This is the first in a series of articles where I plan to address post-traumatic arthritis and iatrogenic conditions.
Medical literature defines arthritis as inflammation of a joint. While the most common cause of arthritis is wearing out of joint surface cartilage (osteoarthritis), plaintiffs attorneys need to be aware that arthritis can be a post-traumatic condition and the most valuable, complicated and disputed part of a claim.
Post-traumatic arthritis is caused by the wearing out of a joint that has had any kind of physical injury. The injury could be from a motor-vehicle accident, a fall or any other source of physical trauma, such as repetitive stresses at work. Such injuries can damage the cartilage and/or the bone, changing the mechanics of the joint and making it wear out more quickly. In other words, the arthritic process is accelerated or hastened by the injury.
In addition, it may not just be the injury itself that causes the acceleration or hastening of the arthritic process — it could be the treatment required for the injury. In the setting of post-traumatic arthritis, iatrogenesis is an inadvertent adverse side effect or complication resulting from medical treatment.
I will start with post-traumatic shoulder arthritis. Shoulder arthritis is a clinical condition in which the joint that connects the ball of the arm bone (humeral head) to the shoulder blade socket (glenoid) has damaged or worn out cartilage. Normally, the ends of the bone are covered with articular cartilage, a surface so smooth that the friction at the joint is less than that of a rollerblade to laminated hardwood. In arthritis, this cartilage is progressively lost, exposing the bone beneath.
Shoulder arthritis is characterized by pain, stiffness and loss of function and often by a grinding on shoulder motion. From a personal injury standpoint, shoulder arthritis is important to establish because it is accompanied by lifelong pain and medical treatment and may ultimately require a shoulder replacement.
Post-traumatic shoulder arthritis often happens after a significant trauma is sustained by the shoulder joint, ruining the cartilage. As indicated earlier, this could be the result of a car accident, a fall or repeated trauma. A plaintiffs attorney can help establish the existence of post-traumatic shoulder arthritis by showing a lack of prior medical care, a lack of existence of the arthritis in early X-rays, a lack of existence of the arthritis in early MRI studies and, maybe most obviously, the lack of shoulder arthritis in intraoperative photographs and intraoperative observation by the shoulder surgeon.
If any of these tests does not show arthritis at the time of the injury and then it is detectable during the process, we know it was post-traumatic. This is necessarily true because arthritis that is degenerative would not appear that quickly. In a separate argument that can be made, some arthritis may have been present at the beginning, but it was worsened at an abnormal or accelerated rate, the plaintiffs attorney can argue, which tells us it is related to the trauma.
In looking for valid opportunities to make either of these arguments, plaintiffs attorneys also need to be aware not to confuse AC joint arthritis and glenohumeral joint arthritis. These are distinct conditions and the presence of one does not mean the other is present. Therefore, just because someone had AC joint arthritis prior to the injury does not mean he or she had glenohumeral joint arthritis. If that glenohumeral joint arthritis appears after the trauma, it is accident-related and vice versa.
Plaintiffs attorneys need to be aware that it is not just the trauma itself that can cause post-traumatic shoulder arthritis, but also the treatment. As all plaintiffs attorney know, shoulder injuries often require surgery. That surgery itself is a separate and distinct trauma. On cross-examination of a defense medical witness, plaintiffs attorneys should also emphasize this point.
With respect to iatrogenic shoulder arthritis, shoulder specialists are currently studying a condition called chondrolysis, rapid destruction of cartilage. Chondrolysis is an unavoidable iatrogenic condition. Chondrolysis is a catastrophic injury that has only been studied extensively in the shoulder since the 1990s. The early theory of those medical experts studying the condition is that new procedures that have been developed have been accompanied by certain side effects.
In any instance where a plaintiffs attorney has a client with persistent complaints of pain after a shoulder surgery, the attorney needs to be aware of the possibility of this condition. The condition is wonderfully explained at www.chondrolysis.com. The website emphasizes that chondrolysis is a devastating condition because the articular cartilage does not repair itself well and there are presently only two alternatives for a person with chondrolysis in the shoulder: a lifetime of pain and pain medications or a shoulder replacement.
In the remaining articles in this series I will address post-traumatic and iatrogenic arthritis in other joints. •
Brandon Swartz is a founding partner of Swartz Culleton. His practice focuses on all types of personal injury cases, including wrongful death, medical malpractice, civil rights violations, motor vehicle, premises liability, products liability, trucking accidents and workers’ compensation.