How to Value Thoracic Outlet Syndrome Settlements in Workers Compensation and Car Accident Cases
What to Consider When Calculating Settlement Amounts After a Work Accident or Motor Vehicle Crash Causes Thoracic Outlet Syndrome
Thoracic outlet syndrome (TOS) is a consequence of many occupational injuries and automobile accidents. It can steal your ability to work, groom, or participate in hobbies you once loved because it takes away your ability to use your arm, hand, and fingers for reaching, grasping, and holding. In addition, thoracic outlet syndrome may cause chronic pain, numbness, and tingling that result in depression, anxiety, and reduced mental capacity.
Unfortunately, thoracic outlet syndrome is a poorly understood medical diagnosis.
Though TOS is becoming better recognized and defined in the medical community, the general public’s lack of familiarity with the condition may affect the settlement value of your thoracic outlet syndrome case. Indeed, we have spoken with numerous workers comp adjusters who do not have a firm grasp of TOC and the treatment and disability it can lead to.
This article explains thoracic outlet syndrome and what factors to consider when negotiating a TOS settlement in a car accident or workers compensation case. Understanding TOS and the evidence you need to win will go a long way in being made whole.
Keep reading to learn more.
Contact us today if you have questions about workers compensation or personal injury law. We help injured employees and victims of others’ negligence in Virginia, Maryland, Florida, and the mid-Atlantic.
What is the Thoracic Outlet?
The thoracic outlet is an area in the upper chest formed by the rib cage, collarbone (clavicle), and neck muscles (the medial and lateral scalene muscles). In this region, a bundle of nerves (the brachial plexus) and the subclavian veins and arteries travel from the base of the neck to the arms.
What is Thoracic Outlet Syndrome?
Your doctor may diagnose thoracic outlet syndrome when trauma, repetitive arm movements, or some other medical condition compress the nerves, arteries, or veins in the thoracic outlet, causing pain and numbness in the arm, shoulder, or neck.
Other names and diagnoses given for thoracic outlet compression syndromes include the following:
- Anterior scalene syndrome
- Brachial plexus disorders
- Nerve root and plexus disorders
What are the Three Types of Thoracic Outlet Syndrome?
Physicians divide thoracic outlet syndrome into neurogenic, venous, and arterial.
However, these categories continue to fall out of favor because your TOS may involve all three types. For example, a high-speed car crash or a crane accident on a construction site may compress multiple structures in the thoracic area.
Your symptoms and treatment will depend on which type(s) of TOS you have.
Neurogenic Thoracic Outlet Syndrome
Neurogenic thoracic outlet syndrome is the most common type of thoracic outlet syndrome. It accounts for more than 80 percent of TOS cases.
In neurogenic TOS, you have a compressed brachial plexus.
The brachial plexus is a group of nerves that carry motor and sensory information between your spinal cord, brain, and the upper extremity (shoulder, arm, hand, and scapula).
Injury to the brachial plexus may lead to these symptoms:
- Gilliatt-Sumner hand: Pain in and atrophy (shrinking, wasting, and weakening) of the thumb and hand.
- Paresthesia (a feeling of pins and needles) in the hand and fingers: The ring and small finger are most commonly affected.
- Numbness and tingling in the arm, hand, or fingers
- Arm fatigue
- Decreased grip strength
- Temperature change in the hands (specifically, cold hands)
- Discoloration of the hand
- Pain in the armpit, shoulder, neck, or upper back
- Tenderness in the scalene, trapezius, chest wall, or brachial plexus areas
- Decreased finger dexterity
- Headache
Thoracic outlet syndrome resulting in a brachial plexus injury may cause lifelong pain due to nerve damage.
Venous Thoracic Outlet Syndrome
Venous TOS occurs when one or more veins under your collarbone are damaged.
One of the dangers of venous thoracic outlet syndrome is that it could lead to a blood clot. Specifically, you may develop effort thrombosis, a type of deep vein thrombosis that forms when overhead motions compress a vein in the thoracic region.
Symptoms of venous TOS include a change in color (for example, turning blue), swelling (edema), weak pulse, weakness, and pain in the affected arm or hand.
Arterial Thoracic Outlet Syndrome
Arterial thoracic outlet syndrome refers to compression of the subclavian arteries, which lie underneath the clavicles and provide the blood supply to the arms, head, and neck. It is the least common type of TOS.
Symptoms of arterial TOS include:
- A lump near the collarbone
- Paleness in one or both hands when reaching overhead
- Tenderness in the neck
- Pain
- Poor blood circulation and swelling in the hands, fingers, and arms
What Causes Thoracic Outlet Syndrome?
TOS can arise in multiple contexts.
Therefore, insurance companies often challenge causation in car crash lawsuits and workers compensation cases claiming benefits and damages for thoracic outlet syndrome. The defendants may argue that something other than the motor vehicle crash or occupational injury caused the compression of the nerves and vascular structures in the thoracic outlet.
Potential causes of TOS include the following:
- A single traumatic event causing physical injury, such as an automobile accident, fall from a height, slip and fall, whiplash, or an occupational incident.
- Repetitive use of the arm from work, sports (for example, pitchers in baseball), or other hobbies
- Medical malpractice, such as when the surgeon keeps the patient’s arm in an outstretched position for an extended period while performing surgery
- Poor posture: Drooping shoulders or forward head posture may cause thoracic outlet compression.
- Congenital: Some people are born with an extra rib above the first rib. This rib, called the cervical rib, narrows the opening through which the brachial plexus nerve and vascular bundle travel, causing TOS because bone growth compresses the brachial plexus or subclavian artery. In addition, an abnormal first thoracic rib, malunion of a clavicle fracture, or the abnormal position of the scalene muscles may contribute to pressure on the thoracic outlet. The latter cause –
- Pregnancy
- Tumors pressing on the nerves in the thoracic outlet.
- Changes in your muscles or ligaments as you age
- Significant weight gain
Who is Most Likely to Get Thoracic Outlet Syndrome?
Physical trauma on the roads or at work can affect anyone and cause TOS.
However, three demographic groups are more likely to develop thoracic outlet syndrome:
- Women: Generally, females suffer TOS at a much higher rate than males. However, arterial TOS is more common in men.
- Age: People between the ages of 30 and 60 have a higher incident rate of TOS
- Employment: People whose jobs require lifting, reaching overhead, and repetitive use of the wrists and arms are more prone to thoracic outlet syndrome. For example, we have represented many warehouse workers (such as those working at Walmart and Amazon distribution centers), electricians, nurses, truckers, forklift drivers, office employees, welders, mechanics, aircraft assemblers, hair stylists, stockers, and construction laborers with TOS.
How is Thoracic Outlet Syndrome Diagnosed?
Diagnosing TOS can be a challenging process because the symptoms of thoracic outlet syndrome are similar to other conditions. For example, an injury to the cervical spine, a torn rotator cuff, complex regional pain syndrome (CRPS), fibromyalgia, carpal tunnel syndrome (CTS), pectoralis minor syndrome, multiple sclerosis, or a syrinx may present with similar symptoms.
In addition, there is not a single clinical sign or test that can confirm thoracic outlet syndrome.
Therefore, the diagnosis of thoracic outlet syndrome is often a diagnosis of exclusion.
The standard TOS evaluation includes:
- A complete medical history, pinning down the timeline of symptoms, activities you perform that involve repetitive arm or hand use (at work or with hobbies), and whether you were involved in a traumatic incident.
- Clinical examination involves physical tests to determine what movements cause or worsen symptoms. The doctor may also look for lumps near your collarbone and check your pulse.
- Diagnostic imaging, such as X-ray, MRI, CT scan, or a duplex ultrasound, to rule out other conditions. The cervical spine, chest, brachial plexus, and shoulder are the most common areas imaged.
- Nerve conduction testing
What Health Care Providers Diagnose and Treat Thoracic Outlet Syndrome?
Your treatment for thoracic outlet syndrome may involve multiple medical specialties, including:
- Anesthesiology
- Cardiovascular medicine
- Neurology
- Physical medicine and rehabilitation (physiatry)
- Psychiatry and psychology to address the pain from TOS
- Radiology
- Rheumatology
- Thoracic surgery
- Vascular surgery
What is the Prescribed Medical Treatment for Thoracic Outlet Syndrome?
Treatment for thoracic outlet syndrome depends on the type.
However, the goals remain the same: reduce pressure on the area and regain arm and hand function.
Depending on the clinical examinations and findings, your doctors and healthcare providers may offer the following TOS treatment:
- Ice to decrease inflammation
- Heat to improve blood circulation
- Non-invasive treatments, such as occupational therapy, physical therapy, and stretching to reduce compression in the thoracic cavity, realign soft tissue structures, and eliminate nerve impingement.
- Exercises to strengthen your chest muscles and improve your posture
- Botox injections into the scalene muscles
- Nerve blocks (similar to epidural steroid injections)
- Pain medications (both prescription and over-the-counter)
- Blood thinners to treat clots that form around the damaged (compressed) vein in the thoracic outlet area
- Surgery, which could include thoracic outlet decompression surgery, rib resection, thrombolysis (removes a clot from a vein), neurolysis of the brachial plexus, reconstruction or replacement if the artery has an aneurysm, or the removal of a scalene muscle (scalenectomy). Your doctor is more likely to recommend surgery if you have venous thoracic outlet syndrome. Potential complications of TOS surgery include infection and loss of sensation and motor control in the upper arm.
You must monitor your posture to avoid recurrent or worsening problems after your symptoms resolve.
Poor posture aggravates thoracic outlet syndrome.
Can I Claim Workers Compensation for Thoracic Outlet Syndrome?
Yes.
Workers compensation covers thoracic outlet syndrome in two situations.
First, you are eligible for workers compensation benefits if you develop thoracic outlet syndrome due to a sudden, specific incident caused by a risk associated with your job.
Second, the insurer will have to cover medical treatment and pay benefits or a settlement if your initial work-related injury contributes to the development of thoracic outlet syndrome (TOS). For example, surgery for the injury may cause scar tissue and the development of TOS. If so, you have a valid workers compensation claim for thoracic outlet syndrome.
Determining Settlement Value for Thoracic Outlet Syndrome: How Much Money Can I Get?
In our law firm’s experience, thoracic outlet syndrome settlements range from $25,000 to $100,000 in workers compensation and car accident cases. However, higher and lower amounts for brachial plexus injury or thoracic outlet syndrome are possible.
The reasonable range for resolving your TOS case depends on many factors, including:
- Liability: Does the insurance company accept liability for the motor vehicle collision or admit that your TOS injury qualifies for workers compensation benefits? If so, your thoracic outlet syndrome claim has a higher value.
- Extent of medical treatment: Did you need surgery to decompress the brachial plexus or one of the arteries or veins in the thoracic outlet region? Needing or having surgery for TOS increases your case’s value. Further, we recommend considering the likelihood that surgery may not eliminate your symptoms when negotiating a settlement. At least one study found that patients with no objective or laboratory findings of TOS had worse outcomes with surgery than those who did.
- Future medical care: You may require additional occupational or physical therapy visits (16 to 32 visits) or pain management. Keep this in mind when calculating the fair value of your TOS case.
- Length of disability: We have seen thoracic outlet syndrome cause injured workers to miss from two months to two years or more.
- Job requirements: The heavier the physical requirements of your pre-injury job, the more likely you will have extended disability from work because of TOS. The longer your potential disability, the higher the claim’s potential value.
- Permanent impairment: Thoracic outlet syndrome may result in permanent loss of use of one or both arms. When you reach maximum medical improvement (MMI), your attorney will send you to a doctor for an impairment rating to determine how much to claim in permanent partial disability (in workers comp) or permanency damages (in tort claims).
- Possibility of recurrence: Neurogenic (brachial plexus) TOS may recur weeks, months, or years after receiving treatment, even if surgery helped initially. Scar tissue from the surgical site may cause further compression and symptoms. Your settlement demand should include money to account for this risk.
- Other conditions: The crash or work-related accident that caused thoracic outlet syndrome may have caused injuries to other body parts. In addition, you may develop post-traumatic stress disorder (PTSD) from the traumatic event that caused thoracic outlet syndrome. Generally, multiple injury claims settle for more money than stand-alone TOS claims.
Read these articles to learn more about factors affecting workers compensation payouts and auto accident settlements.
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Can I Receive Social Security Disability for Thoracic Outlet Syndrome?
Yes.
For thoracic outlet syndrome or brachial plexus injury that prevents you from returning to your pre-injury job, you may qualify for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits.
Indeed, you may have a strong claim for disability for thoracic outlet syndrome if:
- Your past relevant work (jobs in the last fifteen years) required frequent or constant arm or hand use
- You required surgery for thoracic outlet syndrome but continue to have symptoms due to chronic pain
- You have difficulty using your dominant hand to complete activities of daily living
Learn more about applying for disability in Virginia here.
Call Our Attorneys to Talk About Your Legal Options for Thoracic Outlet Syndrome Injuries
If you have suffered thoracic outlet syndrome or a brachial plexus injury in a car crash, truck accident, or work-related incident, call us at (804) 251-1620 or (757) 810-5614.
Our top-ranked personal injury lawyers have recovered fair compensation for many injured workers and accident victims diagnosed with thoracic outlet syndrome.
See if we can help you.
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