1. Orthopaedic Surgery IME& Workers’ Compensation Richard J. Friedman, MD Charleston Orthopaedic Associates

3. Disability l Alteration of an individual’s ability to meet occupational, personal or social demands because of an impairment.

4. Impairment l A deviation from normal in a body part or organ system and its functioning.

5. WC Evaluation l Performed to assist in the evaluation of work-related injuries l Evaluation of permanent physical impairment is the sole responsibility of the physician l Need cooperation and input of nurses and case managers

6. WC Evaluation l Orthopaedic surgeons very involved l No training l Conflict of interest l Secondary gain l Poor system with little incentive for the patient to get better

7. WC l Physician must act without bias or preconceived views l Must treat patient with respect, dignity and in a friendly manner.

9. Change in Physician’s Role PATIENT HISTORY PX EXAM TESTS PHYSICIAN

10. Change in Physician’s Role PATIENT LAWYER PHYSICIAN EMPLOYER ADMINISTRATOR/ADJUDICATOR DISABILITY RATING

11. Similarities l Gather patient’s history l Perform physical examination l Order appropriate lab tests l Assimilate the information l Report the information obtained l Act ethically

12. Differences l Goals l Treatment recommendations l Work history l Rating system requirements l End results

13. Differences l Peripheral issues l Reliance on non-medical personnel l Specific issues addressed l Causation l Legal responsibilities l Referral sources

14. Understanding the Needs of the Referral Source l What critical questions must the medical consultant ask of the referral source? l What are the issues of this case? l What is the purpose of the evaluation? l What are you asking me to do? l What questions do you want me to answer?

15. Contents of the Report l Results of the clinical evaluation l History of the medical condition l Findings of physical examination l Findings from laboratory tests and diagnostic procedures - x-rays, MRI l Clinical impression

16. Contents of the Report l Medical management plan l Recommendations for further diagnostic tests l Active treatment plan l Rehabilitation l Follow-up evaluation l Return to work

18. Shoulder Injuries l Muscle strain l Tendinitis l AC separation l Dislocation l Subluxation l Impingement / rotator cuff l SLAP tear l Fracture

19. Knee Injuries l Ligament sprain l Muscle strain l Tendinitis l Torn meniscus l Osteochondral injury l Fracture l Dislocation

20. Questions?Confusion? Thank You.