Understanding T2 and STIR MRI Findings In my training as a Physician's Assistant, and while working in orthopedic surgery, there are aspects of our education, training and experience that become second nature. However, at times, we tend to overlook the importance of what is perceived as routine everyday use, and the value of these data points is lost on the general population. One of these items is the component of…
When I first entered the world of case management and cost containment dealing with workers compensation cases, a frequent request was for injured individuals with low back pain complaints to have a treadmill placed into their homes, precipitating weight loss and improvement with respect to the low back pain complaints. The running joke became what was the world's most expensive clothes hanger, and the answer is that treadmill. The Rise…
The Evolution of Medications: When Side Effects Lead to New Discoveries In medicine, things are always changing. Constant experimentation, research, and modifications to the original intent are always being investigated. A prime example of an altered pathway would be the development of a new antihypertensive medication. During clinical trials, there was an unintended side effect in terms of blood flow to the corpus cavernosum. With the identification of this side…
For those who’ve followed my blog, it’s clear that the adjudication of workers’ compensation cases has undergone a significant transformation in recent years. Successful rehabilitation from a compensable injury now demands a holistic perspective, focusing on the entire individual, particularly the injured employee, and their active role in the recovery journey. This collaborative approach creates a positive ripple effect, leading to benefits for the injured employee, reduced expenses, and ultimately,…
When evaluating your new file, and noting that there are reported degenerative changes, such as those from chronic conditions like arthritis, disc degeneration, or repetitive strain injuries, focusing solely on immediate costs is a critical oversight. To manage the full scope of treatment, it’s essential to determine which degenerative issues are directly related to the reported injury. The Hidden Costs: Beyond Immediate Treatment Expenses Within the context of workers’ compensation,…
A frequent finding on enhanced imaging studies such as MRI is that the radiologist reports change consistent with a tendinitis or at times changes that reflect a tendinosis. Unfortunately, all too often these two very distinct clinical conditions are used interchangeably. This would be an error. Taking note of the differences in these two clinical scenarios would modify the treatment delivered. To begin this discussion, one must understand what a…
Introduction: Alcohol and Workers’ Compensation I came across an interesting article today regarding alcohol consumption and the compensability of a workers’ compensation claim. It was noted that a commercial driver crashed his truck after downing several beers. A judge in Delaware ruled that this act alone established that the injured driver was not entitled to a workers’ compensation claim. Legal Misstep by the Delaware Industrial Accident Board What is interesting…
A recent report came across my desk where the provider attempted to assign an impairment rating for a flexion contracture of the knee, and the clinical records clearly showed the pathology objectified was an extension lag. Unfortunately, this is a mistake I see on occasion and can be a huge difference maker in the impairment rating assigned. Clearly, issues with the overall functionality of the knee can interfere with mobility,…
During the course of the last week, I stumbled across three separate items that tend to ignite certain passions. In one case, I had to clarify a certain legal position which led me to discuss my three least favorite items, the lack of use of current evidence-based medicine, liberal construction and presumption. The Widening Gap: Evidence-Based Medicine in a Rapidly Changing World When I was in my clinical training, it was…
One of the very first lessons I learned in my clinical career was a quote from Dr. William Osler dating back to 1895. Dr. Osler was at the Johns Hopkins medical school and his quote is “Listen to your patient, he is telling you the diagnosis.” Another is “The good physician treats the disease; the great physician treats the patient who has the disease.” Medicine as Art and Science: The…
