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RESPONSES / COMMENTS (CLINICAL) - PART 1

05/03/2012     




RE: Nerve Compression Vs. Fictitious Injury (Barry Mullen, DPM)
From: Jeffrey Smith, DPM

CRPS was never ruled out. The patient was referred to an inteventional pain management specialist, as well as PT from me. When I got the consult, it had already been about a month from the injury. The patient never got improvement from PT. The interventional pain management physician never scheduled the patient for follow-up. Also, many distraction techniques were attempted during my physical exam. This did not help with making a conclusion, as the patient was very conscious of not extending the toes. I contacted PT to administer TENS therapy while trying to elicit an extensor firing. No conclusions could be made on any account.

Usually, one will see color changes, as well as temperature changes in the extremity. The patient never expressed these symptoms. No atrophy was identified as well. After about a month, an MRI will demonstrate fatty tissue around the muscle belly where there is atrophy. Due to lack of physical findings, lack of improvement from PT modalities and continued pressure from the WC, I sent the patient for a functional capacity evaluation. Results showed inconsistencies with findings, per their note. The only significance in the evaluation showed little to no muscle strength with toe extension.

Shouldn't one find other related symptoms with this sort of injury? Spasms, color changes, atrophy, loss of tone are related symptoms that gain a level of confidence in an organic diagnosis.

Jeffrey Smith, DPM, Miami, FL