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.

COMMON WORK INJURIES AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

The Workers’ Compensation System is a Risk Management System.  It is designed to payout benefits for work-related injuries.   Therefore, it is very important for the industry to identify what types of injuries and occupations have high risk of injury.

The US Government has a Bureau of Labor Statistics which identify both common injuries and what occupations are at risk for injury.  On 11/4/20, statistics were issued for the year 2019.

This article will discuss common work-related injuries, occupations which have high rates of incidence for work injuries and other information.

What are Common Worker Related Injuries?

In the Manufacturing Field, the Injuries Rates were:  Sprains, Strains, or Tears (28.0 percent), Soreness or Pain (14.5 percent), and Cuts, Lacerations, or Punctures (13.3 percent)

What Occupations Have Higher Rates of Injury?

In order of incidences, per the BLS report, the occupations with the highest rate of injuries are listed from highest to lowest:

Nurses Assistants

Heavy and Tractor-Trailer Truck Drivers

Laborers and freight, Stock and Material Movers, Hand

Light Truck Drivers

Construction Laborers

Maintenance and Repair Workers, General

Stockers and Order Fillers

Janitors and Cleaners, except Maids and Housekeeping Cleaners

Registered Nurses

Retail Salespersons

Is There Other Interesting Data? 

Yes.

Elderly Workers:  “Private industry workers age 65 years or over had a median of 16 days away from work due to injuries and illnesses in 2019, compared to 8 days for all private industry workers.”

Male vs. Female Workers:  Men had higher injury rates that Women in 2019.

What Does This Data Mean to Workers?

Employers and Risk Management, knowing this data, will act upon these matter.   For example, Carriers may pay close attention to elderly injured workers due to the fact that they have extended periods of disability.  There may be some incentive to offer them modified work.  Further, for occupations that have high work injury rates, safety classes and other measures may be implemented to address lifting techniques and other techniques to prevent risk.

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.

Injured Workers and Medical Releases: Insurance Companies Requesting Releases and Workers’ Compensation: What You Need to Know

Injured Workers are frequently requested by Insurance Carriers to sign medical release forms.   These releases are also requested by Attorneys who represent both Injured Workers and those who represent Insurance Companies.

This article will discuss workers’ compensation discovery, medical releases, the different types of medical releases, and why insurance carriers and attorneys request medical releases.

What is Discovery?

“Discovery” is a legal term. It essentially means “information gathering” within a legal system. Legal systems, such as the California Workers’ Compensation System provides laws concerning this discovery. Examples of workers’ compensation discovery include witness depositions, medical records subpoenas, and medical-legal examinations.

Records can be obtained formally and informally.  The formal was is by subpoena.  The informal way is by consent.  Consent is obtained via a signed medical release authorizing the document production.

Why Is Workers’ Compensation Discovery Unique?

Workers’ Compensation (WC) Discovery is unique in that is pace is set within the Labor Code. Labor Code Section 5402 provides that Insurance Companies have 90 days, from the date of employer discovery of the claim.

WC Discovery is used to find out a variety of information. Medical records may allow the Insurance Company to verify the injury.   Medical records can provide information about one’s medical history which can impact the Claimant’s entitlement to compensation.

Beyond workers’ compensation, there are federal rules which address medical privacy issues.  This federal law is HIPPA which created national standards to protect individual’s medical records and other personal health information.  It “generally gives patients the right to examine and obtain a copy of their own health records.”  HIPPA

Why Are Medical Releases Important for Discovery?

Labor Code Section 5402 creates urgency for the insurance companies to obtain the claimant’s information as soon as possible.  Medical releases allow for medical records to be produced in a more expeditious fashion.

Also, there releases may authorize psychiatric or drug and alcohol treatment.  A medical release must specify these records.   Releases does not require these releases.  Thus, Injured Workers, especially if the claim is not a psychiatric claim, do not and should not sign a release for these records.   This is noted in the case of Allison vs. WCAB, , it was noted that “[t]he Supreme Court ruled that although the plaintiffs waived their physician-patient confidential communication privilege (Evid. Code, § 990[Deering’s] et seq.) and their psychotherapist-patient confidential communication privilege (Evid. Code, § 1010[Deering’s] et seq.) as to the medical, emotional, and mental conditions placed by them in issue in the case, and information regarding such conditions was therefore discoverable, all medical privacy was not waived.” 64 C.C.C. 624

Is there an Obligation to Provide a Release?

There is no obligation for an Injured Worker to provide a release to an Insurance Company.   Again, with psychiatric or drug and alcohol treatment releases, these should be scrutinized whether they are relevant.

What Happens If I Do Not Sign Releases?

Sometimes, when releases are not signed, a carrier will deny a claim based upon the lack of cooperation in discovery.   Insurance Companies also have the power to subpena records.  Therefore, they can obtain the records.  It may, however, take more time and paperwork to do so.

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.

Thinking Too Much On The Job Can Get You Injured

Can thinking too much at work get you hurt?

A new study investigated this issued of Cognitive Stress.  Cognitive Stress is the term used for thinking.  Commonly, people describe the term as “multi-tasking.”

The study discussed the impact of cognitive load on an individual’s ability to perform secondary tasks.

This article will discuss Cognitive Stress, Cognitive Stress’ impact on Workers, and the “Monday Morning Effect.”

What Is Cognitive Stress?

Cognitive Stress can also be described as Cognitive Load.

For example, I can ask you to remember four numbers.  Then, I can ask you to remember eight numbers.  Then, I can ask you to remember sixteen numbers.   Each time there are additional items to recollect it gets mentally more difficult to perform.

One’s judgement can also be affected when subjected to cognitive stress. Bonsang, Eric and Caroli, Eve, Cognitive Load and Occupational Injuries. IZA Discussion Paper No. 14137, Available at SSRN: https://ssrn.com/abstract=3794083

Thus, individuals may be decision when stressed that they would not make when not stressed.

How Does Cognitive Stress Impact Workers?

The study found that the “handling a large number of non-professional activities generates a threat for health at work for individuals in high-risk occupations and with a low level of education.”  The study suggested “that when an individual is employed in a high-risk job, distraction is a problem but that a high-enough educational level may help coping with the cognitive burden imposed by multi-tasking.” Bonsang, Eric and Caroli, Eve, Cognitive Load and Occupational Injuries. IZA Discussion Paper No. 14137, Available at SSRN: https://ssrn.com/abstract=3794083

In sum, it appears that individuals with higher educational levels may be able to “multi-task easier than those with less education.

Is There a “Monday Morning Effect?”

Monday Mornings are controversial within workers’ compensation.  There are many within the workers’ compensation field that question the veracity of claims that occur on Mondays.   One main driver for this opinion is that a worker can get injured on the weekend and then claim that it occurred on the next workday.  Generally, the next workday is Monday.

Cognitive Stress theory suggests that Mondays are a time at which individuals get mentally reacquainted with their tasks.   Thus, there is a higher level of mental stress activity versus during the week.  Currently, the study did not have appropriate data to make such an analysis.   The study’s authors believe that their findings were definitely consistent with the possibility. Bonsang, Eric and Caroli, Eve, Cognitive Load and Occupational Injuries. IZA Discussion Paper No. 14137, Available at SSRN: https://ssrn.com/abstract=3794083

What Does This Mean?

In California Workers’ Compensation, since the system is “no fault” in terms of injury causation, this information may not offer most than an explanation as to how the injury occurred.   In a disputed case, this information, however, may explain how and why a disputed injury occurred.

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.

 

 

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.

 

 

 

 

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