Repetitive motion injuries result from the repeating tasks required by certain jobs. It is also referred to as RSI or Repetitive Strain Injuries or Repetitive Stress Injuries and involves the musculoskeletal and nervous systems. These injuries can result from a number of factors such as:

• awkward and sustained positions
• forceful exertions
• pressing against a hard surface (or mechanical compression)
• repetitive tasks
• vibrations

Non-specific arm pain and upper limb work-related disorders are also included where RSI’s are concerned. In many cases of this nature, it is apparent that psychosocial and physical stressors play a significant role in these types of injuries.

RSI Symptoms

Patients who have been diagnosed with RSI typically experience the following symptoms:

• lack of endurance and weakness
• pain experienced in the arm, back, hands, shoulders, and/or wrists
• pain that worsens with activity

When you contrast RSI injuries with CTS injuries, the symptoms of the latter tend to be both diffuse and non-anatomical in nature. It crosses the proper distribution of nerves and tendons as well as not being characteristic of specific discrete pathological conditions.

Ms. A and her bilateral CTS case

Ms. A is a candidate for bilateral CTS surgery due to injuries incurred from a bilateral injury to her upper extremities while performing her job. Her job required a great deal of repetitive arm and hand work as she cut and made fiber optics. Despite experiencing pain in her upper extremities, she continued to work until she was no longer able to. Her employer referred her to Dr. S who began treating her with physical therapy. When her conservative care and PT didn’t relieve her pain, she was referred to Dr. B.

Dr. S splinted her arms and put her on “light duty” status. Unfortunately, there was no light duty work for her on the job and she could no longer perform regular work, so she was sent home and remains on full disability (temporary total disability) to this day.  Dr. S ordered an MRI for Ms. A and it revealed that she had lateral epicondylitis partial thickness tearing in the proximal common extensor tendon. The proposed treatment is an initial surgery on Ms. A’s right elbow. Once the right elbow heals, she will have surgery on her left elbow.

Ms. A is now considering whether or not to settle.   On one hand, there is a high degree of  uncertainty with regard to the nature, extent and future cost of future medical care.   Often settlement values are higher when the insurance company is facing open ended medical costs.  On the other hand, if my client settles and her future medical needs involve multiple surgeries and physical therapies, even a settlement of $100,000 or more will not adequately compensate her.  This dilemma of whether and when to settle is one of the more difficult decisions for a significantly injured workers’ compensation claimant.

An overview of DeQuervain’s Syndrome and Lateral CTS

DeQuervain Syndrome is also nicknamed Mother’s Wrist or Washerwoman’s Sprain. In more medical, technical terms it is known as de Quervain’s tenosynovitis, de Quervain’s stenosing tenosynovitis, or Radial styloid tenosynovitis. DeQuervain’s syndrome is an inflammation (or tendinosis) that occurs in the sheath or the tunnel which surround the two tendons which are responsible for the thumb’s movement.

Carpal Tunnel Syndrome or CTS is also referred to as median neuropathy at the wrist and is a condition that results from a compressing or pinching of median nerve in the wrist area. It typically leads to extreme pain, muscle weakness, and numbness of the hand. Night symptoms and waking up off and on are characteristics of CTS as well. The definitive or standard treatment of the condition is a surgical procedure known as carpal tunnel release.

It should be noted that although this surgical procedure effectively relieves the symptoms of CTS, established nerve dysfunction in the form of atrophy, constant or “static” numbness, and weakness are all permanent. Ironically, most CTS cases do not have a specific cause, and some individuals are predisposed at developing the condition based on genetics.

Workers’ Compensation case involving repetitive motion injury: The case of “Ms. C”

Our client, Ms. C, was diagnosed with bilateral CTS as a result of her repetitious work in cake decorating. According to Dr. D, she was diagnosed with “bilateral DeQuervains tenosynovitis and ulnar nerve injury.” As a result of Ms. C’s injuries, she underwent surgeries on both wrists. About 6 weeks later, she went through surgical procedures on the left wrist – carpal tunnel and DeQuervains release surgery.

Ms. C continues living in pain today, even after the different surgeries were performed. Pain is prevalent especially in the hand, at the incision, and in the wrist area. She is currently undergoing physical therapy and has limited range of movement (ROM) as well as the pain mentioned in the above areas. It is evident that she will continue to remain under medical care as well as receiving TTD for quite some time.

Given the residual problems that exist and her surgeries, the PPD (Permanent Partial Disability) rating of each wrist is 10%. Additionally, due to the repetitive nature of Ms. C’s work, it is very obvious that her capacity to perform her job has been severely limited and she will experience continued levels of pain. As a result of her case, we have demanded “X” amount in her Workers’ Compensation case and are awaiting settlement

Case in point.  This week I received the following email from a young woman who works at a factory in north Georgia:

Where I work I have been told that carpel tunnel is not recognized as a workman’s comp injury if I wasn’t having problems with numbness before.  Is this correct?

The short answer is “no, this is not correct.”  Repetitive motion injury (often resulting in a diagnosis of carpel tunnel syndrome) is a very common work injury, especially for factory workers performing manual labor with their hands.

Any employer who tells an employee that “carpel tunnel is not recognized as a workers’ comp. injury” is either very misinformed or downright dishonest.

The point here – if you are injured on the job, you should not rely on your supervisor or the HR person at your job to advise you regarding your rights.  The employer (and its insurer) have a decided interest in avoiding claims.  And they know that if delay reporting an injury or if you do not report an injury accurately to your doctor they stand a better chance at minimizing your settlement or even convincing a judge that you did not really get hurt at work.

If you are injured on the job and you think that you may have a claim, call me or another experienced workers’ compensation lawyer for an opinion.

If rest does not resolve the condition, the usual treatment for carpel tunnel injuries is surgery called a carpel tunnel release expands the space for the nerve and tendons and thereby relieves the pressure on the nerve.

Carpel tunnel injuries usually arise from repetitive motion type jobs.  Examples of these types of jobs include:

• deboning chickens
• typing
• sewing
• meat packing
• small parts assemblers

At Ginsberg Law Offices, we represent many carpel tunnel claimants.  An important part of our work is to get our clients to a doctor who specializes in wrist, hand and repetitive motion injuries and to see to it that our clients get appropriate rehabilitation care.

While most carpel tunnel cases do involve repetitive motion injury, a carpel tunnel case can also arise from a traumatic injury such as a fall or even a neck injury.  These types of traumatic accidents can cause swelling to the tissues in the wrist which can result in a carpel tunnel diagnosis.  Therefore, if you are experiencing swelling, pain, numbness and tingling in your hands and wrist but you do not have a job that involves repetitive motion, do not rule out a work related carpel tunnel injury.

Because you may not have recognized the implications of a fall or sudden trauma to the arms, you need to think about how to report your injury and how you word your WC-14.  If you are facing this type of situation, please feel free to call me to discuss your options.

Thanks to my colleague, Michael Helfand, a Chicago based Illinois workers’ compensation lawyer who wrote about non-repetitive motion carpel tunnel issues in his Illinois Workers Compensation blog.

The HR Manager told me that it was out of his hands and that I should order a tray through my manager for approval.  I asked on several occasions for the tray and my injury started to become more aggravated, so I went to his boss asking him about the status of a computer tray.  He told me that the tray was too expensive and I now needed a doctors note in order for me to receive a keyboard tray.

I went to my doctor and told him the same story and he suggested that I file a workmen’s comp claim since it was a work related injury. It was filed the first week of February with the correct injury date of November 28th  I am scheduled for surgery this Wednesday February 28th and they are now just informing me that I have to use my PTO to compensate my time off.  Now, by law if I use the 21 days from the injury date (which it has been) shouldn’t I receive full compensation?

–Alyce

Jodi Ginsberg responds:  Alyce, thanks for your question.  The law requires that you file your workers compensation claim within 30 days of the injury.  Here it looks like your date of injury was November 28, but you did not file your claim until the first of February.   Is your employer acknowledging that you “reported” your injury in November?

For the benefit of anyone reading this blog, employers and insurance companies use these “reporting deficiencies” all the time to deny claims.  If you get  hurt on the job, you should always try to report the claim in writing and, if possible, file a report of on-the-job injury yourself with the State Board of Workers’ Compensation.

Assuming that your employer recognizes this as a workers comp injury, you ask about the 21 day rule.  The 21 days runs not necessarily from date you reported it,but rather, from date of economic disability (when you stopped working). Did you continue working after the November, 2006 “injury date?”

By the way, if your injury did not “happen” on a specific day but was the result of months or years of overuse, then the injury date you choose is called a “fictitious injury date.”  In cases involving these types of “overuse” injury, it is even more important for the injured claimant to file his own Form 14 notice on injury with the State Board.