Expert Insight

AAA-LAW Med-Legal Post of The Week:

Neck Injury & Risk Factors Due to Rear End Collisions

POSTED: December 10, 2013 by Ash A Ashour

A recent study revealed that occupants that have their head turned during a rear end collision suffer greater injury than all other collisions. This study concluded that “Head-turned rear impact caused significantly greater injury to the cervical spine, as compared to head-forward rear and frontal impacts…” Therefore, when analyzing the injuries sustained in a rear end collision, it is important to know whether the patient/client was looking straight ahead or had their head turned at the moment of impact. A correct and detailed diagnosis of injuries is the key to adequate medical care. Similarly, a proactive knowledgeable attorney is the key to adequate compensation in the unfortunate event that you, or a loved one, suffer personal injuries.

Ash A. Ashour, Esq. of AAA-LAW concentrates his practice on fighting for victim’s rights. The law firm handles all serious injury cases, including all types of car and motorcycle accidents. We are located in Tarzana, CA. For a free consultation with an attorney call (888) FIGHT-4-0 or (888) 344-4840.

Thoracic Outlet Syndrome

POSTED: November 13, 2013 by Ash A Ashour

Overlooked & Often Misdiagnosed in Whiplash Victims. Thoracic Outlet Syndrome (TOS) is the result of pressure on a nerve bundle in the neck between the collar bone and the ribs caused by a spasm of the muscles connected to the first rib. Symptoms of TOS are weakness, tingling, numbness of the arm and portion of the hand as well as heaviness of the upper extremities and headaches. When a patient with whiplash does not respond to conventional therapy, doctors often overlook or misdiagnose the Traumatic Thoracic Outlet Syndrome as a congenital problem rather than one potentially caused by the accident. It is important to note that according to studies, there is no effective long term therapy for these patients. This gives some answers to why victims of whiplash type injuries sometimes suffer chronic, long term pain and symptoms. Auto accidents, slip and falls and other forms of trauma to the body can often cause such injuries. A correct and detailed diagnosis of injuries is the key to adequate medical care. Similarly, a proactive knowledgeable attorney is the key to adequate compensation in the unfortunate event that you, or a loved one, suffer personal injuries.

Steering Wheel Injuries

POSTED: October 21, 2013 by Ash A Ashour

To the surprise of many people, in automobile accidents, the steering wheel can be considered a “blunt instrument” that can create significant bodily injury. As any driver would agree, Steering wheels are often close to the driver’s face and chest and its unusual shape lends itself to entanglement with the fingers, hands and arm in the unfortunate event of an auto accident. The one thing in common for virtually every driver in an accident is that they are holding onto the steering wheel during the accident, leaving their face, chest, hands and wrists exposed to injury. That is why Carpal Tunnel Syndrome (CTS) has been documented to be one of the most common steering wheel injuries. Many victims of an auto accident suffer CTS when the extreme forces of the accident cause the transcarpal ligament (located in the wrint area) to overstretch and compress the median nerve. Furthermore CTS can also be caused by neck spasms causing compression and damage to the nerves traveling through the neck and to the arms. Symptoms can be instant or develop over time. Conservative care is recommended as soon as possible, often with favorable outcomes. Yet due to the fact that we are dealing with nerves, many victims are left with permanent loss of function, even if treated immediately.

In Carpal Tunnel Syndrome and Motor Vehicle Accidents, by Ames, E.L. (1996), it is concluded that “Symptoms of carpal tunnel syndrome developed in 96 patients within 2 months after an automobile accident. Forty-four (46%) of these 96 patients underwent carpal tunnel release [surgery]” (p. 223). You should always make sure you are fully aware of the extent of your injuries prior to settling your personal injury case. A correct and detailed diagnosis of injuries is the key to adequate medical care. Similarly, a proactive knowledgeable attorney is the key to adequate compensation in the unfortunate event that you, or a loved one, suffer personal injuries.

Arthritis & Accidents

POSTED: October 18, 2013 by Ash A Ashour

Often, insurance company adjusters unjustly assume that if an accident patient has pre-existing arthritis, that the ensuing bodily injury was most likely pre-existing. In fact that could not be further from the truth. As an example, if a 21-year-old healthy, strong athlete and an 85-year-old man that is riddled with arthritis are both in the same accident, who will be hurt more, the person with no arthritis or the person with a significant amount of arthritis? The answer is, the 90-year-old man with a significant amount of arthritis. Researchers have repeatedly concluded that a person with pre-existing arthritic degeneration is likely to suffer more bodily injury then a person with no arthritis. Beyond the research, common sense dictates the same. A correct and detailed diagnosis of injuries is the key to adequate medical care. Similarly, a proactive knowledgeable attorney is the key to adequate compensation in the unfortunate event that you, or a loved one, suffer personal injuries.

Strain/ Sprain & Permanency

POSTED: October 11, 2013 by Ash A Ashour

Strain/ Sprain & Permanency: Strains and sprains can be permanent. There are 3 grades of a sprain/strain injury:

Grade 1: Overstretching of the ligament that eventually resolves.

Grade 2: Partial tearing of the ligament that does not heal. The ligament repairs with internal scar tissue and leaves the joint unstable. This is a permanent change in tissue structure and can leave the joint permanently unstable.

Grade 3: This is a complete tear of the ligament and will likely require surgery. This type of injury leaves the joint so unstable that over time, the joint will fill with adhesions. This too is permanent.

Doctors are not given the choice of choosing which type of strain/sprain to place in their diagnosis coding. Many people, specially insurance company adjusters automatically assume that a sprain/strain injury is a grade 1 and is not permanent. That is why it is always important to ask your doctor to clarify which grade the injury is, and if it is a permanent condition or not. These types of injuries can happen in any joint of the body including the spine and all extremities. Auto accidents, slip and falls and other forms of trauma to the body often caused such injuries. A correct and detailed diagnosis of injuries is the key to adequate medical care. Similarly, a proactive knowledgeable attorney is the key to adequate compensation in the unfortunate event that you, or a loved one, suffer personal injuries.

Recurrent Meningeal Nerve

POSTED: October 4, 2013 by Ash A Ashour

Recurrent Meningeal Nerve is a branch of the spinal nerve. It supplies many areas, one being the outer parts of the disc. These nerve fibers are sensory and carry pain signals to the brain when the tissue is damaged. A herniated disc can only be caused by trauma, but in many cases the individual is in pain without the disc compressing the spinal cord or spinal nerve root at all. In such a case a defending insurance company will almost always argue that the patient is fabricating the pain and that there is no pain attached to the disc herniation. Where is the pain coming from? The answer is disco-genic pain. The disc itself has pain fibers, (the Recurrent Meningeal Nerve) and if the disc is torn (herniated), then the disc itself, is what is causing the pain. This answers many questions raised regarding the fact that pain is reported by the patient even though testing reveals that the disc is not compressing the spinal cord or spinal nerves. A correct and early diagnosis of injuries is the key to adequate medical care. Similarly, a proactive knowledgeable attorney is the key to adequate compensation in the unfortunate event that you, or a loved one, suffer personal injuries.

Whiplash

POSTED: September 26, 2013 by Ash A Ashour

Whiplash: Also known as Cervical Acceleration-Deceleration Injury. Whiplash is a common injury in rear end auto accidents. In a rear-end collision, the skulls of the occupants first motion is up. This is called the ramping effect and is due to the spine pushing against the seat, flattening the spinal curve. This sudden and forceful upward motion, in many cases, causes the head to rise above safe levels of the head-rest. The neck-head forcefully extends past its normal limits, often tearing ligaments and damaging discs. The skull then “whips” forward, while the brain is still going backwards, and the brain hits the back of the skull. This can cause concussions, bleeding in the brain, or hematoma. The neck-head then goes past its normal forward limits, tears ligaments and discs (herniations), then “whips” back once more, with the brain hitting the front of the skull. The damage caused to the brain is called a “Coup-Contrecoup Injury,” and can cause bleeding in the brain. The whiplash mechanism, which is often taken lightly, usually causes serious pathology, such as herniations, bleeding and tearing of tissue, which may be permanent conditions. Contrary to the claims of the auto insurance industry, studies have shown that whiplash injuries are much more serious than most think and can even be caused from a single vehicle, little visible damage, accident. That is why after an accident it is important to get the medical care and legal advice you need to protect your health and your rights. A correct and early diagnosis of injuries is the key to adequate medical care. Similarly, a proactive knowledgeable attorney is the key to adequate compensation in the unfortunate event that you, or a loved one, suffer personal injuries.

Myelopathy

POSTED: September 17, 2013 by Ash A Ashour

Myelopathy: Neurological deficits as a result of a disc herniation is called a myelopathy. A myelopathic finding is one of the most significant injuries to the spinal cord. Such a diagnosis usually resulting in an immediate surgical recommendation as often surgery is the only solution to the injury. For the diagnosis to be Myelopathy, the neurological deficit and disc herniation must be “distal” to the level of lesion means that if the herniation is in the neck, the affected area must be below the herniation (e.g. arm and/or leg) however, if the herniation is in the mid to lower back, the problem in the arms cannot be from a myelopathy because the symptoms are above the problem area. A diagnosis of Myelopathy can never happen in the lumbar spine because there is no spinal cord in the lumbar region and therefore there can be no disk herniation distal to the level of the lesion. A correct and early diagnosis of injuries is the key to adequate medical care. Similarly, a proactive knowledgeable attorney is the key to adequate compensation in the unfortunate event that you, or a loved one, suffer personal injuries.

Spinal Cord Compression vs. Spinal Cord Abutment

POSTED: September 11, 2013 by Ash A Ashour

Spinal cord compression vs. spinal cord abutment: When a Space Occupying Lesion (something that does not belong in the space, i.e., splinter, bullet or tumor), in the form of a herniated disc goes beyond the borders of the disc/vertebrate into the spinal canal, it can touch and/or push the spinal cord. If it pushes the spinal cord against the back of the spinal canal with pressure both in front and back of the spinal cord, there is a cord compression. When the herniated disc simply touches, or is against the spinal cord leaving space behind the spinal cord, there is a cord abutment. The difference is dramatic in symptomatology and necessity for treatment. If there is cord compression, the condition is much more serious, often necessitating surgery. A correct and early diagnosis of injuries is the key to adequate medical care and a proactive knowledgeable attorney is the key to adequate compensation in the unfortunate event that you, or a loved one, suffer personal injuries.

Directional Disc Displacements

POSTED: September 3, 2013 by Ash A Ashour

Directional Disc Displacements: When a disc is damaged through external trauma causing internal derangement, it first tears the annular (outer) fibers. As a result, the disarrangement of the disk is focal or directional, and this is indicative of trauma rather than degeneration. When a disc degenerates, it does so circumferentially, or over a region of the disc. Therefore, when you see a medical report and there is a disc pathology associated with a directional displacement (i.e. lateral or anterior), then it is a herniation and according to medical literature it is secondary to trauma rather than degenerative disc disease.

Carpal Tunnel Syndrome

POSTED: August 27, 2013 by Ash A Ashour

Carpal Tunnel Syndrome (CTS): Pressure on the median nerve causing numbness, tingling and loss of motor function (power) in the thumb, forefinger and middle finger over time. There are many cause for CTS, however, trauma can play a major role. In a traumatic event, such as an auto accident or a fall, where the body is exposed to harsh yanking and pulling motions, the transcarpal ligament can overstretch and compresses the median nerve. Symptoms can be instant or develop over time. Furthermore CTS can also be caused by neck spasms causing compression and damage to the nerves traveling through the neck and to the arms. The damaged and inflamed nerves cause a loss of flexibility and strength, tightness of the muscles, as well as general discomfort and pain in the arms. In such a situation, a clinical evaluation correlated with an EMG/NCV is the most accurate tools to differentially diagnose carpel tunnel syndrome. This is because in the EMG/NCV, the patient does not actively participate, making the results objective and highly accurate. While some minor cases of CTS will heal on their own, if caused by trauma, therapy or surgery are required, as this problem is usually progressive over time and can result in further damage to the nerves if not treated.

Disc Protrusion

POSTED: August 21, 2013 by Ash A Ashour

Disc protrusion- a generic term for a disc disorder in which the disc sticks out past the margin of the vertebral endplates. The term encompasses both disc herniation and disc bulging and is often used when the data from the imaging studies is insufficient to discriminate between an actual herniated, and a mere bulging, disc. This is when using a low resolution MRI machine can prove to be a costly mistake as the patient will likely need to redo the expensive MRI study with a stronger machine in order to get an accurate diagnosis. A good personal injury attorney will always recommend an MRI center with a high resolution and up to date machine in order to avoid such a problem.

Stenosis

POSTED: August 16, 2013 by Ash A Ashour

Stenosis- Is the constriction or narrowing of the spinal canal when a disc herniates and causes the canal to become smaller. Stenosis can also be caused genetically. In congenital stenosis, there is already a narrowing of the spinal canal and any disc bulges or disk herniation in that area will have a greater detrimental effect because of the lack of room in the spinal canal. In this instance, the preexisting congenital problem has predisposed the client to greater bodily damage in the event of trauma such as an auto accident. Congenital Stenosis can also often explain why two people, who were in the very same accident, can have such dramatically different levels of injury and pain.

Disc Herniation

POSTED: August 8, 2013 by Ash A Ashour

Disc Herniation – The condition is widely referred to as a slipped disc, but this term is not medically accurate as the spinal discs are firmly attached between the vertebrae and cannot "slip". A disc herniation occurs when the inside of the intervertebral disc (nucleus pulpous) tears its way through the outer portion of the disc (annulus fibrosis) and into the space where the delicate neural structures reside, causing disruption of the neural functions and pain. While Degenerative disk disease may play a role, disc herniation can only be caused from trauma. Auto accidents and slip and falls can, and often do, cause disc herniations. Anti-inflammatory treatments for pain associated with disc herniation, can be effective, however severe herniations may not heal of their own accord and may require surgical intervention.

Spondylolysis

POSTED: July 31, 2013 by Ash A Ashour

Spondylolysis – This is a medical term used to describe the presence of a “defect” or fracture in the posterior arch of the vertebra (spine). Spondylolysis is not a congenital (inherited) condition and has never been identified in a new born infant or a child who has not started to walk. This condition is solely caused by trauma to the spine. That is why there is an increased incidence in people who take part in certain physical, sporting activities or are involved in a traumatic accident such as an auto accident or a slip and falls. X-rays and bone scans after a traumatic accident can conclusively diagnose Spondylolysis. That is why it is important to seek medical aid immediately after a severe accident.