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Clinical Processes for Musculoskeletal Injury

September 21, 2010

By Sarah Anderson, MPT

A morotcycle accident, fall from a rooftop, or typing on a keyboard are all possible mechanisms that can cause your clients an injury.  In the course of your career you will encounter hundreds of clients with musculoskeletal injuries as part of their legal case.  The treatment of a musculoskeletal injury varies depending on the severity of the injury, type of injury, and preference of the physician.  Understanding the steps taken following an injury can help you to better prepare your legal case.

A musculoskeletal injury is an injury to any tissue in the muscular and/or skeletal system such as muscles, bones, ligaments, discs, and cartilage.  This injury will cause pain, inflammation, loss of function, and even disability.  These structures can be harmed from an immediate impact, or over a period of time with repetitive strains.  The injured person will seek treatment from a physician either in the physician's office or in the hospital.  The physician will decide the most appropriate treatment or test for the patient to undergo for their injury and many times several tests and treatments are ordered at once.

Often the first order that a physician makes is imaging to the injured area, especially if they suspect a bone fracture or torn ligament, tendon, or disc.  Magnetic Resonance Image (MRI), Computed Tomography (CT scan), and plain radiograph x-rays are typically types of imaging ordered to examine the injured area.  The most commonly ordered imaging is a plain film x-ray because it is inexpensive and a quick way to rule out many serious injuries, such as checking the integrity of the spinal column after a trauma.  This test is limited, however, because the image is only two dimensional.  A CT scan is an x-ray delivered in multiple directions as the scanner moves in a circular path around the body.  A computer combines the data of the many x-rays taken to make an image.  The CT scan is used when parts of the body cannot be seen on a plain radiograph, as in the pelvis or the skull.  The MRI is best to show soft tissue, such as tendons, cartilage, ligaments, and discs.

When speaking about medical imaging, especially when developing a legal case, it is important to note that findings on medical imaging must correlate with the patient's symptoms and complaints to be conclusive that what the image is showing is actually what is causing the patient's problem.  A New England Journal of Medicine article title "Magnetic Resonate Imaging of the Lumbar Spine in People Without Back Pain" by Jensen et al. concluded that about two-thirds of their asympomatic subject pool had some abnormality appear on their MRI, such as disc bulge, disc extrusion, and degenerative disease.  In other words, two-thirds of the subjects that never had back pain or symptoms still had major abnormalities of their MRI.  You cannot rely on imaging alone for a legal case, and the patient's symptoms and physical examination must correlate with the findings on the image.

Your injured client will most likely have pain associated with their injury.  To address this, the physician may choose pharmacological treatments, such as pain medication, anti-inflammatories, or muscle relaxers as a treatment.  With certain injuries, the patient will be instructed to take the prescribed medication and rest for a given period of time to allow the injury to heal.  This is a common course of treatment for acute back pain or whiplash.  A brace may also be issued to the patient to assist in the resting process by forcing the affected body part to remain immobile.  If the patient's outcome is unsatisfactory after the specified rest period is over, the physician will often refer the patient to a type of therapy, such as physical therapy, chiropractic, and in some cases acupuncture.  If these areas do not succeed, a more invasive treatment, such as injections or even surgery may be considered.

Every client with an injury will have different paths of treatment.  Interpreting the various medical steps that can be taken after their injury will undoubtedly assist you in preparing their case.