Boston Children's Hospital Patient Name: FITZGERALD, ELISA

300 Longwood Avenue MRN: 424-67-12

Boston, MA 02115
Date of Birth: 12/8/2006

Patient Viewable Clinical Documentation

DOCUMENT NAME: Sports Medicine Visit
SERVICE DATE/TIME: 9/21/2023 16:20 EDT
RESULT STATUS: Modified
PERFORM INFORMATION: ASSARD PA,JULIA A (9/21/2023 16:23 EDT)
SIGN INFORMATION: GEMINIANI MD,ELLEN T (9/22/2023 07:59 EDT); ASSARD
PA,JULIA A (9/21/2023 17:18 EDT)

Chief Complaint Problem List/Past Medical History

16 year old volleyball athlete presenting with bilateral shin pain worse on the left then right. Ongoing
Depression
History of Present Illness
Suicidal ideation
16 year old female volleyball athlete presenting today for bilateral shin pain. She reports
Historical
pain began 3 weeks ago after preseason for volleyball where she was exercising for 6
No qualifying data
hours a day for 4 days in a row and then began practice for 2 1/2 hours a day five days a
week. She reports she did not exercise much in the summer. She reports pain in both Procedure/Surgical History
shins with the pain worse in the left shin and it occurs all day. She reports pain to the No Procedure History
medial border of the tibia worse on the left then the right and pain to the anterior tibial
Medications
spine bilaterally. She reports it is worse with walking and will ache when sitting. She
cyproheptadine (cyproheptadine 4 mg oral
reports pain in the morning when she wakes up and at night. She reports going to her
tablet), 4 mg = 1 tab, PO, bedtime
trainer at school last week who advised her to wear a boot for her left leg. She reports not
no home medications
playing volleyball for the last week and wearing the boot with some improvement in
piroxicam (piroxicam 20 mg oral capsule),
symptoms. She reports taking ibuprofen and icing with some relief of symptoms. She
20 mg = 1 cap, PO, daily
denies numbness, burning, or tingling to the legs.
Allergies
Patient was accompanied by independent historian who contributed to the history: YES No known allergies
Review of Systems Social History
Pertinent positives and negatives noted above in HPI. All other systems negative. Basic Social History
Legal Guardian: Parent. Lives With:
Physical Exam
Mother, Guardian, Sister. Grade in
Vitals & Measurements School: 6th. Name of School: Dexter
No Measurements found for this patient(current encounter). Southfield school. Passive Smoke
General: Well-appearing, NAD, pleasant Exposure: No.
Bilateral lower leg exam:
Family History
No erythema, no ecchymosis, no effusion. Non-tender to patella, quad tendon, patella
DVT - Deep vein thrombosis: Negative:
tendon, tibial tuberosity, lateral or medial malleolus, Achilles, cuboid and base of 5th MT.
Mother, Father, Sister, Brother,
TTP to left medial spine of tibia entire length of calf and TTP to upper and lower anterior
Grandfather and Grandmother.
spine of left tibia.
Malignant hyperthermia: Negative: Mother,
TTP to right lower medial spine of tibia and to upper anterior spine of right tibia.
Father, Sister, Brother, Grandfather and
Pain bilaterally with single leg stance, calf raises.
Grandmother.
Pain bilaterally with resisted dorsiflexion, plantarflexion. No pain with inversion, eversion.
Myopathy: Negative: Mother, Father, Sister,
Pain bilaterally with hop testing.
Brother, Grandfather and Grandmother.
Strength 5/5 EHL, tibialis anterior, plantar flexion bilaterally.
Pulmonary embolism: Negative: Mother,
Sensation intact bilaterally.
Father, Sister, Brother, Grandfather and
NVID.
Grandmother.
Imaging
Bilateral XR of Tibia and Fibula performed today. Dr. Geminiani personally reviewed the
imaging today, no evidence of fracture, alignment maintained, no lose body. Final report
pending.

Assessment/Plan
16 year old female volleyball athlete presenting today for bilateral shin pain. Based on her
sudden increase in activity, history and physical exam she has shin splint vs stress
reaction vs stress fracture. XR of shins bilaterally showed no obvious fracture. Ordered MR

THIS IS A COPY OF BCH ELECTRONIC MEDICAL RECORD

Boston Children's Hospital Patient Name: FITZGERALD, ELISA

Patient Viewable Clinical Documentation

bilaterally of lower leg to evaluate for swelling and inflammation of the marrrow and for any
cortical changes. Will follow-up virtually to review MR report.

All questions were answered and patient/family are in agreement with the plan. In the
interim, they may call with any questions or concerns.

The patient was seen by Dr.Geminiani, who examined the patient, formulated the
assessment and plan, and agrees with the above documented findings.

Julia Assard, PA-C

Attending Attestation – NP/PA Supervised

I provided direct supervision for this service, discussed the case with the NP/PA and agree
with the findings and plan as documented in the NP/PA note

THIS IS A COPY OF BCH ELECTRONIC MEDICAL RECORD