Decision #11/13 - Type: Workers Compensation

Preamble

The worker is appealing the decision made by Review Office of the Workers Compensation Board ("WCB") which determined that his ongoing left wrist symptoms were not related to this compensable accident of July 10, 2011. A hearing was held on January 7, 2013 to consider the matter.

Issue

Whether or not the worker is entitled to benefits after August 10, 2012.

Decision

That the worker is not entitled to benefits after August 10, 2012.

Decision: Unanimous

Background

The worker filed a claim with the WCB for a left wrist injury that occurred on July 10, 2011 while climbing up on a tractor to wash windows. The worker reported that he grabbed the side mirror and felt a pull/pop in his left wrist.

When speaking with a WCB adjudicator on July 22, 2011, the worker indicated that he also injured his wrist in January 2011 when trying to pull a converter in line. The worker noted that he sought medical attention and the pain in his wrist went away in 3 to 4 days.

An undated doctor's first report revealed that the worker had tenderness over the medial side of his left wrist and the scaphoid was non-tender. The diagnosis rendered was soft tissue damage of the left wrist and the worker was prescribed ice and medication.

On July 14, 2011, the worker was seen by a second physician for left wrist/forearm pain and paresthesia to his left first and second digits and web space. The diagnosis provided was a carpal strain with radial nerve traction injury.

The claim for compensation was accepted by the WCB based on the diagnosis of a left wrist soft tissue injury and benefits and services were paid. In August 2011, the worker commenced physiotherapy treatments.

On October 11, 2011, the worker underwent nerve conduction studies ("NCS") which did not show evidence of distal radial or a median nerve injury.

On November 5, 2011, the worker was seen at a surgical centre and the treating specialist reported that the worker's symptoms seemed to be consistent with repetitive trauma or strain of the left wrist. The worker's numbness and tingling appeared to be consistent with the distribution of the superficial radial nerve. The specialist reported that the worker had been experiencing improvement in his symptoms and he did not feel that any other measures needed to be taken at this time. He noted that the worker was wearing a brace for additional support during his activities.

A MRI of the left wrist and thumb was done on November 17, 2011. The results were read as follows:

"The TFCC and intrinsic interosseous ligaments all appear intact. The carpal tunnel, median nerve and flexor tendons all appear normal. Carpal alignment is anatomic. No fracture is seen.

Dedicated imaging of the thumb was also performed. The thumb collateral ligaments appear intact. No osseous or tendinous abnormalities are apparent."

In late November 2011, primary adjudication referred the worker's file to the WCB's healthcare branch noting that physiotherapy treatments had not been able to increase the worker's function and diagnostic tests had not identified significant findings. This led to a WCB call-in examination that occurred on December 21, 2011.

On December 1, 2011, the worker advised his WCB case manager that he started having numbness in his ring and pinky finger and up through his left hand.

Following the examination on December 21, 2011, the WCB medical advisor's impression of the worker's left wrist condition was as follows:

  • the diagnosis on initial medical reports was thought to be a sprain and possible nerve injury but it was difficult to relate this diagnosis to the mechanism of injury as there was no significant force, no repetitive activity, and no mechanism that would be expected to injure the wrist.

  • the clinical findings on examination were not consistent with a structural abnormality.

  • the current diagnosis was not accounted for in relation to the mechanism of injury. The medical advisor noted that the worker had a minor mechanism of injury of having his hand on a mirror while he got into a truck. This really would not be expected to cause any injury to the hand. If it did, it would be consistent with the initial diagnosis presented of a minor soft tissue injury to the wrist. During this examination, there was no evidence of a specific structural abnormality.

  • the symptoms in the worker's hand could be related to disuse. A four week reconditioning program with a hand therapist was recommended. After the program, it was felt that the effects of the compensable injury would be considered resolved.

On March 23, 2012, the WCB case manager noted to the file that he spoke with the treating physiotherapist and was advised that the worker had made some positive gains in the program with an increase in strength, good range of motion, and significant improvement in sensation, however, the worker continued to have wrist pain.

In June 2012, primary adjudication referred the worker's file back to the WCB's healthcare branch noting that the worker started a four week daily hand therapy reconditioning program starting March 20, 2012 but he did not attend on a daily basis due to pain complaints. A WCB call-in examination was suggested by the WCB medical advisor.

The worker was seen in follow-up at the surgical centre on July 21, 2012. The treating specialist reported that the worker continued to experience pain of the left wrist radiating towards the left thumb, index finger and more proximally into the forearm. Examination revealed fairly good range of movement involving the fingers, wrist and elbow on the left side. The specialist noted that the worker reported that range of movement did not appear to be significantly impaired; however, strength and endurance were significantly reduced due to his pain. The specialist outlined treatment recommendations which involved prescription medication.

On July 19, 2012, the worker was seen by a WCB medical consultant for an assessment of his left wrist. The medical consultant outlined the following response to questions posed by primary adjudication:

  • the call-in findings were not suggestive of a pathology in the left radial nerve.

  • the diagnosis of a wrist sprain was likely accounted for in relation to the initial workplace injury.

  • wrist sprains typically improve with conservative management over the course of several weeks.

By letter dated August 2, 2012, the worker was advised by his WCB case manager that based on a review of the medical information on file which included the call-in examination findings of July 19, 2012, the WCB was unable to relate his current symptoms objectively to the compensable injury and wage loss benefits would end effective August 10, 2012.

On August 7, 2012, the worker appealed the August 2, 2012 decision to Review Office. The worker noted that his hand injury was no better than when he left work. He said that minor household duties such as cooking supper, washing dishes or vacuuming leave his hand throbbing for days. He had no strength in his hand and his fingers still went numb.

On September 21, 2012, Review Office determined that the worker was not entitled to benefits after August 10, 2012. Review Office stated that it placed significant weight to the medical information on file in making its decision. It stated that the worker was followed up extensively by medical professionals without any positive findings of any structural, anatomic or organic variant to explain his ongoing left wrist symptoms. Review Office therefore was unable to substantiate that the worker's ongoing left wrist issues were still "arising out of and in the course of employment" in relation to the July 10, 2011 accident. On October 22, 2012, the worker appealed Review Office's decision to the Appeal Commission and a hearing was arranged.

Reasons

Applicable Legislation

The Appeal Commission and its panels are bound by The Workers Compensation Act (the “Act”), regulations and policies of the Board of Directors.

The worker has an accepted claim and is seeking benefits beyond August 10, 2012. Under subsection 4(2) of the Act, a worker who is injured in an accident (as defined under the Act) is entitled to wage loss benefits for the loss of earning capacity resulting from the accident. Subsection 39(2) of the Act provides that the WCB will pay wage loss benefits until such a time as the worker’s loss of earning capacity ends.

Worker's Position

The worker attended the hearing with his wife. They answered questions from the panel.

The worker advised that he hurt himself at work. He said that his injury has not improved and that his symptoms are exactly the same. He advised that he cannot return to work as his employer cannot accommodate his injury.

In answer to questions from the panel, the worker described the July 10, 2011 injury which occurred while he was cleaning the driver side window on his truck. He stood on the bottom step below the driver's door, was holding on to the side view mirror frame with his left hand and was using a squeegee device with his right hand to clean the window. His left wrist was not supporting his weight but was helping to stabilize him as he worked. His wrist was in a neutral position. Within about 15 seconds he heard a pop and felt pain in his left wrist area. He said the pain was intense and was in the area across the top of the wrist. The wrist became swollen in a 2 to 3 inch band on top of the bend or wrist joint.

The worker described prior incidents involving his left wrist. The first incident occurred in January 2011 when he was adjusting a converter used to hook-up two trailers. He reported the incident to his family physician who suggested that he ice and wrap his wrist. He did this and the wrist improved within a couple days. He experienced pain on two subsequent occasions while performing the same activity. In each case he iced and wrapped his wrist and the symptoms cleared up. He did not report the incidents to his employer as he did not miss any time from work. He did not hear or feel a pop during any of these incidents. He said while the symptoms were in the same area, they differed from his current symptoms. The pain was not as sharp; there was more of a burning feeling and he had no numbness.

Regarding the effect of his July injury, he advised that he has difficulty while performing household duties. His wrist becomes painful when vacuuming, holding a frying pan while making dinner and holding a cell phone. He estimated his pain level at the hearing at about 4 out of 10 on a pain scale of 1 to 10.

The worker said that he has had periodic numbness in his thumb and forefinger since the injury. He advised that he developed numbness in his 4th and 5th finger. He attributes this to the device that was used to hold his wrist during the MRI. This numbness is increasing.

Regarding medical treatment, the worker advised that he has not seen any physicians about his injury since his benefits were terminated. He said that he tried medications recommended by the pain clinic physician but found that none of the medications provided relief from pain. He no longer performs the home exercise program provided by an occupational therapist.

Employer's Position

The employer did not participate in the hearing.

Analysis

At the outset, the panel notes that it found the worker to be a credible and sincere witness who answered all questions directly.

The panel has been asked to determine whether the worker is entitled to benefits after August 10, 2012. For the worker's appeal to be acceptable, the panel must find that the worker's injury resulted in a loss of earning after this date. In other words, the panel must find that the worker was unable to work after this date due to the workplace accident. The panel was not able to make this finding.

The panel has considered all the medical evidence on file in making this decision and finds, on a balance of probabilities, that the medical evidence does not support an ongoing injury to the left wrist and therefore does not support continued benefits after August 10, 2012.

In addition to two physicians at a sports injury clinic, the worker has been examined by two WCB medical advisors, a physiotherapist, and an occupational therapist. He has also been seen by a pain specialist and neurologist. The worker has had a nerve conduction test and an MRI of his left wrist/hand. The examinations and tests do not confirm an ongoing injury.

The panel especially relies upon the following in reaching this decision:

· Nerve conduction study performed October 11, 2011 which found "left radial, median and ulnar sensory conductions are normal. Left median motor conductions are normal."

· MRI left wrist and thumb performed November 17, 2011 which found "The TFCC and intrinsic interosseous ligaments all appear intact. The carpal tunnel, median nerve and flexor tendons all appear normal. Carpal tunnel alignment is anatomic. No fracture is seen." The MRI also found that "The thumb collateral ligaments appear intact. No osseous or tendinous abnormalities are apparent."

· WCB medical advisor call-in examination report dated July 19, 2012. The medical advisor reviewed the file and performed a detailed examination of the worker's left wrist. She concluded that "I am unaware of a structural pathology emanating from the workplace injury that medically accounts for the current presentation, and as such, I am unable to medically account for the current presentation in relation to the workplace injury on a probable basis."

Both in the file and at the hearing, the worker referred to prior injuries to the left wrist area for which claims have not been adjudicated. In any case the evidence does not identify any significant prior acute injury that could be aggravated or enhanced by the July 2011 injury. Finally, the panel understands that there is no ongoing treatment or investigation of the worker's condition at this time.

The worker's appeal is dismissed.

Panel Members

A. Scramstad, Presiding Officer
A. Finkel, Commissioner
P. Walker, Commissioner

Recording Secretary, B. Kosc

A. Scramstad - Presiding Officer

Signed at Winnipeg this 22nd day of January, 2013

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