Dr Giblin
97Dr Giblin is a consultant orthopedic surgeon with extensive experience. He examined the plaintiff on three occasions and provided reports dated 23 February 2011, 31 May 2012 and 13 February 2013. He observed the surveillance videos taken of Ms Williams prior to giving evidence. His reports reflect the escalation of the symptoms described by the plaintiff over time.
98In his report of 23 February 2011, Dr Giblin described the plaintiff's complaints about her left wrist as,
"she says that the hand feels slightly weak and occasionally has cramps. There are some days where her arm is stiff causing difficulties getting dressed and undressed. Both at home and at work she cannot use her arm for lifting heavy weights or doing prolonged repetitive activities. This tends to interfere with typing and associated clerical duties."
99Dr Giblin noted that the "intrinsic muscles in the left hand have a motor strength Grade 4 plus, definitely slightly less than those on the right hand" but noted reasonable grip strength.
100He found that, "Based on her history and examination, she has the provisional diagnosis of a compound fracture of the left radius and ulnar, complicated by a minor sensor involvement of the branch of the ulnar nerve and possibly, a motor branch of the median nerve in the hand as a result of the subject incident." He felt that her condition was stable and "her symptoms will persist indefinitely and be associated with permanent physical restriction."
101In his report of 31 May 2012 he found that her symptomology in her upper left extremity had increased, "There is now the additional complaint of heaviness and weakness in the left arm, and pain in the left shoulder and the left elbow, these joints being involved over the last 4 or 5 months." He could find no signs of adhesive capsulitis on the left shoulder and found the active range of motion satisfactory. Dr Giblin's prognosis was that, "It is likely that she will have a degree of permanent soft tissue symptomatology in her left arm with permanent physical limitation."
102As in his first report, he assessed the plaintiff as "permanently unfit to use her left upper extremity for repetitious impact activities, including pushing, pulling, lifting, twisting" and he added "prolonged periods of typing". Dr Giblin also thought that there would be difficulties for work to her retirement age other than "...in an environment other than very light, non-repetitive duties."
103On 13 February 2013 he reported that,
"the left upper extremity symptoms have slowly worsened so that she is favouring it more, using the right arm particularly for housework and office work including typing and lifting. She has noticed that the left shoulder has become progressively stiff and sore. Her left forearm feels as though it is tight with cramps and the scar particularly on the valar aspect is very dysthetic. She still remains numb around the dorsal branch area of the ulnar nerve...Prognosis is guarded insofar as the soft tissue changes in her left forearm and hand are not going to improve."
104Dr Giblin noted that, "Both her hands showed no sign of usage anywhere, good intrinsic muscles, normal fists and good grip strength." He stated that, "The left shoulder has definite adhesive capsulitis, whereas the right shoulder is normal...The left shoulder stiffness will be an ongoing problem for the foreseeable future and may continue to deteriorate."
105Dr Giblin diagnosed her with right wrist carpal tunnel syndrome (impingement of nerves) with an irritable median nerve. He noted that in early 2012 she noticed she was developing pins and needles in her right hand. He felt that "these symptoms are related to the favouring of her left arm, notwithstanding, the acknowledgment of the diagnosis of non insulin dependent diabetes in November 2011."
106Dr Giblin was asked in cross-examination:
"Q. Dr Dalton's opinion is that if she was going to develop an overuse syndrome, it would have occurred in a much closer proximity to the accident or the trauma than the plaintiff says 12 months later, Dr Dalton says it was two years later. Do you have anything to say about that?
A. Look, I don't have a great disagreement with Dr Dalton's view on that one. It's just a matter of the adjacent co morbidities that are developing from the time after the accident. He says it's a tenuous relationship, but it is a relationship, and I do see it as a direct cause an event from the time that she had the fracture, to the time she favoured the arm, to the time she put the weight on, to the time she developed diabetes. It's all part of the one clinical picture, from my perspective."
But for the injury, he thought that Ms Williams would not have developed the syndrome.
107Dr Giblin gave evidence that nerve conduction studies are open to interpretation and are not reliable when it comes to sensory testing (T 196.15).
108In relation to the potential for diabetes to exacerbate the nerve irritation or damage, he gave evidence that:
"Diabetes per se is associated with a depression of the immunological system. For a number of reasons, it is also associated with an impairment of nerve recovery. It all adds up to the issue that a nerve may be more readily damaged and have decreased recovery in a diabetic person." (T 187.7)