Physician experts are sometimes asked to evaluate whether a claimant’s diagnoses should be expanded to include “segmental and somatic dysfunction” of the cervical, thoracic, lumbar, or sacral regions. This issue commonly arises in personal injury, workers’ compensation, motor vehicle collision, chiropractic treatment, osteopathic manipulation, and chronic spine pain claims.
Shoulder pain after a rear-end motor vehicle collision is common. The difficult medicolegal question is whether the shoulder pain represents a traumatic shoulder injury, such as a labral tear, or whether it is more consistent with cervical strain, referred pain, radiculopathy, myofascial pain, or an incidental MRI finding.
Independent medical examinations occupy a unique position in medicine. The physician performing an IME is not the treating physician. The examination is usually requested by a third party, such as an insurer, employer, attorney, court, or claims administrator. The purpose is typically to answer medical-legal questions about diagnosis, causation, impairment, work capacity, treatment necessity, prognosis, or disability.
Complex regional pain syndrome, commonly called CRPS, is one of the most challenging diagnoses in medicolegal evaluation. It is painful, disabling, controversial, and often poorly understood. In workers’ compensation, personal injury, disability, and independent medical examination settings, CRPS may be alleged after fractures, sprains, surgery, crush injuries, burns, electrical exposures, or even seemingly minor trauma.
Facet-mediated spinal pain is a frequent issue in personal injury, workers’ compensation, disability, and independent medical examination cases. A common pattern is familiar to many physician experts: a minor accident, no fracture, no instability, no radiculopathy, no objective structural injury, several months of conservative care, then diagnostic medial branch blocks followed by radiofrequency neurotomy or radiofrequency ablation. The claimant reports temporary improvement, and the treating physician recommends repeat procedures indefinitely.
