. h o~ 5 n e 'J' for roo t com pre s 5 i ti nor
radic~Lopathy: MoPaL fixations upp/Lover cerv Iping: Treat.adj C2PR,
C6PL; Stretch/malsac~~~rv/shld/UPP thor mm's: patient feLt much Loose,
and pain free after: (t~
/ )
'-"
patient stated she fglt good for about tvo hours last evening then,
neck got sore and tight again-intgnsity not quite as bad, DigPaL/MoPal
as yest~rday plUS soreness in T~ area esp rt massater/tem9oralis mm's
along v/ loud CliCking in TM Jnts cn opening/Closing cf mouth; Treat
same as yest pLus adj T3PLS and massaged/stretched masseter mm's,
assisted oral closincr, and massaqed sinuses and frontal/~aggital
sutures; patient feLt much tett,?>_.after: Sugg'dpatient may need cral
appliance to reduce TMJ stress ~~
^
patient presenting v/ bad heada~e, sore neCk, vas easing up after
8/30 treat then fLared uo aaain evenina of g/l: friends toLd her that
she vas valking as thcugh she vere "drunk" (svaying)--has h.d epiSOdes
cf dizziness & equiLibrium disturbance, Mouth/Jaw areas been OK;,
Pupil reflex norm. EP-112/6": ortho's neg for root compression/
radieuloeathv: DicrPal soreness-uDe neek(eso alano rt aceio/at/ax areas
lOl,fer rt neck, upp rt thor areas; MoPal fixations-upp/lower cerv spine
upp thor spine, Treat'Licht tooele adjust w/ thumb/index finaer on
atLas trans proc's w/ patient in prone position, T3PLS. C6PL(prcne pus
C2PL; patient faIt marked imct'o'l after: SUIJ(1lrj shp. crc ho;n~ ~nri l"F"llax 0
roll. e d - u P to'. e l. u n d ern e c k for 20m i nut e s; ~1
_patient presentina w/ n~nQral necl~/shld ach~"es~/tightness; headaches
disappeared sudd~nly several days ~qo-she h3d CT of neck at Carlisle
Hos~ shortly after Last visit as he,daches did not abate and they
neg for osseous or soft tissue in~olv; pJti~nt did obtain a cervical
supine traction kit and hJS uS0d it twice st~ting that it did make her
neck feel be~ter..I S1J]0'd she continll~ using it r~g111arly: OigPdl
( () ':'~ ::- )
10/2/95
t:i~Q.I~!-_,P,~:i~_~ .
~L0ge
( 6 )
l'Kld:.,U
1 2 I I
12/5
1/24/96
2/21
3 I a
( C' en t I d) ~ P. n d IJ r n..... ":i ~l (1111 fHi t n 11": ~ / 1 "..... F' ,.. ff' c: I'" n ,.. ~ ,~ -0 I ,.,. [J
upp ~erY mm'SI mino~ t~nderneS9 not~l! 1n intra-splnolJs proc~ss ~C~~Q r
13/.11 MoP~l fixations tound-upp & Lower c~rv spinel Extrem inv~Lv n~q;
Heildach"?!3. other ~ t"]'. P,lt", n<1S"1 or thrl1,1t: tnvolv .1h"iF'!'nt', c.." v Q ;'"
bk ext norm w/out pain, for flex norm wi u~p cerv achiness, l~t (le~.
norm "I tight mm (eelin'), rot;ltion rt n'Hm, 1ft 40 da')l (oramin,} comr:
wi rt 1,lt (lex produce"" ~~()rl?n~SS in u~p n'~ckf 'l'rertt"='.ldi C2::'R, C6PR,
strotch/mass,l<J" cerv/shld mm's, shld/uFF thor mm's. So lumb/ili.!l Elm's(
dlJ~ to minlJt", "brif1( low b.1Ck aChiness); no follo',oj'-up t'lt;hQduled;C'.
10/26 '""iant ,re,entln'! "I tl"ht/achv nakc/shld/ur:o cac:, mm's, t ckll
throat, gf'!ttinq over hn,1ri cold wi nasal.1 cong"1Gt/dripl (ce'lS "t'.Cqht"
In ch~str Lumq 5~unrl5 norm: Cerv ROM norm wi mm tiahtness, DloPal
tendern'~~s-upp n~c~, llpp thor spine/mm'51 McF31 fix3tions-upp cervi
upp thor 5pin~: Terat~~rlJ C2PG, CIASRF, T3Pt.S, 5trQtch/m~5~Jge ccrv/sh
I up P b a--;; r. m nl ' 5, 51 nus I (~ r.1 n i a 1 m.] s 5 a g i?; 5 U g '=1 'd hot s how e r I r. u n r: 1 in 9 - u P
5'" e il tin g 'j u t res t 0 f to x ins: - .-? .,/
/)
v
Patient pres~ntinq wI sore n~cklshtd5/ucp tack--has head, sinus conge
-ion, has sneezinq fit cpt days ago; Neg. (ever or GI distress; Has
been very good since 10/16 tr~at; DigPal soreness-upp/lower neck, uPF
back spine/mrn'si Mopal fixations-upp/tower cerv, upp thor spine;'
Treat:adjC2PR. T3PLS. stretch/m,}ss~cerv/shld/upo back mm's, sinusl
cranial mas~,age; folt much ebtter aft.er: C .-7,,-
Patient pre~entina wi 5cre nA':k & ucc~r b~ck-~ ad ~ad niaht 5l~eping
after seeing horror movie and wo~e up in Myp'~r fetal position wi netk
stiffneSs1 Cerv ROM limited to 45 dogrees rnt3tion, 45 degrees forw
(exion, bkwrd ext abt 40 degrees "I Fain; OigPal soreness ur:F/lower
neck & upp back, Mopal (ixatcons-upp/lo"er cerv & upp thor spine;
Treat~adj C2PR, C6PL, T3PLS, stretch/,"as~age cerv/shld mm's'
Patient p~esentina wi soreness across shlds & in neck, ccass.h adach~
past (ew days, Slipoed on ice alst nicht landing on rt side ru~o
catching hersel( "I rt hand/arm, Can has been pretty good since last
visit, No other tralJmas/med.orob's since alst visit; She claims her
TM Joint has been making louder noises recently wi pain on "snapping"
Neq. oraanlc/extrem lnvelv; Di"Pal s~neSS-IJOO rt neck scinp./!T1m's, rt
lev.scap. mm, mld rt trap mm,.2.E..P thor spine; Mopal (ixacons-upp cerv
upp thor spinal areas, Treat:adj C2PR, C6PL, T3PLS. stretch/massage
cerv/shld mm's, isch.comp.-lev.scap. & mid rt trap mm's; Aqain stress'
she should gat T:-1,] "ork dona a(ter qraduatinq in May;C~
!7
Patient presentinq "I sore, tioht neck/shlds "I oain extendinc to righ
supra-scJpular and upper arm ar~as--5tarted two d~vs aqa wI no sop~ifi
e t i 0 1 0 g y; A 1 S 02 f? C n ex per i e n c i ~ 1 ~ 0 m~"! s tom a c h P ,1 1 n s 1 il tel v: 'r M.J i. s
mare noti~abty noisy mor~ oftqn: ADr. stress~s/Atr~lng--m~nt~l/~mn~lanJ
stresses amplified due to st<lrrinr'J in u~cr)min'1 col~ plnv/mu'3i,..:J.l:
OigPal tenderness-l1oP neck mm' s/'ioin~'"!, r~, :;hlrl/(~~""!rv mm' c;. uo" I"nnr'
spine/mm's: ("(,)r"/ ~()~ nf'lr.m .// ......~_.,'"..."..r~ mm "'n,..nnn~"" MnP~l 'lv:t"{nn~
U p pee r:' v :3 C i n e, 10 Ii C r:'! r v :'; p i. n 1:1, Il rJ t) r. h () r s c i n ~: T r ~ -, t :: ,] d i C 2 P R I
,..
CoPt, T1Pf..S, ~tr~tr:h/m,".~'1,l"~ r:nrv/'1htr! mm''i: F~~tt'. milch b~tt~~r: afte't
Patient pr~sontinq wi 5nr:~, ti~ht n~c:(/Ghld:;/upp bacf; 5tomach h~s
c../
b f1 0 n "l:' " ri" r F1 t': ,... n '" tv, 01 ~ t rlt; ~.... ,... ! t n'1: ' . . f n.., , i n "I b.1" '" ~ n n .;/: ~!" .-Lr~,1 5
me<1. prr"J'r ~ 0; ~ i nr;f.'l 1,' "t', V i "~; ~r"'r;:_~..it.':..t..!'--1...~'~',...:.----D..l.-;:...r:....:L~a..t:,\n,1<':~ 11~
( n I ~ :-: t'. ~,' cl r;~! )
C.\.5E Pi\OI~RE:)~
( 7 )
, I A I q n ((" n rl ~ I A , J 1 ,'" '.[ "" po "" (\ ,.. " ., ,.. ,.. t" 0: q .~ h 1 rl m m. ' '1 I t ... r ~ .1 ,.. k 01: l'" I !"In / m ~ I ~! (" P r V
RO~ norm wI endJstretch mm GOrenQ3~r Moral fixations-upp c~rv, lover
c~rv. upc I:I,nr Reinal ~rp;IRr 'rro~t~,l'lf C2PR. C~Pt, T3PLS, T6PB~;
s. r". r. h 1m., " " ., "" ,.." r v I" I, t <I m m ' S t:/~)
-: / 1 .1 P J tit! n t ere s ~ n tin r: W' / n ~~ (' k :.i 1'. i f (n 1~.'3 S & h f).l.! ,] c h ~ 5 .1 n rj d i ( f i cut t 'I
inhalinq--voke 2 days J.1Q wi con,1iticn--possLbl~ staerin1 postur~
involvment; No traum.ls/m011.prob; IS; stom~ch feels ~~tter than last
visitr Just w~nt throu~h h~r~ exam W~ck at coll~ae prior to sprina
:/16
3129
4/l9
5/2
bre~~: 'An~lsis/~r~a~mnn~ a~ prpViOlJ31
.'
- )
p ,,. i " n t p r" 5 e n tin q w I 50 r P., S t i (f n " 1:1,'15 hId s P 1 Us" bad e had a c h e s " ,
She puts bl~me. on v~ry 50(t m1ttr0s~ ~t motel durinq sprinn creak
1 a 5 to. ow ~ e k, N e '1, P.:< t r f"! m i to. y /1') r (1.1 n i c i nile Lv: C e r v R 0 ~ nor m '.I I t i f1 h to. m m
soreness biL~tr Or~h~'~ n~~ for ~i5C ccmcr0~sioni Di~p~t ~ryrpnp~q nee
!' h L d m m t 5 h i 1 " t: r; 1 'J l' .. ~ n.; p r i n t: r " 9 " i n Q fl ~ ~ 'C " ('" P!; i n '1 ~ l'" .. h ('") r' 0: ~ f n ~ :
MoPat ri:<~tions uoo/t~w~r c~rv Rcin~, u=c thor 9~~~Ret scin~t Trp.at=
--1l2 I CIA S R p, C 2 P R, ~ ~ P r.. T 1 PL S. s. r 0 . chi m a 3 5 a gee e r 'I Ish 1 d m m ' s ,
pc" F1 ..
" >
"
'"
n t .. ~ r ;') , ~. P r' " c=~.
Patient present in? '.II ccntinuin n~ck/shld S'~ t!ness, $OrOn055 &
on/off he<1dachcs: An.l1vsis/Tr(},1tmnnt S,1me as previous: Pat;ient c--
Claimed to tenl much ccttar <1tt~r treat--1lso had treer, greater RO:
Patient J::resentina wi mitd n~~c:.t tichtn(!ss/::rrenI'Jss 1:!JC: f' . c:f',.-. _h
d 1st res 5 (([ n din; it h.\ r d to k e 0 p (c 0 d do '.f n. has no. bee nab 1 e toe 3 t
pro!=erly last~eek or 50); ~:er;J, hf}]rtturn sym~toms, nea, 1:o'.{et or
genito-urinary distress; Some coccyx scrness(she claims pess bruisin;
trom sittinc on hard sur!ac~ a lot recentlv; Orthe's nea, tor radicul
i.is oz root compression s,mptoms; Cer'llts RO~ norm wi end-stage mm
discomfort: ~o traum~s/m~d.prah's since IJst visit: PossiblY from
llnerves" as she's undAr tot of scholastic and selr-impossed stresses;
OiqPal soreness alonrJ occi~ linc_, up~' cer'," spine/mm's, UCI: to mi-i
thor soinf)lls nr~r":~'iSI"!'S: NaP"t fi:<fltions-ucc cerv sein~, ueo tn()t'
s pin e I T r " a t = a d j C 2 P R. II: 6 F r.. T: P t S, T 6 P P S, s t r e . chi mas 5 age c c r v Ish 11
mm's: Friction mJS.~JrlF:! to shl':!/upr; that' m:n'si She c:raduates .5. teaves
this ar~~ in ~n()thAt' m~ntn--"l~ry'd she h~v~ her hometown doators
cheCk her tho~ou~hty whnn sh~ a~ts aeek home: -t
/)
......
Pat t P. n t tl res P, n t 1 n'1 'J/ / n '? r. k /!i 11 t o-i / II C 0 1:., c k so r ~ n A tg s 10:; f' . , , n 1'1 c; <:l ~., '" r'" e s e
- 1 Y a he a d a C h tJ: S I:. 0 m a c h h a 5 1::.~ tJ n m u c h t ol} t 1'; t:'J r 5 i n c e h Q r m I!! die lJ t') I: her
a new medication rocently; She claims neck/shld/bacK/headache mainly
due to stresses of cotlege ~cnior exam ~eeK prep; No traumas/m~~"prot
otherwi:Jel Neq, orlJ,lnir:'/~xtrf}m involv; She clrlim~ <llse th:t" c:1'HI n:\rj a
episode o( pain id 10(. T~ Join., plus rt 'r~.7 is still very noisv,
Cerv RO~ n~rm '.II mm str~~t'.ch r;:,ltn: For.,'lm.Cnmo. ntl:!c:, (or r"nrt r'"l"lmrP"Assi
DIgPJl soren~n~ n~ck/sht~ mmls, uuo/lo~~r carv scin~, v,lrv "~M~P~
ala n '1 . c c i pit all in." u p p tho r in. .. r s pin 0 '1 ssp a c . 5 I MoP a 1 (i x a ...L2. n 5 _
uPP/lo'J/f}r r:.~rv 50inl'"'l,' uap t'.hnr. sninn: 'PRF,\T--:,lrJf Cli'SRP, nf"!"'!fp_pr.
CliP R S, T 1 P [, S, T Ii P ~ s, ., ": r ~ ~ (~.h..L...n.:.L:'i .~ .1 .; A r' ,~ r ./ / '~ h 1 ri m ~ t ~, ~ I"" , ~ t': In., m'~ 5 J "]
to s h l ~ / lJ pot h f) r m rn I "i: A!ll t '1:'1 il.:L2 m:j S '; .1 ';'~ "! ., n 1 1 Ii h .. 1 " Tn f"l "'ll'"'l rt ,:\ ~ II P
"
T~ 1()in~.~: N<1 (<11L<1."....111"J ~...\ooo~.,.I'lln.-j:~
. _I )
./
May 11. 1994
PATIENT. DAWN K, MADIA
DOB. 3/3/74
55.. 155-82-2600
The above named patient pre.ent.d here on May 10, 1994 vith tightness
and general soreness in her posterior neck/shoulder muscles bilater-
ally. alledgedly as a result of an aoto accident vhich took place on
May 6, 1994. See patient'. report of accident.
visual observation revealed no discolorations, lacerations or other
abnormalities in the head, neck or upper back areas or upper extrem~
ities. No obvious abnormal flexion, extension. or rotation vas noted
in the cervical or thoracic spine.
Digital palpation elicited significant tenderness in the cervical
paraspinal musculature posteriorly and over the spinous processes and
transverse processes of the upper and middle cervical spine and over
spinous processes of T3 through T5. Notable hyperthermia vas felt in
the cervical and upper thoracic regions.
Forvard flexion of the neck vas restricted to about 45 degrees vith
patient complaining of tightness and soreness dovn '.to the upper thoracic
region. Backvard bending of the neck vas normal but elicited some
soreness In the occipito/atlanteal and cervlco/thoracic areas. Side-
vays flexion of the neck vas normal vith tension, rotation of the neck
vas normal to the right and slightlY restricted to the left, Hyper-
extension of the upper thoracic spine elicited pain betveen the shoulder
blades,
Motion palpation of the vertebrae revealed rotational fixations in the
upper and lover cervical spine and right lateral flexion fixation
in the upper thoracic spine.
The pupil, biceps and triceps reflexes vere normal. and the patient
indicated no disruptions in vision, hearing. taste or smell. .Theee vas
no numbness or loss of strength in the upper extremities na vas there
any pain throughout the upper extremities.
X-rays taken at Carlisle Hospital on 5/7/94 vere not vieved as yet and
no films vere taken here.
1,
'0hree Cj>oints Ghiropractic elinic
'1),. eh.,I.. 8, z"mo
114 N. ~tano'" Strut
CI,li,I., p" 17013
Phon" 249,1120
March 22, 1995
THE PRUDENTIAL
P,O, Box 2280
W. Caldwell, N.J. 07007-2280
RE I DAWN 1(, MADIA
#38N14487-050
Attn: Cindy Caul bourne
Dear Mrs. Coulbourne,
This is an update and itemization of services rendered to the above
named patient. Enclosed please find copies of data which was sent to
Mr. Patrick G, Geckle after Miss Madia's visit here following her auto
accident in May of 1994,
The patient was seen here on 5/10/94 reporting that she had been in
an auto accident. She reported SUffering from neck and shoulder sore-
ness and tightness.,.the same presenting complaints she had been
getting periodic treatments for since 9/17/92 as a result of student
and self-imposed stresses. .
Miss Madia was examined briefly (aee 5/11/94 work-up letter), treated
with manual adjustments to her cervical and upper thoracic spinal
areas and instructed to return on 5/13/94 for a follow-up and to bring
in insurance information whereupon she stated that her friend would
drop off the information on 5/\1, She was also to sign an x-ray re-
lease form (so t could get her x-rays from the hospital), and a typed-
out version of her accident report, I never saw or heard from Miss
Madia after the 5/10/94 visit until she called in October of 1994
and wanted an appointment, She presented on 10/21/94 complaining of
soreness in her low back and neck/shoulder areas since recently wear-
ing a very tight corsette for a college play plus rehearsals. Asked
about her auto accident, she stated that she left this area after her
5/10/94 appointment and went home for the summer where she was seeing
her regular family Chiropractor who took x-rays and treated ~er through
the summer. When asked if these present complaints were part of her
auto accident care she stated that she didn't think so but would check.
Her mother called me a few days later and informed me that all bills
were to be sent to Dawn's insurance as part of her auto accident cover-
age.
See enclosed progress notes for Miss Madia's care through 3/10/95, AS
of 3/10 the patient has not had any bad headache problems since late
January. She still has flare-ups of neCk/shoulder/upper back soreness
& tightness as previous to auto accident. It is my opinion that she
has reached MMI as regards her auto accident but another reportedly
('15hree CjJoints Ghtroprllctic Glinic
'D" C!/sa,I., ,f/. Lmo
114 N. H.ne... St.UI
Cull".. P.. 17013
P~eno: 249.1120
August 6, 1996
MYCHAK GECKLE WELKER & THIROWAY, P.C.
230 S. Broad se.
Phila., PA. 19102-4190
RE, DAW~ K. MADIA
Attn: Mr. PatriCk G. Geckle
Dear Mr. Geckle,
I am in receipt o~ a letter ~rom you dated 7/30/96 requesting in~orm-
ation relative to .continuin~ treatments. o~ the above named patient
~or auto accident injuries sustained on 5/6/94.
I sent you a letter on December' 1, 1995 (copy enclosed) stating that
as of' March 10, 1995, I lias releasing Miss Madia ~rom any further
care relative to the accident as I felt she had reached HHI and pre-
accident condition.
Miss Madia continued coming to me a~ter that date ~or occassional
neck/shoulder and head aches as she had been doine be~ore the auto
accident. I had in~ormed the patient, her mother,-and Aetna Insurance
Co. o~ the release and that any further visits/treatments by Miss
Madia wou~d be on a none accident basis. Recently, I sent an itemized
statement to Prudential Insurance Co. ~or services rendered to Miss
Madia since March 10, 1995. This was at the request o~ the patient's
mother who was aeain in~ormed that the itemization to Prudential was
~or services not-related to the auto accident in my opinion. 80th the
patient and her mother understood and accepted this decision to release.
With the previous having been said, I don't understand the reason
~or your request letter o~ 7/30/96. The patient ended all treatments
in May of this year as she has graduated ~rom COllege and moved back
home to New Jersey.
I~ I am mis-understanding something regarding t.his case, please ~eel
~ree to contact me and clarify...I will be happy to co-operate ~or
a valid reason,
2i2~lY' '~.. ..
- ~ . ~/qs:::
Charles J"~ D.C.
,/? \'0 5e~ ~~~ ~
~ 1!(Q(<7. (l
O( ( ~'~~
~ -b<.? "'~ c: '/
I \ .A .
CJZ/cJz
.,.
~;~.. MADIA, Dawn _ ___~ O~:__~__~_L?:'__~g..:.._~J 5..: F '
--.J!~~~~(~~ Roa~____..______C'IY ._~~(~r!_t_B_~~Bl!:,:'_~IIlt: N,J. Zip: 07'!ftJ
Phon,'IHoo>.1 539-7621, (Offic.I...
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LOUIS A. LORENZO
FAMILY CHIROPRACTIC CENTER
Wi N. BEVERWYCK ROAD. Pi\RSIPPANY. N) f)if)~.l . 201.B-l.(,H(,H
July 11,1994
Patrick Geckle
Attorney at Law
11th Floor
230 South Broad street
Philadelphia, Pa 19102-4190
RE: Dawn Madia
D/A May 6, 1994
Dear Mr. Geckle:
At ~our request and with the permission ot my patient,
Dawn Madla, I am submitting the following narrative report concerning
the injuries she sustained as a result of an accident on May 6, 1994.
HISTORY
The patient was ambulatory and presented herself for examination
and treatment at this office on May 25, 1994, at which time she
stated that on May 6, 1994 she sustained injuries as a result of an
auto accident. She relates that she was a passenger in a vehicle that
broadsided another vehicle while attempting to turn. She doesn't
recall hit~ing her head on the windshield, but does remember hitting
the headrest.
SUBJECTIVE FINDINGS
The patient stated that since the date of this accident she has
suffered from (symptoms uS listed). Dilateral ~a~acervical pain
associated with occipital headaches that can become intense and
diffuse. Also involved are bilateral upper trapezius muscles,
upper-dorsal pain and shoulder pain.
OBJECTIVE FINDINGS
The patient is a Spanish/Italian female, 20 years of age and
weighs 130 pounds and is 5 feet 5 inches in height, mentally alert
and cooperative.
Palpation of cervical spine revealed muscle spasms of the
trapezius muscles bilaterally. Pain response was elicited upon
palpation of the shoulder muscle groups bilaterally.
ne atlas is right by 3 1/2. The body of the axis is right by 2
.nd the axis spinous is right by 5 1/2. The functional cervical
~ c-2 thr~ugh C-7 is left with a compensated functional
c.r~ico-dorsal spine of right 4.
C.rvical Flexion View
Unusual stair stepping at the levels of C-4 - C-5 is observed.
C.t7ical Extension View
Unusual stair stepping at the levels of C-4 - C-5 is observed.
This patient suffered a moderately severe hyperflexion
hYr""rextension trauma to the cervical spine.
Soft tissue damage is usually more serious than bone injury.
liar"" heals with calr.ium which is one of the substances of bone,
wh~(oas soft tissue heals with fibroun or Gear tisuue. The latter is
dl"~rent than the original soft tissue. Soft tissue takes longer to
he~l than bone tissue and although bone tissue may actually be
ntr~nger after the healing process has taken place, soft tissue is
USV~lly weaker after. repair.
structurally the major area of concern is the upper cervical
Gpl~~ C-l and C-2 and the functional cervical spine C-2 through C-5.
Th~~~ areas are markedly displaced and resistant to our corrective
(or~~s and rehabilitative exercises,
~.(Jno.is/Conclusion/Snlll"arv
On the basis of the findings, it is evident that the patient has
Duttered the following injuries:
Acute traumatic cervical vertebral subluxation complex.
Loss of motoricity of the vertebral units due to subluxation of
cervical spine.
cervical subluxation complex complicated by acquired kyphosis.
th<:
n.at..nt
Fast tra'.l:natic managemelit ..as both corr:acti ve and supportive.
Chiropractic treatment included:
Specific adjustment corrections of the subluxation
COnfigurations.
Specific corrective exercises precisely for her subluxation
C~n(iguration for mobilizing and strengthening the cervical spine
~ lch will establish a more normal mechanical and physiological
unction of the entire spine.
ranges of motion
Normal Exam
Flexion
Extension
Left Lateral Flexion
Right Lateral Flexion
Left Rotation
Right Rotation
60
50
40
40
80
80
50 pain & restriction
40 pain & restriction
30 restriction
35 restriction
70 pain & restriction
75 restriction
The Foraminal Compression Test was positive bilaterally for pain
in the neck of the patient.
Foraminal encroachment was positive bilaterally for neck pain.
Biceps tendon reflexes were bilaterally diminished.
The brachio-radialis reflexes were diminished bilaterally.
Dermatomes tested by the pinwheel on both arms revealed a
hypoesthesi~ in the right arm.
The Soto-Hall test was positive for central upper thoracic pain.
The Shoulder Depression test was positive unilaterally on the
right side.
The supine leg check revealed a functional short leg on the left
side by 1/2.
The dynamic prone leg check exhibited a right contracted leg,
short by 1/4. Upon flexion of the legs a right contracted leg, short
by 1/8 was eXhibited.
Postur.LAn.lllnJ.L..
Head tilt with high ear on the right side.
Shoulder tilt was evident with the high shoulder on the left
side. The shoulders were also rotated with the left shoulder
forward.
The hips were rotated anterior on the left side.
X-ray Ana1.Yl!L
Latdral Cervical View
A 190% loss of the cervical curve, maintaining a state of
hypolordosis with the maximum point of stress at the level of C-4,
C-5.
Nasium (A-P) View
(All measurements relative to the center of the skull mass)
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OAI/IIN MADIA,
Plalntrff
IN THE COURT OF ~OMMON PLEAS
CUMBERLAND CO\JNTY, PENNSYLVANI^
v.
NO. 96-20468 CIVIL TERM
CIVIL ACTION. LAW
ALBERT LLOYD RENN and PETER
MENSKY.
Defondants
JURY TRIAL DEMAfIlDED
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IT IS HEREBY STIP LATED AND AGREED by. between, in! among C<lunsel for the
respective parties that
,. Plaintiff in thl mattcr is Dawn Madia and is reprellented by Patrick Geckle,
F.squlre, 230 S. Broad Street 111"' Floor, PhlladelphlH. Pennsylvania.
2 Defendant, AI~rt Lloyd Renn is ropresent~d by James G. Nealon, III. Esquire. 301
Market Street, 9'" Floor, Harri burg. Pennsylvania
3, Defendant, P er Mensky IS ropresented by the law firm of Thomas, Thomas &
Hafer, LLP, 305 N. Front Stre t, P.O. Box 999. Harrisburg, Pennsylvanlll.
<\ After further r iew and investigation. both Plaintiff and Defendants in this mailer
havo determined that no caus of action or claim eXists against Defen~nt Peter Mensky
5. Pursuant to R 10 229{b) 01 the Pennsylvania Rules of Civil Procedure. the parties
in the above.captioned cause f action are desirous of dismissing Peter Mensky. without prejudice
from this action.
6 The parties h vo authorized their rospective attomeys to 81gn the Stipulation
pursuant to Rule 229(0) of th Perll1sylvanta Rules 01 Civil Proceduro, and, wtwilre appircable. to
any other rule of civil proce ure requiring a dismissal in a case like thill, and to pre~ent this
Stipulation together witt I the a pended Order of Court to soek the disrrisaal wrth prejudi~ with all
~?EO Cf-
Patrick Geckle, EsqUl(e! Jamos G Nealon, III, Esquire
230 S Broad Street 301 Market Street, 9"' Floor
11'" Floor Harnsburg. PA 17108
Philadelphia. Attorney for Defendant
Attorney for Albart Uoyd Renn I
Date: ( Date: -3..J-~ -, (--DO
11j'l J) (l~ 11100 rro' II n ,Olli=-':' 11 U.:r~'.
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7172377:0~
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OAWN MAO''',
PleinlrH
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IN TI'1I! C()U,.T OF I='~MCN ""'&:AS
CUMilEFIlNlD ClWNTY. PENNSYLVANIA
NO 6&-2481 CIVIL TERM
CIVIL ACTION. LAW
ALBERT I.LOYO RFNN ana PETER
MENSKY,
O.,.ndln~.
JU,.V TRIAL neMAIWOI!O
r
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IT IS HP',.~nv STIPULATED AHD AGREED by. ber-n. n:I Imanu coun..1 101' Iho
rfsJ'l4lr.t,Vlt pallil!l8 t~~t,
'. Plalntrff In Ihl~ mollIe' fa Dawn Madia .nd ia rtp,...nled by ,:lil!~ck ('llllcllle,
F;"G'JIre 230 S Broad Street. 11. Floor. Phlladel~ni., Penn5y,,"enla,
, De'endant AllfIrt Lloyd Renn is '.pr86e~ted by Je"'ea G N.alen, Iii, Eequire 301
Market :'ilrer.l, 9'" Floor, HarnSburlil, Plnnaylvanta.
3 Oefend,nt, p~er Menalcy s ,epr.eonlc:d by Ihll liM ~rm of Thomas. Thom.e &
Haf.r, t l p, :105 N, 'renl SlIe,l, PO. Do. m HlIrn5butg, Ponnaylnn.,
4 A"el furtr.et ref/lllW and m_~AlIl'o'" both PI","IIII anlS OeMndlnt.a In "'11 malllllr
have determined thai no tau.~ of action C1 claim e.,.I. Igaintll Defendtnl Fl'I., MInaI<)'
5. P.~u.nt to Rt. 220(0) olIn. P,nnlylyanla Flullll (l! Cnlll Pr~, tlla parll..
In Ihe abQve.~a~l,oned caule r acllon ii' dlll'OU' of d""'luing ,:._ Mllntlky, without prejudlc:>'
from t~i. ac:1lon
S T~e pari,.. h VII aul/loltz.d 1118" r..pective Inomeya 10 allln 1118 Stlpulj;~on
~u"u.n! 10 Rule 2291b) of Ih~ PD~nayl'lo"ia Rul86 01 Civil P'oc.e<lure. 1Ind. Mlere Ilpplic.able. 10
any ~thar rule 0' CIVIl prcee~ure rcquin1'll . dl'mlssal ,n I caae "~. tllle. .nc1 10 prel"nl Ill"
~llpulat'on together wllh th~.arpon<l8d Orll.r of Co~rt'o lie' lhe Is"....1 loll"" prejudice with III
:~~?~j7~E:i:~~ ~ ct -
PaIlle\( GecM11! Esquire Jim,. a Nealon. III. Elquire
210 S I!l"J~" St'"RI 301 Market SIIMI,.... Hoar
1 I' FloQr I H~rnllburg. IIA 11108
"'~llld'lph'a . PA I Y' 02 -L- A/lom.y for Defend""
An~mRY 'Ill !/~"li" MI." UO~tl R.nn /.
oote.l"f/ '/-(T#"" Oat, V~ "f-ct)
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THOMA', THOMAS' HAFE ,LLP
30$ N Frollt Stllel
paA \l88
HQrlleburg, PA 171080998
Arrnmey for netendem
Peler MeMky
O.te I' ;)
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ANDREWS II JOHNSON
'\lIom'1' at La..
78 W, Pom(r., SIree.
enu,I., PII 11013-3216
TAYI.()R P ANDIlEWS
RONALD E JOHNSON
T,l,phone (717) 24)..() 123
Tele(ax (7I7P41-0061
FAXED ONL Y
March 27,2000
ParrlckO, Oeckle- 215.73'-4712 ~~bolm ..737-34.......
JlIIlICS 0, Nealon. 236.9119 L~urftlee Raker. 975.8124
IIrhilralUr
John D, Popilock or
D"u~las Marcello. 237-110$
Rl! DAWN MADIA vs ALBERT LLOYD RENN and PETER MENSKY
Dear Counsel:
I have been apPointed an arbilralol in the abo.e captioned mAiler, I hue IiSled below
D number o( date~ in June:, 2000, If you would ell:h plu,c check your clleI\lJ;u~ and malk An
"x" over the: d.ur(s) that you arc MI aVAilable and fax Ihi~ ~h..1 back III me al YlJur earliest
CCll1\lenicn::e.
lUll' , June X June 12 lune 14
June: X June 21 June 22 Jun~ 26
Jlln. 28 Jllor 29
I will maillhe Arhilldlioll NOliee o( Hearing to you itS soon as a hearing d.le can be
narmwcd lIown.
'raylof p, ~.~'
'~..,,\""~' ~-c>.""",,,~
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il1t 1'3: '~(ll ,;,:: ;~~-'~I
t(ld "..3
1)~lIJ15~:i1J ~.:lriH'~ -: III IUS ':"Ii)t-'.L':'~':"~ t~
June 2000
Taylor Andrews
Sun Man Tue Wed
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Office of the Sheriff
JOHN SZYMANSKI.SHERIFF
I AI_AV'Wi'l.NN^ , I)lJ~d. . ',,'Hilt. I ,.r-. II r,t,' ~ I 'o/H,1^ 11",1' I . ,11/1 '1111 61\ij
SHERIFF'S AFFIDAVIT OF RETURN
, PLAINTIFFISI
DAWN MADIA
3. DEFENDANT ISI
PETER MENSKY
SERVE{~ NAME OF INDIVIDUAL COMPANY
PETER MENSKY
. 6 ADDRESS (Slreel or RFD, Apnrtment
AT 119 CE TERY ST.
2 cg~_~2~~~il
4 rYPE OF WRIT OR COMPLAINT
COMPLAINT AND NOTICE
CORPORA nON ETe
CUMBERLAND CO.
City. Bora. l'wp :;Ialo and ZIP Code)
JERMYN
7, I horeby CERTIFY and RETURN that I hnlJ€l 0 havf.' personally bIJP'(!l1. tJ hilve 5l'rVcd the rwrson in chargo. 0 have serveda person o'sult~
able age and dlscrotlon then H.!51dHlg Alttle defendant's IIsual plilf:1J of abode. 0 have posled tho abo'Jc described property with the wrU or
complillnl dlJscnbed on lhp, Indlvldunl, compnny. corporation, tHe ,ullhn addre~5 shown nbuvoot on lhemdl\llduol, company, corporation, etc"
A! Ihf! oddfll5S Inserted below by handing/or Posllng a TRUE AND ATTESTED COPY lhoroof
8.0 I hereby cerllly and relurn NO S'RVICE bcc.luse t nm unl1lJle 10 localt..> 1t1C individual, company, corporation, ole., named above,
7 12 96-SEND BACK PER SHERIFF'S OFFICE-ATTY. WAS CALLED ON 5/20/96 TO REINS'rATE & NEVER DID
9, Address where served l(,)n1plllIIlQnly " dl,rm""llt1,,1l """'1011 a~I)II"II:;I""'I'" "iF n ^pIl!ln,,'rl! ~~,) I:.ly 110,') ,"'" I 10. DAle of Service 11 Time
12. Name and IUle 01 IndIvidual served III !lol t;ll')WI1 Illmv!!!
13 DElBCripllon. D~spondenl descrlbcs ll'f~ individual served un follows
o Male o While Skin o BliJck t-iatr o While Half o t 4 . ~O Yrs o Under 5' o Under 100 Lbo
o Female o Black Skin o Brown Hfllr o Bald Ing o 21 - 35 Vrs o 5'0" . 5'3" o 100 . 130 Lbo
o Brown Skin o Blond Him o 36 . 50 Vrs o 5'4' . 5'B" o 131 . 160 Lbo
0' Vellow Skin o Red Hair o Mu/;I.1Cho o 51 - 65 Vrs o 5'9" . 6'0" o 161 .200 Lbo.
o Gray Hillr o Boord o OVEJr 65 Vrs DOver 6' o Over 200 Lbo
14 0 I do furlhElr attesl "nd declarethall am a Deputy Sherlll '" and lor the Counlyol Lucknwanna. SIBleo! Pennsylvania; that I am a re!lldenlo'
the Counly and State aforeslJld. that I am over the age of 21 yeArs: lhilt I am duly Qualllted under the rules of our courts to make ~ervtc.
hereunder; and that I am not a party to the WIthin acllon
15.0 AI the lime of service. the stud
WAS not In the Armed Service of the United States,
lB ADVANCE CObTS: Shurltr $32.60
, l I
'[' ~' '0 <c~O'"~ '" j
. '~""~I""~~~""~~al':'
1
Notary PubliC
$2.00 PAID IN FULL
.~....
SO ANSWERS~ J~HN SYZMANSKI, SHERIFF
D,'p,,'v Qa...~ rCl4.'('~r1J~'
DAVID PASCOLINI
II
I
COUNT t. DAWN MADIA VB. ALBERT LLOYD RENH AND PETER MENBKY
,I
i
4. Plaintiff, DAWN MADIA, incorporates by reference
,
,I each and every paragraph from 1 through 3 inclusive as fully
as though they were herein set forth,
5. On or about May 6, 1994, Plaintiff, DAWN MADIA,
was lawfully a passenger in the motor vehicle owned and
operated by Defendant, PETER MENSKY, on Route 11 north at or
, near its intersection with Locust Point Road, Township of
Silver spring, County of Cumberland, Commonwealth of
Pennsylvania, when suddenly and without warning the motor
vehicle owned and operated by Defendant, ALBERT LLOYD RENN,
made a left hand turn from the right lane violently striking
Plaintiff's motor vehicle, causing serious injuries to
Plaintiff hereinafter referred to.
6. Solely as a result of the aforesaid accident,
the Plaintiff, DAWN MADIA, suffered serious physical injuries,
including without limitation, cervical and trapezius strain,
cervical and thoracic myalgia complicated by vertebr.al
subluxations in the upper and lower cervical spine and upper
thoracic spine plus sprain/strain of the posterior cervical
musculature, muscular and ligamentous sprain of cervical
spine, bilateral paracervical muscle pain with associated
occipital headaches that are intense and very defuse, cervical
whiplash, acute traumatic cervical vertebral subluxation
complex, loss of motoricity of the vertebral units due to
subluation of the cervical spine, hypolordosis/ kyphosis
cervical spine and neck pain, all of which may be permanent in
'\)"
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DAWN MADIA __... ___.
3 DEFENfJAN1 I';
ALBERT LLOYD, ET AL.
SERVEl" IJAMf OF INDIVIDUAl. C()MI'AIIY I,'"''
. "'\I"J1IL:~~~~~"~~~~~~ A;,~;;i,;:,~'-
AT 119 CEMETARY S'l"
9~:2.4~!Lf!.,{!~ TERM
!'Wi' 'J! V,Ili!]I1f, 1~t)Mf't.^INr
NOTICE AND COMPLAINT
CUMBERLAND COUNTY
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JERMYN, PA.
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DAVID PASCOLINI
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1M T ne Court CT C.:mrnc;-l r: s::s or t...:.J:--. ~~.~:~1=:1= ,-,=r.:.,;;":" . 'S:1r:zy '/::rd::
Dawn Mal ill
'is.
Peter Mensky
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.July
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July 19, 1996
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right lane violently striking the Mensky vehicle, Any and all other averments paragraph S are
denied and proof is demanded at time of trial.
6, Denied, Answering Defendant is without information or belief as to the truth of
the averments of paragraph 6, Hence it is denied and proof is demanded at time of trial.
7, Denied, Answering Defendant is without information or belief as to the truth of
the averments of paragraph 7. lIence it is denied and proof is demanded at time of trial.
8, Denied, It is denied that any injuries of Plaintiff resulted from any negligence
or recklessness of answering Defendant.
9, Denied. Any and ali allegalions of negligence and recklessness of answering
Defendant is denied.
A, Denied. It is denied lhat answering Defendant failed to properly operate
and control his motor vehicle;
8, Denied, It is denied that answering Defendant drove at an excess rate of
speed under the circumstances;
C. Denied, It is denied that answering Defendant failed to keep a proper
lookout;
D, Denied, It is denied that answering Defendant failed to keep a constant
vigilance of lhe road, traffic, weather and road conditions;
E, Denied, It is denied thai answering Defendant failed to regard lhe point
and position of Plaintiff's motor vehicle;
2
F. Denied, It is denied that answering Defendant violated the Statutes of the
Commonwealth of Pennsylvania or the Ordinunces of Cumberland County
with regard to operating u motor vehicle on the streets und highways;
Q, Denied. It is denied thut unswering Defendunt was wunton and reckless
with regard to the rights and sufety of the Pluillliff;
H, Denied, It is denied thut unswering Dcfendunt fuiled 10 use due care
under the circumstances;
I. Denied, It is denied that unswering Defendant wus negligent or reckless
as a mailer of law,
10. Denied, Answering Defendant is without informution or belief as to the
averments of paragraph 10. Hence they are denied and proof is demanded at time of trial.
11. Denied, Answering Defendant is without information or belief as to the
averments of paragraph 11, Hence they are denied und proof is demanded at time of trial.
12, Denied, Answering Defendant is without information or belief as to the
averments of paragraph 12. Hence they ure denied and proof is demunded at time of trial.
13, Denied, Answering Defendant is without information or belief as to the
averments of paragraph 13, Hence they arc denied und proof is demanded at time of trial.
WHEREI<'ORE, Defendant requests this Honorable Court to dismiss Plaintiff's
Complaint.
3
CROSS.CLAIM
14, The averments 01' paragraph I through 13 of Defendant's Answer are incorporated
herein and made a part hereof as if set forth in full.
IS, The averments 01' Plaintiff's Complaint as to Defendant, Albert Lloyd Renn, are
also incorporated herein without admining or denying the tnuh thereof,
16. To the extent the averments of paragraphs of Plaintiff's Complaint a1\eging
negligence of Defendant, Albert Lloyd Renn, are true, Defendant, Albert Lloyd Renn, is solely
liable to Plaintiff, liable over to answering Defendant, or jointly and severa1\y liable with
answering Defendant or liable for indemnification, any and all a1\egations of negligence or
reckless of answering Defendant are denied and proof is demanded at lime of trial.
WHEREFORE, Defendant requests this Honorable Court to hold that Defendant, Albert
Lloyd Renn, is solely liable to Plainlifl'. jointly or severa1\y liable to Plaintiff, liable over to
answering Defendant including indemnification for any liability of answering Defendant, any and
a1\ liability of answering Defendant being specifica1\y denied,
NEW MATTER
17, Some or a1\ of Plaintiff's injuries may be barred by the Statute of Limitations,
18, Some or a1\ of Plaintiff's injuries may be barred by or limited by Plaintiff's
contributory andlor comparative negligence,
19. Some or a1\ of Plaintiff's damages may be barred or limited by the Pennsylvania
Financial Responsibility Act.
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produce said answers to Plaintiff's Motor Vehicle
Interrogatories and Requests for Production of Documents, Sets
I and II, in the more than thirty (30) day period of time
which has elapsed since service of Plaintiff's discovery
requests.
PA R.C.P. 4006 reads in pertinent part as follows:
.. (a) (1) Answers to Interrogatories shall be in
writing and verified... (2) Each Interrogatory shall
be answered fully and completely unless objected to,
in which event the reasons for the objection shall
be stated in lieu of an answer... .The answering
party shall file and serve a copy of the answers,
and objections if any, within thirty (30) days after
the service of the Interrogatories..." Wexler vs.
Roberts, 85 Mont. Co. 113, 13" (1965).
PA. R.C.P. 4009 reads in pertinent part as follows:
"(2) The party upon whom the request is served
shall serve a written response within thirty (30)
days after the service of the request,... The
response shall state, with respect to each item
or category, that inspection and related activities
will be permitted as requested, unless the request
is objected to, in which event the reasons for
objection shall be stated. If objection is made to
part of an item or category, the party shall be
specified. The party !'ubmitting the request may
move for an order under Rule 4019(a) with respect
to the request or any part thereof, or any failure
to permit inspection as requested."
WHEREFORE, Plaintiff now moves this Honorable Court to
enter an Order in the form attached r8quiring Defendants to
file full and complete answers to Plaintiff's Interrogatories
within twenty (20) days from the date of the Court's Order.
Respectfully submitted,
HYCHAK GECKLE WELKER , THIROWAY, P.C.
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By:
Patrick G. Geckle,
Attorney for Plaintiff
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DAWN MADIA,
Plaintiff
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PENNA
: NO. 96-2468 CIVIL TERM
: CIVIL ACTION. LAW
v.
ALBERT LLOYD RENN,
and PETER MENSKY,
Defendants
: JURY TRIAL DEMANDED
RESPONSE OF THE DEFENDANT.
ALBERT LLOYD RENN. TO PLAINTIFF'S
MOTION FOR SANCTIONS
1. Admitted,
2. Admitted.
3. Admitted.
4. Admitted.
5. Admitted.
6. Denied as stated.
It is admitted that the Defendant has not yet
provided Answers to Interrogatories, By separate letter of this date, counsel for the
Plaintiff will be supplied with a Response to Request for Production of Documents.
7, Denied as stated, See paragraph 6 above,
NEW MATTER
8. Defendant does not object to an Order being entered compelling
Defendant to serve Answers to the Plaintiff's Interrogatories within 20 days,
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Exhibit 'A
NYCBAl OBClLB WELKER' TBIROWAY,
By: Patrick G. Geckle
Attorneys at Law
Identification No. 26718
11th Floor
230 South Broad Street
Philadelphia, PA 19102
(215) 735-3326
DAWN MADIA
DickerGon college
HUB 1138
Carlisle, PA 17013-0927
vs.
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ALBERT LLOYD RENN
3335 South college Road
wilmington, NC 28412
and
PETER MEN SKY
119 Cemetery Street
Jermyn, PA 18433
TRUE COpy FOOM RECORD
In Testimony whereof, I here unto set MY haIId
and I ~I 01 sa1;/h ~trllsle. ~
Thl( (. da '. 19~
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for P intiff
P.O.
Attorneys
COURT OF COMMON;"l>LEl\~
CUMBERLAND COUNTY
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CIVIL ACTION
NOTICE
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SlT _O.T" IhOW TO ,,~O OUT .....1.1 YOu "~'"
GO UGAL ..I~
court Administrator
C\Jl1tlel;land county COurt House
~ court:h:>use Square
carlisle, PA 17013-3387
(717) 240-6200
AVISO
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UIVIISTA OrMA"'OA A UN ASOGAOO IN...rO'''TA
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t~O \u'tC;(~TE 01 :JAC.~;t ~'L Se~.ICu .,aVo1!~
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CUYA OI.!':C'O" sa ,NCUtN'.A ISCOITA A8~0
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UISn"CIA &.lGAL
court l\dministratoI'
C\JlIl:mland County Court HOUSe
1 courthouse Square
Carlisle, PA 170l3-3387
(717) 240-6200
COUNT I. DAWN MADIA V8. ALBERT LLOYD RENN AND PETER HEN8RY
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4. Plaintiff, DAWN MADIA, incorporates by reference
each and every paragraph from 1 through J inclusiye as tully
as though they were herein set forth. /J'lot'/J~U~
5. On or about May' 6, 1994, Plainti~, DAWN MADIA,
was lawfully a passenger in the motor vehicl~~~~df)and
operated by Defendant, PETER MENSKY, on Route 11 north at or
near its intersection with Locust Point Road, Township of
Silver Spring, County of Cumberland, Commonwealth of
Pennsylvania, when suddenly and without warning the motor
vehicle ~;;1nd operated by Defendant, ALBERT LLOYD RENN,
made a left hand turn from the right lane violently striking
Plaintiff's motor vehicle, causing serious injuries to
Plaintiff hereinafter referred to.
6. Solely as a result of the aforesaid accident,
the Plaintiff, DAWN, MADIA, suffered serious physical injuries,
including without limitation, cervical and trapezius strain,
cervical and thoracic myalgia complicated by vertebral
subluxations in the upper and lower cervical spine and upper
thoracic spine plus 3~rain/strain of ~he posteriur cervi~al
musculature, muscular and ligamentous sprain of cervical
spine, bilateral paracervical muscle pain with associated
occipital headaches that are intense and very defuse, cervical
whiplash, acute traumatic cervical vertebral subluxation
complex, loss of motoricity of the vertebral units due to
subluation of the cervical spine, hypolordosis/ kyphosis
cervical spine and neck pain, all of which may be permanent in
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! other financial expenses or losses which do or may exceed
amount which she may otherwise be entitled to recover.
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! WHEREFORE, Plaintiff demands damages of Defendants
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'~herein, individually, collectively, jointly and severally, for
'i a sum in excess of Fifty Thousand Dollars ($50,000.00), plus
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costs, delay damages, and interest on each count.
HYCHAK GECltLE WELKER , THIROWAY, P.C.
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By:
Patrick G. Geckle,
Attorneys for Plaintiff
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PRAECIPE FOR LISTING CASE F'OR ARGUMENT
(MUst be typewrittell ard subnitted in duplicate)
TO THE PROTHONOTARY OF CUMBERLAND COUNTY:
Please list the within matter for the next Arglment Court.
~--------------------------------------------------------------------------------------
CAPTION OF CASE
(entire ClIption must be stated in full)
DAWN ~IADlA,
(Plaintiff)
VB.
ALBERT LLOYD RENN and PETER MENSKY,
( Defendant)
No. 96-24~ Civil
19
1. State matter to be argued (Le.. plaintiff's mUon for new trial. defendant's
dElllJITt!r to c~laint, etc.):
Motion to Compel of Defendant Mensky
2. Identify counsel who will argue case:
(a) for plaintiff: Patrick G. Geckle
.Address: II th Floor, no S. Broad St.
Philadelphia, PA 19102
(b) for defendant: James Nealon, 1I1
.Address: 9th Fl., ~Ol ~Inrket St.
P.O. Rox 86,
Harrlsburlt, PA 17108-086,
for defendant:
DOllltlas R. Marcello
P.O. Box 999
Harrisburg, PA 17108-0999
3. I will notify all parties in writing within two days that this case has
been listed for argumnt.
4. Arg\Jnent Court Date: ~III~ 27, 1[1!JH
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llBted: 4/29/98
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MYCHAX, GBCKLE & WELKER, P.C.
By. Edward Harrington Heyburn
Attorneys at Law
Identification No: 80472
230 South Broad Street, 11th Floor
Philadelphia, PA 19102
(215) 735-3326
Attornevs for Plaintiff
DAWN MADIA
Dickinson College
HUB 1138
Carlisle, PA 17013-0927
COURT OF COMMON PLEAS
CUMBERLAND COUNTY
vs.
AI,BERT LLOYD RENN
3335 South College Road
Wilmington, NC 28412
and
PETER MENSKY
119 Cemetery Street
Jermyn, PA 18433
NO. 96-2468
PLAINTIFF'S RESPONSE TO DEFENDANT PETER MENSKY'S
MOTION FOR SUMMARY JUDGMENT
1. Admitted.
2. Admitted.
3. Admitted. By way of further answer, paragraphs
Sand 9 of Plaintiff's Complaint aver:
8. This action resulted solely from the
negligence and recklessness of the Defendants
herein and was due in no manner whatsoever to Clny
act on the part of Plaintiff.
9. The negligence and recklessness of the
Defendants consisted of the following:
a. Failure to properly operate and control
their motor vehicle;
b. Driving at an excessive rate of speed
under the circumstances;
c. Failure to keep a proper lookout;
d. Failure to keep constant vigilance of the
road, traffic, weather and road
ccmdi t ions;
e. Failure to regard the point and position
of Plaintiff's motor vehicle then and
there being lawfully operated upon said
highway;
f.
Violation of the Statute of the
Commonwealth of Pennsylvania, as well as
the Ordinances of Cumberland County
governing the operations of motor
vehicles on the streets and highways,
Wanton and reckless d.isregard for the
rights and safety of Plaintiff,
Failure to use due care under the
circumstances,
Negligence and recklessness at law.
g.
h.
1.
~ Plaintiff' s Complaint (emphasis added) .
4. - 5.
Denied.
Plaintiff specifically denies
Defendant's allegation that Plaintiff's Complaint fails to allege
any negligent action or failure to act on the part of Defendant
Mensky.
By way of further answer, paragraphs 8 and 9 of
Plaintiff's Complaint aver the following:
8. This action resulted solely from the
negligence and rticklessneBs of the Defendants
herein and was due in no manner whatsoever to any
act o~ the part of Plaintiff.
9. The negligence and recklessness of the
D~fendants consisted of the following:
j. Failure to properly operate and control
their motor vehicle;
k. Driving at an excessive rate of speed
under the circumstances;
1. Failure to keep a proper lookout;
m. Failure to keep constant vigilance of the
road, traffic, weather and road
conditions; ,
n. Failure to regard the point and position
of Plaintiff's motor vehicle then and
there being lawfully operated upon said
highway;
o. Violation of the Statute of the
Commonwealth of Pennsylvania, as well as
the Ordinances of Cumberland County
governing the operations of motor
vehicles on the streets and highways;
p. Wanton and reckless disregard for the
rights and safety of Plaintiff;
q. Failure to use due care under the
circumstances;
r. Negligence and recklessness at law.
~ Plaintiff's Complaint (emphasis added).
HYCHAK, aBCKLE & WELKBR, P.C.
BYI Edward Harrington Heyburn
Attorneys at Law
Identification No: 80412
230 South Broad Street, 11th Floor
Philadelphia, PA 19102
(215) 735-3326 &tornevs for Plaintiff
DAWN MADIA
vs.
ALBERT LLOYD RENN
and
PETER MENSKY
COURT OF COMMON PLEAS
CUMBERLAND COUNTY
NO. 96-2468
CBRTIPICATI OP SIRVI~
I, Edward Harrington Heyburn, Esquire, of MYCHAK, GECKLE
& WELKER, P.C., duly certify that on this date, I served a
true and correct copy of the foregoing Entrv of ADDearanee,
upon the person(s) and in the manner indicated below, which
service satisfies the requirements of the Rules of Civil
Procedure, a true and correct copy of the same via Regular
Mail and Certified Mail, by placing same in the United States
Mail, postage prepaid at Philadelphia, Pennsylvania and
addressed to:
Douglas B. Marcello, Esquire
THOMAS, THOMAS & HAFER, LLP
305 North Front Street
P.O. Box 999
Harrisburg, PA 17108-0999
James G. Nealon, III, Esquire
NEALON & GOVER
301 Market Street, 9th Floor
Harrisburg, PA 17108
Dated:
HYCHAK, alCKLE & WELKER. P.C.
C7
BYI~'
Edward. Harrington H
Attorney for Plainti
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DAWN MADIA,
Plaintiff
v.
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 96-2468 CIVIL TERM
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
ALBERT LLOYD RENN and PETER
MENSKY,
Defendants
IT IS HEREBY STIPULATED AND AGREED by, between, and among counsel for the
respective parties that:
1. Plaintiff In this matter is Dawn Madia and is represented by Patrick Geckle,
Esquire, 230 S. Broad Street, 11'" Floor, Philadelphia, Pennsylvania,
2, Defendant, Albert Lloyd Renn Is represented by James G, Nealon, III. Esquire, 301
Market Street, 9'" Floor, Harrisburg. Pennsylvania,
3, Defendant, Peter Mensky is represented by the law firm of Thomas, Thomas &
Hafer, LLP, 305 N, Front Street, P,O, Box 999, Harrisburg, Pennsylvania.
4. After further review and investigation, both Plaintiff and Defendants in this matter
have determined that no cause of action or claim exists against Defendant Peter Mensky,
5. Pursuant to Rule 229(b) of the Pennsylvania Rules of Civil Procedure, the parties
In the above-captioned cause of action are desirous of dismissing Peter Mensky, without prejudice
from this action.
e, The parties have authorized their respective attorneys to sign the Stipulation
pursuant to Rule 229(0) of the Pennsylvania Rules of Civil Procedure, and, where applicable, to
any other rule of civil procedure requiring a dismissal in a case like this, and to present this
Stipulation together with the appended Order of Court to seek the dismissal with prejudice with all
:'(F:;:;::: ct -
Patrick Geckle, Esquire James G, Nealon, III, Esquire
230 S. Broad Street 301 Market Street, 9" Floor
11" Floor Harrisburg, PA 17108
Philadelphia, PA 19102 Attorney for Defendant
Attorney f?' 'l'ail1iff Albert Lloyd Renn ~
Date: 0.)..1 6,,~ Date ~ /~ '_De:>
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