ARTICLE
Understanding MRI Findings in Personal-Injury PatientsA PI Attorney’s Guide for Chiropractors. Part 1.When a patient is involved in a motor-vehicle collision, the MRI can become one of the most important pieces of evidence in the personal-injury claim. But an MRI does not automatically prove that every abnormality was caused by the crash.For chiropractors treating personal-injury patients, the key is understanding what the MRI actually shows, how it relates to the patient’s clinical presentation, and how the findings fit into the patient’s history.1. An MRI Finding Is Not Automatically a Crash InjuryMRI reports frequently identify findings such as:Disc bulgesDisc protrusionsDisc herniationsAnnular fissures or tearsForaminal narrowingSpinal stenosisDegenerative disc diseaseFacet arthropathySome of these findings can exist before a collision. That does not mean the patient’s symptoms are unrelated to the collision.The important question is whether the patient’s history, examination, symptoms, and imaging are consistent with an injury or aggravation associated with the collision.2. The Pre-Accident History MattersOne of the strongest ways to help establish causation is to clearly document the patient’s condition before the collision.Consider documenting:Whether the patient had prior neck or back painWhether the patient had prior treatmentWhether the patient had previous imagingWhether symptoms were absent, intermittent, or chronicWhether the patient had limitations before the collisionWhen the current symptoms began following the collisionFor example, documenting that a patient reported no significant neck pain or treatment before the collision and developed neck pain immediately afterward provides important clinical context.3. Compare the MRI to the Patient’s SymptomsThe MRI should never be viewed in isolation.A report might identify a disc protrusion at C5-6, but the more important clinical question is whether that finding corresponds with the patient’s symptoms and examination.Document the relationship between:Mechanism ? symptoms ? examination findings ? imaging ? treatmentThe stronger the clinical correlation, the easier it is for everyone involved to understand the patient’s condition.4. Document Changes in SymptomsDon’t simply document that the patient “has neck pain.”Be specific.Instead of:“Patient continues to have neck pain.”Consider documenting:“Patient reports persistent left-sided cervical pain with radiation into the left shoulder. Symptoms increase with cervical rotation and prolonged sitting. Patient reports the symptoms began following the motor-vehicle collision and remain different from her pre-accident condition.”Specific documentation creates a much clearer medical record.5. Don’t Overstate the MRIA chiropractor should document clinical findings accurately without attempting to make the MRI say more than it does.If the radiologist describes a disc bulge, don’t automatically refer to it as a “herniated disc.”If the report describes degenerative changes, don’t automatically characterize those changes as traumatic.Instead, document the actual radiological finding and then explain the clinical significance based on your examination and history.6. What the PI Attorney Needs from the ChartFrom the attorney’s perspective, a strong treatment record should help answer several basic questions:What happened?When did the symptoms begin?What symptoms developed?What objective findings were present?What did the imaging demonstrate?How did the patient’s condition change over time?What treatment was provided?Did the patient improve?What symptoms or limitations remain?The MRI is one part of that story—not the entire story.7. The Most Important TakeawayDon’t treat the MRI report. Treat the patient.The MRI provides objective information, but the patient’s history, examination, functional limitations, treatment response, and clinical progression provide the context necessary to understand that information.For personal-injury patients, consistent and detailed documentation can make the difference between an imaging report that simply lists abnormalities and a medical record that clearly explains the patient’s condition.From the PI Attorney’s PerspectiveWhen we review a personal-injury medical record, we are looking for a consistent story.The best records don’t exaggerate. They don’t speculate. They simply document the patient’s history, complaints, objective findings, treatment, and progression accurately and consistently.That makes the medical record more useful for the patient, the treating provider, and the attorney. Our follow up newsletter will discuss pre-existing conditions and Texas law.Questions? Contact me at Dr.lawson@jdsilvalaw.com
When a patient is involved in a motor-vehicle collision, the MRI can become one of the most important pieces of evidence in the personal-injury claim. But an MRI does not automatically prove that every abnormality was caused by the crash.
For chiropractors treating personal-injury patients, the key is understanding what the MRI actually shows, how it relates to the patient’s clinical presentation, and how the findings fit into the patient’s history.
MRI reports frequently identify findings such as:
Disc bulges
Disc protrusions
Disc herniations
Annular fissures or tears
Foraminal narrowing
Spinal stenosis
Degenerative disc disease
Facet arthropathy
Some of these findings can exist before a collision. That does not mean the patient’s symptoms are unrelated to the collision.
The important question is whether the patient’s history, examination, symptoms, and imaging are consistent with an injury or aggravation associated with the collision.
One of the strongest ways to help establish causation is to clearly document the patient’s condition before the collision.
Consider documenting:
Whether the patient had prior neck or back pain
Whether the patient had prior treatment
Whether the patient had previous imaging
Whether symptoms were absent, intermittent, or chronic
Whether the patient had limitations before the collision
When the current symptoms began following the collision
For example, documenting that a patient reported no significant neck pain or treatment before the collision and developed neck pain immediately afterward provides important clinical context.
The MRI should never be viewed in isolation.
A report might identify a disc protrusion at C5-6, but the more important clinical question is whether that finding corresponds with the patient’s symptoms and examination.
Document the relationship between:
Mechanism ? symptoms ? examination findings ? imaging ? treatment
The stronger the clinical correlation, the easier it is for everyone involved to understand the patient’s condition.
Don’t simply document that the patient “has neck pain.”
Be specific.
Instead of:
“Patient continues to have neck pain.”
“Patient reports persistent left-sided cervical pain with radiation into the left shoulder. Symptoms increase with cervical rotation and prolonged sitting. Patient reports the symptoms began following the motor-vehicle collision and remain different from her pre-accident condition.”
Specific documentation creates a much clearer medical record.
A chiropractor should document clinical findings accurately without attempting to make the MRI say more than it does.
If the radiologist describes a disc bulge, don’t automatically refer to it as a “herniated disc.”
If the report describes degenerative changes, don’t automatically characterize those changes as traumatic.
Instead, document the actual radiological finding and then explain the clinical significance based on your examination and history.
From the attorney’s perspective, a strong treatment record should help answer several basic questions:
What happened?
When did the symptoms begin?
What symptoms developed?
What objective findings were present?
What did the imaging demonstrate?
How did the patient’s condition change over time?
What treatment was provided?
Did the patient improve?
What symptoms or limitations remain?
The MRI is one part of that story—not the entire story.
Don’t treat the MRI report. Treat the patient.
The MRI provides objective information, but the patient’s history, examination, functional limitations, treatment response, and clinical progression provide the context necessary to understand that information.
For personal-injury patients, consistent and detailed documentation can make the difference between an imaging report that simply lists abnormalities and a medical record that clearly explains the patient’s condition.
When we review a personal-injury medical record, we are looking for a consistent story.
The best records don’t exaggerate. They don’t speculate. They simply document the patient’s history, complaints, objective findings, treatment, and progression accurately and consistently.
That makes the medical record more useful for the patient, the treating provider, and the attorney. Our follow up newsletter will discuss pre-existing conditions and Texas law.
Questions? Contact me at Dr.lawson@jdsilvalaw.com