Pennsylvania Workers' Compensation Lawyer Blog

The rotator cuff is where four muscles and several tendons form a covering around the top of the humerus, the upper arm bone, in the shoulder. While tears in this region of the shoulder can occur with the wear and tear of using the shoulder over years, a rotator cuff tear is also a common injury we see in Pennsylvania workers’ compensation cases. This type of injury can occur in many different ways, including lifting or falling on the shoulder. Even repetitive use of the shoulder at work over years can lead to a compensable work-related rotator cuff tear.

A torn rotator cuff is generally categorized as either small, medium, large or massive. Initial treatment for a tear usually consists of “conservative” (non-surgical) options, such as physical therapy, medications and/or injections. If these conservative methods do not relieve the problem, surgery may be indicated.

The problem comes with the “massive” rotator cuff tears. These tears used to be called irreparable. The injured worker was left with only two choices – either live with the pain and disability, or have a “debridement procedure” performed (this is a surgical procedure where the area is cleaned out, though the tear is not repaired). In the past, the injured worker remained on workers’ compensation benefits, and remained unable to perform ordinary daily activities of living, let alone work.

These days, though, the injured worker with a massive rotator cuff tear has some better choices. Technology has brought potential real solutions to the irreparable rotator cuff tear. One such method is the Latissimus Dorsi Tendon Transfer procedure, in which a tendon is borrowed from the patient’s arm or shoulder and used to replace the ruined one in the rotator cuff. This procedure is said to require less than two hours of surgery, and only entail a single overnight hospital stay. A study was performed on the effectiveness of this procedure recently, in part authored by local orthopedic surgeons Dr. Gerald Williams, Dr. Shawn Hennigan, Dr. Sami Kella and Dr. Joseph Iannotti.

Perhaps even more encouraging is the arthroscopic Graft Jacket Allograft procedure, which remains in its early stages. It appears one of the biggest advantages to this surgery is that the procedure is “arthroscopic,” where the cuts are only small holes, rather than the large incisions required for open surgery. Here, the patient’s torn rotator cuff is repaired with a human cadaver graft, in a procedure said to last about four hours.

While these new developments in treatment for rotator cuff tears offer hope to patients, including those on Pennsylvania workers’ compensation, it is always wise to consult with your doctor, to determine the best course of treatment for your particular case.

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In Philadelphia, we recently heard of “prolotherapy” because Philadelphia Flyers’ player, Simon Gagne, who injured his head and neck, has said this treatment method has greatly improved his condition. When I saw that, I wondered if prolotherapy may be beneficial to an injured worker, especially one who has hurt the neck or the back. Workers’ compensation cases are littered with patients taking an abundance of medications, or getting multiple steroid, or other, injections into their spines. We could certainly use a less invasive treatment option.

Prolotherapy seems to involve injecting a substance into the injured area, causing an irritation in the area. This certainly seems an odd step to take (purposely irritating an already injured area), but the idea is that the irritation being caused leads to the area repairing itself. The substance being injected can vary by the type of prolotherapy being done.

As with any potential treatment option, workers’ compensation patients should always discuss the step with their doctor. While it is always good to have options for treatment, some treatment methods may be better than others for any given condition or patient, and your doctor is the best one to guide which treatment would be greatest treatment option.

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It happens all too often. A worker suffers an injury to his or her neck or back. Though the injured worker never had neck or back pain before the injury, the workers’ compensation insurance company questions the claim. According to the workers’ compensation insurance carrier, the injured worker is suffering from “degenerative disc disease,” not a work injury. In reality, of course, it is the work injury which has made the degenerative disc disease start to cause pain. In Pennsylvania, an “aggravation” of a pre-existing condition, like degenerative disc disease, is considered a “new injury,” allowing an injured worker to collect PA workers’ comp benefits.

That is only half the battle, unfortunately. Once the degenerative disc disease has been made symptomatic by the work injury, the symptoms often do not stop. Frequently, the injured worker will try many “conservative” treatment options, such as medications and physical therapy. Failing that, doctors might try various types of injections, including epidural steroid injections. Sadly, though, time and again, the injured worker remains in pain despite these efforts.

Once the pain has continued for longer than six months, and various conservative treatment options have failed to reduce the symptoms, doctors start to talk about surgery as an option. There is no doubt that spinal surgery, whether for the neck or the back, is a last resort. As with any major surgical procedure, there are serious consequences which can result from such an operation. Moreover, there is no guarantee the injured worker will be any better after surgery.

In the past few years, there have been some new options when it comes to cervical or lumbar spine surgery. “Artificial disc replacement” is a procedure which is now available for both the neck and the back. Our spines are comprised of “discs.” One could think of these discs as jelly donuts. When a disc is damaged, the jelly leaks out of the donut, and the donut flattens (putting more strain on the discs above and below the damaged disc). Artificial disc replacement is designed to avoid the strain on other discs, by inserting an artificial disc where the damaged disc was.

The artificial disc used for the lumbar spine, Charite’, was approved for use by the FDA in October, 2004. Then, in July, 2007, the FDA approved Prestige for the cervical spine. As with any medical decision, tremendous thought should go into what action is best for any particular patient. The fact that new options are developing, to relieve the chronic pain faced by the injured worker, is very encouraging.

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Regardless of whether we are seeing an injured worker suffering from a trauma to his or her arm, leg, neck, back, shoulder or any other part of the body, the common thing we are seeing is pain. Often, this is a chronic, unrelenting, pain. These are usually the cases when surgery either has been attempted and has not been successful, or when the doctors do not feel surgery would relieve the pain. Frequently, the only way to even take the edge off this excruciating pain is by taking pain-relieving medications, often narcotics.

One of the more “popular” narcotic medications used in Pennsylvania workers’ compensation matters is OxyCodone (OxyContin). The manufacturer of OxyContin, Purdue Pharma, has recently developed three new dosage strengths. These three new dosage levels now make a total of seven dosage strengths of OxyContin. In theory, this makes prescribing the proper dosage for every injured worker much easier.

With more usage of OxyCodone, and OxyContin, comes more abuse. Unfortunately for those injured workers who actually need this type of pain medication for relief, many people are using such drugs recreationally. Purdue Pharma has attempted to change the type of the OxyContin tablet, to make it less “useful” for recreational use, but so far, the FDA has not approved the changes. According to this article, there were 42.2 million prescriptions written last year for Oxycodone.

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It seems like such a basic thing. An injured worker goes to the doctor and gets a prescription. Big deal, right? What is there to think about? Well, maybe it isn’t so simple after all. Maybe there are some questions an injured worker should be asking when getting a prescription. When I came across this article, I started thinking that some of these ideas make a great deal of sense. The article seemed like a valuable resource to both my injured clients and the general public. I guess you could sum up some of these hints by reminding yourself to know what medication you are taking, why you are taking it, how to take it and how your body reacts to the medication. I would suggest anyone getting a prescription filled review this article.

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Reflex Sympathetic Dystrophy (RSD), also known as Complex Regional Pain Syndrome (CRPS) is a horrible condition we see all too often resulting from work injuries. This condition can develop from a traumatic work injury, even what previously seemed to be a relatively minor one. Scientists still do not seem to know why RSD or CRPS develops.

The hallmark symptom of RSD or CRPS is unrelenting, often burning, pain. This character of pain, called “neuropathic” pain, is caused by irritation of the nerves in the affected area. Frequently, there are also changes in the skin or fingernails of the area as well (known as “trophic” changes). Sadly, there is no cure for RSD or CRPS, and doctors simply try to manage the symptoms of the patient as best they can.

Research is continuing in this area, and there are some promising things on the horizon. A recent study, led by local RSD/CRPS specialist Dr. Robert Schwartzman, found that the drug ketamine, given in an anesthetic dosage, may relieve pain in RSD/CRPS patients who have failed with other treatments. Administration of ketamine while the patient is placed in a five-day coma has been successfully performed in other countries, but has not been approved as yet in the United States. Obviously, in the workers’ comp setting, treatment not approved by the FDA probably does not need to be paid for by the PA workers’ compensation insurance carrier.

An incurable, debilitating, condition like RSD/CRPS raises many issues in Pennsylvania Workers’ Compensation. Unfortunately, the Pennsylvania Workers’ Compensation Act was designed for injuries which will eventually heal. The system is not properly prepared to deal with a lifelong debilitating condition like RSD/CRPS, which makes the selection of lawyers experienced in PA workers’ compensation particularly important.

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Though the reasons for the dramatic increase are not clear, it appears total knee replacements and total hip replacements are much more frequent now than in the past. According to an article on the American Medical Association website, total knee replacements increased 63% from just 1997 to 2004. Over that some period, total hip replacements were up 48%.

One of the potential reasons for the striking increase is the trend of the population to generally be both older and heavier, putting greater strain on these joints. Better technology in performing the total joint replacements has also been said to have increased the frequency with which the procedures are recommended by doctors.

From the perspective of patients, the total knee replacement or total hip replacement may appear to be a safer long-term way to treat their chronic pain than continued use of medications. This is especially true given the controversy, and apparent side effects, of the class of medications including Vioxx, Bextra and Celebrex, known as Cox-2 Inhibitors. An increase in the amount of advertising by the manufacturers of the artificial joints may also make patients more interested in having the total joint replacements done

While not dealing specifically with workers’ compensation, this information is still important to injured workers. Decisions on whether to get a total knee replacement, or total hip replacement, are common in work injury cases.

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Though workers’ compensation insurance companies routinely deny that carpal tunnel syndrome is caused by work activities, a recent article suggests that about half of all cases of carpal tunnel syndrome are, in fact, related to work activities. According to the article, Carpal Tunnel Syndrome Treatment, approximately two million people in the United States suffer from carpal tunnel syndrome. An estimated 260,000 surgeries are performed each year to address the condition.

"Carpal tunnel syndrome . . . tends to affect people more frequently who use their hands excessively, such as pianists, concert violinists, hairdressers, computer operators, manual laborers, artists, sculptors, dentists, and even neurosurgeons," says James R. Bean, MD, American Association of Neurological Surgeons president-elect.

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One of the common injuries we see in workers’ compensation cases is to the neck. A recent study published on Spineuniverse, a website dealing with neck and back pain suggests that acupuncture relieves neck pain as well as injection therapy does, without the use of any medication. Unfortunately, though, neither of these methods seems to work for even half of patients. According to the study, 43.6% of acupuncture patients described themselves as being at least satisfied with their treatment, as compared to 41.3% of injection patients. Since surgery is a last resort, acupuncture can at least be considered as an option to relieve neck pain.

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