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Shoulder Injuries: Workers’ Compensation

Posted on May 12, 2021 by Edward Singer

Shoulders are at risk of industrial injury and are subject to many workers’ compensation claims. The shoulder is a complex body part. As a result, there are variety of medical treatments that can be applied. One type of shoulder injury is to the rotator cuff. Rotator cuff tears account for over 4.5 million annual physician visits due to rotator cuff tears in the United States .Rotator cuff tears are one of the most common forms of upper extremity injury in the workers’ compensation population. Gutman M J, Patel M S, Katakam A, et al. (March 31, 2021) Understanding Outcomes and the Ability to Return to Work After Rotator Cuff Repair in the Workers’ Compensation Population. Cureus 13(3): e14213. doi:10.7759/cureus.14213. One form a treatment for rotator cuff injuries is surgery.

This article will discuss shoulders, rotator cuff surgeries, and a recent study concerning rotator cuff surgeries.

What Types of Surgeries Can Be Performed on Shoulders?

There are a variety of shoulder surgeries that are available.   Shoulder surgeries include rotator cuff tear, total shoulder arthropathy and reverse shoulder arthropathy. Surgery choice is based upon the nature of the injury and what needs to be repaired.

What is the Rotator Cuff?

The rotator cuff is a group of four muscles that come together as tendons to form a covering around the head of the humerus in the shoulder. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm. AAOC

What Are Symptoms of Rotator Cuff Injuries?

The symptoms for rotator cuff tears can include pain at rest and at night, pain when lifting and lowering your arm, pain with specific movements, weakness when lifting or rotating your arm and cracking when moving your shoulder. AAOC

What Is Rotator Cuff Surgery?

A rotator cuff surgery will attempt to repair the torn tendons.   This can include re-attaching them to the bone. AAOC

Does Occupation Matter with Respect to Rotator Cuff Surgeries?

Per the study, “the majority of patients with workers’ compensation claims have excellent outcomes from rotator cuff repair. Those patients that returned to work were more likely to work as non-laborers, had better functional scores and greater satisfaction with their treatment. Patients with three tendon tear repairs demonstrated worse functional outcomes than small full-thickness tendon repairs.” Gutman M J, Patel M S, Katakam A, et al. (March 31, 2021) Understanding Outcomes and the Ability to Return to Work After Rotator Cuff Repair in the Workers’ Compensation Population. Cureus 13(3): e14213. doi:10.7759/cureus.14213.

In sum, occupations such as clerical staff will have better results and happiness from the surgery versus physical laborers. Generally, laborers are individuals that work in the construction field, do warehouse work, and do heavy work.

What Were the Study Results with Respect to Dominant versus Non-Dominant Hand?

Yes. The study “found that patients who did not RTW [return to work] had a higher frequency of rotator cuff tear in the dominant arm. This was especially evident when looking at patients who held labor-intensive occupations that required use of their upper extremities. In general, laborers were less likely to return to work than non-laborers (p = 0.032), but when they had sustained a dominant arm injury, the ability to RTW [return to work) was decreased even further in 90% of laborers with non-dominant cuff tears able to return to work compared to only 54% of laborers with dominant arm cuff tears.” Gutman M J, Patel M S, Katakam A, et al. (March 31, 2021) Understanding Outcomes and the Ability to Return to Work After Rotator Cuff Repair in the Workers’ Compensation Population. Cureus 13(3): e14213. doi:10.7759/cureus.14213.

Is Rotator Cuff Surgery Generally Successful with Respect to Injured Workers’ Return to Work?

The study found “the majority of patients achieved excellent functional outcomes and the ability to return to work. Gutman M J, Patel M S, Katakam A, et al. (March 31, 2021) Understanding Outcomes and the Ability to Return to Work After Rotator Cuff Repair in the Workers’ Compensation Population. Cureus 13(3): e14213. doi:10.7759/cureus.14213.

Is Pain a Factor?

Yes, per the study, “shoulder function and shoulder pain scores were highly predictive of ability to RTW [return to work.] Patients who returned to work had significantly higher shoulder satisfaction and shoulder function.” Gutman M J, Patel M S, Katakam A, et al. (March 31, 2021) Understanding Outcomes and the Ability to Return to Work After Rotator Cuff Repair in the Workers’ Compensation Population. Cureus 13(3): e14213. doi:10.7759/cureus.14213.

Do the Number of Tears Operated on Matter?

Yes. Per the study, “three tendon tears have been shown to have the highest rate of re-tear rate and worse functional outcomes. In the current study, while size of tear (p = 0.12) was not predictive of ability to RTW [return to work], patients with three torn tendons experienced the lowest rates of returning to work and the worst functional outcomes.” Gutman M J, Patel M S, Katakam A, et al. (March 31, 2021) Understanding Outcomes and the Ability to Return to Work After Rotator Cuff Repair in the Workers’ Compensation Population. Cureus 13(3): e14213. doi:10.7759/cureus.14213.

What Does This Study Mean for Injured Workers?

Insurance Companies may use this study to make assessments on an injured Workers’ ability to return to work. Specifically, Injured Workers who are laborers who injured had their dominant shoulder operated on will likely have return to work difficulties.

Insurance Companies may be encouraged to authorize additional post-surgical therapy if there are signs of functional improvement. Functional improvement plays an important factor on   return to work issues.

Insurance Companies will be concerned in rotator cuff shoulder surgeries involving three tears. Carriers may approach these cases with the view that they may be problematic for both return to work issues and for future medical care needs.

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

Posted on April 23, 2021 by Edward Singer

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 Opioid Risk Tool (Ort) And Work Injury Treatment

Posted on April 19, 2021 by Edward Singer

In the field of medicine, tools are used to assess treatment’s nature and course. These tools are used to make assessments to medical treatment. The tools are frequently questionnaires filled out by patients on their own. These tools are considered a cost-effective and reliable means of obtaining information.

Opioid medications can be prescribed to treat work injuries. They can be used in circumstances of acute injuries and in circumstances of chronic pain. Medical Providers are very concerned over prescribed opioid medications as they are controlled substances and are subject to governmental scrutiny.

This article will discuss the Opioid Risk Tool (ORT), the topics addressed, in the ORT, how the ORT is scored, and why it is the ORT is important.

Are Opioids a Problem Within Workers’ Compensation?

It is reported that the “NCCI data shows that injured workers who were prescribed at least one prescription in 2016 received three times as many opioid prescriptions as the US opioid prescribing rate. These figures illustrate that workers compensation is directly affected by the far-reaching societal impacts of the opioid epidemic in the United States.” ncci

What Is the Opioid Risk Tool (ORT)?

The ORT was developed by Webster, et al. as a “self-performed screening tool designed for use by adult patients in primary care settings before beginning opioid treatment for pain management.” ncbi

Note: within workers’ compensation medical treatment, there is concern and analysis over what is medically appropriate treatment that is intended to cure or relieve the effects of an injury pursuant to Labor Code Section 4600. The ORT can be used as a basis for approving or denying the provision of narcotic medications. The ORT information may be employed by Utilization Review and Independent Medical Review for approval or denial of opioid prescriptions.

What are the Topics in the ORT?

The ORT includes the following topics:

Patient’s Gender
Patient’s Family History of Substance Abuse
1. Alcohol
2. Illegal Drugs
3. Prescription Drugs
Patient’s Personal History of Substance Abuse
1. Alcohol
2. Illegal Drugs
3. Prescription Drugs
Patient’s Age Range of Patient, Specially between 16 to 45 years
Patient’s History of Preadolescent Sexual Abuse
Patient’s Psychological Disease
1. Attention Deficit Hyperactivity Disorder
2. Obsessive-Compulsive Disorder
3. Bipolar Disorder
4. Schizophrenia
5. Depression

How Is the Questionnaire Scored?

The scoring on the questions are as follow:

“Family history of substance abuse including alcohol (Female=1; Male=3), illegal drugs (2;3), and/or prescription drugs (4;4) Personal history of substance abuse including alcohol (Female=3; Male=3), illegal drugs (4;4), and/or prescription drugs (5;5) Whether the patient age range is between 16 to 45 years (1;1) A history of preadolescent sexual abuse (3;0) Psychological disease including attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), bipolar disorder, schizophrenia (2;2); and/or depression (1;1).ncbi

Note: There are gender differences when scoring the test. Some drug and alcohol abuse answers score higher for males, and only females receive a score on the issue of preadolescent sexual abuse.

What Does the Score Mean?

“Scores are summed, and a score of 3 or below suggests a low risk for future opioid abuse, while a score of 4 to 7 indicates moderate risk. A score of 8 or greater suggests a high risk of future abusive drug-related behavior.” ncbi

Note: Score suggesting a high risk of future abusive drug-related behavior may be used to call into question prescriptions for those patients.

How Does This Impact Injured Workers?

Medical providers will analyze these scores as part of their decision to prescribe opioid medications. If the scores are too high, it is likely that a provider will consider alternative forms of medication and treatment for the individual to avoid the possibility of substance abuse.

Further, if opioids are prescribed to at risk patients, there may be additional monitoring taking place. “ Higher risk patients require more frequent monitoring than lower-risk patients. Follow-ups may include re-screening of risk, urine drug screening, and observation for other clues of drug abuse. These clues may consist of requests for dose escalation, doctor shopping, forging prescriptions, requesting early prescriptions, unscheduled clinic visits, or emergency room visits with complaints of pain.” ncbi

https://www.ncbi.nlm.nih.gov/books/NBK553147/

What If I Need Advice?

What You Need To Know About The Cage-aid Questionnaire And Workers’ Compensation

Posted on March 3, 2021 by Edward Singer

Workers’ Compensation Medical Treatment can employ various questionnaires to assess an Injured Workers’ need for treatment. One of these questionnaires is called CAGE-AID.

This article will discuss the purpose of the CAGE-AID questionnaire, how it is used in an industrial treatment setting, and how it may impact an injured worker’s treatment.

What is the CAGE-AID Questionnaire?

The CAGE-Aid questionnaire is a substance abuse screening tool. Substance abuse applies to alcohol, legal drugs and street drugs.

Why is Substance Abuse a Problem with Workers’ Compensation Treatment?

Substance abuse is a multi-factorial problem in workers’ compensation. There are workers who, prior to their injury, have histories of either substance or alcohol abuse. Further, there are workers, as a result of their injuries, begin to abuse drugs or alcohol. This abuse can either be with prescription drugs, alcohol, or street drugs. Finally, there are injured workers who, not as a result of their work injuries, engage in substance abuse.

Why is The Questionnaire Called CAGE?

The abbreviation refers to some of the terms within the questions. The terms are cut, annoyed, guilty and eye opener.

What are the Questions Asked?

There are four questions. They are:

Have you ever felt that you ought to cut down on your drinking or drug use?

Have people annoyed your by criticizing your drinking or drug use?

Have you ever felt bad or guilty about your drinking or drug use?

Have you ever had a drink or used drugs first thing in the morning to steady your nerves or get rid of a hangover (eye opener)?

How is it Scored?

It is scored one for yes and zero for no.

How is The Score Interpreted?

If one or more responses is yes, then it is regarded as a positive screening test. Thus, possible substance abuse is something that the medical provider should explore with the partient.

How Should Injured Workers Answer the Questions?

These questions may impact medical treatment decisions. Medical providers need accurate information in order to provide appropriate treatment. Substance abuse, when combined with prescription drugs, can lead to harmful and deadly drug interactions. Therefore, it is important to be honest when answering the questions.

Additionally, if an injured worker has a substance abuse problem that is preventing their recovery from a work injury, it is possible that the workers’ compensation medical system may provide some assistance with respect to substance abuse treatment. This, however, would be subject to the limitations within Labor Code Section 4600.

What If I Need Advice?

THE PAIN, ENJOYMENT AND GENERAL ACTIVITY SCALE (PEG) AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Posted on February 15, 2021 by Edward Singer

The California Workers’ Compensation System employs various scales and tests to assist with Injured Workers’ evaluation and treatment. One of these tests is the Pain, Enjoyment and General Activity Scale (PEG.)

This article will discuss the PEG Scale and how it can be used within the workers’ compensation system.

Why Are Scales Used in General?

Scales can be used for many reasons. Scales are generally self-reporting. Thus, all that is needed to administer one is a pen, a clipboard, and the questionnaire. Thus, they are a cheap, quick and easy way to extract information from Injured Workers. Scales can show that an injured Worker is credible. They can show that an Injured Worker is malingering or exaggerating. Scales can show a cry for help.

One way a scale can be used Is by comparing them to prior scales. When compared, it can show a patient’s assessment of medical improvement or lack thereof.

Scales are employed by medical examiners, treaters and utilization review evaluators to assess the Injured Workers’ disability status, permanent disability, and whether forms of treatment are indicated and should be approved.

In an article discussing PEG, it was noted that “[t]he competing demands of primary care, in which visits are short and pain is only one of several problems warranting attention, make efficiency of assessment a paramount concern. A balance must be found between feasibility and key characteristics such as reliability, validity, and responsiveness.” Krebs EE, Lorenz KA, Bair MJ, et al. Development and initial validation of the PEG, a three-item scale assessing pain intensity and interference. J Gen Intern Med. 2009;24(6):733-738. doi:10.1007/s11606-009-0981-1

What Is PEG Scale’s Complete Name? How Does It Relate to Workers’ Compensation?

The PEG Scale’s full name is the Pain, Enjoyment of Life and General Activity Scale.

California Workers’ Compensation Law employs the AMA Guides to assess permanent impairment. In the assessment of permanent impairment, Pain is a factor that is considered. Also, Activities of Daily Living is also a factor.

In sum, the scale overlaps some of these issues.

What Does the PEG Scale Consist Of?

The PEG Scale consists of three questions that are rated from 0 to 10.

What is the Pain Scale’s First Question?

The first question is “what number best describes your pain on average in the past week?”

How is the First Scale Question Answered?

The question is answered in a 0 to 10 scale. 0 being “no pain” to 10 being “pain as bad as you can imagine.”

What is the Second Question of the Pain Scale?

The second question is “what number best describes how, during the past week, pain has interfered with your enjoyment of life?”

How is the Second Question Answered?

The question is answered in a 0 to 10 scale. 0 being “does not interfere” to 10 being “completely interferes.”

What is the Third Question on the Pain Scale?

The third question is “what number best describes how, during the past week, pain has interfered with your general activity?”

How is the Third Question Answered?

The question is answered in a 0 to 10 scale. 0 being “does not interfere” to 10, “completely interferes.”

How is the PEG Scale Scored?

The scale is scored by adding up all three numbers and dividing by 3.

What Is the PEG Scale Specifically Used For?

“This scale can be administered in person at a clinic or hospital, answered via phone interview or personally completed at home. It is a flexible scale that can be used for many scenarios. For example, the PEG scale is often used to determine if a medication is effective; using it for this purpose helps determine an individual’s level of functioning while taking medication(s). Individuals who show a stable level of functioning, with no other factors that suggest a dosage adjustment, a medication taper or a medication change is needed, would then continue on their medication regime.” Painscale.com

Is There Any Advice to An Injured Worker?

Yes. These scales will be used possibly for two purposes: first, to evaluate your credibility, and second, to evaluate your improvement with respect to prescription medications and treatment.

Thus, it is best to make your best efforts to accurately answer them.

What If I Need Advice?