Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 160

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.

“The 953.0 Diagnosis”


Many of you have contacted me with issues utilizing the 953.0 diagnosis. This is the “Injury to Nerve Root” code and I have held, and still do, that it is applicable with trauma and nerve root involvement clinically and/or structurally.

 

In order for this to be used, you must have traumatic neuropathy. The following explains it very simply:

 

http://www.painclinic.org/nervepain-posttraumaticneuropathy.htm

Post Traumatic Neuropathy implies nerve pain (neuralgia, neuritis) that has come on either after an injury or as a consequence of medical interventions like surgery, injections, radiotherapy etc. It would be impossible to discuss every type of nerve damage, trapped or pinched nerve in every location. I have therefore concentrated on the common ones seen in the pain clinic. Which ever nerve is affected, there are similar clinical findings, investigations, and pain clinic treatments available for it. Rather than repeat these for each of the sections on this page, I have summarised them below:-

Clinical Findings

  • - Symptoms are usually felt at the site of the injury, and also radiate away from the site in the normal distribution of the nerve involved. Detailed anatomical knowledge is required to be able to determine which nerve is involved.
  • - Neuralgic quality pain (burning, shooting) associated with hypersensitivity, numbness, tingling, and muscle weakness depending on whether the nerve involved is purely sensory, purely motor, or mixed sensory / motor.
  • - There may be associated over activity of the sympathetic nervous system in the area e.g. excessive sweating, colour changes (blue through to red), and temperature changes (cold through to hot).
  • - Allodynia may be present. This is pain from a stimulus that does not normally cause pain:-
    • - light touch = vibrational allodynia
    • - pain at temperatures between 37 - 60 deg C (normal warm range) = heat allodynia
    • - pain at temperatures between 4 - 37 deg C (normal cold range) = cold allodynia
  • - Pressure with a finger over the site of the nerve injury will usually reproduce the nerve pain and symptoms. Also stretching a damaged nerve will have the same effect.
  • - Examination may reveal nerve specific abnormal sensory and motor function.
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