Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 199

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.

“Report Writing by Region”


Many of you report findings by region in your narratives. As an example, here is a report I recently critiqued. Although this report has many issues that need correcting, it illustrates the issue.
 
Cervical Spine
Range of Motion:

  • Flexion was decreased with pain.
  • Extension was decreased with pain.
  • Right Flexion was decreased with pain.
  • Left Flexion was decreased with pain.
  • Right Rotation was decreased with pain.
  • Left Rotation was decreased with pain..

Reflexes:

  • The right bicep reflex was graded a plus 2 normal.
  • The left bicep reflex was graded a plus 2 normal. 
  • The right tricep reflex was graded a plus 2 normal. 
  • The left tricep reflex was graded a plus 2 normal.

Testing:

  • Maximal Foraminal Compression caused pain into the bilateral rhomboid.
  • Cervical Distraction (for nerve root adhesions or muscle spasms) was positive as evidenced by a decrease in pain in the cervical spine.
  • George's test  was negative.
  • Jackson's caused pain into the bilateral rhomboid.
  • Shoulder Depression test (for nerve root adhesions) was positive bilaterally.
  • Soto Hall was negative.
  • Valsalva's test was negative.

Lumbar Spine
Range of Motion:

  • Flexion was decreased with pain.
  • Extension was decreased with pain.
  • Right Flexion was decreased with pain.
  • Left Flexion was decreased with pain.

Testing:

  • Percussion caused pain and tenderness at T9 and T10.
  • Bilateral leg lowering test (for sciatica/HNP) was negative.
  • Braggard's test was negative.
  • Kemp's was inconclusive with pain bilaterally side and elicits pain L5 and Left Sacroiliac.
  • Negative Patrick Fabere with pain in the lumbar spine at the level of L5 and Left Sacroiliac.
  • SLR bilaterally Straight Leg Raise bilaterally was positive at 60 degrees at L5 and Left Sacroiliac.
  • Gaenslen's test was positive by exhibiting pain in the sacroiliac joint bilaterally.

Reflexes:

  • The right patellar reflex was graded a plus 2 normal.
  • The left patellar reflex was graded a plus 2 normal. 
  • The right Achilles reflex was graded a plus 2 normal. 
  • The left Achilles reflex was graded a plus 2 normal.

 
Although the doctor was diligent in performing tests, it creates a potential problem on the witness stand and with the claims adjustor, and creates a fragmented scenario. It has been recommended to me to report all ranges of motion in one area and to do the same with motor, sensory, etc. so that the lawyer can present one concept, educate either the jury or claims adjustor and then go to the next issue. As an example:
 

Bicepts 4/5 Right
Tricepts 4/5 Right - Left
Foot Flexors 4/5 Right - Left
Foot Extensors 4/5 Right - Left
Quadriceps 3/5 Right - Left
Hamstrings 3/5 Right - Left


 This minimizes the time needed to explain issues and allows more of the focus to be on the results. It also prevents the lawyer from saying over and over, "Remember when I explained that to you 30 minutes ago that the motor testing..." It also shortens the report by being more concise and isn't as daunting to the reader. Keep it simple and as short as possible although historically, our reports are 7-8 pages in length.

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