WORK-RELATED ROTATOR CUFF SHOULDER INJURIES, SURGERY, AND RETURN TO WORK: SHOULDERS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

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.

THE LOWER EXTREMITY FUNCTIONAL SCALE (LEFS) AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

In Workers’ Compensation, Doctors and Medical Evaluators, in order to address matters of disability and impairment, frequently use testing. Testing can be in the form of self-reporting questionnaires filled out by Injured Workers.

Many Injured Workers have injuries to their lower extremities.  Lower extremity injuries can include the hips, knees, ankles and feet.

This article will describe the Lower Extremity Functional Scale (LEFS), what the questions are asked, how it is scored, and what it means to an Injured Worker.

What is the Lower Extremity Functional Scale?

“The Lower Extremity Functional Scale (LEFS) is a questionnaire containing 20 questions about a person’s ability to perform everyday tasks.” Honorhealth.com

What is the Purpose of the LEFS?

“The LEFS can be used by clinicians as a measure of patients’ initial function, ongoing progress and outcome, as well as to set functional goals. The LEFS can be used to evaluate the functional impairment of a patient with a disorder of one or both lower extremities. It can be used to monitor the patient over time and to evaluate the effectiveness of an intervention.” Honorhealth.com

How Are You to Answer the Questions?

When provided the LEFS, there is language on the form. It provides as follows: “We are interested in knowing whether you are having any difficulty at all with the activities listed below because of your lower limb problem for which you are currently seeking attention. Please provide an answer for each activity.”  Honorhealth.com

“Today, do you or would you have any difficulty at all with:”

What Are the Activities That Are to Be Assessed?

There are twenty activities that are to be addressed within the LEFS:

Usual work, housework or school activities

Usual hobbies, recreational or sporting activities.

Walking between rooms

Getting into or out of the bath

Walking between rooms

Putting on shoes or socks

Squatting

Lifting an object, like a bag of groceries from the floor

Performing light activities around a home

Performing heavy activities around a home

Getting into or out of a car

Walking 2 blocks

Walking a mile.

Going up or down 10 stairs (about 1 flight of stairs)

Standing for 1 hour

Sitting for 1 hour

Running on even ground

Running on uneven ground

Making sharp turns while running fast

Hopping

Rolling over in bed

How Are the Questions Answered?

The questions are answered with respect to a level of difficulty.  The levels of difficulty are as follows: extreme difficulty or inability to perform activity, quite a bit of difficulty, moderate difficulty, a little bit of difficulty, and no difficulty.

How Is It Scored?

Each level of difficulty is assigned a number from 0 to 4.  The range being from “O” for being extreme difficulty or inability to perform to “4” being able to perform with no difficulty.

Extreme Difficulty or Unable to Perform Activity (0)

Quite a Bit of Difficulty (1)

Moderate Difficulty (2)

A Little Bit of Difficulty (3)

No difficulty (4)

What Is the Total Score?

The total score can range from 0 to 80.  The lower the score implies the greater the disability.

How Can This Scale Be Used in Workers’ Compensation?

In California, the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th Edition, employs the use of “activities of daily living” (ADL) to address impairment.   “Activities of daily living” include the following items

Per the AMA Guides 5th Edition, Table 1-2, See Page 599, the following are the definitions of each ADL. These ADLs include standing, sitting, walking, climbing stairs, lifting, dressing oneself and bathing.

Thus, the LEFS may assist doctors and examiners as to the nature and extent of the injury’s impact on the ADLs.   The ADL assessment can impact the assignment of the permanent impairment number.

Are There Any Concerns with Respect to LEFS?

The LEFS presents problems with respect to workers’ compensation.

First, the scale is to be filled out with respect to the individual’s perception as of the day of the evaluation.  Thus, if someone’s condition gets worse during the day from prolonged weight bearing, their answer in the morning may be different from that in the afternoon. Likewise, there is the issue of the Injured Worker having good days versus bad days. Further, there is the issue of whether the assessment is made with respect to one being medicated or not.  For example, an Injured Worker may be able to perform well on activities while on narcotics but have problems without.

Second, the scale may be used for credibility issues.  Since the scale documents activities on a particular day, contemporaneous sub rosa film may show the Injured Worker performing activities either consistent or inconsistent with their answers.

Third, the scale asks a “would” question concerning the activities.  To some extent, the Injured Worker is being asked to speculate as to their ability to perform certain functions.  In workers’ compensation, speculation cannot be used as a basis for an award and is therefore problematic.

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.

 

VISUAL ANALOG PAIN SCALE (VAPS) AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

In the Workers’ Compensation System, Doctors and Medical Evaluators ask Injured Workers to fill out various scales and questionnaires. One of these scales is the Visual Analog Pain Scale (VAPS.)

Scales and questionnaires can impact an Injured Worker’s ability to get treatment and disability payments. Therefore, Injured Worker should understand how to answer them properly.

This article will discuss the Visual Analog Pain Scale(VAPS), how the VAPS is administered, how VAPS is to be answered, how VAPS is graded, and how VAPS can be used within the workers’ compensation setting.

What is VAPS? What Is it Designed to Measure?

The Visual Analog Pain Scale is “a unidimensional measure of pain intensity, which is utilized in diverse adult populations.”  Measure of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP) Gillian A. Hawker, Samra Mian, Tetyana Kendzerska Melissa French 07 November 2011 https: //doi.org/10.1002/acr.20543

The VAPS is intended to explore the issue of pain.

What Does VAPS Look Like?

The VAP Scale can be set up either horizontally or vertically. Supra.

This is an example of a scale:    0 “no pain”   |————————————————–| 100 “worst imaginable pain.”

How Many Questions Are There in VAPS?

One. It is the simple answering of one’s pain level.  This is done by marking a spot on the spectrum to describe the pain. Supra.  The spot can be measured and assigned a number.  See below.  Some scales allow for the patient to assign a number.

How is the Score Interpreted?

“A higher score indicates greater pain intensity. Based on the distribution of pain VAS scores in post surgical patients (knee replacement, hysterectomy, or laparoscopic myomectomy) who described there postoperative pain intensity as none, mild, moderate, or severe, the following cut points on the pain VAS have been recommended: no pain (0-4mm), mild pain (5-44mm), moderate pain (45-74 mm) , and severe pain (75-100 mm) ” Supra.

Why Are These Terms important?

In workers’ compensation, the evaluators look at pain. Pain is often characterized by the terms of slight, moderate or severe.

The definitions for slight, moderate and severe are different in the field of industrial medicine. California used to use them to assign permanent disability.  In order to do so, they defined the terms.  The 1997 Permanent Disability Rating Schedule defined the terms as follows: “Pain is not always disabling. It becomes disabling when its degree affects function. Regulations define four degrees of subjective pain – minimal, slight, moderate and severe. By definition, minimal (mild) pain is not disabling because it causes no handicap in the activity precipitating the pain. However, slight, moderate and severe pain reflect increasingly greater degrees of handicap on work activity, and are ratable factors of disability.” P.1-7.  While these terms are no longer used for permanent disability purposes, they are frequently documented in medical reports.

Pain’s nature and extent, in certain circumstances, can be a factor in assessing whole person impairment. Whole person impairment is then translated into permanent disability.

How Can Testing Impact Injured Workers’ Claims?

Testing creates credibility issues.  When an Injured Worker provides a 100 score, it means either that they are in severe pain, they are exaggerating, or that they are making a cry for help.  In cases with minor injuries, high scores will impact the credibility of the pain reporting.

Also, an injured Worker may wish to ask how the question should be answered. Pain level when medicated or pain level during a certain period of time, i.e. this moment or this week, are legitimate questions.

What Is the Problem with this VAP Scale?

Pain assessments can be confounded with respect to an individual’s “pain reference.”

Some individuals have never experienced severe pain in their life.  For women who have experienced childbirth and for those who have passed a kidney stone, their pain references, however, can be in the severe range.  Thus, an individual’s past medical conditions is important to review as a reference.

It is quite conceivable that they have experienced pain in the 90s up to 100.   Some individuals also have strong pain tolerances.  A 70 to them would be a 95 to others Thus, these individual’s reporting may only be relevant when compared to other  assigned scores provided on different dates of evaluation or treatment.

How Should an Injured Worker Answer the VAPS?

An Injured Worker should make their best effort to accurately describe their pain.

If there is any confusion concerning how to answer or mark the scale, you should clarify with the evaluator. For instance, you could be a 50 on medications and a 70 without.  Thus, it is important that the doctor or evaluator understand your reason for assigning a particular level of pain.

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

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?

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.

 

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.

 

 

 

 

9.3Edward Jay Singer
Edward Jay SingerReviewsout of 22 reviews