THE “STRAIGHT LEG” TEST: INJURED WORKERS BEING EXAMINED FOR WORK INJURIES AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Injured Workers are both evaluated and treated within the Workers’ Compensation System for their work-related complaints.  Workers suffering from back injuries will be physically examined in order to determine a proper diagnosis.

Lumbar Spine Physical Examinations require that the physician or examiner perform a variety of physical tests.  One of these tests is the “straight leg.”

This article will discuss the “straight leg” test, what it means for a back condition, and what it means for Industrially Injured Workers.

Who Conducts Lumbar Spine Physical Examinations?

Physical Examinations are done by medical professionals in the capacity of Treaters,  Qualified Medical Evaluators, and Agreed Medical Evaluators.

Specialties conducting physical examinations for the spine may include Chiropractors, Neurologists, Neurosurgeons, Nurse Practitioners, Occupational Medicine Doctors, Orthopedic Surgeons, Physical Medicine Doctors, Physician Assistants, Osteopaths, Primary Care Physicians, and Sports Medicine Doctors.

What is the Common Back Complaint Relevant to the “Straight Leg” Test?

The common back complaint, relevant to the straight leg test, is back pain which radiates down one or both lower extremities.  The symptoms can include numbness in the lower extremities.

Are There Other Names for the” Straight Leg” Test?

Yes. The straight leg test has different names.   This includes the names “Lasegue Test” and the “Straight Leg Raise Test.”

How is the Straight Leg Test Performed?

“The straight leg raise test is performed with the patient in a supine position. The examiner gently raises the patient’s leg by flexing the hip with the knee in extension, and the test is considered positive when the patient experiences pain along the lower limb in the same distribution of the lower radicular nerve roots (usually L5 or S1).” Camino Willhuber GO, Piuzzi NS. Straight Leg Raise Test. [Updated 2021 Feb 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539717/

In sum, when an Injured Worker is sitting, the examiner will take the worker’s leg and raise it upward.

What Makes a Positive Straight Leg Test?

“[A] positive straight leg raise test is determined when pain is elicited by lower limb flexion at an angle lower than 45 degrees. During the test, if the pain is reproduced during the leg straightening, patients usually request that the examiner aborts the maneuver and by flexing the patient’s knee, the buttock pain is usually relieved(Figure 1).”  Camino Willhuber GO, Piuzzi NS. Straight Leg Raise Test. [Updated 2021 Feb 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539717/

Based upon a review of many medical reports, I have seen Injured Workers have positive straight leg findings with one examiner and not with others.  Thus, in my opinion there is some variability concerning results.

What Is the Aim of the Straight Leg Test?

The straight leg test may indicate whether there is a “sciatic compromise due to lumbosacral nerve root irritation.” Camino Willhuber GO, Piuzzi NS. Straight Leg Raise Test. [Updated 2021 Feb 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539717/

It should be noted, however, that “there are multiple causes of a positive test such as facet joint cyst or hypertrophy.” Camino Willhuber GO, Piuzzi NS. Straight Leg Raise Test. [Updated 2021 Feb 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539717/

If the Test is Positive, What Will Happen?

If a test is positive, there is the possibility of nerve root irritation and possible entrapment.  The positive straight leg test is simply the beginning of the process of making a comprehensive diagnosis.  Thus, the Injured Worker may be requested to participate in additional testing which can include MRI testing, CT scans, X-Rays, and Nerve Conduction Studies.

In sum, a positive finding suggests the need for additional testing to rule out a herniated disc.

What Does a Positive Straight Leg Test Mean for Injured Workers?

For Injured Workers, a positive straight leg test will trigger the examiner to consider ruling out the possibility of a herniated disc injury in the lumbar spine. Thus, a thorough assessment will require additional testing to occur via imaging studies and nerve testing. A positive test may trigger a referral to an orthopedic surgeon or neurosurgeon.

What If I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

 

What You Need To Know About Back Surgery, Return To Work, & Workers’ Compensation

Workers’ Compensation Medical Studies have been done on many topics.   Studies have reported on surgeries performed within the workers’ compensation environment.  Some studies have looked examined spinal surgeries.

Study results impact Injured Workers.  Studies results can create insurance Company expectations concerning surgery success and recovery times.   Insurance Company expectations from these studies can be imposed upon treating doctors concerning temporary and permanent disability.

This article will discuss back surgery, a study concerning back surgery, the back surgery study’s results. and what the study means for injured workers.

What Is Back Surgery?

The Spine has three segments: cervical, thoracic, and lumbar.  The lumbar segment of the spine is usually referred to as back or low back.  Back surgeries are generally on the area referred to as the lumbar spine.   There are various types of surgeries.   There are surgeries to address lumbar spine disks and there are other procedures that address the stability of the spine.   Common surgeries are laminectomies, fusions and disc replacement.

Besides the problems being operated on, there is also issue of levels.   The lumbar spine has multiple levels.   Some surgeries operate on one level and others involve multiple levels.

There are a variety of reasons why a particular surgery may be indicated.  This article will be addressing one of the reasons. A surgery to address a herniated lumbar disk. Specifically, a surgery to address a disk at only one level.   This procedure is called a laminectomy.

Why Is Back Surgery a Significant Workers’ Compensation Issue?

Back Surgeries are expensive.T they cause periods of temporary disability and may result in findings of permanent disability.   Back Surgeries can have complications that can be costly such as treatment for post-operative infections.  Thus, Insurance Companies, in a risk management analysis, may wish to prevent surgery liability by either denying the treatment or settling the case.

What Were the Study’s Results?

The study addressed focused only on a single-level lumbar disk herniation surgery.

According to the study, “[p]atients receiving WC(workers; compensation) with shorter duration of radiculopathy before diskectomy had higher RTW(return to work) rates; fewer physical therapy, chiropractic, and psychotherapy sessions; and fewer postoperative diagnoses of psychological illnesses.”  Ren BO, O’Donnell JA, Anderson JT, Haas AR, Percy R, Woods ST, Ahn UM, Ahn NU. Time to Surgery Affects Return to Work Rates for Workers’ Compensation Patients With Single-Level Lumbar Disk Herniation. Orthopedics. 2021 Jan 1;44(1):e43-e49. doi: 10.3928/01477447-20201202-06. Epub 2020 Dec 7. PMID: 33284984.

The study found that “within 12 weeks of injury, post-diskectomy patients do reasonably well, with a 70.0% (95% CI, 65.9%–74.1%) rate of RTW.”

The study also found that “[o]n the other hand, if a patient waited more than 2 years to have surgery for radiculopathy, RTW(return to work) rates decreased as low as 31.3% (95% CI, 26.3%–36.3%).” Ren BO, O’Donnell JA, Anderson JT, Haas AR, Percy R, Woods ST, Ahn UM, Ahn NU. Time to Surgery Affects Return to Work Rates for Workers’ Compensation Patients With Single-Level Lumbar Disk Herniation. Orthopedics. 2021 Jan 1;44(1):e43-e49. doi: 10.3928/01477447-20201202-06. Epub 2020 Dec 7. PMID: 33284984.

Note: the study’s results are confounding to Insurance Companies.  The study suggests that acting promptly to approve a surgery can lead to more promising results.   The study implies that a long drawn out battle for a back surgery can result in a poor result.  Thus, acting quickly and spending a considerable amount of money for treatment leads to a better result in this circumstance.  Thus, these types of cases are a true test for Adjusters.

Was There Anything Else Interesting from the Study?

Irrespective of surgery, the factors of  legal representation, psychological co-morbidity and mean household income can negatively impact return to work. Ren BO, O’Donnell JA, Anderson JT, Haas AR, Percy R, Woods ST, Ahn UM, Ahn NU. Time to Surgery Affects Return to Work Rates for Workers’ Compensation Patients With Single-Level Lumbar Disk Herniation. Orthopedics. 2021 Jan 1;44(1):e43-e49. doi: 10.3928/01477447-20201202-06. Epub 2020 Dec 7. PMID: 33284984.

Is There Anything an Injured Worker Should Do?

Injured Workers with spinal problems should get appropriate medical care at the onset of injury. In the case of severe back pain and in cases with radiculopathy, they should seek out an orthopedic surgeon to have their condition assessed.

Per the study, if surgery is truly indicated, surgery it suggests that it be done promptly. Each individual’s medical condition and recovery, however, is different. Thus, the treatment course should be done on an individual basis and not per a study.

What If I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for over 28 years. Contact us today for more information.

THE QUEBEC BACK PAIN DISABILITY SCALE AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

For both workers’ compensation treatment and evaluation, Injured Workers are frequently asked to fill out surveys concerning their medical conditions. The Quebec Back Pain Disability Scale (QBPDS) is one of those surveys.

This article will discuss how and why such scales are used within the workers’ compensation system, what is the Quebec Back Pain disability Scale, what questions are asked within the scale, how the scale is scored? and what it can mean to a workers’ compensation claim.

What is the QBPDS?

This questionnaire is one that addresses back pain.  It inquires as to the daily activities that impacted by Back Pain.

Why are Surveys and Scales Used?

Surveys and Scales which ask the Injured Worker to self-report on their conditions are helpful to both treating doctors and evaluators.  First, they are a cheap quick method of getting some insight into the Injured Worker’s complaints.  Second, they can give the doctor or evaluator a sense of how serious the worker perceives their injury.  Third, they can give some insight as to whether someone is exaggerating with respect to the complaints. Fourth, if the same scale is administered over time, it can reveal some insight as to the course of the injured Worker’s condition.  Repeated testing may show whether the Injured Worker sees their pain improving, staying the same, or getting worse.

What are the QBPDS Questions Asked?

There are twenty questions asked within the inventory. The questions are about getting out of bed, sleeping through the night, turning over in bed, riding in a car, standing up for 20-30 minutes, sitting in a chair for several hours, climbing one slight of stairs, walking a few blocks, walking several kilometers, reaching up to high shelves, throwing a ball, running one block, taking food out of the refrigerator, making your bed, putting socks or pantyhose on, bending over to clean the bathtub, moving a chair, pulling or pushing heavy doors, carrying two bags or groceries, and lifting and carrying a heavy suit case.

Note: The questions are interesting in that they include activities that an individual may rarely or never participate in.  For example, there are some people who do not throw balls or handle suit cases.

How Are the Responses Scored?

There are five responses that can be made. They are not difficult at all, minimally difficult, somewhat difficult, fairly difficult, very difficult, and unable to do.  They are scored from 0-5.

Note: The responses address ability to perform activities as opposed to the individual’s pain experience.

What Do the Scores Mean?

A higher score represents a greater level of perceived functional disability.  A lower score represents a lower level of perceived functional disability.

Is The QBPDS Helpful for Treating Evaluators and Physicians With Respect to Permanent Disability Assignment?

In California Workers’ Compensation Law, Activities of Daily Living are a basis for making impairment assessments.  Impairment assessments render a Whole Person Impairment which then translates into a Permanent Disability Percentage. The QBPDS can be helpful to an evaluator on their assessment.  The Activities of Daily Living based upon the AMA Guides 5th Edition are Self-care: urinating, defecating, brushing teeth, personal hygiene combing hair, bathing, dressing oneself, and eating,  Communication:  writing, typing, seeing, hearing, and speaking, Physical activity:  standing, sitting, reclining, walking, and climbing stairs, Sensory Function: hearing, seeing, tactile feeling, tasting, smelling, Nonspecialized Hand Activities: grasping, lifting, tactile discrimination,  Travel: riding, driving, flying, Sexual Function: orgasm, ejaculation, lubrication, erection, and Sleep: restful and nocturnal sleep pattern.

The QBPDS does not explore self-care and sexual function. Therefore, it is not fully comprehensive to render an ADL assessment.

As an Injured Worker, What Should I Do When I Fill Out These Scales?

When fill out these scales, try to be accurate as possible. Sometimes, I personally roll my eyes when I see scales in which every answer is the highest.

What if I Need Advice?

If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. We have been helping people in Central and Southern California deal with their workers’ compensation cases for 27 years. Contact us today for more information.

 

 

 

 

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