Decision #158/07 - Type: Workers Compensation

Preamble

This appeal deals with whether or not there is a relationship between the worker’s bilateral carpal tunnel syndrome (CTS) condition and her work duties as a healthcare aide.

On March 21, 2006, the worker filed a claim with the Workers Compensation Board (WCB) for a bilateral wrist condition that she related to the nature of her work activities. The WCB denied the claim for compensation as it could not establish a relationship between the worker’s right and left wrist difficulties to an accident as defined in subsection 1(1) of The Workers Compensation Act (the Act). This decision was upheld by the Review Office in its decision of April 20, 2007. The worker disagreed and appealed to the Appeal Commission. A hearing was held on October 10, 2007. The panel discussed the case on the same day.

Issue

Whether or not the claim is acceptable.

Decision

That the claim is not acceptable.

Decision: Unanimous

Background

In March 2006, the worker filed a claim with the WCB for symptoms in both wrists that she related to “repetitive pulling and pushing of patients” during her employment as a healthcare aide. The worker indicated that she first began to notice symptoms about seven years ago. She said the numbness and tingling in both her hands have become progressively worse, especially within the last six months. She noted that her employer had been aware of her difficulties over the seven year period.

The employer’s accident report indicated that the worker had CTS in both wrists which was diagnosed by a doctor several years ago. Surgery was suggested at that time however the worker declined the surgery. Over the years, the worker’s wrists had become worse and she was experiencing a lot of numbness in both hands.

A report from the treating physician dated February 24, 2006 indicated the worker had “worsening of carpal tunnel syndrome”. Nerve conduction studies dated June 1, 1999 revealed the worker had right carpal tunnel syndrome.

On April 10, 2006, the worker advised a WCB adjudicator that she started to have problems with both wrists about seven years ago. She had nerve conduction studies done and her doctor gave her the choice of having surgery but she declined as she did not like the idea of surgery on her wrists. She did not continue to seek medical treatment but just learned to live with the pain. The worker advised that she continued to perform her regular work duties as a healthcare aide at full time hours. The worker described her work duties as follows. She used a slider (palms up and pulling towards) when rolling residents over on their sides. Some residents required to be turned or rolled when undressing or changing pads. She would also clean wheelchairs, use a scrub brush in shower stalls, fold tea towels or washcloths. She would empty out garbage and dirty laundry. In the morning, she would wash, change and transfer 2 to 3 residents to wheelchairs. The worker was right handed and smoked a half pack of cigarettes were day. She was 5’5” and weighed 220 lbs. She had high blood pressure and took medication for this. She enjoyed reading and baking but did not do any crafts or sports.

On May 17, 2006, the WCB denied the worker’s claim for compensation on the following grounds:

  • her work duties did not require high repetition involving full flexion and extension. Although some force was involved, it was not done in a highly repetitive fashion.
  • the job duties of a healthcare aide were not causal for the development of bilateral carpal tunnel syndrome

On April 20, 2007, the case was considered by Review Office based on an appeal submission by the worker dated February 27, 2007. Review Office concluded, on a balance of probabilities, that it was far more likely that the worker’s non-work related risk factors were playing a more significant role in the development of her CTS than her job description. It therefore concurred with the position taken by the adjudicator in her letter of May 17, 2006. The worker appealed Review Office’s decision to the Appeal Commission and a hearing was arranged.

Reasons

Worker’s Position

The worker made a submission on her own behalf and answered questions posed by the panel. Her union representative assisted her.

The worker advised that she started working at the employer’s facility in 1991. In 1998 she noticed the first signs of CTS and in 1999 she was diagnosed with CTS in her right wrist. In approximately 2002, she was diagnosed with CTS in her left wrist. She indicated that there were no changes in job duties between 1991 and 1999. She acknowledged there have been some changes since but that these have tended to lighten the work, such as the use of sliders and lifts to move patients.

The worker reviewed her duties. She stated that her job entails wrist flexion and extension that causes pressure on the median nerve. She submitted that she thinks that she has done the damage to her wrists in turning and repositioning patients. Specific duties that she feels contributed to her condition include changing briefs, dressing patients, pulling a slider, lifting patients on draw sheets, using bed cranks, extending her wrist to turn-off call light switches, lifting heavy garbage and laundry bags, and hand washing.

In answer to questions, the worker indicated that moving patients involved forceful hand motions. She described the steps involved in moving and changing patients. With respect to repetitive movements, she noted that she was changing 20 patients up to three times a night. She noted that turning off patient call lights involves awkward movement as she must stretch over the bed to turn off the light.

The worker was asked to take the panel through her shift. She noted there are two healthcare aides working on the ward so the duties are shared between them. She advised that the night starts with listening to reports of the day’s activities. She then washes tables in the dining room and counters. She fills her supplies which include wash clothes and diapers. She begins rounds at about midnight and checks each patient to see if they need to be changed, repositioned, or have breathing problems. She changes those that need changing, etc. After rounds she empties garbage, does wash cloths, checks that things are stocked, answers call lights and deals with patients who are awake. She then takes an hour break. At about 2:30 AM she checks patients again and changes or repositions them, if needed. After second rounds she washes wheelchairs, up to six a night. At 4:30 AM patients start getting up. She washes and dresses some of the patients. At 6:00 AM she begins the final round and changes patients, where needed. Finally she gets the remaining patients washed and dressed.

She noted that her general practitioner and orthopedic surgeon feel her condition is a result of her work. Regarding risk factors for CTS, she noted that she does not have thyroid problems, diabetes or rheumatoid arthritis and that she never had swelling of the wrist.

The worker advised that she had surgery on both wrists and recently returned to work.

The worker’s union representative cautioned the panel regarding reliance on research conducted on the internet and specifically the article submitted by the employer representative. He referred to the disclaimer from the website that the employer representative was relying on. He advised that it is important to recognize the difference between an opinion as to potential causes that is provided through a website and the information provided directly by medical practitioners that have examined the worker.

Employer’s Position

The employer was represented by an advocate who made a submission on the employer’s behalf. The employer representative submitted that the worker’s condition did not arise out of or in the course of her employment as a healthcare aide. She noted that the worker did not have a change in duties between 1991 when she started work and 1999 when she was first diagnosed with CTS.

The employer representative noted that the work is fairly labour intensive but the duties are varied and do not involve high repetition with high force. She submitted that the work does not involve sustained flexion and extension of the wrists or require the wrists to be held in a bent position for greater than five minutes in an hour. The representative referred to literature regarding CTS that she retrieved from the internet.

The employer representative submitted that the worker has some non-occupational risk factors for CTS, such as female gender, smoking and caffeine consumption.

CTS Causes

CTS is defined as the impairment of the motor and/or sensory function of the median nerve as it traverses through the carpal tunnel. It is caused either by intrinsic swelling of the median nerve or by extrinsic compression of the median nerve by one of the many surrounding structures of the wrist. CTS has a variety of causes. It can be caused by underlying systemic conditions such as rheumatoid arthritis, osteoarthritis, hypothyroidism, and diabetes. Middle-aged females, smokers and people genetically pre-disposed to the development of CTS are also at increased risk for the development of CTS. It can also be caused by some work activities. There remains considerable debate in the medical literature as to what work factors may cause CTS.

Occupational factors most commonly accepted to be associated with CTS include a wrist injury, frequent use of vibrating hand tools or any repetitive, forceful motion with the wrist bent, especially when done for prolonged periods without rest. It is generally considered that the greatest frequency of occupationally related CTS is found where job duties involve high force and high repetition.

Where a worker develops bilateral CTS, there is a strong suggestion that the cause is found elsewhere than in work duties. For this reason, it is extremely important to understand the nature of the worker's duties and the stresses placed on her wrists or the position her wrists are in during the performance of these duties to determine whether it is the work duties that are causing stress on the worker’s carpal tunnels.

Analysis

Subsection 4(1) of the Act provides:

4(1) 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 this case, the panel must find that the worker’s CTS arose out of and in the course of her employment. On the basis of the evidence before it, the panel is unable to make that determination.

The panel has carefully considered the worker’s job duties both as described in the file and described and demonstrated at the hearing. The panel acknowledges that the worker’s job can be busy and labour intensive. The panel finds that the job does not involve significant repetition and that the duties are varied. While the duties involve some awkward positions, these are not sustained for significant periods. The panel notes that the worker has several non-occupational risk factors for CTS. Finally, the panel notes that the worker’s CTS is bilateral which, as noted above, is frequently an indication of a non-work related condition. The panel finds, on a balance of probabilities, that the worker’s job duties have not caused her bilateral CTS and that the claim is not acceptable.

The appeal is dismissed.

Panel Members

A. Scramstad, Presiding Officer
B. Simoneau, Commissioner
M. Day, Commissioner

Recording Secretary, B. Kosc

A. Scramstad - Presiding Officer

Signed at Winnipeg this 27th day of November, 2007

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