Bodily Injury Claims: Study 2
Skin and Musculature
The
doctor’s examination may not specifically deal with the particular
event that induced the claim investigation. Doctors will treat patients
for whatever ailments they diagnose. The adjuster must recognize the
terminology so a proper analysis can be made of how much of a treatment
plan or diagnosis relates to the claim at hand. The medical history of
the claimant is needed to assess to what extent such conditions will
affect a settlement.
Skin:
- The skin is a sensory organ. Its function is to:
- Protect against trauma and infection
- Regulate body temperature
- Help eliminate fluids (through sweat glands)
- Prevent dehydration
- Conserve electrolytes
- Manufacture vitamin D
- Melanin is the pigment that determines the colour of skin
- Cutaneous refers to anything pertaining to the skin
- Epidermis is the outermost part of the skin
- Dermis (or corium) is the lower main layer. It contains blood vessels, nerves, glands, hair roots, and fat cells.
- Bedsores are a skin condition that may develop in bedridden patients. They are a type of decubitus ulcer. Patients with some form of paralysis are susceptible. Pressure on the skin over a bony prominence may cause a prolonged deficiency in blood flow which may in turn lead to the death of tissue. Shift a patient’s position frequently to avoid this condition.
Burns:
- Caused by excessive heat, chemicals, or electricity
- Severity measured by amount of skin loss and depth of burn
- Depth severity rating classifications are:
- First degree burns: Superficial. The skin becomes reddened and inflamed on the skin surface. The inflammation usually subsides in a couple of days and the outermost layer of skin peels.
- Second degree burns: cause blistering and some destruction of the superficial layers of skin. This type of wound is susceptible to infection.
- Third degree burns: cause severe damage to the thickness of the skin and underlying tissue. Damage may extend to the bone.
- Secondary and potentially life threatening effects of a burn may include:
- Loss of water, plasma (fluid component of the blood), plasma proteins which can lead to shock
- Bacterial infection
- Reduced circulation of blood
- Decrease in urine production
- Treatments include:
- Replacing lost fluids to prevent shock
- Cleaning the wound by removing all dead tissue so antibacterial agents gain direct contact with the burn surface to prevent infection
- Applying skin grafts
Musculature:
- Over 600 muscles in the body
- 3 groups of muscles are
- Skeletal muscles: move the bones of the body. They must be stimulated by a nerve to function and are known as the voluntary muscles. They have a great capacity for healing because of the large number of blood vessels which run through them. There are two main types of Skeletal muscles:
- Flexors
- Extensors
- Smooth muscles: are found in the blood vessels and internal organs. These small and delicate muscles are not under voluntary control.
- Cardiac muscle: heart tissue is striated involuntary muscle with a single nucleus.
- Fascia and muscles taper into cords of tissue called tendons. Tendons attach to bones.
- Biceps bend and triceps extend the arm
- A total of 35 muscles control the hand
- Sternomastoid moves the head
- Trapezius is involved in raising shoulders.
- Ligaments are bands of fibrous tissue that connect bones or cartilages. They also hold organs in place.
- To treat a muscle strain doctors prescribe anti-inflammatory drugs and muscle relaxants and an early stretching program to decrease the inflammation, promote healing and maintain range of movement.
Cervical and Lumbar Strains:
- Most common injury involving back area is flexion-extension strain to the cervical (neck) area
- More commonly referred to as whiplash
- It is the result of rapid acceleration/deceleration
- Usually sustained in rear-end collisions
- The major medical finding in this type of trauma is muscle spasm in the affected area
- Drug therapy for whiplash may induce depression, anxiety and an inability to exercise
- Newer treatments include such things as:
- Nerve block injections that provide long-term pain relief
- Chiropractic adjustments
- Therapeutic manipulations
- Biofeedback sessions
- Patients may need psychiatric help to cope with chronic pain
- These injuries cannot be seen in x-rays
- Many of the symptoms are subjective and cannot be confirmed or denied by doctors
Fibromyalgia:
- Also called chronic pain syndrome
- Disabling pain that persists three to six months beyond a normal recovery period for a soft tissue injury
- May be treated with:
- Pain management programs
- Analgesics
- Muscle relaxants
- Antidepressants
- Other drugs
- Fairly insignificant soft tissue injuries can burgeon into a diagnosis of chronic pain syndrome
- Recovery should have taken place but symptoms persist often including complaints of pain, loss of function, depression and anxiety.
Definitions:
Congenital: refers to conditions present at birth, regardless of causation.
Neurological Deficit:
is nerve involvement which manifests itself through pain, a tingling
sensation, or a loss of sensation (numbness) in a part of the body
Incise: to incise a wound means to make a surgical cut to the affected area
Skin Grafting:
is the transplanting of healthy tissue from another part of the body to
replace damaged skin in the injured area. New technology exists that
can “grow” skin under laboratory conditions using skin cells. This is
done when large areas of the body are involved in the injury.
Shock:
is brought on by collapse of the circulatory system, a condition often
caused by severe injury. The symptoms include pallor, sweating, weak
pulse, and very low blood pressure.
Flexion: means flexing or bending a part of the body.
Extension: means extending or straightening a part of the body.
Strain: is the overstretching and possible tearing of muscle or tendon fibres.
Sprain: involves the partial or complete tearing of a ligament.
Chronic Pain: is pain that persists over a long period of time.
Acute Pain: is pain that lasts a relatively short time.
Fibromyalgia: describes persistent, disabling pain in the muscles over a long period of time.
Decompression: a surgical procedure to release fluids built up in the injured area below the skin
Abrasion: when the skin is denuded by rubbing and scraping.
Petechia: a rash of little red dots where bleeding is minimal, but the pain can be intense.
Contusions: are injuries where the skin is not broken (bruises).
Haematoma: is the word used to describe pooled blood from damaged blood vessels under the skin’s surface.
Ligation: the tying or bonding of blood vessels
Lacerations:
are tears of the flesh. They have an irregular, jagged and shredded
appearance. They are usually described as to depth and length measured
in centimeters.
Debridement: surgical process of removing dirt, contamination, and badly damaged tissue.
Haemorrhage: is the excessive discharge of blood either internally or externally.
Hypertrophic scar: is composed of dense, fibrous tissue that is usually elevated.
Hypertrophy: refers to the enlargement of an organ or a structure
Keloid Scar: A
more prominent scar caused by excessive amounts of collagen forming in
the corium during healing. It reaches beyond the wound site, tends to be
very itchy and becomes progressively larger.
Dermabrading: Sanding of the skin
Transverse laceration: may sever the cutaneous nerves resulting in numbness at the site of the laceration.
Fascia: is the tough connective tissue that covers, supports and separates muscle.
Plantarflexion: downward movement of the foot
Dorsiflexion: upward movement of the foot.
Ectopic bone: Bone that is forming in a place where it normally does not (such as in a muscle)
Spasm: is a sudden and involuntary movement or convulsive muscular contraction
Myalgia: is tenderness or pain in the muscles
Atrophy: wasting or shrinking of parts that are not used
Surface Electromyogram (EMG):
is a device that records electrical activity of skeletal muscles by
attaching electrodes to the body to show whether muscles are contracting
or not.
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