How Important is a Good History and Physical Examination?

How Important is a Good History and Physical Examination?

If you are reading the title of the blog post you probably already know where I am going with this. A good history and physical examination is the cornerstone to an accurate diagnosis and an appropriate treatment plan. Without a problem-focused examination and history a patient’s complaints will be missed and the healing process will be protracted.

Sure, this seems obvious enough. When you get injured in a Baltimore auto accident and present to your doctor, ER, or urgent care facility, you expect that the doctor examining you is giving you an appropriate evaluation with appropriate radiographs (x-rays). Believe it or not, this may not always be the case. In this day in age with longer wait times and more patients being seen per day, most providers (whether they be doctors, PAs, nurse practitioners, chiropractors etc) are under more pressure than ever to “treat and street” patients to make room for more patients. In doing so they often go through a history and physical examination in a cursory manner, sometimes missing key injuries sustained by patients. You would be surprised how often the time of day or day of the week dictates how thorough a history and examination is given to any given patient. As you might expect, it has been my experience that more diagnoses are missed on Friday nights when the ERs are busy than are on Monday nights. In my nearly 5 years as a Chiropractor treating acutely injured patients involved in Baltimore auto accidents and baltimore worker’s compensation injuries, I am shocked at how often diagnoses are missed by portal of entry providers.

Dr. Arthur Croft in his book “Whiplash and Mild Traumatic Brain Injuries: A Guide for Patients and Practitioners” (page 211) notes that “…medical school training is woefully inadequate to prepare doctors to examine and understand musculoskeletal disorders, despite the fact that this very class of disorder constitutes the leading causes of disability in the U.S. In a recent study published in the Journal of Bone and Joint Surgery, a validated musculoskeletal cognitive examination was given to medical students, residents, and staff physicians in multiple disciplines of medicine to assess the adequacy of their musculoskeletal medicine training. Only 21% received a passing score.”

In news closer to my area of practice treating patients involved in Baltimore auto accidents, “…fourth year medical students from the University of Chicago were presented with a fictitious whiplash patient to evaluate how they would assess him if he were a real patient. He was a 21-year-old male who gave a history of being a passenger in a car that was struck from the rear…Shortly after the crash, he began to experience neck pain and was transported by ambulance to the ER…Only 21% palpated (touched) the neck, and only 17% asked the patient to turn his head from side to side.”

I am in no way trying to be negative towards portal-of-entry providers who must handle tons of new injured patients every day. All I am trying to do is point out that doctors are busy and sometimes rush through the history and physical examination. By doing so, they put a patient’s health at risk by missing diagnoses and not ordering appropriate diagnostic tests. It is important that you, as the patient, speak up and direct a doctor to your chief complaints to ensure that no appropriate diagnoses are missed.

As a Baltimore Chiropractor who routinely treats patients involved in Baltimore auto accidents, I have been trained to ask the right questions and take an appropriate history so that nothing is missed. I routinely work with other specialists such as orthopedists, pain management physicians, and neurologists who can perform special diagnostic testing if necessary. Rest assured that no matter how complex the motor vehicle collision I will take as much time as necessary to diagnose your condition and to establish an appropriate patient-focused treatment plan.

If you, or anyone you know, has suffered injuries as a result of an auto accident in Baltimore and are in need of auto accident treatment in Baltimore, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Dr. Gulitz

Cervical Radiculopathy following Baltimore Auto Accidents

In many of my past blog posts I have touched on topics of injuries associated with Baltimore Auto Accidents. One area that I have not spent much time on is the idea of cervical radiculopathy. In simple terms, radiculopathy is inflammation of a nerve root. Anytime the spine is stressed or compressed, such as in a Baltimore auto accident, there can be irritation to nerve roots. This is the case for the entire spine, but for the sake of this discussion, we will only be considering cervical, or neck, radiculopathy.

The nerve roots in the neck comprise all of the motor and sensory fibers that innervate the upper extremity. Incidentally, they also innervate some muscles in the neck and upper back. The motor fibers control motion in the upper extremity (which I activate as I type this blog post) while the sensory fibers convey sensation from the environment (such as heat, cold, pain, light tough vibration, pressure) to the brain.

Following trauma to the spine, such as that often experienced in Baltimore auto accidents, the nerve roots may become injured, manifesting as a myriad of symptoms. Most commonly patients present with neck pain along with numbness and/or tingling and/or weakness into the upper extremity on the affected side. Often times radiculopathy can be confirmed on physical examination and if need be, advanced imaging studies such as MRIs.

As part of the therapy for Baltimore auto accidents that I provide in my office, therapy usually involves heat, electric muscle stimulation, traction therapy, and if appropriate, chiropractic spinal manipulation. Most patients respond favorably within 6-12 weeks to conservative chiropractic therapy. Those that don’t are referred to specialists for additional intervention. The key to recovery is quick intervention. That is, the longer a patient experiences radiculopathy the longer it takes for the symptoms to resolve.

If you, or anyone you know, has suffered a cervical radiculopathy as a result of a Baltimore auto accident and require Baltimore auto accident treatment, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Viscoelasticity- A Special Property of Human Tissues

Human soft tissue, whether it be muscle, skin, ligament, tendon, nerve, intervertebral disc, or bone all contain a special property known as viscoelasticity. This is a property that allows these tissues to deform depending on the type and direction of force applied. It allows for these structures to start in one place/shape, change as a result of forces applied, and then to “bounce back” to their original size and shape. It is really a remarkable characteristic.

You can liken viscoelasticity to a rubber band. You can stretch them and they bounce right back. However, if the force used to deform them is too strong or occurs to quickly, the tissues are irreparably torn and broken.

If you sit in your chair reading this, you can bend your chin to your chest, and then you can extend it backwards. Provided that you don’t have any underlying problems with your neck, by the time you are done you will have your neck and its tissues in the same shape and condition as it was before you stretched it. Now imagine you are sitting at a stop light and you get rear-ended suddenly. In a matter of milliseconds your neck undergoes the same motion pattern. However, since the impulse occurrs so quickly the viscoelasticity of the neck soft tissue does not allow the tissue to return to its pre-accident shape. This results in torn soft tissues, and a trip to your local Baltimore Chiropractor for whiplash treatment.

While the motion of the neck is within anatomical limits (that is, we can bring our neck to our chest and bring it all the way back) the speed at which this motion occurs in an auto accident is so great as to not allow the viscoelastic structures of the neck to “bounce back” resulting in injury.

As a Baltimore Chiropractor that routinely treats patients with neck pain following a Baltimore auto accident, I routinely treat patients who have torn viscoelastic structures in their neck. If you, or anyone you know, as suffered from a Baltimore Auto Accident and can use the help of a Baltimore Chiropractor, please contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!

Dr. Gulitz

*This information was taken from “Whiplash and Mild Traumatic Brain Injuries” by Dr. Arthur Croft, page 134.

No Correlation Between Property Damage and Bodily Injury

As a Baltimore Chiropractor that routinely treats clients injured in Baltimore auto accidents (Baltimore car accidents) I routinely see patients whose accidents run the gamut from a simple bumper tap collision to a total loss. Most insurance companies (largely responsible for paying out claims for accidents) would have you believe that there is a direct correlation between property damage to a vehicle and the likelihood of injury to an occupant.

The thought process goes like this: If two cars are involved in a crash with a small crash velocity, particularly a crash where there is no damage to either vehicle, no occupants can be injured. Any claim made for bodily injury must therefore be fraudulent.

I’ll admit. Before I became a Chiropractor I sort of believed this to be true myself. But how did I know it to be the case? I had never done any research, I had just “believed it” inherently.

When I started treating patients as a Chiropractor in Las Vegas I came across a lot of “low property damage” or “low PD” crashes where occupants were claiming injuries to their necks and backs. X-rays, physical examination and orthopedic examination confirmed injury. Professional interest lead me to the literature and research of Dr. Arthur Croft of the Spine Research Institute of San Diego and his post graduate series on Whiplash and Mild Traumatic Brain Injury.

Dr. Croft is one of the leading researchers on whiplash biomechanics/kinematics. As an epidemiologist he has studied all published research on the topic and determined that there is no correlation between crash velocity and injury risk. He states “Using paired comparison methods, the authors were able to demonstrate that when correlating crash delta V and comparing subjects within the same vehicle on the basis of injury risk, it appeared that human factors were more deterministic…than crash metrics.” (p. 98 “Whiplash and Mild Traumatic Brain Injuries”).

This makes some sense. I have seen plenty of older patients who suffer severe injuries that are involved in the same crash as young children/younger adults that walk away unscathed.

At the end of the day, as a Baltimore chiropractor that is involved in whiplash treatment in Baltimore, I do not necessarily concern myself with property damage. I treat injured clients- not injured cars. Often insurance companies will look to deny claims that involve low property damage to vehicles, claiming that they must be fraudulent. Fortunately, my patients know that I have research on my side to fight the insurance companies that look to deny their claims.

If you, or anyone you know, is in need of a Baltimore Chiropractor to treat you for injuries sustained in a Baltimore auto accident, please call Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be happy to help!

Dr. Gulitz

Baltimore Whiplash and S-Shaped Cervical Curves

The normal anatomy of the neck (cervical spine) is a C-shaped curve. In rear-end auto accidents that result in whiplash prevailing thought was that getting struck from behind would result in a hyperextension/hyperflexion injury of the neck. That is, first the neck would extend all the way backwards and then it would rebound and hyperflex all the way until the chin touches the chest.

Research has shown that in the milliseconds during a rear-end auto accident the cervical spine actually forms an S-Shaped curve. This is important because it explains why patients with neck pain following an auto accident typically present with pain at the base and the apex of their necks.

During the 150 milliseconds of the rear-end impact the lower part of the neck hyperextends and simultaneously the upper part of the neck hyperflexes, creating an S-Shaped curve. This places extra stress and strain on sensitive tendons, ligaments, discs, and other connective tissue that normal exist in a C-shaped curve formation. The result is inflammation that leads to pain.

Baltimore Chiropractors, such as myself, routinely treat patients with whiplash in Baltimore resulting from auto accidents in Baltimore. If you, or anyone you know needs treatment for a Baltimore auto accident please do not hesitate to contact Mid-Atlantic Spinal Rehab & Chiropractic at (443) 842-5500. We would be glad to help!