Common Workers’ Compensation Injuries
Spine Injuries (Neck, Upper Back, Low Back)
The spine is made up of three regions – the upper back often called the neck (cervical), the upper back (thoracic), and the lower back (lumbar). Each of these is made of up discs between the bony aspects of the spine. The discs or the areas between the bony spine act as shock absorbers for the body as we walk and move and perform activities. Nerves from the human body run into the spaces near the discs, into the spine and ultimately send and receive signals to/from the brain and various parts of the body. The nerves from the cervical spine run from the spine out and down the arms and into the fingers. The nerves from the lumbar spine run out and down the legs and into the feet and toes. Nerves from the thoracic spine run out and to the mid section of the body and to many of our organs.
Back injuries are some of the most common from work activities. The severity of these injuries range from simple sprain/strains to bulging discs, to herniated discs and even fractures of the vertebrae of the spine. When a disc is bulged, it is generally flatter and more squished than a healthy disc (think of pushing down on a tennis ball). When a disc is herniated, this means that the disc has a protrusion or a more narrow disfigurement (think of a peninsula coming out of the tennis ball). If a disc has an annular fissure it means that the outer layer of the disc has cracked or torn open. If a disc has an extrusion or “disc material” it means that the the jelly from inside the disc is leaking out. The jelly from inside the disc is caustic to nerves and painful as it releases into the body. When a disc is bulging or herniated, it can affect the nerve that runs near it, cutting off sensation to areas of the arms/legs or hands and feet near where that nerve runs into the spine. Pain down a nerve in the arm or leg is a common symptom of a disc injury called radiculopathy. The main way a doctor will determine the extent of a spine injury is with an MRI of the lumbar, thoracic or cervical spine.
Depending on the severity of the injury, doctors will first try physical therapy to help with an injury. If that does not work, they may recommend an injection into the spine. If that does not work, surgery is done to either eradicate the part of the disc that ruptured or remove it altogether. This is called a discectomy. If the spine is affected in such a way that the disc cannot be fixed and is unstable above or below, a doctor may recommend a fusion, where the bones above and below are fused together with a plate and screws. In the cervical spine, there is a relatively newer procedure used called an artificial disc replacement, were a prosthetic or artificial disc is inserted in place of the old one.
Many times there are permanent restrictions after spinal surgeries because range of motion and strength can be limited – which may effect one’s ability to return to their job depending on how physical it is. For these reasons, it is important to consult with an attorney familiar with these kinds of cases and can explain what the law allows for when a person can or cannot get back to work after a spinal injury.
The rotator cuff in the shoulder is made up of 4 different muscles/tendons – the infraspinatus, supraspinatus, subscapularis, and teres minor. Additionally, the labrum and the bicep tendons attach at various points in the shoulder and can be effected by an acute injury. One or more of these tendons can become injured as the result of force or a load against the arm. It is important to identify which of these tendons might be injured and the most accurate way of doing so, is with an MRI (magnetic resonance imaging). X-rays will not show ligament issues. Therefore, it is important to get to a doctor that understands these injuries and the need for an MRI. Most often, a company clinic will not recommend or approve an MRI until months into your treatment after you have tried physical therapy or other remedies. The reason is because this MRI test is expensive, and their motivation is to help the insurance carrier save money. Further, most company clinic physicians are not specialized in orthopedic shoulder work. You need to consult with an experienced attorney that can advise you of quality orthopedic specialists in your area.
Typical treatment for shoulder injuries is to start with physical therapy. If no progress is made there and an MRI shows any issue, a doctor may try an injection. If an injection does not provide relief, surgery could be explored. The types of surgery vary in these cases depending on which tendons are involved. However, it is common that the biceps tendon is torn at the same time one of the rotator cuff tendons are torn. In that case, a biceps tenodesis will be recommended in addition to the repair of the rotator cuff. That procedure involves re-attaching the biceps tendon to the bone to stabilize it.
Most often injuries to the knees involve either the ligaments in the inner knee, like the ACL and/or the MCL, or the bones and/or cartilage of the knee, like the meniscus, patella, or tibial plateau. The ligaments have different functions in helping providing stability to the knee joint with different motions. The cartilage and bony components are structural and support the weight of the body and allow the knee to function smoothly. There are two menisci in each knee, medial and lateral meniscus. The smooth cartilage in the meniscus acts as a shock absorber for the knee joint – when a meniscus is torn it is common to feel catching, popping, or locking in the knee, especially when going up or down stairs. Orthopedic “sports medicine” physicians specialize in knee treatment. An MRI is the best way to identify what part of your knee is injured. Most company clinic physicians are not specialized in orthopedic knee injuries. You need to consult with an experienced attorney that can advise you of quality orthopedic specialists in your area.
Typical treatment for knee injuries begins with physical therapy. If no progress is being made there, a doctor may recommend an injection. If the knee is swollen, a doctor could perform an aspiration or drainage procedure. If the knee still does not respond and an MRI shows surgery is needed, a repair of one or more of the tendons can be performed, such as a meniscectomy, ACL repair, or MCL repair or sometimes even a total knee replacement. Many times people can develop arthritis in their knees not related to their work injuries – this is essentially the wearing down of the cartilage in the joint of the knee. The degree of wearing is graded by a doctor from Grade 1 to Grade 4. Once all of the cartilage is gone the knee is bone on bone and cannot move and typically, a total knee replacement is required. A work injury can accelerate the arthritic process, especially when there is a tear of one of the tendons, which compromises the integrity of the entire knee. Therefore, it is imperative that one consult with an attorney to discuss these medical conditions to determine whether their injuries were aggravated by a work activity or not.
Injuries to the Nerves in Your Arms
Cubital tunnel injuries are injuries to the nerve at the elbow while carpal tunnel injuries occur at the wrist. These injuries can be caused by actual direct trauma or repetitive trauma – where one does forceful and repetitive tasks over time that wear down these nerves. If you are having pain down your arm, there are various tests that can be performed to determine where the nerve is damaged, the most common of which is an EMG/NCV test. This test will determine if the nerves down your arm are being compromised at common areas such as the neck, elbow or hand. If at the neck, this can be a spinal injury in the cervical spine pinching the nerve that enters it. If at the elbow, the cubital tunnel could be the problem – pinching the nerve as it goes through. If at the wrist, the carpal tunnel could be pinching the nerve. In any of these scenarios, an orthopedic specialist is needed and a company clinic physician does not have that level of specialty and therefore typically will not order this test until months later. You should consult with an experienced attorney that can advise you of quality orthopedic specialists in your area.
Common treatment for these nerve injuries includes initially therapy and medications to ease the nerve pain. If that does not work, surgery can be performed on the affected area, which could include a carpal tunnel release, a cubital tunnel release, an ulnar nerve transposition, or a medial epicondyle release. All of these are an attempt to allow the nerve to be free of restriction and get feeling back in the effected area and extremity. Many times after these surgeries, one can be left with residual nerve pain and even permanent strength issues. Therefore it is important to speak to an attorney who can explain what the law allows for when a person can or cannot get back to work after a nerve injury.