05/30/2013 // Concord, CA, USA // LifeCare123 // Greg Vigna, MD, JD, Joe Motta, JD // (press release)

Medical Perspective

One percent of all patients admitted to acute hospitals with multiple traumatic injuries have a brachial plexus injury. Associated injuries include fracture and dislocation of the shoulder, cervical spinal cord injuries, traumatic brain injury, and internal thoracic injuries including rib fractures.

The brachial plexus is a network of nerves that combine from the fifth cervical nerve root to the first thoracic nerve root to provide essential functions to the shoulder, arm, and hand. These injuries are most commonly seen in young males and cause devastating neurologic deficits that cause life-long disabilities. The deep muscles of the neck and the clavicle protect the brachial plexus, but when injured by blunt trauma, lacerations, direct pressure by hematomas, or stretch injuries, the results can be tragic. Stretch injuries are the most common injury to the brachial plexus and occur when the shoulder is pressed down, while at the same time, the head is pushed up and away from the shoulder. This stretching of the nerves of the plexus can cause damage to the network of nerves or in the most severe form, cause the nerves to be torn.

Brachial plexus injury may involve the portion below the clavicle (infraclavicular) or above the clavicle (supraclavicular). There may be an associated nerve root avulsion where the nerves are pulled away from the spinal cord where they emerge. Nearly two thirds of brachial plexus injuries are supraclavicular, which are typically more severe than infraclavicular injuries. Supraclavicular plexus injuries require surgical exploration in nearly half of the cases. In contrast, infraclavicular injuries required surgical intervention in only 17 percent of cases.

Proper management requires a multidisciplinary approach, which often includes a team of physicians including neurosurgeons, plastic surgeons, orthopedic surgeons, neurologists, and physiatrists. Intraoperative nerve testing is essential for the surgical management of these patients. Allied health care professionals including physical and occupational therapist, psychological services, and catastrophic case managers are essential to the success of the multidisciplinary approach.

State of the art brachial plexus management is only available at a handful of centers in this country, so access to care is limited. Also, patients who have injuries to the brachial plexus, will often have additional bodily injuries requiring additional rehabilitation and hospitalization. Making things more challenging for survivors and caregivers of brachial plexus injuries, are studies that suggest a delay in surgical exploration and repair of more than four months, leads to a decreased potential for recovery.

Life Care Planner Perspective:

A properly constructed life care plan will serve as a guide for the future medical, rehabilitation, vocational, and day to day needs of a catastrophically injured patient for the life of the patient. One of the life care planner’s roles is to be an educator; an objective evaluator of the present and future needs of the patient who cannot be influenced by limits of insurance and who provides a guide that is medically necessary and appropriate for the patient. Brachial plexus injuries are generally seen in young men in their working ages; vocational rehabilitation services will be necessary for education and job training. Psychological interventions may be necessary on an ongoing basis to monitor for depression and assist with psychosocial stress and post-traumatic stress disorder. Brachial plexus patients’ needs are diverse and complex. The present and future needs should be based on clinical interviews of the patient and family, a comprehensive review of the medical records, a psychological assessment (in some, not all cases), and communications with the treating physicians and other medical providers. Utilizing this information, the life care planner will follow specific methodologies based on published standards that are subject to peer review to devise a comprehensive plan. A proper life care plan should provide a road map for the care of these patients to maximize function, reduce or eliminate complications, and improve the individual’s quality of life going forward.

Attorney Perspective:

Damages awards in brachial plexus patients have ranged from very little to significant. Several factors are the driving factors, including the permanence of injury, the needs for future care and loss of wages/lost earning capacity. Past and future economic damages (lost wages, medical expenses, medical care) and past and future noneconomic damages (pain and suffering) need to be carefully mapped out by a qualified team of litigators who have experience helping catastrophically injured clients. Future medical needs and future economic losses can be a major component of a damages award when person suffers a brachial plexus injury caused by the carelessness (negligence) or wrongdoing of another. There is often a significant vocational impact on these patients which will be a significant factor in determining wage loss or loss of earning capacity. A vocational counselor will address these factors in detail in well-designed life care plan and serve as evidence when proving a client’s damages.

An attorney experienced with helping seriously injured clients must be proficient in establishing the medical foundation for future needs related to a catastrophic injury in order for a patient to receive a full and fair outcome. Failure to take into account costs related to chronic pain, future medical needs, and future care costs, especially as the patient ages with a disability, will lead to an inadequate and unjust result. Pain and suffering can include, “physical pain, mental suffering, loss of enjoyment of life, disfigurement, physical impairment, inconvenience, grief, anxiety, humiliation, and emotional distress.” An attorney must provide evidence of pain and suffering by way of testimony of the patient, care providers, and loved ones like family members and friends, to paint a before and after picture so that the client receives for fair and just compensation for her or his injuries.

Source: San Francisco Serious injury lawyers of LifeCare123.com

Media Information:

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