Georgia Workers Compensation blog

Jodi Ginsberg's Georgia Workers' Compensation Blog

Carpal Tunnel

How Workers’ Compensation Doctors Use Nerve Conduction Studies and EMG to Pinpoint Work Injuries

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When you’ve suffered a work injury, the path from initial pain to an approved treatment plan can often feel shrouded in medical terminology. If your injury involves numbness, tingling, or weakness—symptoms often associated with back pain, neck pain, or repetitive motion injuries like carpal tunnel syndrome—your authorized physician may recommend a pair of critical diagnostic procedures: the Nerve Conduction Study (NCS) and Electromyography (EMG).

If the authorized treating physician does not order an NCS or EMG, possibly due to pressure from the insurance adjuster, we will try to convince the adjuster to agree to this testing, or we may schedule a conference call with a workers’ compensation judge to force the issue.

These tests are foundational tools used by neurologists and physicians to assess the intricate communication system between your brain, nerves, and muscles. Understanding how workers’ compensation doctors use this electrodiagnostic testing is essential, as these results can determine the presence, location, and extent of your injury, thereby influencing the authorization of necessary medical treatment.

The Essential Diagnostic Duo: NCS and EMG

The Nerve Conduction Study (NCS) and Electromyography (EMG) are procedures often performed together, frequently with the NCS done immediately before the EMG. Together, they are utilized to help diagnose injuries and conditions that impact your skeletal muscles and the motor nerves that control them. They are essential components of electrodiagnostic testing, helping providers detect neuromuscular abnormalities. [Read more…] about How Workers’ Compensation Doctors Use Nerve Conduction Studies and EMG to Pinpoint Work Injuries

Yes, Post Surgical Infections are Covered Under Georgia Workers’ Compensation Law

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There is risk to every type of surgery but most of us focus on the possibility that the surgery will not fix the problem it was intended to solve.

  • You underwent a laminectomy at L3/4 but you are still having severe pain radiating into your left hip and weakness in your left leg
  • You underwent a diskectomy and fusion at L5/S1 but the hardware has not remained in place and you can barely walk much less perform any work activity
  • You underwent a carpal tunnel release but your hand is still numb and you cannot rotate your hand at all

Poor results from surgery are always an issue in workers’ compensation because often times the insurance company has delayed approving surgery and permanent nerve damage can occur if a problem is not addressed quickly.

But an equally serious complication from surgery can create even more issues. Sometimes, despite the best efforts by the surgeon and your attempts to keep your wound clean, an infection can develop at the surgical site. [Read more…] about Yes, Post Surgical Infections are Covered Under Georgia Workers’ Compensation Law

Poultry Plant Worker Injuries Likely to Increase Under New USDA Regulations

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chicken processing plant work injuriesWhen I first started practicing law back in 1988, I worked as an associate attorney for a well established insurance defense law firm.  I stayed at that firm for about 7 years before leaving to start my own practice, representing injured workers.

My days as an insurance defense lawyer were invaluable, however, because I learned a great deal about workers’ comp. law from some very good lawyers and I litigated hundreds of cases.   I also traveled throughout the state and got to see numerous job sites in person.

I remember distinctly visiting several poultry processing plants north of Atlanta near Gainesville.  I will never forget watching poultry workers “popping blisters” on conveyor lines of chickens moving quickly overhead.

It is no surprise that poultry plant workers experience a high number of work injuries.  The most obvious type of injuries are repetitive motion injuries such as carpel tunnel, but I also see shoulder injuries, crush injuries and puncture wounds.

Now, I am reading that the U.S. Department of Agriculture has proposed a rule change that will reduce federal oversight of poultry processing plants while allowing processors to speed up their kill lines. 1.

The federal government will save $90 over three years by eliminating the fourth inspector.  At the same time, large processing companies will save over $250 million by increasing the speed of the lines. [Read more…] about Poultry Plant Worker Injuries Likely to Increase Under New USDA Regulations

  1. Currently USDA regulations required processors to allow four inspectors per line with the lines producing 140 chickens per minute.  The new regulations would only call for three inspectors per line, while allowing the lines to turn 25% faster – 175 birds per minute. ↩

Case Study: Bilateral CTS and Workers’ Compensation

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Repetitive motion injuries

Repetitive motion injuries result from the repeating tasks required by certain jobs. It is also referred to as RSI or Repetitive Strain Injuries or Repetitive Stress Injuries and involves the musculoskeletal and nervous systems. These injuries can result from a number of factors such as:

  • awkward and sustained positions
  • forceful exertions
  • pressing against a hard surface (or mechanical compression)
  • repetitive tasks
  • vibrations

Non-specific arm pain and upper limb work-related disorders are also included where RSI’s are concerned. In many cases of this nature, it is apparent that psychosocial and physical stressors play a significant role in these types of injuries.

RSI Symptoms

Patients who have been diagnosed with RSI typically experience the following symptoms:

  • lack of endurance and weakness
  • pain experienced in the arm, back, hands, shoulders, and/or wrists
  • pain that worsens with activity

When you contrast RSI injuries with CTS injuries, the symptoms of the latter tend to be both diffuse and non-anatomical in nature. It crosses the proper distribution of nerves and tendons as well as not being characteristic of specific discrete pathological conditions.

Ms. A and her bilateral CTS case

Ms. A is a candidate for bilateral CTS surgery due to injuries incurred from a bilateral injury to her upper extremities while performing her job. Her job required a great deal of repetitive arm and hand work as she cut and made fiber optics. Despite experiencing pain in her upper extremities, she continued to work until she was no longer able to. Her employer referred her to Dr. S who began treating her with physical therapy. When her conservative care and PT didn’t relieve her pain, she was referred to Dr. B.

Dr. S splinted her arms and put her on “light duty” status. Unfortunately, there was no light duty work for her on the job and she could no longer perform regular work, so she was sent home and remains on full disability (temporary total disability) to this day.  Dr. S ordered an MRI for Ms. A and it revealed that she had lateral epicondylitis partial thickness tearing in the proximal common extensor tendon. The proposed treatment is an initial surgery on Ms. A’s right elbow. Once the right elbow heals, she will have surgery on her left elbow.

Ms. A is now considering whether or not to settle.   On one hand, there is a high degree of  uncertainty with regard to the nature, extent and future cost of future medical care.   Often settlement values are higher when the insurance company is facing open ended medical costs.  On the other hand, if my client settles and her future medical needs involve multiple surgeries and physical therapies, even a settlement of $100,000 or more will not adequately compensate her.  This dilemma of whether and when to settle is one of the more difficult decisions for a significantly injured workers’ compensation claimant.

Case Study: Workers Compensation and Repetitive Motion Injuries

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Welcome to the 3rd installment of my summer long series on Georgia Workers’ comp case studies. In the following case study, I discuss workers’ compensation and repetitive motion injuries.

An overview of DeQuervain’s Syndrome and Lateral CTS

DeQuervain Syndrome is also nicknamed Mother’s Wrist or Washerwoman’s Sprain. In more medical, technical terms it is known as de Quervain’s tenosynovitis, de Quervain’s stenosing tenosynovitis, or Radial styloid tenosynovitis. DeQuervain’s syndrome is an inflammation (or tendinosis) that occurs in the sheath or the tunnel which surround the two tendons which are responsible for the thumb’s movement.

Carpal Tunnel Syndrome or CTS is also referred to as median neuropathy at the wrist and is a condition that results from a compressing or pinching of median nerve in the wrist area. It typically leads to extreme pain, muscle weakness, and numbness of the hand. Night symptoms and waking up off and on are characteristics of CTS as well. The definitive or standard treatment of the condition is a surgical procedure known as carpal tunnel release.

It should be noted that although this surgical procedure effectively relieves the symptoms of CTS, established nerve dysfunction in the form of atrophy, constant or “static” numbness, and weakness are all permanent. Ironically, most CTS cases do not have a specific cause, and some individuals are predisposed at developing the condition based on genetics.

Workers’ Compensation case involving repetitive motion injury: The case of “Ms. C”

Our client, Ms. C, was diagnosed with bilateral CTS as a result of her repetitious work in cake decorating. According to Dr. D, she was diagnosed with “bilateral DeQuervains tenosynovitis and ulnar nerve injury.” As a result of Ms. C’s injuries, she underwent surgeries on both wrists. About 6 weeks later, she went through surgical procedures on the left wrist – carpal tunnel and DeQuervains release surgery.

Ms. C continues living in pain today, even after the different surgeries were performed. Pain is prevalent especially in the hand, at the incision, and in the wrist area. She is currently undergoing physical therapy and has limited range of movement (ROM) as well as the pain mentioned in the above areas. It is evident that she will continue to remain under medical care as well as receiving TTD for quite some time.

Given the residual problems that exist and her surgeries, the PPD (Permanent Partial Disability) rating of each wrist is 10%. Additionally, due to the repetitive nature of Ms. C’s work, it is very obvious that her capacity to perform her job has been severely limited and she will experience continued levels of pain. As a result of her case, we have demanded “X” amount in her Workers’ Compensation case and are awaiting settlement