UPPER EXTREMITY SURGERY, POST-OPERATIVE VISITS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Workers’ Compensation Studies will often provide Injured Workers insight as to Insurance Companies’ and Medical Providers’ tactics.   Injured Workers often feel like there is an agenda working against them.  A recent study about post-operative visits for Upper Extremity Surgery raises concerns.

This article will discuss Upper Extremity Surgery, the Study’s results and the Study’s implications for Injured Workers.

What Are Upper Extremity Surgeries?

In the workers’ compensation system, upper extremities can fit into two categories.

First, there are traumatic injuries which require surgeries.  A skill saw accident involving amputation is one which may require extensive and specific procedures.

Second, there are surgeries that are due to Occupational Illness.  These surgeries are most likely related to repetitive trauma.

One common occupational illness surgery is carpal tunnel.

What Are Typical Workers’ Compensation Upper Extremity Surgeries?

Typical workers’ compensation surgeries, which were also the subject to the Study, are Carpal Tunnel Release, Trigger Finger Release, Cubital Tunnel Release, and De Quervains.

With respect to these surgeries, sometimes two or more of these procedures can be done at the same time.

What Did the Study Find?

The study found that workers’ compensation patients have more post-operative visits after surgery than non-industrial surgeries.  Henry TW, Townsend CB, Beredjiklian PK. Workers’ Compensation Status Confers a Greater Number of Postoperative Visits After Common Upper Extremity Surgeries. Cureus. 2021;13(4):e14629. Published 2021 Apr 22. doi:10.7759/cureus.14629

The study viewed these additional visits as being an additional cost which could be targeted for saving.   Telehealth appointments were suggested as a means of lowering costs. Also, there is the concern overburdening the providers with additional appointments.

Comment: Workers’ compensation claims have reporting obligations. Therefore, there is a greater need for appointments.   Likewise, there are return to work issues which may also cause the need for additional post-operative appointments.

Further, non-industrial patients, if they are satisfied with their result, may be inclined to cancel or not follow through with post-operative appointments.   Thus, there are a number of drivers in the workers’ compensation system which cause more appointments than non-industrial patients.  The notion of telehealth evaluations, however, may be of value.   In matters where there is excellent post-surgery healing, an actual appointment with the provider may not be so important. A telehealth evaluation may suffice.

Besides Costs, What Are Other Concerns in the Workers’ Compensation System Claims involving Upper Extremities?

Risk Management concerns on post-operative cases include the Injured Worker’s compliance with treatment, their functional outcome, their symptom relief, their return to work and their satisfaction. Henry TW, Townsend CB, Beredjiklian PK. Workers’ Compensation Status Confers a Greater Number of Postoperative Visits After Common Upper Extremity Surgeries. Cureus. 2021;13(4):e14629. Published 2021 Apr 22. doi:10.7759/cureus.14629

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.

DUPUYTREN’S DISEASE(DD) AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Dupuytren’s Disease (DD) is an upper extremity disorder.   DD has been a source of controversy with respect to whether it should be considered as an industrial injury. If DD is considered an industrial injury, then the Injured Worker suffering from the disorder would be entitled to workers’ compensation benefits. These would include medical treatment and disability compensation.  A recent study addressed industrial causation of the condition and made interesting findings.

This article will discuss Dupuytren’s Disease (DD), industrial causation for DD, the study’s results, and what it means to Injured Workers.

What Is Dupuytren’s Disease (DD)?

Dupuytren’s disease (DD) results in “the chronic contracture of the fourth and/or fifth finger of the hand towards the palm and is usually accompanied by a thickening of the palmar skin. These clinical manifestations significantly impair and restrict hand functioning.” Murínová L, Perečinský S, Jančová A, Murín P, Legáth Ľ. Is Dupuytren’s disease an occupational illness? Occup Med (Lond). 2021 Feb 6;71(1):28-33. doi: 10.1093/occmed/kqaa211. PMID: 33420499.

Why is Dupuytren’s Disease Important for Workers’ Compensation?

Per mayoclinic.org, “Dupuytren’s contracture can make it difficult to perform certain functions using your hand. .. as Dupuytren’s contracture progresses, it can limit your ability to fully open your hand, grasp large objects or to get your hand into narrow places.”  These activities are both labor disabling and can impact the performance of activities of daily living. Thus, DD can be the basis for impairment within workers’ compensation and would therefore translate into a permanent disability percentage.

In sum, if DD is work-related, it is likely an injury for which a permanent disability award is possible.

What Work Activities Did the Study Find That Impact DD?

There are two types of work activities that have been implicated as a source of causation for industrially-related DD.   They are working with vibrating tools and performing heavy manual labor.

There are many tools used in the work force that vibrate.   For example, jackhammers and power saws. The study used involved workers who used hand-held pneumatic rock drills.

Heavy manual labor can take place in various occupations. Heavy labor that was used  in the study was working involving “prolonged, heavy, physical labour that required strength and energy, and included lifting, lowering, pulling, pushing or carrying a load.”

The theory behind these two types of activities is that they can cause cumulative micro-traumas which then can cause impairment of the micro-circulation in the hands. Murínová L, Perečinský S, Jančová A, Murín P, Legáth Ľ. Is Dupuytren’s disease an occupational illness? Occup Med (Lond). 2021 Feb 6;71(1):28-33. doi: 10.1093/occmed/kqaa211. PMID: 33420499.

It was noted that risk was 4-fold for vibrating tools and 3-fold for heavy manual labor compared to controls. Supra.

“A significant independent association was found between DD and HTVs (OR 4.59; 95% CI 2.05–10.32) and HMW (OR 3.10; 95% CI 1.21–7.91).” Supra.

In the Study, Was the Length of Time Performing the Injurious Activities Significant?

Yes.  They study found the length of exposure to be significant.   This was especially the case when there was at least 15.5 years of employment. “Exposures that lasted for more than 15.5 years were sensitive and specific predictors for the presence of DD.” Murínová L, Perečinský S, Jančová A, Murín P, Legáth Ľ. Is Dupuytren’s disease an occupational illness? Occup Med (Lond). 2021 Feb 6;71(1):28-33. doi: 10.1093/occmed/kqaa211. PMID: 33420499.

In the Study, Did Age Matter?

Yes.  The study noted “[w]hile DD was more common in older patients, it was much more frequent in exposed subjects compared to controls across all age categories.” Murínová L, Perečinský S, Jančová A, Murín P, Legáth Ľ. Is Dupuytren’s disease an occupational illness? Occup Med (Lond). 2021 Feb 6;71(1):28-33. doi: 10.1093/occmed/kqaa211. PMID: 33420499.

Is There Any Limitation to the Study?

Yes. The study was limited to only men.  Thus, additional studies beyond this one would assist is a female injured worker making a DD claim.  Murínová L, Perečinský S, Jančová A, Murín P, Legáth Ľ. Is Dupuytren’s disease an occupational illness? Occup Med (Lond). 2021 Feb 6;71(1):28-33. doi: 10.1093/occmed/kqaa211. PMID: 33420499.

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.

 

FINGERTIP INJURIES AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Upper Extremity Injuries are very common in an occupational setting.  Upper Extremity Injuries can include injuries to the fingertip.  Fingertip injuries can involve an amputation.

In the general population, “[i]t is estimated that as many as 45,000 finger amputations are performed in the US per year with an incidence rate of 7.5/100,000 people.” Kawaiah A, Thakur M, Garg S, Kawasmi SH, Hassan A. Fingertip Injuries and Amputations: A Review of the Literature. Cureus. 2020;12(5):e8291. Published 2020 May 26. doi:10.7759/cureus.8291

This article will discuss Fingertip Injuries, causes of fingertip injuries, treatment for fingertip injuries, a special workers’ compensation law with respect to amputation cases, and issues relating permanent disability.

What is the Fingertip? Why is It Unique?

 Fingertips are unique. “The tip of the digit comprises virtually all tissue components present elsewhere in the body: skin, bone, joint, synovial membrane, ligaments, tendons, tendon sheaths, arteries, veins, lymphatic channels, nerves, and advanced nervous end organs.” Kawaiah A, Thakur M, Garg S, Kawasmi SH, Hassan A. Fingertip Injuries and Amputations: A Review of the Literature. Cureus. 2020;12(5):e8291. Published 2020 May 26. doi:10.7759/cureus.8291

Thus, a traumatized tip can experience a variety of symptoms.  These symptoms and factors of impairment can include tenderness, sensitivity to cold, discoloration, and deformity.   Kawaiah A, Thakur M, Garg S, Kawasmi SH, Hassan A. Fingertip Injuries and Amputations: A Review of the Literature. Cureus. 2020;12(5):e8291. Published 2020 May 26. doi:10.7759/cureus.8291

What Are Common Causes of Fingertip Injuries?

Many occupational hand injuries involve metal items.  The metal items can include hand tools which include blades.  On a personal note, I have had fingertip injuries occur on table saws in which safeties have been removed.  Also, I  have had fingertip injuries in which the hand accidentally went into a piece of moving machinery.

Fingertip injuries can also occur as a result of sharps.   Sharps are devices that are used to cut.  These include many items used in the medical field such as auto injectors, connection needles and sets, infusion sets, lancets, needles, and syringes.

Sharp injuries can result in lacerations, amputations, or neurovascular injuries. Kawaiah A, Thakur M, Garg S, Kawasmi SH, Hassan A. Fingertip Injuries and Amputations: A Review of the Literature. Cureus. 2020;12(5):e8291. Published 2020 May 26. doi:10.7759/cureus.8291

 What Are Goals of Treatment?

 Treatment goals for fingertip injuries include restoration of sensation of the tip, improving the durability of the tip, and providing for proper bone support to allow for nail growth. Kawaiah A, Thakur M, Garg S, Kawasmi SH, Hassan A. Fingertip Injuries and Amputations: A Review of the Literature. Cureus. 2020;12(5):e8291. Published 2020 May 26. doi:10.7759/cureus.8291

What Problems Can Arise from a Fingertip Injury?

Problems arising from fingertip injuries can include deformities, intolerance to cold, skin tenderness, stiffness, and long-term functional loss. Kawaiah A, Thakur M, Garg S, Kawasmi SH, Hassan A. Fingertip Injuries and Amputations: A Review of the Literature. Cureus. 2020;12(5):e8291. Published 2020 May 26. doi:10.7759/cureus.8291

How Is a Fingertip Injury Treated?

Due to the complexity and importance of the fingertip, there are many issues that can present.  There are concerns with respect to psychological factors that can present with such injuries.

Also, there may be issues of pain syndromes that can occur as a result of a fingertip injury.  These pain syndromes can even occur in the case of minor contusion. Approach to Fingertip Injuries Patricia Martin-Playa, MD, Anthony Foo, MD* Clin Plastic Surg 46 (2019) 275–283 https://doi.org/10.1016/j.cps.2019.02.001

Treatment can include repairing the skin by stiches or glue, skin grafting, reconstruction, composite grafts, flap reconstruction, bone graft, nail complex reconstruction.

Are There Psycho-Social Factors Issues with Fingertip Injuries?

Yes.  Fingertips are an extremely important part of the body.  They are used frequently during the day for a variety of tasks. Fingertip injuries can impact one’s occupation and their participation in hobbies.  For example, a fingertip injury may impact on one’s ability to perform a musical instrument.

Fingertips are usually visible to the public.  Therefore, there can be an emotional impact on the patient.

Fingertip injuries that are part of a workers’ compensations have secondary motivation issues. For instance, the patient may have concerns about disability status and impairment.

Fingertip injuries can be subject to clinical bias. For example, medical practitioners may view the severity of the injury differently from the patient. Approach to Fingertip Injuries Patricia Martin-Playa, MD, Anthony Foo, MD* Clin Plastic Surg 46 (2019) 275–283 https://doi.org/10.1016/j.cps.2019.02.001

Is There a Special Law for Amputation Cases?

Yes. In the case of amputations, total temporary disability benefits are extended out to 240 weeks from 104 weeks.  This is pursuant to Labor Code Section 4565(c)(3)(c.)

What Type of Permanent Impairment Can Arise from A Fingertip Injury?

Fingertip injuries can cause many types of impairments.  There are impairments that relate to amputations, there are impairments that relate to skin conditions, there are impairments that relate to nerve damage, there are impairments which relate to loss of function such as range of motion.  Also, there may be a pain impairment add-on.

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.

 

 

 

 

UPPER EXTREMITY WORKERS’ COMPENSATION SURGERIES: WHAT YOU NEED TO KNOW

Studies about workers’ compensation as always of interest to Injured Workers.   A lot of these studies tell us how and why insurance companies, employers and doctors act in particular ways.   A study addressing upper extremity surgeries provides us such insight. The study compared the results of industrial versus non-industrial upper extremity surgeries.

This article will discuss, upper extremity surgeries, issues relating to upper extremity surgeries, and the results of the study.

What Are Upper Extremity Surgeries?

 With respect to upper extremities, there are a variety of surgeries that are done on an industrial basis.  Upper extremity surgeries can range from shoulders to finger tips. Parts operated on can include areas such as the shoulders, biceps, elbows, forearms, wrists, and fingers.

For shoulders and elbows, there operations can include fracture surgeries, total shoulder replacements, shoulder arthroscopies, rotator cuff repairs, tennis elbow, golfer’s elbow, and elbow arthroscopy.

For the wrist, operations can include fracture surgeries, carpal tunnel releases, wrist arthroscopies, wrist joint replacements and wrist fusions.

How Are Workers’ Compensation Upper Extremity Surgeries Different Than Non-Industrial Upper Extremity Surgeries?

Approval:  Unlike Health Insurance Company approval for surgeries, Workers’ Compensation surgeries are subject to utilization review and independent medical review. Thus, there are guidelines and algorithms that must be met in order for surgeries to get authorized.  This can lead to delays in getting approval.

Medical Providers:  For many Injured Workers, they are constrained to using hand surgeons and upper extremity surgeons within the workers’ compensation insurance medical provider networks. Thus, the quality of the surgeon is subject to the insurance company’s dedication to having good providers.

Total Temporary Disability Benefits: For Injured Workers, they receive benefits is they remain symptomatic. Therefore, it is necessary that the voice all of their problems.

Permanent Disability Benefits: For Injured Workers, they need to be critical of the results of the surgery and be able to describe them.  Therefore, the result is viewed with this mindset.

What Was the Study’s Conclusion?

 The study “found that patients receiving WC[workers’ compensation] had worse postsurgical results after upper extremity surgery and demonstrated less pre- vs postoperative improvement than uncompensated patients regardless of which outcomes were measured. However, this effect was not uniform among different types of outcomes. Functional measures, such as AOM or grip strength, were least likely to demonstrate a significant difference between compensated and uncompensated patients. The same was true in studies that measured pre- vs postoperative improvement rather than only assess patient postoperatively.” Fujihara Y, Shauver MJ, Lark ME, Zhong L, Chung KC. The Effect of Workers’ Compensation on Outcome Measurement Methods after Upper Extremity Surgery: A Systematic Review and Meta-Analysis. Plast Reconstr Surg. 2017;139(4):923-933. doi:10.1097/PRS.0000000000003154. It was noted that this analysis was aware that compensated patients can result in artificial reduction of the therapeutic effect which may lead to incorrect conclusions. Supra.

The study noted that “.. the effect of WC on surgical outcome is not solely an issue of malingering Americans. Compensation systems that do not incentivise feigning impairment, also observe worse outcomes associated with WC. Rather, this may indicate that increased impairment among workers receiving WC may be a result of psychological effects on patients caused by a sense of victimization or injustice .” Fujihara Y, Shauver MJ, Lark ME, Zhong L, Chung KC. The Effect of Workers’ Compensation on Outcome Measurement Methods after Upper Extremity Surgery: A Systematic Review and Meta-Analysis. Plast Reconstr Surg. 2017;139(4):923-933. doi:10.1097/PRS.0000000000003154

In sum, it would appear that Injured Workers have poorer post-operative results.   There are factors of income, malingering, psychological effects of victimhood and injustice may be the factors lead to a poorer workers’ compensation result.

Knowing these Results, How Will an Injured Worker Be Treated?

 Insurance Companies, knowing the surgery result may be poor, may want to avoid providing for it.  This can be done in two ways: one, settling the case before surgery, two, contesting the need for the surgery.

Doctors take pride in their work.  Doctors like to have good results.  Therefore, doctors may not thrilled with Injured Workers because there will be some level of dissatisfaction and representations that the surgical result was not optimal.

Employers, like Insurance Companies, may not be happy with surgeries with poor results.  For them, they are faced with a costlier claim as well as possible issues with respect to return to work.   Return to work issues would involve either qualified Injured worker status or the need to provide alternative or modified work.

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.

 

EVEN TREATERS GET INJURED AT WORK: OCCUPATIONAL AND PHYSICAL THERAPISTS SUSTAINING INDUSTRIAL INJURIES:  MEDICAL PROVIDERS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Occupational and Physical Therapists play a large role in helping Injured Workers recover from their industrial injuries.  In doing so, however, Occupational and Physical Therapists may be placing themselves at risk for sustaining a work injury. More specifically, both Occupational and Physical Therapist’s work activities can place them at risk for sustaining musculoskeletal disorders. These musculoskeletal disorders can include back problems, shoulder problems, and wrist problems.

The article will discuss Occupational and Physical Therapists, what activities they perform on the job that may be injurious to them, and the rates of injuries that occur for Occupational and Physical Therapists.

What is an Occupational Therapist (OT)?

Per the American Occupational Therapy Association, “occupational therapists …help people… participate in the things they want and need to do through the therapeutic use of everyday activities (occupations.)”

OT Programs can include “an individualized evaluation, during which the client/family and occupational therapist determine the person’s goals, [a] customized intervention to improve the person’s ability to perform daily activities and reach the goals, and an outcomes evaluation to ensure that the goals are being met and/or make changes to the intervention plan.”

What is a Physical Therapist (PT)?

Per the American Physical Therapy Association, “[p]hysical therapists are movement experts who improve quality of life through prescribed exercise, hands-on care, and patient education.”

“Physical therapists examine each person and then develops a treatment plan to improve their ability to move, reduce or manage pain, restore function, and prevent disability.”

What is the Difference Between an Occupational and Physical Therapists?

The Occupational Therapist focuses on the patient’s ability to perform work-related functions.  The Physical Therapist focuses on physical activities in general.

What Are The Work Activities That Are Injurious to OTs and PTs?

Transfers/Lifts and manual therapy have been found to be associated with musculoskeletal disorders. “Darragh AR, Campo M, King P. Work-related activities associated with injury in occupational and physical therapists. Work. 2012;42(3):373-84. doi: 10.3233/WOR-2012-1430. PMID: 22523031; PMCID: PMC3839086.  These activities have been found to impact the lumbar spine.  Supra.

Patient handling activities include (transfers, repositioning and patient lifting. Supra.

Manual therapy includes soft tissue work, joint mobilization, and orthopedic techniques. Supra.

Manual Therapy was found also found as a risk factor consistent risk factor for both injuries as well as gradual onset of WSMDs. Supra.  In workers’ compensation terms, this would be considered as a cumulative trauma injury.

With Respect to Musculoskeletal Disorders? Is There Any Difference Between OTs and PTs?

No. “Occupational (OTs) and physical therapists (PTs) have substantial and similar rates of work-related injury (WRI), musculoskeletal pain and musculoskeletal disorders (WMSD)” Darragh AR, Campo M, King P. Work-related activities associated with injury in occupational and physical therapists. Work. 2012;42(3):373-84. doi: 10.3233/WOR-2012-1430. PMID: 22523031; PMCID: PMC3839086.

“Darragh et al. reported an annual WRI incidence rate among OTs and PTs of 16.5 and 16.9 per 100 full-time workers, respectively.” Darragh AR, Campo M, King P. Work-related activities associated with injury in occupational and physical therapists. Work. 2012;42(3):373-84. doi: 10.3233/WOR-2012-1430. PMID: 22523031; PMCID: PMC3839086.

What Are Injury Rates for Activities?  What Do Therapists Think Are the Causes of Their Injuries?

“Manual therapy and transfers/lifts accounted for more than half of all injuries (54.0%), across all practice areas.” Supra.  “Manual therapy was the greatest proportion of injuries to the wrist and hand (69.1%).” Supra.  “Transfer and lifting activities were associated with 26.6% of injuries Over half of these injuries were to the low back (53.0%), followed by the shoulder (19.7%) and the head/neck (18.2%).” Supra.   “Other activities associated with injury included environmental and equipment interactions (10.9%), multiple activities (6.5%) and patient falls (5.7%)”

What Do Therapists Think of How They Get Hurt?

Therapists opine that force, awkward posture, repetitive motion, sustained posture, and fatigue were factors contributing to those type of injuries.  Supra.

For wrist and hand injuries, therapists opine that repetitive motion (experienced during joint mobilizations and range of motion activities), force (experienced during range of motion, soft tissue work, and joint mobilizations), awkward posture and sustained posture were factors contributing to those type of injuries. Supra.

For transfer and lifting activities, opined that “these injuries occurred both gradually because of repeated performance of transfers over time and more suddenly when a patient behaved in an unexpected way (grabbed the therapist, stumbled, or moved in an unexpected direction.) The majority of therapist identified force (72.7%;48/66), including overexertion and lifting, and awkward posture (54.5%; 36/66) as the primary contributing factors to their transfer injuries.” Supra.

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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