Decision #59/03 - Type: Workers Compensation

Preamble

A Non-oral file review was held on May 7, 2003, at the claimant's request.

Issue

Whether or not responsibility should be accepted for the claimant's left wrist complaints for which surgery has been performed.

Decision

That responsibility should not be accepted for the claimant's left wrist complaints for which surgery had been performed.

Decision: Unanimous

Background

While employed as a labourer on September 5, 2001, the claimant's right hand/wrist became caught in a belt when he tried to free a rag which had became entangled. The initial diagnosis was a right hand sprain. X-rays of the right hand and wrist dated September 5, 2001 read as follows: "Marked depression of the medial aspect of the articulating surface of the radius with marked angulation and apparent subluxation of the ulna but these changes are long-standing. No evidence of recent injury is seen." The Workers Compensation Board (WCB) accepted the claim and the claimant received eight days of wage loss benefits as a result of the accident.

In February 2002, the claimant spoke with a WCB adjudicator to report that he was now having problems with his left wrist which he attributed to the September 5, 2001 accident, when he used his left wrist to free his right wrist from the conveyor belt. The claimant also said that he noticed pain in his left wrist at work on approximately February 19, 2002. He stated that he had to pull heavy hoses with pressure triggers and extension cords as part of his regular duties. He could not relate the onset of his left wrist symptoms to any one specific incident. The claimant advised that he had been receiving treatment for his left wrist and was told he had either tendonitis or bursitis. The adjudicator advised the claimant that she could not relate his left wrist problems to the accident of September 5, 2001 and that he should establish a new non-specific claim for his left wrist difficulties. In April 2002, primary adjudication accepted the new claim for left wrist tendonitis/bursitis with the accident date being February 19, 2002.

X-rays of the left wrist dated February 22, 2002 read as follows: "There is depression of the medial aspect of the articular surface of the radius with associated angulation and apparent subluxation of the ulna. These findings are similar to the appearance of the right wrist and are likely on a congenital basis. No acute bony injury is recognized."

X-rays of both wrists dated April 1, 2002 read as follows: "There is bowing of the shaft of the radius bilateral and elongation of the ulna bilateral with dorsal displacement. The articular margins of radius and ulna are inclined towards each other and there is alteration of the proximal carpal alignment. These changes are developmental in origin and represent Madelung's deformity."

In a letter to the attending physician dated April 16, 2002, a plastic surgeon indicated that the claimant had congenital Madelung's deformity bilaterally. He noted that the claimant sustained an injury to his left wrist six months ago and since that time has had persistent pain around his lower end of the ulna. The lower end was more protruding and tender than on the right. On x-rays there was an increased positive variance on the left. The surgeon stated that there had been some subluxation and instability and felt that the claimant would benefit from a Darrech's procedure with an ECU lasso to stabilize the lower end. In a letter to the attending physician dated May 8, 2002, an orthopaedic surgeon stated that he agreed with the plastic surgeon that the claimant should proceed with the recommended surgery.

On July 18, 2002, a WCB medical advisor wrote to the plastic surgeon to advise that the WCB would not accept financial responsibility for the Darrech's procedure. In a memo dated July 25, 2002, the medical advisor noted that he refused the surgery due to the fact that the claimant had a congenital bilateral condition, i.e. Madelung's deformities.

On August 16, 2002, the claimant was examined by a WCB medical advisor and on August 19, 2002, the claimant underwent a Functional Capacity Evaluation.

In a letter dated October 3, 2002, primary adjudication advised the claimant that it was the WCB's position that his tendonitis/strain injury had now resolved and that his present difficulties were directly related to his pre-existing/congenital bilateral wrist problems.

In a letter to Review Office that was received on December 5, 2002, the claimant disagreed with the WCB's decision of not accepting responsibility for his surgery. The claimant contended that something traumatic had to have happened to cause his ulna to move out of place. The claimant said he had no problems with his wrist until the accident of September 2001.

On December 23, 2002, Review Office determined that no responsibility could be accepted for the claimant's ongoing left wrist complaints for which surgery had been recommended. Review Office stated there was no evidence that the claimant sustained any significant trauma to the left wrist on September 5, 2001 and was satisfied that any suggestion for surgery was solely related to the claimant's congenital Madelung's deformity rather than any at-work injury. On March 26, 2003, the claimant appealed Review Office's decision and an oral hearing was convened.

Reasons

This case involves a worker who incurred injuries to both of his wrists in separate accidents, one in September 2001, the other in February 2002. Separate claims were made and accepted. Benefits were paid accordingly.

In April 2002, it was determined that he had Madelung's deformity in both wrists. This is a congenital disorder. Surgery was recommended. Review Office concluded that the need for surgery was related to his congenital condition and not to the workplace accident. The worker then appealed to this Commission.

For his appeal to succeed, the Appeal Panel would have to determine that the surgery to the worker's left wrist was causally related to his workplace accident of February 2002. We did not come to that determination.

We came to our decision by way of a non-oral file review, which followed a thorough review of the claim file by each of the panelists.

In coming to our decision, we took particular note of the following pieces of medical evidence, contained on the file:
  • February 22, 2002 -- report of x-ray of left wrist: "These findings are similar to the appearance of the right wrist and are likely on a congenital basis. No acute bony injury is recognized."

  • April 1, 2002 -- report of x-ray of both wrists: "These changes are developmental in origin and represent Madelung's deformity."

  • April 16, 2002 -- the attending plastic surgeon recommended surgery, noting that the claimant had "congenital Madelung's deformity, bilaterally."

  • May 8, 2002 -- a consulting orthopaedic surgeon confirmed the need for surgery, noting that the claimant "has a deformity bilateral"; as well as noting that "the patient is getting some degenerative changes at the left distal radius ulnar region."

  • July 18, 2002 -- a WCB medical advisor denied acceptance of the surgery on the basis that its need did not arise out of a workplace accident.
On August 16, 2002, the claimant was examined by another board medical advisor, who made the following observations, of relevance to this appeal:
  • "It is conceivable that [the claimant's] workplace duties in February 2002 provoked mechanical pain at the left ulnar wrist, occurring in association with the pre-existing Madelung's deformity."

  • "…. since stopping work on April 25, 2002, there has been marked improvement of [the claimant's] wrist symptoms and function, particularly with respect to the more symptomatic left wrist…."

  • "…. it would appear the [the claimant] has materially recovered from the workplace influence of February 2002. There is no indication that the workplace exposure enhanced the pre-existing left wrist condition."
In January 2003, the claimant contended that the accident of September 2001 had caused a worsening of the congenital deformity of his left wrist. A third board medical advisor, this one an orthopaedic specialist, reviewed the file and concluded that there was no medical evidence to support this.

Our review of the foregoing leads us to agree with the conclusion of the Review Office that the need for surgery is not related to any workplace injury. There is no evidence to support the premise that he suffered any significant trauma to his left wrist as a result of either compensable injury, of September 5, 2001 or February 19, 2002. It is our conclusion that the surgery was necessitated by his congenital deformity, which affects both of his wrists.

As a result of these findings, the appeal is dismissed.

Panel Members

T. Sargeant, Presiding Officer
A. Finkel, Commissioner
M. Day, Commissioner

Recording Secretary, B. Miller

T. Sargeant - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 26th day of May, 2003

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