Types of Injuries Archives - Louisville Accident & Injury Attorney Jim Desmond

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.

Louisville Motorcycle Accident Injuries

It can be a dangerous world on two wheels! Motorcycle accident injuries exhibit interesting patterns. The Center for Disease Control (CDC) studies over 1.2 million people who were treated in emergency rooms across the United States for non-fatal motorcycle related injuries and this is what they found. Injuries to the legs and feet account for 30% of all non-fatal motorcycle injuries. Next up were head and neck injuries accounting for 22%. Third were wounds to the chest, shoulders, and back, next were injuries to the arms and hands, and lastly were injuries to the hips and pelvis.

The Association for the Advancement of Automotive Medicine (AAAM) did a study over a four-year period in the state of Maryland where they tracked injuries related to helmet use and differences in injuries sustained by younger and older riders. This AAAM study used both hospital discharge records as well as police reports. This study broke injury locations down into nine different areas including the head, chest, abdomen, spine, neck, face, upper extremities, lower extremities, and external skin, which they ranked by severity.

In the helmet versus no helmet portion of their study, helmeted riders had a fewer severe injuries and a greater number of not as severe injuries. Their overall findings (not addressing the differences in age groups) ranked them as follows:

Lower extremities injuries highest in the 55-60% range,
Upper extremities in the 48-52% range,
Head injuries in the 25-29% range,
Face and neck injuries in the 21-25% range,
Injuries to the thorax (between the neck and abdomen including the ribs, breastbone, etc.) in the 22-28% range,
Injuries to the abdomen in the 19-20% range and finally,
Injuries to the spine 10-14%.

This correlates with the CDC findings, however this study did not take into account helmet use.

A study by the World Health Organization (WHO) studied motorcycle accident victims with their findings also correlating with both the CDC and AAAM studies. Namely, the majority of injuries occurred to the lower limbs with the tibia and fibula bones being the most commonly broken in the lower extremities with the femur being next. In the upper extremities the radius and ulna were most commonly broken followed by the humerus.

The National Highway Traffic Safety Administration (NHTSA) tracked fatal motorcycle accident data over a 3 year span showing that in all three years studied, motorcyclists not wearing a helmet had fatalities in the 50-52% range while helmeted rider fatalities ranged in all three years right at 35%.

Obviously, head injuries as a result of a motorcycle accident are lower among those riders wearing a helmet. Among both helmeted and unhelmeted riders, the leading injury accounting for motorcycle crash fatalities is a head injury.

What can we learn from this? Safety gear greatly reduces severe injuries and fatalities in the case of a motorcycle accident. One way to remember this is ATGATT which stands for All The Gear, All The Time! Enjoy your ride, but be safe and protect yourself!

Rib Fractures and Car Wrecks

The 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 1^st and 2^nd 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

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.

Category: Types of Injuries

Trauma From Car Wreck Injuries Could Trigger RSD Symptoms

Types of Sprains and Strains

Common automobile accident injuries:

Subcutaneous Hematoma:

Whiplash Injury:

Bone/Joint Injury:

Concussion:

Seatbelt Injury:

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