Opinion ID: 2116711
Heading Depth: 1
Heading Rank: 2

Heading: rennes' trial

Text: Joyce Renne's Medical History Before the Automobile Accident. As brought out in her trial that commenced on September 19, 1989, Joyce Renne, in 1976, complained of numbness in her right arm and pain in her left arm with numbness extending into her wrist, thumb, and index finger of her left hand. Renne contacted Dr. Louis J. Gogela, a neurosurgeon, who performed two surgical procedures in 1977 for decompression of a carpal tunnel syndrome in each of Renne's wrists. A carpal tunnel syndrome is a complex of symptoms resulting from compression of the median nerve in the carpal tunnel, with pain and burning or tingling paresthesias in the fingers and hand, sometimes extending to the elbow. The Sloane-Dorland Annotated Medical-Legal Dictionary 689 (1987). St. Elizabeth's records showed that on July 18, 1985, a little over a month before the automobile accident, Renne was admitted to the hospital's emergency room and was examined for an injury sustained when she was seated at a picnic table that collapsed and caused her to fall backward. As Renne was falling, she reached out with her left hand to break her fall. A physician, later treating Renne for her fall at the picnic table, applied a splint to immobilize Renne's left arm and wrist. Also, Renne hurt her left shoulder in the picnic table incident and experienced pain for approximately 2 weeks. As a result of her wrist and shoulder injuries from the fall at the picnic table, Renne was undergoing physical therapy at St. Elizabeth, her destination at the time of the automobile accident. Temporomandibular Joint Syndrome. Since Joyce Renne was experiencing ringing in her ears and suffering from headaches, in November 1985, she went to Dr. Jim Ganser, a dentist. In supplying her history to Dr. Ganser, Renne did not mention an accident other than the motor vehicle accident of August 29, 1985, and she told him about severe pain in the area of her jaw and her difficulty with sleeping and chewing. During his examination of Renne, Dr. Ganser found quite a bit of muscle sensitivity in the muscles of mastication and in the muscles that support the head and neck area.... She had problems with opening. When she did, she had some popping and clicking in the joints. Dr. Ganser diagnosed Renne's problem as temporomandibular joint syndrome, which pertains to the point where the lower jaw joins the upper jaw in a ball-and-socket arrangement. A series of ligaments, muscles, and tendons hold the temporomandibular joint together. Temporomandibular joint syndrome is a dysfunction at the juncture of the temporal bone (part of the lateral surface of the skull at its base) with the mandible, which is the lower jawbone, and is marked by a clicking or grinding sensation in the joint, pain in or around the ear, stiffness of the jaw, and soreness upon waking. See The Sloane-Dorland Annotated Medical-Legal Dictionary 696 (1987). Dr. Ganser concluded that Renne's symptoms were probably consistent with whiplash, a sudden jerking of the head either forward or backward, in which the initial trauma causes severe edema, or swelling, in the tissue surrounding the temporomandibular joint and impedes proper functioning of the joint. As Dr. Ganser explained: [I]t becomes difficult for the teeth to fit together the way they did before, and so you get into a situation that kind of builds on itself. Because it's difficult to chew and do everything else, you begin to brace the muscles differently and it gets to be a cycle of musculature problems that builds on itself. Dr. Ganser prescribed muscle relaxants and anti-inflammatory agents to alleviate Renne's discomfort and, to relieve pressure on the temporomandibular joint, directed Renne to wear an acrylic splint similar to a football mouth guard to build an ideal bite so that she has contact on each of the teeth in an attempt to take some of the load off the joint and reduce the inflammation that takes place back in that area. In later examining and treating Renne, Dr. Ganser found that Renne's temporomandibular joint just doesn't seem to be totally healthy and noted that Renne's symptoms were consistent with intercapsular damage to the temporomandibular joint, or in Dr. Ganser's words: [T]he joint itself is surrounded by a cartilaginous membrane and there's actually a piece of cartilage that fits between the ball and socket. When you move that forward in a traumatic fashion, oftentimes you'll tear the ligaments and the tendons that are attached to that. The healing process in the joint is quite a bit different than those in muscles and things because you don't have a direct circulation. It depends on transfer of fluids through the membrane walls rather than a direct blood supply, and so if you have stretched or torn those areas, the healing process can become very difficult, if not impossible. Based on Renne's history and his examination, and with a reasonable amount of medical or dental certainty concerning the cause of Renne's condition, Dr. Ganser concluded that, since Renne had been symptom free, the act of trauma which necessarily was the automobile accident as the only traumatic event in the history given by Renne was causally related to the accident because one follows from the other, that is, Renne's condition resulted from the auto accident. In the course of direct examination of Dr. Ganser, the following interrogation occurred: Q. Can you formor have you formed an opinion with reasonable medical and dental certainty as to whether she will improve more over the rest of her life than she has now? A. My guess is that without intervening surgically or something, that you're probably not going to change the situation that exists now. Later, Dr. Ganser testified that Renne would need adjustments of the acrylic splint for her mouth because almost invariably there's a series of adjustments necessary to make sure that it's perfectly symmetrical. When asked whether Renne's condition would become better or worse, Dr. Ganser answered: I expect that it will either be stable or probably deteriorate. Dr. Ganser's bill for dental services to Renne was marked as an exhibit and was received into evidence without objection. Thoracic Outlet Syndrome. Joyce Renne was examined by Dr. Chester Paul, a thoracic surgeon, in April 1987. At that time, Renne was experiencing pain and discomfort in her arms, neck, and shoulders with weakness and numbness in her right hand. Renne informed Dr. Paul that she had been involved in an automobile accident in August 1985 and told Dr. Paul about the care of Dr. William Garvin, an orthopedist, and Dr. George Walcott, a neurologist, during the 18 months preceding Renne's examination by Dr. Paul. As the result of three subsequent examinations, Dr. Paul, in 1989, was a little more convinced and finally rendered the diagnosis that Renne suffered from thoracic outlet syndrome. When asked whether he had an opinion, to a reasonable degree of medical certainty, concerning the causal relationship between the automobile accident and Renne's thoracic outlet syndrome, Dr. Paul responded: I see no other circumstances which would have caused this, so my answer is yes, I think so. However, in light of Renne's history of pain, weakness, and numbness in her hands before the accident and her injury to her arm and wrist in the picnic table incident, none of which had been disclosed to Dr. Paul while he was examining or treating Renne, Dr. Paul commented: If in fact she had similar complaints, I would assume that she had some of the problems or some kind of problem ahead of the automobile accident. According to Dr. Paul, Joyce's prognosis is not particularly good, and, regarding any permanent disability, even after surgery, and the possibility of future medical expenses, Dr. Paul commented: That's just speculation.