Diagnosing Neck and Back Injuries

• Author: Michael J. Morse
• Pages: 125-254

CHAPTER 3

Diagnosing Neck and Back

Injuries

I. Examination

A. Introduction

§ 3:10 Overview

§ 3:20 Office Examination

§ 3:30 Emergency Room Examination

B. Objective Findings

1. Introduction

§ 3:40 Overview

§ 3:50 General Tests

2. Testing Individual Nerve Roots

§ 3:60 Overview and Checklist

§ 3:70 Motor Power

§ 3:80 Sensation

§ 3:90 Reflex

§ 3:100 Relating Disc Levels With Motor, Sensory and Reflex Deficits

§ 3:101 Signs and Tests Table

§ 3:102 Electrodiagnostic (EDX) Medicine

§ 3:103 Nerve Conduction Studies

§ 3:104 Needle Electromyography

§ 3:105 Evoked Potentials

C. Subjective Findings

§ 3:110 Overview

§ 3:120 Range of Motion (ROM)

§ 3:130 Valsalva Test

§ 3:140 Distraction Test

§ 3:150 Compression Test

§ 3:160 Lasegeu’s Test

§ 3:170 Straight Leg Raising Test (SLR)

§ 3:180 Bragard’s Test

§ 3:190 Fabere or Patrick Test

§ 3:200 Beevor’s Sign

§ 3:200.1 Nonorganic Signs are Unreliable as Screening Tool

LITIGATING NECK AND BACK INJURIES

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D. Common Injuries and Diseases

1. Whiplash Injuries

§ 3:201 Clinical Presentation of Cervical Hyperextension Injuries

§ 3:210 Overview

§ 3:220 Biomechanics and Pathomechanics

§ 3:220.1 Whiplash Symptoms

§ 3:221 Descriptions of Low Back Problems

§ 3:222 Sprains and Strains

§ 3:222.1 Symptoms of a Neck Sprain

§ 3:230 Checklist: Sources of Pain

§ 3:231 Checklist: Causes of Low Back Pain

§ 3:232 Smoking and Back Pain

§ 3:233 Sacroiliac Joint Disease

§ 3:234 Blunt Trauma and Piriformis Syndrome

§ 3:240 Checklist: Injuries and Symptoms

§ 3:241 Injuries and Rear-End Collisions

§ 3:242 Injury-Producing Forces and Movements

§ 3:243 Injury Risk Factors

§ 3:244 The Superimposed Indirect Acceleration Injury

§ 3:245 Indirect Acceleration Injury Cases

§ 3:246 Mechanisms of Soft Tissue Injury in Motor Vehicle Accidents

§ 3:246.1 Mechanism of Injury in Cervical Hyperextension

Cases

§ 3:246.2 Whiplash Syndrome: Brain Damage and Impaired

Cognitive Performance

§ 3:247 Checklist on Causes of Neck and Back Pain

§ 3:248 Postural Pain

§ 3:249 Clinical Classifications of Cervical Hyperextension Injuries and

Associated Disorders

2. Fractures and Other Disorders

§ 3:250 Overview

§ 3:260 Checklist of Fracture Types

§ 3:260.1 High Risk Fractures

§ 3:261 Craniocerebral, Cervical Spine and Spinal Cord Injuries

§ 3:262 Endocrinologic Disorders of the Cervical Spine

§ 3:263 Suppression of Vitamin K and Increased Risk of Bone

Fractures

3. Temporomandibular Joint Pain Syndrome

§ 3:270 Introduction

§ 3:280 Anatomy

§ 3:290 Mechanism of Injury

§ 3:300 Symptoms

§ 3:310 Diagnosis

§ 3:320 Treatment

§ 3:321 Additional Treatments

n DIAGNOSING NECK AND BACK INJURIES

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4. Head Injuries

§ 3:330 Introduction

§ 3:340 Types of Damage

§ 3:350 Injury Absent Objective Signs

§ 3:360 Diagnosis of Head Injuries

§ 3:360.10 Anatomy

§ 3:360.20 Examination and Treatment

§ 3:360.30 Documenting Level of Consciousness

§ 3:360.40 Imaging Techniques

§ 3:360.50 Assistance of Neurosurgeon

§ 3:360.60 Assistance of Neuropsychologists

§ 3:370 Common Defense Tactics

5. Spinal Shock

§ 3:380 Overview

§ 3:381 Spinal Epidural Abscess

6. Discs

§ 3:390 Pre-Existing Disc Degeneration

§ 3:391 Relationship Between Disc Herniation and Degenerative Disc

Disease

§ 3:392 Smoking as a Causative Factor in Disc Degeneration

§ 3:400 Bulging Discs Versus Herniated Discs

§ 3:400.1 Bulging and Some Protruding Discs as

Degenerative in Nature

§ 3:400.2 Bulges, Extensions, Protrusions and

Sequestrations

§ 3:401 Types of Herniated Discs

§ 3:402 Non-Mechanical Causes of Recurrent Pain

§ 3:403 Spinal Disk Abnormalities

§ 3:410 Defense Arguments

7. Thoracic Outlet Syndrome

§ 3:420 Overview

§ 3:430 Diagnosis and Treatment

8. Piriformis Syndrome

§ 3:431 Overview

9. Chronic Compartment Syndrome (CCS)

§ 3:432 Overview

§ 3:433 Coccydynia

§ 3:434 Diagnosis of Coccydynia

§ 3:435 Conservative Treatment for Coccydynia

§ 3:436 Surgical Treatments for Coccydynia

II. Diagnosis

A. Introduction

§ 3:440 Overview

§ 3:450 The Daubert Standard

§ 3:460 Daubert on Remand

§ 3:461 Daubert and Psychological Syndrome Evidence