The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

This claim essentially deals with the issue of whether the worker's left-sided neck, shoulder and back complaints which have been variably diagnosed as myofascial pain, myofascial dysfunction, and fibromyalgia, are causally related to her workplace duties as a cleaner. The worker says that they are. She says that since a prior workplace injury in 1997, she continued symptomatic despite an initial return to work. She says that by October 29, 2004 the pain was such that she remained off work until she received adequate treatment for myofascial pain or dysfunction that allowed her to resume her duties on January 3, 2006.

The Workers Compensation Board (hereafter the "WCB") determined that the worker's symptoms are not causally related to her workplace duties. This determination was upheld in a Review Office decision dated January 25, 2006. It is this decision that the worker appealed to the Appeal Commission.

An appeal panel hearing was held on May 18, 2006. The worker appeared and was represented by a worker advisor. The employer also appeared.

Issue

Whether or not the claim is acceptable.

Decision

That the claim is not acceptable.

Decision: Unanimous

Background

Reasons

Background
The worker is a cleaner. Her daily duties consist mainly in cleaning approximately 60 toilets and 30 sinks in the female bathrooms, washing graffiti off of the walls, as well as general wall and floor washing. Though the worker is right hand dominant, she uses both hands to perform her duties, switching when one gets fatigued.

On October 29, 2004 she went off work. She saw her doctor on that day complaining of pain in her left neck, shoulder and back as well as numbness in the right side of her face. An x-ray taken that same day revealed degenerative changes with small anterolateral osteophytes, some narrowing of the intervertebral disc spaces at C5-6 and 7 with small anterolateral and posterior osteophytes, together with degenerative changes in the apophyseal joints. Her doctor diagnosed her with myofascial pain.

Then on November 6, 2004, she went to the emergency department of a hospital twice, with facial pain and spasms.

The emergency report from November 6, 2004 at 0255 hours indicates that the worker reported a 5 year history of tension type headaches with whole head numbness which was worse over the previous few days. The worker was diagnosed with anxiety and instructed to follow up with her family physician.

The emergency report from November 6, 2004 at 1710 hours indicates that the worker had a several year history of neck and left shoulder pain and headaches. On this occasion, the worker presented with spasms involving the face. The diagnosis was "facial spasms (not yet diagnosed)".

At the hearing, the worker explained her symptoms as a tight, knotted pain going up in her head. She was dizzy and her vision was blurry. Later she experienced spasms that she described as electrical shocks.

As a result of her hospital visit, the worker was referred to a neurologist on December 15, 2004. An MRI was done which was normal. A February 1, 2005 follow-up report by the neurologist notes that the worker's right sided facial numbness and spasm had since moved to the left side. He did not find any organic basis for the worker's symptoms and recommended that should the worker's symptoms increase or interfere with her daily routine, then a psychological basis for the symptoms should be explored.

On May 31, 2005, a WCB medical advisor reviewed the file. He was uncertain as to the diagnosis of the worker's complaints but opined that it could be either myofascial pain syndrome or fibromyalgia, and that her workplace duties could be consistent with myofascial pain syndrome.

The worker was then referred to and seen by a physiatrist. No diagnosis was made but there were some findings of tight left scalene muscles and sternomastoid bands.

She was also seen by an occupational health physician who, in a report dated September 14, 2005 suggests a diagnosis of "myofascial dysfunction with trigger point pain referral involving the left sternocleidomastoid, left scalenes, right suboccipital and posterior cervical pillar, the upper back extensors in the left shoulder, infraspinatus and pectoralis major". Based on the worker's reporting, the physician thought that the worker experienced a continuity of symptoms since her workplace accident in 1997 which were consistently aggravated by her work duties, tasks at home and driving. He recommended a course of Stretch, Massage and Breathe. It is this program that the worker says provided her the relief and the techniques required to return to and remain at work.

Analysis
To accept the worker's claim for compensation, we must find that the worker suffered a workplace accident within the meaning of section 4(1) and 1(1) of The Worker's Compensation Act (hereafter the "Act").

We are unable to make that finding.

The worker's symptoms mainly involved the left side of her neck and shoulder muscles. Though there have been complaints of facial numbness, the location of the numbness is not, in our opinion, consistent with any specific nerve entrapment or muscle irritation, nor is there any convincing medical evidence to this effect.

The worker says that there was no specific accident that gave rise to her left sided muscle complaints other than that she had been symptomatic since a prior 1997 workplace accident. This was the case even though she remained off work for an extended period of time between 1998 and 2000, and then between October 29, 2004 and January 3, 2006.

The worker's left sided muscle complaints have been variously diagnosed. No matter the diagnosis, the worker testified that her symptoms resolved with the Stretch, Massage and Breathe program. This program not only helped with her sore muscles but it also taught her correct sitting and standing posture which she has implemented.

Given the lack of any specific workplace accident, the variety of the worker's duties and that she got no relief from her symptoms when off work, we find, on a balance of probabilities, that the worker's symptoms are not causally related to her workplace duties.

We therefore find that the worker's claim is not acceptable. Accordingly, her appeal is dismissed.

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 6th day of July, 2006