Grazian & Volpe Law Firm News

Rear-End Auto Crashes: Post-Traumatic Cervicogenic Headaches

In a rear-end auto collision, whiplash, or an acceleration flexion-extension neck injury, often occurs as a result of the forces acting on the body. While a properly set headrest can minimize incidences of whiplash, most drivers (approx. 90%) don’t have their headrest in the right position: the headrest is best set so that the top of the headrest is above the driver’s ears with less than four inches (4”) between the back of the head and the headrest. Failure to properly set one’s headrest can increase the risk of whiplash by up to six fold.

rear-end-car-accident

Whiplash usually leads to cervical strain or cervical sprain, but it may take days or even weeks until you begin to feel the effects of a rear-end collision. Moreover, headaches themselves are common secondary injuries in car crashes, especially rear-end crashes that involve whiplash. Yet a headache can have more than 300 differential diagnoses. A cervicogenic headache is but one of many chronic headaches, and, while it is a common one, it is often misdiagnosed.

The attorneys at the law firm of Grazian & Volpe have handled hundreds of auto crash cases and understand the medicine related to post-traumatic cervicogenic headaches. In this Blog, which is part of a series on spinal injuries caused by auto accidents, we shall explain what a cervicogenic headache is, how a cervicogenic headache is diagnosed, and what is done to treat a cervicogenic headache.

Post-Traumatic Cervicogenic Headaches

The neck, also called the cervical spine, consists of seven (7) vertebrae, labelled C1 through C7; their corresponding cervical nerves; and muscles and ligaments. Of those seven vertebrae, C1, also known as the atlas, connects the skull to the spine; C2, the axis, allows for rotation of the head; and C7 connects the neck to the upper back (the thoracic spine) at the shoulder level. When whiplash occurs, it is the cervical region of the spine that usually becomes injured.

A cervicogenic headache is a secondary headache, meaning it is a result of another injury, such as cervical osteoarthritis (spondylosis), a damaged disc, or whiplash resulting in the irritation or compression of a cervical nerve. At times, the symptoms associated with a cervicogenic headache may mimic that of a migraine. At first, the pain may be only intermittent; but then it often spreads to one side of the head (unilateral) and may become continuous. Additionally, cervicogenic headaches can be exacerbated by certain neck positions or neck movements. Cervical nerves C1, C2, or C3 is often where the underlying injury exists in cervicogenic headache cases because these nerves enable movement and sensation of the head and neck.

Signs and Symptoms of Cervicogenic Headaches

The International Headache Society (IHS) defines a cervicogenic headache as:

  1. Pain, referred from a source in the neck and perceived in one or more portions of the head and/or face, fulfilling paragraphs C and D below.
  2. Clinical, laboratory and/or imaging evidence of a disorder or lesion within the cervical spine or soft tissues of the neck known to be, or generally accepted as, a valid cause of headache.
  3. Evidence that the pain can be attributed to the neck disorder or lesion based on at least one of the following:
    1. demonstration of clinical signs that implicate a source of pain in the neck;
    2. abolition of a headache following diagnostic blockade of the cervical structure or its nerve supply using placebo- or other adequate controls.
  4. Pain resolves within three (3) months after successful treatment of the causative disorder or lesion¹

Other symptoms may include:

  • Stiffness in neck
  • Nausea and/or vomiting
  • Dizziness
  • Blurred vision
  • Sensitivity to light or sound
  • Pain in one or both arms
  • Mobility difficulties

Diagnosis of Cervicogenic Headaches

Cervicogenic headaches can be diagnosed by x-ray, MRI, and CT scan. However, these tests are not necessarily conclusive. The only dispositive diagnostic test for cervicogenic headaches is the use of nerve block injections.

In a nerve block injection, an injection is made into the medial branches of the nerves that supply the cervical facet joints (learn more about facet joints and facet joint injuries in our previous blog, here). If the headache is a cervicogenic headache, then the injection should bring immediate relief to the patient’s pain, thus confirming the diagnosis.

Long Term Treatment of Cervicogenic Headaches

Treatment of cervicogenic headaches usually begins with over-the-counter non-steroidal anti-inflammatory medications, such as aspirin, then moving on to a prescription anti-inflammation and/or pain reliever if not effective. Other treatments include trigger point injections, facet joint blocks, nerve blocks, radiofrequency pulse ganglionotomy, and, rarely, spine surgery.

The good news, however, is that, according to one study, incidences of cervicogenic headaches decreased to almost none after one year from the date of onset and that a full recovery is expected in most cases.

If you have suffered from neck or headache pain due to someone’s negligence, getting an accurate diagnosis of your injuries is crucial. It is important to be informed and to utilize qualified medical professionals and experienced personal injury lawyers to help you fully recover. Call attorney Kurt D. Lloyd of Grazian & Volpe today at 773.838.8100, or fill out our online form for a free consultation.


The above article was written by Kurt D. Lloyd of Grazian & Volpe. Kurt Lloyd has been practicing personal injury law in the Chicagoland area for over 30 years and has helped his clients win more than $355 million in jury verdicts and settlements from insurance companies and corporations. Kurt helps his injured clients regain their lives after injury. The information provided comes from his extensive legal and medical research and years of experience trying injury cases in courtrooms throughout Illinois.

¹ Maja Stupar, BSc, DC and Peter SY Kim, BSc, DC, FCCS(C). Delayed-onset post-traumatic headache after a motor vehicle collision: a case report. The Journal of the Canadian Chiropractic Association. 2007 Jun; 51(2): 83–90.

 

Rear-End Auto Crashes: Traumatic Facet Joint Injuries

In a rear-end auto collision, spinal injuries of the neck and back often occur. A traumatic facet joint injury to the spine as a result of a rear-end auto crash is a common injury. Facet joint injuries are an “invisible” injury. A traumatic facet joint injury is usually not seen on X-rays and MRI imaging studies.

The attorneys at the law firm of Grazian & Volpe have handled hundreds of auto crash cases and understand the medicine related to a facet joint injury in the spine. In this Blog, which is part of a series on spinal injuries caused by auto accidents, we shall explain what a facet joint injury is, how a facet joint injury is diagnosed, and what is done to treat a facet joint injury.


Facet Joints

The facet joints help stabilize our spine, holding the spinal column in place and preventing excessive rotation (twisting) and flexion or extension (bending) of the spine.

Facet joints also prevent rotation of the vertebral column to a great degree. In addition, facet joints are necessary to prevent spondylolisthesis, which is forward slippage of one vertebra upon another. When this injury happens, the spinal canal gets compromised and there can be problems with pinching of the spinal cord.

Traumatic Injury to the Facet Joints

In an auto collision, the sudden impact can produce mechanical forces to the body that cause violent flexion-extension (“whiplash”) of the cervical spine or neck. See Image No. 1 below. This is also medically known as cervical acceleration-deceleration syndrome. This sudden force is transferred to the facet joints which attempt to maintain stability of the spinal vertebrae during whiplash by preventing the spine from excessively bending forward or backward. However, the facet joint can be abruptly injured by dislocation of the joint or from tearing or inflammation to the cartilage in the facet joint.

Image No. 1 Flexion-Extension X-Ray images

Image No. 1 Flexion-Extension X-Ray images

Signs and Symptoms of Facet Joint Injuries

  • Acute onset of neck, mid or low back or pain.
  • Palpable tenderness directly over the facet joints and reduced range of motion and muscle spasms.
  • In the neck, pain increases when extending backward and improves when flexing forward.
  • In the low back, pain can radiate or extend from the back to the buttocks; pain is present when standing but increases with sitting.
  • In the neck, the pain can radiate or extend from the neck onto the top of shoulders and upper shoulder blades.
  • The pain and restricted motion are recurrent and ongoing.

Diagnosis of Facet Joint Injuries

A CT-scan at the spinal level involved is the imaging study of choice for a clinically suspected facet joint injury. However, a CT-scan is only sensitive for diagnosis of damage to the facet joint fifty percent (50%) of the time.

The best diagnostic method for facet joint injuries is a medial branch block procedure. The medial branch nerves supply sensation and enervation to the facet joints. During a medial branch block procedure, an anesthetic is injected in the spine near the small medial nerves connected to a specific facet joint.¹

If the facet joint or joints targeted in the block procedure are causing the pain, then a patient will obtain relief from the medial branch nerve block; and if the facet joint is not causing the pain, then a patient will not obtain pain relief. This is what makes the procedure diagnostic for facet joint injuries. See Image No. 2 below.

Image No. 2 Medial Branch Block procedure. Needle injection of corticosteroid to nerve.

Image No. 2 Medial Branch Block procedure. Needle injection of corticosteroid to nerve.

Usually, a medial branch block is performed on two different dates, months apart, to confirm the diagnosis.


¹ Cohen SP, Moon JY, Brummett CM, White RL, Larkin TM. Medial Branch Blocks or Intra-Articular Injections as a Prognostic Tool Before Lumbar Facet Radiofrequency Denervation. Regional Anesthesia and Pain Medicine. 2015;40(4):376-383.

https://pubmed.ncbi.nlm.nih.gov/26066382/


Long Term Treatment of Facet Joint Injuries

A procedure known as radiofrequency ablation (“RFA”) is used to treat a facet joint injury and obtain long term relief. An RFA is a minimally invasive procedure that reorganizes and modulates the nerve fibers carrying pain signals to the brain. In a radiofrequency ablation procedure, also called a rhizotomy, a probe is placed in the spine under x-ray guidance, and heat wave energy is delivered to the affected nerves. The waves “ablate,” or burn, the nerves that are causing the pain, thereby stopping pain signals from traveling along the nerves to the brain.

If you have suffered from back or neck pain due to someone’s negligence, getting an accurate diagnosis of your injuries is crucial. It is important to be informed and to utilize qualified medical professionals and experienced personal injury lawyers to help you fully recover. Call attorney Kurt D. Lloyd at Grazian & Volpe today at 773.838.8100, or fill out our online form for a free consultation.


The above article was written by Kurt D. Lloyd of Grazian & Volpe. Kurt Lloyd has been practicing personal injury law in the Chicagoland area for over 30 years and has helped his clients win more than $355 million in jury verdicts and settlements from insurance companies and corporations. Kurt helps his injured clients regain their lives after injury. The information provided comes from his extensive legal and medical research and years of experience trying injury cases in courtrooms throughout Illinois.

Spinal Injuries in Auto Crashes: Herniated Disc Injuries

In rear-end auto crashes, spinal injuries of the neck and back often occur. A herniated disc of the spine from a rear-end auto crash is a common injury. But a herniated disc injury is usually not diagnosed by your physician for many months, despite ongoing pain, numbness and tingling in your neck, back, arms or legs.

The attorneys at the law firm of Grazian & Volpe have handled hundreds of auto crash cases and understand the medicine related to a herniated disc injury. In this Blog—the first in a series on spinal injuries caused by auto accidents—we shall explain what a herniated disc injury is and how a herniated disc injury is eventually diagnosed.

A new, acute herniated disc in the spine is usually not seen on imaging studies immediately after a rear-end auto collision. In fact, the diagnostic features of a herniated disc which are found on a magnetic resonance imaging study (“MRI”) actually take time to develop in the spine before the MRI will be positive.

This phenomenon holds true even though you may have symptoms consistent with a herniated disc injury in the hospital Emergency Department immediately after an auto collision. Indeed, in the Emergency Department immediately after the car crash, the X-rays of the neck or back are usually negative, even though an MRI study of spine turns out positive for an acute herniated disc several months later.

Our attorneys understand the biomechanical processes that cause a herniated disc. In a rear-end car crash, the mechanical forces acting on your body can result in an abnormal flexion-extension of your spine. When this happens, one of the spinal discs between two of your vertebra can become herniated, that is, the impact forced “disc material beyond the limits of the intervertebral disc space.”* Our spinal discs are made up of two parts: the outer, fibrous part known as the annulus or annular ring; and the inner part, which is a jelly-like nucleus that absorbs shocks to the spine. Think of your discs as if they were jelly donuts which act as the shock absorbers of your spine.

When a herniated disc occurs, what happens is that the mechanical forces from the rear-end car impact tear the annulus (the outer wall of the donut) and some of the jelly-like nucleus pushes or extrudes into vertebral space. The resulting disc protrusion often irritates a nearby spinal nerve causing signs and symptoms of numbness, tingling, discomfort and pain.

MRI showing herniated disc

MRI showing herniated disc.

The MRI study of the cervical, thoracic or lumbar spine performed at the right time can be the gold standard for diagnosing an acute herniated disc ninety-two percent (92%) of the time. An MRI study involves radio waves, a magnetic field and a computer to create image of the spine and surrounding tissues. Our attorneys know how to read and review MRI images from a legal point of view. If your attorney does not understand how an MRI is read and interpreted, then you can lose your case.

Winning your case starts and stops with understanding the MRI results; what demonstrates an acute disc injury versus a chronic disc disease. A bright signal or “lucency” found on the T2 weighted images of disc on the MRI study proves relative acuteness from a rear-end auto collision. In older patients who have suffered from a rear-end auto injury, the presence of this bright signal can prove a new disc injury which is superimposed over a naturally aging spine. What the defense attorneys and defense experts like to do is call it degenerative disc disease of the spinal discs and blame that as the cause of numbness, tingling, discomfort and pain after a car crash, even though you were asymptomatic for a disc injury before the impact.

That’s why you need a good attorney.

At Grazian & Volpe, our years of experience spine injuries have given us the knowledge and skills to help our clients win their cases and recover the money they need to get on with their lives. After an auto accident, if you have low back pain, neck pain, or numbness, tingling in your arms, hands, legs or feet then you may a herniated disc or other disc injury. Call us at 773.838.8100, email us at Attorney@GrazianVolpe.com or fill out our online contact form for a free consultation. We can help you.


* Fardon, D., “Lumbar Disc Nomenclature: Version 2.0Recommendations of the Combined Task Forces of the North American Spine Society, the American Society of Spine Radiology, and the American Society of Neuroradiology,” Spine: November 15, 2014 – Volume 39 – Issue 24 – p E1448-E1465.


 

WORKPLACE INJURIES FROM COVID-19 IN ILLINOIS

Covid-19 work injuries The spread of COVID-19 across Illinois has resulted in many work-related infection claims. If you have been diagnosed with COVID-19 that was related to your workplace conditions, you can pursue a potentially compensable claim under the Illinois Occupational Diseases Act.

The employer’s defense to an alleged work-related COVID-19 claim likely will be that there was no greater risk of infection to the worker at the workplace than there is to the general public. But from news reports and health agency investigations, we know that certain workplace occupations and industries (for example, meat packers) do face exposure to a greater risk than the rest of the general public.

For the protection of workers, the Illinois Occupational Diseases Act provides:

“A disease shall be deemed to arise out of the employment if there is apparent to the rational mind, upon consideration of all the circumstances, a causal connection between the conditions under which the work is performed and the occupational disease. The disease need not to have been foreseen or expected but after its contraction it must be apparent to have had its origin or aggravation in a risk connected with the employment to have flowed from that source as a rational consequence.” 820 ILCS 310/1(d).

But the Illinois Occupational Disease statute does not require direct proof of causation.  Sperling v. Industrial Commission, 129 Ill.2d.416, 421, (1989). A worker’s medical expert opinion that an accident “could have” or “might have” caused an injury may be sufficient. Also, a chain of events suggesting a causal connection may suffice to prove causation. Consolidation Coal Co. v. Industrial Commission, 265 Ill.App.3d 830, 839 (1994).

Here at Grazian & Volpe, we’ve already begun receiving clients with workplace transmissions of COVID-19. If you believe you were infected with COVID-19 in your workplace, we know what to do and we’re here to help you. Contact us by phone at 773.838.8100 or fill out our online form to schedule your free initial consultation with an experienced attorney.

Welcome to our Chicago Injury Law Blog

Things change fast in the legal world. Every day, state legislatures and judges make hundreds of decisions that impact the way cases are prepared and presented for court. At Grazian & Volpe, we know how important it is to stay current with legal issues. We follow the legal stories that will have an impact on the strategies we use while protecting your rights.

We also know that keeping you informed about the legal process will help you make better decisions about your own case. This Blog page is intended to serve as a forum for discussing case law and relevant court decisions in the legal areas of motor vehicle accidents, work injuries and workers’ compensation, and premises liability cases. Periodically, we will update the information and Blog topics, so please return often to see our most current post and comments.

Our firm has always placed an emphasis on personalized attention and responsiveness to our clients’ concerns. Your input means a lot to us and we take your comments seriously. We invite your feedback about this and future Blog posts on this page. Thank you for visiting. Call us at 773-838-8100 or contact us by e-mail to discuss your specific legal need today.