The Appeal CommissionThe Workers Compensation Act of Manitoba

Worker’s Position

The worker made her submission to the panel via teleconference. The worker advanced the position that since the injury first occurred in September 2010, there has been no improvement and that she continues to experience ongoing symptoms of pain in her shoulder, neck and back arising out of that compensable workplace injury. The worker suggested the injury resulting from the workplace accident has not resolved at all. She noted that she continues to experience symptoms of pain in her lower back as well as pain and swelling in her right shoulder and neck with activity.

Employer's Position

The employer did not participate in the hearing.

Analysis

The issue to determine is whether the worker is entitled to benefits after August 24, 2011. In order to determine this issue, the panel must decide whether the worker continued to suffer personal injury on August 24, 2011 arising out of the workplace accident of September 13, 2010.

In making our decision, the panel considered the medical evidence on file and the submissions of the worker in support of her position that the compensable injury had not resolved by August 24, 2011.

The accepted diagnosis, as found by the Appeal Commission in its July 14, 2014 decision was myofascial pain, consistent with the early diagnosis of a neck and back sprain/strain. In coming to their decision, that panel considered the evidence of the worker’s physiatrist, based upon examinations that took place on March 10, 2011, June 22, 2011 and August 24, 2011.

We have reviewed the same reports from the worker’s treating physiatrist, including the summary of findings set out in a report dated March 24, 2014. The physiatrist noted that in March 2011, her impression of the worker was that she had myofascial pain syndrome. A referral to physiotherapy was made at that time. On further examination in June 2011, the physiatrist reported that the worker had not noted any improvement as a result of physiotherapy. The medical findings included tenderness of the right trapezius, though no taut bands. In the mid trapezius and rhomboids, there were no taut bands, although the worker complained of pain. There was a taut band in the right infraspinatus, but no active trigger points. Follow-up physiotherapy was advised and a further assessment scheduled for August 2011.

On August 24, 2011, the physiatrist examined the worker for the final time. Clinical findings included “fairly good mobility of her thoracolumbar spine” with no neurological deficits and no active trigger points to be found. Notably, the physiatrist stated that “I felt her psychosocial predicament was causing further amplification of her pain perception. I did counsel her at that time about trying to work at a job which did not require her to do repetitive bending and heavy lifting.”

In the March 24, 2014 report, the physiatrist speculates that the ongoing diagnosis for the worker is myofascial pain syndrome and mild degenerative disc disease of her cervical spine. This assessment was based on the last examination which occurred in August 2011. The physiatrist noted that “It is very difficult to prognosticate soft tissue pain because it is very much dependent upon the amount of stretching exercises and strengthening that the patient is willing to do to keep up the flexibility and the strength of her muscles.”

Subsequent to seeking physiotherapy treatment and her assessments by the physiatrist, the worker continued to seek care from general practitioners.

The findings from a July 23, 2012 complete physical examination indicates some mild restriction in the worker’s range of motion in her neck, shoulder and back with some tenderness in her lower cervical paraspinal muscle and lower lumbar paraspinal muscle. The resulting diagnosis is of degenerative changes in the neck and lumbar areas. Findings from a June 17, 2013 examination by the same physician indicate chronic neck and back pain due to degenerative disease and muscle tightness.

A March 24, 2014 report from the general practitioner seen by the worker in November and December 2013 indicates that on November 22, 2013 the worker had “almost complete range of motion of her neck. The rest of the physical exam was non-contributory.” X-ray images taken at that time revealed degenerative changes. In follow-up on December 18, 2013, the general practitioner noted “absolutely normal range of motion of her arms, legs and neck and the rest of the exam was non-contributory.” At that time, the worker presented to follow up on her chronic pain, indicating it was “not much better” than at the previous visit.

The most recent medical report on file is from another general practitioner seen by the worker on October 10, 2014. Complaints noted are of ongoing pain in the worker’s neck and low back. The clinical findings noted are limited range of motion in the cervical spine and single leg raise lumbar spine OK.

The worker, in her submission stated that she continues to experience symptoms of pain in her lower back as well as pain and swelling in her right shoulder and neck with activity. She indicated that she felt no benefit from the physiotherapy treatments undertaken in 2011 but continues to do the exercises at home, as well as treating her symptoms with a heating pad and hot baths.

While it is clear from the reported findings noted in the medical reports and the worker’s own submissions that she continues to experience pain in her neck and lower back, the medical findings do not support the worker’s assertion that on August 24, 2011, she continued to suffer personal injury arising out of the workplace accident of September 13, 2010.

The evidence of the treating physiatrist from August 24, 2011 indicates that the accepted compensable diagnosis of myofascial pain syndrome had resolved by that date. This evidence is supported by subsequent reports from the general practitioners who examined the worker in July 2012, June 2013 and in November and December 2013.

Having considered all of the evidence before us, we have determined on a balance of probabilities that the compensable diagnosis of myofascial pain had resolved by August 24, 2011. The worker is therefore not entitled to benefits after August 24, 2011.