Medical News

August 22, 2024

Torn Meniscus Is Significant Injury in PA Workers’ Comp

Knee injuries are common in Pennsylvania workers’ compensation. Over the years, we have had many clients with a torn meniscus in his or her knee. This is generally regarded as a minor injury by the insurance industry, a perception we have never understood.

Recently, Minnesota Vikings Quarterback J.J. McCarthy injured his knee. Further testing revealed a torn meniscus. Note that the referenced article describes the meniscus as a “tendon,” though it is not. The meniscus is a piece of cartilage in the knee. Essentially, the meniscus functions as a cushion between the “tibia” (shin bone) and the “femur” (thigh bone).

Surgery is often required to address a meniscus tear, though it is not usually the first avenue to try (that said, Mr. McCarthy had the surgery immediately and will miss the entire 2024 season while recovering). Typically, in our experience, an injured worker will receive conservative treatment initially, in an effort to avoid surgery. If surgery is eventually required, this obviously extends the total period the injured worker may be out of work.

October 3, 2023

Types of Diagnostic Testing Used for PA Workers’ Compensation Spinal Injuries

by Glenn Neiman

When an injured worker in Pennsylvania hurts his or her spine, there are many diagnostic tests that a doctor may prescribe. Sometimes, the doctors do not fully explain what a test is, or what it may show. We believe that an injured worker should be fully informed, whether as to the legal aspects of his or her case, or the medical aspects. While we are certainly not doctors, and would never suggest or recommend treatment, if the doctor will not educate his or her patient, that responsibility can fall to us. We believe our clients are best served by being fully informed about what is happening in their case, both medically and legally.

From our experience, the first thing a doctor does when seeing a patient for a work injury to the neck or back is get x-rays. An x-ray will show bone, such as a fracture (including, potentially, a stress fracture), but will not visualize soft tissue, like discs, muscles, tendons or ligaments. This would be to rule out the presence of a fracture (though, if a fracture is still suspected, a bone scan can be done to better analyze the presence or absence of a fracture).

If the injured worker has pain, numbness or tingling into one or both arms, or one or both legs, a doctor may suspect the presence of “radiculopathy” or “radiculitis”, meaning that a nerve is possibly being pinched or touched by another structure, either a bulging or herniated disc, or due to “stenosis,” a narrowing of the spine which can be degenerative (though stenosis can be “aggravated” by an injury at work). To assess the discs, and degree of stenosis, doctors often prescribe an MRI, with or without contrast. The results of the MRI may help the doctor determine whether surgery can help reduce the pressure on the nerve, to potentially relieve the radiating symptoms to the arm or leg.

December 9, 2022

MRI Results Not Foolproof to Show Extent of Work Injury

by Glenn Neiman

If you are a football fan, you may have been following the story about Von Miller, star linebacker for the Buffalo Bills. The story is also of interest, however, to injured workers, including those in PA. (Parenthetically, we should note that Miller is, in fact, an injured worker, though the Pennsylvania Workers’ Compensation Act has special provisions for professional athletes – that said, the point of this article is that the care given to Miller is not the care received by the typical injured worker in PA).

On November 24, 2022, Miller injured his knee in a game against the Detroit Lions. Being a star NFL player, Miller had access to the best medical tools possible, and was not required to have any kind of delay. An MRI done the day after the injury showed the Anterior Cruciate Ligament (ACL) remained intact. This meant the injury was not as severe as the team and player initially feared.

But, then an interesting thing happened. Miller underwent exploratory surgery on the knee earlier this week. A tear of the ACL was discovered, and repaired, during the procedure. A tear that was not seen on the MRI. Rather than missing a couple of weeks, suddenly Miller’s season was over.

August 3, 2020

In a PA Work Injury, Concussion Can Be Confused With Whiplash

by Glenn Neiman

We have previously discussed on this blog the difficulties in differentiating shoulder injuries to injured workers, noting that according to medical literature, several conditions can account for similar symptoms in a similar area. Some recent articles have now shed light on some difficulties in diagnosing a concussion versus a whiplash injury, given the similar presentation between the two conditions.

According to an article in the Journal of Orthopedic & Sports Physical Therapy, since the presenting symptoms of concussion and whiplash can be similar (neck pain, headache, dizziness, and concentration deficits), and the causes of both conditions (biomechanically) is similar, there is a very real risk of misdiagnosis. This is seems especially prevalent in the workers’ compensation system where panel physicians hesitate to refer injured workers to specialists, or for diagnostic testing, to avoid angering either the employer or the workers’ compensation insurance carrier. The very nature of the panel physician/employer relationship unfortunately creates an incentive for the panel physician to undertreat the injured worker and return him or her to full duty before the injured worker is ready to do so.

While many times either a concussion or whiplash will resolve within a three month period, in those cases where it does not, misdiagnosis can be very dangerous. Paul Lagerman (“a Physiotherapist with 20 years of experience in pain management, musculoskeletal injury and rehabilitation”), posted a deep analysis of this problem, along with the dangers and effects of not understanding what condition is actually in need of medical treatment. This can cause the problem to linger far longer than necessary.

November 21, 2019

Contusions or Bruises Can Be Serious Injuries in PA Workers’ Compensation

by Glenn Neiman

How many times must an injured worker in PA hear something like, “Why are you still out of work – it was just a bruise?” What is not widely understood is that a bruise, or a contusion, can, indeed, be a serious injury with very severe consequences. Recently, we saw an example of this in the sports world.

Tyler Lockett, a wide receiver for the Seattle Seahawks in the NFL, suffered a bruised lower leg in a game on November 11, 2019. According to an article in the Washington Post, Mr. Lockett was hospitalized overnight as a result of the injury. In addition to causing pain and immobility, a bruise or contusion can also cause swelling. This swelling, when in a small area, such as a lower leg, can instigate “compartment syndrome.” According to the article, “Compartment syndrome is a rare but potentially dangerous condition in which pressure builds to extreme levels in a limb after it undergoes some sort of trauma, either from a big hit or simple exercise.”

On the website for the American Academy of Orthopaedic Surgeons (AAOS), it is reiterated that compartment syndrome can result from badly bruising a muscle, which we do often see in PA workers’ compensation cases. When this compartment syndrome is the result of acute trauma, it is a medical emergency. Immediate treatment is necessary to avoid permanent damage to muscle, nerve and tissue. There is no non-surgical treatment for compartment syndrome. Specifically, the treatment involved would be:

November 1, 2019

Fusion a Pain in the Neck (or Back) for Injured Workers – Adjacent Segment Disorder and Adjacent Segment Pathology

by Glenn Neiman

The vast majority of work injuries in Pennsylvania heal with conservative treatment, allowing the injured worker to return both to work, as well as to activities of normal life. However, there are certainly the more serious injuries, where more invasive medical treatment is required.

Often the more invasive treatment options entail surgery. When we are talking about work injuries to the neck and back, the procedures we usually see are laminectomy, microdiscectomy and traditional lumbar fusion. For a description of each of these, and more information regarding these procedures, check out this post from Penn Medicine. For our purposes today, we are looking at the traditional lumbar fusion. As explained in the Penn Medicine article:

“Traditional spinal fusions are used to treat instability of the spine, scoliosis, severe degeneration of the discs, or a combination of these issues. A fusion involves using bone from the patient’s body to fuse one vertebrae to another. Often, metal screws (pedicle screws) are placed into the vertebrae to assist with the fusion process.”

October 23, 2019

Brilliant & Neiman LLC attending Rothman Orthopedic Institute’s Workers’ Compensation Conference

by Glenn Neiman

While we are very conscious of being available to our clients as much as possible, the practice of PA workers’ compensation law, and the litigation process, means we are not always in our offices. Sometimes, in addition to being at workers’ compensation hearings and depositions, our attorneys attend events or presentations that may help us better perform our job protecting the injured worker in PA.

And, so it follows, our attorneys were invited by Rothman Institute to attend their Workers’ Compensation Conference, being held all day on Friday, October 24, 2019. We sincerely apologize if this means we are not available to help our clients on that day directly, though our office staff certainly remains available (and can reach the attorneys for any emergencies). As our clients know, it is the practice of Brilliant & Neiman LLC for the clients to speak directly to the attorney, rather than being forced to always speak to support staff. We apologize for this deviation from our regular course of business.

The Workers’ Compensation Conference will no doubt provide our attorneys with additional tools to help us best protect the rights of injured workers in PA. Topics being presented will include 3-D printing in orthopedic surgery, issues with complex rotator cuff surgery, as well as general updates regarding treatment options for injuries to the neck, back and knees. The Workers’ Compensation Conference will be moderated by Dr. Nicholas Taweel, and will include presentations from Dr. Pedro Beredjiklian, Dr. Mark Lazarus, Dr. Michael Molter, Dr. Howard Yeon and Dr. Paul Steinfield.

September 19, 2019

Broken Bones Not Always Found Initially

by Brilliant & Neiman

Left Fielder Corey Dickerson, of the Philadelphia Phillies, was just diagnosed with a broken foot. Why is that relevant to injured workers? Because it confirms that an injury is not always what it initially appears. Unlike a major league baseball player, however, an injured worker is not always given the benefit of the doubt.

On September 4, 2019, Dickerson fouled a ball off his left foot. They took x-rays that night, which were negative for a fracture. Since he was diagnosed with just a bruise (or, the fancy word, “contusion”), Dickerson then played, in pain, in the next several games. When the pain continued, additional testing was performed. Only then did a CT scan reveal a fracture of the left foot. Indeed, Dickerson may now require surgery.

Too often in PA workers’ compensation cases, we see an insurance carrier grab on to an initial negative test like a dog with a bone. Unlike a professional athlete, however, an injured worker can have great difficulty getting additional diagnostic testing. With the workers’ comp insurance carrier failing to provide pre-approval, getting an MRI, CT scan or bone scan, can be problematic.

February 11, 2019

Too Many Total Knee Replacements Being Performed?

by Glenn Neiman

As far back as 2008, our blog reported on a marked increase in the number of total knee replacements that were being performed. This trend seems to have been continuing, and, perhaps, not for the best. According to a recent article in The Intelligencer, a rather high number of patients who elected to have a total knee replacement performed, were dissatisfied with the results. According to the article:

“Research suggests that up to one-third of those who have knees replaced continue to experience chronic pain, while 1 in 5 are dissatisfied with the results. A study published last year in the BMJ found that knee replacement had “minimal effects on quality of life,” especially for patients with less severe arthritis.”

In Pennsylvania workers’ compensation, a total knee replacement is a procedure with see with some regularity. Whether the injured worker had a preexisting arthritic condition, which was aggravated by a work injury, or whether the work injury itself led directly to the procedure, a total knee replacement is not uncommon in a workers’ comp case.

May 17, 2018

Thoracic Outlet Syndrome and Brachial Plexopathy in PA Workers’ Comp

by Glenn Neiman

Thoracic Outlet Syndrome (TOS) and Brachial Plexopathy are two conditions we see representing injured workers in Pennsylvania. These conditions were recently in the news in the Philadelphia area, with the report that Phillies pitcher Vince Velasquez underwent surgery for TOS in the previous offseason. Indeed, it is not an uncommon injury for a professional baseball pitcher; our firm has represented a former major league pitcher with the condition (of course, we have represented many more types of injured workers with this condition than professional athletes!).

Both TOS and brachial plexopathy are sort of general terms, each regarding issues in the brachial plexus area (think of it like a big city train station, where it is many branches of nerves coming together rather than railroad tracks). There are many forms of these conditions, making diagnosis difficult. As we have mentioned previously on this blog, brachial plexopathy can be confused for conditions in the shoulder and/or neck of the injured worker. This difficulty is also mentioned in the Medical FAQs on our website. In the PA workers’ compensation system, we are often litigating to have TOS or brachial plexopathy accepted as part of the work injury (since such conditions are rarely, if ever, voluntarily accepted by the workers’ compensation insurance carrier).

Part of the problem in getting TOS or brachial plexopathy accepted as a work injury is the fact the conditions can be caused in various ways. In fact, some occurrences are “idiopathic,” meaning that there is no known cause. On the other hand, trauma is an established cause of the conditions. It is also important to note that when we talk of “trauma” as a cause of TOS or brachial plexopathy in a work-related injury, we are speaking both of a single injury, as well as some type of repetitive motion kind of injury. As we have discussed on this blog, repetitive motion injuries are just as much “work injuries” as single traumatic episodes.