Complex Regional Pain Syndrome
Complex Regional Pain Syndrome, formally known as Reflex Sympathetic Dystrophy was first documented by Silas Weir Mitchell in his work involving wounded Civil War soldiers. In 1993 the International Association for the Study of Pain (IASP) changed the name of the condition to complex regional pain syndrome (CRPS). CRPS appears as Type 1 and Type 2. CRPS Type 2 results from an ascertainable major nerve injury. CRPS Type 1 arises from injuries to minute, peripheral nerves.
There are no diagnostic tests which are absolutely determinative of the existence or non-existence of Complex Regional Pain Syndrome. It is a diagnosis which must be made by clinical examination, based on reports of symptoms by the patient and finding of certain signs by the medical examiner. Positive results of certain diagnostic tests, such as a triple phase bone scan may support a clinical diagnosis of CRPS, but a negative test result does not rule out CRPS.
CRPS usually begins in the hand or foot. There is medical evidence that CRPS can spread to other limbs and other areas of the body in a non-dermatomal fashion. That is, not following the motor nerve pathways.
CRPS is most often described as a severe, constant pain which may be burning, freezing, or may actually feel like burning and freezing simultaneously, and stabbing pain. The affected area may be extremely painful to even light touch, with non-painful stimuli causing pain (allodynia) and a mildly painful stimulus (such as pin prick) may be sensed as excessively painful (hyperalgesia). Injuries causing complex regional pain syndrome do not have to be severe. CRPS may result from minor injuries such as sprains, fractures, casting, or a period of immobility of the affected limb.
It is characterized by continuing pain which is disproportionate to any inciting event, which may be accompanied by hyperesthesia, allodynia, temperature asymmetry, skin color changes, skin color asymmetry, swelling, sweating changes, sweating asymmetry, decreased range of motion, weakness, tremor, or dystonia of the affected limb, and changes in hair, nails, and skin of the affected area. For a diagnosis of CRPS, there must be no other medical condition which better explains the signs and symptoms.
CRPS is a condition which is usually permanent. Treatment of CRPS consists of medications, physical therapy, spinal stimulator implants, surgical insertion of a morphine pump, infusion of Ketamine and other medication, and sympathectomy or removal of a nerve ganglion. There is no known cure for the condition, and it is usually permanent. CRPS is a devastating, life changing condition. It frequently results in long term or permanent disability, disrupts marriages and families, and has been known to result in suicide of those who suffer this horribly painful condition.
Mr. Shisler has successfully represented clients who suffer from CRPS in automobile collision, slip and fall, product liability and workers’ compensation cases. He regularly teaches other attorneys how to represent plaintiffs in CRPS cases and is a nationally known authority on CRPS, having experienced the condition himself. He is well versed in the diagnostic criteria and treatment of CRPS and frequently co-counsels with attorneys throughout the country in CRPS cases.
Traumatic Brain Injuries
A traumatic brain injury occurs when an external mechanical force causes brain dysfunction. Traumatic brain injuries range from mild to severe. Symptoms may include loss of consciousness, headache, blurred vision, ringing in the ears, memory or concentration problems, mood swings, depression, anxiety, convulsions, seizures, loss of coordination, cognitive dysfunction, confusion, speech difficulties, and coma.
Mr. Shisler has successfully represented patients with mild, moderate, and severe traumatic brain injuries, caused by motor vehicle collisions, defective products, work related injuries, birth injuries, and gunshot injuries.
While there are many causes of spinal injuries, they often result from motor vehicle collisions, sports injuries, falls, work related incidents, and physical assault. There are two kinds of injuries to the spinal cord, complete and incomplete. In a complete spinal cord injury, the person loses all ability to feel and voluntarily move below the level of the injury. In an incomplete spinal injury, there is some function of the injured area.
Complete spinal cord injury at the cervical spine, the thoracic spine, the neck, results in quadriplegia, or paralysis from the area of the spinal cord injury down. Paraplegia results from a complete injury to the spinal cord at an area of the lower thoracic or lumbar spine.
Herniated disks occur when the outer portion of a disk between the spinal vertebrae is torn, enabling the nucleus or inner portion to herniate. A spinal disk is similar to a jelly donut with a softer center encased within a tougher exterior. When a disk herniates, the “donut” exterior tears, and the jelly, protrudes out of the “donut”. Herniated disks become painful when the extruded nucleus impinges upon nerves causing pain, numbness and weakness in an arm or leg.
While many people who suffer from a herniated disk experience little or no pain, some experience excruciating pain and require a discectomy, surgical removal of the herniated disk which is causing pressure on a nerve or nerve root. In some cases the entire disk is removed and in other cases a portion of the disk is removed. In some cases the surgeon will remove the disk by making an incision in the patients back or neck where in other cases a less invasive procedure may be used, a microdiscectomy. Other procedures for herniated disks include a laminotomy or laminectomy. In a laminotomy, a surgeon makes an opening in the vertebral arch or lamina to relieve pressure on the nerve roots. If necessary, the lamina is removed in a laminectomy. A spinal fusion may be necessary, where two or more vertebra are permanently fused together, and/or screws and rods may be inserted to provide additional support. Artificial disk surgery may be used to replace a damaged disk with an artificial disk made from plastic and metal.
Mr. Shisler has successfully represented paraplegic clients who were injured in motor vehicle accidents. He has also represented clients who suffered herniated disks from motor vehicle accidents, slip and falls, and work related incidents.
Other Nerve Injuries
The peripheral nervous system is a network of nerves that connect the brain and spinal cord to the entire human body.
Some of the more commonly injured peripheral nerves are the brachial plexus, the network of nerves exiting the spine at cervical vertebra C-5 through C-8 and the first thoracic (T-1) vertebra. These nerves control motion and feeling in the arms.
Brachial plexus injuries often occur in child birth, motorcycle collisions, and falls where the arm is outstretched. If there is root avulsion, the nerve root is torn from the spinal cord and cannot be repaired, resulting in permanent paralysis of the area of the arm which is innervated or controlled by that nerve. Where the nerve of the brachial plexus is peripherally torn or stretched but not torn from the spinal cord, the nerve may heal.
Branches of the brachial plexus include the median nerve, radial nerve, and ulnar nerve. These nerves may also be damaged by being cut or resected during surgery, such as carpal tunnel surgery, or injury may result in carpal tunnel syndrome, a painful neurological condition which can result from an accident or from repetitive motion such as a work related injury. Ulnar nerve injury may result from laceration or may result from nerve entrapment at the elbow or cubital tunnel syndrome from accidents. Injuries to the radial nerve of the arm may also occur from collisions, repetitive motions, and falls, and may cause radial tunnel syndrome, a stabbing pain at the top of the forearm or back of the hand. Cubital tunnel syndrome is also known as ulnar neuropathy. Neuropathy is a dysfunction of one or more peripheral nerves, usually causing numbness or weakness. It may be caused by physical trauma, repetitive motion injury, infection, and exposure to chemicals. Neuropathy, with or without sympathetic nervous system involvement, can occur from electric shocks.
The sciatic nerve extends from the back of the pelvis down the back of the thigh and is the primary nerve of the leg, and innervates the muscles in the hip and legs. Injuries to the sciatic nerve often occur from motor vehicle collisions, herniated disks, and falls.
Mr. Shisler has successfully represented clients who suffered brachial plexus injuries from birth complications, motor vehicle collisions, and falls. He suffered a severe brachial plexus injury as well as complex regional pain syndrome as a result of a motor vehicle accident in which he was involved during his college years. He has also represented numerous clients who suffer from herniated disks, carpal tunnel syndrome, cubital tunnel syndrome, and neuropathy as a result of motor vehicle collisions, falls, work related injuries, electrical shocks, medical malpractice, and improper needle sticks and blood draws.
Other Serious Injuries
Mr. Shisler has successfully represented clients with other serious injuries, including but not limited to, wrongful death, traumatic amputations, facial disfigurement, brain injuries, crush injuries, compartment syndrome and other peripheral nerve injuries, de-gloving injuries, knee injuries involving torn ligaments and cartilage, shoulder injuries involving rotator cuff tears and tears of other muscles, ligaments and tendons, various fractures, and many other serious and severe injuries, caused by defective machines, lawn tractor and golf course equipment rollovers, injections, needle sticks, and blood draws, as a result of motor vehicle collisions, from falls, work incidents, and medical malpractice.
Mr. Shisler has numerous medical experts who regularly work with him in evaluating cases, providing medical reports and medical testimony. He also has engineers of all types with whom he regularly works in evaluating cases, providing reports, and testifying in product liability cases, slip and falls, and motor vehicle accident cases.
Citations for above content available upon request.
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