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.

 

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.

NURSES: DOES YOUR WORKING SHIFT MATTER?  MUSCULOSKELETAL INJURIES, SHIFT CHOICE AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Nurses are at risk for work-related musculoskeletal injuries (WMSD.)  A study addressed whether a Nurse’s Work Shift impacted WMSDs.

This article will discuss Nursing, Nursing Shifts, and how particular Shift Work may impact industrial injuries.

What Are Nursing Duties? What Makes Nurse at Risk for Injury?

Nursing Duties are physically demanding.  Patient care can require individuals to work in awkward positions and deal with individuals whose weight can shift at any moment.

“WMSDs(work-related musculoskeletal disorders) in nurses are mainly caused by shifting patients (which includes helping patients turn over or get in and out of bed), routine treatments in nursing, poorly designed work environments, and remaining active for prolonged periods of time.4 The physiological loads created by these nursing activities are all risk factors of WMSDs in nurses.” Chang WP, Peng YX. Differences between fixed day shift nurses and rotating and irregular shift nurses in work-related musculoskeletal disorders: A literature review and meta-analysis. J Occup Health. 2021 Jan;63(1):e12208. doi: 10.1002/1348-9585.12208. PMID: 33682989; PMCID: PMC7938703.

Likewise, “cllinical nurses must deal with daily routine work in busy wards, patient care and treatment, and correspondence for various matters. Their jobs are time‐consuming, complicated, and full of stress, and they are often on tight schedules, all of which are associated with WMSDs.” Supra.

What Musculoskeletal Body Parts Do Nurses Injure?

Nurses are susceptible to injury for every body part imaginable.   This includes the neck, shoulders and back.

Nurses are prone to WMSDs in the lower back, shoulders, neck, back wrists, knees, and ankles. Supra.

What are Shifts?

Hospitals and other medical facilities provide 24 hours a day service for 7 days a week.  Thus, the facilities have various work shifts.  Some facilities may have 8-hour shifts, some 10-hour shifts, and others 12-hour shifts.    

What Shifts are There?

Within an 8-hour format, there is generally a morning shift, an evening shift, and an overnight shift.

How Do Nurses’ Shifts Vary?

Nurses can have regular fixed shifts.   Also, there are Nurses who have rotating or irregular shifts.

What was the Study About?

The study focused on Nurses who worked rotating and irregular shifts. The theory of the study was that “working rotating and irregular shifts, which causes the physiological burden of disrupted circadian rhythms in the body, may also exacerbate muscle tension and pain.” Differences between fixed day shift nurses and rotating and irregular shift nurses in work-related musculoskeletal disorders: A literature review and meta-analysis. J Occup Health. 2021 Jan;63(1):e12208. doi: 10.1002/1348-9585.12208. PMID: 33682989; PMCID: PMC7938703.

What Were the Results?

The study “indicated that RS (rotating shifts) + IS (irregular shifts) nurses are more likely to experience back pain associated with WMSD than are FDS (fixed day shift) nurses.”  Differences between fixed day shift nurses and rotating and irregular shift nurses in work-related musculoskeletal disorders: A literature review and meta-analysis. J Occup Health. 2021 Jan;63(1):e12208. doi: 10.1002/1348-9585.12208. PMID: 33682989; PMCID: PMC7938703.

In sum, Nurses working irregular shift are more likely to experience musculoskeletal disorders.

As a Lawyer, Are There Any Reasons That May Cause the Higher Rate?

In my opinion, irregular shifts can include irregular routines.  Nurses who have regular shifts may have better understanding of their shift’s physical requirements.   Also, they may be more familiar with their surroundings.   Thus, they are able to take better precaution to prevent injury.

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.

RADIOGRAPHIC WORKERS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

Radiology Workers have safety challenges when they perform their duties. They are exposed to a variety of things that make them susceptible to work injuries.

In event they get injured while performing their duties, they would be entitled to file a workers’ compensation claim to collect benefits and receive medical care.

This article will discuss the Radiology Worker Occupation, Industrial Exposures that place them at risk of industrial injury and the mechanisms of injury.

What Are Radiographic Workers?

Radiographic Workers are medical professions. They handle medical imaging of the human body.  There are many different technologies that are used to perform such imaging.  Imaging studies that that Radiologists can perform Computed Tomography Scan (CT), Magnetic Resonance Imaging (MRI), Nuclear Medicine Imaging (This includes Positron-Emission Tomography (PET)), Ultrasound, and X-Ray.

Some of these imaging studies require the patients to have dyes injected into their bodies to allow for enhanced imaging.

Radiographic Workers can work in both the public and private sections. They can work in hospitals, prisons and other medical facilities.

What Types of Medical Conditions Can Radiology Workers Be Exposed to at Work?

Radiology Workers can sustain industrial injuries to practically all body parts and systems.  Radiology Workers are at risk of infectious disease in the workplace. Radiology Workers are at risk of musculoskeletal disorders in the workplace. Occupational Health and Radiation Safety of Radiography Workers Hasna Albander

What is an Infectious Exposure? Are There Different Forms?

Infectious exposure is an exposure that is transmitted from one source into a host.  The term host refers to the infected person. Thus, the Radiology Worker becomes the host of the infectious disease. Essentially, these occupational exposures enter the worker’s body and causes illness.

How Many Forms of Infectious Exposures Are There?

There are six forms of Infectious exposure.  They are Direct Transmission, Indirect Transmission via Fluids, Indirect Transmission by vectors, Indirect transmission by Vehicles ,Indirect Transmission via Vehicles, Indirect Transmission via Airborne Media, and Indirect Transmission via Droplets. Occupational Health and Radiation Safety of Radiography Workers Hasna Albander

What Is Direct Transmission?

Direct Transmission is when the infectious agent is transmitted by direct contact of the infectious agent from one individual to a susceptible host (worker. CDC)  For example, direct transmission can be skin to skin contact.

What Is Indirect Transmission via Fluids?

Indirect Transmission by Fluids. An example of indirect transmission by fluid is urine.

What is Indirect Transmission via Vectors?

Indirect Transmission by Vectors. The term vector essentially refers to insect bites. Examples of transfer by vector would be bites from mosquitos, fleas and ticks.

What is Indirect Transmission via Vehicles?

Indirect Transmission by Vehicles is essentially when an object carries the infection. Examples of vehicles include a number of items such as food, water, biologic products (blood), and fomites (inanimate objects such as handkerchiefs, bedding, or surgical scalpels). CDC.

What is Indirect Transmission by Airborne Media?

Indirect Transmission by Airborne Media is when the agents are suspended in the air.  An example of this agents includes dust and droplets that contain microorganisms or spores.  CDC

What is indirect Transmission by Droplets?

Indirect Transmission by Droplets is when there is a liquid transmission. Eye, Nose or Mouth fluids are examples of this transmission. Thus, sneezing, coughing and tearing are forms of droplet transmission.

What Types of Illnesses Can Arise from Transmission?

Per the CDC, “[w]orkers in the healthcare industry are also at risk for influenza as well as airborne (such as tuberculosis “[TB]) and percutaneously transmitted (such as HIV) infection from patients” Su CP, de Perio MA, Cummings KJ, McCague AB, Luckhaupt SE, Sweeney MH. Case Investigations of Infectious Diseases Occurring in Workplaces, United States, 2006-2015. Emerg Infect Dis. 2019;25(3):397-405. doi:10.3201/eid2503.180708

What Are Examples of Cumulative Trauma Musculoskeletal Exposures of Radiology Workers?

There are a variety of ways that repetitive trauma musculoskeletal injuries are described in literature. This includes recurrence motion injury, repeated strain and cumulative trauma disorder. Occupational Health and Radiation Safety of Radiography Workers, Hasna Albander

Cumulative Trauma injuries can be specific to the imaging that the worker performs.  For example, “[c]omputerized technologists are more likely to experience spinal stress and RSI from intensive keyboard work. Intense keyboard work. RSI keyboard affects CTD ‘s hands and grips. Like tendinitis, carpal and ganglion syndrome. Occupational Health and Radiation Safety of Radiography Workers, Hasna Albander

Sonographers are also at risk for cumulative trauma injuries due to equipment design, low posture, constant transducer pressure, difficult movements, unsatisfactory breaks, and overall stress. Occupational Health and Radiation Safety of Radiography Workers, Hasna Albander

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.

 

 

 

OCCUPATIONAL PNEUMONITIS AND WORKERS’ COMPENSATION: WHAT YOU NEED TO KNOW

There are a variety of lung diseases that may have occupational components.   One of these lung diseases is Pneumonitis.  If a Worker succumbs to Pneumonitis, and there is an occupational component as to its cause, they would be able to file and pursue a workers’ compensation claim to obtain medical treatment and monetary benefits for their lung condition.

This article will discuss Pneumonitis, how it can be work-related, and a discussion of various caselaw that addressed issues relating to the disease.

What Pneumonitis? Is It the Same as Pneumonia?

Pneumonitis is a medical condition which involves the inflammation of lung tissue.

The medical disease Pneumonia is essentially a subset of Pneumonitis.  It is an inflammation of the lungs caused by an infection.

What Are the Symptoms of Pneumonitis?

Symptoms of Pneumonitis can include difficulty breathing and a dry, nonproductive, cough. If the condition progresses to Chronic Pneumonitis, symptoms can also include fatigue, loss of appetite and unintentional weight loss. Mayo Clinic.

Are There Degrees of Pneumonitis?

Yes. There are varying degrees of Pneumonitis.  The degrees are Acute, Subacute and Chronic.

Pneumonitis is very serious.  If it goes unnoticed or untreated can cause irreversible lung damage.

What Tests and Treatments are there for Pneumonitis?

Pneumonitis is a complex medical condition. Therefore, a thorough evaluation by a specialist is recommended.  This specialist will conduct the physical examination and order testing.

The testing with respect to Pneumonitis can include blood tests, bronchoalveolar lavage (BAL), chest x-rays, computed tomography (CT), inhalation challenge tests lung biopsies, lung function tests, and precipitin tests.  Mayo Clinic.

How Is Pneumonitis Diagnosed?

Diagnosis of the condition can be complicated. It can take a long time to diagnose. In writing this blog, this matter must be deferred to a specialist without further comment.

The diagnosis of HP in general remains often challenging as there is no gold standard test and the diagnosis is made from a combination of procedures. In addition, the diagnosis of OHP requires ascertaining the work relatedness of the disease with a high level of confidence. A multidisciplinary approach, including clinicians, radiologists, pathologists, and occupational physicians/hygienists, is strongly recommended to improve the diagnosis of OHP, as demonstrated for IPF  Quirce S, Vandenplas O, Campo P, Cruz MJ, de Blay F, Koschel D, Moscato G, Pala G, Raulf M, Sastre J, Siracusa A, Tarlo SM, Walusiak-Skorupa J, Cormier Y. Occupational hypersensitivity pneumonitis: an EAACI position paper. Allergy. 2016 Jun;71(6):765-79. doi: 10.1111/all.12866. Epub 2016 Mar 11. PMID: 26913451.

What is Occupational Hypersensitivity Pneumonitis (OHP)?

“Based on the key features of the disease that were outlined by previous authors 411 and the EAACI nomenclature for allergic diseases 12, the following consensus definition is proposed: ‘OHP is an immunologic lung disease with variable clinical presentation and outcome resulting from lymphocytic and frequently granulomatous inflammation of the peripheral airways, alveoli, and surrounding interstitial tissue which develops as the result of a non‐IgE‐mediated allergic reaction to a variety of organic or low molecular weight agents that are present in the work environment’. Quirce S, Vandenplas O, Campo P, Cruz MJ, de Blay F, Koschel D, Moscato G, Pala G, Raulf M, Sastre J, Siracusa A, Tarlo SM, Walusiak-Skorupa J, Cormier Y. Occupational hypersensitivity pneumonitis: an EAACI position paper. Allergy. 2016 Jun;71(6):765-79. doi: 10.1111/all.12866. Epub 2016 Mar 11. PMID: 26913451.

What Is the Treatment for the Condition?

Treatment for some medical conditions is not just medical care.

In the case of Pneumonitis, one of the forms of treatment is avoidance of harmful exposure.   This can include the removal of causative substances, the replacement of products that have the causative substances, changes in work that will avoid exposures to the causative substances, and avoidance in general of known sources of the causative substances.

Treatments can include corticosteroids or other immunosuppressants. Treatment can include oxygen therapy, bronchodilators, opioids, and lung transplants.  Mayo Clinic.

In viewing the range and scope of treatments, it is fair to say that Pneumonitis should be viewed as a serious medical condition.

What Are the Causes of Pneumonitis? What Are Occupational Causes of Pneumonitis?

Common causes of pneumonitis include airborne irritants at your job or from your hobbies. In addition, some types of cancer treatments and dozens of drugs can cause pneumonitis.

With respect to work-related exposure, “A large number of occupational agents/antigens have been described as potential causative agents of HP in a wide variety of occupations. These offending agents can be classified into six broad categories that include bacteria, fungi, animal (glyco) proteins, plant (glyco) proteins, low molecular weight chemicals, and metals (Table 2). Using a quantitative structure–activity relationship (QSAR) model, it was found that chemicals causing OHP tend to have a higher predicted asthma hazard, are more lipophilic, and are more likely to be protein cross‐linkers than those causing occupational asthma .” Quirce S, Vandenplas O, Campo P, Cruz MJ, de Blay F, Koschel D, Moscato G, Pala G, Raulf M, Sastre J, Siracusa A, Tarlo SM, Walusiak-Skorupa J, Cormier Y. Occupational hypersensitivity pneumonitis: an EAACI position paper. Allergy. 2016 Jun;71(6):765-79. doi: 10.1111/all.12866. Epub 2016 Mar 11. PMID: 26913451.

What Types of Occupations That Are At Risk of Pneumonitis?

The following are occupations that may be at risk for the disease: aircraft industry, animal feeding, bagasse workers [slaughterhouse], bird breeders, ceramic workers, cheese workers, chemical and polyurethane industry, compost workers, cork workers, cosmetic industry, dental technicians,  farmers, florists, food processors, hard metal workers, humidifiers, laboratory workers, maple bark strippers, malt workers, mushroom workers, painters, paprika slicers, pearl industry, peat moss processors, pharmaceutical industry, plastic industry, plastic workers, potato riddlers, seaweed workers, smelters, stucco workers, textile workers, tobacco growers, wine makers, wood workers, and yacht manufacturing. Quirce S, Vandenplas O, Campo P, Cruz MJ, de Blay F, Koschel D, Moscato G, Pala G, Raulf M, Sastre J, Siracusa A, Tarlo SM, Walusiak-Skorupa J, Cormier Y. Occupational hypersensitivity pneumonitis: an EAACI position paper. Allergy. 2016 Jun;71(6):765-79. doi: 10.1111/all.12866. Epub 2016 Mar 11. PMID: 26913451.

Is There An Alternative Theory of Industrial Causation for Pneumonitis?

Yes.  Radiation treatment has been considered as a source of this disease.

Treatment for an industrial injury can give rise to a work injury claim.   Thus, if there is a work-related medical condition that involves radiation treatment, they may possibly be able to pursue a claim.   This may be the case with cancers such as lung or breast.

Is There Any Caselaw Concerning Pneumonitis?

Yes.  There have been a variety of cases with respect to the disease.

The pneumonia presumption for safety and law enforcement officers was found to not apply in the case of pneumonitis.  As noted above, pneumonia is a subset of the disease.

Pneumonitis was found work-related for a meat cutter.  The WCAB panel determined that the applicant developed compensable hypersensitivity pneumonitis while working as a meat cutter. See Costco Wholesale Corp vs. WCAB (2010) 75 C.C.C. 1187 (writ denied.)

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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