Surfahgurl Posted January 20, 2014 Share Posted January 20, 2014 I am in a difficult bind. About 6 wks ago I woke up to wrist pain and wrist subluxation in which I am able to twist and relocate myself. No prior wrist problems. Ever since I have recurrent subluxations throughout the day and have trouble with supination and suturing, lifting, writing, injections, and even pressing the button for the cautery. I thought it would be temporary but its still the same 6 wks later even after Christmas break. I am still working but trying to rest it as much as possible. I have seen multiple orthos who are all perplexed, giving different diagnosis. The last one called it radio-ulnar joint laxity and inflammation which makes the most sense but he states he has never seen it in his 35 years of practice. He also said that, legally he felt this was most likely a workman's comp case because it started the day after I did a very long genital wart removal procedure using cautery and scissors. I didn't want to file wc and risk my doctor/pa relationship as well as hurting my potential for learning more procedures and surgeries (I've been working in derm for 1.5 yrs now). However, now I am worried that this problem may not get better or get worse. We are in the middle of contract re-negotiations as well. I am very worried as this could certainly be life changing in regards to career and health. Any advise and words of wisdom would be very appreciated. Link to comment Share on other sites More sharing options...
Guest JMPA Posted January 20, 2014 Share Posted January 20, 2014 if your injury occured on the job than it is a wc injury. if it occured when you awoke in the morning than most likely not unless you can relate it to repetitive movements and classify it as an occupational disease. that would be difficult but not impossible. Without a physical, i would take a potshot and say you most likely suffer from laxity but would recommend a MRI to rule out ligamentous injury. Link to comment Share on other sites More sharing options...
jdenning Posted January 20, 2014 Share Posted January 20, 2014 I was a hand therapist for many years prior to PA school. Not sure what to tell you about the work comp aspect of this. It sounds as though you may have had some degree of instability (probably the distal radio-ulnar joint) that was exacerbated by the lengthy scissoring. These type of problems are often chronic and can be disabling depending on occupation. You should ask to see a hand/wrist specialist who can better evaluate your wrist better than most Ortho folks. An MRI with fluoroscopic dye injection can determine the integrity of the distal radio-ulnar joint and whether surgical repair is needed. Whether or not you pursue this as work comp you need to let your employer know what's going on. Good luck Link to comment Share on other sites More sharing options...
Z PA-C Posted January 20, 2014 Share Posted January 20, 2014 Document everything!! I used to work in the work. comp. field and have seen how messy things can be when an injury did not clearly happen at time X on day Y while doing Z on the clock. It is important though that you tell your employer what's happening because the longer you wait to tell them the harder it is to defend your case if in fact something is wrong with your wrist. Link to comment Share on other sites More sharing options...
Moderator ventana Posted January 20, 2014 Moderator Share Posted January 20, 2014 sounds like it would be fraud to file a WC claim it was not an injury suffered at work "I woke up with it" Link to comment Share on other sites More sharing options...
KMD16 Posted January 20, 2014 Share Posted January 20, 2014 I agreed with the above. It wouldn't stick! It will makes you look bad. I see cases like this in my practice. Does your employer provide any form of disability insurance? If so, then, that would be your starting point/where to seek for help in the event your are not able to do your job. Link to comment Share on other sites More sharing options...
KMD16 Posted January 20, 2014 Share Posted January 20, 2014 OK. I re-read your post again and realized that your injury occurs morning of after a long day in surgery. If that's the case and if your job required repetitive use of your wrist & if the injury is in your dominant hand then it's MOST LIKELY a work related injury. It might be tough to fight it or proof your case & might requires a good WC attorney. Just saying. Link to comment Share on other sites More sharing options...
Guest JMPA Posted January 20, 2014 Share Posted January 20, 2014 I believe that it qualifies as a WC injury. You would need to be evaluated by a WC specialist, i suggest if you wish to take that route to see a wc attorney. the attorny may be able to give you some insight. it also depends on which state you reside and work in. If you are using wc to legitamitely treat an injury than you have no worry of fraud. most state wc regulations can be reviewed online without any associated fees. Link to comment Share on other sites More sharing options...
Nakasoner Posted January 25, 2014 Share Posted January 25, 2014 I believe this would be a viable work comp injury. Repetitive strain after a long surgery. Was it bothering you prior? Any past history of hand/wrist probs that impaired your ability to work, or caused you to seek care? The employer accepted you as is (Labor Code). While your employer might fight AOE/COE (causation), I believe you would prevail albeit a long and drawn out W/C process. You would most likely create an adversarial relationship with your employer and it would hamper your ability to work in your field of surgery and procedures. The question is is it worth filing a claim and opening up that box. It sounds like it would eventually get accepted as a work-related injury but their may be some apportionment to a pre-existing laxity if they can prove it was causing you some type of impairment prior to starting your current employment. Your other option is to continue to rest it, seek specialized help via hand specialists and diagnostic testing and try conservative care and bracing vs or surgical stabilization. Link to comment Share on other sites More sharing options...
Moderator ventana Posted January 25, 2014 Moderator Share Posted January 25, 2014 I would disagree on this being WC with out a very aggressive fight waiting 6 weeks and no reporting right when it happened will be held against you - and by your history is sounds debatable rather it is even a valid claim to begin with Link to comment Share on other sites More sharing options...
Acebecker Posted January 25, 2014 Share Posted January 25, 2014 I have seen 1 distal radio-ulnar joint subluxation and it was after a pretty good trauma. For yours to happen overnight is certainly rare. That said, I deal with a lot of workman's comp and there is that question of whether or not it was related; in your case, I'd start the paperwork or call the WC office and see what they have to say about it. Legally your employer has no grounds to come back at you on this. It's up to the WC office to prove it, not you. They'll ask for records... Probably all of them. You need to provide them, but otherwise they'll make the call. Andrew Link to comment Share on other sites More sharing options...
Guest Paula Posted January 26, 2014 Share Posted January 26, 2014 Don't hold your breath that the WC will be on your side. I witnessed a work injury to a co-worker who ended up having a cervical disk bulge from wheeling a 300 pound lady UP the ramp to the ER. She eventually had to have surgery. Her claim was denied and the injury was blamed on a horse riding accident she had when she was a teenager. No lie. The"special" WC physician ( who was hired by the WC company to give a second opinion) was a sham and the office she had to go to was in the back corner of a strip mall and the whole-foods saleslady was the receptionist. The exam room was in a closet. He spent less than 5 minutes with her and did not even examine her. The report he wrote was five pages long. I read it. She threatened to sue our employer and they agreed to pay for the MRI. Then they put lots of restrictions on her and the work environment became even more hostile. My co-worker had also gone to an excellent physiatrist for treatment initially because that is where the WC company first sent her. They didn't like his assessment that this was indeed a work injury and it would take surgery and PT to heal. It dawned on me that WC is not to protect the patient but to protect the employer. I had it wrong all the time....I thought it was all about getting the patient the right treatment for an injury sustained at work. Plus, as soon as my contract was over at that job I was out of there. My co-worker resigned. Hopefully your employer is fair-minded, but you must have all your paperwork and exams in order. Consider carefully what you will do. Link to comment Share on other sites More sharing options...
Moderator ventana Posted January 26, 2014 Moderator Share Posted January 26, 2014 Don't hold your breath that the WC will be on your side. I witnessed a work injury to a co-worker who ended up having a cervical disk bulge from wheeling a 300 pound lady UP the ramp to the ER. that just does not make sense!!! non-traumatic "bulge" in the neck from WHEELING someone up an assumed handicapped ramp..... sorry but I don't buy the story either..... unfortunately there are people out there that hurt themselves on Sunday and go to work on Monday and try to file a claim..... I had a guy who 2.5 weeks AFTER being out of work, came to me for low back pain and it just did not add up. Inconsistent exam findings, and then I watched up jog down our clinic steps, across the parking lot and jump into his jacked up full size pickup. He was trying to place a WC claim! Found out later that he had been FIRED 2.5 weeks earlier and now was fishing for $$$$ Flat out denied by WC WC is for injuries on the job that prevent you from working, it is not everyone's personal disability policy - you want a disability policy (you should have one as a PA) then go buy it! The things adjusters look for immediate reporting of a verifiable work place injury which happened at work and was witnessed RED flags Delay in reporting unwitnessed injury non-verifiable injury soft tissue "pain only" complaints Prior injury or WC claims (people make a living out of doing this) I don't mean to be negative but before being a PA I was Bodily Injury Claims adjuster for a few years (could not leave that profession fast enough bc it is simply is a wrought with fraud and immoral activity from both claimants and attorneys who just want a check. ) The few true honest injuries were a joy to deal with , but even with those it got to be abuse by the claimants who viewed it as their retirement fund. On a side note - yes you should indeed have a personal disability policy restricted to same profession coverage which you pay for with AFTER tax monies so that if you ever need to use it your disability payments are tax free. This will protect you to 65 and allow you to remain out of work should you become disabled from ANY type of injury. And the last comment - make sure you have at least 250,000/500,000 dollar uninsured/under insured on your automobile insurance policy. This is insurance you buy to protect yourself if you are ever hurt while in, on, around a moving vehicle (ie riding a bike, passenger in a car, struck by a car). If I got hit by a car when walking I could claim against my own insurance company for up to $250,000 no matter rather the other vehicle was ever found or identified. That protects myself and my family....... Link to comment Share on other sites More sharing options...
Guest Paula Posted January 26, 2014 Share Posted January 26, 2014 Truth is stranger than fiction. Link to comment Share on other sites More sharing options...
TPA16 Posted February 4, 2014 Share Posted February 4, 2014 TFCC Instability/ peripheral tear Link to comment Share on other sites More sharing options...
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