Fractures of the clavicle, humeral head and the first and second ribs are not difficult to diagnose. There is usually a mechanism of injury, such as abrupt forward movement into the steering wheel and/or dash or side movements into the driver door or passenger door during a car accident. Obviously, if an individual is not wearing a seat belt and is ejected, it is not being catapulted through the air that is dangerous; it is always the sudden stop. It is important to remember that with any of these injuries, there can be an associated injury to the rotator cuff that is not always diagnosed shortly after the accident.

The rotator cuff is subject to stretch injuries, torsional injuries and impact injuries. The majority of rotator cuff tears are due to long-term wear-and-tear and frequently the abnormalities noted on MRI's of the shoulder are pre-existing problems. Acute tears of the rotator cuff are always associated with a history of immediate onset of pain, decreased range of motion and severe sleep dysfunction. These symptoms occur within the first 24-48 hours of an injury, if there is an acute rotator cuff tear as a result of the accident.

The driver of a vehicle who is rear-ended and who is grabbing the steering wheel at the 10:00 and 2:00 positions and placing the elbows in full extension, is subject to rotator cuff trauma. The more difficult cases are those where the vehicle is rear-ended and pushed forward into the vehicle in front, or is pushed off in a direction to the right or left and the driver attempts to regain control. This produces torsional events on the rotator cuff, which can also cause tears. In some cases, the driver is pushed forward and strikes the steering wheel with the anterior part of the shoulder. This can also produce injuries to the bicipital tendon and the anterior aspect of the rotator cuff.
Automobile accident where there is a side impact and the vehicle spins in the opposite direction, when at the same time the driver is attempting to regain control of this changing direction, also puts the rotator cuff at risk because of the rapidly changing direction of the steering wheel.

It is important to notice and memorialize the bruise patterns. Photos of the bruising help identify whether the primary impact collision was from the front, the back, or the side. All persons who are injured in an accident and who complain of shoulder pain with decreased range of motion during the first 24 hours should undergo diagnostic studies. Initially, x-rays should be obtained and based on the x-rays and physical examination, on many occasions an MRI of the shoulder is indicated if the doctor suspects rotator cuff tear.  An orthopedic surgeon performing the examination is in a better position because he or she has determined the points of tenderness as well as presence of any impingement abnormalities.
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Non-displaced or minimally displaced fractures are treated in a comfort sling and usually do not warrant a surgery. Severe fractures of the clavicle occasionally warrant open reduction internal fixation. The diagnosis of rotator cuff injury can be deceiving within the first 30-45 days, especially in individuals who develop a partially frozen shoulder. The usual treatment focuses on regaining range of motion with physical therapy and a home exercise program.

The importance of witnesses and their statements at the scene of the injury accident heavily depends on the strength of the otherwise available evidence of liability of one of the drivers. If the evidence is compelling (such as when one vehicle is rear-ended by the other) and it is supported by a police report, in which the officer finds the rear-ending party at fault, then the statement of a witness doesn't play a significant rule as liability will likely be established.

However, when in a contested liability situation, a statement of a witness can be crucial to proving a case. Recently, I have been contacted by a driver who was "t-boned" at a busy intersection in San Francisco, when another driver ran the red light. The other driver adamantly argued that my client was the one running the red light and the insurance company for that driver would not accept liability and would not engage in settlement discussions. However, one statement and one written declaration from a witness, who testified that the other driver ran the red light, tipped the scales of of liability in my clients favor, which was enough for insurance company to accept liability and make a settlement offer.

If you have been involved in an injury accident and have a contact information of one or more witnesses, call them as soon as possible and ask them to write down exactly what they saw. This is important because memory tends to fade when it comes to little details that make a big difference, such as location, time of the date, the color of the vehicles involved in the accident and other facts of the incident.

Ideally, your witnesses should be unbiased and disinterested. These should not be your friends or relatives, and the value of the witness who was a passenger in your car at the time of the accident is not very high.

Most brain injuries that doctors and lawyers see are classified as "mild." Mild traumatic brain injury (MTBI) accounts for more than 80 percent of closed head injuries. Moderate and severe brain injuries are among the most disabling conditions resulting from physical trauma, since the operations of the brain underlie all of our behaviors, emotions and experiences, and thus - any issues in the brain function can adversely affect or completely impair just about any of our physical, mental, or cognitive abilities and skills.

The prevalence of mild traumatic brain injuries with the risk of permanent brain injury is one of the most hotly contested conditions in personal injury claims and injury litigation. The dispute is usually around whether a person who has significant symptoms of cognitive and/or emotional dysfunction  after the brain injury is suffering from permanent brain damage or is likely to recover.  This fact will naturally have a significant effect on the outcome of any settlement negotiations or trial of an injury claim.

For both medical and legal purposes it is essential to evaluate a patient for the long-term consequences of brain injury by several different and slightly overlapping specialties as soon as possible after the accident or an incident giving rise to the injury.  A good starting point is seeing a neurologist - a medical doctor who can evaluate the general health of the injured nervous system and its functioning. Neurologists can order an interpret brain scans looking for abnormalities in the brain structure (CT Scan, MRI) and metabolic function (PET, SPECT). The neurologist can also evaluate and treat the complications of brain injury, such as post-traumatic seizures and provide medical treatment for headaches and dizziness.

A neuropsychologist can evaluate changes in a person's cognitive or mental abilities  and in behavior caused by the brain injury.  This specialist can administer objective tests of memory, attention, problem-solving, sensory perception, planning, organization, and a long list of other types of cognitive ability.  In some cases, the complex behavioral difficulties that can arise from brain trauma are treatable  by psychiatrists, specializing in organic brain impairments - the doctors known as neuropsychiatrists.

Like with most other serious injuries, getting evaluation and treatment promptly can significantly affect the recovery of the person diagnosed with a traumatic brain injury.