Attorney Jim Desmond

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Category: Types of Injuries

Reflex Sympathetic Dystrophy (RSD) Pain

Reflex Sympathetic DystrophyReflex 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.

Rib Fractures and Car Wrecks

X-Ray image of the human chestThe most common injury sustained from blunt trauma to the chest is rib fractures and account for more than half of all thoracic injuries from non-penetrating trauma.  Whereas in the elderly the most common cause of rib fractures is a fall and in youth the most common cause is recreational or athletic activities, in adults, motor vehicle accidents are the most common cause!

Fractures of the 1st and 2nd ribs are often associated with vascular injury and carry a much higher mortality rate.  X-rays are often used to diagnose rib fractures, however, sensitivity can be as low as 50%.  CT scan and MRI are much more sensitive in detecting rib fractures.

Pain control is of utmost importance in management of rib fractures in order to keep the patient breathing as deep as possible and clear pulmonary secretions (i.e., coughing).  An intact chest wall, which includes the ribs, clavicles, sternum, and scapulae, is necessary for normal respiration.  Due to the risk of pneumonia, binding the chest is no longer recommended.  Kinesiology tape has proven quite successful in stabilizing a rib fracture and reducing severe pain.

Minor rib fractures can often be controlled with narcotic pain medications while in more severe cases intercostal nerve blocks are required.  Surgery is generally only recommended when a broken rib has penetrated an internal organ or if there is a malunion of the rib when healing.

Fragments of fractured ribs can act as penetrating objects and can result in a hemothorax, which is a collection of blood in the space between the chest wall and the lung – also known as the pleural cavity or a pneumothorax, also known as a collapsed lung and occurs when air leaks into the space between the lung and the chest wall.  This collection of air on the outside of the lung pushes on the outside of the lung causing it to collapse.  Symptoms of a pneumothorax typically include sudden sharp one sided chest pain and shortness of breath.  A hemopneumothorax is a combination of both conditions.

Ribs often fracture at the point of impact or the posterolateral bend, which is the weakest spot of the rib.  In the case of first rib fractures, those which can be life threatening, the weakest point is at the groove for the subclavian artery.

In a car wreck, the mechanism for first rib injury seems to be the violent contraction of muscles caused by the sudden forward movement of the head and neck.  The prevalence of reported rib fractures (with only approximately 70% of chest injury being reported annually) is higher in countries with a higher incidence of motor vehicle accidents.  The incidence of rib fractures in children is low due to their more pliable, elastic ribs.

Rib fractures often take six weeks to heal and return to work or activities of daily living during that time depend on the activity involved and the level of pain.  Generally, when pain is not present at rest, the patient can gradually begin to increase their activities.  It is also recommended for patients to sleep in a recliner during this initial time as getting in and out of a flat bed can be extremely painful and continue to stress the fracture.

Types of Sprains and Strains

Personal Injury ClaimsHave 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 1st degree to 3rd degree.  First degree sprains are mild with little or no pain or other symptoms.  2nd degree sprains can cause pain, muscle spasm and possibly some joint instability.  3rd 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 1st degree being mild causing little pain, 2nd degree causing some pain and loss of strength, and 3rd 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

Ambulance at Emergency Room entranceInjuries 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

Symptoms of a Herniated DiscLet’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.