Burn Injuries

At Parker & Lazzara, PLLC, we know burn injuries. We recognize that burn injury victims will often suffer physical disfigurement and severe pain for the rest of their lives. As a result, our Arizona burn injury lawyers fight relentlessly on behalf of injured victims and work hard to ensure they recover the full amount of compensation they are entitled to.

 

When skin is badly burned, patients will experienced nerve damage, which is associated with excruciating pain. At Parker & Lazzara, we recognize such injuries are catastrophic and can dramatically affect our clients’ lives forever.

 

If you or someone you love has been a victim of a serious burn injury, you deserve to have the best legal representation possible. To speak with an attorney who will fight aggressively to ensure you are compensated for your physical, emotional and financial losses, contact  Parker & Lazzara today.

Injuries from Low Impact

injuries-from-low-impact-accident

How Low Speed Impacts Cause Soft Tissue Injuries…
A low impact auto accident is usually defined as an incident that takes place at speeds less than 10 miles per hour (mph). This type of collision usually causes the least amount of demolish to the vehicles involved. Body injuries can result from any accident & that includes ones that occur with vehicles going less than 10 mph. Soft tissue injuries are the most common issue for those involved in a low impact accident.

A motor vehicle accident that takes place at speeds between under 10 mph often brings about miniscule visible demolish to the cars involved. Sometimes due to the fact that minimal demolish was finished to vehicle the injuries to the people in the vehicles are overlooked. This does not mean that bodily injury did not occur to the passengers in the course of the crash.

A contusion is an injury to the soft tissue caused by blunt force. This force produces pooling of blood around the injury causing discoloring of the skin. This is usually is often called a bruise. Bruising can be present in different shapes & colors.
A sprain is an injury to a ligament often brought about by a wrench or twist. A sprain can be a simple sprain, a partial tear or a complete tear. This can happen to various parts of a person’s body during an accident. It is not unusual for a person to twist in their seat as a vehicle strikes theirs in the course of the incident.

While an automobile is built to take a slow 5 to 10 mph crash that is not necessarily true for your body. In a low impact accident a person’s soft tissue can be damaged.The back & neck are the usual issue spots for soft tissue injuries. Soft tissue is fundamentally a person’s ligaments, tendons & muscles. Soft tissue injuries are usually classified as contusions or bruises, sprains or strains.

A strain is an injury to the muscle or tendon caused by overuse, force or stretching. The force of the automobile crash can push on a person’s soft tissue or cause parts to stretch in an abnormal way.Muscles & tendons support your bones. A strain may cause a partial or complete tear in the muscle & tendon combination.

The neck of a automobile occupant can whip forward causing the most common rear impact injury known as whiplash. General Motors (GM) did a study regarding crashes at speeds below three mph. GM found, to no surprise, that injuries do occur at such low speeds. The study also showed that whiplash injuries account for over half of all injuries connected to vehicular accidents.

Although these types of injuries are characteristically classified as minor  30 percent of those hurt in low speed collisions have reported having neck pain up to five years later. This injury is likely to be worse in those that experienced a rear finish collision. Depending on the age of the person this injury could cause a permanent disability.

A motor vehicle can take the force of a low speed collision without showing much demolish due to the advances automobile manufacturers have made in the construction of their vehicles. When a collision does occur the force of the accident pushes inertia somewhere & two times the automobile has taken part of that energy away the occupants take the rest. These forces are what may cause people bodily harm even in a crash of below 10 mph.Soft tissue injuries can occur to those involved in a low speed impact & though these injuries might be hard to see they exist.

Closed Head Injury

Closed head injury from car accident incidents occurs when a victim’s head violently impacts some internal portion of a vehicle, is struck by a moving object during collision, or strikes any other non-moving object in the course of a motor vehicle accident. Closed brain injury from car accident incidents results in damage to the skull, brain, or scalp, but does not penetrate the skull. Closed head injury from car accident incidents may be difficult to diagnose because there might not be any visible external injury that indicates head trauma.

Closed head injury from car accident injuries that results in brain injury is most commonly known as a concussion. A concussion can range from mild to critical in terms of severity. Concussion closed head injury from car accident incidents can result in a temporary loss of consciousness or coma, or symptoms may not appear for some time after the initial trauma. Bleeding and swelling of the brain can occur from this type of closed head injury from car accident incidents when the brain is violently jolted back and forth in the skull upon impact. Even a mild concussion can result in subtle brain damage.

Brain damage in a closed head injury from car accident incidents can have physical, cognitive, and psychological repercussions. The physical characteristics of a closed head injury from car accident incidents can occur immediately following the initial accident or can worsen in the period following the accident. Physical repercussions of a closed head injury can include: headaches, paralysis, coordination difficulty, weakness, sensory problems, nausea, and difficulty sleeping.

Concussion related brain damage in a closed head injury from car accident incidents can also impede on a victim’s cognitive abilities. This can greatly affect one’s ability to work or attend school following a car accident. Problems with attention and concentration, difficulty with both short and long term memory functions, trouble reasoning and problem solving, and reduced information processing may all be cognitive impairments that develop after a closed head injury from car accident incidents.

The consequences of a closed head injury from car accident incidents can also intrude on a victim’s personal relationships and psychological well being. People who have suffered these types of head injuries may experience changes in their personality. Closed head injury from car accident victims may suffer increased irritability, anxiety, and dis-inhibition. These victims may lack adequate coping mechanisms and social skills as a result of their injuries.
Victims who have suffered closed head injury from car accident incidents may be eligible to seek compensation for their damages if the accident was the result of another party’s negligence. This liable party may be another driver or it may be the producers, distributors, or repair people responsible for the defective auto parts that caused the car accident. Victims of closed head injury from car accident incidents can seek compensation for medical expenses, loss of income or earning potential, property damage, and pain and suffering.

Driving Anxiety

Why am I so anxious behind the wheel after my accident? Driving anxiety is not an ailment. It is a condition, where a person driving a vehicle suddenly gets anxious and starts panicking, to the extent of passing out – in extreme cases. Now the big question is “do you suffer from driving anxiety”?

There are several situations that might spur anxiety attacks while driving. Studies have revealed that there may be multiple reasons leading to anxiety while driving. In most cases it is seen that the patient suffering from driving anxiety must have had or seen a car wreck very closely. And it is the impact of the incident that has jolted the senses to the extent that the incident is flashed back as soon as he/she sits behind the wheels. There are also cases when a person experiences driving anxiety attacks, even when someone else drives the car too.

People suffering from driving anxiety usually can experience their palms sweating, their heart beats racing and sometimes even on the verge of being in tears, when stuck in an unfortunate traffic situation or driving on the road.

Vertigo

(Vertigo Blog written by Webmd.com)

Vertigo is the feeling that you or your environment is moving or spinning. It differs from dizziness in that vertigo describes an illusion of movement. When you feel as if you yourself are moving, it’s called subjective vertigo, and the perception that your surroundings are moving is called objective vertigo.

Unlike nonspecific lightheadedness or dizziness, vertigo has relatively few causes, such as Head trauma and neck injury.

Vertigo Symptoms
Vertigo implies that there is a sensation of motion either of the person or the environment, often perceived as if the room is spinning around you. This should not be confused with symptoms of lightheadedness or fainting. Vertigo differs from motion sickness in that motion sickness is a feeling of being off-balance and lacking equilibrium, caused by repeated motions such as riding in a car or boat.

  • If true vertigo exists, symptoms include a sensation of disorientation or motion. In addition, the individual may also have any or all of these symptoms:
  • nausea or vomiting,
  • sweating, and/or abnormal eye movements.
  • The duration of symptoms can be from minutes to hours, and symptoms can be constant or episodic. The onset may be due to a movement or change in position. It is important to tell the doctor about any recent head trauma orwhiplash injury as well as any new medications the affected individual is taking.
  • The person may have hearing loss and a ringing sensation in the ears.
  • The person might have visual disturbances, weakness, difficulty speaking, a decreased level of consciousness, and difficulty walking.

When to Seek Medical Care
Any signs and symptoms of vertigo warrant an evaluation by a doctor. The majority of cases of vertigo are harmless. Although vertigo can be debilitating, most causes are easily treated with prescription medication. Have a doctor check any new signs and symptoms of vertigo to rule out rare, potentially serious or life-threatening causes.

Certain signs and symptoms of vertigo may require evaluation in a hospital’s emergency department:

  • Double vision
  • Headache
  • Weakness
  • Difficulty speaking
  • Abnormal eye movements
  • Altered level of consciousness, not acting appropriately, or difficulty arousing
  • Difficulty walking or controlling the arms and legs

Exams and Tests
The evaluation of vertigo consists primarily of amedical history and physical exam.

The history is comprised of four basic areas.

  1. The doctor may want to know if the patient feels any sensation of motion, which may indicate that true vertigo exists. Report any nausea, vomiting, sweating, and abnormal eye movements.
  2. The doctor may ask how long the patient has symptoms and whether they are constant or come and go. Do the symptoms occur when moving or changing positions? Is the patient currently taking any new medications? Has there been any recent head trauma or whiplash injury?
  3. Are there any other hearing symptoms? Specifically, report any ringing in the ears or hearing loss.
  4. Does the patient have other neurological symptoms such as weakness, visual disturbances, altered level of consciousness, difficulty walking, abnormal eye movements, or difficulty speaking?

The doctor may perform tests such as a CT scan if a brain injury is suspected to be the cause of vertigo.

Blood tests to check blood sugar levels and the use of an electrocardiogram (ECG) to look at heart rhythm may also be helpful.

Vertigo Medical Treatment
The choice of treatment will depend on the diagnosis.

  • Vertigo can be treated with medicine taken by mouth, through medicine placed on the skin (a patch), or drugs given through an IV.
  • Specific types of vertigo may require additional treatment and referral:
  • Bacterial infection of the middle ear requires antibiotics.
  • For Meniere’s disease, in addition to symptomatic treatment, people might be placed on a low salt diet and may require medication used to increase urine output.
  • A hole in the inner ear causing recurrent infection may require referral to an ear, nose, and throat (ENT) specialist for surgery.
  • In addition to the drugs used for benign paroxysmal positional vertigo, several physical maneuvers can be used to treat the condition.
  • Vestibular rehabilitation exercises, also referred to as Epley maneuvers, consist of having the patient sit on the edge of a table and lie down to one side until the vertigo resolves followed by sitting up and lying down on the other side, again until the vertigo ceases. This is repeated until the vertigo no longer occurs.
  • Particle repositioning maneuver is a treatment based on the idea that the condition is caused by displacement of tiny stones in the balance center (vestibular system) of the inner ear. The head is repositioned to move the stones to their normal position. This maneuver is repeated until the abnormal eye movements are no longer visible.

Commonly prescribed medications for vertigo include the following:

  • meclizine hydrochloride (Antivert)
  • diphenhydramine (Benadryl)
  • scopolamine transdermal patch (Transderm-Scop)
  • promethazine hydrochloride (Phenergan)
  • diazepam (Valium)

Follow-up
Anyone with a new diagnosis of vertigo should follow-up with his or her doctor or be referred directly to a neurologist or ENT specialist.

Loss of Consciousness

When something interferes with interactions in the brain that allow awareness, a person’s level of consciousness can change in several ways. Altered level of consciousness (ALC) is among the most common problems seen in medicine. Studies estimate that up to 5% of emergency room admissions in urban hospitals are related to disorders of consciousness.

Consciousness can be measured on a spectrum that ranges from full wakefulness to deep coma.

Altered levels of consciousness include the following conditions:

  • Confusion: A confused person cannot properly process all the information from their surroundings. Apathy and drowsiness are the most noticeable symptoms. The person may be disoriented, especially to time. A severely confused person is usually unable to carry out more than a few simple commands.
  • Delirium: This is a common and complicated problem, especially in the elderly. The signs of delirium include disorientation, which may be total. People with delirium may not remember who they are, or may have delusions and hallucinations. People with delirium may also become drowsy or less alert at times.
  • Obtundation: A lower level of alertness typically characterizes this state. A person in this state often sleeps much more than usual, and when awakened, remains drowsy and confused. Wakefulness can only be maintained by continuously talking to the person, or through constant painful stimulation.
  • Stupor: Stupor is characterized by unresponsiveness from which a person can be aroused only by vigorous and repeated painful stimulation.
  • Coma: A person in a coma appears to be asleep, but cannot be awakened. Oftentimes reflexes are absent, and the legs and arms may be rigid. The respiration rate of someone in a coma is usually slowed.

Causes

Trauma to the brain can cause impaired consciousness. Traumatic brain injury (TBI) is the leading cause of death and disability in young adults in the U.S. Several types of head trauma may cause TBI. For example, a closed head injury – the most common TBI – can result if the head rapidly accelerates or decelerates, causing the brain to move through the fluid in the skull and strike the inside of the skull. Other causes include direct impact on the head or penetration by a foreign object such as a bullet.

Infections are a common cause of impaired consciousness. The inflammation that accompanies infection is responsible for ALC. Encephalitis and meningitis are two nervous system-specific infections that can cause ALC.

Defects in the metabolic system can lead to waste build-up that can cause altered levels of consciousness (ALC). As the body goes about the normal processes needed to keep us alive, chemicals and other by-products are produced. In most cases, byproducts get into the bloodstream and are filtered by the liver, kidneys, and other organs. If one of these systems fails, waste products can build-up and act as a poison that interferes with the brain’s ability to function. The insulin/sugar imbalance of diabetes, for example, is a major metabolic problem that can cause impaired consciousness. Diabetics with low blood insulin levels produce ketones, a toxic by-product of fat metabolism. Conversely, when there is too much insulin, cells begin to starve to death. Either case can result in ALC.

Drug exposure is a common cause for ALC. Drug-induced ALC can result from an overdose of either over-the-counter or illegal drugs. Alcohol intoxication is probably the most common cause of drug-induced ALC. Similarly, exposure to certain readily available home or industrial chemicals can lead to changes in consciousness or even to death.

Structural abnormalities of the brain can lead to ALC [Figure 1]. Tumors (benign or cancerous) can form and crowd out the normal structures of the brain. As a result, weakness in the walls of the blood vessels in the brain (aneurysms) may begin to swell, or may even break, causing blood to pool inside the head and push the brain against the bony wall of the skull. The resulting damage can then cause ALC.


Figure 1. MRI Scan Showing a Brain Tumor

When tumors crowd out the normal structures of the brain, they can cause aneurysms that may rupture. A ruptured aneurysm causes blood to pool inside the head, pushing the brain against the bony wall of the skull. The resulting damage can then cause ALC.

Symptoms

The symptoms of ALC are varied. Initial signs of ALC can be as subtle as slurring words while talking, or as severe as death. ALC can present as any of the levels of consciousness, from confusion to stupor to coma.

Symptoms accompanying ALC provide clues to the underlying cause [Table 1]. For example, if a person with ALC also has a tongue that is bitten or scarred, a doctor would suspect that epilepsy is the underlying cause. Likewise, if the person with ALC also has neck stiffness, the doctor may suspect that meningitis is the cause.


Table 1. Possible Causes of ALC by Accompanying Symptom or Sign

System or region Symptom Possible cause(s)
Vital signs Hypertension Cerebral hemorrhage, hypertensive encephalopathy, increased intracranial pr=
essure, renal or endocrine disorder
Hypotension Ethanol or sedative drug toxicity, blood loss, diabetic coma
Hyperthermia Systemic infection, heat stroke, withdrawal from alcohol or drugs
Hypothermia Ethanol or barbiturate toxicity, shock, extracellular fluid deficit
Bradycardia Heart block, Stokes-Adams syndrome, increased intracranial pressure, hypothyroidism
Tachycardia Arrhythmia associated hypoxemia; atrial fibrillation associated with cerebral embolism
Breath Peculiar odor Alcohol ingestion, hepatic failure, ketoacidosis, or uremia
Skin Jaundice Hepatic disorder
Needle-tracks Drug overdose
Rashes Infectious disease, drug reaction, autoimmune disease, pellagra, thrombotic thrombocytopenic purpura
Pallor Hemorrhage (internal or external)
Head Localized tenderness, hematoma, crepitus Skull fracture
Hemorrhage from ears or nostrils; hematoma, tenderness, or crepitus over mastoid process Basilar skull fracture
Face and conjunctiva hyperemic Alcohol intoxication
Tongue bitten or scarred Epilepsy
Neck Stiffness Suggests meningitis/encephalitis, trauma, or subarachnoid hemorrhage

Risk Factors

Certain causes of ALC are more common in particular groups of individuals. Traumatic brain injury is the leading cause of death and disability in those under 45 years of age, while metabolic problems, which can also cause ALC, occur most often in middle-aged and older people.

Treatment

Urgent Care
ALC is a medical emergency. As there is usually nothing an onlooker can do to treat the cause, the best advice is to call 911 and get the person to the hospital as soon as possible. It should be remembered, however, that even minor changes such as slurring words or unsteadiness could be an early sign of impending problems that should beinvestigated. Do not wait for the person to – pass out – before seeking medicalcare.

After contacting the ambulance, there are some things that can be done to help keep the person safe until help arrives. For example, if the person does not respond when you shake them or yell their name, check to make sure they are still breathing, and that they have a pulse. If they do not, begin cardiopulmonary resuscitation (CPR).If you do not know CPR, an ambulance dispatcher can talk you through the procedure over the telephone. If heat stroke is a possibility, get the person into the shade or an air-conditioned area immediately. If there is ice available (or even cold soft drink cans), place it in the groin area and under the neck. If you know that the probable cause of ALC is type II diabetes, provide the person with sugar as soon as possible. The best way to provide this sugar is through a paste that can be applied to the gums (called Glucagon, among other things). If this paste is not available, regular table sugar can also be placed under the lips and against the gums. The blood vessels in this area are very close to the surface, and readily absorb the sugar, getting it into the blood system and to the brain very quickly. If the person is having a seizure, do not touch them unless it is absolutely necessary to help them avoid injury. If possible, open their collar, remove ties or other constricting things from around the neck and unbutton their shirt. Never try to force anything into the mouth. Remove from the area any objects such as chairs or tables that the person might strike, thereby further injuring themselves. Do not attempt to restrain the person in any way. When the seizure has stopped, place the person on their side in the recovery position. Look around the area for any pill or chemical containers.This will give the healthcare team valuable clues about overdose, poisoning, or medication interaction as cause for the ALC.

Surgery
Surgery is used to relieve pressure in the brain from a developing mass. A growing mass, which can take many forms (i.e., bleeding from a stroke or aneurysm, abscess from an infection, a tumor or swelling related to trauma), can press on the brain and cause ALC. If this is the case, your doctor will order surgery to remove the offending mass.

If surgery is necessary, a craniotomy will most likely be done. A craniotomy is a surgical method of cutting open the skull to gain access to the brain. After anesthesia is given and the patient is asleep, the surgeon will cut a flap in the skin to expose the bone of the skull. They will then usually drill a number of holes is the skull and use a specialized saw to connect them. The bone flap is then removed, exposing the brain. What happens next will depend on the underlying cause of ALC. If it is an aneurysm, then it may either be clipped, or a special reinforcing fabric will be placed around it to keep it from getting bigger. If the cause is bleeding into the brain or abscess, the surgical team will remove it from the area. In other cases, a tumor may be removed.

Following surgery, the patient is usually admitted to an intensive care unit where vital signs and pressure inside the skull can beclosely monitored. Medications are usually given to limit the chance for infection and seizures after surgery. The person will also be watched closely for changes in level of consciousness and weakness or loss of speech that often signal problems. Frequently the person will only stay in the ICU for about 24 hours. Depending on the outcome, the person may be released home or sent to are habilitation hospital for further treatment.

Whiplash

What is whiplash?
Whiplash is an injury to the neck caused by the neck bending forcibly forward and then backward, or vice versa. The injury usually involves the muscles, discs, nerves, and tendons in the neck.
What causes whiplash?
Most whiplash injuries are the result of a collision that includes sudden acceleration or deceleration. Many whiplash injuries occur when a person is involved in a rear-end automobile collision, or as a result of a sports injury, particularly during contact sports.
What are the symptoms of whiplash?
The following are the most common symptoms of whiplash. However, each individual may experience symptoms differently. Symptoms may include:

  • neck pain
  • neck stiffness
  • shoulder pain
  • low back pain
  • dizziness
  • pain in the arm and/or hand
  • numbness in the arm and/or hand
  • ringing in ears
  • blurred vision
  • concentration or memory problems
  • irritability
  • sleeplessness
  • tiredness

The symptoms of whiplash may resemble other conditions and medical problems. Always consult your physician for a diagnosis.
How is whiplash diagnosed?
In addition to a complete medical history and physical examination, diagnostic procedures for whiplash may include the following (as many whiplash injuries include damage to soft tissue that cannot be seen on x-rays):

  • computed tomography scan (Also called a CT or CAT scan.) – a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
  • magnetic resonance imaging (MRI) – a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

Treatment for whiplash:
Specific treatment for whiplash will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the injury
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the injury
  • your opinion or preference

Treatment may include:

  • ice applications for the first 24 hours
  • cervical collar
  • gentle active movement after 24 hours
  • nonsteroidal anti-inflammatory medications
  • muscle relaxing medications
  • physical therapy
  • chiropractic care
  • epidural injections
  • surgery

Up to half the people who experience whiplash will continue to have pain months after the injury occurred. In some people, this chronic pain can be traced to damage in the joints, disks and ligaments of the neck. But in many cases, no abnormality can be found to explain this persistent neck pain.

Whiplash injuries can be mild or severe. Treatment typically begins with over-the-counter pain relievers and ice applied to the painful neck muscles. If pain persists, prescription medications and physical therapy may be helpful.
Most people recover from whiplash in just a few weeks, but some people with whiplash injuries develop chronic conditions that can be extremely painful and disabling.
Some of the whiplash symptoms that can develop within 24 hours of the injury may include:

  • Neck pain and stiffness
  • Headaches, most commonly at the base of the skull
  • Dizziness
  • Blurred vision
  • Fatigue

Some people also experience:

  • Difficulty concentrating
  • Memory problems
  • Ringing in the ears
  • Sleep disturbances
  • Irritability

Managing Back Pain

There can be many causes of back pain including accidents, strains, and injuries. Two types of back injury are spondylolisthesis and cervical radiculopathy. Both have their own set of symptoms, causes, and treatments.

The spine, or backbone, is made up of a column of 33 bones and tissue extending from the skull to the pelvis. These bones, or vertebrae, enclose and protect a cylinder of nerve tissues known as the spinal cord. Between each one of the vertebra is an intervertebral disk, or band of cartilage serving as a shock absorber between the vertebrae. The types of vertebrae are:

  • Cervical vertebrae: the seven vertebrae forming the upper part of the spine
  • Thoracic vertebrae: the 12 bones between the neck and the lower back
  • Lumbar vertebrae: the five largest and strongest vertebrae located in the lower back between the chest and hips
  • The sacrum and coccyx are the bones at the base of the spine. The sacrum is made up of five vertebrae fused together, while the coccyx (tailbone) is formed from four fused vertebrae.

In addition to performing a complete history and physical exam for your back pain, your doctor may suggest one of the following diagnostic studies:

  • X-rays, which can be used to provide detail of the bone structures in the spine and to check for instability (such as spondylolisthesis, see below), tumors, and fractures.
  • CT scans, which can identify specific conditions, such as a herniated disc or spinal stenosis.
  • MRI scans, which can provide details about the backs’ discs and nerve roots. MRI scans are most commonly used for pre-surgical planning.
  • CT scans, which can identify specific conditions, such as a herniated disc or spinal stenosis.

A number of other imaging and electrical studies may also be used to identify back problems, and some injections are used for diagnostic purposes as well as for pain relief.

Two main types of back injury include:

  • Spondylolisthesis: This is a slipping of vertebra that occurs, in most cases, at the base of the spine. Spondylolysis, which is a defect or fracture of one or both wing-shaped parts of a vertebra, can result in vertebrae slipping backward, forward, or over a bone below.
  • Cervical Radiculopathy: Cervical radiculopathy is the damage or disturbance of nerve function that results if one of the nerve roots near the cervical vertebrae is compressed. Damage to nerve roots in the cervical area can cause pain and the loss of sensation in various upper extremities, depending on where the damaged roots are located.

Symptoms of spondylolithesis include:

  • Lower back pain
  • Muscle tightness and stiffness
  • Pain in the buttocks
  • Pain radiating down the legs (due to pressure on nerve roots)

Spondylolisthesis is treated with the strengthening of supportive abdominal and back muscles through physical therapy. For patients who continue to have severe pain and disability after physical therapy, there is the option of surgical fusion (arthrodesis) of the vertebra to the bone below.
In cervical radiculopathy, damage can occur as a result of pressure from material from a ruptured disc, degenerative changes in bones, arthritis, or other injuries that put pressure on the nerve roots. In older people, normal degenerative changes in the discs can cause pressure on nerve roots. In younger people, cervical radiculopathy tends to be the result of a ruptured disc. This disc material then compresses the nerve root, causing pain.

The main symptom of cervical radiculopathy is pain that spreads into the arm, neck, chest, and/or shoulders. A person with radiculopathy may experience muscle weakness and/or numbness or tingling in fingers or hands. Other symptoms may include lack of coordination, especially in the hands.
Cervical radiculopathy may be treated with a combination of pain medications such as corticosteroids (powerful anti-inflammatory drugs) or non-steroidal pain medication (Motrin or Aleve) and physical therapy. Steroids may be prescribed either orally or injected epidurally (into the dura, which is the membrane that surrounds the spinal cord).

Physical therapy might include gentle cervical traction and mobilization, exercises, and other modalities to reduce pain.

If significant compression on the nerve exists to the extent that motor weakness results, surgery may be necessary to relieve the pressure.

Rotator Cuff Tear

The rotator cuff is a group of muscles and tendons that hold the shoulder joint in place and help move the shoulder. The 4 muscles (and their tendons) that make up the rotator cuff are:

  • the supraspinatus;
  • the infraspinatus;
  • the subscapularis; and
  • the teres minor.

What is a rotator cuff injury?
Rotator cuff injury is a strain or tear of the rotator cuff – the muscles and tendons that stabilise your shoulder. Injury often involves a tear to the rotator cuff tendons (the thick bands of tissue that connect the muscles to the bones), but sometimes the tear occurs in the muscle.

The most common site of a tear is in the supraspinatus tendon. Severe injuries can cause several of the tendons and muscles to tear.

Symptoms of a rotator cuff injury
Symptoms include pain and tenderness in the shoulder, pain on elevating the arm, weakness of the shoulder, and pain when sleeping on the affected side. Special movement tests can help your doctor determine which of the muscles or tendons has been torn.

Treatment for rotator cuff injuries
The mainstay of treatment includes resting the shoulder, anti-inflammatory medicines and special exercises and physical therapy. Steroid injections or surgery may be needed in severe cases.

Back Spasms

Muscles of the back may produce spasm or extreme muscle stiffening after a traumatic injury or repetitive strain.  The difference between a repetitive strain and a traumatic injury is that with a repetitive strain the muscles are being irritated over a long period of time until they reach a point that finally triggers the spasm.

The muscles then spasm to protect the area from further injury.  For example, a person who has improper posture at a computer on a regular basis, or a golfer who plays frequently with bad form may have their muscles tighten over time, but the muscles may not start to spasm until something as simple as reaching for a glass of water occurs. This spasm can be extremely painful and lead to tearing of the muscles if undue stressors are placed on them.  This tearing will than lead to guarding of the back musculature through extreme stiffening to protect the area from further harm.

With proper care for the area, the pain in the back musculature should lessen over three weeks, but it should be noted that the healing of the area continues and doesn’t even peak until at least six weeks following the initial injury.  This is due to scar tissue formation which initially acts like the glue to bond the tissue back together.  Scar tissue will continue to form past six weeks in some cases and as long as a year in severe back pulls

Post Concussion Syndrome

Post-concussion syndrome is a complex disorder in which a combination of post-concussion symptoms — such as headaches and dizziness — last for weeks and sometimes months after the injury that caused the concussion.

Concussion is a mild traumatic brain injury, usually occurring after a blow to the head. Loss of consciousness isn’t required for a diagnosis of concussion or post-concussion syndrome. In fact, the risk of post-concussion syndrome doesn’t appear to be associated with the severity of the initial injury.

In most people, post-concussion syndrome symptoms occur within the first seven to 10 days and go away within three months, though they can persist for a year or more. Post-concussion syndrome treatments are aimed at easing specific symptoms.

Post-concussion symptoms, which vary, include:

  • Headaches
  • Dizziness
  • Fatigue
  • Irritability
  • Anxiety
  • Insomnia
  • Loss of concentration and memory
  • Noise and light sensitivity

Headaches that occur after a concussion can vary and may feel like tension-type headaches, cluster headaches or migraines. Most, however, are tension-type headaches, which may be due to a neck injury that happened at the same time as the head injury. In some cases, people experience behavior or emotional changes after a mild traumatic brain injury. Family members may notice that the person has become more irritable, suspicious, argumentative or stubborn.

No specific treatment for post-concussion syndrome exists. Instead, your doctor will treat the individual symptoms you experience. The types of symptoms and their frequency are unique to each person.

Headaches
Medications commonly used for migraines or tension headaches, including some antidepressants, appear to be effective when these types of headaches are associated with post-concussion syndrome. The overuse of over-the-counter and prescription pain relievers may contribute to persistent post-concussion headaches.
Physical therapy may be helpful in relieving tension-type headache symptoms.

Memory and thinking problems
No medications are currently recommended specifically for the treatment of cognitive problems after mild traumatic brain injury. Most cognitive problems go away on their own in the weeks to months following the injury. Brief, focused rehabilitation that provides individualized training in how to use a pocket calendar, electronic organizer or other techniques to work around memory deficits is often helpful.

Depression and anxiety
If you’re experiencing new or increasing depression or anxiety after a concussion, it may be helpful to discuss this with a psychologist or psychiatrist who has experience in working with people with brain injury. Medications to combat anxiety or depression also may be prescribed. The symptoms of post-concussion syndrome often improve after the affected person learns that there is a cause for his or her symptoms, and that they will likely improve with time. Education about the disorder can ease a person’s fears and help provide peace of mind.

Subluxation

In simplest terms, a subluxation (a.k.a. Vertebral Subluxation) is when one or more of the bones of your spine (vertebrae) move out of position and create pressure on, or irritate spinal nerves. Spinal nerves are the nerves that come out from between each of the bones in your spine. This pressure or irritation on the nerves then causes those nerves to malfunction and interfere with the signals traveling over those nerves.

How does this affect you?  Your nervous system controls and coordinates all the functions of your body. If you interfere with the signals traveling over nerves, parts of your body will not get the proper nerve messages and will not be able to function at 100% of their innate abilities. In other words, some part of your body will not be working properly.

It is the responsibility of the Doctor of Chiropractic to locate subluxations, and reduce or correct them. This is done through a series of chiropractic adjustments specifically designed to correct the vertebral subluxations in your spine. Chiropractors are the only professionals who undergo years of training to be the experts at correcting subluxations.

Whiplash Treatment

Whiplash Treatment

Up to half the people who experience whiplash will continue to have pain months after the injury occurred. In some people, this chronic pain can be traced to damage in the joints, disks and ligaments of the neck. But in many cases, no abnormality can be found to explain this persistent neck pain.

Whiplash injuries can be mild or severe. Treatment typically begins with over-the-counter pain relievers and ice applied to the painful neck muscles. If pain persists, prescription medications and physical therapy may be helpful.
Most people recover from whiplash in just a few weeks, but some people with whiplash injuries develop chronic conditions that can be extremely painful and disabling.
Some of the whiplash symptoms that can develop within 24 hours of the injury may include:

  • Neck pain and stiffness
  • Headaches, most commonly at the base of the skull
  • Dizziness
  • Blurred vision
  • Fatigue

Some people also experience:

  • Difficulty concentrating
  • Memory problems
  • Ringing in the ears
  • Sleep disturbances
  • Irritability

Why Soft-Tissue injuries are anything but soft on the body

Serious, even permanent damages can result from sustaining soft-tissue injuries.  Some examples of these serious injuries include:  cerebral concussion, fracture of part of the bony structure or cartilage in the cervical area, protrusions or herniations of intervertebral discs, or aggravation of preexisting degenerative condition in the vertebral structures.

There is a vast collection of medical research and studies that recognize the disabling effect soft-tissue injuries can have on the human body, even when a rear-end impact is minimal and the vehicle damage is slight.

The Journal of the American Medical Association published a medical study of women who had suffered disabling neck injuries from auto accidents in metropolitan areas.  Of the women involved in the study, 75% experienced ongoing symptoms for more than six months, regardless of whether they were pursuing a personal injury lawsuit or not.

It is important to know that, because of the complexity of the neck’s structure, it is more subject to injury than any other portion of the vertebral column.  In lieu of such complexity, it is important that you retain counsel who is knowledgeable, and/or has medical resources at his/her fingertips, regarding the anatomy of the neck and how acceleration forces will impact the delicate balance of the interconnecting structures.

At Parker & Lazzara, we work closely with healthcare providers to ensure that we are fully informed of our clients’ conditions and to secure whatever medical records and literature will assist in our representation of our clients.

Cervical Spine Sprain/Strain Injuries: Treatment & Medication

Treatment

Acute Phase
Rehabilitation Program
Physical Therapy
The tissue injury and clinical signs and symptoms of cervical spine strain/sprain injuries are treated during the acute phase of rehabilitation. The goals of this phase are the following:

  • Decrease pain and control inflammation
  • Reestablish nonpainful ROM
  • Improve neuromuscular cervical spine postural control
  • Prevent the development of any muscular atrophy of the cervical spine muscle groups and postural muscles
  • Facilitate primary tissue healing

Therapeutic activities during the acute phase of rehabilitation include the following:

  • Relative rest
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Physical therapy modalities
  • Manual therapy approaches
  • Protected ROM and stabilization
  • Isometric muscle strengthening
  • Conditioning of other areas

If no neurologic history or deficit is present in a patient with a cervical strain and/or sprain, the athlete should use ice packs for 15-20 minutes every 1-2 hours or have an ice massage for 5-10 minutes every 1-2 hours during the early management of the injury. This treatment aids in decreasing muscle spasms, decreasing pain, and promoting vasoconstriction.
Cold has a number of physiologic effects that are therapeutic. Local application of cold causes vasoconstriction, lowers cell metabolism, decreases extensibility of collagen tissue, decreases muscle contractility, decreases nerve conduction velocity, and increases the pain threshold. The spasticity of the muscle is reduced because local cold affects the muscle spindle’s responsiveness to stretching. Local cold also has a direct effect on the conduction velocities of the afferent and efferent fibers, which further decreases muscle spasm.
The relatively deep penetration of cryotherapy makes it an ideal form of treatment for tissues lying deep to superficial layers. The cooling agent must be utilized for a sufficient amount of time for effective deep-tissue cooling to occur. Subcutaneous fat is an effective thermal barrier to heat exchange. A duration of 15-30 minutes is a commonly accepted timeframe required for therapeutic results and physiologic changes to take place. Ice is far more penetrating than heat. Because the vasodilation responses of heat therapy increase tissue edema and may extend the injury or delay healing, heat is not recommended in the acute stage.
Starting active ROM (AROM) and isometric strengthening exercises as soon as possible is very important. After at least 24 hours of cryotherapy, most patients are able to start gentle, painless active-assistive range of motion (AAROM) or AROM. To aid in AROM, transcutaneous nerve stimulation (TENS) or cryokinetics (exercising while the musculature is numbed with ice) may also be used.
Isometric exercises are started in neutral positions and then progressed through the full ROM once the patient demonstrates that ROM has improved. Pain should not be exacerbated by these exercises. AROM and strengthening exercises are progressively increased until the athlete achieves full pain-free ROM and normal strength. Stretching exercises should not be instituted acutely because they may cause reactive paraspinal muscle spasm and tightness. Gentle passive stretching may begin after resolution of the acute inflammatory phase (usually within 72 h), which avoids eccentric muscle loads and stays within the painless arc of motion.
The reactive cervical spasm and tightness after an injury can produce a loss of ROM and chronic contractures if not corrected. Chronic contractures greatly increase the potential for reinjury because if a contracture exists, sudden motion at a moment of contact through that restricted ROM is likely to reproduce the injury and severe pain. A program of cervical stretching and ROM exercises can prevent contractures and restore a protective ROM.
While the athlete undergoes progressive rehabilitation for a cervical injury, stationary bicycling provides a way of maintaining aerobic fitness and an athlete’s competitive weight. Swimming also offers an acceptable aerobic exercise program in a semi-unweighted environment; however, a mask and snorkel should be used to avoid aggravation of the cervical muscles that is encountered as the neck is rotated during breathing when swimming.

Any aerobic exercise should be modified for the particular injury so that the activity does not exacerbate the patient’s symptoms. The repetitive impact encountered during running, in particular, can aggravate a cervical injury and should be avoided early on in the recovery period. Before workouts, light exercise and stretching should be performed to prepare the muscles for activity.
Criteria for advancement to the recovery phase of rehabilitation include the following:

  • Resolution of significant cervical pain
  • Significant improvement in passive ROM (PROM), AROM, and neuromuscular control
  • Decreased muscle spasms
  • Improvement in the muscles and other tissue that maintain the postural adaptive changes

Related eMedicine topics:

Medical Issues/Complications
The clinician should always rule out a significant bony or ligamentous injury, as missing such an injury could result in neurologic injury. <http://emedicine.medscape.com/article/94387-treatment> 18 <http://emedicine.medscape.com/article/94387-treatment> ,19 <http://emedicine.medscape.com/article/94387-treatment>
Consultations
Consult a spinal surgeon for any patient with suspected ligamentous spinal instability.
Other Treatment
Athletes who have limited ROM and severe pain with a history of a collision can be placed in cervical immobilization in order to rest the musculature and assist with pain control. Careful instruction should be given to patients using cervical collars so that dependency does not occur. Patients should spend at least 1 of every 3 hours out of the cervical collar by the third day of use; this time can then be gradually increased. The patients should discontinue collar use by 1 week from their injury unless there is a significant bony/ligamentous injury.
Manual therapy techniques can also help to decrease pain and improve mobility and function to the point that the patient may begin to exercise in a painless manner. These techniques include soft-tissue massage, manually sustained or rhythmically applied muscle stretching, traction applied in the longitudinal axis of the spine, and passive joint mobilization.
To help decrease pain and spasm, a trained therapist may apply grade 1 or grade 2 mobilizations. Repetitive passive joint oscillations carried out at the limit of the joint’s available ROM can have a mechanical effect on joint mobility, thus improving a restriction of vertebral motion. Mechanically controlled passive or active movements of joints can improve remodeling of the local connective tissue, the rate of tendon repair, and the gliding function within tendon sheaths during the repair process.
If the patient’s pain is not significantly relieved during the acute phase of rehabilitation, trigger point injections, typically along the medial border of the scapula, may help decrease trigger zones and referred pain and help improve muscular flexibility. These injections may allow rehabilitation to progress more rapidly, but they should be used judiciously when the active rehabilitation has stalled. Repeated injections are not recommended.
Recovery Phase
Rehabilitation Program
Physical Therapy
During the recovery phase of rehabilitation, the tissue overload and functional biomechanical deficit complexes are addressed. <http://emedicine.medscape.com/article/94387-treatment> 12 <http://emedicine.medscape.com/article/94387-treatment> ,13 <http://emedicine.medscape.com/article/94387-treatment> ,14 <http://emedicine.medscape.com/article/94387-treatment> ,15 <http://emedicine.medscape.com/article/94387-treatment> ,16 <http://emedicine.medscape.com/article/94387-treatment> ,17 <http://emedicine.medscape.com/article/94387-treatment>

The goals of this phase are the following:

  • Completely eliminate the patient’s pain
  • Improve and normalize cervical PROM and AROM
  • Improve and normalize cervical strength and neuromuscular control
  • Continue to improve posture
  • Initiate sport-training progressions

Therapeutic activities during this phase include the following:

  • Protected ROM
  • Appropriate loading
  • Resistive exercise
  • Functional exercises

NSAIDs are probably unnecessary in this phase, and these agents should be tapered. The improved ROM permits further normalization of the patient’s posture as muscular strength and balance are enhanced to help maintain the improved posture during daily activities as well as athletic training and competition. Strength training using independent single-plane and complex multiplane coordinated motions is performed using varying combinations of concentric and eccentric isotonic exercises. Thera-Band or Sportscord can be used to allow training at home. Criteria for advancement to the maintenance phase of rehabilitation include the following:

  • Fully pain-free cervical PROM and AROM
  • Significantly improved cervical spine posture
  • Normal neuromuscular control
  • Significantly improved strength and flexibility of the supporting muscles and joints

Other Treatment (Injection, manipulation, etc.)
Manual therapy, including soft-tissue and manipulative techniques, still may be needed to help eliminate vertebral motion restrictions and improve the flexibility and motion of the soft tissues so that cervical PROM and AROM are normalized.
Occasionally, trigger point injections may be used for recalcitrant, taut, hyperirritable muscles. Again, multiple and repeated injections are discouraged.
Maintenance Phase
Rehabilitation Program
Physical Therapy
During the maintenance phase of rehabilitation, the functional biomechanical deficit and subclinical adaptation complexes are addressed. The goals of this final phase of rehabilitation are the following:

  • Increase and improve balance, power, and endurance of the cervical muscles as well as other muscles in the kinetic chain
  • Normalize posture
  • Normalize multiplane-coupled neuromuscular control to eliminate subclinical adaptations
  • Enable the patient to return to unrestricted sport-specific activities

Therapeutic activities during this phase include the following:

  • Activities emphasizing endurance, strength, flexibility, and balance
  • Functional sport-specific progressions

Soft-tissue flexibility and proper balance of flexibility and strength are emphasized to allow the athlete to assume and maintain a biomechanically correct posture. Power and endurance training is focused on maintaining normal multiplane-coupled cervical motion.
Medication
Pain and inflammation can be reduced by the judicious use of NSAIDs. The antiprostaglandin effect of NSAIDs may control the inflammatory response to an injury and may provide pain relief. The duration of the analgesic effect of an NSAID may be different than the duration of its anti-inflammatory effect. Some investigators have expressed concern that NSAIDs may actually interfere with the later stages of tissue repair and remodeling in which prostaglandins still help mediate cleanup of debris. The dosage, timing, and potential side effects of NSAIDs should be evaluated.
Nonsteroidal anti-inflammatory drugs
NSAIDs have analgesic, anti-inflammatory, and antipyretic activities. The mechanism of action of these agents is not known, but they may inhibit cyclooxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.

Ibuprofen (Motrin, Ibuprin)
DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Adult
200-400 mg PO q4-6h while symptoms persist; not to exceed 3.2 g/d
Pediatric
<6 months: Not established
6 months to 12 years: 4-10 mg/kg/dose PO tid/qid
>12 years: Administer as in adults

Naproxen (Naprosyn, Naprelan, Anaprox)
For relief of mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing the activity of cyclooxygenase, which results in the decrease of prostaglandin synthesis.

Adult
500 mg PO followed by 250 mg q6-8h; not to exceed 1.25 g/d
Pediatric
<2 years: Not established
>2 years: 2.5 mg/kg/dose PO; not to exceed 10 mg/kg/d

Muscle relaxants
Muscle relaxants are thought to work centrally by suppressing conduction in the vestibular cerebellar pathways. These agents may have an inhibitory effect on the parasympathetic nervous system.

Cyclobenzaprine (Flexeril)
Skeletal muscle relaxant that acts centrally and reduces motor activity of tonic somatic origins, influencing both alpha and gamma motor neurons. Structurally related to tricyclic antidepressants and thus carries some of their same liabilities.

Adult
20-40 mg/d PO divided bid/qid; not to exceed 60 mg/d
Pediatric
Not established
Complications
Long-term complications that may develop from cervical injuries include chronic pain <http://www.medscape.com/resource/painmgmt> , headaches <http://www.medscape.com/resource/headache> , depression <http://www.medscape.com/resource/depression> , permanent loss of cervical ROM, and disability. In patients with chronic symptoms that are unresponsive to a progressive rehabilitation approach, diagnostic zygapophyseal joint injections may help to identify a potentially treatable process, which may respond to radiofrequency denervation treatment in a properly selected patient group.

Author: Gerard A Malanga, MD, Director of Pain Management, Overlook Hospital; Director of PM&R Sports Medicine Fellowship, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, UMDNJ-New Jersey Medical School; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael’s Medical Center; Fellow, American College of Sports Medicine
Coauthor(s): Michael J Mehnert, MD, Volunteer Faculty, Department of Physical Medicine & Rehabilitation, Thomas Jefferson Medical School; Associate Physiatrist, Rothman Institute of Orthopedics; Graduate of Musculoskeletal/Pain Management Fellowship, New Jersey Medical School; Daniel Kim, MD, Staff Physician, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey