WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
DECISION NUMBER: 20100145
OBJECTION BY: Worker
EMPLOYER: Not Participating
REPRESENTATIVE: Worker Representative
ISSUES
The worker representative is objecting to the denial of entitlement for the neck and right shoulder.
The worker representative is objecting to the denial of entitlement for regional pain syndrome.
HOW THE ISSUES AROSE
On March 19, 2007, this then 51 year old homemaker reported she was positioning a client at the kitchen table when she felt a pull in her left upper arm. The worker sought initial medical attention at the hospital on March 22, 2007 and the diagnosis provided is left shoulder strain. The worker attempted a return to modified work with the employer however this was unsuccessful. The worker required left shoulder surgery on November 27, 2007. The worker is allowed a 22% NEL award for the left shoulder in this case.
The record indicates the worker began to experience problems with her neck and right shoulder in May 2008. The worker reports to the Case Manager she feels her secondary areas of injury, particularly the right shoulder, are the result of overuse in compensating for the work-related left shoulder injury. The worker is provided with a decision letter dated April 27, 2009 advising entitlement is not extended in this case to include these secondary areas of injury. The worker objected to this decision with a letter dated May 4, 2009.
The worker representative provided a report from a neurosurgeon dated September 14, 2009 and the diagnosis provided is regional pain syndrome. The Case Manager requests an opinion from the Medical Consultant, a doctor on staff at the WSIB with respect the compatibility between the work-related left shoulder injury and the diagnosis of regional pain syndrome. The Case Manager accepted the opinion offered by the Medical Consultant and denied entitlement in this case for regional pain syndrome and communicated this decision to the worker with a
letter dated December 9, 2009. The worker representative provided the completed objection form dated March 3, 2010 and these matters are now before me.
AUTHORITY
15-05-01 – Resulting from Work-Related Disability
RESOLUTION METHOD AND PROCESS
It was agreed this matter would be resolved without a hearing and there are no submissions
ASSESSMENT OF THE EVIDENCE
I have reviewed the record and considered the evidence.
The record reveals the worker has had extensive physiotherapy and massage therapy treatment subsequent to the date of surgery in this case without any improvement. During the course of her physiotherapy treatment the worker developed a frozen left shoulder according to the report from the physiotherapist dated March 20, 2008.
According to memorandum 54 of the record, the worker related the symptoms in her neck and right shoulder to overuse and to her frozen left shoulder. The worker reported a chronic ache in the left shoulder, neck and right shoulder and that she has pain to her elbows and both of her hands are numb. The worker is right hand dominant and the restrictions for the left shoulder are to avoid repetitive use of the left arm and avoid use of the left arm at shoulder height and avoid lifting greater than ten pounds.
The worker is unable to return to her pre-injury job as a homemaker and there is evidence of permanent impairment for the left shoulder. The employer is unable to accommodate the worker within the restrictions identified for the left shoulder and the worker is entitled to Labour Market Re-entry (LMR) Services. I note the worker expressed difficulty with the requirements of the LMR program in relation to the work-related left shoulder injury and the problems she was experiencing with the neck and right shoulder.
The orthopaedic surgeon in her report dated April 8, 2009 indicates the worker has experienced pain in the right shoulder that is greater than the left in the past weeks and the diagnosis is cuff tendonitis and the worker is referred for medical investigations for the right shoulder and neck. The worker is denied entitlement for a MRI scan of the cervical spine as this is not an accepted area of entitlement however the report from the neurosurgeon dated September 14, 2009 indicates the results of the MRI scan revealed some minimal foraminal narrowing bilaterally at C7/T1and from C4/5 to C6/7 on the right with no evidence of disc herniation or nerve root compression.
The medical report from the neurosurgeon dated September 14, 2009 notes the worker was quite tender on palpation over the lower paraspinal muscles and trapezii bilaterally but more so on the left. The worker demonstrated a mild decrease in the range of motion of the cervical spine in all directions with end range neck pain but no arm symptoms. The neurological examination revealed the worker had normal bulk, power and tone in the upper extremities and the worker was quite guarded with movements involving the left arm and the worker was able to demonstrate maximal power briefly. Deep tendon reflexes are 1+ and symmetrical and the sensory examination is unremarkable.
The neurosurgeon noted that she suspected the worker’s neck pain was secondary to the worker’s left shoulder and the trapezius and indicated the worker presented with regional pain syndrome. The Case Manager requested a medical opinion from the medical opinion with respect to the compatibility between the problems the worker is experiencing with the right shoulder and the neck and the diagnosis of regional pain syndrome.
In my assessment of the evidence in this case, the worker sustained a left shoulder injury that required surgical repair. The worker is allowed a 22% NEL award for the left shoulder in recognition of the residual impairment from the work-related injury. In determining a worker’s entitlement recognizing secondary areas of injury, a causal link must exist between these secondary areas of injury and the work-related injury. I find no evidence to suggest the worker injured the right shoulder or the neck at the time of the accident or that these areas required treatment at the time of the work-related injury involving the left shoulder.
The worker reported problems with the right shoulder and neck beginning in May 2008, slightly more than a year post injury. The worker is right hand dominant and it is not clear how the right shoulder symptoms are related to overuse in this situation when normally the dominant side performs most activities and with the restrictions in place for the left shoulder the worker would have been limiting her activities and therefore not subjecting her right shoulder to any undo strain.
The orthopaedic surgeon provided the diagnosis of cuff tendonitis and the neurosurgeon indicates the worker presented with regional pain syndrome thus two different opinions. In December 2008 the orthopaedic surgeon suspected the problems the worker was experiencing with the lateral aspect of the left shoulder were either from the left shoulder problem or perhaps originating from the cervical spine.
In my opinion, the problems the worker is experiencing with the neck and the right shoulder are not related to the work-related injury. I acknowledge the worker did develop a frozen left shoulder well into her physiotherapy treatment post-operatively however I find the medical evidence does not support a clearly defined causal relationship between the symptoms the worker is experiencing in the neck and the right shoulder and the left shoulder injury covered under this claim.
The worker is described as guarded in terms of movement involving the left shoulder and although the worker complained of numbness in both hands and arms the medical evidence does not reveal any nerve root compression in the cervical spine. I accept the opinion provided
by the Medical Consultant in that the findings reported during the examination by the neurosurgeon do not appear to be compatible with the diagnosis of regional pain syndrome or consistent with the history provided by the worker in this report.
The worker initially related the problems with the right shoulder to overuse and in the neurosurgeon’s report dated September 14, 2009, the worker reported she experienced pain radiating up into her neck in May 2008. In my opinion these causations do not establish a direct link to the left shoulder injury allowed in this case.
CONCLUSION
I find the denial of entitlement for the right shoulder and neck appropriate.
I find the denial of entitlement for regional pain syndrome in this case appropriate.
The objection is denied.
DATED September 21, 2010
C. Anzil
Appeals Resolution Officer
Appeals Branch