Decision #09/02 - Type: Workers Compensation

Preamble

An Appeal Panel hearing was held on November 22, 2001, at the request of a union representative, acting on behalf of the claimant. The Panel discussed this appeal on November 22, 2001.

Issue

Whether or not the claim is acceptable.

Decision

That the claim is acceptable.

Decision: Unanimous

Background

On January 15, 2001, the claimant submitted an application for compensation benefits in relation to "trigger finger" which she related to her employment activities as a housekeeper. Information obtained from the employer indicated that the trigger finger condition was due to lifting and pulling due to cleaning and that the claimant was scheduled for surgery on June 6, 2001.

During a telephone conversation with a Workers Compensation Board (WCB) adjudicator on February 19, 2001, the claimant stated that she had been employed with the accident employer for 22 years and commenced working in housekeeping in May 2000. She is right-hand dominant. The claimant described her job duties in housekeeping as follows: dusting/cleaning the doctor's offices, washing down beds, washing and mopping floors. The claimant said she would dust and clean about 20-30 offices per day and wash the waiting room. Her biggest problem was holding the mop.

She stated that she used both hands to hold the mop and there was a lot of grip and pressure placed on the long fingers when mopping. The claimant held the mop at least 2 hours at a time and found that she had a hard time opening her hand after mopping. The majority of her day was spent mopping and she also lifted heavy garbage bags with both hands and constantly lifted chairs or pulled stretchers and beds to clean them. None of the equipment had an actual trigger.

The claimant advised the adjudicator that she had no prior history of arthritis in her family or any problems with her fingers. The onset of her problems started about one year ago and her fingers would stay locked down and she would have to pull them up. Her condition progressively became worse over time. There was no specific injury at any time and there were no trauma to her hands. Extra-curricular activities included no physical activities except for normal housework, watching TV or reading and cooking.

Medical information included a report from an orthopaedic specialist dated January 15, 2001. He indicated that he examined the claimant on January 11, 2001 regarding her triggering right and left long finger. The specialist noted that the claimant worked in a hospital and that her symptoms began a few months ago without any evidence of major trauma apart from repeated hand strain during her daily work. X-rays of the hands and wrists showed no significant bony or joint abnormality. Clinically the claimant had triggering of both long fingers. It was felt that the claimant would benefit from surgical decompression of her triggering fingers and arrangements were made for the proposed surgery.

On February 20, 2001, primary adjudication requested a WCB medical advisor to review the case and to provide a medical opinion as to whether or not the triggering of the claimant's fingers were directly related to her job duties. In response, the medical advisor stated that in his opinion, prolonged rubbing and pressure over the tendon were generally accepted causes of triggering. He stated that trigger finger was common in middle aged females involving the middle and right finger without any identifiable cause. It was the medical advisor's opinion that surgery should not be accepted as a WCB responsibility.

In a letter dated February 28, 2001, primary adjudication informed the claimant that her claim for compensation was not acceptable as it could not be established that the triggering of her fingers was directly due to an accident arising out of and in the course of her employment. On March 26, 2000, a union representative, acting on behalf of the claimant, appealed this decision to Review Office.

Prior to considering the above appeal, Review Office sought the medical opinion of a WCB orthopaedic consultant as to whether or not there was a relationship (caused or aggravated) between the claimant's job duties and her bilateral trigger finger condition. The consultant's response is contained in a memo dated April 5, 2001.

In a decision dated April 12, 2001, Review Office confirmed that the claim was not acceptable for personal injury by accident arising out of and in the course of the worker's employment.

Review Office believed that the claimant's trigger fingers did not arise out of her employment duties. In support of its decision, Review Office made reference to the medical literature that was submitted by the union representative under the titles "Possible causes" and "What is Trigger Finger", the opinions expressed by the WCB medical advisor on February 20, 2001 and that of the WCB orthopaedic consultant on April 5, 2001. On June 22, 2001, the union representative appealed Review Office's decision and an oral hearing was convened.

On November 22, 2001, an oral hearing took place at the Appeal Commission. At this time it was agreed to by all parties that the claimant's union representative would be submitting additional medical literature to the Appeal Panel and that this information would be shared with the employer's advocate for comment. On November 28, 2001 the union representative submitted the additional information and it was forwarded to the employer's advocate for comment. On December 17, 2001, the Panel met further to discuss the case and rendered its final decision on the issue under appeal.

Reasons

This case involves an appeal by a worker, from a decision of the Review Office dated April 12, 2001 whereby the Review Office denied the worker's claim for benefits.

The issue before the Panel at its hearing on November 22, 2001, therefore, was whether the worker's claim was acceptable.

Section 4(1) of The Workers Compensation Act (the "Act") provides for the payment of compensation benefits to a worker where he or she sustains personal injury by accident arising out of and in the course of employment.
    "Where, in any industry within the scope of this Part, personal injury by accident arising out of and in the course of the employment is caused to a worker, compensation as provided by this Part shall be paid by the Board out of the Accident Fund, subject to the following subsections."
In accordance with this section, the Panel must be satisfied that there has been an accident within the meaning of Section 1(1) of the Act. That is,
    "a chance event occasioned by a physical or natural cause; and includes
    1. a wilful and intentional act that is not the act of the worker,
    2. any
      1. event arising out of and in the course of, employment, or
      2. thing that is done and the doing of which arises out of, and in the course of, employment, and
    3. an occupation disease
    and as a result of which a worker is injured."
Both the claimant and the employer attended the hearing. Both had able representation and oral submissions were made on behalf of each party. The claimant herself also testified.

The evidence disclosed that the claimant has worked for the same employer for over 20 years. It was confirmed at the hearing by both parties, that the claimant's job description and duties changed in May of 1999 when she began working in the housekeeping department, still with the same employer. This was a clarification of what was originally indicated in the Board's file which had identified that the claimant commenced working in the housekeeping department one year later, i.e. in May of 2000.

The claimant testified that she began to experience pain and locking of the middle fingers of her right and left hands several months after she began performing her duties in the housekeeping department. The claimant is right hand dominant.

There was no dispute that the claimant has been accurately diagnosed with a condition known as trigger finger. In June of 2001, the claimant underwent surgery which was successful, to alleviate the symptoms in her right hand. Her evidence was that she will probably have to undergo similar surgery with respect to the middle finger of her left hand, at some time in the future. The claimant's position in this appeal is that her duties in the housekeeping department are, on a balance of probabilities, the cause of her bilateral trigger finger condition.

Excerpts from various medical authorities describing trigger finger and its causes were submitted by both parties. For example, the employer, through its representative, submitted the following information obtained from the Indiana Hand Centre:
    "Trigger finger is a common disorder of the hand which causes a painful snapping or locking of the fingers or thumb. Trigger finger is often caused by inflammation of the synovial sheath surrounding the tendons. It may also result from enlargement of the tendon itself or a narrowing of the first annular band. ...

    The exact cause of trigger finger or thumb is not always readily apparent. Tasks that require repetitive grasping or the prolonged use of tools ... [with examples given such as scissors, screwdrivers, etc.]

    ... press firmly on the tendon sheath at the base of the finger or thumb may irritate the tendons and result in thickening of the tendons themselves or the tendon sheath."
The employer's representative also referred to information from Medical MultiMedia Group which indicated:
    "Triggering is usually the result of a thickening in the tendon that forms a nodule ... Rheumatoid arthritis, partial tendon lacerations, repeated trauma from pistol gripping power tools or long hours grasping a steering wheel can cause triggering ..."
The claimant testified that the first time she experienced any difficulties with her fingers was when she was working at her housekeeping job and that she had never noticed any problem prior to working at that employment. In reaching its decision, the Panel was particularly persuaded by the claimant's evidence as to her job description. She described her daily work routine as follows:
    "Cleaning the patient and examining room, offices, mopping. This is the hard thing, because you have the bucket, you put the mop in it, in the bucket and you have to wring and wring all the time, twist the mop, because you cannot have a wet mop on the floor. You have to twist it. And this is a constantly [sic] thing when you have over 50 or 45 doctors' room to clean, you've got to sweep the dust, sweep the - there's a sweeping and you sweep the room, and then when you finish you have to mop it, because that room, you have to mop it every day. It's not something that you leave. You have to mop it every day."
The claimant further commented that the constant squeezing and turning of the hard wooden mop handle was what she believed affected her. Her evidence was that after the mop has been wet each time, she is required to squeeze the water out by holding the handle of the mop and twisting it, thereby applying pressure against the base of her fingers. Using a pen, she performed a physical demonstration, for the Panel, of the mechanism involved in drying the mop, showing how she wrings the water out of the mop by closing her hands tightly around the wooden stick handle and twisting or wringing the mop in the bucket until it is dry. She also testified that she feels pain in her hand any time she squeezes the mop.

The employer in its submission did not dispute that mopping forms a big part of the claimant's job duties and that the claimant does in fact spend approximately 3 hours per day or shift, carrying out that activity. The employer simply did not feel that the mopping duties were consistent with the development of trigger finger.

It is significant, however, that the claimant's description of her job duties and in particular the method of physically twisting the mop handle, applying pressure at the base of her fingers, is indeed consistent with medical information supplied by both the Board's medical advisor and its orthopaedic consultant. For example, the Board's medical advisor stated in an opinion provided February 20, 2001, that a generally accepted cause of trigger finger is: prolonged rubbing pressure over the tendon. Further, the opinion of a Board orthopaedic consultant set out in a memo dated April 5, 2001 states that
    "any gripping or pressure related phenomenon affecting the middle finger would have to be at the base of the finger, on the flexor aspect and overlying the metacarpal head and neck to the finger and in this particular situation, might aggravate the problem."
In light of the forgoing evidence, adduced at the hearing, and the medical information available to the Panel from all sources, we find, on a balance of probabilities that the claimant's personal injury did arise out of and in the course of her employment. We therefore find the claim to be acceptable.

Panel Members

S. Walsh, Presiding Officer
A. Finkel, Commissioner
M. Day, Commissioner

Recording Secretary, B. Miller

S. Walsh - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 17th day of January, 2002

Back