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Case Study: Establishing Causation of Complex Regional Pain Syndrome



We recently settled a case for a young man who developed bilateral upper limb Complex Regional Pain Syndrome (CRPS) in both hands, which naturally meant he was extremely disabled.


He worked in the motor industry in manufacturing and due to a lack of job rotation, excessive forces, using his hand as a hammer, constantly having wet and cold hands, having to fit defective parts and poor health supervision by his employers, he developed carpal tunnel syndrome and torn TFCC joints in both hands, he was only in his mid-20s when he was injured.


Following decompression surgery and TFCC repair surgery and then revision surgery, he developed CRPS in both hands.

At first glance, given the early admission of negligence, which admitted that the workplace processes had caused some injury, we felt confident that we would succeed in pursuing a high-value claim.

Dissection of the Claimant’s medical records

In this particular case, the claimant’s medical history was called into question.


It was argued that he had attended his GP and hospital appointments on numerous occasions for health issues over the course of his life, which had no organic basis, i.e., no physical evidence of a condition.

This was important because this supported the defendant’s case that the Claimant was pre-disposed to experience a heightened perception of pain and they produced psychological evidence that he had developed Somatoform Symptom Disorder (SSD).


This is a real condition of a psychological origin which in simple terms can cause someone to experience pain, which is genuine, but which is psychological rather than physiological.


SSD can be successfully treated with psychotherapy and therefore is thought not to be permanent, unlike CRPS which can be.  

Newtons Craddle

Award Winning compensation claim experts for Complex Regional Pain Syndrome (CRPS), Fibromyalgia and other Chronic Pain conditions

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Other causes of carpal tunnel syndrome

The Defendants argued that, due to his raised BMI and because he had done weight training in the past, the Claimant was predisposed to develop carpal tunnel syndrome.  


A proportion of the population, some 10% or more, will develop carpal tunnel syndrome naturally and the defendant’s case was that this Claimant would have developed carpal tunnel syndrome in any event, even if he had not worked for the defendant.


They therefore argued that he would have required surgery in any event and so would also have developed CRPS in the absence of carrying out work for the defendants, which they alleged was just incidental.

The Defendant's case was supported by medical experts who disputed the diagnosis of CRPS and accepted he had carpal tunnel syndrome but in terms of ongoing symptoms, stated the Claimant was at best suffering from a psychological disorder (SSD) or else was exaggerating his claim for purposes of financial gain.


Withdrawal of the admission


Some three years after their liability admission, once the true value of the claim became clear, the defendants obtained a report from an ergonomist (an expert in forces and workplace systems and their impact on the human body) to disprove that each of the work processes undertaken in the workplace were of sufficient force or repetition to cause carpal tunnel syndrome and TFCC tears.  



In addition, the Defendant obtained over 30 hours of surveillance footage on the Claimant over several weeks and months throughout the life of the claim. 


Medical evidence


The Defendants obtained medical expert reports which were used to interpret the surveillance footage, the medical notes and the ergonomics evidence. The medical experts gave opinions on causation and prognosis.


The evidence of those experts was detailed and voluminous and sought to discredit the Claimant at every turn alleging pre-existing vulnerability, and psychological illness and even opening the suggestion of conscious exaggeration.

Interestingly, the solicitors were not so convinced as to allege fraud or fundamental dishonesty, leaving the possibility of this a matter for the courts to determine.


Claimant’s response


The Defendants were in a difficult position despite mounting what superficially looked to be a strong defence because they did not have any strong surveillance footage to discredit the Claimant. Much of the footage was very useful to the Claimant in proving specific disadvantages he faced due to what were genuine symptoms of disability.

We looked closely through the lifetime of records to show that the Defendant's medical experts omitted references to numerous entries where there was a physical cause of complaint and that following treatment the complaints stopped, countering to some extent the suggestion of SSD. However, there was no doubt from the records that the Claimant was anxious about his health in general.

Much work was conducted involving a further ergonomist and preparing highly detailed witness statements and video exhibits to prove that the workplace processes were repetitive, and great force was required to complete work and that would have exposed the Claimant to a risk of injury. The causation of loss and damage must be established in court. To help with this we obtained statements from five former colleagues of the Claimant, all of whom supported that the poor work processes were a significant factor in the onset of the Claimant’s symptoms. These statements discredited the employer's attempts to demonstrate a perfect workplace and health surveillance system, which was not present.

We obtained very detailed statements from the Claimant and family members all supporting the onset of pain and the impacts of the injuries on the Claimant and his family over time. Family members were all interviewed, and statements were prepared.  It had to be said that this approach added a great deal of weight to the Claimant’s case about the variability and severity of his symptoms.

With expert evidence of our own we were able to argue that whilst a proportion of the population is at risk of developing carpal tunnel syndrome, the vast majority are successfully treated with non-invasive techniques, such as physiotherapy and anti-inflammatory medication, with treatments such as Calmare therapy currently being researched in the US. Only a small proportion would go on and require surgery and a smaller proportion still would develop CRPS as a result.

There was very little evidence to show that the Claimant would have been one of the few to have surgical intervention as a result of naturally developing carpal tunnel syndrome. The balance of probability test assisted us in the face of overwhelming evidence about poor work systems and processes.

It helped that the Claimant had never worked in a manual role before working for the defendant. Despite numerous other health complaints pre-dating the accident, he had never injured his wrists before or had any signs or symptoms of carpal tunnel syndrome before working for the Defendant. He had gone from no symptoms to first surgery within 18 months of commencing his role. The onset of discomfort and objective signs and symptoms recorded post-injury proved pivotal in linking the workplace processes to the onset of his condition.

It helped in this case that the Defendants also sent the Claimant back onto the production line against doctors’ orders whilst he was on light duties. After that, he required revision surgery which it was agreed by treating and medico-legal experts had exacerbated his condition.

Eventually, we were able to settle the Claimant’s case at a joint settlement meeting for a seven-figure sum.

From the Claimant’s perspective, it is important that a range of experienced and suitably qualified medical experts assess you over time to demonstrate the timescale for the onset of symptoms of CRPS.

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