June 19, 2019

Case Study: Bilateral CTS and Workers’ Compensation

Repetitive motion injuries

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.

When Should You Expect Your Lawyer to Predict a Settlement Value for Your Case ?

When speaking to prospective clients, I often get the questions "what is my case worth?" and "when will my case settle?   I cannot think of any situation where I would be able to answer this question truthfully before I would have an opportunity to dig into the file and read all of the medical records.  I think that any lawyer who throws numbers and dates at you is not being straight with you because there are so many factors that influence the timing and settlement value of your case.

This about it this way – if you were to drive your car into a repair garage, would you expect the mechanic to diagnose exactly what is wrong with your car before driving it or opening the hood?

When I open a new file, the medical record often is not very complete.  Many times no objective testing – MRI, CT scan, even x-rays – have not been done.  Objective testing helps doctors and judges evaulate the severity of your injuries.  A herniated disk or a broken bone will be much more compelling evidence than a generalized pain syndrome and thus impact settlement value.

I would also want to know who your authorized treating doctors are.  Over the years, I have become very familiar with many of the doctors in North Georgia who handle workers compensation claims.  If your treating doctor is very conservative and is likely to return you to work with no restrictions, your settlement value will be affected.  If I see an angle to argue for a change in treating physician, your case will be more valuable.

In my experience, claimants sometimes don’t realize just how seriously they are hurt.  If you are having excruitating pain in your back, you might not think abuot that nagging ache in your heel – but down the road, your heel problem and resulting inability to walk could have a more lasting impact on you.  A big part of my job is to ask the right questions based on what I would expect to see given a particular injury.  Shoulder pain may mask a neck injury.  Knee pain may mask foot problems.

Along these lines, as your case develops I will be thinking about whether you will be able to return to your past work, whether your employer is likely to create a job to accommodate you and whether you will be able to return to a job where you can earn close to what you have earned before.

In my view, the timing of our settlement demand i crucial, and the decision about when to talk settlement will be the result of a lot of discussion between you and me.  My job as your counsel is to give you the pros and cons of settlement and to help you make a good decision for yourself and your family.