Far too often we at Gerard Malouf & Partners Personal Injury Lawyers see clients who have had an injury but may not have had the full compliment of proper medical and radiological investigations. It is essential that thorough radiological investigations are carried out at the initial stages after the accident to ensure that all possible areas of the injury have been investigated.
Clients may have sustained an injury to one particular area e.g. the lower back known as the lumbar spine but they may also have sustained injuries to other areas but the lower back injury is the one that was initially complained about and which the doctors are investigating. It is for this reason that it is important to advise your treating doctor of all possible areas and to closely monitor all symptoms in the first four weeks after an accident.
The general health status related to an injury of our client must be evaluated and documented in any assessment by the doctors so as to ensure all injuries are incorporated in the claim and to ensure maximum result is obtained.
To proper investigate injuries appropriate radiological investigations need to take place. Apart from the obvious location of the injury where there is a fracture or cut or a laceration or a bruising, secondary aspects of the injury must be looked at such as:
(a) Referred pain, paraesthesia, numbness from the area of the injury;
(b) Psychological effects resulting from the pain and dysfunction.
(c) Gastroenterological effects from prolonged ingestion of medication.
(d) Sexual effects due to pelvic and lower back/neurological injury.
Of course when you see a doctor the doctor may recommend various investigations that are commonly carried out. You need to be aware what these investigations include.
MRI and CAT SCANS
These investigations will only show changes in anatomy as the result of the injury. Examples of the latter are a disc protrusion, compression of a nerve root by a protruding disc, a displaced fracture, changes in a meniscus in a knee injury, disruption of a ligament, a past rib injury if there is thickening or displacement.
All of the above represent changes to the normal structure of the anatomy.
These investigations will not show the presence of inflammation but may show a swelling of a structure such as a nerve root. Whether that nerve root is the cause of the pain can probably only be established by a Nuclear scan of the area. The inflammation at the nerve root may be minimal but this cause of pain may only be seen by the “hot spot”, representing the local metabolic changes which cannot be seen on an MRI.
If the anatomy is normal and the patient still has pain, then often the patient is labelled as having nothing wrong unless further investigation by bone scan is performed.
Hence the importance of a bone scan. An MRI will not localize pain unless there is changed anatomy, whereas a Nuclear Bone Scan which will localize the area of changed metabolism and will verify the area of pain.
RadioNuclear Bone Scan
The value of a bone scan is important in that it shows bone or tissue metabolism changes which is not the case of an MRI or Cat Scan. It allows evaluation of damage to the bones or soft tissues due to trauma, infection or multiple other causes of pain. The presence of a “Hot Spot” on the scan will suggest that the effects of the trauma are persisting and is evidence that the patient still has a significant problem at the site of the injury due to metabolic changes due to the injury even though the anatomy on MRI is normal. This may be the result of persist inflammation, or a nerve irritation event though there is no obvious swelling of the nerve. This test may confirm the presence of persisting pain in the location where the patient complains, and may not be confirmed by other means.
This is a simple test to assess nerve conduction velocity and if this is changed by injury. The commonest cause of nerve malfunction is by impingement on the nerve by a disc or by pressure inside the carpel tunnel related to a work injury. There may be simply chemical irritation of the disc material onto the nerve root in the absence of significant compression dependant on the amount of nerve disruption. There may be residual scarring (in the spine "arachnoiditis”) around a nerve root from a disc rupture in the presence or absence of significant disc protrusion. Hence the causes of nerve malfunction are complex but can be reliably investigated by an EMG assessment both of the nerve conduction velocity and the response of the muscle supplied by the nerve.
An EMG may reliably predict the prognosis of the patient’s condition is related to the severity of impairment of the nerve impingement. The changes may be described as mild or severe, partial or complete. The results will indicate the likelihood of resolution or not and allow categorization under DRE system.
When a patient has a chronic injury often there is usually a long period of time where medications are required to reduce the severity of the pain.
This is frequently accompanied by long term and permanent injury to either the upper or lower gastrointestinal tract which can be assessed under the WorkCover guidelines to allow a WPI assessment. Macquarie will arrange to evaluate your client for WPI associated with gastrointestinal damage.
It goes without saying that the proper documentation of all injuries and symptoms by the doctors in the early stages greatly support our clients claims.
It is equally important for the injured person to ensure they advise all their doctors of ongoing problems and insist on having these investigated thoroughly.