Being involved in a road traffic accident is a frightening experience. No matter the severity of the collision, the physical and psychological impact, plus the complexities of sourcing the right treatment, can be demoralising and disheartening. In this Case Study, we find out how our Rehabilitation Case Manager, Rachel Walters, overcame these challenges for her client to provide them the right support following their multi-trauma road traffic accident.
Case Summary
Case Manager: Rachel Walters
Gender: Male
Injury Details: Right forearm fracture, open injury to right index finger, right shoulder pain, a genital hernia, knee pain and psychological trauma.
Background Information
Andrew* owns a haulage firm, Amazon merchandise business, and at the time of his accident, had just purchased a caravan site with his wife.
Whilst driving one of his haulage lorries as part of his work duties, Andrew was involved in a head on collision with another driver. Even though his vehicle was crushed in the accident, Andrew was able to remove himself from his lorry and receive assistance from an off-duty medic at the side of the road. He was then driven to an NHS hospital for more in-depth assessment, receiving a body CT scan that revealed a fractured right forearm and injury to the right index finger that resulted in the amputation of the tip of his finger.
He was discharged with home exercises and was informed he would need no further treatment, except a follow up x-ray to be done a month later to monitor his progress.
Symptoms at Referral
Upon referral, it was clear that Andrew’s injuries were far more severe and required face-to-face assessment and support. Rehabilitation Case Manager, Rachel Walters, met Andrew and his wife at their home to conduct the Initial Needs Assessment (INA).
Right Shoulder
- Visual Analogue Scale- 7/10 pain rating
- Reduced range of movement
- Pain waking him up from sleep
Andrew was scheduled to attend an NHS MRI for his right shoulder, but this couldn’t be arranged by the NHS until October 2022.
Right Forearm
- Visual Analogue Scale- 4/10 pain rating
- Intermittent cramping in hand- 8/10 pain rating
- Reduced finger movement and grip strength in hand
Following an NHS x-ray, it was discovered that the radius and ulna bones in Andrew’s arm were not uniting and no long-term treatment plan could be agreed until they started binding once more.
Glass was discovered in Andrew’s hand which was removed following NHS surgery. However not all of the glass was removed as it was too close to some nerves, meaning the pain in his hand hadn’t subsided.
Bilateral Knee
- Intermittent aching in both knees when descending the stairs
- Instability
- Unable to complete squatting movement
The NHS discovered articular ligament damage in Andrew’s left knee but didn’t want to operate on it.
Genital Hernia
- Constant aching in the genital pelvic area that increased when going to the toilet.
Laparoscopic surgery was suggested for Andrew’s hernia, but surgery wouldn’t have been possible with the NHS until Autumn 2023.
Psychological Symptoms
- Disturbed sleep pattern
- Feeling anxious when the phone rang, especially if they were calls related to work
- Increased pressure on marital relationship
- Reduced confidence
- Increased frustration with reduced physical activity
- Increased fear and anxiety with car travel
- Financial issues with not working
- Generalised Anxiety Disorder Assessment (GAD7) score- 19/21
- Patient Health Questionnaire (PHQ9) score- 19/27
Andrew was provided CBT and EMDR Therapy via the NHS to support his mental health following his accident.
Barriers to Recovery
- Non-binding of bone in right forearm
- Ongoing upper and lower limb physical symptoms, including pain and weakness
- Unclear and limited NHS treatment plans and surgery delays
- Reliant on wife and others for personal care, domestic activities and travel requests
- Psychological trauma for both himself and his wife
- Financial implications of not working due to injuries
Rehabilitation Goals
- Provide and seek the right support to aid all physical injury recovery
- Provide and seek support for psychological conditions of both Andrew and his wife
- Restore and maintain stability and increase mobility and function
- Return and resume pre-injury work duties with Return to Work support within 12-18 months
Our Involvement
The INA emphasised that Andrew was in immense physical pain. Through delays with receiving treatment, his symptoms were not improving.
Rachel intervened to ensure Andrew received the right support and treatment in a timely manner, providing him with much needed support.
She arranged consultations with specialists in their field, including:
- Assessment from a Consultant Laparoscopic, Bariatric and Upper GI Surgeon for his hernia.
- Consultation with an Orthopaedic surgeon who suggested nerve conduction tests be done on Andrew’s shoulder to determine the pain.
- Organised an Occupational Therapy assessment to support Andrew’s right upper limb function and planned a hand therapy programme to assist and support strengthening, range of movement and sensation in his hand.
- Arranged consultation with a specialist who did MRI imaging to determine the issues with Andrew’s knee.
Whilst in consultation with this specialist, Andrew mentioned his other symptoms to provide a better understanding of how he acquired his injuries. Within this discussion, it was discovered that this specialist was able to also complete surgery on Andrew’s hernia, unite the bones in his forearm and remove the additional glass that was left in Andrew’s hand, all whilst under anaesthetic for his knee surgery.
However, it wasn’t just Andrew’s physical symptoms that were affecting his daily function. His physical pain was affecting his mental health. Andrew was experiencing intrusive thoughts, anxiety and depression following his accident. Due to these conditions, Rachel supported Andrew’s psychological treatment with the NHS and remained in communication with him about his progress with CBT and EMDR to ensure he was provided the right help.
Rachel also coordinated private psychological treatment for Andrew’s wife, who received fortnightly CBT sessions to support her mental health due to the pressure of having to run the businesses on her own, plus look after Andrew who was dependent on her, whilst feeling anxious and overwhelmed following his accident.
Rachel remained in constant communication with Andrew and his wife throughout treatment of both physical and psychological conditions. She remained up to date on every specialist consultation, having regular phone calls with Andrew and his wife to determine their progress and perspective on each meeting and establish their mental wellbeing on a regular basis. She also communicated with every specialist consultant to ensure treatment plans remained on track to relieve Andrew of his symptoms as quickly as possible. All of this information was then relayed back to the insurer and claimant lawyers instructing this case, keeping every relevant party up to date on their progress.
Outcomes
The specialist consultant able to coordinate four different operations in one achieved success from the surgery. Rachel arranged for Andrew to have this surgery on 14/02/2023. Following this, she arranged all due diligence and communication with everyone involved and ensured payment of the procedure was completed by 17/03/2023.
Andrew is now undergoing physiotherapy for his knee, following Rachel’s recommendation, to help strengthen it.
Rachel also decided that Andrew’s hand therapy programme should be put on hold until his hand has recovered from the glass removal surgery.
Rachel arranged a CT scan on Andrew’s right forearm to check the binding of the two bones. It still highlights that Andrew’s bones haven’t united so she arranged a two-stage operation to alleviate this issue.
Rachel has also put in place arrangements for Andrew to have physiotherapy for his upper limb injuries, as well as his knees, to help his recovery and encourage a return to his pre-injury function and movement.
Andrew is also continuing to have psychological treatment under Rachel’s recommendation. In Rachel’s reviews with Andrew, it has been agreed that his treatment should be amended to address his feelings of anger from the accident, but it has been observed that the therapy has improved his thought processes and assists him day-to-day.
Andrew’s wife also reported an improvement in her mental health following her treatment, however Rachel is continuing to arrange psychological therapy for continued support.
Whilst Andrew’s case is not at complete closure just yet, the further treatment measures put in place by Rachel mean that he will be able to return to his pre-injury work role within the goal timeframe and achieve the mobility to return to an optimum level of function to enjoy his life and gain independence once again.
Andrew’s rehabilitation journey has not been an easily navigated one. The setbacks he endured prior to his referral deepened psychological concerns, elevating his anxiety and anger.
With Rachel’s commitment to Andrew and his wife, her skilful organisation and professional ability to manage multi-disciplinary teams of experts, she was able to get Andrew access to the support he needed to alleviate his physical symptoms and help his mental wellbeing.
Rachel’s dedication to communicating regularly with every relevant party within this case meant that Andrew received the surgical treatment he needed in a timely manner, significantly progressing his recovery.
Due to Rachel’s attentive management of this case, Andrew is now able to witness progress in his rehabilitation, encouraging him to achieve an optimum recovery and successfully return to his work.
*Name changed for confidentiality
