Limbs and lower spine

• Author: R. John Naranja
• Pages: 301-496

LIMBS AND

LOWER SPINE

17-1

CHAPTER 17

LIMBS AND LOWER SPINE

§171 CASE 1: ACCIDENTAL AMPUTATION OF UPPER LIMB AT MIDFOREARM

§17-1.1 Fact Summary

§17-1.2 Clinical Discussion

§17-1.3 Forensic Questions and Answers

§17-1.4 Glossary

§17-1.5 Additional Reading

§172 CASE 2: BRACHIAL PLEXUS INJURY DUE TO BICYCLE ACCIDENT

§17-2.1 Fact Summary

§17-2.2 Clinical Discussion

§17-2.2.1 Surgical Approach

§17-2.2.2 Arthrodesis

§17-2.2.3 Brachial Plexus Repair

§17-2.2.4 Brachial Plexus Def‌icits Due to C5 and C6 Injury

§17-2.3 Forensic Questions and Answers

§17-2.4 Glossary

§17-2.5 Additional Reading

§173 CASE 3: CARPAL TUNNEL SYNDROME

§17-3.1 Fact Summary

§17-3.2 Clinical Discussion

§17-3.2.1 Median Nerve

§17-3.2.2 Surgical Procedure

§17-3.3 Forensic Questions and Answers

§17-3.4 Glossary

§17-3.5 Additional Reading

§173A CASE 3A: CARPAL TUNNEL SYNDROME:

PERSONAL INJURY OR WORKERS’ COMPENSATION?

§17-3A.1 Fact Summary

§17-3A.2 Medical Report

§17-3A.3 Clinical Discussion

§17-3A.3.1 Anatomy

§17-3A.3.2 Pathophysiology

§17-3A.3.3 Clinical Effects of Median Nerve Compression in Carpal Tunnel (CTS)

[Editor’s Note: All medical illustrations that appear or are referenced in this chapter are available online – in full-size

and most in four-color – through James Publishing Digital Access.]

LIMBS AND

LOWER SPINE

Medical Evidence 17-2

§17-3A.4 Diagnosis

§17-3A.5 Treatment

§17-3A.5.1 Conservative Treatment

§17-3A.5.2 Surgical Treatment

§17-3A.5.2.1 Decompression of Carpal Tunnel

§17-3A.5.2.2 Post-Operative Care and Treatment

§17-3A.5.2.3 Note re: Surgical Neurolysis of Median Nerve

§17-3A.6 Prognosis

§17-3A.7 Forensic Questions and Answers

§17-3A.8 Additional Reading

§174 CASE 4: LUMBAR INTERVERTEBRAL DISC HERNIATION FROM LIFTING

§17-4.1 Fact Summary

§17-4.2 Clinical Discussion

§17-4.2.1 Peripheral Nerves in Lumbar Spine Injury

§17-4.2.2 Lumbar Discectomy

§17-4.3 Forensic Questions and Answers

§17-4.4 Glossary

§17-4.5 Additional Reading

§174A CASE 4A: LOW BACK & RADIATING PAIN AFTER MVA

§17-4A.1 Fact Summary

§17-4A.2 Medical Report

§17-4A.3 At Issue

§17-4A.4 Clinical Discussion

§17-4A.4.1 Lumbar Disc Herniation at L5/S1

§17-4A.4.2 Signif‌icance of MRI Findings

§17-4A.4.3 Correlation Between Clinical Finding and MRI Finding

§17-4A.4.3.1 Analysis

§17-4A.4.3.2 Application to Ms. Smith

§17-4A.4.4 Symptom Magnif‌ication/Malingering

§17-4A.4.5 Pain Behavior

§17-4A.4.6 Other Diagnoses That Manifest With Sciatica

§17-4A.4.6.1 Sacroiliac Joint Strain/Dysfunction

§17-4A.4.6.2 Piriformis Syndrome

§17-4A.5 Additional Reading

§175 CASE 5: DEGLOVING AND CRUSHING INJURY OF

THE LOWER LIMB: A RAILROAD ACCIDENT

§17-5.1 Fact Summary

§17-5.2 Clinical Discussion

§17-5.2.1 Muscular Injuries

§17-5.2.2 Vascular Injuries

§17-5.2.3 Neural Injury

§17-5.2.4 Degloving of the Limb

§17-5.3 Forensic Questions and Answers

§17-5.4 Glossary

§17-5.5 Additional Reading

§176 CASE 6: HIP FRACTURE

§17-6.1 Fact Summary

§17-6.2 Clinical Discussion

§17-6.2.1 Hip Replacement Surgery

§17-6.2.2 Muscular and Neurovascular Relationships

LIMBS AND

LOWER SPINE

17-3 Limbs and Lower Spine

§17-6.3 Forensic Questions and Answers

§17-6.4 Glossary

§17-6.5 Additional Reading

§177 CASE 7: PATELLAR TENDON DISRUPTION

§17-7.1 Fact Summary

§17-7.2 Clinical Discussion

§17-7.3 Forensic Questions and Answers

§17-7.4 Glossary

§17-7.5 Additional Reading

§178 CASE 8: ANTERIOR CRUCIATE LIGAMENT RUPTURE

§17-8.1 Fact Summary

§17-8.2 Clinical Discussion

§17-8.3 Forensic Questions and Answers

§17-8.4 Glossary

§17-8.5 Additional Reading

§179 CASE 9: MULTIPLE LEG FRACTURES: A BICYCLEAUTOMOBILE ACCIDENT

§17-9.1 Fact Summary

§17-9.2 Clinical Discussion

§17-9.3 Forensic Questions and Answers

§17-9.4 Glossary

§17-9.5 Additional Reading

§1710 CASE 10: AVASCULAR NECROSIS OF FEMORAL HEAD IN CHILD

§17-10.1 Fact Summary

§17-10.2 Diagnosis

§17-10.2.1 The Differential Diagnosis

§17-10.2.1.1 Femoral Neck Fracture

§17-10.2.1.2 Slipped Capital Femoral Epiphysis

§17-10.2.1.3 Leg-Calve-Perthes Syndroginous

§17-10.3 Clinical Discussion

§17-10.3.1 Development of Hip and Femur

§17-10.3.2 Gross and Vascular Anatomy of the Hip

§17-10.3.2.1 Bony Elements

§17-10.3.2.2 Blood Supply

§17-10.3.3 Hip Dislocation in Children

§17-10.4 Treatment

§17-10.5 Prognosis

§17-10.6 Forensic Questions and Answers

§17-10.7 Glossary

§17-10.8 Additional Reading

§1711 CASE 11: COMPOUND FRACTURE OF DISTAL THIRD OF

HUMERUS WITH SUBSEQUENT RADIAL NERVE PALSY

§17-11.1 Fact Summary

§17-11.2 Diagnosis

§17-11.3 Clinical Discussion

§17-11.3.1 The Humerus

§17-11.3.2 The Radial Nerve

§17-11.3.3 Impairment Due to Radial Nerve Injur y

§17-11.3.4 The Deep Brachial Artery and the Brachial Artery

§17-11.3.5 Other Structures That May Be Damaged by Fracture of Distal Humerus