Car Accident Case Study

Dealing with a complex neurological condition

We also received a significant six figure settlement for a client who broke her wrist in a car wreck and later developed RSD (Reflex Sympathetic Dystrophy, also known as CRPS or Complex Regional Pain Syndrome) in the same wrist. RSD is a complex neurological condition that involves some initial traumatic injury to the nerve.

RSD is a chronic pain syndrome where a physical injury triggers the nervous system in a way that creates a continuing cycle of excruciating pain, which is the hallmark, or defining characteristic of the disease. RSD is a pain syndrome where the injury site and the sympathetic nervous system create a cycle of pain from the injury, to the brain and then back to the injury. RSD (now more commonly known as CRPS or complex regional pain syndrome) was discovered in 1872 by a doctors who treated wounded soldiers in the Civil War. The soldiers had wounds form bayonets or bullets that appeared to completely heal but these patients mysteriously continued to report debilitating pain and would even show symptoms such as skin discoloration and tissue swelling. The syndrome was termed “Causalgia”. There are two types of RSD: Type 1 is the cycle of pain from the injury site through the sympathetic nervous system; Type 2 is the cycle of pain through the sympathetic nervous system but with a specific nerve injury.

The sympathetic nervous system has nerve fibers that run along your spinal cord. They control functions in “the background” — such as when your skin sweats from exercise or gets clammy and flushes from fear or anxiety. When your system functions normally and you get scared, anxious or tired, the “on switch” for your sympathetic nerve system opens or restricts the blood vessels in, for example, your hand, and your palms get sweaty, you may feel your heartbeat throb in your hands or they may get cool and clammy, but they don’t stay this way. Your body eventually “turns off” the switch and the blood vessels go back to normal. In a person who has RSD, the injury they have suffered — say from a broken wrist or nerve damage to the back of their hand causes the switch to be stuck in the “on” position. What this means is that throughout the day, the sympathetic nervous system will trigger the blood vessels to open and close for no reason in the area of the injury.

With RSD, you have (1) pain from the injury that hasn’t gotten a chance to go away, and (2) blood vessels opening and closing, “flushing” the skin, and irritating the site of the injury — like pouring fuel on a fire. The problem for people who have an injury that causes RSD is that the pain from the injury doesn’t go away, but “cycles” between the injury and the brain while the sympathetic nervous system throws “fuel” on the fire.

People who have RSD describe it as a burning, aching pain that can rise and fall throughout the day. When it “spikes” — because something touches the injury site, or the sympathetic nervous system throws fuel on the fire — the pain is excruciating. For men, it is compared to the pain of a kidney stone; for women, the pain of childbirth. In about half of people who develop RSD, the pain goes away — often in several weeks or months. In the other half, the pain does not go away and is expected to stay with them.

There are several different approaches to treating RSD, some involving pain medications and pain management and some involving surgical implants and / or nerve surgery. There is no real consensus in the medical community about one treatment method being more beneficial than another as each one has complications and risks.

Even in our case, there was disagreement between two doctors who both saw our client as a patient. While her anesthesiologist believed that the complications of surgical implants and nerve surgery were too risky for her, her neurologist believed he could help her more by implementing procedures such as spinal implants or nerve surgery.

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