To investigate the diagnostic properties of magnetic resonance imaging (MRI) scans in detecting surgically verified disruptions of the cervical intervertebral disc and anterior (ALL) and posterior longitudinal (PLL) ligaments.

Data were extracted from the reports of cervical spine MRI scans of patients who subsequently underwent surgical stabilization for presumed instability following disco-ligamentous injuries of the cervical spine. The level and severity of disc, ALL and PLL disruption was compared with surgical findings. Unweighted kappa statistics were used to assess agreement. The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated after findings where dichotomised into complete rupture, yes/no. Sensitivity analyses were performed to account for missing data.

The MRI and surgical findings were compared on 31 consecutive patients. The kappa values for intervertebral disc disruption, ALL and PLL disruption were 0.22, 0.25 and 0.31 respectively, indicating fair agreement. Sensitivity, specificity, PPV and NPV are shown in Table 1. The false negative rates for diagnosing complete disruption of the disc, ALL and PLL were 0.18, 0.40 and 0.14 respectively.

The ability of cervical MRI scans to detect surgically verified disruptions of the intervertebral disc, ALL and PLL varied depending on the structure examined. In this series, the cervical MRI scan reliably detected disruption of the intervertebral disc disruption and ALL. The false negative rates are of concern and indicate the need for additional investigations to exclude instability in the absence of negative MRI findings.

The aim was to investigate the outcomes of patients admitted with orthopaedic injuries to adult Level 1 trauma centres.

All patients admitted to the two Level 1 adult trauma centres in Victoria, Australia were registered by the Victorian Orthopaedic Trauma Outcome Registry (VOTOR). Baseline data collected included age, gender and injury cause, diagnosis and management. Patients were contacted 6 months after their trauma. Pain, disability, health related quality of life and work status were determined using visual analogues scales, global disability scales, SF12 and the work subscale of the Sickness Impact Profile. Patients were categorized into 3 groups: isolated orthopaedic injury alone, multiple orthopaedic injuries alone and orthopaedic injuries and other injuries. Non-parametric tests were used to compare outcomes across these groups.

Six month outcomes were determined in 75.6% of 1181 eligible patients. The patients lost to follow-up were more likely to be male, younger and have isolated injuries than those who were available for follow-up. Patients reported ongoing pain (moderate-severe pain 37.2%), disability (79.5%) and inability to return to work (35.2%). Poorer outcomes were evident in those who had other injuries than those with isolated or multiple orthopaedic injuries alone.

A large proportion of patients presenting to adult Level 1 trauma centres have ongoing pain and disability and a reduced capacity to work 6 months after orthopaedic injuries. Further research into the long-term outcomes of these patients is required to identify patient sub-groups and specific injuries and treatments that result in high morbidity.

Although the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was designed, and has been validated, as a measure of disability in patients with disorders of the upper limb, the influence of those of the lower limb on disability as measured by the DASH score has not been assessed. The aim of this study was to investigate whether it exclusively measures disability associated with injuries to the upper limb. The Short Musculoskeletal Functional Assessment, a general musculoskeletal assessment instrument, was also completed by participants. Disability was compared in 206 participants, 84 with an injury to the upper limb, 73 with injury to the lower limb and 49 controls.

We found that the DASH score also measured disability in patients with injuries to the lower limb. Care must therefore be taken when attributing disability measured by the DASH score to injuries of the upper limb when problems are also present in the lower limb. Its inability to discriminate clearly between disability due to problems at these separate sites must be taken into account when using this instrument in clinical practice or research.

Science is an endeavour built on facts. Scientific methods discover facts, which have force because they are believed to be directly observable and exist independently of theory. Facts so discovered, constitute the solid and reliable foundations of scientific knowledge. Science is objective and rational because it predicts and explains outcomes that are valid and reliable. Applying scientific methods to medical practice is therefore thought to protect medical decision making from arbitrariness, bias, and error.

Pain presents a particular challenge to physicians seeking to base their practice on science. Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. It is defined as subjective, because it is an internal phenomenon, not directly observable. It represents a quality, not a fact.

Tensions arise when scientific methods attempt to include subjective experiences within its objective framework. These tensions however, must be resolved if subjective phenomena, such as pain, are to be treated in a reliable and rational manner.

This paper presents a philosophical exploration of the tensions inherent in the study of subjective phenomena, such as pain, within an objective framework, based on contemporary models of rationality.