Articles Posted in Medical Procedures

Traumatic Carpal Tunnel Syndrome

Traumatic Carpal Tunnel Syndrome

Many people are familiar with carpal tunnel syndrome (CTS) as a condition caused by repetitive stress injuries such as working with vibrating tools, heavy manual labor, and even less impactful but repeated movements such as typing. Within these categories, carpal tunnel syndrome is often a workplace injury. What is less well known, however, is traumatic carpal tunnel syndrome that can be triggered by a single injury to the hand or wrist from an event such as a motor vehicle collision, a sports injury, or a slip-and-fall injury.

Symptoms of Carpal Tunnel Syndrome

castManaging pain after orthopedic surgery is vitally important to successful rehabilitation and recovery.   Proper pain management after surgery allows the patient to begin movement that will result in the most favorable possible outcome.

In some hospital settings, a multifaceted pain management approach is employed.  Factors such as the patient’s medical history and age are considered by the rehabilitation specialist and that information is used to develop a course of individualized pain management care following orthopedic surgery.

Some of the analgesic options following orthopedic surgery include long- and short-acting narcotic pain medicine, anti-inflammatories and topical analgesics.  Adequate pain relief ensures that the post-op patient can rest comfortably and get the sleep necessary to aid in recovery, as well as participate in meaningful rehabilitative therapy.  The method of measuring pain that is used by nearly every health care facility is the 1-10 pain scale – 1 being minor discomfort to 10 being the worst pain a patient can imagine.  The goal is to get the patient to a low number and again, allow for comfortable rest and therapy to an extent that will be useful in returning to normal activities as quickly as possible.

I’m Ed Smith, a Sacramento personal injury attorney since 1982. Many people over the years have asked me what a “personal injury” actually is.

Legally, a personal injury lawsuit is a suit filed in a court by someone who has been emotionally or physically injured by the act of another.

Some of the common types of personal injury are injuries arising from auto accidents, motorcycle accidents, pedestrian accidents and trucking accidents.

In car accidents, there can be many cases of blunt abdominal trauma. One study looked at an isolated jejunal tear in a 24 year old male trucker who exhibited abdominal pain after sustaining blunt abdominal trauma after hitting the steering wheel in an accident. The treating abdphysician missed the isolated jejunal tear and a nearby contusion and secondary tear so conservative care was recommended. He gradually deteriorated and died from his injury. The autopsy showed the jejunal tear in the small bowel with secondary peritonitis. An exploratory laparotomy and special x-rays would have uncovered the problem and he would likely have survived his injuries.

Another study looked at the pattern of small bowel mesenteric injuries caused by contact with the steering wheel during a motor vehicle. They recognized that small gut mesenteric injuries were rare after blunt abdominal trauma from steering wheels. The researchers did a 10 year retrospective study on these types of injury. They found that all such injuries occurred in males with 13 jejunal mesenteric injuries and four ileal mesenteric injuries.

They concluded by acknowledging that these are rare injuries and that tears in the tissue could be longitudinal or transverse. Suture repair is necessary and these patients need to get to a tertiary care facility because a delay in treatment can increase morbidity and mortality. While rare, these types of injuries should be considered when the individual sustains a blunt trauma with a steering wheel in a motor vehicle accident.

Hi, I’m Ed Smith, a Sacramento personal injury attorney and I love what I do. Personal Injury attorneys have the best job in the world for many many reasons. Please note though that when I say personal injury lawyers, I mean lawyers who represent people who have real injuries. Attorney’s who represent insurance companies are not really by any sense of the word personal injury lawyers. They are insurance lawyers, and they have  one of the worst jobs in the world.

1. Injury Lawyers always meet new people who start as clients and often become friends.

2. Injury lawyers  are always learning more about law.

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I. Background

2000 years ago, Hippocrates, the father of medicine, coined an adage that for millennium medical doctors have adhered to: “First, do no harm.” By overwhelming numbers, most individuals called to medicine have a deep desire to comfort, help and heal.

Insurance Companies’ Deception

Whenever there is a defect in the skin or a non-vital section of skin, such as from burns or other damage resulting in scars, it needs to be replaced with a partial or full thickness skin grafting. Skin generally covers the entire body and protects underlying tissues from damage and infection. It also provides thermoregulation via skin temperature changes and radiation of heat through the skin. Restoring a normal skin border is the purpose behind skin grafting.

Skin grafting was performed two millennia ago in India but wasn’t popular in western medicine until almost two hundred years ago. Grafting was found to speed healing and reduce fluid loss from major wounds and burns. Grafting makes wounds look better and reduces scar contraction. Wounds that extend to bone must be grafted because bone does not cover itself with tissue or skin.

Skin can be transplanted from one location to another on the same individual. This is called an autogenous graft or an autograft. If the dermis is used in its entirety, it is called a full thickness graft. It looks more like normal skin after this type of grafting when compared to split thickness grafting. In full thickness grafting, the doctor needs more optimal conditions for survival because of the greater amount of tissue that needs to be revascularized.

Fingertip accidents are commonplace amputations at home or on the job. Fingertips can slam in doors, in car doors, while chopping food or when clearing out a lawnmower or snowblower. These types of injuries can involve crushing of the fingertip, tearing of the fingertip or cutting off of the fingertip, including the thumb. The nailbed, soft tissue and bone (phalanx) can be involved in the injury. The tips of the fingers are injured more commonly than the rest of the finger because they are the least likely to escape harm’s way.

These types of amputations are very painful because there are a lot of nerves in the area. They also tend to bleed quite a lot due to a rich blood supply. When an amputation happens, you should elevate the stump and cover the wound with a sterile dry dressing. Apply pressure if needed. If there is a part of the finger that is cut off, it should be wrapped in a moist sterile gauze and placed in a baggie. You should then place the baggie in some ice water. Don’t put the amputated part directly on ice and do not use dry ice to keep the amputated part cold.

At the hospital, the doctor will likely do a digital block to numb the finger. The wound will be flushed out completely with any devitalized tissue trimmed off. If the amputated finger is vital enough to be reattached, it is reattached to the stump. If the finger has taken too long to be reattached, approximately 16 hours or more, then the stump will be closed with skin and the finger will be considered an amputated finger. Because there is a high chance of infection, preventative antibiotics are given to keep the wound free of infection.

Gallbladder Injuries in Traffic Accidents

Gallbladder Injuries in Traffic Accidents

Blunt trauma to the abdomen is not uncommon in traffic accidents. This type of blunt trauma can lead to injuries to a solid organ, such as the pancreas, liver, and spleen. These injuries can cause severe internal bleeding and death. Some solid organ fractures can be treated conservatively, while others need surgery to correct the bleeding and repair or remove the traumatized organ.

There can also be a ruptured viscus as part of the blunt trauma. A ruptured viscus generally involves leakage of bowel or intestinal contents into the peritoneal space. This often means bacterial contamination of the peritoneal space and secondary peritonitis. This can be fatal if not recognized and treated early enough. The gallbladder is considered a viscus, too, and can cause caustic bile to enter the peritoneum if compromised.

Pelvic fractures are not uncommon in motor vehicle accidents. Because of the size and nature of these fractures, hemorrhages are likely to happen and these can be fatal. Arterial hemorrhages are the worst injuries from this type of fracture because bleeding can be substantial.

CT scanning can be done to highlight the areas of bleeding and to visualize the fracture. If a pelvic arterial hemorrhage is detected, the doctor can go ahead with an angiographic embolization procedure that clots off the bleeding artery, therefore saving the life of the patient. Contrast material is injected into the pelvic arteries and veins. When the contrast material is seen to extravasate or bleed through the vessel, this is the area that needs to be embolized.

Pelvic hemorrhages can be very dangerous in car accident cases. This type of bleeding causes half of all fatalities in patients with pelvic fractures. In one study, 236 patients were treated following motor vehicle accidents in which they sustained a pelvic fracture. In this study, the average age of patients was 31.5 years. The group was comprised of 2/3 men and 1/3 women. The average Injury Severity Score was 21.3 and, on average, patients required approximately 5 units of blood. A hospital stay averaged almost 17 days.