This is the report of the medical exam by the doctor paid for by the workers compensation insurance company. Keep in mind, Dr. Stirrat was aware of the trip to China and did not comment on it.  Dr. Stirrat did not dispute the three weeks away from work as recommended by Dr. Gordin's 8/9/96 note.

LONGWOOD HAND
630 BOYLSTON STREET
CHESTNUT HILL. MASSACHUSETTS 02167
(617) 232-5361

CRAIG R. STIRRAT, M.D.
BOARD CERTIFIED ORTHOPEDIC SURGERY
PRACTICE LIMITED TO
SURGERY OF THE HAND

September 16, 1996

William Silverstein
Employer: Microsystems
Policy No.: 71639858
DOI: 6/4/96

Thirty-three year old left handed software engineer being evaluated for bilateral hand complaints. By history has worked for his employer for approximately 3 1/2 years. Typically will work an entire 8 hour period an a keyboard. Also returns home and spends several hours an his home computer. Beginning in April of 1995 noted bilateral pains around his wrists, right more than left. Indicates pains were in the deQuervain's area, the ECU area and the volar wrist area. Also had some sense of cramping in the hands. Gradually over time developed a sense of pareathesias in the hands. Has been seen by several medical specialists. There is a question of his having bilateral upper extremity tendonitios. Currently under the treatment of Dr. Gordin. His note from 8/9/96 is appreciated. He talks about possible metabolic problems and makes the suggestion of dietary supplement shots and acupuncture. Patient has also been seen by Dr. Borgstein. He is a physiatrist. Has been referred to a muscle therapist for massage. In the past has had rheurmatologic work-up which was negative. Feels symptoms have remained fairly constant despite the interventions that he has had. Prior to the onset of symptoms was active with sports. Typically did biking and home work-out equipment He has tended to back off of   both those. Has not been doing any swimming or other regular exercise. There is no history of any thyroid or diabetic problems. Recently married. Considers himself healthy and does eat a regular diet. There is a possibility of an old right wrist injury from a fall in 1976 plus there may have been a more recent injury several years ago from a bicycle accident.

EXAM: Cooperative gentleman looking stated age with exam limited to the upper extremity areas. Range of motion through the upper extremities is essentially full with the exception of supination within the right forearm which only goes to 30 degrees. This appears to be a fairly definite block for further supination. Wrist alignment on the right however is normal. Thoracic outlet maneuvers do not seem to increase his symptoms. He does complain of some shoulder tightness with positioning of the arm but there