FILED: RICHMOND COUNTY CLERK 01/17/ :45 PM INDEX NO /2015 NYSCEF DOC. NO. 65 RECEIVED NYSCEF: 01/17/2019

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Marcia May
5 years ago
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1 BROOKLYN, N.Y Kalant & Roytblat, PLLC January 3, Queens Blyd., Ste. 313 Elmhurst, NY Attention: Alexander Roytblat, Esq. Re: Eran Taussi Date of Accident: January 30, 2014 Dear Mr. Roytblat: Mr. Taussi is.a 47 year old male who was first seen by me in consultation at my office on for injuries sustained on January 30, HISTORY GIVEN BY MR. TAUSSI: Mr. Taussi stated his car stolen and he contacted the Police Dept. When the police arrived at the designated location to meet with Mr. Taussi he fully cooperated with the police and gave them all information they requested, as well as his License and Car Registration/. He was told to wait for a few minutes and when the police retumed to Mr. Taussi he was told he was under arrest and they proceeded to handcuff him with his arms behind him. He was put into the police car and in doing so was pushed in to the car and subsequently fell hitting his head, neck, back and left shoulder. CHIEF COMPLAINT DIRECTLY RELATED TO THIS ACCIDENT: 1. Neck pain with weakness, numbness and tingling of the bilateral upper extremities. 2. Low back pain radiating to the bilateral lower extremities with weakness, numbness and tingling of the lower extremities. 3. Left shoulder pain, weakness of the left arm and restricted motion 4. Headaches

2 BROOKLYN, N.Y ALLERGIES: None reported. PHYSICAL CERVICAL SPINE - performed on June 5, 2014: On examination of the cervical spine there were spasms and trigger points on the paraspinal, supraspinatus, middle deltoid and rhomboid muscles. Spurling Test was positive bilaterally. Active range of motion was as follows (cervical) - performed on June 5, 2014: Flexion Extension Rotation Lateral Flexion PHYSICAL LUMBAR SPINE - performed on June 10, 2014: On examination of the lumbar spine there were spasms and trigger points on the paraspinal muscles. Patrick Test was Positive bilaterally. There was difficulty performing heel and toe gait and bending forward. Active range of motion was as follows (lumbar) - performed on June 10, 2014: Flexion Extension Rotation Lateral Flexion Straight Leg Raise 45 90

3 LEFT SHOULDER - performed on June 10, 2104 : Tenderness was present over the left shoulder with soft tissue swelling. Difficulty raising left arm with pain. Range of motion was as follows (left shoulder) - performed on : Flexion Extension Abduction Adduction Internal Rotation External Rotation NEUROLOGICAL : Neurological examination showed the patient to be alert and oriented. Mood and affect: Appropriate. Memory is intact. Spoken language comprehension is intact. The ears, nose and throat are unremarkable. Gag reflex is preserved. Swollowing is not impaired. Cerebellar testing was normal in finger to nose and heel to shin tests. MUSCLE TESTING: Motor strength of the peripheral upper limb muscles revealed 3/5 in the left deltoid and left bicep muscle, 4/5 in the right deltoid and in the right bicep muscle, 3/5 in the left triceps, wrist flexors and extensors, 4/5 in the right triceps, wrist flexors and extensors. Motor strength of the peripheral lower limb muscles revealed in the left hip flexor and left quadriceps, 4/5 on the right hip flexor and the right quadriceps, 4/5 on the right hamstrings, dorsi flexors and plantar flexors, 3/5 on the left hamstrings, dorsi flexors and plantar flexors. There was pain and spasms upon muscle testing of the cervical and lumbar paraspinal musculature upon both flexion and extension.

4 INITIAL IMPRESSION: 1. Cervical 11adiculopathy with Nerve Root Involvement. 2. Lumbar Radiculopathy with Nerve Root Involvement. 3. Left Shoulder Derangement. PLAN AND RECOMMENDATION: The patient has been prescribed a moderate plan consisting of the following: 1. Ultrasound therapy to cervical, lumbar spine and left shoulder. 2. Spinal Manipulation 3. Isometric and isokenectic exercises. 4. Anti-inflammatory medication. This treatment was prescribed to relieve pressure and swelling on the nerve root. It is also prescribed to improve range of motion and to decrease spasm in addition to pain. Mr. Taussi was treated by me for follow-up medical treatments on a regular basis. He was referred for the following: MRI Lumbar Spine - 2/5/15 and 7/17/14 - with findings of L5/S1 posterocentral disc herniation with impingement on the thecal sac and disc bulges MRI Cervical Spine - 2/24/15 - with findings of Mild to moderate compression fracture and disc bulges multiple levels. MRI Thoracic Spine - 5/5/15 - with findings of left sided disc herniation T4/5 with impingement on left intervertebral foramen. MRI Left Shoulder 5/15/15 - with findings of partial tear supraspinatus, anterior, posterior, superior glenoid labrum and mild impingement. In addition to the MRI, study, EMG & NCS of the upper and lower extremities were also performed on June 5, 2014 and June 10, 2014 on Mr. Taussi. The findings are for Cervical and Lumbar Radiculopathy C5/6 and L5/S1 with nerve root involvement. The above tests results directly correlate to the injuries sustained in this accident.

5 Mr. Taussi is post lumbar laminectomy and anterior cervical fusion Dr. Ronit Gilad. Mr. Taussi remains under my care for continued follow-up medical treatments. His last examination was on December Upon my re-evaluation on this date, the patient continues to have complaints of neck pain radiating to the bilateral upper extremities with numbness and tingling of the upper extremities. He also complains of low back pain radiating to the sciatic notch and lower extremities and numbness and tingling intermittently. He has difficulty with prolonged walking, standing, sitting, bending and twisting. There are still spasms and trigger points on the paraspinal muscles. He still has complaints of left shoulder pain with diminished range of motion. Positive Hawking sign. I did a follow-up range of motion study with the following findings: Active range of motion (cervical spine) done on 12/4/18: Flexion Extension Rotation Lateral Flexion Active range of motion (lumbar spine) done on 12/4/18: Flexion Extension Rotation Lateral Flexion Straight leg raise 45 90

6 Range of motion Left Shoulder done on 12/4/18 Flexion Extension Abduction Adduction Internal Rotation External Rotation Note: all measurements performed with a goniometer. Additional, to assure objectivity, all movements in mobility studies have been performed multiple times in each plan. EMG findings of radiculopathy are objective proof of nerve damage. When the injury force is sufficient to damage the spinal motor neuron, the muscles they supply are starved of the nerve supply, which controls their actions. By inserting a recording needle electrode into the affected muscles, the activity of the muscles were observed for characteristic electronic abnormalities of motor neuron loss. The findings of radiculopathy on EMG indicate that the impact upon the spinal column was sufficient to cause motor neuron damage at the level of the spinal nerve roots. With many soft tissue injuries, the involved areas - which if they heal - do so by deposition of a fibrous non-elastic scar tissue. As a result of these depositions, adhesions occur, limiting elasticity and contractility and the tissues will never be as flexible or elastic as the original. This then can cause insidious progressive diminution of function due to the resultant limitation of the range of motion and strength, and chronic recurrent fibromyositis. This is associated with painful dysfunction. In addition, the disruption of the joint elements can result in instability and/or irregularity of appositional surfaces and could continue to subject the involved joints to an accelerated onset of traumatic osteroarthritis and other degenerative changes. These can be accompanied by further permanent limitations of function and can become more pronounced with the passage of time.

7 SU1TES C9, 10, 11 BROOKLYN, N.Y JACOB NIR, M.D., EA.A.E M. & R. FUTURE TREATMENT: Based upon the history obtained, clinical examination findings and review of MRI report and EMG, it is my professional opinion that the patient has sustained a permanent and partial disability causally related to the accident of January 30, He has clearly sustained a permanent consequential limitation and loss of use of the cervical and lumbar intervertebral discs and left shoulder. Since these injuries are permanent in nature, the patient will require continued medical treatments for the rest of his life with a reasonable degree of medical probability. He will require periodic lumbar MRI re-evaluations every two to three years. He needs to be seen by a physiatrist at least I2 times per year. He needs at least 30 to 40 physical therapy sessions per year to diminish pain and spasm and to prevent this condition from getting progressively worse. This injury will result in a permanent reduction in the normal range of motion and will result in pain upon the performance of ordinary function. Mr. Taussi will never fully recover. He has, and will continue to have pain and loss of use of the affected areas, with limitations of motion in her lumbar spine and his condition may worsen over time. CONCLUSION: In my opinion this patient has sustained a serious injury in that he has incurred a permanent consequential limitation of use of his cervical and lumbar spine and left shoulder. In my opinion stated with a reasonable degree of medical certainty and based upon the history, examination and testing, this patient has sustained injuries which include a permanent partial loss of use of his cervical and lumbar spine which is now and is expected to continue to be the source of chronic pain and functions now at a decreased percentage of nonnal, with associated chronic pain,,discomfort and dysfunction and with moderate loss of use of the normal ranges of motion overall.

8 JACOB NIR, M.D., F.A.A.P.M. & R. Based upon the history, examination, diagnosis test results and findings in this case, the injuries, limitations and chronic symptoms sustained by Mr. Taussi described above are the direct result of the accident of January 30, I, Dr. Jacob Nir, a physician duly licensed to practice medicine in the field of Physiatry in the State of New York, pursuant to CPLR Section 106 hereby affirms under the penalties of perjury that the statements contained herein are true and accurate. Very truly yours, acob vir, M..

HISTORY AND CHIEF COMPLAINT:

submitted by Keith M. Bartley, D.C. Jasper, IN 07/21/11 presented at Cox Seminar in Nashville, TN, on October 8 9, 2011 HISTORY AND CHIEF COMPLAINT: 01/21/11 55 year old male press operator for Jasper