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Accident Injury Medical Case Management

It is the position of Stanger Injury Treatment Centers that proper case
management of injuries consists of a series of decision-making junctures.

Decisions made by physicians at these junctures will determine the
appropriateness and thoroughness of care.

To illustrate the type of decisions typically made during treatment by Stanger

Injury Centers doctors, consider the following hypothetical vignette: a patient
enters a Stanger Injury Treatment Center office complaining of lower back pain

following an automobile accident. After completing basic paperwork, a detailed
history is obtained, and a physical examination is performed of the muscular

skeletal system. A decision is made at this point by the physician, based on

subjective and objective findings, to perform a series of spinal x-rays.

Considering all findings thus far, the Stanger Injury Centers physician makes a

preliminary diagnosis of lumbar sprain/strain with possible radiculopathy. The
physician, at this juncture, decides to prescribe anti-inflammatory and pain

medication and to begin the patient on a course of physiotherapy, massage,

therapeutic exercises and spinal manipulations.

After four weeks of therapy, the patient is re-examined and is found to still be
experiencing restricted range of motion and radiation of pain down the leg. The

Stanger Injury Treatment Centers physician then makes the decision to refer the

patient for a lumbar MRI scan. The MRI reveals a herniated disc with nerve
impingement and a referral is made to a physiatrist to check for nerve damage. To

rule out nerve damage, the Stanger Injury Treatment Centers physiatrist

(specialist in physical medicine and rehabilitation) feels it is necessary to perform
nerve conduction and electromyelogram (EMG) studies. A positive EMG is

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