Articles Posted in Medical News

Thoracic Outlet Syndrome (TOS) and Brachial Plexopathy are two conditions we see representing injured workers in Pennsylvania.  These conditions were recently in the news in the Philadelphia area, with the report that Phillies pitcher Vince Velasquez underwent surgery for TOS in the previous offseason.  Indeed, it is not an uncommon injury for a professional baseball pitcher; our firm has represented a former major league pitcher with the condition (of course, we have represented many more types of injured workers with this condition than professional athletes!).

Both TOS and brachial plexopathy are sort of general terms, each regarding issues in the brachial plexus area (think of it like a big city train station, where it is many branches of nerves coming together rather than railroad tracks).  There are many forms of these conditions, making diagnosis difficult.  As we have mentioned previously on this blog, brachial plexopathy can be confused for conditions in the shoulder and/or neck of the injured worker.  This difficulty is also mentioned in the Medical FAQs on our website.  In the PA workers’ compensation system, we are often litigating to have TOS or brachial plexopathy accepted as part of the work injury (since such conditions are rarely, if ever, voluntarily accepted by the workers’ compensation insurance carrier).

Part of the problem in getting TOS or brachial plexopathy accepted as a work injury is the fact the conditions can be caused in various ways.  In fact, some occurrences are “idiopathic,” meaning that there is no known cause.  On the other hand, trauma is an established cause of the conditions.  It is also important to note that when we talk of “trauma” as a cause of TOS or brachial plexopathy in a work-related injury, we are speaking both of a single injury, as well as some type of repetitive motion kind of injury.  As we have discussed on this blog, repetitive motion injuries are just as much “work injuries” as single traumatic episodes.

Recently, we discussed the status of Senate Bill 936, which was passed by the House.  We are pleased to relate that Governor Thomas Wolf has vetoed this legislation, recognizing that it was a thinly disguised attack on injured workers and not a solution to any problem.

As discussed in the Morning Call, Gov. Wolf said:

Make no mistake, Senate Bill 936 is not a bill designed to fight the opioid crisis. Senate Bill 936 threatens health care for millions of workers who could be injured on the job, including police, corrections officers, and firefighters, who put their lives on the line every day, and whose injuries can be unique, debilitating and severe. It is wrong to sacrifice health care for our first responders to protect the bottom-line for insurance companies and corporations.”

Previously, we have warned of the pending legislation that will restrict the access of injured workers across the State of Pennsylvania to get medications they need.  Now, thanks to the House passing Senate Bill 936, the legislation heads to the Governor.  It is not bad enough that innocent people suffered injuries at work, now they have to deal with the reality that they will be treated different than patients who are not in the Pennsylvania workers’ compensation system.

As noted in an article on Pennlive.com, this legislation “was drawn up in response to reports in the Philadelphia Inquirer and Daily News about doctors and law firms specializing in worker’s compensation that were operating their own pharmacies.”  Perhaps someone would be kind enough to explain why the legislation did not simply prohibit the ownership of pharmacies by these groups?  Instead, this legislation does not even deal with this issue.  At all.  Rather, the legislation makes medications (all medications, not just the opioids that caused all of the supposed angst) more difficult for an injured worker in PA to obtain.

And, again we ask, is this fair?  Is this how our elected representatives protect us?  By making sure that we have difficulty getting medications if we are unlucky enough to be injured at work?  We urge all injured workers, those who care about injured workers and those who care about fairness and justice, to reach out to their legislators, and reach out to the Governor’s office, and let everyone know this will not be done without a fight!

Pennsylvania’s legislators try their best to represent their constituents; I believe this is true the vast majority of times.  But, there are certainly times when the results of their actions are very difficult to reconcile with the best interests of those they have sworn to protect.

Currently pending in the PA legislature is House Bill 18/Senate Bill 936.  If passed, this legislation would completely change how an injured worker in Pennsylvania can receive medications.  A “drug formulary” would be set up.  This means that no longer would a patient be treated based on the individual needs of the patient, and the individual judgement of his or her doctor.  Nope.  Instead, decisions would be based on “evidence-based medicine.”  That means that what medications would generally be prescribed for a given condition, for the period generally prescribed, would be all that an injured worker in PA could receive.

Therefore, the individual judgment of the doctor is totally irrelevant.  The needs of the patient?  Not a factor.  This is an absurd system, since medicine is not an exact science.  Indeed, any physician will openly admit that not every patient will react to every condition in the same way.  Some heal faster than others.  Not every patient has exactly the same symptoms or limitations, even from the same condition.

House Bill 18 has made it out of committee and is expected to be voted on early next week (Tuesday).  This bill would drastically change how injured workers in Pennsylvania would get their medications (and what medications they could get).  Basically, the Bill introduces “Evidence-Based Medicine” to PA workers’ compensation prescriptions.  This means that patients of a work injury would no longer be able to have care (or at least medicine usage) dictated by treating physicians; instead, the use of medications would be through established guidelines (amassing statistical data).  This, of course, ignores the simple fact that every patient is different and requires different care.  One cannot treat every person identically the same.

This could just be the first step in making “Evidence-Based Medicine” the care for every aspect of a work injury.  Imagine that your treating doctor is powerless to order care as he or she feels best, but is instead limited to what statistics say should be done for the majority of patients.  It is an absolute disgrace that Pennsylvania legislators think so little of injured workers to subject them to this kind of dangerous and substandard care.

Call your State legislators and tell them how you feel, before this Bill becomes reality!

Representing injured workers in Pennsylvania, we see many severe injuries.  One condition which certainly belongs in this category is Reflex Sympathetic Dystrophy (RSD), otherwise known as Complex Regional Pain Syndrome (CRPS).  This debilitating condition has been discussed on our blog in the past.

Since a hallmark of RSD/CRPS is incapacitating pain, much of the challenge in treating patients with the condition is providing some level of relief.  A tool which may be coming to the arsenal of pain management physicians in the future is Neridronic Acid.  Clinical trials of this medication are promising enough to have led the U.S. Food and Drug Administration (FDA) to label Neridronic Acid with the Breakthrough Therapy designation, as noted by the U.S. National Institute of Health (NIH). These clinical trials appear to have shown a significant reduction in pain and symptoms of CRPS with the Neridronic Acid treatment, as reported by Pain News Network.

We will be keeping an eye on this, and other, avenues that the medical community pursues to care for injured workers with this serious condition.

Pennsylvania work-related injuries occur in many forms.  We see musculoskeletal trauma, such as a broken wrist or ankle, a herniated disc in the neck or back, or tears in the knee or shoulder, among many others.  Neurological injuries also unfortunately happen, and can include Reflex Sympathetic Dystrophy (RSD)/Complex Regional Pain Syndrome (CRPS), Traumatic Brain Injury (TBI), or various nerve abnormalities, like carpal tunnel syndrome or ulnar neuropathy.  Different than these conditions, though certainly no less serious, can be injuries at work which lead to a severe burn.

For these burn victims, recent research is giving hope to a new way of treatment, using stem cells.  In what sounds like something taken from the pages of a science fiction novel, or a Star Trek episode, according to CNN, RenovaCare has created what it dubs “The SkinGun.”  This amazing tool would take harvested stem cells, put into a water-based solution, and “shoot” the spray onto the burned area.  New skin would then begin to develop at the cellular level.  Typical complications in burn cases, such as infection and a body’s graft rejection, are minimized by the SkinGun.

At this point, the SkinGun has not yet been approved by the Food and Drug Administration, though continued research and testing is taking place.  We will continue to monitor this, and other medical advances, to keep our clients well informed.

A recent study from Northwestern Medicine and the Rehabilitation Institute of Chicago, published in Science Daily, relates that scientists have identified what part of a patient’s brain is triggered during a “placebo effect.”  A “placebo” is a “fake medicine,” which can actually cause real pain relief.

We have many injured workers who suffer tremendous pain due to a litany of different conditions, from a fractured ankle, to a lumbar radiculopathy, to complex regional pain syndrome [CRPS] (formerly known as Reflex Sympathetic Dystrophy [RSD]).  Even years after a work injury, many of our clients continue to suffer chronic and unremitting pain.  Relief through medications is often hit and misses.

This research is not suggesting that injured workers are not actually suffering from pain, or that placebos should be more widely used.  Instead, the significance of this research is to identify where to look in the brain of an injured worker, to determine how that person is processing a medication (since each person is a unique individual, and treatment helping one may not help another).

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.

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?