Language Matters: When Is a “Tear” not a “Tear”?

The language we use to describe various medical conditions impacts how the conditions are viewed in the medicolegal context.  Some of the common culprits include “tear,” “herniation,” and “edema.”  The everyday understanding of these words suggests to readers of medical reports that they are the result of acute injuries rather than the normal result of aging.  Take for example the word “tear,” which is frequently used to describe the condition of tendons, ligaments, and meniscuses.  To the ordinary reader, if some says that they “tore” a tendon or have a tendon “tear,” the immediate image is something akin to paper being torn.  In many tendon “tears,” nothing could be further from the truth.  Instead, many tendon “tears” are actually degenerative in nature, resulting from the normal effects of time and aging on the body.  Medical experts and claims professionals should be more precise in describing such conditions so that it is clear to the ordinary reader that the condition is degenerative rather than the result of an acute injury.

How can this be done?  A good example is found in a Wisconsin Labor and Industry Review Commission decision.  There, the Commission quoted Dr. Paul Goodman:

MRI scan reports and common medical lingo frequently utilize the words 'tear' when describing the disruption of tissues and structures found on diagnostic imaging or at times of surgery. However, for the most part such language is misleading, manipulating the mind of the reader to understand that some sort of traumatic event is responsible for the 'tear' or 'torn' rotator cuff, event in the absence of any objective evidence of trauma having occurred. In the examinee's case, although her diagnostic reports indicate such language, I find it better to use the word 'disruption' which avoids a traumatic connotation. Over time, tendon structures deteriorate, breakdown, and become disrupted as a usual and normal consequence of the aging process. This is what has occurred in the examinee's case. No injury per se is medically determined.

The proof that this careful attention to language matters:  the Commission concluded the employee’s condition was not work-related and dismissed her claim.