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Alassaadi v. Davidson Transit Organization8/24/2005
ght, the left sternocleidomastoid muscle is used. The left side appeared to be strong when turning right and the right side appeared to be weak when turning left which contradicts his having a totally left sided problem. There was no atrophy in the neck muscles on the left and right sides.
A purely one-sided problem can only be caused by some kind of nerve problem, spinal cord injury or intra-cranial problem. Since the examination, a brain MRI and an EMG test were been performed. There was no evidence of any neurologic damage on the EMG studies and no evidence of any intra cranial abnormalities on the MRI scan of the brain.
Dr. Terry performed strength testing which revealed reduced strength on the left side. Dr. Terry noted that strength testing is difficult since the doctor must rely on the patient's effort. There may be a lack of effort or there may be pain or something of that nature such that the person may not be able to give a good effort. In view of the elapsed time between the injury and the examination, the lack of strength on the left side should have resulted in atrophy to the muscles in the forearms, thighs and legs. Since there was no atrophy, Dr. Terry was concerned that there may have been a lack of effort given during the examination.
Additionally, the weakness on the left side was inconsistent with the EMG study that was performed. The EMG study revealed that the nerves appeared to have full function and full capacity to transmit a signal from their starting point to the muscle innervation site.
Mr. Alassaadi's reflexes appeared to be equal and normal in the upper extremities and equal and normal in the lower extremities. Equal and normal reflexes indicate a lack of neurologic abnormality. If there is an abnormality, when you stimulate the tendon, the reflex doesn't go to the brain, it goes to the spinal cord and comes back.
Mr. Alassaadi had full passive range of motion in both the left and right shoulders. He did not have full active range of motion in his left shoulder. Dr. Terry reviewed an MRI scan that was done at the time of Mr. Alassaadi's injury which revealed a degenerated disc with bulging at C4/5 with neural foraminal narrowing. According to Dr. Terry, degenerative disc disease is a chronic, ongoing condition that results from wear and tear on the disc over time. Dr. Terry was of the opinion that the slip and fall did not cause the degenerative disc. A degenerated disc happens over time. It is not a one-time, single event. According to the report of Dr. Greg Smith who reviewed the MRI, it showed bilateral neural foraminal narrowing at this level which would not indicate one side was worse than the other. The reviewing physician also did not indicate there was significant impingement on the nerves on one side or the other. Moreover, the EMG study was normal, which does not indicate any evidence of compression of the nerve at the level of the cervical spine. Dr. Terry reviewed the MRI done on June 27, 2002. The scan was read as a minimal, diffuse, central disc bulge at L5/S1, with degenerated disc manifesting by decreased signal. No impingement on the nerve roots was noted. Dr. Terry's opinion was that this was not caused by trauma related to this accident but was caused by changes in the disc related to time.
Dr. Terry indicated that the reports of Mr. Alassaadi about his difficulty in walking and complaints of facial numbness, drooping, slurred speech, and drooling were not supported by the physical examination. None of the complaints of Mr. Alassaadi were supported by physical examination and the diagnostic tests. Dr. Terry did not find any permanent condition that resulted from his fall based upon the AMA Guide
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