May 26, 2015

New Spinal Cord Stimulator Gives Hope for Chronic Pain

Spinal cord stimulators have been around for many years. In fact, the FDA first approved the use of such devices back in 1989. These devices can provide relief to those who live in chronic pain. Many of our clients have benefited from these devices, though not all patients have success with them. The FDA recently approved a new version of spinal cord stimulator, which can provide pain relief without causing an uncomfortable tingling sensation.

This new spinal cord stimulator is called the Senza System, manufactured by Nevro Corp., based in Menlo, California. The pain relief can be accomplished without the tingling (also known as paresthesia) through “high frequency stimulation (at 10 KHz) and low stimulation amplitudes.”

Obviously, any increase in the ability to control chronic pain is of benefit to the injured worker that we encounter every day. A reduction of narcotic medication, which has significant and dangerous side effects, is always an advantage. This chronic pain can be a result of many types of conditions, including failed low back syndrome (after surgery did not relieve the pain), and Complex Regional Pain Syndrome (CRPS, also known as Reflex Sympathetic Dystrophy [RSD]). We also note, in passing, that an aggravation of a preexisting low back condition can still form the basis of a valid workers’ compensation claim in Pennsylvania.

As with any medical treatment, it is important to discuss thoroughly with your doctor whether a spinal cord stimulator may be of benefit to your specific condition. Advancements in pain relief, though, give hope to all injured workers.

April 7, 2015

Physical Therapy As Effective as Low Back Surgery?

In 2009, we discussed an article in the Journal of the American Academy of Orthopaedic Surgeons, which advised patients to try physical therapy before resorting to low back surgery for degenerative disc disease. Now, six years later, a University of Pittsburgh study found that surgery and physical therapy achieved roughly the same success rates for “lumbar spinal stenosis.”

Perhaps the first thing to address is what are “degenerative disc disease” (DDD) and “spinal stenosis.” As the name implies, degenerative disc disease is the damage, the wear and tear, that is caused just by years of activity. As with grey hair, bad eyesight or other physical traits, some people are more prone to this condition than others. “Spinal stenosis” is a narrowing of the spine, which can lead to a nerve being irritated. This can be caused by DDD or by another condition (scoliosis or arthritis, for example). A herniated disc can also cause the canal in which the nerves pass to become much narrower.

Why, then, would this topic be of interest to injured workers, you might ask. If this is a degenerative problem, then what could work have to do with it? As it turns out, work often has a great deal to do with it. Many people, some say the majority of a certain age, have these degenerative changes, but have no symptoms. Often, a work injury “aggravates” these degenerative changes, making something symptomatic which never was before. It is important to know that an aggravation of pre-existing condition, such as degenerative disc disease, is a “new injury” for workers’ compensation purposes. The work injury need not “cause” the disability; simply aggravating an already existing condition is enough. And that makes sense – after all, if you were able to do your job before the work injury, and then were no longer able to do your job after the work injury, shouldn’t you be compensated?

Back to the main topic, this new study continues to enforce what had been said in the past – lumbar surgery for these conditions should not be a primary response. The lead author of the recent article, Tony Delitto, chair of Pitt's physical therapy department, stated, “they should exhaust nonsurgical options, which include physical therapy, before they consent to surgery.” Certainly sounds like a reasonable way to proceed.

February 3, 2015

Size of Rotator Cuff Tear May Have No Impact on Pain Level

One of the more common injuries we see in Pennsylvania workers’ compensation is a tear of the rotator cuff in the shoulder. We have discussed this kind of injury previously on the blog. This kind of injury can happen suddenly, or it can occur progressively, over a period of months, or even years. Regardless of the timing, a tear in the rotator cuff can certainly be disabling and, if caused by work duties, make one entitled to PA workers’ comp benefits.

A recent study on rotator cuff tears showed that the degree of pain one suffers is NOT necessarily based on how significant a tear has occurred. This would certainly be of interest to the many physicians who perform Defense Medical Examinations (officially, and humorously, called “Independent” Medical Examinations), who seem to automatically question the truth of a patient who complains of significant pain without having a substantial tear reflected on an imaging study, such as an MRI. This is further proof that medicine is not an exact science, and that the history, and complaints, of a patient must be given true attention.

It is also important to keep in mind that having had some shoulder problems in the past, such as degenerative joint disease, may not prevent receiving Pennsylvania workers’ compensation benefits, if work duties materially worsen the condition. We call this an “aggravation,” and it is treated as a new injury for the purposes of workers’ comp.

September 8, 2014

Hydrocodone Reclassified – More Difficult to Fill Such Prescriptions

There are many different kinds of injuries and conditions we face in Pennsylvania workers’ compensation matters. One common thread in those injuries and conditions, however, is pain. Often, the pain is to a level that is severe, requiring significant medications to obtain relief. Various types of medications are classified differently. Basically, the more powerful, or dangerous, a medication is perceived to be, the more limited the access to the medication.

Starting early next month, Hydrocodone Combination Products (HCPs) will change from a Schedule III drug to a Schedule II according to the Controlled Substances Act. To the injured worker, this is important for several reasons. First, all hydrocodone prescriptions will now require an actual written “hard copy” prescription. In other words, telephone, fax, verbal and email prescriptions are not acceptable. Second, there are no refills available for this classification of medication. Third, any existing refills for hydrocodone prescriptions will be void as of midnight on October 5, 2014.

For additional information, you can visit the website for Injured Workers Pharmacy (IWP), a mail order prescription service used by many of our clients.

May 15, 2014

Acetaminophen Limited by FDA to Prevent Liver Damage

For some time now, it has been known, or at least suspected, that high doses of pain-relieving agent acetaminophen can lead to serious liver damage. Acetaminophen is sold over the counter on its own (Tylenol), or as an ingredient in more powerful pain medications, such as Percocet (oxycodone and acetaminophen) and Vicodin (hydrocodone and acetaminophen). Back in 2011, the Food and Drug Administration (FDA) issued a release, taking steps to reduce the risk of liver damage from acetaminophen.

Essentially, the FDA called for two things of medicines containing acetaminophen. First, there must be a clear warning on the box, detailing the potential risk for “severe liver injury.” Second, prescription medications should be limited to a maximum of 325 milligrams of acetaminophen per tablet, pill or capsule.

Recently, the FDA issued a statement that all manufacturers of medications containing more than 325 milligrams of acetaminophen per dosage unit have stopped marketing such products. Additionally, the FDA also issued a statement reminding health care providers not to prescribe such products, and pharmacists to stop dispensing them. In short, the position of the FDA is that “(t)hese products are no longer considered safe by FDA and have been voluntarily withdrawn.”

Injured workers, and others with chronic pain, can safely continue to use medications containing acetaminophen, according to the FDA, within these guidelines. As with any medication, it is important for users to follow the dosage recommendations of their physicians, or their pharmacists, to assure that these (and other) medications remain safe, and risks or harmful side effects are lessened.

May 5, 2014

Zohydro No More Dangerous Than Other Pain Relievers, Says FDA

A couple of months ago, we mentioned the FDA approval of a new pain medication, called Zohydro. The same properties which make Zohydro so exciting for the medical profession, and injured workers everywhere, caused great angst among government and addiction officials. Fast and effective relief of severe pain, unfortunately, also can lead to misuse and/or abuse of any substance. These concerns had officials lobbying the FDA to revoke its approval for this medication.

Recently, the FDA issued a Fact Sheet about Zohydro. After taking a close look at the benefits and risks of this medication, the FDA determined that its approval (for its intended usage) was correct. In fact, the FDA issued this release, in part, to correct some misconceptions about Zohydro.

Specifically, the FDA noted that Zohydro is available in varying strengths. Since it is designed to be a time-release medication, though Zohydro contains more hydrocodone than some other products, it is actually less potent than other opiate-based pain relievers currently on the market, as they are immediate-release products. Further, there is evidence that abuse-deterrent properties of some competing medications, such as Oxycontin, are not completely effective at preventing abuse or addiction. The FDA also recognized that, even if Oxycontin has some abuse-deterrent properties not found in Zohydro, Oxycontin “does not meet the medical needs of all people in severe pain.”

In the end, the FDA could not justify keeping fast and thorough pain relief from those in severe pain. As usual, we must rely upon the doctors, and the patients, to make sure this medication (as we would with any medication) is used safely and effectively.

May 2, 2014

Using Nanotechnology in Anesthesia for Work Injuries?

Once limited to a role in science fiction books and movies, nanotechnology is getting ready to invade our lives in beneficial ways. Nanotechnology is the study of, or use of, extremely small things, often at the atomic level. How small? One nanometer is a billionth of a meter, or, in other words, there are 25,400,000 nanometers in an inch. Obviously, we cannot see these things with the naked eye (or even a basic microscope).

Scientists have discussed how nanotechnology could impact medicine for years. Or, at least, they have done so in theory. Nanobots could, in theory, perform surgical tasks in a human body; sort of a real version of the 1966 movie, Fantastic Voyage. Nanotechnology could also assist in prosthetics, medical tools and processes. The possibilities are truly endless.

But, some uses of nanotechnology have left the realm of “theory” and moved into that of “reality.” One recent example is an experiment conducted using an injection of magnetic nanoparticles in place of traditional anesthetic for an ankle block. The study was successful, demonstrating that this process does work (at least in rats). By identifying specific areas in which nanotechnology may benefit us, these researchers are helping other scientists refine realistic use of the nanotechnology.

March 7, 2014

Powerful and Controversial New Pain Medication Available

A common theme we see with work injuries in Pennsylvania, whether with a complex regional pain syndrome, failed back surgery, brachial plexopathy, knee, hip or shoulder replacement, or other permanent conditions, is an injured worker dealing with chronic pain. As a result, we always keep an eye out for new methods of helping patients deal with the lingering agony that can accompany a serious work injury.

While many of these new methods, whether it be medication or other treatment option, arrive quietly, one new medication is coming with quite a fuss. Zohydro ER, manufactured by Zogenix, Inc., is a powerful new hydrocodone product. This medication was recently approved by the FDA, and, as stated in the press release issued by the FDA, “is the first FDA-approved single-entity (not combined with an analgesic such as acetaminophen) and extended-release hydrocodone product.”

Because Zohydro ER is so potent, there is great concern in the medical and news community that the product will cause addiction and health issues. According to ABC News, Zohydro ER can have up to ten times more narcotic than Vicodin. In fact, that same article stated that “the FDA's own advisory committee voted against approval.”

According to CBS Philly, local police and safety officials in the Philadelphia and Bucks County areas are also concerned that Zohydro ER will cause an increase in both pharmacy and home burglaries, as desperate people seek the drug. In the article, Bensalem Public Safety Director Fred Harran said, “We’re going to see a spike in burglaries, robberies and thefts across the nation. We’re going to see more heroin overdoses, more overdoses of this drug because it’s so potent, it’s so powerful.”

While, in theory, any medication can be abused and can lead to an overdose. Many medications are known to potentially cause addiction. These things, however, do not seem like a reason to deny relief to folks who live each day in excruciating pain because existing medications cannot achieve an acceptable level of relief. Those lobbying the FDA to revoke its approval probably never found themselves in the chronic pain faced by an injured worker.

October 18, 2013

Garden State Magnetic Imaging Gives Seminar

To properly represent injured workers in PA, we feel it is critical that we be educated not only on the law, but also on the medical side of things. The more we can understand all aspects of a case, the better we can represent our clients.

One of the more common types of work injuries we see are those to the spine, both neck and back. In reviewing and litigating a case, we have to digest all types of medical records, including diagnostic studies. Magnetic Resonance Imaging (MRI) is a type of test frequently performed with spinal injuries. Being lawyers, not doctors, we certainly do not want to be reading films, but we do want to understand what things mean when we see them in MRI reports.

With this in mind, I attended a seminar last night given by Dr. Lisa Sheppard of Garden State Magnetic Imaging. A Board Certified Radiologist with a Certificate of Additional Qualification in Neuroradiology, Dr. Sheppard thoroughly explained the anatomy of a spine, and how it appears on an MRI study. Dr. Sheppard described what abnormal findings on an MRI study may indicate a chronic, perhaps degenerative, condition and what findings would be more suggestive of trauma.

Additionally, Dr. Sheppard discussed what each term in an MRI report, prepared by a radiologist, would actually mean. In other words, the terms we see thrown around, like whether a disc is herniated, extruded, protruding or bulging, all have a specific meaning, based on the anatomy of the disc. Plus, the position of the disc abnormality, relative to the nerve, has significance for whether the nerve is impacted (called a “radiculopathy”).

I came away from the seminar better understanding both the anatomy of the spine, and how that anatomy is seen on an MRI study. Given the experience and knowledge displayed by Dr. Sheppard, I would not hesitate to have my clients treated by Garden State Magnetic Imaging.

October 9, 2013

CRPS/RSD a Crippling Condition Seen in PA Workers’ Comp

Injured workers in PA are like every other person in society. They are susceptible to conditions that affect everyone else. One of those conditions is a scary disorder called Chronic Regional Pain Syndrome (CRPS) or Reflex Sympathetic Dystrophy (RSD). Having had trauma, through a work injury, the injured worker may be even more at risk.

We have previously discussed CRPS/RSD on our blog. One of the most frightening aspects of CRPS/RSD is how much the experts don’t know. For example, it is not known how or why a person develops the condition. According to the National Institute of Neurological Disorders and Stroke, CRPS/RSD is caused by an injury or trauma, but not necessarily a severe one. The condition has been known to develop from sprains, strains, cuts, burns or bruises, in addition to fractures or surgical procedures. Most commonly, CRPS/RSD occurs in a patient between 25 and 55, and women are three times more likely to develop the ailment than men, says the American Society for Surgery of the Hand.

Another area that makes CRPS/RSD difficult is the problems in reaching a proper diagnosis. The hallmark symptom is extreme pain, which appears out of proportion to the injury suffered. There may also be changes to the skin of the injured worker, including discoloring, swelling, dryness, tightness, redness, rashes, changes to the hair or nails and/or an increase or decrease in sweating. Many of these symptoms are common to other conditions as well. Worse, according to a recent presentation by Dr. Pradeep Chopra, Assistant Professor at Brown Medical School and Director of the Pain Management Center in Rhode Island, diagnostic tests, such as x-rays, MRI, bone scan and EMG are “not helpful for diagnosing RSD,” though they may be useful to rule out other causes and diagnoses. Therefore, CRPS/RSD is essentially a “clinical diagnosis,” best made by a physician’s personal observations of the injured worker.

There is no single “best” way to treat CRPS/RSD. The case must be examined on a patient-by-patient basis. Treating with a physician experienced with CRPS/RSD is critical, says Dr. Chopra. Options include one or more medications, drawn from several different types, injections, spinal cord stimulators and therapy.

Since CRPS/RSD is difficult to diagnose, and the causes are so vague, this condition is often met with litigation in the Pennsylvania workers’ compensation system. Much like a patient should consider using a physician with experience with the condition, when the patient is an injured worker in PA, he or she should consider using an attorney certified as a specialist in the practice of workers’ compensation law (as both of the attorneys at Brilliant & Neiman LLC are).

June 11, 2013

Acupuncture Shown to be Effective for Relieving Pain

Regular readers to our blog know that, in addition to noting recent court decisions involving workers’ compensation matters in Pennsylvania, we also try to keep injured workers informed about any developments in diagnosing or treating work injuries. Along these lines, one of the frequent topics we blog on is pain, and how it can be relieved. We’ve looked at what methods may be coming in the future, and at other possible contributions to pain.

We have also discussed acupuncture in the past. This treatment method has always been controversial, perhaps even more so in the workers’ compensation setting. Like chiropractic treatment, acupuncture is frequently met by the workers’ compensation insurance carrier with Utilization Review (to challenge whether the treatment is “reasonable and necessary”). According to a recent article published on the website of the International Anesthesia Research Society, there is proof that acupuncture actually can help with certain physical ailments, including post-operative pain, and chronic pain.

This article cited various studies, where acupuncture was tested against a placebo (sort of faked acupuncture). In at least one of these controlled studies, it was definitively shown that “acupuncture is more effective than placebo.” This result led the authors of that study to conclude that, “acupuncture is effective for the treatment of chronic pain and is therefore a reasonable treatment option.” In fact, at least one study showed that the difference between acupuncture and placebo is similar to the difference between medication and placebo, in relieving pain with arthritic knee conditions.

There were some studies, however, which cast doubt on whether acupuncture provides actual pain relief. Given the fact that acupuncture has far fewer side effects than other treatment options, such as medications, and there are studies demonstrating the value of acupuncture in relieving chronic pain as well as these other methods, there seems little reason why injured workers in Pennsylvania would not try acupuncture as a method of managing their chronic pain.

May 17, 2013

Can Potential Carpal Tunnel Syndrome be Predicted?

In the Pennsylvania workers’ compensation system, we frequently see cases involving carpal tunnel syndrome (CTS). As many of you know, this condition occurs when the median nerve is entrapped in the wrist. There are many potential causes of CTS, including familial history, certain medical conditions, trauma and certain physical activities. CTS can also occur “idiopathically” (without a known cause). Frequently, we see litigation regarding whether CTS in any given case is related to the work activities.

Are we all at the same risk to develop CTS? According to a recent study published in the Archives of Physical Medicine and Rehabilitation, and referenced in The Wall Street Journal recently, the size and shape of a person’s hand and wrist can show whether that person is predisposed to the development of CTS. Specifically, if a person has a “short and wide hand with square wrist matching to narrow and deep tunnel entrance,” that person has an increased likelihood for developing CTS. Of course, that leads us into an examination of what causes CTS, and whether CTS in any given case can be accepted as a work-related injury.

According to the University of Maryland Medical Center, “Work that involves high force or vibration is particularly hazardous (to developing CTS), as is repetitive hand and wrist work in cold temperatures.” They also note that repetitive use of the hands and wrists can cause repetitive stress disorder, overuse syndrome and chronic upper limb pain syndrome. Similarly, the National Health Service in the United Kingdom relates that CTS can be triggered by activities with “strenuous grip, repetitive wrist flexion and exposure to vibration,” including motions associated with manual labor. This is consistent with the view of the National Safety Council, who noted that “(r)epetitive manual work tasks requiring a forceful grip and use of vibrating tools can damage the median nerve in the arm, contributing to CTS.”

As you are reading this, also understand that for an injury to be compensable under the Pennsylvania Workers’ Compensation Act, the work duties do NOT need to have CAUSED the CTS. It is sufficient if the work duties “aggravated” the underlying condition, rendering the injured worker disabled. Whether the injured worker may have eventually developed CTS, even without the work activities, is irrelevant. Similarly, whether the injured worker had the size and shape of his or her hand and wrist to be predisposed to CTS has no meaning. We simply take what we actually know – the injured worker performed his or her work duties and developed CTS as a result.

April 2, 2013

Pain Relief For the Injured Worker Coming?

As attorneys who limit their practice to representing injured workers in Pennsylvania, we see many different conditions which affect various parts of the body. We see injuries to the feet, ankles and knees, the hands, arms and shoulders, the neck, back and the head. The constant? Well, that’s easy – pain. Often severe and devastating, the vast majority of injuries we see cause various degrees of pain.

Given our experience in dealing with folks in debilitating pain, we always have an eye on medical developments and research, especially when it comes to new ways of dealing with pain. And that is what makes the concept of a wearable pain patch being developed by Thimble Bioelectronics, and reported on, so interesting.

This device is not your typical pain patch, like Duragesic or Fentanyl, which delivers regulated dosages of pain medication through the skin. This new device would actually be a miniature TENS unit (Transcutaneous Electrical Nerve Stimulation). A TENS unit delivers low voltage electrical stimulation, which provides relief without the use of heavy duty narcotic medications, which contain dangerous side-effects.

Instead of needing to use a full size TENS unit for relief, with this device, the injured worker would merely stick on a patch, roughly the size of a band-aid. Unfortunately, this device is still being developed, so it does not appear to be of any immediate help. However, it is always good to see things on the horizon which can potentially provide relief to the injured worker in PA.

March 12, 2013

Developments in “Walking” for Paralyzed Injured Workers

A few months ago, we shared our excitement about the ReWalk motorized exoskeleton. We are now proud to note that one of our very own clients is working with another of these devices, called Ekso, through Good Shepherd Rehabilitation Hospital in Allentown, PA.

According to Susan Golden, Director of Neurorehabilitation at Good Shepherd, the facility became the first rehabilitation center in the entire Country to be trained in the upgraded Ekso device. They had been the third center in the Country to receive the Ekso unit back in March, 2012.

Working with Good Shepherd, our client, Jason A., has been an inspiration to other injured workers. Back in June of 2010, a farming injury left Jason paralyzed from the waist down. A young man, only 33 years old at that time, Jason has never stopped working and hoping for further recovery. When the doctors told him he had irreparable damage to his spinal cord, and that he would never walk again, Jason simply took that as a challenge rather than a sentence.

As Jason explained:

“It is exciting to be part of something so new in technology. Gives you hope to keep on working for something. Many people I have seen in my situation at Good Shepherd just give up and fall off the face of the earth. If something good has come out of this, it is that I am using my hard work and positive attitude to inspire others at Good Shepherd to keep working towards their goals.”

In May, 2012, Jason began working with the Ekso device. Through his efforts and perseverance, Jason became only the third person to do a step up a single stair with the new unit. Seeing progress like this is beyond exciting for the paralyzed injured worker. It spells hope, which had never been there before. Jason is continuing to work with the Ekso unit and continuing to make progress.

We hope that Jason’s dedication and hard work can be an inspiration to all injured workers, not just those who have suffered catastrophic spinal injuries. The fact that his great effort has given Jason hope should be a motivation to every injured worker in Pennsylvania. The commitment and determination shown by Jason makes us proud to be his attorneys.

February 19, 2013

ACL Tear Does Not Automatically Mean Surgery

A frequent injury we see in PA workers’ compensation cases is a tear of the anterior cruciate ligament (ACL) in the knee of the injured worker. In the past, this type of injury automatically required extensive reconstructive surgery to repair the tear. As we mentioned in a blog a few years ago, the thought process was changing to recommend rehabilitation before resorting to surgery.

Recently, the website for Andrews Institute for Orthopaedics & Sports Medicine referenced a study performed on skiers, which showed that approximately a quarter of those patients with a torn ACL can avoid surgery entirely, instead just rehabilitating the knee with physical therapy. Many sports fans are no doubt familiar with Dr. James Andrews, the head of this facility, who serves as orthopedic consultant for many college and professional sports teams.

The ACL is one of four ligaments in the knee. The others are medial collateral ligament (MCL), lateral collateral ligament (LCL) and posterior cruciate ligament (PCL). The primary function of the ACL is to prevent the shin bone from sliding out in front of the thigh bone. When this ligament is torn, the injured ACL is less able to control knee movement, and the bones are more likely to rub against each other. This can damage adjacent structures and can lead to osteoarthritis in the knee.

Since having immediate surgery for a torn ACL may expose an injured worker to an unnecessary major operation, but waiting too long can cause damage to other parts of the knee and lead to a chronic debilitating condition, there is a need for quality medical treatment in the weeks after the work injury.

How long should an injured worker wait to see if surgery will be necessary? According to Dr. Robert Marx, an orthopedic surgeon in the Sports Medicine and Shoulder Service at the Hospital for Special Surgery in New York City who led the study, unless there is damage to other ligaments or parts of the knee, an injured worker should "wait and be reevaluated at six to 12 weeks unless there is some other obvious reason to do surgery . . .”

December 26, 2012

Hope for Injured Workers with Paraplegia Due to Spinal Cord Injury

Too often in representing injured workers in Pennsylvania, we see lives deeply impacted by severe spinal cord injuries causing paraplegia. For this reason, we are extremely excited by the research being done in this area.

A new study was published in the November 2012 issue of the American Journal of Physical Medicine & Rehabilitation, which assessed the safety and performance of the ReWalk device. The ReWalk mechanism is a motorized exoskeleton, which allows paraplegics to regain their upright mobility. Though the device looks and seems like something from a science fiction movie, this study suggests it is ready for the here and now.

Not only can the ReWalk device give paraplegics a feeling of being upright, it can also lead to improvements in pain, bowel and bladder function, and spasticity. Additionally, we are proud to report that this study was based in Pennsylvania. Obviously, we look forward to increased use of devices like the ReWalk, which can lend some semblance of normalcy to an injured worker’s traumatically altered life.

November 12, 2012

Coping Better With Chronic Pain . . . Through Vitamin D?

Limiting our practice to PA workers’ comp cases, we see all kinds of injured workers, necks, backs, knees, elbows, wrists, ankles, shoulders . . . you name it. One thing that is consistent, unfortunately, is pain. And, a new study says an injured worker may find some relief in an unexpected place.

A recent article on addressed a study linking increased knee pain (from osteoarthritis) to a deficiency of Vitamin D. Much more work has to be done, to confirm there really exists such a connection, but as the article notes, if there truly exists a relationship between the vitamin deficiency and the level of pain, this could represent “a safe and inexpensive way of easing the chronic pain of osteoarthritis.”

While osteoarthritis is not necessarily related to trauma, such as that suffered in a work injury, we frequently see injured workers whose work injury aggravated pre-existing (not symptomatic) osteoarthritis, leading to his or her inability to work any longer.

October 26, 2012

Epidural Steroid Injections Source of Meningitis Outbreak

The injured worker in Pennsylvania already has enough to worry about. Is my back injury a bulging or herniated disc? Is the nerve root involved (called “radiculitis” or “radiculopathy”)? Now, the injured worker in PA, and throughout the Country, has to worry about whether the treatment for his or her back injury is endangering their life.

According to CBS News, as of yesterday, 323 people have contracted fungal meningitis as a result of receiving a tainted epidural steroid injection. Of those 323 cases, 24 patients have died. Epidural steroid injections are routinely provided to injured workers for back pain, often radiating to the patient’s leg. The epidural steroid injection is designed to reduce the swelling and inflammation in the area around the nerves, in an effort to provide relief to the patient. While the vast majority of the victims in this outbreak did contract the fungal meningitis from an epidural steroid injection into the spine, a handful of patients actually developed the meningitis from an injection into a joint (such as the hip, knee, shoulder or ankle).

This situation is currently being monitored by the Centers for Disease Control and Prevention, as well as by some of the individual States involved, such as New Jersey.

August 20, 2012

Andrew Bynum – Treatment for Knees That May Benefit Injured Workers

As most sports fans in the Philadelphia area are aware, the Philadelphia 76ers recently completed a blockbuster trade, netting them star center Andrew Bynum from the Los Angeles Lakers. These same fans are also likely aware that Bynum is heading to Germany for a procedure on his troublesome knees which is currently not available in the United States.

In the past, Bynum has had multiple problems with his knees, including a dislocated knee cap, a torn MCL and a torn meniscus. Though he seemed to be fairly healthy last season, Bynum desires this treatment. The procedure Bynum will be having is not approved by the U.S. Food & Drug Administration, which is why he must travel to Germany to get this care.

The treatment at issue here is called Regenokine Therapy. While it is said to be beneficial to knees, it is also alleged to help with low back pain and other conditions, including osteoarthritis. Other athletes to have undergone Regenokine Therapy reportedly include the Lakers’ Kobe Bryant and the Yankees’ Alex Rodriguez.

In Regenokine Therapy, according to the website for the actual provider, blood is taken from the patient’s body and treated to extract certain elements within the blood. Additional compounds may then be added to the solution before it is injected back into the patient. Since this procedure is not readily available, reportedly, it is typically paid for by the patient, at the rate of between $7,400 and $9,000, per knee.

This concept is exciting for the injured worker in PA, as well as throughout the United States. As the research continues, and the process obtains FDA approval, this procedure could lead to relief for pain from work related injuries, not only to the knee, but for other areas of the body.

July 26, 2012

New Threat to Workers’ Compensation in PA

Through the efforts of concerned citizens, and attorney groups united to support injured people, such as the Pennsylvania Association for Justice, there has been no legislation really harmful to the injured workers in Pennsylvania passed since 1996. Unfortunately, it appears there is now a new threat on the horizon, and we call on every injured person, and anyone who cares about the injured worker in PA, to make their concerns known to their State Representatives and State Senators.

The Pennsylvania Chamber of Commerce has a new “wish list” for the reform of the workers’ compensation system in PA. The changes desired by the Chamber primarily impact the medical providers, rather than the injured workers directly. Obviously, however, this will impact the injured worker by narrowing the treatment options open to injured workers in Pennsylvania, and generally add another layer of difficulty to what is already a minefield for those unfamiliar with the process.

One of the primary changes that the PA Chamber of Commerce would have made is to increase the time an injured worker in PA is required to treat with a company “doctor” from 90 days to 180 days. Any injured worker who has experienced substandard medical care in those first 90 days, or the difficulties of having a medical provider more concerned with a return to work than a cure, understands the significance of this expansion. No mention was made by the Chamber of the developing practice we are seeing where the injured worker is stuck with a nurse practitioner for that captive period, effectively denying the injured worker from even being evaluated by a medical doctor.

Other changes the Chamber supports include preventing the injured worker from using a pharmacy of his or her choice, and having to rely on a claims adjuster to get the medication (a scary proposition when we consider how frequently the claims adjusters cannot even process checks in a regular fashion); severely limiting the type and duration of medical treatment based on a diagnosis made by the insurance company; reducing what the doctor can get paid for treating an injured worker impacting access to necessary care; and, finally, having a treating doctor’s care reviewed by a nurse with no right to appeal that review to a Workers’ Compensation Judge.

We, of course, will be fighting this battle in Harrisburg, along with the Pennsylvania Association for Justice. But, we cannot win this alone. We need you to help us protect the injured worker in PA. Please take a few minutes to make your State Representatives and State Senators aware that you, as a voter, care about the injured worker in Pennsylvania, and that you are against the changes being proposed by the Chamber of Commerce.

April 10, 2012

Concussions can be a Real Headache for Injured Workers

As many of our loyal readers know, we occasionally delve into the world of sports for matters that may be of interest to injured workers in Pennsylvania. For example, we have brought up injury problems facing a football player for the Philadelphia Eagles as well as a hockey player for the Philadelphia Flyers.

Perhaps no injury is seen more often in football and hockey these days, however, than concussions. Indeed, as Melissa Gilbert can attest, even Dancing with the Stars can lead to such an injury.

Typically, though, a professional athlete, or an actress, is not doubted about whether an injury has been suffered. Treatment is readily given and the condition is taken very seriously. Often, the injured worker in PA does not have such a luxury.

As this recent article on Science Daily demonstrates, there are many frequently misunderstood facts and myths about concussions, several which can significantly complicate a PA workers’ comp case. For instance, did you know that a concussion will not necessarily show up on a CT scan? How about the fact that one can have a very serious concussion without being knocked unconscious? Another important point shown in this article is the fact that concussions vary from person to person, in symptoms as well as duration.

A concussion (and post-concussion syndrome) can be an incredibly debilitating condition for an injured worker in PA. One can suffer from headaches, depression and difficulty in memory, concentration and sleep, as well as other symptoms. Further, since there is no diagnostic study that can accurately confirm its presence (as an x-ray can do for a broken arm), the worker suffering with a concussion also has to deal with the workers’ comp insurance carrier disputing that he or she is even disabled. As fans of the Philadelphia Flyers know, though, those suffering from concussions have good company, from Eric Lindros and Keith Primeau in the past, to Chris Pronger, Danny Briere, James van Riemsdyk and Claude Giroux just this year. More information and support for these injured workers can be found at

March 21, 2012

Hurt at Work in PA – Have Medical Questions?

As attorneys who represent folks who have been hurt at work in Pennsylvania, we get many questions beyond legal ones dealing with PA workers’ comp issues. The average injured worker has led a fairly healthy life, and this change is sudden and understandably scary. Many injured workers have medical questions, not only about their conditions, but how their conditions may relate to workers’ compensation issues.

Seeing this need in the community, we have created a new page on our website, Medical FAQ. We hope this new page will provide some helpful answers to questions held by injured workers throughout Central and Southeastern Pennsylvania.

Of course, every injured worker is free to contact us, to get answers to questions regarding any aspect of their workers’ compensation issues. We take pride in limiting our entire practice to helping injured workers with their workers’ comp cases.

October 11, 2011

Shoulder Pain, Brachial Plexopathy and Quadrilateral Space Syndrome – Difficult Diagnoses to Solve

While many injured workers with shoulder or neck pain do truly suffer from the initial diagnosis they are given, some have a more rare condition. Sure, a strain or sprain of the shoulder or neck is quite common, and the torn rotator cuff or labral tear in the shoulder, or disc herniation with radicular symptoms in the neck, is seen fairly often, but other conditions are seen on occasion as well.

In the September 2011 issue of the newsletter from Mink Radiologic Imaging, there is discussion of Parsonage-Turner syndrome (PTS), also known as acute brachial plexopathy. Additionally, this article mentions Quadrilateral Space Syndrome (QSS), another condition that could be considered in the presence of shoulder pain. The difficulty in clarifying a diagnosis in such a case is reflected in this article from The American Journal of Roentgenology.

These are things an injured worker, and, of course, his or her physician, should keep in mind if a presumed shoulder strain or sprain is not healing as would be expected. The continued presence of symptoms in the injured shoulder could be an indication of another, undiagnosed, condition.

July 12, 2011

Bulging Disc in Lumbar Spine Can Cause Nerve Problem

Often, physicians who perform Independent Medical Examinations (IMEs), hired by the PA workers’ compensation insurance carrier, seem less than truly independent (I know, shocking, huh?). I have heard IME doctors over the years testify that a bulging disc is a natural finding, one that cannot cause symptoms, and cannot lead to nerve impingement. This, of course, is not the only view, as an article on Laser Spine Institute’s website demonstrates.

I also know another person who would disagree with the view shared by these doctors in the IME community. While Phillies pitcher Roy Oswalt does not have to worry about the Pennsylvania workers’ comp system (unlike most of us, he gets paid whether he works or not), he does have to live with the symptoms of a bulging disc.

As Mr. Oswalt described in this article on, the bulging disc is sending pain down his leg. Interestingly, I have also heard IME doctors testify that a nerve being impinged or irritated by a disc (called “radiculopathy” or “radiculitis”) will cause pain along the entire course of the nerve, down to the foot. In this case, Mr. Oswalt noted that his pain has gradually gone all the way down the leg. Since he has no reason to magnify his symptoms (considering IME doctors would say injured workers always have a financial motivation to lie), this information from Mr. Oswalt is both reliable and persuasive.

This should be a reminder to Workers’ Compensation Judges throughout the State of Pennsylvania, that a bulging disc (even, as Mr. Oswalt has, a “mild” bulging disc) can cause debilitating symptoms that not only can sideline a pitcher, but can put a construction worker, warehouse helper, chef, secretary, nurse and any other job, out of work.

April 13, 2011

Functional MRI May Actually Show Pain for Injured Workers

Several months ago, we posted a blog entry observing how diagnostic testing, MRI in particular, does not show “pain.” What can be seen on such studies are anatomical conditions which may or may not actually cause pain. We observed how this creates difficulty in litigation, such as a Pennsylvania workers’ compensation case, since an injured worker may testify that he or she suffers pain from an injury, but would be unable to “prove” it.

After the blog entry was posted, I was contacted by Dr. Donald Marks, whose company, Cognitive Engineering, LLC, maintains that they can “show” the pain an injured worker is feeling. Specifically, Dr. Marks stated, “Consider that a functional MRI can show actual activation of the pain centers of the brain, which validates/ illustrates the complaint of pain. I have published on this, and my work has supported two litigations.” You can see more about this concept on Dr. Marks’ website by clicking here.

This is a fascinating, and developing, area of medicine, which we, as attorneys who represent injured workers, will be keeping a close eye on.

February 21, 2011

FDA Limits Amount of Acetaminophen in Prescription Pain Relievers

Dealing with victims of work-related injuries every day, we understand that many of our clients need pain medications just to get through their days. Some of those prescriptions, however, are going to be changing, in an effort to make them safer.

Many pain medications combine an opioid, such as codeine, oxycodone or hydrocodone, with acetaminophen. In high doses, acetaminophen can cause liver damage, or even liver failure. Trying to combat these dangerous side effects, the U.S. Food & Drug Administration recently announced a limit on the amount of acetaminophen that can be used in these pain medicines (no more than 325 milligrams).

This change will be phased in over a period of three years, and no shortages of pain medicine are anticipated. Over the counter medications containing acetaminophen would not be effected by this action. If you have any questions about this action, or anything regarding the medications you take, you should always discuss such concerns with your doctor or pharmacist.

January 28, 2011

Metal Hip Replacements May Wear Better, But Have Dangerous Potential Effects

According to the American Academy of Orthopedic Surgeons, recent advances in hip replacements have made the procedure easier, and made the results last longer. All of the news is not good, however, as these advances may come with potential consequences.

Metal-on-metal hip replacements can dramatically improve a patient's quality of life, and return an injured worker to gainful employment. Unfortunately, the metal-on-metal hip replacements can also lead to cobalt toxicity. Patients getting metal-on-metal hip replacements may require some monitoring, or testing, after the procedure, to make sure cobalt levels are not unusually elevated.

The type of hip replacement performed, and, of course, whether a patient should even get a hip replacement at all, are discussions we encourage our clients to have with their orthopedic surgeons.

November 24, 2010

Hearing Loss in PA Workers’ Comp

Though, generally speaking, Pennsylvania’s workers’ compensation system is based purely on wage loss, there are exceptions to the rule. With most work-related injuries in PA, workers’ comp is paid only if the injured worker is disabled from his or her job by the work injury.

One large exception is the category of injuries called “specific loss.” This encompasses when an injured worker permanently loses the use of certain body parts or senses. In this event, benefits are paid under the Pennsylvania Workers’ Compensation Act, whether or not there is any disability resulting from the injury. This covers fingers, toes, hands, feet, arms and legs, in addition to the senses of sight and hearing.

Loss of hearing has had many changes in PA workers’ compensation law over the years. In fact, the entire way hearing loss is compensated under PA workers’ comp was changed with Act 1, passed in 1995. For all hearing loss since then, the amount of workers’ compensation benefits paid varies according to the percentage of binaural (both ears) hearing impairment. To receive any workers’ comp benefits, there must be at least a 10% hearing impairment; while, on the other hand, an impairment over 75% is deemed to be a complete loss of hearing.

One issue that arises in hearing loss cases is the contribution of “presbycusis,” the name for the loss of hearing which happens naturally as we age. When addressing the impact of harmful noise-exposure at work in a hearing loss, we also look at the type of hearing loss, as there are different characteristics for different causes. Of course, we also look at other kinds of noise to which the injured worker may have been exposed (military, hunting, power tools, just for a few examples).

Often, a loss of hearing is an insidious, gradual, process, which is not discovered for several years. Indeed, in many of our clients over the years, the injured worker is the last to notice (the family, and friends, who deal with the injured worker, are typically the first to notice).

When the loss of hearing is not raised until after retirement, there can be additional issues arising. One of these issues was faced recently by the Commonwealth Court of Pennsylvania in City of Philadelphia v. Workers’ Compensation Appeal Board (Seaman).

In this case, the injured worker was a fireman in the City of Philadelphia for many years. Several months after he retired, a hearing loss test (known as an “audiogram”) revealed a significant loss of hearing. The injured worker filed a Claim Petition, which was granted by a Workers’ Compensation Judge (WCJ).

The PA workers’ compensation insurance carrier appealed to the Commonwealth Court of Pennsylvania, saying that the injured worker could not win, because he could not prove the extent of hearing loss on the date he retired. The Court, however, rejected this defense and affirmed the granting of the Claim Petition. Unless there was a previous hearing loss test done close in time to the retirement, showing a significantly lesser hearing impairment, there is no such burden on the injured worker, the Court found.

Even more recently, in a decision rendered November 19, 2010, the Commonwealth Court of Pennsylvania again addressed hearing loss in the matter of Joy Mining Machinery Company v. Workers’ Compensation Appeal Board (Zerres). Here, as in the Seaman case above, the WCJ granted the Claim Petition finding a work-related loss of hearing (13.125% hearing loss in this case).

The issues in the Zerres case were whether the injured worker could prove he was exposed to the harmful noise within the three years before a Claim Petition was filed, and whether the WCJ could properly give greater weight to the injured worker’s testimony about noise level than noise-level studies (called “dosimetry readings”) offered by the employer.

The Court affirmed the decision of the WCJ, finding that the testimony of the injured worker, without more, if believed by the WCJ, was sufficient both for the timing of the noise exposure, as well as the level of exposure. The Court noted that the dosimetry readings offered by the employer were not done on the person of the injured worker, nor were they done every day in every area, thus, the dosimetry readings did not prove to what extent the injured worker was actually exposed.

September 21, 2010

Chronic Pain May Be Treated Without Prescription Medications

As Pennsylvania Workers’ Compensation attorneys, we see a wide variety of conditions faced by injured workers, from broken arms and legs to Complex Regional Pain Syndrome and Brachial Plexopathy, and everything in between. While the conditions plaguing these injured workers vary widely, there is one constant we see in case after case – chronic pain.

All too often, we see an injured worker become addicted to prescription pain medication. Nobody wants to live in pain, and often the first thing doctors try to relieve symptoms is a pill of one type or another. Many times, as the injured worker recovers from the work injury, and the pain relents, the need for the pain medication disappears. Unfortunately, when the work injury does not get better, and the pain becomes chronic, prescription pain medication may no longer be a viable alternative.

According to a recent article on Medical News Today, there are options aside from pain medication to relieve symptoms. Advances are being made in “neurostimulators,” small devices which are implanted to help block pain impulses from reaching the brain. There is hope that these, and other advances, may lessen the need for giving medications to injured workers in chronic pain.

August 11, 2010

Rehab for ACL Tear May Be Beneficial Before Surgery

A recent study published in the New England Journal of Medicine, reported by the Associated Press, found that amateur athletes (and by extension, victims of work injuries in PA), who have torn the anterior cruciate ligament (ACL) in their knee, actually do better by trying to rehab the knee before trying the surgical route.

According to the article, less than half of those in the study needed the ACL surgically repaired within two years. It appears the rehabilitation, alone, was enough in those cases.
"It seems that if you start out with rehabilitation only ... you have a good chance of ending up with an equally good outcome as if you had early ACL surgery," said Richard Frobell, of Lund University Hospital in Sweden, an author of the work.

While all situations in medicine are different, depending on the particular patient, and other factors, this article certainly suggests that an injured worker with an ACL tear should be in no rush to undergo surgery on his or her knee.

July 14, 2010

Acupuncture Served As a Fatigue And Pain Treatment

We are pleased to present a guest blog post from regarding the use of acupuncture. We thought this may be of benefit to injured workers, who may be interested in exploring alternative areas for pain relief:

Acupuncture is one of the oldest forms of health care and treatments on the planet, but it still serves its purposes even today. Now, while inserting dozens of needles into your body doesn't seem like the most fun way to treat ailments, acupuncture is a tried and true therapeutic practice that has helped people deal with pain for centuries.

By inserting needles into various pressure points around the body, physical pain and stress can be relieved and even treated using acupuncture. For most, it's funny to think that sticking needles into the pain areas and pressure points of the body would be the answer, but when it comes to people who suffer from fibromyalgia and chronic fatigue syndrome, it might just be that.

New studies have shown that that acupuncture in certain areas of the body releases adenosine, which is a natural pain killer that is usually released after an injury. This allows people who are suffering from constant fibromyalgia to gain some much-needed relief.

By releasing adenosine, pain signals can be blocked from ever reaching the brain thus helping sufferers deal with their pain problems. This brings up a lot of questions about how much acupuncture has to do with adenosine release and if this is the reason that so many benefit from it. Yet, whatever the reason, studies have shown acupuncture to be great at treating the condition and helping the people who suffer from it.

From the fatigue angle, the study also went on to show that adenosine released from acupuncture has a lot to do with the regulation of the sleep cycle. By being able to regulate sleep correctly, chronic fatigue syndrome may be able to be properly treated and even fixed.

Acupuncture paired with the correct medicine can help both constant pain and fatigue, as new studies have gone on to show. This is good news for sufferers of both ailments, and goes to show that this ancient art of health may still have some new tricks to share.

By Rachelle Holmes of Chicago Breast Augmentation and Chicago Liposuction Center, MetropolitanMDs

June 1, 2010

Trauma a Cause of “Water on the Knee”

“Water on the knee” is one of those phrases we hear that harkens back to years ago, like lumbago (low back pain) or causalgia (Reflex Sympathetic Dystrophy (RSD); now also known as Chronic Regional Pain Syndrome (CRPS)). Simply put, “water on the knee” is swelling (also called “effusion”) of the knee.

Like lumbago, for years people associated “water on the knee” with aging and related degenerative changes. For lack of a better term, years of wear and tear. A recent article on Medical News Today, however, points out that “water on the knee” is not just a sign of aging or degeneration.

In fact, the article states that trauma and injury can be causes of the knee problem. Interesting, doctors can study the fluid which is drained from the swollen knee, to gain some insight on the condition involved. For example, if the swelling is due to injury or trauma, there may be blood in the fluid. Bacteria in the fluid could point to infection as the source of the swelling. Some types of acids in the fluid may cause doctors to lean toward other causes, such as gout.

Regardless of the cause of the swelling, “water on the knee” is not something that stopped in years past.

April 21, 2010

Noise-Induced Hearing Loss Larger Factor than Heredity in Tinnitus

In representing injured workers in Pennsylvania, we frequently see hearing loss cases. Many work environments require employees in those areas to be exposed to dangerously high levels of noise. Over a period of time, this can lead to a loss in hearing.

Tinnitus, perceived usually as a “ringing” in the ear, is a condition that can be seen along with a loss of hearing. Workers’ compensation insurance carriers often allege that tinnitus, when present, is not the result of noise exposure at work, but of another cause, such as heredity.

A recent article discussed on suggests that tinnitus is far less likely to be the result of inheriting bad genes than from environmental factors, such as noise exposure at work.

In Pennsylvania, hearing loss as a result of noise exposure at work is compensable, as long as the loss of hearing is greater than 10%. The amount of compensation one can receive for loss of hearing in PA is relative to the percentage of the hearing impairment.

February 9, 2010

New CRPS/RSD Treatment May Help Relieve Chronic Pain

Perhaps the most debilitating of conditions we see in Pennsylvania Workers’ Compensation cases are ones of Complex Regional Pain Syndrome (CRPS) [Formerly known as Reflex Sympathetic Dystrophy (RSD)]. The hallmark of this condition is severe and constant pain. Since there is no cure for CRPS/RSD, all doctors can do is try to relieve and manage the chronic pain.

An article in Medical News Today says that researchers at the Pain Research Institute have found that a low dose of intravenous immunoglobin (IVIG) can provide dramatic pain relief for around five weeks in almost half of the patients surveyed. While the research is still in progress, this certainly represents hope for the many folks inflicted with this horrible condition. Also, by understanding how this drug works on the human body, additional treatments could be developed.

December 9, 2009

Orthopedic Hospital Opened By Rothman Institute in Bensalem, PA

According to the, Rothman Institute, a highly respected medical practice based in Philadelphia, PA, has now opened a private hospital in Bensalem, PA. The hospital, the first opened by Rothman Institute, will handle only orthopedic conditions. There are 24 beds in the facility, which also contains medical offices.

More information can be found on the website dedicated to the new hospital, known as The Bucks County Specialty Hospital. While this facility is the first hospital opened by Rothman Institute, the practice does have ten offices throughout the Philadelphia area. The headquarters is located at Thomas Jefferson University Hospital in Center City Philadelphia.

November 2, 2009

MRI Does Not Always Explain Pain And Other Symptoms

In the PA Workers’ Compensation system, we often see the workers’ comp insurance company doctors employ a fanatical reliance on “objective” diagnostic studies, at least when the results are negative. These doctors who perform Independent Medical Examinations (IMEs)[More accurately known as Defense Medical Examinations (DMEs)] use a negative study to say the injured worker must be fully recovered.

This view, of course, is far too simplistic and quite flawed. One could ask Kevin Curtis for confirmation. As many of you know, Kevin Curtis is a wide receiver for the Philadelphia Eagles. He has not been able to play football this year due to persistent pain in his knee. Repeated MRI studies of the knee were negative for any structural damage at all. Had Mr. Curtis been an injured worker, the IME/DME doctors would have said there is nothing wrong with him, and he can return to unrestricted work.

Yet, with millions of dollars hanging in the balance, Mr. Curtis remains unable to return to the field. In fact, the symptoms were so troubling to Curtis that he underwent arthroscopic surgery on his knee. This type of case should serve as a reminder to Workers’ Compensation Judges (WCJs), as well as to those doctors performing IMEs and DMEs, that no diagnostic test, whether x-ray, MRI or CT scan, is infallible. And, sometimes, when an injured worker says his or her knee (or shoulder, or back, or whatever) really hurts, even in the face of a negative study, maybe it really does still hurt.

October 6, 2009

Pain Relief May Soon Get Safer and Easier

Handling Pennsylvania workers’ compensation cases, we see a wide variety of work injuries. From problems with the neck and the back, to shoulders, elbows, knees, hands and everywhere in between. The one constant, though, is pain. Whether the injured worker has a herniated disc in the back, a broken arm, or a sprain or strain of a muscle, the injury usually involves pain.

To treat pain, and inflammation, in an acute work injury, doctors often prescribe non-steroidal anti-inflammatory drugs (or, NSAID for short). However, according to a recent article on The Medical News website, Transdel Pharmaceuticals, Inc. has a new approach which they say is safer and more effective for pain relief than standard NSAID medications.

Recent clinical testing has reportedly been successful for Ketotransdel, an alternative to standard NSAIDs (which are in the form of a pill that is swallowed). Ketotransdel has a transdermal delivery system (or, in other words, this medication is applied to the skin, not a pill to be swallowed).

According to lead clinical investigator Evan F. Ekman, M.D. and President of Southern Orthopaedic Sports Medicine and Medical Director of Palmetto Health Parkridge Surgery Center, Ketotransdel will provide effective pain relief without the risks of standard NSAID medications, “which are associated with gastrointestinal, cardiovascular and other medical problems."

Any advances in managing pain, even if only in the acute stage, is a benefit to the injured worker, not only in PA, but throughout our Country.

August 4, 2009

Prescription Pain Medication: Facts and Myths

In Pennsylvania workers’ compensation, we see all sorts of injuries. Everything from a torn rotator cuff in the shoulder, to an ACL tear in the knee, to an amputation of a finger or toe, to a herniated disc in the neck or back – and everything in between. One thing common to many work injuries, though, is pain. Often, severe and chronic pain.

This pain causes many an injured worker to take prescription pain medication, narcotic pain medication, for the first time on a prolonged basis. Taking such a strong medication, for a long period of time, can be frightening for some. The fear of addiction to pain medication often clouds the judgment of an injured worker, perhaps causing the injured worker to suffer chronic pain needlessly.

A recent article on WebMD addresses seven myths with regard to prescription pain medication. This article offers some good information to those injured workers who are now dealing with these issues, perhaps for the first time. Given the misunderstandings and fears regarding narcotic pain medications, this article should be required reading for all injured workers in the PA workers’ compensation system.

July 14, 2009

Complex Regional Pain Syndrome (CRPS)/Reflex Sympathetic Dystrophy (RSD) May See New Treatment

Complex Regional Pain Syndrome (CRPS), also known as Reflex Sympathetic Dystrophy (RSD), is a debilitating condition we see in Pennsylvania workers’ compensation all too often. This condition, whose sufferers experience tremendous, unrelenting, burning pain, has been known to develop from traumatic injury. Even when a work-related traumatic injury is not too severe, CRPS and RSD can develop. Medical experts remain at a loss to explain why this condition strikes some, but not others.

There is no cure for CRPS or RSD. The best doctors can offer is trying to relieve the terrible pain. As we have discussed in previous blog entries, research is continuing on possible treatment options.

Now, it appears there is a study looking into whether Functional MRI (fMRI) may be of benefit to those inflicted with CRPS or RSD. This treatment may also be of benefit to patients suffering from fibromyalgia, neuralgia, neuropathy and migraine headaches.

May 4, 2009

Healthcare Workers' Exposure to Infectious Diseases

With the dangers of Swine Flu on the minds of everyone, but perhaps especially the minds of those workers in the healthcare industry, this article from the Centers for Disease Control (CDC) may be of interest. Ironically, this article was posted on March 31, 2008, long before the current Swine Flu pandemic.

Raising this issue also brings to light that a healthcare worker in Pennsylvania who is stricken with an infectious disease as a result of his or her job is entitled to PA workers’ compensation benefits. We often see this type of case with Clostridium Difficile Colitis (C-Dif), Methicillin-resistant Staphylococcus Aureus (MRSA), and other infectious diseases which are known to exist in hospitals, nursing homes and other healthcare facilities.

If you suspect you have caught an infectious disease as a result of performing your job duties in PA, it is critical that you contact an experienced Pennsylvania workers’ compensation attorney.

April 2, 2009

Trust in Workers' Compensation Insurance Company Doctors Misplaced?

An article in the New York Times, talking about how insurance company’s “Independent Medical Examiners” (IME) may not be acting truthfully, hit home to me. Though the article deals specifically with New York workers’ comp, their system is close enough to Pennsylvania’s that comparisons are valid.

While I urge folks to read the entire article, the part that was my absolute favorite was the insurance company doctor who said, “If you did a truly pure report, you’d be out on your ears and the insurers wouldn’t pay for it. You have to give them what they want, or you’re in Florida. That’s the game, baby.”

March 26, 2009

Physical Therapy Found to be Effective Treatment for Low Back Pain

According to a recent article in the Journal of the American Academy of Orthopaedic Surgeons, physical therapy, combined with anti-inflammatory medication, is the most effective treatment for low back pain caused by degenerative disc disease.

As many injured workers know, one can have degenerative changes in their lumbar spine without even knowing. Once a work injury takes place, by lifting or twisting, or other common movement, the weakened lumbar spine becomes symptomatic. This results from the instability of the damaged discs.

According to the article, physical therapy helps by strengthening the surrounding muscles in the abdominal area and the lumbar spine, and by physically manipulating the spine. To obtain the best results, the patient has to remain active and use appropriate body mechanics.

As a doctor at an orthopedic clinic was quoted in the article as saying, “Surgery should be the last option, but too often patients think of surgery as a cure all and are eager to embark on it.”

January 12, 2009

Back Surgery Patients Recover Better Than Patients Without Surgery

In an interesting study, posted on, patients with lumbar disc herniations have been found to recover better than those patients who refuse surgery to concentrate on medications, exercise and physical therapy. An injured worker suffering a herniated disc in his or her back (or neck, for that matter) is a frequent condition we see in PA workers’ comp cases. Often, the injured worker is undecided regarding whether to have surgery performed. This study should be interesting, and enlightening, reading for those injured workers.

The study, known as the Spine Patient Outcomes Research Trial (SPORT), appeared in the December 1, 2008 issue of Spine. This trial reviewed 1244 patient cases, from 13 American spine clinics, over a period of four years. Each patient had at least a six-week history of a herniated disc in the lumbar spine, causing both back and leg pain. The patients either underwent a surgical procedure (standard open diskectomy), or a course of medications, home exercises and physical therapy.

After the four-year period, the patients who had the lumbar surgery were statistically happier, and better recovered, than those who did not. The surgical patients had better relief of pain (by about 15 points on a 100-point scale), greater physical functioning (also by about 15 points) and lesser disability (by about 13 points). Overall, 79.2% of the surgical patients, and 51.7% of the nonsurgical patients, reported major improvements in their condition. The benefits of surgery were seen as soon as six weeks after the surgical procedure, and were found to last through the four years of the study.

Obviously, whether an injured worker should have lumbar surgery in any specific case depends on that particular individual. This is a major decision which the injured worker should carefully discuss with the medical professionals. Under the Pennsylvania Workers’ Compensation Act, an injured worker is not limited to any specific number of medical opinions. As such, we often advise our PA workers’ comp clients to seek a second, if not a third or fourth, medical opinion as to whether surgery would be in their best medical interests. It is also very important to keep your PA workers’ compensation attorney advised of any changes in your medical condition or treatment, such as surgery.

January 9, 2009

Chronic Pain Help - Tramadol Extended-Release Approved by FDA

A recent article on noted that the U.S. Food & Drug Administration (FDA) has approved an extended-release version of the chronic pain medication, Ryzolt (sold under the name of “Tramadol”). Though Tramadol has previously been available, this simplified dosage is new. Unfortunately, chronic pain is something we see all too often in PA workers’ compensation cases.

This drug is used for managing moderate to moderately severe chronic pain. The extended-release form of the drug should allow patients to better control their pain over the course of the day. With both immediate-acting, and extended-release, parts, Tramadol hopes to provide better relief to chronic pain sufferers.

The article notes that chronic pain impacts approximately 75 million people in the United States, “more than diabetes, heart disease and cancer combined.”

December 15, 2008

Knee Injuries May Have New Treatment in Future

Recently, two pharmaceutical companies, Genzyme Corporation and Osiris Therapeutics,
announced that they have joined to develop two adult stem cell treatments. These medications, known as Prochymal and Chondrogen, may be a valuable resource to treat a wide variety of conditions. Benefits from these treatments may include control of inflammation, development of tissue regeneration and prevention of scar formation.

Clinical trials for Prochymal are currently underway for Crohn’s disease, diabetes, chronic obstructive pulmonary disease (COPD) and acute myocardial infarction. Chondrogen, to interest of those injured workers suffering from persistent knee pain, is in clinical trials to treat osteoarthritis of the knee.

Genzyme is no stranger to development of treatments for knee injuries. In fact, the company developed and commercialized the first-ever cell therapy product approved by the FDA, Carticel, used in knee cartilage repair. Genzyme’s products also include Synvisc, used to address the pain associated with osteoarthritis of the knee. The hope is that Chondrogen can not only treat the osteoarthritic knee pain, but also may be able to actually cure the disease.

September 23, 2008

Total Ankle Replacement Technology Improving

While ankle injuries are common in PA workers’ comp cases, we do not hear about total ankle replacements as much as we hear of total knee replacements or total hip replacements. Unfortunately, sometimes a work injury causes such damage to the ankle, or triggers the development of arthritis in the ankle, such that a total ankle replacement is necessary.

A recent article on the American Academy of Orthopaedic Surgeons‘ website talked of improvements in total ankle replacements. At this point, in the United States, only four types of implants are available for total ankle replacements. Each of these devices consists of only two components. This means there will not be much mobility in the ankle. Of course, the alternative, of fusing the ankle in one position, offers no movement at all.

Outside the United States, total ankle replacements are being done with a device containing three components, allowing greater mobility. FDA approval is being recommended for such devices to be approved for use in the U.S. The article suggests approval for these devices could come as soon as later this year.

September 15, 2008

Workers’ Comp Claimants Face More Risk in Surgery Than They Think?

As if an injured worker needed another reason to think of surgery as only a last resort, a recent article in Annals of Surgery journal noted that there is a discrepancy in the count of surgical instruments (including sponges) in nearly 13% of surgical procedures. This, of course, does not mean an instrument, or a sponge, is left in a surgical patient in 13% of procedures (that percentage is closer to 0.02%, or one in 5,000). Still, this seems like a staggeringly high percentage to have a miscount.

An article in suggests some solutions to reducing this figure. One is putting bar codes on sponges, which would then be scanned in and out. The count would then be automatic. The article suggests this would add only about $9.00 per surgical case. Another option is placing tiny radio-frequency identification (RFID) tags in the sponges. A wand could then be used to locate missing sponges, either inside a patient, or around the operating room. This would cost an additional $25.00 to $45.00 per surgical procedure.

While certainly no injured worker wants to rush into surgery, sometimes a work injury requires surgical intervention, whether it is a back surgery, a total knee replacement, or any other procedure. The hope is that these new technologies can make surgery safer, and less risky, for every injured worker.

September 8, 2008

Lumbar Discectomy May be of Benefit to Injured Workers in PA

One of the most common work injuries we see in PA is to the back, whether it is a herniated or bulging lumbar disc, an aggravation of degenerative disc disease, or a soft tissue injury, such as a strain or sprain. These injuries run from a minor strain, which can be cured by rest and medication, to a herniated disc encroaching on a lumbar nerve root, which can require injections and surgery.

When an injured worker has suffered a herniated lumbar disc, and is having pain or numbness down one or both legs (“radicular symptoms” or “lumbar radiculopathy”), surgery may be discussed. One of the more common procedures to relieve the pressure of a herniated lumbar disc pressing on a nerve root is called a discectomy, where the disc material is simply removed.

A recent article published in the Journal of Bone & Joint Surgery examined some previous studies regarding the timing and effectiveness of lumbar discectomies. One of the more interesting findings was that pain relief occurs first after a lumbar discectomy, followed by recovery of motor function (strength), then improvement in sensation. In other words, it is not unusual for the injured worker to continue to have abnormal sensation after surgery. This is an important thing to keep in mind after surgery, so that the injured worker does not feel as if his or her recovery is not going well.

Another interesting finding in the article is that once severe extensor weakness (in this case, the big toe) has begun, lumbar discectomy is not likely to help. In that situation, apparently the nerve has been damaged too badly by the pressure of the herniated disc.

Obviously, whether a patient needs surgery is a determination to be made between the patient and the doctor. Our role as workers’ compensation attorneys in Pennsylvania is to make sure our clients have that decision to make. In other words, we want to make sure the workers’ comp insurance company is covering the treatment the injured worker needs.

July 28, 2008

Fentanyl Transdermal Patch Answers

Many of those who are injured at work and receiving Pennsylvania workers’ compensation benefits are using, or have used, the Fentanyl Transdermal Patch (FTP). As with any medication, the injured worker often has questions regarding the usage of the Fentanyl patch. This set of Frequently Asked Questions about FTP may be of interest to those workers’ comp claimants who use this medication.

July 19, 2008

Thoracic Outlet Syndrome – New Treatment on the Horizon?

Thoracic outlet syndrome is a debilitating injury we see in Pennsylvania workers’ compensation cases. In this condition, the blood vessels and/or nerves in the arms may be compressed, causing various symptoms, including pain, numbness, tingling and a “cool” feeling in the arms.

There is no easy cure for thoracic outlet syndrome. No medication, surgery, or other treatment method seems universally able to help the injured worker with this condition.

Hope may be on the horizon, however. A study is currently underway, investigating whether an injection of BOTOX may be an efficient reliever of symptoms from thoracic outlet syndrome. While it will be some time before this treatment is approved by the FDA (if ever), this development is worth watching for those who suffer from this diagnosis.

June 18, 2008

Massive Torn Rotator Cuff May Not Be Permanent For An Injured Worker Anymore

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.

May 30, 2008

Prolotherapy – Pain Relief for Workers’ Compensation Claimants?

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.

May 28, 2008

Artificial Disc Replacement Offers Hope of Pain Relief to Injured Workers

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.

May 17, 2008

Chronic Pain and OxyCodone in Workers Compensation

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.

May 12, 2008

Prescription Advice for Injured Workers in Pennsylvania

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.

May 10, 2008

Reflex Sympathetic Dystrophy (RSD) and Complex Regional Pain Syndrome (CRPS) Often Seen in PA Workers' Comp

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.

April 27, 2008

Total Knee Replacement and Total Hip Replacement on the Rise

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.

April 19, 2008

Carpal Tunnel Syndrome is Often Work-Related

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.

April 17, 2008

Work-Related Injury: Neck Pain May be Relieved by Acupuncture as Well as by Injections

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.