Kenneth Vercammen (732) 572-0500

2053 Woodbridge Ave. Edison, NJ 08817

Ken is a NJ trial attorney who has published 130 articles in national and New Jersey publications on litigation topics. He was awarded the NJ State Bar Municipal Court Practitioner of the Year. He lectures for the Bar and handles litigation matters. He is Past Chair of the ABA Tort & Insurance Committee, GP on Personal Injury and lectured at the ABA Annual Meeting attended by 10,000 attorneys and professionals.

New clients email us evenings and weekends go to www.njlaws.com/ContactKenV.htm

Monday, July 21, 2008

Knee Injuries in Accidents

Persons who fall down or are in car accidents often do not feel pain in their knee until the next day. Testing for knee damage could include: muscle conduction tests, MRI, CT scan, and X-ray. A person concerned about a knee injury should probably consult an orthopedic doctor who can order and read most of the above tests. Kenneth Vercammen & Associates Law Office helps people injured due to the negligence of others. We provide representation throughout New Jersey. The insurance companies will not help. Don't give up! If our Law Office can provide experienced attorney representation if you are injured in an accident and suffer nerve damage.
Even in a low impact accident, there can be a knee injury. According to medical journal excerpts:

1) "The truth is that all driving can be dangerous. More than 80 percent of all car crashes occur at speeds less than 40 mph. Fatalities involving non-belted occupants of cars have been recorded at as low as 12 mph. That's about the speed you'd be driving in a parking lot."

Seat belt safety pamphlet, number D)T HS 802 152, distributed by the U.S. Department of Transportation, National Highway Traffic Safety Administration.

2) "The amount of damage to the automobile bears little relation to the force applied to the cervical spine of the occupants. The acceleration of the occupant's head depends on the force imparted, the moment of inertia of the struck vehicle, and the amount of collapse of force dissemination by the crumpling of the vehicle. The inertia of the struck vehicle is related to the weight and the relative ease with which the vehicle rolls or moves forward."

Charles Caroll, M.D., Paul McAfee, M.D., Lee Riley, Jr., M.D.: Objective findings for diagnosis of "whiplash". Journal of Musculoskeletal Medicine, March, 1986, pp. 57-74.

3) "The accident does not need to be severe in order to generate cervical trauma. Using the brakes when the light suddenly turns red and when the neck is too relaxed is enough to cause trauma. The neck may be projected backwards even though not violently. The head, which weighs five kilograms and is balanced over the cervical spine, being supported by only two small articular surfaces no greater than a thumbnail, is also thrown backwards pulling the cervical spine with it. In addition, a sudden reflex contraction of the flexors on the neck occurs with a certain delay. We shall not describe all the details of the mechanism of the production of these whiplash injuries..."

It is easy to imagine that the joint injuries are not the same if, during a collision, or any other accident, the head is directed along the axis of the impact or if the head is rotated or if the impact is directed laterally. In the final analysis, it is the result of the injury which is important."

Robert Maigne, M.D., Orthopedic Medicine - A New Approach to Vertebral Manipulations, CC. Thomas, 1972, p. 196.

4) "The position of the head at the moment of collision influences the type of injury. This is particularly true of the degree of rotation in relationship to the direction of the impact...the foramen are open equally when the head faces forward but are narrowed on the side toward which the head is laterally flexed or to which the head is turned. Not only will the already narrowed foramen be compressed ligaments will be far more damaging. Rotating the head at the time of collision increases the possibility of more serious injury."

Rene Cailliet, M.D., Neck and Arm Pain, 1972, Davis Company, p. 69.

Although no specific studies are available for analysis, some medical authors have suggested the possibility that perhaps collisions that produce little physical damage place the occupants at GREATER risk of injury. The crumpling of metal during a collision is believed to absorb some of the force generated by the impact. Where little damage is produced, it may suggest that none of the force was absorbed by the metal, leaving it to pass through the automobile, thereby exposing the occupants to the full force of the impact.

In early 1989, Dr. Francis Navin, a professor of Civil Engineering at the University of British Columbia and a scientific team of investigators conducted simulated low-speed rear impact studies at the UBC Accident Research Facility in Vancouver to assess vehicle damage and occupant injury from this type of collision. The investigators set up a simulated experiment in which a heavy pendulum was swung at speeds lower than 20 km/h to strike the rear bumper of a Volkswagen Rabbit carrying bolted crash dummies. Later that year, Dr. Navin published his findings at an international conference on experimental safety vehicles in Gothenburg, Sweden.

The results of their studies showed that the test occupants were flung forward and rotated at higher speeds than impact "in an attempt to catch up with the car."

According to Dr. Navin, "It was observed that the resulting deflection of the seat-back, with subsequent rebound tends to pitch the occupant forward during impact with the shoulder displacement leading the head. The relative head to shoulder motion is the likely source of whiplash injury."

The investigators also noticed an absence of structural damage to the rear bumper of the Rabbits when struck by the pendulum at speeds of up to 15 km/h. This led Dr. Navin to the same conclusion of earlier American studies which demonstrated that rear-end collisions, unlike most other types of collisions, frequently result in "minor car damage with major bodily harm."

Dr. Navin's findings are fully explained in the proceedings of the 12th International Conference of Experimental Safety Vehicles, May 29 - June 1, 1989, Gothburg, Sweden, in the article "Low Speed Rear Impacts and the Elastic Properties of Automobiles", as well as in the Proceedings of the Multi-disciplinary Road Safety Conference VI, June 5-7, 1989, Fredricton, New Brunswick, in the article "An Investigation Into Vehicle and Occupant Response Subjected to Low-Speed Rear Impacts."

1) "Long-term studies show that aches and pains with no evident physical cause persist in 20% to 45% of patients with significant whiplash injuries."

"Roentgenographic studies show that degenerative problems develop after injury in 39% of patients. By comparison only 6% of the general population over age 30 develops degenerative changes over a comparable time. Thus, it would seem that whiplash injuries predispose patients to cervical degenerative osteoarthritis."

Charles Caroll, M.D., Paul McAfee, M.D., Lee Riley, Jr., M.D.: Objective findings for diagnosis of "whiplash". Journal of Musculoskeletal Medicine, March, 1986, pp. 57-74.

2) "From the discussion of the natural history of the degenerative process, it will be appreciated that this process is often a continuing one and therefore we cannot expect a permanent cure from manipulation or from any modality, including operation."

W.H. Kirkaldy-Willis, M.D., Managing Low Back Pain, 1983, Churchill Livingstone, pp. 183.

3) "In addition there are long term effects of injuries [automobile accidents] which do not become evident until years after the insult, for example with osteoarthrosis of joints and epileptic seizures."

Aldman B., Mellander H., Mackay M., The Structure of European Research into the Bio-mechanics of Impacts, in the quarterly journal of the American Association For Automotive Medicine, April, 1986, p. 26.

4) "If the displacement (post-traumatic disc protrusion) is left where it is to get larger or smaller as fortune dictates, it will sometimes take the latter course. Even so, the longer the protrusion lasts, the more time it has to stretch the posterior longitudinal ligament, perhaps irretrievably, thus enhancing the likelihood of further attacks. The prevention of eventual pressure on a root or the spinal cord is clearly the reduction of the displacement (manipulation) when it first appears. James Cyriax, M.D., Textbook of Orthopaedic Medicine, Tindall, 8th edition, 1982, p.103.

5) "Disk disruption in milder cervical trauma may be the cause of acute as well as chronic pain syndrome...This type of pain pattern can become chronic over many years without resolving. The areas affected by pain include the neck, inner part of the scapula, shoulder, and arm. This pain is relieved by rest, immobilization, and traction. The pain recurs when the patient becomes active again."

Bohlman HH: Musculoskeletal Disorders, ed. by Robert D. D'Ambrosia, M.D., 1977, J.B. Lippencott Company, pp. 220-222.

This points out that the fear that symptoms associated with traumatic soft-tissue injury will return in the future is an opinion shared by many respected medical authorities, and reported in numerous medical texts, journals and professional papers. The sequela of post-traumatic injury, especially as it relates to joint function, are well established in the medical literature, and carry a significant predisposition for further dysfunction and painful syndromes.

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