Personal Injury Archives

Reflex Sympathetic Dystrophy (RSD) Pain

Reflex Sympathetic Dystrophy (RSD), also referred to as Complex Regional Pain Syndrome (CRPS), is a condition that can be characterized by a variety of symptoms including pain, frequently a burning type of pain, tenderness, swelling of the area or extremity, sweating, flushing, warmth and/or coolness of the area, discoloration, and in some cases shiny skin.

How RSD develops is not well understood and some would say is unknown, however, it is believed to be caused by an irritation of nerve tissue or abnormal excitation of nerve tissue, which causes abnormal impulses along the nerves which in turn affects blood vessels and skin in the area. This seems to involve the involuntary nervous system, the peripheral nerves, and the brain. The peripheral nervous system is a network of 43 pairs of motor and sensory nerves that connect the brain and spinal cord to the entire human body.

Causes of RSD can be from a wide range of triggers including injury, surgery, shingles, heart disease, degenerative arthritis, stroke or other diseases of the brain, nerve entrapment or irritation such as in carpal tunnel syndrome, joint problems, cancer, specifically breast cancer, and certain drugs such as those used to treat tuberculosis and barbiturates, which act on the central nervous system.

Trauma From Car Wreck Injuries Could Trigger RSD Symptoms

RSD can come on suddenly or slowly over time. There are four stages of RSD/CRPS including the acute phase (stage 1), the dystrophic phase (stage 2), the atrophic phase (stage 3), and stage 4, which most patient’s never advance to and where there is involvement of the inner organs. The acute phase can last 3-6 months and often involves burning, flushing, blanching, sweating, swelling, pain, and tenderness. Patchy thinning of bone can be seen on x-ray in this stage. The dystrophic phase can also last 3-6 months and is marked by early skin changes including shiny, thickened skin and contractures (a shortening or hardening of muscles, tendons or other tissue). This stage is marked by persistent pain with a lesser degree of swelling and flushing. The atrophic phase can be longstanding and involves loss of motion and function of the involved area with contracture and thinning of the fatty layers under the skin. Often during this stage significant osteoporosis can be seen on x-ray.

Since there are few clinical tests that can detect RSD/CRPS, it is usually diagnosed based on the symptoms described above. Treatment for RSD can range from cool moist applications to the area to relieve the burning or stinging sensation. Exercise can help prevent contracture.

Medications may be helpful in reducing pain and swelling. For more persistent symptoms, cortisone (Prednisone) starting with high doses and gradually tapering may be prescribed. Medications such as amitriptyline (Elavil), which is used for nerve pain and depression, pregabalin (Lyrica) which is used to treat nerve and muscle pain, and clonidine (Catapres) which is a medication most often prescribed to treat high blood pressure, however, has shown benefits in treating CRPS involving chronic arm or leg pain developed after an injury, surgery, stroke or heart attack.

More advanced forms of treatment would include nerve blocks, implantable pain pumps, spinal cord stimulators, and even surgery to interrupted the nerves known as surgical sympathectomy.

Filing a Lawsuit Against an Uninsured Driver

I filed a lawsuit against what appears to be an uninsured driver this weekend. The Jefferson County Clerk has set it up so I can file a Complaint, the document that starts a lawsuit electronically from my computer. However, the filing fee for a lawsuit tends to cost me about $198 for each lawsuit filed with the Jefferson Circuit Court. The question is did I waste my money filing a lawsuit against an uninsured driver?

According to the Insurance Information Institute, about 11.5% of Kentucky motorists were, in violation of Kentucky, driving without insurance on their automobile. For Indiana, the rate was closer to 16.7%. https://www.iii.org/fact-statistic/facts-statistics-uninsured-motorists. So when a car accident or a motorcycle wreck occurs, one of the first questions a personal injury attorney has to deal with is whether the at-fault driver, or the vehicle they were operating, was insured.

The easiest way to find insurance coverage on an at-fault driver is hope that the police report has the proper insurance company listed. If that does not work, I will typically run the license plate of the at-fault vehicle with the Jefferson County Clerk. The Clerk can provide me with the insurance company and policy number the last time that vehicle was registered.

As a last resort, I will send the driver and owner of the at-fault vehicle a letter asking for their insurance information and threatening to file a lawsuit if they do not cooperate. The problem is filing a lawsuit against an uninsured driver may not be worth the time and expense involved.

Recall that a Judgment is really just a piece of paper that says someone owes you money. So, in essence, a Judgment against someone can be worthless if they have no assets to collect it against or if they can bankrupt that Judgment by filing Bankruptcy proceedings. So for the personal injury suits I filed, it could be that we won’t even recover the filing fee much less the value of the client’s personal injury claim. Granted, in Kentucky, K.R.S. 187.410 allows me to revoke someone’s driving privileges if the unpaid Judgment relates stems from a car wreck. However, if the at-fault driver files Bankruptcy, the suspension, and my client’s Judgment, is dissolved.

Nevertheless, I believe this instance justified a personal injury lawsuit. My injured client had an initial Emergency Room bill in excess of $19,000 and he may not have had uninsured motorist coverage either. As a result, unless I can find insurance coverage on the at-fault driver, my client really has no source to recover his pain and suffering claim from.

However, in this instance, my first goal is not to recover the value of his personal injury but rather, to keep my client from owing a large amount of medical expenses for a car wreck that was not his fault.; to do that, I’m going against the odds and hoping that filing a lawsuit against an uninsured driver will discover insurance coverage not readily apparent.

So what’s my fallback position(s) for everything? If all else fails, I will have to use health insurance to pay the medical bills. My client appears to be qualified for Medicaid after the car wreck occurred. While Medicaid will have a right to recover whatever medical expenses they pay out through what is known as subrogation claim or a right of reimbursement, they can only recover the amount that is actually paid to satisfy the $19,000 medical expense. My hope is that the amount Medicaid seeks to recover will be about one-third of the $19,000 expense. This way, I can reserve my client’s no-fault coverage of $10,000 and use that no-fault, a.k.a. as PIP coverage, to satisfy Medicaid’s subrogation claim.

Yes, in this worst-case scenario, regardless of the personal injury lawsuit, the client can not recover any more towards the value of his personal injury because the at-fault drive was uninsured and he did not purchase uninsured motorist coverage before the car wreck. However, in Kentucky, 99% of the time you are entitled to no-fault benefits of at least $10,000 as long as the car wreck happened in Kentucky and you were not driving a vehicle you owned that was uninsured.

As a result, this no-fault coverage may be the only insurance coverage that exists for this car wreck. Consequently, we have to stretch that $10,000 in no-fault coverage in every way possible so that the client, while uncompensated for his personal injury claim, will not owe medical bills for a car wreck that he did not cause.

At the end of the day, filing a lawsuit against an uninsured driver at least provides valuable information to determine my client’s best options.

Seat Belt Safety Laws

One of the leading causes of death among those between the ages of 1 and 54 in the United States is motor vehicle crashes, and one of the most effective ways to reduce injuries and save lives is the use of a seat belt.

All 50 states have some form of seat belt law, be it a primary offense in which a police officer can pull someone over for him/her or passengers not being properly restrained or a secondary offense in which an officer cannot pull someone over solely for the offense of not wearing a seat belt, however, if pulled over for another citable violation and unrestrained, the officer can issue a ticket for not wearing a seat belt.

Currently in 18 of the 50 states, the seat belt law is considered a secondary offense with the exception of Colorado, which although is a secondary offense state for adults, children not properly restrained is a primary offense with a much larger fine. New Hampshire is the only state not requiring adults to wear seat belts, however, they do have a primary child passenger safety law covering anyone under 18. All other states have a mandatory seat belt use law for drivers and front seat passengers.

We’ve all met that person who knew of someone whose life was spared because they were NOT wearing a seat belt, however, the chances of this happening is slim to say the least! One study from 2002 estimated that 4,200 lives could be saved each year if 90% of the population in the United States wore seat belts. There are rare instances when a seat belt can cause harm.

A friend of mine who is an ICU nurse even had a pediatric patient with a liver laceration following an automobile accident with a lap belt, however, this was not supported by a shoulder strap and injuries sustained from wearing a seat belt are generally surface bruises and/or abrasions and significantly far less severe than injuries that may have been sustained from not wearing a seat belt.

According to the National Highway Traffic Safety Administration (NHTSA), seat belts have saved roughly 300,000 lives in the United States since 1975.

Seat belts were invented in the mid-19^th century by an English engineer named George Cayley, however, the first U.S. patent was granted to Edward Claghorn of New York on February 10, 1885. Motor Vehicle Safety Standard enacted a federal law on January 1, 1968 that required all vehicles with the exception of buses to be fitted with seat belts in all designated seating positions. The world’s first seat belt law was in 1970 in Victoria, Australia, however, in the United States the first state to enact primary enforcement seat belt laws was New York in 1984. By July of 2010, 31 states including the District of Columbia had primary seat belt use laws while 18 states had secondary enforcement laws.

One study found that the use of seat belts in primary belt law states averaged 88% and was less in states with weaker enforcement laws. Studies have also been conducted by the Centers for Disease Control and Prevention and have found increased belt usage in primary belt law states and decreased fatalities in these states as well. Overall, serious injuries and fatalities are reduced by wearing a seat belt, and unless you are an adult in New Hampshire it is the law in one form or another so buckle up!

This article is provided by the Desmond Law Office, Louisville, Kentucky. We handle accident cases in both Kentucky and Southern Indiana.

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.

Category: Personal Injury