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The industry's top independent medical evaluation service provider offers timely information on a wide range of medical news and claims management topics - all in the name of helping you manage injury claims in the most efficient and cost effective manner.   

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A skull fracture is defined as any break in the cranial bone.  There are many types of skull fractures, but they all result from one major cause and that is an impact or blow to the head that’s strong enough to break a bone.  The types include: 

  • Linear – a break resembling a thin line or crack

  • Depressed – a break in or crushing injury

  • Basilar – occurs at the base of the bran sometimes causing leakage of cerebral spinal fluid

Skull fractures are not always easily seen.  Following an impact or blow to the head some symptoms which may indicate fracture include:  swelling and/or tenderness around the area of impact, facial bruising, bleeding from the nostrils or ears. 

For mild fractures, pain medication may be the only necessary treatment, but neurosurgery may be required for more serious fractures.

Defined as an accumulation of blood within the brain or between the brain and skull.  They form when a head injury causes blood to accumulate in the brain or between the brain and the skull. 

Here are the different types of hematomas:

  • Epidural – a blood clot outside of the brain but under the skull

  • Subdural – located between the brain and the dura

  • Intracerebral – a ruptured blood vessel in the brain that causes bleeding

  • Subarachnoid Hemorrhage – bleeding under the arachnoid layer

  • Intraventricular Hemorrhage – bleeding into ventricles of the brain

Diagnosing intracranial hematoma can be difficult because sometimes people with head injury can seem fine.  And sometimes they are if the hematoma is small and produces no signs or symptoms.  However, symptoms can appear or worsen days or even weeks after the injury, which is why following a head injury the person should be watched for neurological changes, to have intracranial pressure monitored, and undergo repeated head CT scans. Sometimes surgery is required to drain the blood.

2/14/2019 in Medical Conditions

The Cerebrum is the largest part of the brain.  Divided into two hemispheres, the outermost layer, the cerebral cortex, has four lobes:

  • Occipital used for processing visual information

  • Temporal, one close to each ear, used for auditory processing, but may also be involved in emotion, learning and pronunciation/ learning a new language.

  • Frontal used for solutions to complex tasks, voluntary movements, forming complete sentences when talking and personality traits

  • Parietal for general sensation and feeling

 

The Cerebellum is located behind the top part of the brain stem where the spinal cord meets the brain and is made up of two hemispheres.  It receives information from the sensory systems, spinal cord and other parts of the brain and then regulates motor movement.  The cerebellum coordinates voluntary movement such as balance, coordination, posture, and speech, resulting in smooth and balanced muscular activity.

The Brainstem lies underneath and behind the cerebellum.  It controls the flow of messages between the brain and the rest of the body.  The brainstem also controls basic bodily functions such as breathing, swallowing, heart rate, blood pressure, consciousness, and state of sleepiness.

Surveillance can be a good way to move a case to closure.  The success of the investigation depends on both the adjuster and the investigator’s ability to gather accurate and reliable information.  Arm your investigator with as much information as you can provide.  Here are some tips to assure effective surveillance:

  • Select an investigation company that has experienced investigators with a proven success record.   
  • Before the investigation begins, conduct a Social Security trace, ANI trace and social media check.  Make sure these findings are communicated to the investigator.
  • Start off with two full days of surveillance starting at 6:30AM.  Based on the results after two days, decide whether further time is warranted.
  • Always have surveillance conducted on days when the claimant has a medical appointment.

For every 6 million occupants in Low Speed Rear Impact Collisions: 

  • About 3 million will be injured (about the population size of South Carolina).
  • About 1.5 million will have chronic pain (about the population size of Nebraska).
  • About 300,000 of these become disabled usually due to pain (about the population size of Wyoming).
  • Nearly half of all chronic neck pain in America is due to car crashes—mostly Low Speed Rear Impact collisions. 
  • About 9% of all Americans suffer from chronic neck pain due to Low Speed Rear Impact Collisions. 
  • Children are at 2/3 the risk of adults.

Information provided by the Spine Research Institute of San Diego

Tarsal Tunnel Syndrome is to the foot and ankle as what carpal tunnel syndrome is to the wrist and hand.  Tarsal Tunnel Syndrome occurs when the posterior tibial nerve (running along the ankle and foot) becomes compressed or damaged, causing inflammation of the tarsal tunnel.  This condition results from prolonged walking, running, standing or exercising, traumatic injury, or no apparent reason. 

Often Tarsal Tunnel Syndrome responds well to conservative treatment.  With the goal of treatment being to reduce inflammation and pain, rest, ice, compression and elevation are often recommended along with the use of over-the-counter non-steroidal anti-inflammatory medications (acetaminophen or ibuprofen).  If this is not effective, injection therapy using corticosteroids and local anesthetics can be tried.  Orthopedic devices and corrective shoes may assist in reducing foot pressure.  Exercises learned in physical therapy can help reduce symptoms by stretching and strengthening connective tissues and mobilizing the tibial nerve and opening surrounding joint space reducing compression. 

Surgery can be performed for severe or chronic cases that do not respond to any other forms of treatment.  The procedure releases (or decompresses) the tarsal tunnel with a recovery period of 6 weeks up to several months.  Surgery is successful in about 50%-90% of cases.

Fortunately, tarsal tunnel syndrome is a rare disorder.

There are several areas of research that may prove successful; stem cell injections, a Collagen Meniscal Implant (CMI), and 3-D research.

In a clinical trial of stem cell injections for meniscal tears, only 15% of participants experienced an increase in meniscal tissue at one year following treatment.  This could be because without healthy cartilage to pad the bones that meet in the knee joint, the bones become battered and misshapen and a new meniscus can’t fix that damage.  So, it would make sense to try stem cell medicine on people with new injuries who do not have the damage to their bones.

The Collagen Meniscal Implant, a biological completely absorbable implant made from highly purified collagen with a porous structure showed some promise.  This device is attached arthroscopically to fill the void resulting for damaged or lost meniscal tissue and makes use of the body’s own ability to re-populate the structure with its own cells over time to regenerate the normal structure of the meniscus.  There is data showing benefit in chronic meniscal injuries for the right patient.

In a study successfully conducted on sheep, a meniscus was regenerated with a 3-D printer, infused with human growth factors that prompt the body to regenerate the lining on its own. It begins with MRI scans of the intact meniscus in the undamaged knee.  The scans are converted into a 3-D image which is used to drive a 3-D printer.  A scaffold in the exact shape of the meniscus down to a resolution of 10 microns (less than the width of a human hair) is produced within 30 minutes.  This research is preliminary but it demonstrates potential for meniscus regeneration.

However, the reality is at present there’s little that orthopedists can do to regenerate a torn knee meniscus.  Small tears can be sewn back in place, but larger tears have to be surgically removed which helps with pain and swelling, but leaves the knee without its natural shock absorber.  There are three viable options on the horizon, but they are still in the research stages and it could be years before they are offered to the general population.

The best way to obtain a good recorded statement is to have a predetermined process for planning and preparation of the interview.  Here are some tips to conduct a thorough interview:

  • Be a Good Listener – Thoroughly listen to what is being said, do not think about your next question or what you’re going to say next.  Clear your head and simply listen to what is being said.  You may pick up on new information that would otherwise not be communicated.
  • Standard Questions – These should be predetermined by insurance company protocol and based on the type of insurance coverage and injury.
  • Focus Questions – In advance of the interview, review all information available and prepare a list of questions that focus on the specific injury and how it occurred.
  • Flexibility – Be ready to take the interview in a different direction depending upon the answers to standard and focus questions. 

The success of the investigation depends on the adjuster’s ability to gather accurate and reliable information.

11/1/2018 in Medical Conditions

The anterior cruciate ligament (ACL) can be injured as a result of getting hit very hard on the side of the knee, overextend injury to the knee, or landing from a jump incorrectly.  Symptoms include a “popping” sound heard at time of injury, swelling within 6 hours, and pain.  A mild injury may only result in a feeling of instability of the knee or it seems to “give way” when using it.

ACL injury can sometimes be diagnosed during a physical exam alone, but diagnostic testing may be required to rule out other causes and determine the severity of the injury.  Tests could include x-rays, magnetic resonance imaging (MRI), and/or ultrasound.

Initial treatment is aimed at reducing pain and swelling, with rest, ice, compression and elevation.  Several weeks of rehabilitation can be expected, with a physical therapist initially teaching exercises which can be performed with continued supervision and/or at home.  A brace can stabilize the knee and possible crutches to avoid weight bearing.  The goal is to restore full range of motion and strengthen the knee.

Surgical repair could be recommended if more than one ligament or the cartilage of the knee is injured, the claimant is young and active, and/or the injury is causing the knee to buckle.  The procedure, an ACL reconstruction, involves removing damaged ligaments and replacing with a segment of tendon.  After surgery, rehabilitation takes place to restore strength, stability and function to the knee.

There is a revolutionary new procedure, called BEAR (Bridge-Enhanced ACL Repair) that is currently in testing stages.  A “bridge” is surgically inserted into the ACL which allows the ACL ends to heal back together themselves.  So far, the procedure when tested in pigs showed significantly less arthritis (a complication of ACL injuries).  Three months after surgery on the first human trials, all BEAR recipients had healing ACLs, flexibility close to that of the healthy knee, and recovered strength more quickly than the traditional ACL repair.  While more testing is needed, this new procedure appears to show extreme promise.

Source:  https://theundefeated.com/features/new-acl-surgery-could-cut-rehab-and-recovery-time-in-half/

10/25/2018 in Medical Conditions

Meniscus tears are one of the most common knee injuries.  That’s because an athlete, an older person and anyone in between can tear a meniscus. 

They can be torn in different ways.  Tears are described by how they look as well as where the tear occurs.  Common tears include bucket handle, flap and radial.  Sports related tears often include more than just the meniscus (such as an anterior cruciate ligament tear). 

A meniscus tear is diagnosed by obtaining a medical history, discussing symptoms, and examination of the knee.  One of the main tests for meniscus tears is the McMurray test.  The doctor bends the knee, straightens it and then rotates it.  This puts tension on a torn meniscus and will cause a clicking sound.  Imaging tests, such as x-ray or MRI may be ordered as well.

Treatment depends on the type of tear, size and location.  The outside one-third of the meniscus has a rich blood supply which may allow it to heal on its own.  The inner two-thirds of the meniscus lacks a blood supply which does not allow it to heal.  These are complex tears which often occur in thin, worn cartilage.  These types of tears usually require surgery.

Without treatment a piece of meniscus may come loose and drift into the joint.  This can cause the knee to slip, pop or lock.

Since meniscus tears are extremely common knee injuries, proper diagnosis, treatment and rehabilitation often returns patients to their pre-injury abilities.

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