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.

 

STRESSED OUT WORKERS: SOCIAL MEDIA, UNSYMPATHETIC CUSTOMERS, AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

A TikTok trend, is stressing out Starbucks Baristas.  The NyPost reports that customers who are TikTok fans are essentially harassing workers with outlandish orders.  One famous order is from an Edward.  Edward’s drink is a double blended drink containing 13 ingredients. nypost.   Unless a commensurate tip is provided for time consuming orders, it is  understandable why these customized drinks can be a source of Barrista stress, anxiety and upset.  Further, too many of these orders simultaneously ordered could place a real grind on the fulfillment of regular orders.

Customer stress can a valid basis for a Workers’ Compensation “Stress” or “Psyche” claim. Should the stress from being inundated by these ridiculous time consuming orders give rise to an emotional disorder, a Barrista could consider filing a workers’ compensation claim to seek medical attention and benefits.

Are There Any Requirements to File Such a Claim?

Before filing a workers’ compensation claim, it is important for an Injured Worker to have some understanding as to whether they will prevail.

The “Six-Month” Rule

Given a claim relating to excessive order, an employee must have six months of employment that need not be continuous.  If you have issues as to whether you worked six months, an attorney consultation is indicated.

“Predominant Cause”

The employee must provide by a preponderance of the evidence that the injury was caused by work.  There is a defense of good faith personnel action.   If there are various sources of work stress such as write-ups or discipline, an attorney consultation is indicated.

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.

 

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.

 

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.

9.3Edward Jay Singer
Edward Jay SingerReviewsout of 22 reviews