Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 1147
Clinical Information 273 CI

From the Desk of Dr. Mark Studin
Academy of Chiropractic

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

"Explaining directional bulge from trauma"


Dr Studin: So what's going on?

Guest Dr: I just had some general questions first before in reference to PI, the term forensic, you just define that thing for me?

Dr Studin: forensic simply means you're taking things apart and analyzing it. So when we look at forensic documentation, it's documentation really looking at every aspect like of an accident, when you have forensics on a crime scene, they are looking at everything: Hair, fibers, fingerprints, blood spot, blood splatter, patterns. It's really looking at it, not just the big picture but all the littles.

Guest Dr: Cause I know what it means in a crime scene. I just didn't know what it meant in PI.

Dr Studin: well again, in PI, you're looking at the injuries, you're looking at the mechanism of injury. You're looking at the crush zones in the car, maybe the skid marks. But if you're looking at documentation, then what you want to do is you want to look at the injuries, you want to be forensic about it. You're not just looking at someone being in pain. You want to look at the vertebrae and rotated perhaps the ligaments being torn, the disk being herniated, what nerves are being evaluated. You're really breaking it down forensically.

Guest Dr: The Bulging disc without the degeneration that goes beyond the edges. Is that considered trauma?

Dr Studin: A bulging disc can be a very live etiologies. You can take any one finding and say, is this directly causally related to the trauma. Now, for instance, if you're early on scoliosis, you're going to have bulging discs. If I'm laying in the MRI to bend all the way to the left, it's going to be a bulging disc. But if you leave that scoliotic patient there for years, that bulge is going to start to degenerate. It will be a degenerative disc. Now if you have a recent trauma, that's why you need to incorporate X-ray digitized because you need to see if in fact the cause of that bulge is the abdomen plays Vertebra where the ligament is a secondary strange sprain, so you'll see if there's greater than three and a half or four and a half millimeter Entreposto was thesis combined with greater than 11 degree angulation. If there is your George's line is just really trashed because that's not the case of a ligament issue as well. That's the cause. Now the effect of that is a bulge which is zero to less than 50% of the circumference off to one side without a degenerative angulus, which in a really good T2 weighted MRI, you could see. You need to take the MRI course, Cause when I say a severely degenerated, lower signal annual list and the T2 weighted image, that's what I'm going to start to lose you. Because you're not expert at that level, and this is where your confusion comes in. If you had taken the MRI course and the spinal trauma pathology course and the connective tissue pathology, you wouldn't even ask these questions because these are all integral to what we do. And also one of the reasons why lawyers will work with you and medical specialists will have relationships with you and lawyers will stop wanting to screw you in settlement offers because they want to keep working with you because you become the solution to the lawyer's case, their solutions to the medical specialists business, just because you understand all of these things. You really need that level of education to fully understand that because you're not seeing it. 

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