Sample diagnostic paradigm and treamtent algorithm
Scheduled Test Information To print results, please use only the "Printable Version" print button at the bottom of this page. Please DO NOT use any other print method. Todays Date : Apr 20, 2010 Prefix: Mrs. First Name: Priscilla Middle Initial : R Last Name: XXXXX Suffix : Street Address (2) : XXXXXXX Street Address : City : XXXXXXXX My Country : United States Hom State or Province : Maryland e Postal Code : XXXXXX Page Phone Number: 999 999 999 ( ) - Client Company : Free Test User Claim / Account Number: 732 Logo Authorization Number : 100002895 ut Test Language : English Diagnostic Paradigm and Treatment Test To Take : Algorith Test (tm) Test Scheduled to be taken between : 04/07/2010 -04/08/2010 Test Completed : 04/07/2010 Test Status : Completed Test Score : 0.000000 To print results, please use only the "Printable Version" print button at the bottom of this page. Please DO NOT use any other print method. Test Messages : The following is a report of those conditions and information that the patient indicated on the Pain Test: The patient was born on 04/10/1940.
Patient reports that the pain is not the result of an accident. Patient reports havingthe following conditions: "Lupus", "Arthritis", "Heart disease, or high bloodpressure, or stroke". The patient did not report having any of the followingconditions: "Diabetes", "Thyroid disease", "Multiple Sclerosis or M.S.","Cancer", "Infection", "Muscular Dystrophy". The injury that gave rise to theclaim occurred on 02/24/1989. Patient reports not having had accidents or injuriesbefore this date. Patient reports not having had accidents or injuries since thisdate.Patient reports having a low back problem. Patient reports having had no surgeryto the low back. Patient reports that low back pain: "comes and goes". Patientreports that the low back problem feels like: "dull ache". Patient reports that thelow back problem gets worse when: "I ride in a car", "I lift things", "I stand toolong". Patient reports that the low back pain gets better when: "I lay down", "Irest".Patient reports having no problems in the left leg. Patient reports having had nosurgery or injury to the left leg.Patient reports having no problems with the right leg. Patient reports having hadno surgery or injury to the right leg.Patient reports having no neck problems. Patient reports having had no surgery orinjury to the neck.Patient reports having no problems with the left arm. Patient reports having hadno surgery or injury to the left arm.Patient reports having no problems with the right arm. Patient reports having hadno surgery or injury to the right arm.Patient reports having no problem just in front of the ear (where the jaw hingesthe skull).Patient reports having no problem with the chest or ribs. Patient reported havinghad no injury to the chest. Patient reported having had no surgery to the chest.On the left side of the body, the patient reported the following:Left side of low back: "pain that comes and goes".On the right side of the body, the paitient reported the following:In right middle finger: "weakness", "swelling". In right middle finger: "pain thatcomes and goes".
Right side of the low back: "pain that comes and goes".The patient also reported the following:Along left ribs, in the back: "pain that comes and goes".The Patient reported no problems in the mid back. Patient reported having aninjury to the mid back. Patient reported having no surgeries on the mid back.Patient reported not having a medical problem other than injury or surgery in themid back. Patient reported the mid back problem, "comes and goes". Patientreported that the mid back problem feels like a: "dull ache". Patient reported thatthe mid back problem gets worse if: "I ride in a car", "I lift things". Patientreported that the mid back problem gets better if: "I lie down", "I rest".Below is a list of possible diagnoses, organized into groups for viewingpurposes:Group 2 - Lumbar Herniated Disc L2-S1 L5-S1 Herniated or Disupted Disc - Score=0.916667 L4-L5 Herniated or Disrupted Disc - Score=0.666667 Unstable Spinal Segment at L3-L4 - Score=0.500000 Unstable Spinal Segment at L4-L5 - Score=0.500000 Spondylolysis/Spondylolythesis/Anterio-Lysthesis/Unstable Lumbar Spinal Segment - Score=0.500000 Unstable Spinal Segment at L5-S1 - Score=0.500000 L3-L4 Herniated or Disrupted Disc - Score=0.416667 Lumbar Facet Syndrome L3-S1 - Score=0.250000Lumbar Herniated Disc L2-S1 If If Positive, If Negative, Treatme If Treatment/T next Positiv next Treatment/T nt Negativ est Treatme e Treatme est Time Number e then: nt then: nt Number Number Bed rest as needed, NSAID, 2.1 STOP - 2.2 - 3 weeks muscle relaxants, and narcotics STOP. Trial with 2.2 STOP Remov 2.3 - 3 weeks corset e
corset. If pain returns , go to #2.3 Flexion- Extension X-2.3 Rays with 2.5 - 2.4 - 1 day obliques of lumbar spine M.R.I. of L2-2.4 2.5 - 2.6 - 1 day S1 EMG/Nerve conduction studies of2.5 2.7 - 2.6 - 1 day legs, and neurometer studies 3D-CT of L2-2.6 2.10 - 2.7 - 1 day S1 Body jacket with thigh2.7 2.11 - 2.8 - 1 day spika to leg with less pain Root blocks, L2-L3, L3-2.8 2.10 - 2.9 - 2 days L4, L4-L5, L5-S1 If Negativ e, go to Provocative protocol2.9 discogram 2.11 - 14.1 for 1 day L2-S1 Lumbar Facet Syndro me Orthopedic2.10 surgery 2.12 - 2.11 - 1 day consult Neurosurgical2.11 2.12 - 2.13 - 1 day consultation
Wait 1 Discectomy year, and fusion 2.12 2.13 then 2.14 - 1 year and/or go to foraminotomy #2.13 Functional capacity evaluation, 2 days to 3 2.13 then STOP - STOP - weeks vocational rehabilitation - then STOP M.R.I. with gadolinium, 2.14 2.13 - 2.15 - 1 day to rule out scarring 3D-CT to rule 2.15 out broken 2.11 - 2.16 - 1 day fusion Bone scan - 2.16 rule out 2.11 - 2.17 - 1 day infection Indium 111 2.17 2.11 - 2.18 - 1 day scan Rule out disc above or below 2.18 Gallium scan 2.11 - 2.3 1 day fusion site is disrupte d.Group 14 - Lumbar Facet Syndrome Lumbar Facet Syndrome L3-S1 - Score=0.250000Lumbar Facet Syndrome If IfTreatm Positive Negativ If Treatment/ If Positive Treatment/ ent , next e, next Negative Test then: Test TimeNumber Treatm Treatm then: ent ent
Number Number Muscle relaxants,14.1 NSAID, bed STOP - 14.2 - 3 weeks rest as needed14.2 Corset STOP - 14.3 - 3 weeks Flexion- If positive Extension for facet14.3 14.4 14.4 - 1 day X-rays with sclerosis, obliques go to #14.4 Facet blocks14.4 14.5 - 14.6 - 1 day L3-S1 Immediat ely, or if the facet denervatio ns lose their effectiven There is a ess, new 40% Facet diagnoses chance the denervation are to be patient will14.5 at STOP 14.6 considere 1 day have 2 appropriate d - a) years of level Facet relief - break, b) STOP neural foraminal stenosis, or c) unstable back. Go to 14.6 The diagnosis will be Consider either: (A) unstable Facet break14.6 3D-CT STOP 14.9 spine, 1 day (B) Neural then go to foraminal 14.7 stenosis. Go to appropriate
surgery: (A) Intrabody fusion or factectomy (B) Foraminot omy Go to14.7 Facet break STOP appropriate STOP - 12 weeks surgery Neural Go to14.8 foraminal STOP appropriate STOP - 3 weeks stenosis surgery Body jacket with thigh spika to leg14.9 14.11 - 14.11 - 6 weeks without pain or leg with less pain Fusion at14.10 appropriate STOP - 14.13 - 1 year level Provocative14.11 14.12 - 14.13 - 1 day discogram Discectomy,14.12 STOP - STOP - 1 year and fusion Bone scan, indium 111 scan, gallium scan, blood studies CBC14.13 14.14 - 14.14 1 day with diff, sed rate, C3. C4. Total compliment, alk phos for infection Institute 14.15 weeks to14.14 medical STOP - and - months therapy 14.1614.15 Group STOP - STOP - 1 year
therapy for chronic pain patients Functional capacity evaluation and return to 2 days to 3 14.16 STOP - STOP - work, after weeks vocational rehabilitatio n - STOPGroup 15 - Herniated or Disrupted Thoracic Disc T1-T12 T1-T4 Herniated or Disrupted Disc - Score=1.000000 T1-T4 Facet Syndrome - Score=0.750000 T5-T8 Herniated or Disrupted Disc - Score=0.687500 T5-8 Facet Syndrome - Score=0.625000 T9-T12 Herniated or Disrupted Disc - Score=0.416667Herniated or Disrupted Thoracic Disc T1-T12 If If Positive, Negative, Treatme If If Treatment/T next next Treatment/T nt Positiv Negativ est Treatme Treatme est Time Number e then: e then: nt nt Number Number Do MRI of T spine, Provocative 15.1 discogram of 15.2 - 15.2 - - T spine and 3D-CT of T spine. Does MRI and/or 3D-CT 15.2 show 15.6 - 15.3 - - compression fracture? Does MRI or 3D-CT show 15.3 neural 15.7 - 15.4 - - foraminal stenosis or
spinal stenosis? Does MRI or 15.4 3D-CT show 15.8 - 15.5 - - facet disease? Is Provocative 15.5 Discogram 15.10 - 15.11 - - positive? Do 15.6 STOP - 15.12 - - vertebroplasty Do 15.7 decompressio STOP - 15.11 - - n Do facet blocks above, 15.8 15.9 - 15.11 - - at the site, and below the site Do facet 15.9 STOP - 15.11 - - denervation Do disectomy 15.10 STOP - 15.12 - - and fusion Body jacket 15.11 with thigh 15.10 - 15.12 - - spika Epidural 15.12 Morphine STOP - 15.13 - - Pump Use pain 15.13 STOP - STOP - - medicationTo print results, please use only the "Printable Version" print button at the bottomof this page. Please DO NOT use any other print method. Save Changes Printable Version CancelView or Print the Authorization Letter