The Appeal CommissionThe Workers Compensation Act of Manitoba

Background

The worker has been an LPN for approximately 30 years. Her duties involve use of her upper limbs to pull, push, lift and reach. In about December 2004, the worker began to notice a deep aching tiredness in her left shoulder. Initially, this feeling would subside with rest. However, over time, it progressed to the point that it became painful and radiated into her upper back.

She saw her family physician in March 2005 who was unsure of the cause of the worker’s complaints. He therefore referred her to an orthopaedic specialist in April, 2005. The orthopaedic specialist referred the worker for an MRI.

The MRI was done on May 17, 2005. It revealed a mild corracohumeral ligament thickening consistent with adhesive capsulitis. It was at about this time that the worker’s left shoulder froze totally into position. Her orthopaedic specialist took her off work effective May 25, 2005. He referred her to a sports medicine specialist for her secondary back pain, and for physiotherapy.

It is in this context that the worker filed a claim with the WCB on June 14, 2005.

On July 13, 2005 a WCB medical advisor reviewed the worker’s file and offered the following opinion:

“1. The diagnosis appears to be adhesive capsulitis. This diagnosis is offered by treating physicians and the treating physiotherapist. This diagnosis is suggested by the MRI report.

2. Generally, work activities are not considered causative for this condition.

3. Risk factors for adhesive capsulitis include: blunt trauma (particularly when followed by immobilization), thyroid disease, diabetes mellitus, elevated lipids, and stroke.

4. [The sore back] is not a common accompanying disorder. The file mentions that the treating physician provides the opinion that the primary problem was the shoulder and that the back problem…occurred as a result of compensating for the shoulder problem. Typically the first stage of adhesive capsulitis is painful so it would be difficult to presume that the back problem was occurring as a result of an unrecognized shoulder problem. It appears more likely that these problems were not related to one another.

5. On a balance of probabilities, the adhesive capsulitis is not related to the work activities as described. Although we do not understand the reasons that adhesive capsulitis occurs in people, the above noted risk factors rather than occupational exposure have been cited as being associated with adhesive capsulitis.”

On July 14, 2005 the WCB advised the worker that her claim for compensation was denied as it could not establish a relationship between her left shoulder diagnosis and an accident as defined under subsection 1(1) of The Workers Compensation Act (the “Act”). On September 20, 2005, a worker advisor appealed this decision to Review Office.

On October 25, 2005, Review Office asked a WCB orthopaedic consultant to review the worker’s description of injury/symptoms and to provide an opinion regarding the diagnosis, the etiology of the worker’s condition, etc. In response, the consultant stated,

“…Adhesive capsulitis usually develops secondary to any condition that gives rise to pain in or near the shoulder and the patient becomes overly protective of the shoulder due to pain or movement and it becomes stiff. The multiple conditions can be primary with the shoulder, i.e. inflammatory, degenerative, trauma etc. or referred pain conditions, i.e. from back, neck, heart problems, stroke, etc. No evidence of significant pre-existing condition that might have been aggravated or affected by work. Reported humeral head cyst on MRI might indicate early degenerative change.”

On October 26, 2005, Review Office confirmed that the claim was not acceptable. Review Office did not believe there was the necessary medical evidence to establish that a relationship existed between the worker’s left shoulder problems and her job as a LPN.

The worker’s treating orthopaedic specialist disagreed. His November 24, 2005 report states that “although there was no discrete single work related injury, it is quite likely that the physical demands of her job have contributed to the condition”.

This position is echoed by an occupational health specialist in a January 18, 2006 report:

“By my assessment, I suspect her left shoulder condition developed in relation to her physical duties at work, but there is no clear relationship of its onset to a particular incident on the job or work duty. The problem had an insidious onset which by the second and third month began to significantly interfere with overhead reaching and strenuous lifting activities due to shoulder related pains and left arm weakness.”

Despite this additional information, Review Office upheld its decision on March 17, 2006. On April 6, 2006, the worker advisor appealed Review Office’s decision and an oral hearing was arranged.

Worker’s Position

The worker says that her claim is acceptable as her adhesive capsulitis developed secondary to the strain put on her shoulder from her work duties.

Employer’s Position

The employer takes the position that the worker’s claim is not acceptable as this condition is not causally related to her work duties.

Analysis

To accept the worker’s appeal we must find that she suffered a workplace accident within the meaning of subsections 4(1) and 1(1) of the Act. We are unable to make that finding.

As stated previously, the cause of adhesive capsulitis is unknown. That said, it is generally accepted that it is a condition which develops secondary to a primary condition. In the case before us, the primary or underlying condition is unknown. While it has been suggested that the worker might have an underlying degenerative process in her left shoulder, the worker’s evidence is that she has not suffered from any prior symptoms.

Though the cause of the worker’s adhesive capsulitis is not clear, it is not for this panel to determine what that cause is. We must only determine whether the adhesive capsulitis is, on a balance of probabilities, causally related to her work duties.

The worker says that it is. She says that her condition developed as a result of overuse of her left shoulder at work. We do not accept this position. The worker testified that she is right handed and uses both of her limbs in her work. Her left shoulder is therefore not put under any additional stress. Further, the evidence is that her back condition developed secondary to her adhesive capsulitis, not the reverse.

We have considered the opinions of her treating orthopaedic and occupational health specialists that her duties likely contributed to the onset of her adhesive capsulitis. However, these specialists do not provide any rationale for their opinion. In these circumstances, we are unable to find any convincing evidence that the worker’s duties played a significant role in the onset of her condition.

For these reasons, we find that the worker’s claim is not acceptable.