The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

An appeal panel hearing was held on April 4, 2006, at the request of a worker advisor, acting on behalf of the worker. The worker appeared and provided evidence. She was represented by a worker advisor. The accident employer also attended and provided evidence. It was represented by an advocate.

Issue

Whether or not the worker is entitled to compensation benefits beyond January 7, 2005.

Decision

That the worker is not entitled to compensation benefits beyond January 7, 2005.

Decision: Unanimous

Background

Reasons

Background
The worker worked as a catcher on an autopac gluing machine for eight years with her accident employer. She would receive boxes coming toward her on the conveyor belt, flip them, and push them to the side.

In around January, 2004, the speed at which the autopac gluing machine worked was increased when a new operator was assigned to it. Shortly thereafter, she began to experience pain in her left hand shooting up into her left arm, and then stiffness in her shoulder. The worker did not report the workplace incident until March, 2004 as she always had "lots of pain that comes and goes and usually goes but this one stayed". This pre-existing neck and shoulder condition is confirmed in a September 2, 2004 report by a sports medicine specialist.

The worker attended her treating sports medicine specialist who initially diagnosed her with carpal tunnel syndrome. However, this diagnosis was later changed to a left cuff and girdle strain in May, 2004.

The worker's claim for compensation was accepted by the Workers Compensation Board (hereafter "WCB") on May 19, 2004.

The worker continued to work but was placed on light duties auditing machines, from March to July, 2004.

On July 15, 2004, the worker was examined by a WCB medical advisor. He noted some tenderness over the trapezii, the right supraspinatus and left rhomboids, but no taut bands or trigger points. He thought that there were little objective findings on examination but that based on the worker's history and examination, she likely suffered a muscle strain type injury to her upper back and neck, possibly related to her repetitive work. However, he also found evidence of scapulothoracic dysfunction and weakness in her shoulder girdle stabilizers that might predispose her to muscle strain type injuries. He recommended the worker attempt a graduated return to work.

On August 17, 2004, the worker commenced a graduated return to work program with her employer. One to two weeks later she complained of severe pain and her employer put her on modified duties painting offices with a roller and brush. She remained on these modified duties until February or March, 2005.

During this time, the worker continued to be seen by various medical practitioners.

On August 31, 2004 she was seen by a neurologist who could not find any evidence of a serious neurological problem. He offered however that her symptoms might be related to myofascial pain. The physiotherapist who was treating the worker thought that the worker might have myofascial pain syndrome. He referred the worker to a chiropractor on November 1, 2004. The chiropractor diagnosed her with left cervicothoracic strain and treated her with active release therapy, dry needling and acupuncture.

In October, 2004, the medical advisor to the WCB who had examined the worker on July 15, 2005 reviewed these latter medical reports and thought that the worker might be suffering from myofacial pain syndrome but thought that the worker had a mood disorder that played a significant role in her symptomotology. He deferred however to the opinion of a WCB physical medicine and rehabilitation consultant.

A WCB physical medicine and rehabilitation consultant eventually examined the worker on December 9, 2004. He did not find any evidence of myofascial pain syndrome. In fact, he did not find any significant evidence of soft tissue symptoms. His report of December 14, 2004 states, in part:

"The current clinical examination did not suggest a significant soft tissue origin of symptoms. She did report that she has had an 80% improvement with the most recent acupuncture, dry needling treatment and manipulation treatments. I would agree with the prior general medical advisor's impression that the initial symptom pattern is as for a muscle strain, and would be consistent with her current reporting of 80% improvement with the needling and acupuncture. This supports likely prior soft tissue involvement. This appears to have resolved to date likely as a result of the time that has elapsed and treatment received, as there were no findings to support any persistent soft tissue problem."

He thought that the worker's pre-existing condition and her body habitus, postural abnormalities and scapular imbalance would benefit from exercise though she would have a higher risk of re-injury because of them. He expected that the worker could return to her work duties with restrictions to avoid pushing, pulling or lifting items weighing over 40 pounds.

Based on the results of the medical examination of December 9, 2004 and the fact that the employer was modifying the work area to accommodate the worker's restrictions, the WCB denied further responsibility for her claim effective January 7, 2005. This decision was upheld by the Review Office November 3, 2005. It is this decision that the worker appeals.

Worker's Position
The worker takes the position that she suffers from myofascial pain syndrome as a result of her compensable injury from which she had not recovered on January 7, 2005 when the WCB cut off her benefits. She says that she continued to require medical treatment from her chiropractor and physiotherapist after January 7, 2005 and eventually stopped working on May 24, 2005 based on the recommendations of her family physician and occupational health physician to avoid repetitive activities.

Employer's Position
The employer disputes the diagnosis of myofascial pain syndrome and takes the position that the worker simply suffered from a muscle strain which has resolved.

Analysis
The issue before the panel is whether the worker is entitled to compensation benefits beyond January 7, 2005. To accept this appeal, we must determine that the worker continued to be symptomatic after January 7, 2005 as a result of her compensable injury. We are unable to make this determination.

The worker says that we should accept that her injury in January, 2004 was more than a muscle strain. She says that it is myofascial pain syndrome. If this diagnosis is accepted, we would therefore have to accept that the worker never fully recovered from her injury.

We are unable to accept a diagnosis of myofascial pain syndrome. Though there is some reference to myofascial pain and trigger points in some of the medical reports, there has not been a clear diagnosis of myofascial pain syndrome which is an entirely different medical condition.

The evidence is that the worker suffered from some pre-existing neck and shoulder symptoms which appear to be related to her body mechanics. In January, 2004 we find that she suffered a repetitive type muscle strain to her left cuff and shoulder girdle. The worker's symptoms progressively improved over time with treatment and the avoidance of repetitive type activities involving her left shoulder (with the exception of a brief worsening in August, 2004 when she returned to work in cell C for one to two weeks).

By December, 2004, close to eleven months after her injury, she felt that she had improved by 80%.The WCB physical medicine and rehabilitation consultant opined that this improvement in symptoms confirmed a muscle strain and of prior soft tissue involvement. By this time therefore, the worker had essentially recovered from the effects of her compensable injury.

We note that the worker's attending physician has recommended that she change jobs. Based on our findings of her recovery from the original compensable injury, we would characterize the physician's advice or restrictions as preventative (non-compensable) in nature, and not as a result of an ongoing compensable medical condition.

The worker's appeal is therefore denied.

Panel Members

L. Martin, Presiding Officer
A. Finkel, Commissioner
M. Day, Commissioner

Recording Secretary, B. Miller

L. Martin - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 17th day of May, 2006