1. The Relationship Between Age And Injury No Tougher Job In All Of Medicine

2. Causality- Bite of The Apple Pre-existing Conditions Mechanism of Injury Appropriateness of Treatment Timing of Treatment Surgery and Specific Procedure Functional Level Interpersonal, Family Objects Short vs. Long-term work status The New World Of Pain & Medicine Compassion vs. Objectivity Is The Case Ever Closed? Synthesize Diverse Circumstances

3. Concepts of Determining Old vs. New Injury Pre –Existing Conditions In The Symptom Free Population Soft Tissue vs. Bone Abnormalities Mechanism Of Injury in Relationship to Pre-Existing Condition Spine Knee Shoulder

5. History- Most Important Condition,ER Records, Initial Report of injury, Family Doctor Records Technical Aspects- Old Varsity High School Foot Ball Injury Examination- Knee Varus Deformity X-ray Changes - Bone Spurs of Osteophyte Take 3-5 Years to Form. Importance of Multiple Views e.g. Weight Bearing X-rays of Knees MRI- Mass Soft Tissue Changes a Water Content Primarily e.g. Desiccated Disc, Shoulder Bursitis or Knee Effusion. Continuity of Soft Tissue Structures, Complete Rotator Cuff Tear. EMG- Best For Entrapment Syndrome e.g. CTS Not As Valuable For Spine. Can Determine Recent vs. Old Injury. C Spine vs. CTS Bone Scan- Will Show Joint Replacement Loosening After 1-2 Years. Nonunion After 4-5 Years.

6. Weight Bearing vs. New Weight Bearing Knee X-ray

7. MRI Lumbar spine showing desiccated & herniated disc

8. Hyaline Cartilage Bone Cartilage Covering End of Every Bone, Including Facet Joint of Spine Low Metabolic, Highly Durable, and Resilient Cannot Repair Itself Except With Scar. Once Per Joint Per Lifetime Hyaline Cartilage Only Repairs With Fibrous Tissue of Fibrocartilage.

9. Annual Correlation is Paramount, in Addition to Prior Trauma are Prior Conditions That could be Congenital, Developmental Arthritis (DJD vs. Inflammation), Postoperative Infections, Disc Space, Metabolic Gout. Weight Bearing vs. Non Weight Bearing Joints Shoulder Rotator Cuff Tears. McNoal- 50% Tears on Arthroscopy in Symptom Free Workers Spine- BOOS – 63% Herniated Disc Abnormalities are Pain Free Heavy Workers at Risk Group Knee- The Future Challenge. “ The Back of This Decade.” 50% over 50 Years Old DJD, The Population Works to Older Age.

10. Soft Tissue vs. Bone/Joint Abnormalities Mechanism Of Injury Fall On Out Stretched Hard Distal Radius, Radial Head, Rotator Cuff Foraminal Knee Injury vs. Knee of Dashboard Impact Lifting Injury vs. Acceleration/ Deceleration Spine Repetitive Injuries Defined CTS and Rotator Cuff

11. Causality- Bite of The Apple Use All Tools To Determine Pre-Existing Conditions Comprehensive Statistics of Symptom Free Radiologic Findings Clinical Correlation, Final Determination of Relative Causality and Injury Treatment Specific Challenges For Spine, Shoulder, & Knee You Are The Gate Keepers For a Major Segment of American Medicine

12. ENJOY THE BOARDWALK!! Thank You!