MCD title
Pain Validity Test Result for
Objective Pain Patient

PAIN VALIDITY TEST

 

Scheduled Test Information

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Today's Date : Sep 22, 2009

Prefix:

First Name:

Objective

Middle Initial :

Last Name:

Patient

Suffix :

Street Address (2) :

987 Main

Street Address :

City :

Somewhere

Country :

United States

State or Province :

Alabama

Postal Code :

12345

Phone Number:

()-

Client Company :

MCD

Claim / Account Number:

1002

Authorization Number :

100002417

Test Language :

English

Test To Take :

Pain Validity Test (tm)

Test Scheduled to be taken between :

05/29/2008 -05/30/2008

Test Completed :

05/29/2008

Test Status :

Completed

Test Score :

4.500000

To print results, please use only the "Printable Version" print button at the bottom of this page. Please DO NOT use any other print method.

Test Messages :

Scoring Category: Objective Pain Patient

Interpretation: Based on the above score, the claimant is categorized as an Objective Pain Patient. The PVT was originally validated on 796 chronic pain patients, with the results published in seven peer-reviewed articles in medical and other journals. As documented in the most recent of these articles, 95% of the time claimants categorized as Objective Pain Patients by the PVT will have moderate or severe pathology corresponding to their complaint of chronic pain on at lease one objective diagnostic test or laboratory study such as an MRI, EMG, nerve velocity conduction study, facet blocks, peripheral nerve blocks, root blocks, neuromter (CPT), myelogram, CT, 3D-CT, provocative discogram, X-ray or bone scan, and other tests. The literature documenting this can be viewed at www.MarylandClinicalDiagnostics.com.

Recommendation: It is recommended that the Diagnostic Paradigm (DP) and Treatment Algorithm (TA) be administered to this patient. The DP&TA gives a diagnosis for the source of the pain experienced by patients who have real medical problems but are not getting well. It also outlines the most appropriate courses of diagnostic studies and treatments for such patients. These treatment algorithms begin with the least expensive and least invasive diagnostic test and treatments and then progress through a series of increasingly complex diagnostic tests and treatments. By following the recommended course of tests and treatments, treating physicians can expect results comparable to those obtained at one of the country's leading pain clinics. For more information, please go to www.MarylandClinicalDiagnostics.com.

These results are intended to provide information that will assist an insurer or other payer in evaluating a claim. They should not be used as the sole basis for accepting or denying a claim. The test results do not constitute medical advice or a diagnosis, and the test is not intended to be a substitute for a medical examination. Test users hsould excercise their own professional judgement when evaluating the usefulness of the test results.

To print results, please use only the "Printable Version" print button at the bottom of this page. Please DO NOT use any other print method.



Pain Validity Test Result for
Exaggerating Pain Patient

 

 

PAIN VALIDITY TEST

Scheduled Test Information

To print results, please use only the "Printable Version" print button at the bottom of this page. Please DO NOT use any other print method.

Today's Date : Sep 22, 2009

Prefix:

First Name:

g

Middle Initial :

Last Name:

g

Suffix :

Street Address (2) :

8

Street Address :

h

City :

u

Country :

United States

State or Province :

Alabama

Postal Code :

88888

Phone Number:

()-

Client Company :

MCD

Claim / Account Number:

123

Authorization Number :

100002733

Test Language :

English

Test To Take :

Pain Validity Test (tm)

Test Scheduled to be taken between :

04/08/2009 -04/09/2009

Test Completed :

04/08/2009

Test Status :

Completed

Test Score :

31.000000

To print results, please use only the "Printable Version" print button at the bottom of this page. Please DO NOT use any other print method.

Test Messages :

Scoring Category: Exaggerating Pain Patient

Interpretation: Based on the above score, the claimant is categorized as an Exaggerating Pain Patient. The PVT was originally validated on 796 chronic pain patients, with the results published in seven peer-reviewed articles in medical and other journals. As documented in the most recent of these articles, 85% of the time claimants categorized as Exaggerating Pain Patients by the PVT will have no pathology or only minor pathology corresponding to their complaint of chronic pain. There is an 85% chance that there will be an absence of findings, or only minimal findings, on objective diagnostic test or laboratory study such as an MRI, EMG, nerve velocity conduction study, facet blocks, peripheral nerve blocks, root blocks, neuromter (CPT), myelogram, CT, 3D-CT, provocative discogram, X-ray or bone scan, and other tests. The literature documenting this can be viewed at www.MarylandClinicalDiagnostics.com.

Recommendation: This claimant has little likelihood of having any objective or valid complaint of pain. It is recommended that the results of this test be shared with the claimant or his/her representative, or attorney. It is recommended that this claimant have an IME and surveillance conducted to evaluate the validity of their claim.

These results are intended to provide information that will assist an insurer or other payer in evaluating a claim. They should not be used as the sole basis for accepting or denying a claim. The test results do not constitute medical advice or a diagnosis, and the test is not intended to be a substitute for a medical examination. Test users hsould excercise their own professional judgement when evaluating the usefulness of the test results.

To print results, please use only the "Printable Version" print button at the bottom of this page. Please DO NOT use any other print method.



Diagnostic Paradigm Treatment Algorithm
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Scheduled Test Information

Today's Date : Jul 20, 2008

Prefix:

Mrs.

First Name:

Mary

Middle Initial :

Last Name:

XXXXX

Suffix :

Street Address (2) :

XXXXX

Street Address :

XXXXXXXXXX

City :

XXXXX

Country :

United States

State or Province :

Maryland

Postal Code :

XXXXX

Phone Number:

()-

Client Company :

XYZ Law Firm 

Claim / Account Number:

08 auto accident

Authorization Number :

100009567

Test Language :

English

Test To Take :

Diagnostic Paradigm and Treatment Algorith Test (tm)

Test Scheduled to be taken between :

07/20/2008 -07/21/2008

Test Completed :

07/20/2008

Test Status :

Completed

Test Score :

0.000000

To print results, please use only the "Printable Version" print button at the bottom of this page. Please DO NOT use any other print method.

Test Messages :

The following is a report of those conditions and information that the patient indicated on the Pain Test:

The patient was born on 03/19/1954

Patient reports that the pain is not the result of an accident. The patient did not report having any of the following conditions: "Diabetes", "Thyroid disease", "Lupus", "Multiple Sclerosis or M.S.", "Arthritis", "Cancer", "Heart disease, or high blood pressure, or stroke", "Infection", "Muscular Dystrophy". The injury that gave rise to the claim occurred on 01/01/2008. Patient reports having had accidents or injuries before this date. Patient reports having had accidents or injuries since this date.

Patient reports having a low back problem. Patient reports having had no surgery to the low back. Patient reports that low back pain: "comes and goes". Patient reports that the low back problem feels like: "dull ache", "burning pain", "shooting pain", "cramp or spasm", "numb feeling", "pins and needles feeling". Patient reports that the low back problem gets worse when: "I ride in a car", "I lay on my stomach", "I lay on my left side", "I lay on my right side", "I lay on my back". Patient reports that the low back pain gets better when: "I lay on my side with my knees bent, and a pillow between my knees", "I lay on my back with a pillow under my knees", "I lay on my stomach", "I stand", "I lean forward", "I get up and move around", "I use i ce".

Patient reports having no problems in the left leg. Patient reports having had no surgery or injury to the left leg. Patient reports that the left leg problem is a: "dull ache", "burning pain", "shooting pain", "cramp or spasm", "numb feeling", "pins and needles feeling". Patient reports that the left leg problem gets worse if: "I ride in a car", "I lay on my stomach", "I lay on my left side", "I lay on my right side", "I lay on my back". Patient reports that the left leg problem gets better if: "I lay on my side with my knees bent, and a pillow between my knees", "I lay on my back with a pillow under my knees", "I lay on my stomach", "I lay on my left side", "I lay on my right side", "I lay on my back", "I stand", "I get up and move around ", "I use ice".

Patient reports having a problem with the right leg. Patient reports having had no surgery or injury to the right leg. Patient reports that the right leg problem, "comes and goes". Patient reports that the right leg problem is a, "dull ache", "burning pain", "shooting pain", "cramp or spasm", "numb feeling", "pins and needles feeling". Patient reports that the right leg problem gets worse if: "I ride in a car", "I lay on my stomach", "I lay on my left side", "I lay on my right side", "I lay on my back". Patient reports that the right leg problem gets better if: "I lay on my back with a pillow under my knees", "I lay on my stomach", "I lay on my left side", "I lay on my right side", "I lay on my back", "I lean forward", "I get up and move ar ound", "I use ice".

Patient reports having a neck problem. Patient reports having had no surgery or injury to the neck. Patient reports that the neck problem, "comes and goes". Patient reports that the neck problem is a: "stabbing pain". Patient reports that the neck problem gets worse if: "I lean my head backwards", "I turn my head to the right", "I reach with my right arm". Patient reports that the neck problem gets better if: "I rest", "I lean my head forward", "I use ice".

Patient reports having no problems with the left arm. Patient reports having had no surgery or injury to the left arm.

Patient reports having a problem with the right arm. Patient reports having had no surgery or injury to the right arm. Patient reports that the right arm problem, "comes and goes". Patient reports that the right arm problem is a: "dull ache", "weakness". Patient reports that the right arm problem gets worse if: "I lift things", "starting with my arm at my side, I lift my right hand away from my side". Patient reports that the right arm problem gets better if: "I rest", "I use ice".

Patient reports having no problem just in front of the ear (where the jaw hinges the skull).

Patient reports having no problem with the chest or ribs. Patient reported having had no injury to the chest. Patient reported having had no surgery to the chest.

On the left side of the body, the patient reported the following:

Back left side of head: "pain that comes and goes". Back of neck, on the left: "pain that comes and goes". Between shoulder blades: "pain that comes and goes". Across top of left shoulder: "pain that comes and goes". Muscle just behind left ear: "pain that comes and goes". Behind left ear, toward middle of neck: "pain that comes and goes".

Left side of low back: "pins & needles". Left buttock: "pins & needles". Back of left thigh: "pins & needles". Left calf: "pins & needles". Upper inside of left buttock: "pins & needles".

On the right side of the body, the paitient reported the following:

Just in front of right ear: "pressure", "click". Just in front of right ear: "pain that comes and goes". In right cheek: "pain that comes and goes". Muscle behind right ear, coming forward and down right side of neck to collarbone: "spasm". Muscle behind right ear, coming forward and down right side of neck to collarbone: "pain that comes and goes".

Back right side of head: "pain that comes and goes". Back of neck, on the right: "pain that comes and goes". Between shoulder blades: "pain that comes and goes". Across top of right shoulder: "pain that comes and goes". Muscle just behind the right ear: "pain that comes and goes". Behind right ear, toward middle of neck: "pain that comes and goes".

Forearm and/or palm on side of right thumb: "constant pain".

Upper right arm, muscle you feel when you say "make a muscle": "constant pain". Side of right forearm from the outside of elbow to thumb: "pain that comes and goes".

Right side of the low back: "pain that comes and goes". Right buttock: "pain that comes and goes". Back of right thigh: "pain that comes and goes". Right calf: "pain that comes and goes". Upper inside of right buttock: "pain that comes and goes".

The patient also reported the following:

Any sensation that follows along path of any rib on left: "pain that comes and goes". Any sensation that follows along path of any rib on right: "pain that comes and goes".

Outside of left thigh: "pain that comes and goes".

Outside of right thigh: "pain that comes and goes".

The Patient reported no problems in the mid back. Patient reported having no injuries to the mid back. Patient reported having no surgeries on the mid back. Patient reported not having a medical problem other than injury or surgery in the mid back.

Below is a list of possible diagnoses, organized into groups for viewing purposes:

Group 1 - Nerve Entrapment of the Leg

  • Lateral Femoral Cutaneous Nerve Entrapment - Score=0.500000

  • Sural Nerve Entrapment - Score=0.500000

  • Deep Vein Thrombosis - Score=0.250000

Nerve Entrapment of the Leg

Treatment Number

Treatment/Test

If Positive, next Treatment Number

If Positive then:

If Negative, next Treatment Number

If Negative then:

Treatment/Test Time

1.1

Rest, splint, TENS unit, NSAID, clonazepam, tri-cyclic antidepressants, vitamin B 6 q.i.d.

1.2

-

1.3

-

4 weeks

1.2

Job analysis, select proper level of work

STOP

-

STOP

-

2 days

1.3

Blood for TSH, T4-RIA, T3-RIA, thyroid antibodies, RPR, STS, HIV, HLA-B27, . b12, folic acid, Lyme, A1C glycohemoglobin

1.4

Refer to the proper specialist, and deny the Worker's Comp or accident claim

1.5

-

1 day

1.4

Treat underlying infection and or metabolic disease

STOP

-

1.5

-

3 weeks to 3 months, unless HIV+

1.5

Neurometer studies, and EMG/nerve conduction studies

1.6

-

1.6

-

1 day

1.6

Nerve block of the affected nerve or suspected nerve

1.8

-

1.7

-

1 day

1.7

Bone Scan

1.10

-

1.14

-

1 day

1.8

Consult with neurosurgeon specializing in nerve entrapments

1.9

-

1.14

-

1 day

1.9

Surgery on trapped nerve

1.2

-

1.7

-

6 weeks

1.10

Sympathetic block

1.11

-

1.14

-

1 day

1.11

Vascular surgery consult

1.12

-

1.13

-

1 day

1.12

Sympathectomy

1.2

-

1.13

-

6 weeks

1.13

Contralateral sympathetic block

1.11

-

1.14

-

1 day

1.14

Go to protocol for Lumbar Herniated Disc L2-S1

2.1

-

2.1

-

-

Group 2 - Lumbar Herniated Disc L2-S1

  • L5-S1 Radiculopathy - Score=1.000000

  • L5-S1 Herniated or Disupted Disc - Score=1.000000

  • L4-L5 Herniated or Disrupted Disc - Score=0.750000

  • L3-L4 Radiculopathy - Score=0.750000

  • L4-L5 Radiculopathy - Score=0.708333

  • Lumbar Facet Syndrome L3-S1 - Score=0.700000

  • Neural Foraminal Stenosis L1-S1 - Score=0.625000

  • Retrolysthesis L1-S1 - Score=0.625000

  • L3-L4 Herniated or Disrupted Disc - Score=0.500000

  • Unstable Spinal Segment at L3-L4 - Score=0.250000

  • Unstable Spinal Segment at L4-L5 - Score=0.250000

  • L2-L3 Radiculopathy - Score=0.250000

  • Spondylolysis/Spondylolythesis/Anterio-Lysthesis/Unstable Lumbar Spinal Segment - Score=0.250000

  • Unstable Spinal Segment at L5-S1 - Score=0.250000

Lumbar Herniated Disc L2-S1

Treatment Number

Treatment/Test

If Positive, next Treatment Number

If Positive then:

If Negative, next Treatment Number

If Negative then:

Treatment/Test Time

2.1

Bed rest as needed, NSAID, muscle relaxants, and narcotics

STOP

-

2.2

-

3 weeks

2.2

Trial with corset

STOP

STOP. Remove corset. If pain returns, go to #2.3

2.3

-

3 weeks

2.3

Flexion-Extension X-Rays with obliques of lumbar spine

2.5

-

2.4

-

1 day

2.4

M.R.I. of L2-S1

2.5

-

2.6

-

1 day

2.5

EMG/Nerve conduction studies of legs, and neurometer studies

2.7

-

2.6

-

1 day

2.6

3D-CT of L2-S1

2.10

-

2.7

-

1 day

2.7

Body jacket with thigh spika to leg with less pain

2.11

-

2.8

-

1 day

2.8

Root blocks, L2-L3, L3-L4, L4-L5, L5-S1

2.10

-

2.9

-

2 days

2.9

Provocative discogram L2-S1

2.11

-

14.1

If Negative, go to protocol for Lumbar Facet Syndrome

1 day

2.10

Orthopedic surgery consult

2.12

-

2.11

-

1 day

2.11

Neurosurgical consultation

2.12

-

2.13

-

1 day

2.12

Discectomy and fusion and/or foraminotomy

2.13

Wait 1 year, then go to #2.13

2.14

-

1 year

2.13

Functional capacity evaluation, then vocational rehabilitation - then STOP

STOP

-

STOP

-

2 days to 3 weeks

2.14

M.R.I. with gadolinium, to rule out scarring

2.13

-

2.15

-

1 day

2.15

3D-CT to rule out broken fusion

2.11

-

2.16

-

1 day

2.16

Bone scan - rule out infection

2.11

-

2.17

-

1 day

2.17

Indium 111 scan

2.11

-

2.18

-

1 day

2.18

Gallium scan

2.11

-

2.3

Rule out disc above or below fusion site is disrupted.

1 day

Group 3 - Sacro-Iliac Joint Disease

  • Sacro-Illiac Joint Instability - Score=0.625000

Sacro-Iliac Joint Disease

Treatment Number

Treatment/Test

If Positive, next Treatment Number

If Positive then:

If Negative, next Treatment Number

If Negative then:

Treatment/Test Time

3.1

Bed rest as needed, NSAID and narcotics as needed

STOP

-

3.2

-

3 weeks

3.2

X-ray

3.3

-

3.4

-

1 day

3.3

Bone scan

3.5

-

3.4

-

1 day

3.4

Sacroiliac joint block

3.6

-

3.7

-

1 day

3.5

CBC with diff., ANA, RF, Lyme titer HLA-B27

3.8

-

3.4

-

1 day

3.6

Steroid injection in sacroiliac joint

STOP

-

3.7

-

1 day

3.7

3D-CT of sacroiliac joint

3.9

-

3.9

-

1 day

3.8

Oral antibiotics

STOP

-

3.10

-

3 weeks

3.9

Trial with body jacket with thigh spika to the leg without pain or with less pain

3.11

-

3.12

-

3 weeks

3.10

Gallium scan

3.12

-

3.9

-

1 day

3.11

Go to protocal for Lumbar Herniated Disc L2-S1

2.1

-

3.13

-

-

3.12

Intravenous antibiotics

STOP

-

3.11

-

4 weeks

3.13

Sacroiliac joint fusion

STOP

-

STOP

-

6 months

Group 4 - Nerve Entrapment of the Arm

  • Radial Nerve Entrapment - Score=0.500000

  • Carpel Tunnel Syndrome - Score=0.416667

  • Ulnar Nerve Entrapment - Score=0.250000

Nerve Entrapment of the Arm

Treatment Number

Treatment/Test

If Positive, next Treatment Number

If Positive then:

If Negative, next Treatment Number

If Negative then:

Treatment/Test Time

4.1

Rest, splint, TENS unit, NSAID, clonazepam, tri-cyclic antidepressants, vitamin B 6 q.i.d.

4.2

-

4.3

-

4 weeks

4.2

Job analysis, select proper level of work

STOP

-

STOP

-

2 days

4.3

Blood for TSH, T4-RIA, RF T3-RIA, thyroid antibodies, RPR, STS, HIV, HLA-B27, B12, folic acid, Lyme, A1C glycohemoglobin, ANA

4.4

If any test in #4.3 is positive, refer to the proper specialist, and deny the workers comp or accident claim - then go to #4.4

4.5

-

1 day

4.4

Treat underlying infection and or metabolic disease

STOP

-

4.5

-

3 weeks to 3 months, unless HIV+

4.5

Neurometer studies, and EMG/nerve conduction studies

4.6

-

4.6

-

1 day

4.6

Nerve block of the affected nerve or suspected nerve

4.8

-

4.7

-

1 day

4.7

Bone scan

4.10

-

4.14

-

1 day

4.8

Consult with neurosurgeon specializing in nerve entrapments

4.9

-

4.14

-

1 day

4.9

Surgery on trapped nerve

4.2

-

4.7

-

6 weeks

4.10

Sympathetic block

4.11

-

4.14

-

1 day

4.11

Vascular surgery consult

4.12

-

4.13

-

1 day

4.12

Sympathectomy

4.2

-

4.13

-

6 weeks

4.13

Contralateral sympathetic block

4.11

-

4.14

-

1 day

4.14

Go to protocol for Cervical Herniated Disc C4-C7

5.1

-

5.1

-

-

Group 5 - Cervical Herniated Disc C4-C7

  • C5-C6 Radiculopathy - Score=1.000000

  • C5-C6 Herniated or Disrupted Disc - Score=0.875000

  • C4-C5 Herniated or Disrupted Disc - Score=0.800000

  • C5-C6 Facet Syndrome - Score=0.625000

  • C6-C7 Radiculopathy - Score=0.583333

  • C4-C5 Radiculopathy - Score=0.500000

  • C6-C7 Herniated or Disrupted Disc - Score=0.437500

  • C4-C5 Cervical Facet Syndrome - Score=0.416667

  • C6-C7 Facet Syndrome - Score=0.250000

  • C5-C6 Unstable Spinal Segment - Score=0.250000

  • C4-C5 Unstable Spinal Segment - Score=0.250000

Cervical Herniated Disc C4-C7

Treatment Number

Treatment/Test

If Positive, next Treatment Number

If Positive then:

If Negative, next Treatment Number

If Negative then:

Treatment/Test Time

5.1

Bed rest as needed, NSAID, muscle relaxants, narcotics and over the door traction

STOP

-

5.2

-

3 weeks

5.2

Trial with 2 poster brace

STOP

STOP. Remove brace. If pain returns, go to #5.3

5.3

-

3 weeks

5.3

Flexion-Extension X-Rays with obliques of cervical spine

5.5

-

5.4

-

1 day

5.4

M.R.I. of C4-C7

5.5

-

5.6

-

1 day

5.5

EMG/Nerve conduction studies and neurometer studies of the arms

5.6

-

5.8

-

1 day

5.6

3D-CT of C4-C7

5.7

-

5.11

-

1 day

5.7

Facet blocks C4-C7

5.8

-

5.10

-

1 day

5.8

Root blocks C4-C5, C5-C6 and then C6-C7

5.9

-

5.10

-

3 days

5.9

Provocative discogram C4-C7

5.10

-

5.11

-

1 day

5.10

Orthopedic surgery consult

5.11

-

5.12

-

1 day

5.11

Neurosurgical consultation

5.12

-

5.13

-

1 day

5.12

Discectomy and fusion and/or foraminotomy

5.13

Wait 12 weeks, then go to #5.13

5.14

-

12 weeks

5.13

Functional capacity evaluation, then vocational rehabilitation - then STOP

STOP

-

STOP

-

2 days to 3 weeks

5.14

M.R.I. with gadolinium, to rule out scarring

5.16

-

5.15

-

1 day

5.15

3D-CT to rule out broken fusion

5.11

-

5.16

-

1 day

5.16

Bone scan - rule out infection

5.11

-

5.17

-

1 day

5.17

Indium 111 scan

5.11

-

5.18

-

1 day

5.18

Gallium scan

5.11

-

5.3

Rule out disc above or below fusion site is disrupted.

1 day

Group 6 - Cervical Herniated Disc C2-C4

  • C2-C3 Radiculopathy - Score=0.750000

  • C2-C3 Herniated or Disrupted Disc - Score=0.625000

  • C3-C4 Herniated or Disrupted Disc - Score=0.625000

  • C3-C4 Radiculopathy - Score=0.500000

  • C2-C3 Unstable Spinal Segment - Score=0.500000

  • C3-C4 Facet Syndrome - Score=0.250000

  • C2-C3 Facet Syndrome - Score=0.250000

Cervical Herniated Disc C2-C4

Treatment Number

Treatment/Test

If Positive, next Treatment Number

If Positive then:

If Negative, next Treatment Number

If Negative then:

Treatment/Test Time

6.1

Bed rest as needed, NSAID, muscle relaxants, and narcotics

STOP

-

6.1

-

3 weeks

6.2

Trial with 2 poster brace

STOP

STOP. Remove brace. If pain returns after removing brace, go to #6.3

6.3

-

3 weeks

6.3

Flexion-Extension X-Rays with obliques of cervical spine, and odontoid views

6.5

-

6.4

-

1 day

6.4

M.R.I. of C1-C4

6.5

-

6.6

-

1 day

6.5

Occipital nerve blocks

6.7

-

6.6

-

1 day

6.6

3D-CT of C1-C4 with and without rotation

6.8

-

6.7

-

1 day

6.7

Facet blocks C2-C4

6.12

-

6.8

-

1 day

6.8

Root blocks, C2-C3 and then C3-C4

6.10

-

6.9

-

2 days

6.9

Provocative discogram C2-C4

6.11

-

6.10

-

1 day

6.10

Orthopedic surgery consult

6.12

-

6.11

-

1 day

6.11

Neurosurgical consultation

6.12

-

6.13

-

1 day

6.12

Discectomy and fusion and/or foraminotomy

6.13

Wait 12 weeks, then go to #6.13

6.14

-

12 weeks

6.13

Functional capacity evaluation, then vocational rehabilitation - then STOP

STOP

-

STOP

-

2 days to 3 weeks

6.14

M.R.I. with gadolinium, to rule out scarring

6.13

-

6.15

-

1 day

6.15

3D-CT to rule out broken fusion

6.11

-

6.16

-

1 day

6.16

Bone scan - rule out infection

6.11

-

6.17

-

1 day

6.17

Indium 111 scan

6.11

-

6.18

-

1 day

6.18

Gallium scan

6.11

-

6.3

Rule out disc above or below fusion site is disrupted

1 day

Group 7 - Tietze Syndrome

  • Tietze's Syndrome - Score=1.000000

Tietze Syndrome

Treatment Number

Treatment/Test

If Positive, next Treatment Number

If Positive then:

If Negative, next Treatment Number

If Negative then:

Treatment/Test Time

7.1

NSAID

STOP

-

7.2

-

3 weeks

7.2

X-ray, and bone scan of sternum

7.3

-

7.4

-

1 day

7.3

Referral to a thoracic surgeon, to consider wiring the sternum

7.5

-

7.4

-

1 day

7.4

Steroid injections into the costo-chondral junction, several sessions

STOP

-

7.6

-

2 weeks

7.5

Surgical repair

STOP

-

7.6

-

4 wwks

7.6

Go to protocol for Slipping Rib

8.1

-

8.1

-

-

Group 9 - Temporo-Mandibular Joint Syndrome

  • Temporo-Manibular Joint Syndrome - Score=1.000000

Temporo-Mandibular Joint Syndrome

Treatment Number

Treatment/Test

If Positive, next Treatment Number

If Positive then:

If Negative, next Treatment Number

If Negative then:

Treatment/Test Time

9.1

Trial with NSAID, and muscle relaxants

STOP

-

9.2

-

2 weeks

9.2

Fit for biteplate, and use

STOP

-

9.3

-

12 weeks

9.3

Cine MRI of TMJ with jaws open and shut

9.5

-

9.4

-

1 day

9.4

Trigger point injections of internal ptergoid and sterno-cleido-mastoid muscles

STOP

-

9.6

-

3 days

9.5

Arthroscopic repair of disc

STOP

-

9.7

-

5 days

9.6

Arthroscopic evaluation of the TMJ

9.5

-

9.7

-

1 day

9.7

Go to protocol for Cervical Herniated Disc C2-C4

6.1

-

6.1

-

-

Group 10 - Thoracic Outlet Syndrome

  • Thoracic Outlet Syndrome - Score=0.437500

Thoracic Outlet Syndrome

Treatment Number

Treatment/Test

If Positive, next Treatment Number

If Positive then:

If Negative, next Treatment Number

If Negative then:

Treatment/Test Time

10.1

Put affected arm in a sling, rest NSAID, muscle relaxants

10.2

-

10.3

-

2 weeks

10.2

Job analysis, select proper job

STOP

-

STOP

-

2 days

10.3

EMG/nerve conduction velocity studies, and neurometer studies, with the arms up and down

10.4

-

10.6

Refer to vascular surgeon

1 day

10.4

Transaxillary resection of first rib

10.2

Refer to thoracic surgeon

10.5

-

10 weeks

10.5

Supraclavicular decompression of the brachial plexus

10.2

-

10.7

-

10 weeks

10.6

Doppler flow studies of the radial artery, arms up and down

10.4

-

10.7

-

1 day

10.7

Go to protocol for Cervical Herniated Disc C4-C7

5.1

-

5.1

-

-

Group 12 - Shoulder Problems

  • Supraspinatus Tendonitis - Score=1.000000

  • Acromo-Clavicular Joint Impingement or Slerosis - Score=0.750000

  • Rotator Cuff Tear - Score=0.500000

Shoulder Problems

Treatment Number

Treatment/Test

If Positive, next Treatment Number

If Positive then:

If Negative, next Treatment Number

If Negative then:

Treatment/Test Time

12.1

Rest, NSAID, heat

12.2

-

12.3

-

3 weeks

12.2

Job analysis, select proper level of work

STOP

-

STOP

-

2 days

12.3

MRI of the shoulder

12.4

-

12.5

-

1 day

12.4

Arthroscopic surgery

12.2

-

12.6

-

1 day

12.5

Steroid injection in shoulder

12.2

-

12.8

-

3 days

12.6

Open surgery of shoulder

12.2

-

12.2

-

6 weeks

12.7

Arthrogram of shoulder

12.4

-

12.8

-

2 days

12.8

Go to protocols for Cervical Herniated Disc C4-C7 and Thoracic Outlet Syndrome

5.1,10.1

-

5.1,10.1

-

-

Group 14 - Lumbar Facet Syndrome

  • Lumbar Facet Syndrome L3-S1 - Score=0.700000

  • Neural Foraminal Stenosis L1-S1 - Score=0.625000

  • Retrolysthesis L1-S1 - Score=0.625000

Lumbar Facet Syndrome

Treatment Number

Treatment/Test

If Positive, next Treatment Number

If Positive then:

If Negative, next Treatment Number

If Negative then:

Treatment/Test Time

14.1

Muscle relaxants, NSAID, bed rest as needed

STOP

-

14.2

-

3 weeks

14.2

Corset

STOP

-

14.3

-

3 weeks

14.3

Flexion-Extension X-rays with obliques

14.4

If positive for facet sclerosis, go to #14.4

14.4

-

1 day

14.4

Facet blocks L3-S1

14.5

-

14.6

-

1 day

14.5

Facet denervation at appropriate level

STOP

There is a 40% chance the patient will have 2 years of relief - STOP

14.6

Immediately, or if the facet denervations lose their effectiveness, new diagnoses are to be considered - a) Facet break, b) neural foraminal stenosis, or c) unstable back. Go to 14.6

1 day

14.6

3D-CT

STOP

The diagnosis will be either: (A) Facet break (B) Neural foraminal stenosis. Go to appropriate surgery: (A) Intrabody fusion or factectomy (B) Foraminotomy

14.9

Consider unstable spine, then go to 14.7

1 day

14.7

Facet break

STOP

Go to appropriate surgery

STOP

-

12 weeks

14.8

Neural foraminal stenosis

STOP

Go to appropriate surgery

STOP

-

3 weeks

14.9

Body jacket with thigh spika to leg without pain or leg with less pain

14.11

-

14.11

-

6 weeks

14.10

Fusion at appropriate level

STOP

-

STOP

-

1 year

14.11

Provocative discogram

14.12

-

14.13

-

1 day

14.12

Discectomy, and fusion

STOP

-

STOP

-

1 year

14.13

Bone scan, blood studies for neoplasm, infection

14.14

-

14.15

Go to 14.15, and 14.16 simutaneously

1 day

14.14

Institute medical therapy

STOP

-

STOP

-

weeks to months

14.15

Group therapy for chronic pain patients

STOP

-

STOP

-

1 year

14.16

Functional capacity evaluation and return to work, after vocational rehabilitation - STOP

STOP

-

STOP

-

2 days to 3 weeks

Group 15 - Herniated or Disrupted Thoracic Disc T1-T12

  • T1-T4 Facet Syndrome - Score=1.000000

  • Intercostal Neuralgia - Score=0.750000

  • T1-T4 Herniated or Disrupted Disc - Score=0.750000

  • Spinal Accessory Nerve Entrapment - Score=0.250000

  • T5-T8 Herniated or Disrupted Disc - Score=0.250000

Herniated or Disrupted Thoracic Disc T1-T12

Treatment Number

Treatment/Test

If Positive, next Treatment Number

If Positive then:

If Negative, next Treatment Number

If Negative then:

Treatment/Test Time

15.1

Do MRI of T spine, Provocative discogram of T spine and 3D-CT of T spine.

15.2

-

15.2

-

-

15.2

Does MRI and/or 3D-CT show compression fracture?

15.6

-

15.3

-

-

15.3

Does MRI or 3D-CT show neural foraminal stenosis or spinal stenosis?

15.7

-

15.4

-

-

15.4

Does MRI or 3D-CT show facet disease?

15.8

-

15.5

-

-

15.5

Is Provocative Discogram positive?

15.10

-

15.11

-

-

15.6

Do vertebroplasty

STOP

-

15.12

-

-

15.7

Do decompression

STOP

-

15.11

-

-

15.8

Do facet blocks above, at the site, and below the site

15.9

-

15.11

-

-

15.9

Do facet denervation

STOP

-

15.11

-

-

15.10

Do disectomy and fusion

STOP

-

15.12

-

-

15.11

Body jacket with thigh spika

15.10

-

15.12

-

-

15.12

Epidural Morphine Pump

STOP

-

15.13

-

-

15.13

Use pain medication

STOP

-

STOP

-

-

Group 17 - Thoracic Nerve Entrapment

  • Spinal Accessory Nerve Entrapment - Score=0.250000

Thoratic Nerve Entrapment

Treatment Number

Treatment/Test

If Positive, next Treatment Number

If Positive then:

If Negative, next Treatment Number

If Negative then:

Treatment/Test Time

17.1

Rest, TENS unit, NSAID, clonazepam, tri-cyclic antidepressants, vitamin B 6 q.i.d.

17.2

-

17.3

-

4 weeks

17.2

Job analysis, select proper level of work

STOP

-

STOP

-

2 days

17.3

Blood for TSH, T4-RIA, RF T3-RIA, thyroid antibodies, RPR, STS, HIV, HLA-B27, Vit. B12, folic acid, Lyme, A1c glycohemoglobin, ANA

17.4

-

17.6

-

1 day

17.4

Condition is likely to be caused by an organic illness, not the result of an accident or work related injury, refer to the proper specialist .

17.5

-

17.5

-

-

17.5

Treat underlying infection and or metabolic disease

STOP

-

17.6

-

3 weeks to 3 months, unless HIV+

17.6

Neurometer studies, and EMG/nerve conduction studies

17.7

-

17.7

-

1 day

17.7

Nerve block of the affected nerve

17.9

-

17.8

-

1 day

17.8

MRI of shoulder

17.11

-

17.14

-

1 day

17.9

Consult with neurosurgeon specializing in nerve entrapments

17.10

-

17.14

-

1 day

17.10

Surgery on trapped nerve

17.3

-

17.8

-

6 weeks

17.11

Arthroscopic evaluation

17.12

-

17.14

-

1 day

17.12

Orthopedic surgery consult

17.13

-

17.14

-

1 day

17.13

Arthroscopic surgery

17.3

-

17.14

-

6 weeks

17.14

Go to protocol for Thoracic Outlet Syndrome

10.1

-

10.1

-

1 day

 

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