The Appeal CommissionThe Workers Compensation Act of Manitoba

Preamble

The worker is appealing the decision made by the Workers Compensation Board ("WCB") that responsibility should not be accepted for their left ring finger difficulties as being a consequence of the May 28, 2020 accident. A hearing was held on August 26, 2025 to consider the worker's appeal.

Issue

Whether or not responsibility should be accepted for the worker’s left ring finger difficulties as being a consequence of the May 28, 2020 accident.

Decision

Responsibility should not be accepted for the worker’s left ring finger difficulties as being a consequence of the May 28, 2020 accident.

Background

This claim has been the subject of a previous appeal. Please see Appeal Commission Decision No. 113/21, dated September 27, 2021. The background will therefore not be repeated in its entirety.

The worker has an accepted WCB claim for a left small finger avulsion fracture that occurred at work on May 28, 2020. The worker appealed the WCB’s decision on their entitlement to wage loss benefits and pursuant to Appeal Commission Decision No. 113/21, dated September 27, 2021, it was determined they were not entitled to wage loss benefits after September 17, 2020.

As part of the worker’s recovery from the compensable injury, they sought treatment from an occupational therapist and physiotherapy. On September 28, 2020, the worker’s treating therapist contacted the WCB to advise the worker had developed trigger finger in their left ring finger during their recovery and it would delay their ability to return to their full duties. They further noted the worker had advised their treating plastic surgeon had provided an injection in that area on September 24, 2020 but it had not provided any relief. An Occupational Therapy Assessment for the worker’s appointment on October 7, 2020 was received by the WCB. The Assessment noted the worker’s reporting of being able to flex and extend their little finger fairly well but they still had trigger issues with their ring finger. The treating therapist recommended restrictions of use of hand as tolerated and that repetitive, resistive activity may aggravate the trigger finger. The September 24, 2020 report from the worker’s treating plastic surgeon was received by the WCB on October 9, 2020 and confirmed the worker received an injection to their ring finger for trigger finger. An October 7, 2020 physiotherapy assessment indicated the worker’s report their ring finger was still locking but released more easily after the injection, with the treating physiotherapist noting the worker’s ring finger locked with active flexion on examination of the worker. Under restrictions, the physiotherapist noted the worker’s trigger finger may affect some gripping activities.

In a discussion with the WCB on October 13, 2020, the worker advised they felt approximately 90% recovered and had returned to their full duties on October 12, 2020. The worker noted they had received an injection but felt it did not help. Their treatment for the finger included massage to help break down the inflammation. The worker further noted they were seeing their treating plastic surgeon on November 19, 2020 to determine if they require surgery for the trigger finger.

The worker’s file was reviewed by a WCB medical advisor on November 3, 2020 at the request of the WCB. The advisor reviewed the medical information on file and noted that the September 9, 2020 physiotherapist’s report was the first mention of “Triggering and locking was noted at the ring finger…”, representing a new finding. The WCB medical advisor confirmed the worker’s compensable left small finger avulsion fracture, based on the medical information on file, and opined that had the worker’s left ring finger trigger finger occurred as a result of an acute blunt trauma, the worker would have experienced symptoms and there would have been findings of same closer to the time of the May 28, 2020 workplace accident.

On July 15, 2021, the WCB received a report from the worker’s treating plastic surgeon regarding the worker’s appointment on that date. It was noted the worker had plateaued in their recovery related to range of motion in their left small finger. Left ring finger trigger finger was noted to be causing significant problems and trigger finger release surgery was recommended. The worker’s file was reviewed on July 26, 2021 by a WCB medical advisor with respect to the proposed surgery, who noted that the left ring finger triggering was not an accepted diagnosis on the worker’s file and therefore, the proposed trigger finger surgery would not be approved. On August 23, 2021, the WCB provided the worker with a decision letter advising responsibility would not be accepted for their left ring finger triggering as it had been determined those difficulties were not related to the May 28, 2020 workplace accident.

The worker requested reconsideration of the WCB’s decision regarding their left ring trigger finger to Review Office on September 22, 2021. In their submission, the worker noted their belief they developed trigger finger in their left ring finger during therapy and it happened when they also developed trigger finger in their small finger that they were receiving treatment for. The worker noted they continued to experience difficulties with their left ring finger and required surgery to help with gripping with their left hand. On October 27, 2021, the employer provided a submission in support of the WCB’s decision, a copy of which was provided to the worker. Review Office determined on November 16, 2021, responsibility would not be accepted for the worker’s left ring finger difficulties. Review Office accepted and agreed with the November 3, 2020 opinion of the WCB medical advisor and found the development of trigger finger could be idiopathic in nature, given the worker did not sustain an accident in relation to their left ring finger.

The worker underwent trigger finger release surgery on the left ring finger on May 25, 2022. A follow-up report from the treating surgeon on June 17, 2022, noted the worker’s finger was no longer locking but the worker did not feel their strength was back enough for them to return to work. The surgeon also provided the opinion that the “…original injury was a central slip avulsion to the adjacent small finger. It is not uncommon to develop swelling in the hand which can tip patients into getting a stenosing tenosynovitis (trigger finger). As such there is reasonable grounds that the trigger finger is related to the original injury.”

The worker contacted Review Office to request that the new medical information on their file be considered. On August 4, 2022, Review Office spoke with the worker and it was decided Review Office would have the medical information reviewed by a WCB medical advisor, based on the worker’s advice their treating healthcare providers supported their trigger finger developed as a result of their physiotherapy treatments. The worker’s file was reviewed by a WCB plastic surgery consultant, who placed their opinion to the file on November 14, 2022. The consultant indicated the file was reviewed for reports of swelling in the area of the left ring finger, based on the worker’s treating plastic surgeon’s opinion of patients developing trigger finger due to swelling. The consultant noted the worker did not seek treatment until 2 weeks following the May 28, 2020 workplace accident and as such, information prior to June 17, 2020 was not available. The June 17, 2020 left hand x-ray was reviewed by a WCB musculoskeletal radiology consultant on November 1, 2022, who advised “…there was not soft tissue swelling apparent at the ring finger or other fingers.” The WCB plastic surgery consultant provided that the medical reports on file found localized swelling to the left small finger. A copy of the opinion was provided to the worker and the employer, who participated in the reconsideration and provided a response on March 1, 2023.

On March 20, 2023, Review Office upheld the previous decision responsibility for the worker’s left ring finger difficulties would not be accepted. Review Office found the new medical information provided did not support the worker’s position their trigger finger difficulties were caused by the May 28, 2020 workplace accident or the medical treatment of same.

The worker’s representative filed an appeal with the Appeal Commission on April 15, 2025 and a hearing was arranged. Following the hearing, the appeal panel requested additional medical information prior to discussing the case further. The requested information was later received and was forwarded to the interested parties for comment. On January 21, 2026, the appeal panel met further to discuss the case and render its final decision on the issues under appeal.

Reasons

Applicable Legislation and Policy

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

Section 4(1) of the Act provides that the WCB will pay compensation when a worker has sustained personal injury by accident arising out of and in the course of employment, and Section 4(2) outlines that a worker injured in such an accident is entitled to wage loss benefits for the loss of earning capacity resulting from the accident. When the WCB decides that a worker has sustained a loss of earning capacity, an impairment or requires medical aid because of an accident, compensation is payable under Section 37 of the Act. Section 39 of the Act sets out that wage loss benefits are payable until the worker's loss of earning capacity ends or the worker reaches the age of 65 years.

The WCB has established Policy 44.10.80.40, Secondary Injury, which explains when a secondary injury will be compensable. This policy outlines that an injury is a secondary injury when it results from an intervening incident, event or exposure and there is a causal link or relationship between that event and the workplace accident. A secondary injury is compensable if the dominant cause of the intervening event is the previous workplace accident, or when the secondary injury is caused by an intervening event over which the WCB exercises direct, specific control or when the secondary injury is caused by the delivery of treatment for the workplace accident.

Worker’s Position

The worker was present at the hearing, represented by a worker advisor. The worker’s representative made an oral submission to the panel and provided medical information to the panel advance of the hearing. The worker answered questions posed by their advisor and by members of the appeal panel.

The position of the worker is that they developed trigger finger in their left ring finger as a result of the swelling from the original injury, or as a secondary injury, resulting from the period of not using their hand and/or the intensive physiotherapy with forceful gripping exercises and the muscle inflammation resulting from the physiotherapy.

The worker’s evidence is that the physiotherapist noted the worker was showing symptoms of trigger finger after approximately two weeks of physiotherapy. The worker states that using their injured hand in intensive physiotherapy, that focused on gripping and grasping activities, is the cause of the trigger finger.

The worker relies on the treating surgeon’s opinion that it is not “uncommon to develop swelling in the hand which can tip patients into getting stenosing tenosynovitis, trigger finger. As such, there is reasonable grounds that the trigger finger is related to the original injury."

The worker argues that repetitive gripping or grasping activities, or trauma to the hand can be the cause of trigger finger.

The worker’s position is that the Review Office erred in their opinion that there was no soft tissue swelling at the ring finger and their review of x-rays to confirm this. The worker states that x-ray imaging is not reliable imaging to look for soft tissue injury or swelling.

The worker is seeking that the WCB accept responsibility for their left ring finger difficulties as being a consequence of the May 28, 2020 accident.

Employer’s Position

The employer’s representative appeared at the hearing and made an oral submission to the panel. The representative answered questions posed by members of the panel.

The position of the employer is that the information on file does not establish a nexus between the worker’s left ring finger and the compensable workplace injury.

The employer relies on the lack of medical evidence confirming edema or swelling. The employer states that there was one mention of edema regarding the worker’s D5 joint, but otherwise no mention of any kind of swelling or other subjective or objective findings related to the worker's left fourth ring finger.

The employer requests that the panel maintain the prior decisions and dismiss the worker's appeal.

Analysis

The issue before the panel is whether or not responsibility should be accepted for the worker's left ring finger difficulties as being a consequence of the May 28, 2020 accident. For the worker's appeal to succeed, the panel would have to find that as a result of the workplace accident of May 28, 2020, the worker sustained an injury to their left ring finger, and that the worker sustained a loss of earning capacity as a result of that accident. As detailed in the reasons that follow, the panel was not able to make such findings and therefore the worker's appeal is denied.

The panel is required to determine whether it is more likely than not that the worker’s left ring finger condition arose out of, or was caused by, the compensable workplace injury or its treatment.

The panel carefully reviewed the evidence on file, including the medical reports, the opinions of WCB medical advisors and consultants, the opinion of the worker’s treating plastic surgeon, and the submissions made by the worker and the employer.

The evidence confirms the worker sustained a compensable injury to their left small finger on May 28, 2020, diagnosed as an avulsion fracture. The initial medical reporting and subsequent treatment records relate specifically to the worker’s left small finger. The panel notes there is no indication of complaints, symptoms, or clinical findings involving the worker’s left ring finger in the period immediately following the workplace accident.

The first documentation of difficulties involving the worker’s left ring finger appears in a physiotherapy report dated September 9, 2020, more than three months after the workplace accident, which referenced triggering and locking in the ring finger. The panel finds the delay between the accident and the onset of symptoms involving the ring finger to be significant. As noted by the WCB medical advisor in the opinion dated November 3, 2020, if the trigger finger had resulted from an acute traumatic event associated with the workplace accident, it would be expected that symptoms or clinical findings would have been reported closer in time to the accident.

The panel also considered the worker’s position that the trigger finger developed during the course of their rehabilitation and physiotherapy for the compensable injury. However, the medical evidence does not establish a causal relationship between the therapy provided for the left small finger injury and the development of trigger finger in the adjacent ring finger. While therapy reports confirm the presence of triggering in the ring finger and note that certain activities may aggravate the condition, those reports do not provide an opinion attributing the development of the condition to the compensable injury or its treatment. Further, the panel accepts the evidence from the physiotherapist that there were no resistance exercises initially and is of the view that the exercises the worker did (multiple times a day) using putty would not be considered highly repetitious.

The panel also considered the opinion of the worker’s treating plastic surgeon provided following the worker’s surgery in May 2022. The surgeon indicated that swelling in the hand following the original injury could potentially contribute to the development of stenosing tenosynovitis (trigger finger) and suggested there were reasonable grounds to relate the trigger finger to the original injury. While the panel acknowledges this opinion, it places greater weight on the opinions provided by the WCB medical advisor and the WCB plastic surgery consultant, who reviewed the entirety of the medical file.

In particular, the WCB plastic surgery consultant reviewed the evidence with specific consideration of whether swelling associated with the compensable injury could have contributed to the development of the trigger finger. The consultant noted that available imaging and medical reports did not document swelling affecting the ring finger. The June 17, 2020 x-ray was reviewed by a musculoskeletal radiology consultant who confirmed there was no evidence of soft tissue swelling at the ring finger or other fingers. The medical documentation instead described swelling localized to the injured small finger.

Based on this evidence, the panel finds there is insufficient objective medical evidence to support that swelling associated with the compensable injury affected the ring finger or contributed to the development of trigger finger in that digit.

The panel also accepts the medical opinion that trigger finger may occur idiopathically. In the absence of contemporaneous symptoms following the accident, clinical findings demonstrating swelling or injury to the ring finger, or persuasive medical evidence establishing a causal link between the compensable injury or its treatment and the development of the trigger finger, the panel is unable to conclude that the worker’s left ring finger difficulties are related to the workplace accident.

After weighing the evidence before it, the panel finds, on a balance of probabilities, that the worker’s left ring finger trigger finger did not arise as a consequence of the May 28, 2020 workplace accident or the treatment of the compensable injury.

Accordingly, the panel finds that responsibility should not be accepted for the worker’s left ring finger difficulties as being a consequence of the May 28, 2020 accident.

The worker’s appeal is denied.

Panel Members

R. Lemieux Howard, Presiding Officer
J. Peterson, Commissioner
S. Magian, Commissioner

Recording Secretary, J. Lee

R. Lemieux Howard - Presiding Officer
(on behalf of the panel)

Signed at Winnipeg this 12th day of March, 2026