The Personal Injury Exam

Written by Billing Dynamix

Gregg Friedman, DC

When it comes to the questions about injuries and low speed collisions…

If your entire exam consists of the ortho/neuro exam, you lose.

The same problem exists when your trauma patient was evaluated by an Independent Medical Examiner.

The ortho/neuro exam is most important when your patient has radicular complaints.  According to the Official Disability Guidelines, 95% of all neck patients and 90% of all low back patients are NON-RADICULAR.  When you examine a patient with neck pain, but no radicular symptoms, and you note that Foraminal Compression or Jackson’s Test or Spurling’s Test produced localized neck pain, it doesn’t mean much, if anything.  These tests are nerve root tests and are looking for radicular findings.  

What about the low back?

For the lumbar spine, we have Kemp’s Test.  For a patient with low back pain with no radicular complaints, and you note that Kemp’s Test produced localized low back pain, that doesn’t mean much, if anything, either.

The reality is this:  for patients with no radiating complaints, the typical ortho/neuro exam that is performed by most chiropractors ends up being, well, pretty normal.

So what should we be examining?

According to the American Board of Independent Medical Examiners, the standard of the Independent Medical Exam is to follow the examination outlined in the AMA Guides to the Evaluation of Permanent Impairment.  According to the 5th Edition of the AMA Guides, these are the findings we should be looking for:

  1. Muscle guarding or spasm observed at the time of the exam
  2. Loss or asymmetric range of motion
  3. Radicular complaint 
  4. Loss of motion segment integrity

Of these five possible findings, only muscle spasm and neurologic symptoms/findings can be determined from the typical ortho/neuro exam.  That means, if all you do is the ortho/neuro exam, and there are no radicular complaints and no muscle spasms, you’ve got…

A whole bunch of nothing.