Many work injuries give rise to Peripheral Neuropathies. Peripheral Neuropathy, for all intents and purposes, means damage to the nerves. Nerve Damage can come from many sources. Familiar Neuropathic Injuries include Carpal Tunnel Syndrome and Herniated Disks in the Spine which compress upon nerves.
Peripheral Neuropathies are important in workers’ compensation. They can dictate industrial causation, they can determine the course and scope of treatment, and they can determine the nature and extent of permanent disability.
This article will discuss what is a peripheral neuropathy, the different types of peripheral neuropathies, the various ways that a Worker can sustain a peripheral neuropathy injury, and how peripheral neuropathies can result in permanent disability.
What is Peripheral Neuropathy?
Peripheral Neuropathy is a condition that represents a deficit relating to the nerves that connect the brain to essentially the rest of the body. These connections from the brain include connections to the spine, muscles, skin and internal organs. The nerves provide important communications between the brain and these other body parts. When there is damage to these nerves, it is referred to as Peripheral Neuropathy.
There are varying degrees of nerve damage. This nerve disruption can be complete, it can be a disruption that causes inappropriate transmissions, or it can be a disruption that contains errors in the nerve transmissions.
How Can Peripheral Neuropathy Impact Me?
Peripheral Neuropathies can cause muscle weakness, muscle twitching, and muscle shrinking. They can harm the ability to feel vibrations and touch. They can impact one’s coordination. It can impact on one’s ability to feel temperature, i.e. heat, or pain. It can cause severe pain. Damage to nerves in the autonomic system can cause symptoms such as excessive sweating, heat intolerance or gastrointestinal symptoms.
What Are the Types of Peripheral Neuropathic Conditions?
Peripheral Neuropathic Conditions include Carpal Tunnel Syndrome, Cubital Tunnel Syndrome, Meralgia Paresthetica, and Complex Regional Pain Syndrome.
Are There Different Types of Peripheral Neuropathy? Are There Different Types of Nerves?
Yes. There are different types of neuropathy. Also, there are different types of nerves. There are Motor Nerves, Sensory Nerves, and Autonomic Nerves.
Some neuropathies impact a single nerve. Some neuropathies impact multiple nerves. When more than one nerve is involved, it is sometimes called Polyneuropathy.
What are the Causes of Peripheral Neuropathy and How Can It Be Work-Related?
Peripheral Neuropathy can be caused by physical trauma that stretches, crushes, compresses or detaches nerves. This physical trauma can be from a specific work injury such as a car accident causing a back injury with nerve damage to a cumulative trauma work injury which can be an injury to the wrist which causes carpal tunnel syndrome. Carpal Tunnel Syndrome involves damage to the Median Nerve. Cubital Tunnel Syndrome involves damage to the Ulnar Nerve.
Peripheral Neuropathy can be caused by Diabetes. Diabetes can be work-related in a variety of ways. Diabetes, that is considered as work-related, is usually a compensable consequence of an underlying injury. Post-Injury excess weight gain or the use of steroids during medical treatment can bring rise to industrial diabetes.
Peripheral Neuropathy can be caused by vascular and blood problems which cause limited supply. This can be work-related. For example, a Safety Officer with a Heart Presumption can suffer from Coronary Artery Disease that can contribute to nerve damage.
Peripheral Neuropathy can be caused by a Systemic Autoimmune Disease. Diseases such a Lupus or Rheumatoid Arthritis can caused neuropathic pain. Diseases such as Lupus can be industrially aggravated.
Hormonal Imbalances can also cause nerve problems.
Kidney and Liver Disorders can also lead to nerve damage. Kidney Damage can be work-related in that it can be aggravated by an industrial hypertension injury.
Nutritional or vitamin imbalances, alcoholism, and exposure to toxins can cause nerve damage. This can be work-related via an industrial toxic exposure.
Certain cancers and benign tumors can cause neuropathy. This neuropathy can be work-related in that Safety Officers have presumptive cancer injuries.
Chemotherapy Drugs that are used to treat cancer can cause neuropathy. Again, treatment for a Safety Officer for a presumptive cancer injury can give rise to this as a work-related condition.
Infections can also cause neuropathy. Illnesses such as Chicken Pox, Shingles, West Nile Virus or Lyme Disease, HIV can cause nerve damage. These Infections can be work-related. They can occur in the medical profession and in laboratory workers. Lyme Disease work-related contraction can occur for Firefighters who are working in a Forest or Grassland who come in contact with ticks.
How Is Peripheral Neuropathy Tested?
A common form of testing for Peripheral Neuropathy are Nerve Conduction Velocity Tests(NCV) and Electromyography (EMG.) These tests involve the insertion of very fine needles into certain muscles. These tests can reveal nerve damage.
How Does Peripheral Neuropathy Effect Treatment?
Peripheral Neuropathy can determine the course of treatment in numerous ways. Some treatment involves the decompression of nerves or treating entrapped nerves. Treatment for these conditions can include spinal surgery such as a discectomy. Treatment for this condition can include carpal tunnel surgery. Further, there are medications that are used to treat neuropathy such as Lyrica.
Can Peripheral Neuropathy Determine Industrial Causation?
Yes. Peripheral Neuropathy can assist in determining industrial causation. For example, nerve testing that shows carpal tunnel syndrome. This may aid the Examining Physician to conclude a repetitive trauma injury. Nerve testing showing nerve damage in the spine. This may aid the Examining Physician to conclude that there was a work-related spinal injury.
How Does Peripheral Neuropathy impact Permanent Disability?
In California Workers’ Compensation, the AMA Guides for Evaluation of Permanent Impairment 5th Edition is used to determine Permanent Disability via the assignment of Whole Person Impairment. Various section of the Guides that provides for instructions on how to assess impairment when there is Peripheral Neuropathy present.
Chapter 13 of the Guides provides for assessment for various forms of nerve damage.
With respect to the Spine, there are assessments made with respect to radiculopathy. The AMA Guides on P. 382-383, discusses Electrodiagnostic Verification of Radiculopathy. The AMA Guides provides that “[u]nequivocal electrodiagnostic evidence of acute nerve root pathology includes the presence of multiple positive sharp waves or fibrillation potentials in muscles innervated by one nerve root. However, the quality of the person performing and interpreting the study is critical. Electromyography should be performed only by a licensed physician qualified by reason of education, training, and experience in these procedures. Electromyography does not detect all compressive radiculopathies and cannot determine the cause of the nerve root pathology. On the other hand, electromyography can detect non-compressive radiculopathies, which are not identified by imaging studies.”
As noted above, Radiculopathy is a form of nerve damage or peripheral neuropathy. As Part of Spinal Injury Assessment of impairment, Verifiable Radiculopathy may determine the level of Whole Person Impairment that an individual may have.
Where Can I Find Advice?
If you would like a free consultation regarding workers’ compensation, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation.
They have been helping people in Central and Southern California deal with their worker’s compensation cases for 26 years. Contact us today for more information.