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Carpal tunnel syndrome

 Schneider v State of NSW [2009] NSWDC 108. Levy DCJ. 16.10.09.

To damages, Levy DCJ canvassed medical evidence. The plaintiff had struck her tail bone and hands in the fall, and complained later of sore neck and back. She returned to work after a week, with persistent and increasing symptoms. Several months later, she suffered another fall the hurt of which was transient.

Treating orthopaedist Dr John Morton diagnosed acute bilateral carpal tunnel syndrome related to the fall, and performed surgical release in November 2005. Persistent symptoms brought treating neurologist Dr Dennis Crimmins to opine right brachial plexus injury or cervical nerve root injury in the fall, without procedure to relieve, but causative also of the plaintiff’s depression. In April 2007 treating psychiatrist Dr David Butler diagnosed chronic adjustment disorder with depression and anxiety, reactive to her injury, prescribing medication.

Levy DCJ traversed medico-legal opinions. There was some support from the defendant’s experts. At [232], his Honour: “I prefer the foregoing opinions on causation of carpal tunnel syndrome to that of Associate Professor Oakeshott who thought that the plaintiff’s carpal tunnel syndrome was not in any way related to the fall. I find Associate Professor Oakeshott opinion unpersuasive on this issue because he did not entertain, mention or even consider the possibility of the post-traumatic capsulitis as a causative mechanism as was explained by Dr Bye. Nor did he consider the possibility of precipitation or aggravation of an underlying median nerve lesion in both wrists, as was considered by Dr Dalton. He simply dismissed the condition as being of constitutional origin which leads me to the view that gave the issue only limited and therefore insufficient consideration.”

Also, infra [233]: “I do not accept that Dr Bourke’s reference to ‘longstanding’ in reference to the plaintiff’s hand symptoms was a reference to those symptoms pre-dating the fall on 24 February 2005 in the sense that the plaintiff was affected by a pre-existing and continuing carpal tunnel problem at the time of her fall. To find to the contrary in circumstances where Dr Bourke was not called to give evidence or where the plaintiff’s evidence on this issue was not the subject of detailed examination would be unreasonable in the circumstances: Mason v Demasi [2009] NSWCA 227; Container Terminals Australia Ltd v Huseyin [2008] NSWCA 320.”

Later [244], “Fourthly, the hypothesis put forward by Dr Virgona that the plaintiff may have had a pre-injury personal style that was somewhat passive, dependent and self-defeating, thereby rendering her vulnerable to the development of a chronic pain syndrome is one that I find persuasive and I accept it. It follows that the defendant must be found to be responsible for the plaintiff’s post-injury psychological problems: Watts v Rake [1960] HCA 58; (1960) 108 CLR 158 Consequently, I reject the defendant’s submission that the plaintiff’s psychiatric or psychological reaction to her pain is not causally attributed to her injury.”

His Honour had cited Purkess v Crittenden [1965] HCA 34; (1965) 114 CLR 164 that it was the defendant’s unmet onus to prove predisposition, and not the fall, caused the psychiatric symptoms.

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