Archives for 2017

PTSD After a Serious Car Wreck

What is Posttraumatic Stress Disorder (PTSD)? After someone goes through a traumatic event or life threatening situation it is not uncommon for that person to experience anxiety, flashbacks of the event, nightmares, increased jumpiness, etc. This has often been associated with war veterans or persons who have been physically or sexually assaulted, however, it’s also possible someone to experience PTSD after a serious car wreck, as well. If the symptoms last longer than three months, create great stress, and disrupt work or home life it is important that person seek help.

Due to the high volume of commuter and personal travel in the United States there is increased incidence of personal injury and even fatalities. “In any given year, approximately 1% of the U.S. population will be injured in motor vehicle accidents (MVA). Thus, MVA’s account for over three million injuries annually and are one of the most common traumas individuals experience.” [U.S. Department of Veteran Affairs; National Center for P.T.S.D.]

Although not everyone involved in a car wreck will develop mental health problems, those that due generally experience PTSD, major depression and anxiety disorders. This may range from anxiety when driving to an outright fear of driving. On study reported that 15% of serious car wreck survivors reported a phobia of driving.

The risk factors for developing PTSD after a serious car wreck can be broken down into 3 sets of variables. Basically, pre-accident variables, accident related variables, and post-accident variables.

Pre-accident variables would include things like the person having had a poor ability to cope with stressful or traumatic events previously, pre-accident mental health issues such as depression, and a poor social support system.
Accident related variables would include things like the amount of physical injury, the potentially life threatening injuries, and the loss of significant others in the accident. As the amount of injury and fear of dying increase, the change of developing PTSD also increases.
Finally, post-accident variables that can be predictive of the development of PTSD following a serious car wreck may include the rate of physical recovery from injury, the amount of social support the person has from friends and family as well as the level of active re-engagement with both work and social activities. Survivors of an automobile accident should be encouraged to maintain as much of their pre-accident lifestyle to the extent that their physical injuries and/or limitations will allow. This coping strategy along with as much support from friends and family as possible tends to lead to positive outcomes.

What kind of treatment is there for PTSD after a serious car wreck?

One thing different about automobile accident-related PTSD that is different from PTSD caused by other traumas is the increased chance of developing a chronic pain condition. Common treatments may include behavior therapy, cognitive therapy, and medications. Working with a chronic pain specialist is often useful in helping the person manage the physical pain caused by the accident. Whether one treatment is used or a combination of treatments are used, it is best to recognize symptoms early on and get help!

Types of Sprains and Strains

Have you been in an car accident? Are you experiencing neck or back pain? Maybe you’ve been diagnosed with a cervical, thoracic or lumbar strain/sprain. What is the difference between the types of sprains and strains?

A sprain is a stretching or tearing of the ligaments in the area. Ligaments are the tough bands of fibrous tissue that connect two bones together in your joints. The most common location for a sprain is the ankle. A strain is the stretching or tearing or muscle or tendon. A tendon is the fibrous cord of tissue that connects muscles to bones. Both sprains and strains are soft tissue injuries. Confusing, huh?

A cervical spine or neck is the most mobile segment of the spine. This mobility makes it susceptible to strain or injury. This injury is often referred to as whiplash. Although similar a cervical sprain is different than a cervical strain. A cervical sprain is caused by tearing, twisting or stretching of the ligaments while a cervical strain is caused by damage to the muscles or tendons. Symptoms of whiplash can be hard to ignore. These may include pain, decreased range of motion of the neck and tightness in the neck. You will likely have pain or tenderness when you turn your head to look over your shoulder, and headaches are common that begin at the base of the skull and radiate toward the forehead, regardless of the types of sprains and strains.

A thoracic spine refers to the upper and middle parts of the back. It connects with the cervical spine and extends down about five inches past the bottom of the shoulder blades where it connects with the lumbar spine or lower back. The lumbar spine has 5 intervertebral (between the vertebrae) segments labeled 1 through 5. The vertebrae are the small bones forming the backbone. Thoracic and lumbar sprains and strains cause pain and spasm in the area and it is often difficult to bend or twist.

Types of Sprains and Strains

Treatment for all three of these sprains/strains is relatively similar and depends on the severity of the injury. Most soft tissue injuries are graded on a scale from 1^st degree to 3^rd degree. First degree sprains are mild with little or no pain or other symptoms. 2^nd degree sprains can cause pain, muscle spasm and possibly some joint instability. 3^rd degree sprains usually result from a complete tear or the ligament producing severe pain and joint stability.

Strains are graded in the same fashion with a 1^st degree being mild causing little pain, 2^nd degree causing some pain and loss of strength, and 3^rd degree involving complete tears of the muscles and tendons with complete loss of muscle function. In addition to pain, instability and weakness there may also be tenderness and swelling.

Treatment for all of the above generally includes decreased activity, ice for the first 48 hours and then heat thereafter, used of non-steroidal anti-inflammatory medications, and pain relievers. Physical therapy may be recommended with targeted exercises to strengthen the back. Although limited activity is recommended initially it should NOT be prolonged!

Common Automobile Accident Injuries

Injuries sustained in an automobile accident depend on direction of travel, speed of travel, and collisions. Generally, if a vehicle is hit from behind the chances of severe damage or injury is less likely, however, a client of mine was recently hit so hard from behind her car was written off as a total loss, she suffered a closed head injury from her head hitting the steering wheel (while restrained), and cervical and thoracic strain from the impact. Car accidents involving a head-on collision at a high speed are often fatal. Car accidents involving side impact often result in moderate impact and destruction of the vehicle. Intensity of injuries depends on use of seat belts and injuries to vital organs. Life threatening injuries are often seen following injuries of the head, neck, chest, and abdomen. Injuries can range from mild to severe.

Common automobile accident injuries:

Subcutaneous Hematoma:

A hematoma is a collection of blood within the subcutaneous tissue. This may occur from a tear of blood vessels in the skin, subcutaneous tissue or muscle. Further investigation is necessary to rule-out internal tissue damage like a fracture, dislocation or a visceral tear (internal organ), which often depends on the area of the body and the size of the hematoma. If the hematoma is over 2-4 inches in diameter, further investigation in an emergency room should be done.

Whiplash Injury:

The neck is the most vulnerable anatomical part of the body, and whiplash can occur with head-on, side or rear impact collisions causing hyperflexion of the neck. Whiplash can also be used to describe lower body injuries depending on the impact and the position of the body at the time of the accident as well as the site of the injury. Whiplash injury can cause muscle tears, joint injury, joint dislocation, ligament injury and tears to viscera (internal organs) and/or blood vessels.

Bone/Joint Injury:

Blunt injury at the time of impact may cause bone or joint fracture or dislocation, which can also lead to tears in the ligaments or joint capsule (sprain) or tear of the muscles or tendons (strain) leading to further investigation such as x-rays or MRI. Bone and joint injuries can including skeletal injuries of the spine leading to pain in the neck, back, extremities ranging from mild to severe and possibly even cause disc bulge or herniated disc. Skeletal injury of the chest wall may result in multiple rib fractures, which could lead to a pneumothorax (collapsed lung).

Concussion:

Impact of the head or neck can cause can cause mild traumatic brain injury (MTBI) also referred to as a concussion. This can lead to headaches, dizziness, confusion, and vertigo (a sensation of spinning). Further investigation with a CT scan of the head is recommended to rule out further damage. A severe blow to the head can cause bleeding in the brain, which can be life threatening.

Seatbelt Injury:

While seatbelts can prevent injury, they can also cause injury. This is actually one of the most common automobile accident injuries. Mild injuries would include bruising or abrasion either across the chest or across the abdomen whereas moderate and severe injuries could include fractured ribs and resulting lung injury from the shoulder strap and injury to internal organs from the lap belt.

If you’re involved in a wreck, you may have suffered from one or more of these common automobile accident injuries. For more information on other types of injuries, please see some of the other blog posts by the Desmond Law Office.

Symptoms of a Herniated Disc – Part 2

Let’s take a closer look at possible symptoms of a herniated disc. In some cases a herniated disc will cause no symptoms and in other cases the condition can create localized pain if the tear affects the small nerves located in the uppermost layers of the outer wall of the affected disc. Additional symptoms can develop if the disc wall or escaped nucleus pulposus (the jelly like center) exerts pressure on the spinal cord or a spinal nerve root. Some people may experience neck or back pain, radiating pain that travels down the arms or legs, muscle weakness, numbness or walking difficulties.

A herniated disc can occur in the cervical (neck region), thoracic (mid back region) or lumbar (lower back) region of the spine, although it is most likely to develop in the cervical and lumbar spine segments. That’s because the neck and lower back are both highly flexible and responsible for supporting significant body weight, which takes its toll over time. The thoracic spine, by comparison, is far more stable because it is attached to the rib cage and doesn’t have the same mobility nor does it support the same weight load.

The specific symptoms associated with a herniated disc also depend on the location of the disc degeneration. Most commonly, this condition is associated with localized pain near the origin of the tear in the disc wall, although symptoms can also extend throughout the body when the extruded disc material irritates a nearby nerve root or the spinal cord.

In fact, when nerve root or spinal cord compression occurs, it can result in symptoms that appear far from the origin of the problem, making at-home diagnosis difficult if not impossible.

Here are just a few examples of the symptoms that can develop as a result of a herniated disc:

Cervical herniated disc — localized pain in the neck; a sensation of pins and needles, muscle weakness and numbness that permeate through the shoulders, arms, hands or fingers; difficulty walking; a feeling of heaviness in the hands or feet; a decline in fine motor skills

Thoracic herniated disc — upper back pain that can radiate into the chest or stomach; back stiffness and muscle weakness; symptoms caused by a herniated disc in the thoracic spine that can also be incorrectly attributed to a problem with the heart, gastrointestinal tract or lungs

Lumbar herniated disc — discomfort in the lower back; pain that travels into the lower body; pain in one or both legs; weakness or tingling in the lower extremities; diminished reflexes and muscle spasms; in rare cases a loss of bowel or bladder control, which can indicate a serious neurological condition called cauda equina syndrome (CES), a rare but serious condition of extreme pressure and swelling on the nerves at the end of the spinal cord. This condition requires immediate medical attention.

The symptoms of a herniated disc can vary widely depending on both the location and severity of the damaged disc, and many of the symptoms commonly associated with this condition can also be explained by the presence of additional spinal degeneration, including facet disease (spinal osteoarthritis – degenerative arthritis that affects the facet joints), spinal stenosis (narrowing of the spaces within your spine), and spondylolisthesis (a condition in which one vertebrae slides forward over the bone below it). In order to effectively manage the symptoms of a herniated disc, the exact cause, location and severity of the condition has to be identified by a medical professional.

If you’d like more information about a herniated disc, please read our previous post.

What is a Herniated Disc – Part 1

The spine is made up of individual bones (vertebrae) and discs, which are rubbery cushions between the vertebrae. These discs are like a jelly doughnut with a softer center encased in a tougher exterior. A herniated disc (also known as a slipped disc torn disc or a ruptured disc) occurs when some of the softer “jelly” pushes out through a tear in the tougher exterior.

A herniated disc can irritate nearby nerves resulting in pain, numbness or weakness in the arms or legs. In some cases, people experience no symptoms from a herniated disc. Most cases do not require surgery to correct the problem.

It is important to understand the cause of the disc herniation in determining the best treatment options for the condition. For example, a doctor may recommend a different form of treatment for a herniated disc that developed gradually from weight gain as opposed to a herniated disc that developed suddenly from an auto accident.

Let’s back up a minute. The spinal column begins at the base of the skull and spans from the cervical spine in the neck through the thoracic spine in the middle back and into the lumbar spine in the lower back. There are 24 individual vertebral bodies and several fused vertebrae in the pelvic region. The spinal column is flexible enough to allow for the full range of motion in the neck and back that’s required for daily activity and strong enough to support the weight of the upper body.

Discs serve as shock-absorbing cushions for the spine. They are positioned between adjacent vertebrae to facilitate movement and reduce friction. Each disc has two parts (1) a thick exterior composed of collagen fiber (annulus fibrosus). This surrounds and contains (2) an inner core of protein gel (nucleus pulposus). These components are high in water content and must remain well hydrated and pliable in order to function properly.

For a variety of reasons, the discs can begin to deteriorate and dehydrate over time, becoming brittle and prone to breakage. If a fissure develops in a disc’s annulus fibrosus, some of the nucleus pulposus can pass through its compromised boundary. This condition is referred to as a herniated disc. Pain and other uncomfortable symptoms can develop if displaced inner disc material, which contains inflammatory proteins, irritates or pressures the disc wall, the spinal cord or a nearby nerve root.

A herniated disc can result from a number of factors, including:

The natural aging process – due to the cumulative effects of an aging body and ongoing wear and tear on the spinal components, the discs gradually weaken and become more susceptible to rupture.
Spinal trauma – injuries that results from a forceful blow to the spine can cause immediate disc herniation.
Repetitive stress – sitting for prolonged periods or repeatedly lifting heavy objects can cause a series of small tears to develop in the disc’s outer wall, tears that can worsen over time and lead to full disc herniation.
Unhealthy body weight – the spine must support the majority of the body’s weight, and the pressure of carrying extra pounds, particularly in the abdominal region, can strain and damage the spinal components.
Poor nutrition – an unbalanced diet can lead to weight gain and also deprive the discs of the nutrients needed to remain supple and strong.
Tobacco use – smoking inhibits circulation and interferes with the delivery of essential nutrients throughout the body, including the spine. Cigarette smoke also contains a multitude of toxins that can affect the discs as well as other parts of the body.
Genetics – a family history of disc herniation and other degenerative spine conditions can increase the likelihood an individual will develop similar conditions.

Look for more about this topic in an upcoming post from the Desmond Law Office.

Year: 2017

Archives for 2017

What kind of treatment is there for PTSD after a serious car wreck?

Types of Sprains and Strains

Common automobile accident injuries:

Subcutaneous Hematoma:

Whiplash Injury:

Bone/Joint Injury:

Concussion:

Seatbelt Injury: