Articles Posted in Medical News

A recent article on www.emaxhealth.com noted that the U.S. Food & Drug Administration (FDA) has approved an extended-release version of the chronic pain medication, Ryzolt (sold under the name of “Tramadol”). Though Tramadol has previously been available, this simplified dosage is new. Unfortunately, chronic pain is something we see all too often in PA workers’ compensation cases.

This drug is used for managing moderate to moderately severe chronic pain. The extended-release form of the drug should allow patients to better control their pain over the course of the day. With both immediate-acting, and extended-release, parts, Tramadol hopes to provide better relief to chronic pain sufferers.

The article notes that chronic pain impacts approximately 75 million people in the United States, “more than diabetes, heart disease and cancer combined.”

Recently, two pharmaceutical companies, Genzyme Corporation and Osiris Therapeutics,

announced that they have joined to develop two adult stem cell treatments. These medications, known as Prochymal and Chondrogen, may be a valuable resource to treat a wide variety of conditions. Benefits from these treatments may include control of inflammation, development of tissue regeneration and prevention of scar formation.

Clinical trials for Prochymal are currently underway for Crohn’s disease, diabetes, chronic obstructive pulmonary disease (COPD) and acute myocardial infarction. Chondrogen, to interest of those injured workers suffering from persistent knee pain, is in clinical trials to treat osteoarthritis of the knee.

While ankle injuries are common in PA workers’ comp cases, we do not hear about total ankle replacements as much as we hear of total knee replacements or total hip replacements. Unfortunately, sometimes a work injury causes such damage to the ankle, or triggers the development of arthritis in the ankle, such that a total ankle replacement is necessary.

A recent article on the American Academy of Orthopaedic Surgeons’ website talked of improvements in total ankle replacements. At this point, in the United States, only four types of implants are available for total ankle replacements. Each of these devices consists of only two components. This means there will not be much mobility in the ankle. Of course, the alternative, of fusing the ankle in one position, offers no movement at all.

Outside the United States, total ankle replacements are being done with a device containing three components, allowing greater mobility. FDA approval is being recommended for such devices to be approved for use in the U.S. The article suggests approval for these devices could come as soon as later this year.

As if an injured worker needed another reason to think of surgery as only a last resort, a recent article in Annals of Surgery journal noted that there is a discrepancy in the count of surgical instruments (including sponges) in nearly 13% of surgical procedures. This, of course, does not mean an instrument, or a sponge, is left in a surgical patient in 13% of procedures (that percentage is closer to 0.02%, or one in 5,000). Still, this seems like a staggeringly high percentage to have a miscount.

An article in Amednews.com suggests some solutions to reducing this figure. One is putting bar codes on sponges, which would then be scanned in and out. The count would then be automatic. The article suggests this would add only about $9.00 per surgical case. Another option is placing tiny radio-frequency identification (RFID) tags in the sponges. A wand could then be used to locate missing sponges, either inside a patient, or around the operating room. This would cost an additional $25.00 to $45.00 per surgical procedure.

While certainly no injured worker wants to rush into surgery, sometimes a work injury requires surgical intervention, whether it is a back surgery, a total knee replacement, or any other procedure. The hope is that these new technologies can make surgery safer, and less risky, for every injured worker.

One of the most common work injuries we see in PA is to the back, whether it is a herniated or bulging lumbar disc, an aggravation of degenerative disc disease, or a soft tissue injury, such as a strain or sprain. These injuries run from a minor strain, which can be cured by rest and medication, to a herniated disc encroaching on a lumbar nerve root, which can require injections and surgery.

When an injured worker has suffered a herniated lumbar disc, and is having pain or numbness down one or both legs (“radicular symptoms” or “lumbar radiculopathy”), surgery may be discussed. One of the more common procedures to relieve the pressure of a herniated lumbar disc pressing on a nerve root is called a discectomy, where the disc material is simply removed.

A recent article published in the Journal of Bone & Joint Surgery examined some previous studies regarding the timing and effectiveness of lumbar discectomies. One of the more interesting findings was that pain relief occurs first after a lumbar discectomy, followed by recovery of motor function (strength), then improvement in sensation. In other words, it is not unusual for the injured worker to continue to have abnormal sensation after surgery. This is an important thing to keep in mind after surgery, so that the injured worker does not feel as if his or her recovery is not going well.

Many of those who are injured at work and receiving Pennsylvania workers’ compensation benefits are using, or have used, the Fentanyl Transdermal Patch (FTP). As with any medication, the injured worker often has questions regarding the usage of the Fentanyl patch. This set of Frequently Asked Questions about FTP may be of interest to those workers’ comp claimants who use this medication.

Thoracic outlet syndrome is a debilitating injury we see in Pennsylvania workers’ compensation cases. In this condition, the blood vessels and/or nerves in the arms may be compressed, causing various symptoms, including pain, numbness, tingling and a “cool” feeling in the arms.

There is no easy cure for thoracic outlet syndrome. No medication, surgery, or other treatment method seems universally able to help the injured worker with this condition.

Hope may be on the horizon, however. A study is currently underway, investigating whether an injection of BOTOX may be an efficient reliever of symptoms from thoracic outlet syndrome. While it will be some time before this treatment is approved by the FDA (if ever), this development is worth watching for those who suffer from this diagnosis.

The rotator cuff is where four muscles and several tendons form a covering around the top of the humerus, the upper arm bone, in the shoulder. While tears in this region of the shoulder can occur with the wear and tear of using the shoulder over years, a rotator cuff tear is also a common injury we see in Pennsylvania workers’ compensation cases. This type of injury can occur in many different ways, including lifting or falling on the shoulder. Even repetitive use of the shoulder at work over years can lead to a compensable work-related rotator cuff tear.

A torn rotator cuff is generally categorized as either small, medium, large or massive. Initial treatment for a tear usually consists of “conservative” (non-surgical) options, such as physical therapy, medications and/or injections. If these conservative methods do not relieve the problem, surgery may be indicated.

The problem comes with the “massive” rotator cuff tears. These tears used to be called irreparable. The injured worker was left with only two choices – either live with the pain and disability, or have a “debridement procedure” performed (this is a surgical procedure where the area is cleaned out, though the tear is not repaired). In the past, the injured worker remained on workers’ compensation benefits, and remained unable to perform ordinary daily activities of living, let alone work.

In Philadelphia, we recently heard of “prolotherapy” because Philadelphia Flyers’ player, Simon Gagne, who injured his head and neck, has said this treatment method has greatly improved his condition. When I saw that, I wondered if prolotherapy may be beneficial to an injured worker, especially one who has hurt the neck or the back. Workers’ compensation cases are littered with patients taking an abundance of medications, or getting multiple steroid, or other, injections into their spines. We could certainly use a less invasive treatment option.

Prolotherapy seems to involve injecting a substance into the injured area, causing an irritation in the area. This certainly seems an odd step to take (purposely irritating an already injured area), but the idea is that the irritation being caused leads to the area repairing itself. The substance being injected can vary by the type of prolotherapy being done.

As with any potential treatment option, workers’ compensation patients should always discuss the step with their doctor. While it is always good to have options for treatment, some treatment methods may be better than others for any given condition or patient, and your doctor is the best one to guide which treatment would be greatest treatment option.

It happens all too often. A worker suffers an injury to his or her neck or back. Though the injured worker never had neck or back pain before the injury, the workers’ compensation insurance company questions the claim. According to the workers’ compensation insurance carrier, the injured worker is suffering from “degenerative disc disease,” not a work injury. In reality, of course, it is the work injury which has made the degenerative disc disease start to cause pain. In Pennsylvania, an “aggravation” of a pre-existing condition, like degenerative disc disease, is considered a “new injury,” allowing an injured worker to collect PA workers’ comp benefits.

That is only half the battle, unfortunately. Once the degenerative disc disease has been made symptomatic by the work injury, the symptoms often do not stop. Frequently, the injured worker will try many “conservative” treatment options, such as medications and physical therapy. Failing that, doctors might try various types of injections, including epidural steroid injections. Sadly, though, time and again, the injured worker remains in pain despite these efforts.

Once the pain has continued for longer than six months, and various conservative treatment options have failed to reduce the symptoms, doctors start to talk about surgery as an option. There is no doubt that spinal surgery, whether for the neck or the back, is a last resort. As with any major surgical procedure, there are serious consequences which can result from such an operation. Moreover, there is no guarantee the injured worker will be any better after surgery.