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In health care objective evidence of an injury is vital during litigation. A lot of spinal injuries do not always have a way to shown objectively. Some of the easiest objective evidence we have for spine is imaging. MRI, CT and x-rays can be vital in showing objective injuries. My podcast has spent a lot of time discussing disc pathology seen on an MRI and ligament damage seen on x-rays. I have spent a lot of time with my podcasts covering ligament damage and how this

I think in a lot of ways forensic health care can be summed up in showing objective evidence of an injury with causation. There a lot of different ways to do this. Unfortunately, there is rarely a 100% way to show causation. My last podcast I shared a real life example of a patient with a 100% certainty what caused his injury. As a refresher he had hot antifreeze spill on him while at work causing very significant burns. This case is by far the exception and most injury

We talked on the second podcast about the origins of cervical alteration of motion segment integrity or AOMSI. If you have not listened to that podcast, I strongly recommend giving it a listen. Today I want to spend some time talking about origins of the lumbar AOMSI. I will be using a research article and one text book. The article is A biomechanical analysis of the clinical stability of the lumbar and lumbosacral spine by IRA Posner et al. This was published in the sp

We have spent a lot of time with the different podcasts discussing findings seen on MRI. We have talked a lot about modic changes. These changes are called Modic changes due to Dr, Michael Modic first classifying changes seen on MRI in 1988. He specifically looked at changes to the top and bottom of the vertebra and this is called the endplates of the vertebra. The findings we see with modic changes can be seen on MRI in any bone, but would not be called modic changes in

I spent a lot of time on the last podcast talking about the term soft tissue. As I’m sure you are aware I hate the term soft tissue. Today I want to spend time discussing another type of injury that is often categorized by insurance adjusters as a soft tissue injury. This study is all about facet joints or the bony joints in the back of the vertebra. These bony structures are not soft at all, but hard. If we are going off of the AMA Guides to the Evaluation of Permanent

I want to cover more of the healing process of what the legal world refers to as soft tissue injuries. This was such a new term for me years ago when I started working on medical legal cases. It seemed that all an adjuster had to say was this is a soft tissue injury and this should just be known to all that there really isn’t an injury. It seemed that soft tissue injuries by attorneys were to be avoid at all cost and that a real case needed more than just soft tissue. Th

I covered a lot of information about ligaments in the first 3 podcasts and then on the 13th podcast we talked a little more about ligaments. Ligaments are such a common injury that I would like to spend a little more time talking about ligaments and the repair process. I hesitate to say the healing process since this gives the idea that there is a good recovery with healing. That is not the case with ligaments and repair is maybe a more appropriate term. Today’s study w

The majority of people listening to my podcast will not be able to order advanced imaging of patients. Most of my listeners are attorneys and unable to order MRIs, but I wanted to take some time today and discuss indications for advanced imaging. I have worked with some attorney’s I am sure none that are listening to this podcast, but ones who demand MRIs on every case. This is dishonest and should not be done. We need a clinical justification for ordering advanced imagin

For the first 3 podcasts I covered a lot of information on ligament damage. The second podcast in particular I spent a lot of time talking about alteration of motion segment integrity or AOMSI. That podcast shows how we can objectively show catastrophic ligament damage. As a refresher AOMSI is when we have changes in the angle between the motion segments in the spine of over 11 degrees. AOMSI is also when we have translation forward or backwards of the vertebra by 3.5mm

The last podcast covered how injuries occur with no damage to vehicles and patients in collisions with no damage often go through more treatment than patients with damage to the vehicle. I would like to spend some time today going over the chances of being hurt in a low speed and minimal to no damage collision and how this compares to normal activities of daily living. Today’s study was published in 2021 in the International Journal of Environmental Research and Public He

We have spent the last 10 podcasts talking about injuries and what they mean to patients and how we can show causation. Today I want to talk about MVC’s with minimal damage to the vehicle. Like I’ve talked about in prior podcasts, I don’t like assumptions that are often used. I hear there was no damage to the vehicle and therefore there is no way the patient could have been hurt. I also hear reported that the vehicle was totaled and therefore they were really hurt. We ne

For the podcast I have gone over a few different research articles that discuss how to time date injuries with imaging and in particular MRIs. The last podcast discussed what a disc herniation might mean to a patient. I went over research showing the effects of a disc herniation when it takes the space of the spinal cord and nerve roots. The last podcast showed, if a disc herniation is compressing nerve tissue this will lead to cellular death and permanent nerve damage and

The last few podcasts have focus on disc damage and time dating injury based on imaging. We have not covered all the ways to time date an injury based on imaging. I wanted to spend some time today talking about what disc damage means to patients and not just the causation of the injury. I will have to spend a few podcasts on this subject as well. One common theme with disc herniations is real estate. Disc herniations can cause significant pain due to the recurrent men

The last few podcasts are all about time dating injuries with imaging. Is there a way to look at imaging and determine if we have a new injury that was caused by recent trauma or are we looking at pre-existing injuries. We have gone over multiple ways to help paint a picture of new vs. old. When we look at all the evidence it becomes easier to determine age of an injury seen on imaging. There have been articles published showing a certain percentage of the population ha

The last few podcasts have been about time dating injuries with MRI. Today’s podcast will not be specific to just MRI, but will be useful with CT and x-ray. Keep in mind that all methods for time dating injuries just help paint a picture. Will all of the evidence add up to show a new injury, or will the evidence stack up to show a pre-existing injury unrelated to recent trauma. Today I want to go over 2 separate studies. The first study is The diagnostic value of an x

The last 2 podcasts have discussed ways to help time date injuries with MRIs. We talked about modic changes, degenerative changes, and subjective radicular pain. Today I want to focus more on changes to the bone surrounding injuries. I want to go over Wolff’s Law and 2 separate research articles. Wolff’s Law came out in the 1800’s and says Bones will adapt to the loads under which it is placed. One of my favorite examples of Wolff’s Law is loss of bone density in astro

The last podcast discussed MRIs and findings of new vs old disc damage. We went over a lot of findings on MRIs of evidence to suggest new vs old injuries. The last podcast should be helpful with demonstrable objective evidence of injury and causation. In the medical legal world objective demonstrable evidence is often the key. What about subjective evidence? Does the way the patient experiences their injuries have an impact on diagnosis and a medical legal case? The stu

I have talked a lot about ligaments in the first 3 podcasts. When someone has a persistent or permanent injury following trauma in their spine I typically see ligament damage or disc damage. Disc damage and some ligament damage can be seen on MRI. MRI is a great tool to show demonstrable evidence of an injury. Today I want to talk about using an MRI to help with causation. The question I get asked a lot is: Is there a way to time date an injury with MRI? Time dating i

Today’s article will go along with the first 2 podcasts and discusses ligaments. The first podcast talked about the makeup of ligaments, how they get injured, what the inadequate healing process for damaged ligament is like and how to manage ligament damage. The second podcast was on the history of Alteration of Motion Segment Integrity or AOMSI and impairment ratings. Today’s article is Ligaments: A Source of Musculoskeletal disorders. This was published in the Journal o