Articles Posted in Medical News

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.

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.

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 MedPageToday.com 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.

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.

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.

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.