The whole claim

Personal injury — chest and chest wall

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Condition and prognosis reports in chest injury, for claimant, defendant and joint instruction. Examinations in London, nationwide, by home visit or remotely, usually available within 7 working days.

Injuries I report on

Scope of injury

Rib fractures, single, multiple and flail segment Sternal fracture Costal cartilage injury and costochondral separation Post-traumatic slipping rib syndrome Seat belt injury to the chest wall Lung contusion and its sequelae Traumatic pneumothorax and haemothorax, and the consequences of drainage Diaphragmatic rupture Penetrating chest injury and its residual effects Chronic post-traumatic chest wall pain, including intercostal neuralgia Consequences of thoracotomy performed for trauma, including post-thoracotomy pain syndrome

What a condition and prognosis report from me covers

Ten things, addressed in every report

The mechanism of injury and whether the injuries described are consistent with it

The nature and extent of the injury, established from the imaging rather than from the notes alone

The treatment given, and whether the recovery has followed the expected course

The cause of any continuing symptoms, and specifically whether continuing pain has an identifiable structural cause

Whether further treatment would improve matters, what it would involve, and what it would cost

Permanent restrictions on lifting, carrying, work, driving, sport and activities of daily living

Effect on respiratory function and exercise capacity

Care, aids and equipment requirements where relevant

Prognosis, with a stated time frame and a statement of the confidence I have in it

Whether the claimant’s presentation is consistent with the injury, addressed neutrally and on the evidence

Two things that recur in these cases

Worth checking before you rely on an earlier report

Continuing chest wall pain is usually dismissed too early

The assumption that pain must have resolved because the fractures have united is wrong often enough to matter. Non-union, malunion, costal cartilage injury, intercostal neuralgia and post-traumatic slipping rib all produce persistent, structurally caused pain that does not appear on a plain radiograph. Where an earlier report has concluded that the symptoms are disproportionate to the injury, it is worth checking whether anybody examined the chest wall properly.

Treatability changes quantum

Identifying a structural cause frequently opens up treatment, which alters both the prognosis and the shape of the schedule. This cuts both ways: it can convert a claim for lifelong pain into a claim for a treatable condition, and it can convert an undervalued claim into a properly valued one. I report what I find in either direction.

Examinations

How and where I will normally examine the claimant where the report concerns continuing symptoms, because the chest wall examination is where the structural causes of persistent pain are identified, and it cannot be done remotely. Where the instruction concerns only records review, or where the claimant’s condition makes travel unreasonable, remote assessment or a home visit can be arranged. Chaperones are available. Claimants may bring a family member or a representative from your firm. Examinations can be conducted in English or Italian.

Turnaround

What to expect Appointments usually within 7 days, sooner where a limitation date requires it. Reports within 4 weeks of the examination.

Book an examination or discuss a case

Fifteen minutes on the telephone, free of charge. I will tell you whether the issues fall within my expertise before anything is committed to paper.

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