IRAT 1 - WC/TOS/CTS Flashcards
Compensation to injured workers dates back to
2500 BC
The origins of WC are placed
At the beginning of the industrial revolution (19th century)
Three principals gradually developed which determined what injuries would be compensable
Contributory negligence
The fellow servant rule
The assumption of risk
Held that employers were NOT held liable if the worker’s injury resulted from the negligence of a fellow worker
The fellow servant rule
Held that the employee knew of the hazards of the job when he signed on thereby agreeing to all the inherent risks
The assumption of risk
Western nations began to adopt a model for workers compensation in the
Late 1800s
In 1910 representatives from teh industrial states met
In chicago to outline a set of guidelines for WC
The 1st WC law was passed in ____ in 1911 and 9 states followed shortly thereafter
Wisconsin
Physician attitudes toward worker injuries changes in the 1930s when
Social security disability insurance was created
Social security disability insurance was created and shortly after the AMA published th
Guides to teh evaluation of permanent disability
WC coverage eventually advanced to a no fault system
A system that allows for an injured worker to be treated and compensated for an niury without negligence being allocated to the employer
in california today there are
More than 300,000 claims per year
Billions of dollars are spent in CA each year in
Benefits
The CA WC law requires that the injured worker prove that the injury
Arose out of and occurred in the course of employment
Injuries WC in CA can be either
Specific
Cumulative
Psychiatric, mental or emotional
Benefits in CA include
Temporary disability Medical treatment Permanent disability Vocational retraining Serious and willful misconduct Death benefits
Temporary disability WC in CA
Paid at 2/3 of the injured workers average wage
Max is 1066.72 per week
Minimum is 160 per week
Phone rings at office WC filed
Dr. Files DFRI
You will then after DFRI have to
Request authorization for treatment
The UR (utilization review) process is to determine the medical necessity and appropriateness of treatment and is not
An approval or guarantee for payment of medical services.
Only the ___ can approve payment off UR
Insurance carrier or claims representative
After review of the request, based on teh medical information submitted, the following specific treatment and/or service for patient is denied
Adverse determination
Requested service meets the established criteria of medical necessity and reasonableness based on the information provided. If additional treatment is required, please forward request for ongoing/concurrent care in writing at least 3 days prior to start/implementation date.
Approval letter
You determine the patient to be at
MMI or P&S
Now determine PD and apportionment
Median nerve entrapment pronator teres syndrome
Common entrapment site that is between 2 heads of pronator teres adn the arch of flexor digitorum superficialis
Most common cause of pronator teres syndrome/median nerve entrapment
Fibrous bands
If entrapment of median nerve takes place in carpal tunnel we call it
CTS
Carpal tunnel formed by
Superior - transverse carpal ligament
Medially - pisiform/hamate
Laterally - navicular/trapezium
Patient S&S
Pain and numbness/tingling in median nerve distribution area
Symptoms worse upon awakening
May complain of clumsiness or difficulty gripping
Thenar atrophy
CTS
Most common to have HX of prolonged wrist oversuse
Pressure inside the tunnel increases with extreme positions
CTS
Demographics of CTS
Women in 40s and 50s 4x more likely to develop it
2nd most common WC injury
CTS
CTS risk is high for work such as
Auto assembly, meatpacking, poultry processing
Why are women predisposed to CTS
Smaller wrist bones
Genetic links
Strong hormonal changes during menses, pregnancy, and menopause
After age 50 men and women are equally predisposed
CTS acute
Numbness and tingling in palmar thumb, index and radial half of middle finger
Positive tinel’s
Positive phalens
Goals for CTS acute
Reduce any internal swelling, decrease pain or numbness/tingling frequency
Concerns for acute CTS
If condition progresses to atrophy, surgery is likely
Criteria CTS subacute
Frequency of numbness/tingling event is decreasing
Goals CTS subacute
Retrain pt to proper activities to reduce stress on CT
Concerns CTS acute
Pt is unable to avoid aggravating activites
CTS symptom free criteria
No complaints with moderate daily usage
Goals symptom free CTS
Maintain proper work ergonomic environment
Wean patient off night support
Concerns CTS symptom free
Pt returns to work activities without proper ergonomic support
Keyboard use and CTS
No association
Mouse usage adn CTS
Still a question
__ of CTS patients recover within a few weeks of surgical release
90%
__ of CTS patients fully recover with conservative treatment after 2-12 weeks
30-70%
Standard of nonconservative treatment for CTS is
Nocturnal neutral splintings or cock-up splint
Prevention of CTS
Splinting
__ of those in splint study group eventually ahd surgery after 18 months
41%
US CTS
After 7 weeks showed significant improvement
Classic Katz diagram
Greater than 2 out of digits 1-3; no palm involvement but radiation into forearms
Probable katz diagram
Greater than 2 out of 1-3 digits;; palm involved
Unlikely katz diagram
0 out of digits 1-3 with possible medial palm involvement
Illustrates more ulnar nerve involement
TOS aka
Cervical rib syndrome Scalenus anticus sydnrome Pectoralis minor syndrome Hyperabduction syndrome Costoclavicular syndrome
TOS anatomic space bordered by
1st rib
Clavicle
Superior border of scapula through which great vessels and nerves of upper extremity pass
TOS is a syndrome characterized by symptoms attributable to compression of the neural or vascular anatomic structures that pass through the
Thoracic outlet
TOS is bordered
Anteriorly by
Posteriorly by
Inferiorly by
Anterior scalene
Middle scalene
1st rib
TOS tests
Adsons Wrights Eden Roos Auscultation US of carotid artery
Adson
Pain and/or paresthesia decreased or absent pulse amplitude, pallor
Compression of neurovascular bundle by scalenus anticus or cervical rib
Wright
Aka hyperabduction maneuver
Compression of axillary artery by pectoralis minor or coracoid process. TOS
Eden
Aka costoclavicular maneuver
Compression of neurovascular bundle between clavicle and 1st rib
Roos
Aka EAST
Ischemic pain, heaviness of arms, numbness adn tingling of hand
TOS on side invlved
This is most accurate for TOS evaluation
