[Psychosomatic aspects in orthopedic legal assessment].
OBJECTIVE
Complaints in orthopaedics that are not sufficiently explainable can be caused (partly) by psychosomatic disorders. A manual psychosomatic disorders for legal assessment in orthopaedics will be supplied.


METHODS
Diagnoses essential for orthopaedics are classified by DSM-IV and ICD-10 in consideration of the current literature; evaluation was performed under legal assessment criterions.


RESULTS
The most important complaints that are often poorly explainable results in musculoskeletal pain. Since a sensorial perception of pain is combined with emotions, emotions and psychic disorders can be perceived as pain. The most important diagnoses for assessing not sufficiently explainable complaints by somatic cause are "somatoform pain disorder", "somatization disorder", "undifferentiated somatoform disorder", "conversion disorder", "hypochondriasis", "body dysmorphic disorder", "maior depression", "dysthymic disorder", "posttraumatic stress disorder", and "adjustment disorder". The relevance of psychosomatic comorbidity in legal assessment is possible in all affairs of civil and social law. Private accident insurances exclude psychic and psychosomatic diseases from all insurance benefits.


CONCLUSIONS
When composing legal assessments in orthopaedics, especially on pain, the knowledge of psychosomatic (co)morbidity is necessary for meeting the different causes of the complaints. Under awareness of possible psychosomatic disorders, additional psychosomatic legal assessments can be recommended and understood as well.
Schiltenwolf
M
M
Stiftung Orthopädische Universitätsklinik, Abteilung 1, Germany. marcus.schiltenwolf@ok.uni-heidelberg.de
D003937:Diagnosis, Differential; D005104:Expert Testimony / Q000331:legislation & jurisprudence*; D005858:Germany; D006801:Humans; D007346:Insurance, Accident / Q000331:legislation & jurisprudence; D009140:Musculoskeletal Diseases / Q000175:diagnosis* / Q000523:psychology; D010146:Pain / Q000523:psychology; D011602:Psychophysiologic Disorders / Q000175:diagnosis*; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000523:psychology