Academy of Chiropractic Personal Injury & Primary Spine Care Program
Quickie Consult 1139
Testifying 15 T
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006
"How do I report bodily injuries with no herniations"
Dr Studin: So tell me again, you're going into deposition. What's the clinical setup?
Guest Doctor: The patient was at work and she went to go sit down in the chair and the chair had tipped backwards because there was a code on the back of the chair, she slipped all the way backwards, felt on her back, hurt her neck and her left wrist. On MRI. All we got is degenerative changes, with some disc bulging or some narrowing in the cervical spine and in the lumbar spine. EMG was positive both in the cervical and in the lumbar. In the cervical XT 5 and 6 in the lumbar at L34. And at L5S1.
Dr Studin: How old was the patient?
Guest Doctor: The patient is approximately 50 years old, female, and she weighs 289 pounds. And she's 5”6.
Dr Studin: Does she have previous MRIs or EMGs?
Guest Doctor: She did have a previous MRI that I didn't see it, didn’t know about. And it said in the Lumbar MRI, didn't have a cervical previous…
Dr Studin: how many years ago?
Guest Doctor: I don't know. I didn't get the MRI. The MRI company sent over and just said there wasn't much difference from the previous results. But she says it was about two years ago.
Dr Studin: Two years isn't a whole long time. So the first thing you must do is you have to get a hold of the previous images because I don't care what radiologist says, I don't trust the reading. That's number one. So with that being said, you've got to do a comparative study and I will look at that with you if you need help to do that. But now you've got positive EMG. So does the EMG based upon the amplitude show that it's chronic or acute?
Guest Doctor: consistent with the timing of the injury.
Dr Studin: Therefore, it’s acute it's not chronic if it's consistent with the timing of the injury in both cervical and lumbar, if there was a double crotch upstairs to show that as a concomitant, a carpal Tunnel?
Guest Doctor: she has carpal tunnel, she said it's mild.
Dr Studin: but on the EMG, does it show ridiculopaty and Carpal tunnel?
Guest Doctor: Yes.
Dr Studin: So she has double crush. The question is there an exacerbation or an aggravation? So now what we've got to do is you have to be able to apportion or determine that. And if you look at the MRI, the new MRI, you can look for things like bone spurs. You could look for modique changes, modique two to perhaps to show its old or a model one to show its new. Or You could look for high signal in the disk. And perhaps it's not a bulge, perhaps it is a herniation. But if there's high signal on a bulge, you've got a new issue super imposed on an old issue, if in fact you've got a positive EMG in both upper and lower extremities with a double crush upstairs, then we know that it's consistent with an acute problem. So we know that there are functional deficits with the new stuff. But where's your structural deficit? Did you do x-rays?
Guest Doctor: She had an x ray done as soon as she got injured. The lumbar and cervical spine.
Dr Studin: but they didn't do flexion extension studies.
Guest Doctor: They did not.
Dr Studin: So this is where you need to get selection extension studies and digitize them. And now if you show that there's lacks of the ligament, this could be your demonstrative evidence to show the currently that this is the reason why the EMG is positive, your evidence isn't on the MRI. Now you could say that there's lacks of the ligament which is creating issues at the vertebral level, which is evidenced by the positive EMG MCV. And now you've got your demonstrative evidence as to why and you've got laxity of ligament on top of that. And those ligaments are the wound repair with inferior tissue and that's going to have permanent sequalae. That is huge. So what you need to do with get a copy of the current MRIs and you can discern plenty from them. But you must get Emma a current x-rays, just flexion extension, cervical and lumbar because it'll change the diagnosis, prognosis and treatment plan for the rest of this patient's life.