Dr. Bernhardt provides educational analysis of medical topics frequently encountered in personal injury, workers’ compensation, independent medical evaluation, and expert witness matters.
Trauma • Pre-Existing Conditions • Causation
Degenerative changes are common on spinal imaging, particularly with increasing age. Their presence does not by itself determine whether symptoms following a motor vehicle collision are traumatic, pre-existing, or represent an aggravation of an underlying condition.This article examines the clinical factors used to evaluate that relationship, including pre-injury symptoms, mechanism of injury, temporal association, examination findings, imaging, treatment response, and subsequent clinical course.
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Imaging • Clinical Correlation • Causation
MRI can identify structural abnormalities, but an abnormal imaging finding does not necessarily identify the source of a patient's symptoms—or establish when or how that abnormality developed.This article examines how imaging should be interpreted alongside the history, physical examination, symptom distribution, neurologic findings, treatment response, and other clinical evidence.
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Spine Injury • Disc Herniation • Medical Causation
Disc abnormalities may be traumatic, degenerative, or reflect a combination of pre-existing pathology and a subsequent injury.Determining the significance of a disc herniation requires more than identifying it on imaging. This article discusses the role of prior history, mechanism, morphology, associated findings, symptom onset, examination, and clinical course in medical causation analysis.
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Prognosis • Treatment • Future Medical CareF
Future medical care should reflect what a patient is medically likely to require—not simply every treatment that could theoretically be performed.This article examines the factors relevant to future-care analysis after spine injury, including diagnosis, previous treatment and response, prognosis, functional status, medications, rehabilitation, interventional procedures, surgery, neuromodulation, and anticipated long-term management.
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Not every post-injury pain condition can be explained by structural pathology alone. Some cases require consideration of neuropathic mechanisms, evolving clinical findings, and diagnostic criteria that depend heavily on the longitudinal clinical picture.
CRPS • Neuropathic Pain • Diagnosis
The severity of the initiating injury does not necessarily predict the severity of complex regional pain syndrome. At the same time, persistent pain following an injury does not by itself establish CRPS.This article reviews the clinical reasoning involved in evaluating suspected CRPS, including the relationship between the inciting event, symptoms, objective findings, diagnostic criteria, alternative diagnoses, and longitudinal clinical course.
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Medical literature provides an important foundation for medical-legal analysis, but evidence must ultimately be applied to the individual patient.History, mechanism of injury, examination findings, diagnostic studies, pre-existing conditions, treatment response, functional consequences, and clinical course may all influence how medical evidence should be interpreted.
The objective is not simply to identify what the literature says, but to determine how well it applies to the medical facts of the case.