7-23-2021; Amazing New Surgery for CTS to Change U.S. Repetitive Stress Claims; Confusion from Colorado about Off-Site Workout Injuries and more

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Synopsis: New Surgical Development Greatly Lessens Carpal Tunnel Repairs. This is a “Must-Read” for the United States WC industry. 

Editor’s comment: In Illinois, carpal tunnel claims and repairs skyrocketed for a time when the IL WC community was making giant PPD awards for such conditions. About a decade ago, there was a scandal, when numerous prison guards at a southern IL prison were all claiming CTS due to allegedly shaking truck steering wheels and opening/unlocking prison gates. At least one IL WC Arbitrator made CTS claims during this scandal to cash in. The IL Legislature passed new legislation limiting CTS claims in response to the scandal.

What is now happening is the medical/surgical industry has developed new technology that will dramatically limit the impact of CTS repairs/revisions.

Please note carpal tunnel syndrome (CTS) is a cumulative stress injury felt to be caused by repetitive motion that leads to compression of the median nerve from thickening of the transverse carpal ligament. An individual who suffers from CTS will likely have symptoms such as numbness, tingling, pain, swelling, and weakness in the wrist and fingers. In the early stages, CTS can be managed conservatively by:

  • Wearing a splint at night or during certain activities

  • Regularly completing strengthening exercises and stretches

  • Medications, primarily anti-inflammatory medications

  • Adopting recommendations to improve body mechanics, posture, and equipment usage

 

However, in the event of more severe CTS cases that significantly impact work and daily function, surgery will relieve pressure on the median nerve. Carpal tunnel release surgery has traditionally been performed using an open incision or sometimes endoscopically to cut through the ligament that that is compressing the nerve. Both of these procedures leave behind a 2-4 centimeter scar and require patients to abstain from most activities (including work) for weeks or more. What industry observers saw was a patient getting CTS surgery on one hand and take 90 days off to then have surgery on the other hand and take another 90 days off! Then our liberal IL WC system was awarding thousands of dollars in PPD. Several large businesses moved their operations out of our State due to these sorts of claims.

 

While the old-method surgeries are technically considered minimally-invasive, operating in such a small space is challenging, costly for both the procedure, surgicenter fees and several months of rehab treatment, and increases the risk of complications. The aftercare for these procedures is similarly burdensome. CTS has yielded some of the highest workers’ compensation payouts of all injuries/conditions and the longest average disability duration among employees receiving workers’ compensation.

 

We have recently learned of Ovation Hand Institute with locations in Chicago, Minneapolis, Milwaukee and Green Bay. Their highly innovative surgical technique redefines the term “minimally-invasive” by involving only two minuscule pinholes at the wrist. The new procedure is called Thread Carpal Tunnel Release (TCTR)—it is a proven-effective surgical procedure with over 2,000 cases to date and more being performed every day. TCTR eliminates the need for surgical tools and resulting scars. TCTR uses ultrasound imaging to insert a tiny thread into the hand/wrist that cuts the ligament and relieves pressure on the nerve.

 

This new and amazing surgical procedure:

 

  • Reduces the risk of cutting nearby nerves, blood vessels, or tendons and this has never occurred in over 2,300 cases

  • Has been successfully performed on over 2,300 patients with CTS, and no significant complications

  • Only requires local anesthesia

  • Is typically performed in under 20 minutes

  • Performed in an office-based surgical suite with a single global fee with no equipment/surgical device costs and no surgicenter fees

 

Most importantly, TCTR has an unsurpassed recovery time and a much more rapid return to normal activities than was previously possible with endoscopic and traditional mini-open techniques.  All the Boston CTS scores of symptoms and functional abilities in the first six months after TCTR are also far superior to the endoscopic and mini-open scores.  Patients who received TCTR report returning to most daily activities within 1-2 days. The majority of patients even returned to work in under one week. TCTR is a revolutionary treatment method that stands to change the surgical care of carpal tunnel syndrome one patient at a time.

 

In my view, all aspects of CTS work comp claims should change as this new surgical procedure grows. Please note lost time in such claims may be contained to the IL WC three-day waiting period, ending the need to pay any TTD or otherwise greatly limit lost time. The results of the surgery leave the patient with pin-hole scars that may disappear and should provide greatly limited PPD, if any.

 

If you have Claimants seeking CTS repairs due to work, you have to recommend this new surgical phenomenon. Learn more at http://www.ovationhand.com

 

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Synopsis: Colorado Ruling Adds Confusion to “Working-Out-Away-From-Work” Injuries in the Post-Pandemic Era. Comments and research by Michael J. Palmer, J.D.

 

Editor’s Comment: A ruptured Achilles during offsite workout leaves a former Denver Broncos player without a career and hung out to dry. This injury posits a novel question for employees injured away from employer premises.

 

During the past NFL offseason, the NFL Players Association made a push for players to workout away from team facilities due to Covid-19 concerns. Former Denver Broncos offensive tackle, Ja’Wuan James, elected to do so and tore his Achilles while working out away from the team. The Broncos promptly placed him on the “non-football” injury list and released/fired him a week later.

 

This scenario raised the question, whether an injury sustained during an offsite workout arose out of and in the course of employment. A 1996 Colorado Supreme Court decision lends some guidance to the situation.

 

In Price v. Industrial Claim Appeals Office, the Colorado Supreme Court upheld benefits denial for two off-duty law enforcement officers who suffered injuries while working out away from their employer’s facilities. The Court laid out a five-prong test, giving more weight to the first two prongs. The Court stated

 

(1)  The injury must have occurred during working hours;

(2)  it must have happened on the employer’s premises;

(3)  the employer had to initiate the exercise regimen;

(4)  the employer had to exhibit some control over the regimen; and

(5)  the employer stood to benefit from the worker’s exercise. 

 

The Court noted, however, that an “extremely strong showing” on the last three factors could overcome a failure to satisfy the first two.

 

In James’ case, he was following a team workout plan the Broncos recommended, and the team sent letters to players encouraging them to stay in shape during the offseason. James can arguably make a strong showing on prongs three through five of the test laid out in Price, were he to seek workers’ compensation benefits. Employers who require their employees to stay in shape for their job should contemplate the level of control they exert while the employee is away from the premises.

 

This Article was researched and written by Michael J. Palmer, J.D. Please do not hesitate to inquire or ask for more information at mpalmer@keefe-law.com.

 

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