WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER: 20100008
OBJECTION BY: Worker
EMPLOYER: Not participating
REPRESENTATIVES: None
ISSUES
This worker has claimed entitlement for a right shoulder impairment as related to the basis for which this claim has been allowed, as well as ongoing chiropractic treatment for the right shoulder.
As entitlement for the right shoulder has been denied, and so has ongoing chiropractic treatment as outlined in the claims adjudicator’s decision of September 29, 2008.
HOW THE ISSUES ARISES
This worker is employed as an Assistant Manager and his date of hire was June 2, 1975.
An Employer’s Report of Injury/Disease (Form 7) states that on March 10, 2005 the worker reported an injury due to keyboarding.
The Worker’s Report of Injury/Disease (Form 6) indicated the areas injured were elbows and shoulders. The worker stated he worked on a computer for several hours a day and the time would vary from day to day; however, he could be keyboarding for a half-hour or four hours at any time. The worker stated he first noticed pain in his elbow in late January or February 2005. It was not severe and he did not know the cause. He was subsequently on the computer more and more in the following months and the pain began to spread to both shoulders. The worker ordered a new keyboard and an ergonomic assessment of the workstation.
The initial Health Professional’s Report (Form 8), from an assessment of March 24, 2005, diagnosed a repetitive strain injury/sprain as a result of computer overuse and the fact that the workstation was setup improperly. The diagnosis was left lateral epicondylitis with bilateral biceps tendonitis. The report indicated that the worker had a sharp pain in his left elbow extending from the elbow with lifting, as well as dull and aching pain in the shoulders. Deep laser therapy as well as active release treatment was prescribed for two to three days per week for approximately 12 weeks.
A chiropractic report of September 13, 2005 indicated that the worker had presented to the healthcare centre on February 4, 2005 with the main complaint of bilateral shoulder pain and left elbow pain.
After examination, the worker was diagnosed with bilateral biceps tendonitis and left lateral epicondylitis. The left shoulder pain and left-elbow pain resolved on June 7, 2005; however, right shoulder pain continued. The worker was instructed to obtain an ultrasound and x-ray of the right shoulder on August 17, 2005 and the results were negative, although the worker continued to complain of pain in the right shoulder. At that time, the worker indicated his right shoulder had improved 80 to 85 per cent. It was noted that the worker is a Type II diabetic, and this slowed down the healing process.
The chiropractor thought the worker would overcome his injury after a course of ultrasound/deep-laser therapy, myofascial release, and active rehabilitation. The chiropractor extension report of September 13, 2005 continued to provide a diagnosis of left lateral epicondylitis with bilateral biceps tendonitis.
A chiropractor extension report from an assessment on June 7, 2005 indicated 100 per cent resolution of the left biceps tendonitis and the left lateral epicondylitis with the right biceps tendonitis 60 per cent improved. A chiropractor extension report from an examination on December 14, 2005 indicated 80 to 90 per cent improvement although this seemed to have declined to 70 per cent improvement subsequent to an assessment of March 21, 2006. Interestingly, the diagnosis remained related to biceps tendonitis.
The worker was seen at a regional evaluation centre (REC) on May 1, 2006. The report indicated there was a probable biceps tendinopathy that would wax and wane, although this was not considered to be disabling but rather resolving. At that time, the report indicated no indication to impose any limitations or restrictions on activity. This report concurred that the ultrasound done on April 17, 2005 of the right shoulder did not show any abnormality, nor did
x-rays. The bicipital tendinopathy was largely resolved.
The next medical chiropractic extension report from an assessment on August 15, 2006 indicated that the worker was 90 per cent improved before treatment was terminated, but felt he had deteriorated subsequent to stopping treatment.
The next medical report is an ultrasound of the right shoulder from April 2008 which demonstrated a lesion in the mid-right supraspinatus tendon which could represent a partial or full thickness tear. An MRI was recommended. The MRI from July 2008 indicated no full thickness rotator cuff tear. The worker had tendinosis and that tendinosis and tiny partial thickness tears often co-exist and can be difficult to discriminate even on MRI documents. Degenerative changes were present in the acromioclavicular (AC) joint.
The most recent report from an orthopaedic specialist, dated September 17, 2009 indicated that the nature of the original injury involved both shoulders and the left elbow and that the Workplace Safety and Insurance Board (WSIB) has not accepted that the right shoulder was actually part of the original injury. This physician stated it was his opinion the right shoulder pain and weakness persisted since the original injury in 2004 (the ARO notes the actual injury is documented for 2005) and the current symptoms are unquestionably related to the initial
work-related injury. It was suspected the worker would have an element of long-term disability, specifically related to abilities to perform overhead work, heavy lifting, and repetitive tasks, although there were no specific restrictions as to his activities at the time. This appears related to the fact that the worker’s job activities are not of a heavy labouring nature.
This case has been reviewed by a WSIB medical consultant on several occasions. The review on September 20 2006 indicated the consultant had several concerns about the worker’s activities outside the workplace and questioned the work-relatedness of any injury. As a result of that review, initial entitlement was rescinded. It was later reinstated after an investigation as the adjudicator accepted that the poorly set up work station could have caused problems with the biceps and left elbow.
Another review took place on September 4, 2008. This report indicated the shoulder now suggested pathology of tendinosis and degenerative changes at the AC joint. As the consultant indicated, there were no previous MRI studies to compare; however, it is noted that the original ultrasound was negative and it was not accepted that the current MRI findings suggested a new injury or unresolved injury as related to the basis for which this claim was established.
In the Memorandum dated September 24, 2008, the medical consultant actually questioned the viability of the original diagnoses that were accepted in this claim as related to the description of the worker’s job on the worker’s Form 6. Technically, this consultant did not think that the lateral epicondylitis or biceps tendonitis could be entirely explained by the keyboarding activities.
That being said, this worker is pursing ongoing entitlement for the right shoulder and chiropractic treatment.
In a conversation with the worker in January 2010, the worker indicated he was objecting to the denial of the right shoulder and chiropractic treatment which he continued to receive through to approximately November 2009.
AUTHORITY
- Secondary conditions resulting from a work-related disability are assessed in accordance to Operational Policy Manual Document (OPM), 15-05-01;
- Recurrences are assessed according to OPM document, 15-03-01;
- Entitlement to healthcare is assessed in accordance to OPM document, 17-01-02;
- An accident is defined in accordance to OPM document, 15-02-01.
RESOLUTION METHOD AND PROCESS
This worker requested a decision in accordance with the Appeals Branch (AB) 60-Day Option process.
ASSESSMENT OF THE EVIDENCE AND SUBMISSIONS
In reviewing this evidence, it is clear that this worker related the symptoms in his arms to keyboarding in the workplace. Although the Form 6 initially stated that the worker felt pain in his elbows and shoulders, the initial treating physicians always diagnosed lateral epicondylitis on the left side with a bilateral biceps tendonitis. The biceps tendonitis is particularly odd with respect to keyboarding; however, these are the diagnostic findings that were accepted for the allowance of this claim.
There is a chiropractic report of September 13, 2005 which states that this worker was treated on February 4, 2005 complaining of bilateral shoulder pain and elbow pain. In other words, the descriptions of the worker’s pain symptoms were related to the shoulders, although the diagnosis remained that of bilateral biceps tendonitis.
Biceps and shoulders are technically not the same area and, as such, the area diagnosed for impairment does not seem compatible with where the worker was describing his pain. Part of this reason may be that there were really no findings from a physical standpoint, specifically related to the worker’s shoulders. It is especially significant in this case that an ultrasound of the right shoulder, August 17, 2005, was completely negative. In other words, there was no evidence of any type of tear or tendinosis at that time.
The worker was assessed May 1, 2006, at a REC. The report stated the worker was seen with respect to right shoulder pain. The worker gave a history of having intermittent pain over the interior aspect of the right shoulder which was most noticeable when he was pruning trees with his arm overhead or shovelling. It had, however, improved significantly with exercises. This report states the worker noted the onset of the current symptoms from approximately one year to two years prior, and developed gradual aching and discomfort in both his shoulders, especially with exercises like doing push-ups. Then in approximately February 2005, the worker developed pain in the lateral aspect of the elbow and had been attending chiropractic treatment.
The REC report indicated that with respect to the workplace, there was an ergonomic assessment done on the workstation as the worker used a laptop and the assessment was helpful. The worker was also provided with a different type of mouse. The worker continued to attend chiropractic treatment and did strengthening exercises for the upper extremities, including push-ups.
Examination at the REC demonstrated no deformity of either shoulder and no muscle wasting. There was no evidence of impingement signs in either shoulder and in fact, there was no tenderness about the longhead of biceps in either shoulder.
This report indicated that x-rays of the right shoulder had been normal and the only clinical diagnosis that remained was a probable biceps tendinopathy (by history of the worker’s description), which had largely resolved.
In reviewing the evidence, specifically from the REC report, this worker obviously participates in activities outside the workforce that are definitely compatible with a number of the injuries listed, and more so than would be with using a laptop in the workplace.
The fact that the worker went to a doctor and indicated he had pain in his elbows and shoulders does not mean that this pain is related to the work duties. This was actually a disablement claim, which means that the pain came on gradually and the WSIB did allow a claim for the biceps and left elbow as related to the use of a laptop; however, the appeals resolution officer (ARO) agrees with the position of the WSIB medical consultant that one certainly cannot relate the current findings of the right shoulder to this worker’s job activities.
CONCLUSION
The ARO concurs with the decisions rendered by the claims adjudicator and denies entitlement to the right shoulder and any ongoing chiropractic treatment.
The worker’s objection is therefore, denied.
DATED February 3, 2010
S.M. Elliott
Appeals Resolution Officer
Appeals Branch