Category Archives: Car Accident Disc Injuries

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Pain After Car Accident Delayed?

pain after car accident delayed

Can There Be a Delay in Car Accident Symptoms and What to do About Late Appearing Car Accident Injuries?

The typical scenario after a car accident is to feel neck or back soreness and tightness, headaches and other symptoms within a day or two of the accident. However, not all injuries show up so soon. The medical literature points out that a delay in symptoms of days, weeks and even months can occur.

What Causes a Delay in Symptoms After a Car Accident?
There are a couple of factors at play that may contribute to a delayed onset.

Initial Shock

There is an initial “shock” response you suffer after an accident in which your body releases endorphins which numbs your senses. This may last 1-2 days after a trauma masking your injuries.

Minimizing Behaviors

Willful disbelief can occur in which due to a collision that does not appear to be “that bad” because vehicle damage is low, or the impact was perceived to be a slow speed, you simply cannot believe you could be hurt and therefore minimize your pain or blame it on “sleeping wrong,” exercise or “coming down with the flu.” It isn’t until the pain persists and is undeniable that you allow yourself to accept and experience the pain and seek attention.

Similarly, if you suffer relatively mild symptoms, you may put off seeing a doctor until weeks or months later when you realize it just isn’t going away. By the time you report it, an inexperienced doctor may write in your file that is was a delayed onset when in fact it presented right away, you just delayed treatment.

Multiple Injuries

Multiple injured areas with high intensity levels of pain may mask other, lesser, injured areas. Your brain can only keep track of so many injuries and give priorities to the ones that cause the most immediate pain. Therefore you could have a neck injury that shoots severe pain down your arm that masks the fact that your knee is mildly injured. As your neck and arm pain begin to subside, your brain now allows you to “feel” the knee pain. You may believe it just started, but the injury could have been there all along unknown to you.

Gradual Progressing Injuries

Some injuries are like a slowly deflating tire. Car accident injuries to the discs between your spinal bones can occur, but take a while to show up. The outer fibers of the disc become torn or cracked which may not initially be painful, but in time inflammation increases and symptoms appear. Additionally, the inner gel like substance of your disc can slowly begin migrating through the cracks in the outer fibers until it reaches the nerves and causes pain. Like air gradually escaping a tire, the disc slowly malfunctions leaking pressure and gel until it is noticeable.

“Dashboard knee” is another commonly delayed injury. Your knee may fly up and strike the dashboard on impact. The force crushes the cartilage underneath the knee cap, but not cause immediate symptoms. After a couple of weeks inflammation eventually causes you to feel the pain. In other cases, the inflammation never reached a noticeable level, but because of the injury the cartilage begins trio break down and deteriorate and then you feel it. This could take several months to occur.

What to Do About Pain Delayed After a Car Accident?

It’s vital to report all symptoms and changes in symptoms to your doctor. Do not assume a slight change or little ache or pain is irrelevant, sometimes they are, but sometimes they are a clue to an injury that was previously hidden. An experienced car accident doctor will understand this and be able to determine if it is related to the accident or not.

If you’ve struck your head, elbow or knee in the collision, report it to the doctor even if they do not hurt, as these are common places to show a delayed injury.

Late appearing car accident injuries are not uncommon. There are many reasons for them and they may confuse you and insurance companies into thinking they are not related to your collision. A true car accident specialist doctor will know how to decide if they are related and plan appropriately for treatment.

It is Always Best to Be Evaluated by a Doctor Specializing in Car Accident Injuries as Soon as Possible After a Car Accident. Hidden Injuries May Be Found and Treated before They Become a Problem. Orange County Car Accident Doctor Barry Marks, DC Serving OC Car Accident Injury Specialist Since 1986.

Call for an Evaluation Today (714) 938-0575

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How to Tell If Disc Problems Found After a Car Accident Are Traumatic or Degenerative

This is not a neuroradiological treatise on disc pathology from trauma. This is an overview to make a difficult topic more understandable to treating physicians, insurance adjusters and personal injury attorneys.

The Dilemma of Disc Pathology

A dilemma facing doctors and personal injury attorneys is whether or not a disc problem is caused by the motor vehicle collision in question or is degenerative and therefore not related to the accident. This single fact can make a huge difference in the case. Obviously, the defendants (the insurance company) will want a radiologist to say the disc problem is old and degenerative and predated the collision to escape responsibility. The Plaintiff on the other hand will want the disc condition to be ruled traumatic in origin and caused by the accident to increase the value of their claim.

The Arbiter of Truth

This is where the treating doctor must make a purely clinical decision and report to each side the facts of the matter. The treating doctor must be the arbiter of truth. Medical ethics insists that a treating physician look at the medical facts and report them regardless what that means to a case. The rub of the matter is, and defense experts and insurers will not like this, but it is a fact, studies have shown that approximately 70% of disc lesions found after a car accident were in fact traumatic herniations. Therefore, a plaintiff attorneys should not fear an impartial and ethical treating doctor. After all, the odds are in their favor. The defense must take solace in the fact that they will get their way 30% of the time.

Disc Pathology: Bulge vs Herniation

(American Society of NeuroRadiologists definitions are used)lumbar-disc-normal-labeled

 

Disc Bulge: bulging or extension of 50% or more of the annular disc tissue beyond the normal disc margin boundaries.lumbar disc bulge

A disc bulge or a degenerative disc is a condition in which due to long standing pressure, activities, obesity, aging, etc the fibers in the outer disc layers lose integrity and begin to spread and expand. The disc ends up bulging out in every direction. Imagine a water balloon and you sit on it. The balloon will “bulge” outward all around. This finding is a bulge and is always degenerative in nature. Disc bulges are usually 3  mm or less in depth and are often associated with abnormal bone growth (osteophytes) around he areas of bulging. Disc bulges because of their generalized size are not referred to as left or right. You will usually see terms such as “circumferential bulging” or “circumferential bulging with osteophytic ridging.”

Disc Herniation: localized extension or displacement of less than 50% of  the disc tissue beyond the normal disc marginslumbar-disc-herniation

Disc herniations, as defined, are discreet areas of disc displacement beyond the disc boundaries. Herniations are a result of trauma. Kinetic forces on the body from a traumatic force causes a significant defect within a portion of the disc and it herniates. The herniation will be seen on MRI immediately after the injury, although it may not appear as symptoms for some time. Annular tears or fissures are actually total disruption of the annulus fibers allowing the nucleus material to migrate through the annulus to the outside. Many tears are usually attributed to degenerative bulging. A solitary tear is caused by a single traumatic event. Any report that reads “left, right or central” as a location of a disc lesion is generally a herniation.

So What’s the Problem?

The problem is many fold and has to do with the expertise of the people reading and interpreting the images. A 2009 Study published in Spine, reported a 42.2% misdiagnosis rate among general radiologists reading spine films. Radiologists disagree on terminology and many use lexicon that is outdated. General radiologists who see a few spines a day or even a week may not be up to date on guidelines. Reading radiologists who do not often report on personal injury medical-legal matters may be careless with their words and write ambiguous reports or use erroneous language.

Most doctors rely on the radiology report, but by doing so will be incorrect almost half the time. Few MD’s or DC’s read their own MR scans and even fewer are actually certified to read them. Sitting in many doctor’s files and in narrative reports lawyers rely on to represent their clients are reports that are completely wrong. Reports that say “bulge” and attribute the lesion to aging, but that are in fact traumatically induced herniations. In general, if you read a report that says “bulge” but also gives a direction such as left or right, be wary. This may be a herniation that was incorrectly called a bulge.

What to Do About This Problem?

It is imperative that ALL MR films be read by both the treating doctor who is specifically trained in spine MRI AND a neuroradiologist. With both sets of trained eyes and using the same ASNR definitions and guidelines, the patient’s condition is much more likely to be accurately reported. This is a major defining point between doctors who treat personal injury cases and those that are specifically trained in these matters.