When Working with Traumatically Induced Clients
When Working with Traumatically Induced Patients
When working with traumatically induced clients and patients, it is imperative that the clinical expertise of the doctor is at the highest level possible. Whether the patient presents with neck pain, lower back pain, shoulder pain, disc injury, or whiplash trauma, the doctor's education and expertise is essential to the patient receiving the best care and outcome, as well as for the attorney to be able to communicate clearly to payers what the injuries truly are and how they are and could and will affect the patient in the potential future. This is most important when it comes to understanding the correlation between physical examination and diagnostic imaging. When clinical findings are missed and not properly documented, the result is a convoluted case and can possibly lead to health consequences for the client.
In a very recent article published in the journal Injury, Leucht, Fischer, Muhr, & Ernst (2009) analyzed 562 patients that presented to a level 1 trauma center after an accident. They stated, “The most common cause of accident was a high-energy fall (39%), followed by traffic accidents (26.5%)” (Leucht et al., 2009, p. 166). What they were looking to do was to correlate the findings on physical examination to those on imaging studies.
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One important aspect of clinical examination is the testing of neurologic systems to screen for damage. There are simple tests that can give a complex look into the body to ensure the proper tests are ordered. When a trauma victim presents for clinical work up, these tests are performed and are used to help determine a working diagnosis. For years, astute clinicians have argued there are many cases in which clinical examination findings are minimal in the presence of significant underlying injuries.
The authors of this paper showed, “Sixty-three (11.2%) patients exhibited a complete motor and sensory deficit, 76 (13.5%) an incomplete and 423 (75.3%) no neurological deficit” (Leucht et al., 2009, p. 166). The important point in this reference is 75.3%. These trauma patients presented for evaluation and the neurological tests performed on physical examination were NORMAL. However, the patients had sustained spinal fractures.
When working with clinicians in the trauma arena, it is imperative that they understand implications of injury and how to properly use the tools available. Proper diagnosis and prognosis is imperative to establish causality to bodily injury. The absence of findings on portions of the physical examination does not necessarily mean there are no injuries. If you are working with traumatically injured clients, this article is a MUST have for your library.
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Leucht, P., Fischer, K., Muhr, G., & Mueller, E. J. (2009). Epidemiology of traumatic spine fractures. Injury, 40(2),166-172.