29 Sep Thoracic Outlet Syndrome

In Hsu v. Choquette, 2015 BCSC 1123, the Court considered whether the Plaintiff developed thoracic outlet syndrome following a motor vehicle collision.  The court accepted that the motor vehicle collision caused “reasonably severe soft-tissue issues that go into spasm regularly, causing neck and shoulder pain and headaches”. [para. 68]  However, the issue was the diagnosis of her arm and hand symptoms, which included numbness, tingling, and weakness.  The Plaintiff and Defense experts disagreed on whether the symptoms related to thoracic outlet syndrome or carpal tunnel syndrome.

Each Party had retained experts with different specialities.  The Plaintiff retained Dr. Salvian, a vascular surgeon.  The Defendant retained a neurologist.  The Court commented on the expert’s different specialities and then considered each expert’s evidence.

[70]         Clearly Dr. Salvian and Dr. Dost are both very experienced and knowledgeable expert witnesses in their respective fields.

[71]         While in the abstract one might well defer to a neurologist over a vascular surgeon on an issue of nerve compression, it seems to me that Dr. Salvian’s extensive clinical experience in this sub-specialty and his obviously extensive knowledge of the various structures in the thoracic outlet area addresses any presumed disadvantage that he might otherwise have based on his general specialty. I also found his report very clearly expressed and his responses to questions on cross-examination very fair and balanced. He did not seem to me to be acting as an advocate for the kind of TOS here that he has diagnosed here, which Dr. Dost regards as controversial. He merely explained, in a very straightforward and understandable way, why he believes that condition is present.

[72]         In contrast both Dr. Dost’s reports and his testimony were more combative, and seemed strategically directed to defeating the availability of this disputed form of TOS. The portion of his evidence that actually dealt with Ms. Hsu was rather superficial by contrast.

[73]         The essence of Dr. Dost’s rejection of TOS here is that well-known and well-accepted conditions (myofascial pain syndrome and CTS) are sufficient to explain all of Ms. Hsu’s symptoms, so there is no need to resort to the controversial or unprovable diagnoses that Dr. Salvian offered. I found these alternative explanations, which rested more on general assertions than on the diagnosis of the actual plaintiff before the Court, less convincing than Dr. Salvian’s fairly transparent explanation of the syndrome and its relationship to his clinical findings.

[74]         The mechanism by which myofascial pain produces pseudoneurological symptoms that mimic neurological ones over an extended area of the body was not well explained by Dr. Dost. I was left unclear how central sensitization figures into Ms. Hsu’s specific situation. It is noteworthy on that point that Dr. Feldman emphasized during his cross-examination that pain that results in compression of myofascial trigger points only extends to the length of the actual muscle involved.

[75]         As to the ability of CTS to account for all of the hand symptoms, I preferred Dr. Salvian’s very focused analysis of the potential role of hidden CTS here to Dr. Dost’s general assertion of the wide range of symptoms of CTS that can present in any given situation.

[76]         I was intrigued by Dr. Dost’s allegations of methodological shortcomings in Dr. Salvian’s approach but to the extent that they were put to Dr. Salvian in cross-examination, he did not accept them. They were also not described or explained by Dr. Dost in a way that endowed them with any inherent reliability or persuasiveness. They caused his report to seem more like a critique of Dr. Salvian’s approach than a stand-alone opinion.

[77]         For these reasons, I prefer and accept the evidence of Dr. Salvian that Ms. Hsu suffers from TOS, in this case based on nerve compression.

After accepting the Plaintiff’s expert evidence, the Court assessed damages.  The Plaintiff was awarded $106,782.52.

If you have been injured in an accident, contact Acheson Sweeney Foley Sahota LLP.  We have the ability to ensure you receive the medical care you require, from the proper medical experts needed to support your claim in court.

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