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CONFIDENTIAL MEDICAL REPORT

Prepared on:

By R.H.Wade M.D., F.R.C.S. (Tr. & Orth.) 540 Etruria Road, Basford, Newcastle, Staffs, ST5 OSX

ADDRESSED TO THE COURT
REQUESTED BY: OUR REFERENCE: YOUR REFERENCE: INSTRUCTORS REF: ACCIDENT DATE: EXAMINED ON: EXAMINED AT: DATE OF REPORT: DOCUMENTS AVAILABLE:

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CONTENTS: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 The Mandate Authors Professional Profile Introduction The Accident Subsequent History Previous History Present Situation Consequential Loss Review of Records Examination Radiological Examination Discussion Summary Statement to Court References (if required)

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1.1

MANDATE
I have been requested by dated to provide a medical report on following an accident

1.2

This report has been prepared using the accident and medical files. The client was examined on

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2.1

PROFESSIONAL PROFILE
I am a consultant orthopaedic surgeon working at North Staffordshire NHS Trust. I have worked as consultant since January 2003. I work as a trauma surgeon in a very busy trauma unit taking casualties covering a wide area via the air ambulance. I take tertiary referrals from surrounding district general hospitals. I am involved in all aspects of trauma care and I undertake a regular on call duty. My elective work covers all aspects of sports injuries and arthroscopic surgery.

2.2

I qualified from Liverpool Medical School in 1992. I obtained my fellowship to the Royal College of Surgeons in 1996. topic concerned problem fractures. Trauma and Orthopaedics in 2002. My basic training was undertaken in the I undertook my higher surgical training in Liverpool area after which I worked as a research fellow in Oswestry. My research Manchester, Oswestry and Stoke-on-Trent. I obtained my specialist fellowship of

2.3 I am widely published in the field of Trauma and Orthopaedics. I have a doctorate of medicine based on trauma orthopaedic research that I obtained in 2002 from Keele University. This gave me an insight into the critique all aspect of published research. 2.4 I prepare over 200 reports a year. I have attended conferences on medico-legal matters and understand Part 35 of the Civil Procedure Rules. I have a specific interest in the recovery from orthopaedic injury in the medico-legal setting. I base this on a critical review of the medical literature.

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3.1 3.2 3.3 3.4

INTRODUCTION
Mr Bloggs is a 36 year old sales representative. He would undertake about 3,000 miles a week driving for work. He presented with a passport for ID. At the time of the accident he worked from home and did not take any specific time off.

3.5

He is right handed.

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4.1

THE ACCIDENT (as told to me by Mr Bloggs)
On 12/12/2008 Mr Bloggs was the driver of a car involved in a road traffic accident. There were two other passengers.

4.2

He was wearing a seatbelt. The car was fitted with headrests which had been adjusted by himself. The driver’s airbags was deployed. He did not get a burn from this.

4.3

He was driving along the motorway at approximately 50 mph when a car in the outside lane had stopped with no lights on. He stopped just in time and a vehicle hit the rear of his car at significant speed. This impact shunted him forward.

4.4

There was a lot of damage to his Vauxhall Vectra. The other car was a Range Rover.

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4.5

He was jolted. He was unaware of the impending impact. He was looking to the left. There was a direct blow to his left wrist from the airbag.

4.6 4.7

His other passengers did sustain injuries. He noticed pain increasing in his neck over a day or so following the accident. This radiated to his arms. There were pins and needles in his fingers.

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5.1

SUBSEQUENT HISTORY (as told to me by Mr Bloggs)
An ambulance attended the scene. He was taken to the local Hospital. He was examined and had x-rays taken. He has been to see his General Practitioner.

5.2

He has completed 6 sessions of physiotherapy with little help. His general practitioner had arranged these.

5.3

Neck injury This increased for 2 days and then remained the same. It has not really improved since this time.

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6.1

PREVIOUS MEDICAL HISTORY (as told to me by Mr Bloggs)
Nil to note.

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7.1

PRESENT SITUATION (as told to me by Mr Bloggs)
Neck injury

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He continues with constant pain. It is there most days but only for an hour or so. There are no ongoing pins and needles or numbness. On a visual analogue score he describes this as 3-4 out of 10. 7.2 He takes medication occasionally. This is usually paracetamol but can also sometimes be co-proxamol.

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8.1

CONSEQUENTIAL LOSS
His leisure activities of the gym and football are reduced. He struggles when he is driving with his neck.

8.2

He struggles with DIY and needed to get a painter in when he was unable do work he would normally do himself.

8.3

He has no ongoing working reduction except to say it is uncomfortable when he drives.

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9.1

REVIEW OF RECORDS
Photocopied notes were reviewed. Notes only of relevance to this case have been commented upon Text in quotations is verbatim. Text in square brackets is a personal opinion.

9.2

4/12/2005

General Practitioner record: ‘Spontaneous onset of neck pain.” [Reference to previous problem with neck.]

9.3

12/12/2008

Hospital record: ‘RTA neck pain’

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‘X-ray normal’ ‘Soft tissue injury’ ‘Advice and analgesias’

9.4

5/01/2009

General Practitioner record: ‘Neck now improving’ ‘Physiotherapy arranged’

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EXAMINATION

10.1 He attended alone today. 10.2 He answered my questions and co-operated with the examination. 10.3 He is 5 foot 8 and weighs 10 stone 4 pounds. 10.4 Tender in right trapezius. Full range of movements. Neurological examination normal. No inappropriate signs. No shoulder impingement signs. No rotator cuff weakness.

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RADIOLOGICAL EXAMINATION

11.1 X-rays reviewed on E viewer personally. 11.2 12/12/2008 Cervical spine: No fractures seen. No underlying osteoarthritis.

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DISCUSSION

12.1 On 12/12/2008 Mr Bloggs was involved in a road traffic accident. 12.2 He sustained a soft tissue injury to his neck. 12.3 Neck injury He noticed pain immediately. This radiated to his arms. There were pins and needles in his fingers. 12.4 This increased over 2 days and then reached a plateau. It has continued since the accident. 12.5 I note he has had physiotherapy. He takes medication occasionally. He still has some leisure activity restrictions. 12.6 Factors which in this case relate to a poorer outcome, are: a) A lack of awareness at the time of injury (Ryan et al 1994). b) Pain distribution more distal than the neck (Squires et al 1996). c) A front seat passenger (Allen et al 1985). d) A rear-end collision (Spitzer et al 1995). e) Early onset of symptoms (Deans et al 1987).

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12.7 Factors in this injury which may predict a better outcome, are: a) No previous whiplash type injury (Khan et al 2000). b) No known pre-existing cervical spondylosis (Maimaris et al 1988). c) No abnormal neurology at the time of injury (Maimaris et al 1988). d) Aged under 50 at the time of injury (Hohl et al 1974). 12.8 At present he is scale C on a Gargan and Bannister scale. 12.9 He does have a past history of neck pain in 2005. 12.10 Taking into account all the above factors on the balance of probability I would expect this to improve and settle fully 12 to 18 months post injury. requires no further investigation or treatment. deteriorate in reference to this accident in the future. 12.11 If it does continue beyond this time his past medical history needs to be considered and further investigations such as an MRI may well pick up abnormalities that will have predated the accident. 12.12 He took no time off work. This will not affect his working capacity in the future. 12.13 His ongoing leisure activity restrictions will settle when his symptoms settle as previously noted. This This will not significantly

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SUMMARY

13.1 On 12/12/2008 Mr Bloggs was involved in a road traffic accident. 13.2 He sustained a soft tissue injury to his neck. On the balance of probability this will settle 12 to 18 months post injury.

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DUTY TO THE COURT

I confirm that insofar as the facts state in my report and within my knowledge, I have made clear which they are and I believe them to be true, and that the opinion that I have expressed represents my true and complete professional opinion. I understand my duty to the Court and have complied and will continue to comply with that duty.

_______________ R.H. Wade M.D., F.R.C.S. (Tr. & Orth.) Consultant Orthopaedic Surgeon

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REFERENCES

Gargan MF & Bannister GC. 1990. Long-term prognosis of soft tissue injuries of the neck. J. Bone J. Surg. 72-B: 901-03.
GROUP A B C D SYMPTOMS Symptom-free. Symptoms not interfering with occupation or leisure Symptoms restricting occupation or leisure with or without frequent intermittent use of analgesia, orthotics or physical therapy. Loss of occupation, continuous use of analgesics, orthotics, repeated medical consultations.

Ryan GA, Taylor GW, MooreVM, Dolinis J 1994. Neck strain in car occupants: Injury status after 6 months and crash related factors. Injury 25 (8): 533-537. Squires B Gargan MF, Bannister GC 1996. Soft tissue injuries of the cervical spine. 15 year follow up. J. Bone J. Surg. 78-B:955-57. Allen MJ Barnes MR, Bodiwalagg GC. 1985. The effect of seat belt legislation on injuries sustained by car occupants. Injury 16: 471-476. Spitzer WO, S’kovron ML, Salmi LR, Cassidy JD Duranceau J, Suissa S, Zeiss E. 1995. Scientific monograph of the Quebec task force on whiplash-associated disorders. Spine 20(85): 1-73. Deans GT, Magalliard JN, Kerr M, Rutherford WH. 1987. Neck sprain-a major cause of disability following car accidents. Injury 18:10-12. Khan S Bannister G, Gargan M, Asopa V, Edwards. 2000. Prognosis following a second whiplash injury. Injury 31: 249-251. Maimaris C, Barnes MR, Allen MJ 1988, ‘Whiplash injuries of the neck’: A retrospective study. Injury 19: 393-396. Hohl M. 1974 .Soft-tissue injuries of the neck in automobile accidents-factors influencing prognosis. J.Bone Joint Surg. 56(A): 675-81.