Introduction

Assessment of the upper limb after injury is a highly specialised field. A good knowledge of anatomy as well as experience in the management of injuries is a prerequisite. This enables a full understanding of the effects of the injury; the identification of problems that are amenable to correction and provision of a final prognosis.

The hand and wrist are complex structures. Normal function depends on the presence of all structures, intact sensation, active movement and comfort. The loss of any of these attributes causes loss of capacity.

Normal Injured
Intactness Amputation
Movement Stiffness
Power Weakness
Sensation Numbness
Comfort Tenderness

Assessment after injury has to consider each of these factors. Examination needs to be detailed and involves the use of specific tests as well as specialist instruments to assess movement, sensation and power.

Claimant

I have been instructed by a solicitor and/or insurance company to prepare a report on your injury/case. This report will be used as evidence in the assessment of your claim.

I serve as an independent expert who has and will not be involved in your treatment. In most personal injury claims, I have been jointly instructed by both sides (claimant & defendant). My duty is to represent the Court and to provide an impartial report of the entire episode. In negligence cases, my instructions are usually singular for claimant (you) or defendant (hospital) and it is likely that you will be examined by another expert for the "other side".

The report involves my review of all your medical records and your attendance for examination. The interview is wide-ranging including your medical background, the injury, the treatment and the problems you are experiencing. I will want to check details such as dates of clinic attendances, dates of return to work, duties and modifications in the work-place, etc. My responsibilities are often broader than is appreciated and I will be considering a number of issues including: -

• Was the injury caused by the accident described?
• Was the medical care satisfactory?
• Was the time off work reasonable?
• Are the symptoms and functional problems presented to me consistent with my clinical findings?
• How has the injury affected your ability to function at home, to work and to pursue your hobbies?
• Will it cause premature retirement?
• Do you need any further treatment to improve your outcome and scarring?
• Has the injury predisposed you to the later development of conditions such as arthritis?

The report is sent to the instructing party. In cases where I am instructed jointly or I have been instructed singly by your solicitor, it will be sent to you for comment and correction. It will not be sent to your general practitioner or treating surgeon but it can be communicated by you to your medical team at your discretion. The report can serve as a useful "second opinion".

For the consultation, you must bring some proof of identity such as passport or photo-card driving licence. Also please bring any information you may have relating to your injury (photographs, diagrams, etc.) and subsequent treatment (photographs, appointment cards for clinics and physiotherapy, splints, etc.). I may terminate the appointment if these items are in your possession but have not been presented, as preparation of a satisfactory report will not be possible.

It is your claim and it is in your interest to be as helpful as possible. I would urge you to be punctual, organised and to prepare a folder containing relevant material to be available at all meetings related to your claim. If the case is complicated, keep good records and write a chronology/diary to record events accurately and bring this to our consultation.

Solicitor

I have been involved in medico-legal practice for over twenty years and negligence work for at least ten. I have completed the Cardiff University Bond Solon (CUBS) Expert Witness Certificate. I have both lectured and published in this field.

I undertook 163 medical reports in 2015. 29 of these were negligence cases; 4 for defence, 25 for Claimant. My personal injury work is generally under joint instruction.

My turn-around time is 6-8 weeks once I have received all the notes, x-rays, etc that I require. I generally defer preparing reports without the necessary materials unless the matter is urgent and Limitation is looming. Reports are issued within 2-3 days of the examination.

Desk-top reports on liability issues prepared from the notes can be completed within about three weeks of the receipt of the notes and x-rays.

My CV and T&C are herewith provided.