Personal Injury Updates

Information about Personal Injury in Washington State

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Monthly Archives: October 2012

Common Treatment Modalities for Facet Joint Injuries

Categories: Other Physical Injuries, Personal Injury Resources

By Melissa D. Carter. Posted on .

Almost everyone is familiar with the injury term “whiplash” as a result of spinal trauma.  What, however, is a facet joint injury, and what are the common treatment methods to reduce or alleviate the pain?

The facet (zygapophyseal) joints are the articulations or connections between the vertebraes in the spine and occur in pairs at each vertebral level. The facet joints work with the corresponding disc to link the vertebrae directly above and below to form a working unit that lends stability and weight-bearing capacity while permitting flexibility and movement of the spine.  The facet joints have a synovial lining, covered with hyaline cartilage.  These joints contain nerves, the medial branches, that transmit pain back to the spinal cord.  Injuries to the spine can inflame the facet joints, or cause the cartilaginous surfaces to wear away, causing back pain in the vicinity of the inflamed joint as the friction increases within the joint space.  On occasion, the pain is located several inches away from the inflamed joint, or even into the limbs.

Treatment of facet injuries includes physical therapy, acupuncture, spinal manipulation, massage, heat and medications to reduce pain.  Anesthetic and steroidal injections under fluoroscopic (x-ray) guidance are another common diagnostic tool that can provide very good therapeutic results in combating a facet joint injury.  Immediate alleviation of pain following a facet injection confirms the pain source.  If conservative treatment modalities provide only temporary relief, radiofrequency neurotomy can provide a longer lasting result.  Under this procedure, a radiofrequency probe deadens the small nerves that supply the facet joint to reduce pain.

A less traditional modality which can have very good results, but not always covered by insurance plans, is prolotherapy.  Prolotherapy involves repeated injections of a solution of concentrated dextrose (pharmaceutical-grade sugar water) and local anesthetic into the injured facet joint.  Prolotherapy is thought to encourage the body to naturally produce connective tissues, collagen and cartilage, in the injured area to reduce pain by stimulating the immune system to bring fibroblasts and chondroblasts to the pain area and to rejuvenate it.[1]


My Car Is “totaled” – Now What?

Categories: Auto Accidents

By Arthur D. Leritz. Posted on .

Getting in a collision is scary. In addition to getting the medical care you need, often the first task (and sometimes most daunting) is dealing with the property damage loss.  If your vehicle is “totaled” (meaning the cost of repair is more than the actual cash value of the car) then you will have to deal with an insurer to come up with a fair value for the vehicle.  Here are a few important things to remember:

  1. Insurers will value the vehicle at “fair market value” or “actual cash value.”  So, don’t take their word for it.  Do your homework and check local ads for similar vehicles in your area with similar mileage, options, condition, etc. If you think their offer is too low.
  2. If you are making a claim under your own policy and you can’t agree on a value, invoke the independent appraisal clause in your policy and get an independent appraiser to look at it.  If you are dealing with the at-fault party’s insurer, make a claim under your own policy (if you have that coverage) or you may need to consult with an attorney.
  3. The insurer also has to add in any applicable taxes, license fees and any other fees required to transfer ownership.
  4. If you just put on new tires or other accessories or items that add to the value then let the insurance company know about it.  They will likely give you credit for that – but remember it will not be dollar for dollar.  The key thing to remember is the “fair market value” of anything added to the vehicle.
  5. If you decide to keep the vehicle, the insurer will deduct the salvage value of the vehicle from the settlement amount.  You will also be issued a new title that indicates your vehicle is a salvage vehicle.

Pedestrian Safety Facts

Categories: Auto Accidents

By Jacob W. Gent. Posted on .

According to the National Highway Traffic Safety Administration, 4,378 pedestrians were killed in motor vehicle collision nationwide, with another 69,000 pedestrians injured in 2008. This averages out to one motor vehicle collision-related pedestrian death every 2 hours, and a pedestrian injury every 8 minutes.1 Pedestrians are 1.5 times more likely than passengers in a motor vehicle be killed in a motor vehicle collision on each trip.2

Pedestrians ages 65 and older accounted for 18% of all pedestrian deaths and approximately 10% of all pedestrian injuries in 2008. 1 One in five children between 5 and 9 years old killed in traffic collision was a pedestrian. 1 Alcohol-impairment, whether the driver or pedestrian, was reported in nearly half (48%) of traffic-related incidents resulting in pedestrian death. Of the pedestrians involved, 36% had a blood alcohol concentration (BAC) above the illegal limit of .08.1

Higher vehicle speeds increase the chances of a pedestrian being struck by a motor vehicle as well as injury severity.3 Most pedestrian and bicyclist deaths occur in urban areas, at non-intersection locations, and at night.1

How can pedestrians avoid being injured or killed by a motor vehicle?

  • Pedestrians should be alert at intersections, where drivers may fail to yield the right-of-way to pedestrians while turning onto another street. 1
  • Pedestrians can increase their visibility at night by carrying a flashlight and wearing light reflective clothing. 1
  • Pedestrians should cross a street at designated crosswalks whenever possible.
  • Pedestrians should always walk on a sidewalk, if present.  If no sidewalk is available, pedestrians should walk facing oncoming vehicle traffic. 1


  1. Department of Transportation (US), National Highway Traffic Safety Administration (NHTSA). Traffic Safety Facts 2008: Pedestrians. Washington (DC): NHTSA; 2008 [cited 2010 May 19].
  2. Beck LF, Dellinger AM, O=Neil ME. Motor vehicle crash injury rates by mode of travel, United States: Using exposure-based methods to quantify differences. American Journal of Epidemiology 2007;166:212B218.
  3. Rosen E, Sander U. Pedestrian fatality risk as a function of car impact speed. Acc Anal Prev 2009;41:536-542.



Post-Traumatic Stress Disorder – Causes, Symptoms and Treatment

Categories: Psychological Injury

By Arthur D. Leritz. Posted on .

Post-Traumatic Stress Disorder (PTSD) is a diagnosis frequently made for patients who have survived a serious traumatic event, but it is also a diagnosis that is greatly misunderstood.

While PTSD has been commonly associated with veterans returning home from combat zones, 8% of the general population in the United States is believed to have suffered from PTSD at some point in their lives. (1)   In comparison, 13.8% of veterans returning from Iraq and Afghanistan reportedly suffer from PTSD. (2)  Enlisted personnel are twice as likely to suffer from PTSD as officers. (3)

There is no doubt that physical trauma caused by armed conflict, assaults, motor vehicle crashes, falls, burns, or loss of a limb can, and often does, result in significant pain and emotional traumatic injury.  However, the mere presence of psychological distress related to traumatic injury does not necessarily mean the patient has post-traumatic stress disorder.

It is now accepted in the health care community based on a growing body of scientific literature that persistent and profound changes in some of the body’s physiologic systems occur in individuals with PTSD.  Researchers have found evidence of damage to the physical systems associated with PTSD such as increased sympathetic nervous system activity, alterations in stress hormones secretion, memory processing and limbic system abnormalities in brain imaging studies of traumatized patients.

In order for a psychological injury to rise to the level of a diagnosis of PTSD, it must meet all of the specific diagnostic criteria of the DSM-IV (Diagnostic and Statistical Manual — 4th edition) published by the American Psychological Association, including the following:

  • Exposure to a traumatic event in which “the person experienced, witnessed, or was confronted with . . . actual or threatened death or serious injury, or a threat to the physical integrity of self or others.” The patient must also have experienced the event with “intense fear, helplessness, or horror.”
  • The traumatic event is persistently re-experienced “by distressing recollections of the event, distressing dreams, reliving of the event, or intense psychological or physical distress at exposure to cues that remind the patient of the trauma.”
  • Persistent avoidance of stimuli associated with the trauma or “numbing” of the senses. Examples include: avoiding thoughts of the event; avoiding activities, places, or people that arouse memories of the event; inability to recall important aspects of the trauma; diminished interest or participation in life activities; feelings of detachment; reduced range of emotional expression; or a lack of a sense of future.
  • Persistent symptoms of increased arousal. Examples are: insomnia, irritability, difficulty concentrating, or an exaggerated startle response.
  • A duration of more than one month, with a disturbance in the person’s social and work life. (1)

In the area of motor vehicle crashes, there are characteristics that make for a greater risk of PTSD or related psychological symptoms, including:

  1. The event is completely out of the individual’s control, much like an unprovoked and completely unexpected physical attack.
  1. The event causing the traumatic injury involves feelings of helplessness and fear; the victim was unable to do anything to avoid or prevent it.
  1. Phobias.  Fear of driving or fear of the traumatic event’s location.
  1. Injuries can be very painful.  PTSD has been associated not only with the physical trauma of a violent event, but also arising from intense pain experienced by the patient separate from the traumatic event itself.  Prolonged and severe pain experienced immediately after a traumatic injury, but before the intervention of care, can be the traumatic experience itself leading to PTSD symptoms.
  1. Cognitive disorders can increase PTSD symptoms. Cognitive disorders following trauma are often not diagnosed early on.  This can have a very negative psychological impact on those who experience further fear, anxiety, or depression because real symptoms are not believed or validated by the treatment provider.  This can lead to the exacerbation of PTSD symptoms.

Treatment of PTSD

The most successful treatment for PTSD has been the use of cognitive-behavioral therapy, often in conjunction with medication. (5)  The medications Sertraline (Zoloft) and Paroxetine (Paxil) are Selective Serotonin Re-uptake inhibitors (SSRI) that are the first medications to have received FDA approval as indicated treatments for PTSD. (5)   In addition to cognitive-behavioral therapy and medications, group therapy is also frequently used for mildly to moderately affected PTSD patients.  (5)  In the group setting, the PTSD patient can discuss traumatic memories, PTSD symptoms, and functional deficits with others who have had similar experiences. This approach has been most successful with war Veterans, rape/incest victims, and natural disaster survivors. (5)

PTSD and Traumatic Brain Injury

PTSD and Traumatic Brain Injury (TBI) have several symptoms in common.  Among these are irritability, concentration deficits, amnesia for the causal event, reduced cognitive processing ability, and sleeping disturbances.  The overlap of symptoms of PTSD with traumatic brain injury can make diagnosing more challenging for a healthcare professional not well versed in both conditions. (6)

Treatments for PTSD, TBI and other co-morbidities are typically symptom-focused and evidence based.  For example, early data shows that the treatments that have worked well in Veterans with PTSD alone, such as cognitive processing therapy, prolonged exposure or SSRI’s, can also work well for Veterans who have suffered a mild traumatic brain injury as well as emotional trauma.  (7)  Memory aids can also be useful in this population.  Patients can also benefit from occupational rehabilitation and case management, depending on the severity of their injuries. Patient should be referred to consultants, such as neurologists, neuropsychologists, and substance abuse or other specialized treatment as needed. (7)



  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Liebowitz, Michael R, Barlow, David H., Ballenger, James C., Davidson, Johnathan, Foa, Edna, Fyer, Abby.
  2. Gradus, Jaimie L. Epidemiology of PTSD, National Center for PTSD.
  3. The History of Post Traumatic Stress Disorder,
  4. U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General—Executive Summary. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999.
  5. Friedman, Matthew J.  PTSD History and Overview, National Center for PTSD.
  6. Glaesser, al. (2004).  Posttraumatic Stress Disorder in patients with traumatic brain injury.  BMC Psychiatry. 2004; 4: 5.)
  7. Summerall, E. Lanier.  Traumatic Brain Injury and PTSD, National Center for PTSD.