A good share of the Journal's readers were not starting from zero. The knee had arthritis before anyone rear-ended them on Lindbergh. The shoulder was the one they hurt playing softball in their twenties. The hip already complained on cold mornings. After a crash, those readers tend to talk themselves out of an exam with one sentence: it was already bad, so this is probably just that.
Maybe. Maybe not. The only way to know is to have the joint examined by someone who hears the whole history, and the history is exactly the part readers are tempted to leave out.
Why the old story belongs in the new record
Osteoarthritis, which the National Institute of Arthritis and Musculoskeletal and Skin Diseases describes on its site, is common, and so are old ligament and tendon injuries. A joint with a history is still a joint that can be strained, bruised, or sprained in a crash, and it is still a joint whose plan depends on an honest starting point.
An examiner who does not know about the old knee cannot tell what is new. An examiner who does know can compare, ask sharper questions, and write a record that says what was there before and what appears to have changed since the crash. That record is a care document first. It works only when it is complete.
Leaving out the history does not make anything simpler. It makes the record wrong, and a wrong record is no use to anyone, least of all the person whose joint it describes.
Describe the joint as it was last month
The most useful thing you can bring is a picture of the joint before the crash. Not a medical history, just a plain account of an ordinary week:
- What the joint could do: "I walked the dog two miles most mornings." "I carried the laundry basket up the stairs." "I played nine holes on Saturdays."
- What it complained about: "Stiff for ten minutes after I got up." "Sore after mowing, fine the next day."
- What you did for it: the brace in the closet, the physical therapy two years ago, the surgery, the stretching routine.
- Who has seen it: a primary care doctor, an orthopedic office, a previous therapist, and roughly when.
Readers sometimes have better evidence of last month than they realize. A step counter on the phone shows how far you walked the week before the crash. A calendar shows the pickleball games and the yard work. Photos from a hike or a ballgame show what a normal Saturday looked like. None of it needs to be presented as proof of anything. It simply helps you remember accurately.
Then describe what changed
This is the part of the history only you can supply. Readers who had a joint problem before a crash tend to describe the change in a few recognizable ways:
- A new location. The knee always hurt on the inside. Now it hurts at the back.
- A new time of day. It used to be stiff in the morning. Now it wakes you at night.
- A new limit. The two-mile walk is now half a mile. The stairs now need the rail.
- A new sign. Swelling, bruising, a click, a catch, or a give-way that was never part of the old pattern.
- No change at all. That is a real answer too, and worth saying.
Keep the two lists separate when you talk. "Before the crash" and "since the crash" is a structure any examiner can follow, and it keeps the two from blending together in a week when everything hurts.
What not to do
Do not shrink the old problem, and do not enlarge the new one. The Journal says it this way because both temptations are real. A reader worried about being dismissed tends to leave out the arthritis; a reader in a bad week tends to describe everything as new. Neither helps the joint. An exact account does.
Do not wait for the joint to settle back to its usual. A joint with a history can take longer to show what a crash did, and the useful moment to measure it is the first week, not the second month. Entry 07 is the Journal's full entry on why the date on that first exam matters.
The bright line
A history does not change the emergency rules. Chest pain, a sudden severe headache, weakness or numbness on one side, trouble speaking, a loss of bowel or bladder control, or a head injury with vomiting or worsening confusion is an emergency room trip right now, not a call to a clinic. A joint you cannot bear weight on, or one that looks out of position, needs same-day imaging.
The standing prescription
Bring both lists to an exam this week. Missouri Injury Clinic publishes its auto injury lane as diagnosis and a treatment plan after a crash, and an honest before-and-after history is where that diagnosis starts. The nearest office for this edition is Tesson Ferry, at 11144 Tesson Ferry Road, Suite 200, (314) 530-5480, open Monday through Thursday 9am to 6pm and Friday 9am to 12pm, closed from 12 to 2 daily. Asked at the desk has more of the questions readers bring.