FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

CAR WRECK CAN BE PAIN IN THE NECK

Question: I was in a car accident eight months ago and received a neck and shoulder injury that was diagnosed as a cervical strain. I've recently moved and consequently have seen a new doctor about my continuing neck pain. New x-rays and an MRI show that I have degenerative disc disease and arthritis in the same area of my neck that was injured in the accident. I think the wreck caused these problems because the x-rays taken at the time of my injury were normal. The insurance company says that these are pre-existing conditions and consequently, are not related to the accident. Do you think that the wreck caused my problems?

Answer: First, I need to explain a bit about the conditions you now have - degenerative arthritis of the neck (cervical spine in doctor language) and degenerative disc disease. I'll deal with arthritis first.

Arthritis is the general term used to describe inflammation and degeneration of a joint or joints. There are several types of arthritis with osteoarthritis being the most common one. The frequency of this disorder increases with age so that almost everyone has at least one joint with it by age 65. The joint damage in osteoarthritis begins in the cartilage that covers the surface of the bones. The cartilage becomes rougher, develop cracks and cause the "squeaks" and "click" with movement that most of us over 40 notice from time to time. The degree of pain and inflammation in the arthritic joint may be mild or it can be so substantial that replacement with an artificial one is necessary. Osteoarthritis is classified into two categories - primary and secondary. Primary osteoarthritis has no specific individual cause. This is commonly thought of as resulting from "wear and tear" strain on joints. This often produces arthritis in the hips, spine or in the fingers. Secondary osteoarthritis occurs because of a specific cause such as disease or injury. Your initial x-rays were normal, and now eight months later they show arthritis at the part of your neck that was injured. This certainly is suggestive of secondary arthritis caused by the wreck. Now for the second component of your neck pain - the degenerative disc disease. As I'm sure you know, the vertebra that form the spine are separated by cushioning and supportive structures called the intervertebral discs. These important parts can wear out. When this occurs, the disc bulges. When these changes are seen on x-ray, CT scan or MRI, it is called degenerative disc disease - the condition you have.

Degenerative disc disease in much like osteoarthritis in that both occur in a large percentage of individuals, and many with these "abnormalities" do not have significant pain or disability because of them. In some, however, the abnormality is the source of misery. In your situation it is difficult to say with certainty that your arthritis and degenerative disk disease is the consequence of your car wreck eight months ago.

Insurance companies exist to make money for their shareholders. They do this by charging premiums that bring in more money than the sum of their administrative costs and payments for claims. Obviously, they can be more successful by diligently avoiding payment of questionable (from their perspective) claims. Since degenerative disc disease and degenerative joint disease are common disorders, they look at your claim as being questionable.

I'd suggest that you have your doctor write a letter supporting your claim that the accident caused your condition. You may find that the insurance company still refuses to pay. Don't despair - this is a legal matter of their failure to meet their obligations. Talk to a lawyer. He or she can help you accurately assess your chances of getting a reasonable settlement. (I know it is unusual, but we doctors occasionally have nice things to say about those in the legal profession.)

"Family Medicine" is a weekly column.

To submit questions, write to: John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.