SUMMARY DECISION NO. 1121/99I. Adjournment (additional medical evidence).

Transcription

1 SUMMARY DECISION NO. 1121/99I Adjournment (additional medical evidence). The hearing of the worker's appeal was adjourned to obtain a report from a Tribunal medical assessor. [5 pages] DECIDED BY: Carroll DATE: 04/08/99 ACT: WCA

2 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1121/99I [1] This appeal was heard in Toronto on June 23, 1999 by Tribunal Panel Vice-Chair, Thomas Carroll. THE APPEAL PROCEEDINGS [2] The worker appeals the decision of Ms. T. Cerone, Appeals Officer at the Workplace Safety and Insurance Board, dated November 12, [3] The worker attended and was represented by Mr. Peter Walker of the Office of the Worker Adviser. [4] The employer was represented by Mr. Charles Tahirali, consultant. Mr. Steve Kuris, operations manager with the employer, attended as an observer. THE EVIDENCE [5] The Vice-Chair heard evidence under oath from the worker and considered the following documents: Exhibit #1: Case Record Exhibit #2: Addendum No.1 to the Case Record Exhibit #3: Addendum No.2 to the Case Record THE NATURE OF THE CASE [6] The worker has been diagnosed as having adhesive capsulitis of the left shoulder, frozen left shoulder and adhesive capsulitis with rotator cuff tendinitis. On September 19, 1997 the worker underwent a left shoulder arthroscopic subacromial decompression. [7] On January 19, 1996 the worker suffered a work related staple gun injury to her left thumb. [8] The worker attributes her left shoulder condition to the work related injury of January 19, The Appeals Officer, T. Cerone denied the worker s claim for benefits in regard to her left shoulder condition. THE REASONS [9] After the taking of evidence and consideration of documents, the Vice-Chair determined that he would issue this interim decision. In this interim decision, the Vice-Chair reviews his findings of fact

3 Page: 2 Decision No. 1121/99I regarding this worker s accident, her symptoms in regard to her left thumb and left shoulder, her treatment and relevant medical opinions. [10] Based upon the findings set out by the Vice-Chair in this interim decision, the Tribunal Counsel Office will be directed to obtain additional medical evidence. (i) The Vice-Chair s Findings of Fact [11] On January 19, 1996, this 42 year old female worker suffered a work related injury when using a staple gun. She discharged a staple into her left thumb. The injury was described as a puncture wound to the left thumb. The wound was on the volnar surface of the thumb just below the IP joint. Complete recovery was expected within ten days. Work restrictions required no use of the left hand. [12] X-rays taken of the worker s left hand in January and March 1996 found no fracture or bony abnormality. Bone structure was reported to be normal. [13] In March 1996 the worker was diagnosed with a left thumb strain injury. The worker had been treated with heat, soft laser, ultrasound and exercises. Her restrictions at that time were to avoid manual dexterity work with the left hand and thumb. [14] The worker returned to work on March 11, 1996, but was only able to work one day. The worker reported pain and swelling in the left thumb with swelling and pain to the left wrist. The worker was sent for physiotherapy for her left hand and was prescribed anti-inflammatory medication. Physiotherapy continued for eight weeks. [15] The worker first reported pain in her left shoulder to her family doctor on April 20, She also reported left shoulder pain to her family doctor on May 7 and 14, and July 22 and 31, The worker reported left shoulder problems to Dr. F. Lista, plastic surgeon, on August 13, [16] The worker also reported left shoulder pain on September 9, 1996 while attending the Board s Downsview Rehabilitation Centre. The diagnosis was partially frozen left shoulder and a puncture wound to the left thumb. Insulin dependent diabetes mellitus was noted as a significant co-existing condition. Physiotherapy was recommended. [17] On October 16, 1996 the worker was examined by Dr. M. McKee, orthopaedic surgeon., Dr. McKee believed the worker had adhesive capsulitis and rotator cuff tendinitis. He did not think that the worker s shoulder stiffness was related to the worker s thumb injury. [18] The worker saw Dr. D. F. Wilson, orthopaedic surgeon, in November Dr. Wilson found x-rays of the left shoulder were unremarkable and a bone scan described a synovitis. Dr. Wilson diagnosed a frozen shoulder. On November 19, 1996 Dr. Wilson manipulated the worker s left shoulder and injected the shoulder with 80 milligrams of depo metrol. Dr. Wilson opined that the worker s shoulder injury was related to the worker s thumb injury.

4 Page: 3 Decision No. 1121/99I [19] Dr. R. T. Manktelow, orthopaedic surgeon, examined the worker s left hand on December 17, He found that the worker had a little bit of post-traumatic stiffness on the dorsum of the thumb. Dr. Manktelow did not think there would be a permanent disability and that the worker should obtain a full range of movement of the thumb without discomfort. [20] On May 1, 1997 the worker was again seen by Dr. D. F. Wilson in regard to her left shoulder. Dr. Wilson believed the worker had plateaued in regard to her physiotherapy. The worker continued to have impingement-like left shoulder pain. Dr. Wilson referred the worker to Dr. R. Saplys. [21] Dr. R. Glofcheskie at the Board did not believe the worker s shoulder problems were related to the worker s left thumb injury and the worker s claim in regard to her left shoulder was denied. [22] In May 1997 Dr. Saplys, orthopaedic surgeon, diagnosed the worker with adhesive capsulitis of the left shoulder. Dr. Saplys operated on the worker on September 19, The doctor performed a left shoulder arthroscopic subacromial decompression. The worker underwent further physiotherapy for approximately two months. Dr. Saplys set the worker s restrictions of the left shoulder as no activities involving repetition at or above shoulder level. It was Dr. Saplys opinion that the worker s left shoulder symptoms were likely related to her staple injury to the left thumb. He felt the worker s diabetes may be an aggravating factor. [23] The worker testified at the hearing and the Vice-Chair accepts as fact that the worker has no difficulties with any other of her joints save for the left shoulder. The worker has had no accidents that have involved injury to the left shoulder. [24] The worker continues to have pain in the left shoulder. She has not worked since March 11, The worker was diagnosed as a diabetic in approximately 1984 and has been taking insulin from approximately (ii) Conclusion [25] Before the hearing of this matter convened, Tribunal Counsel provided the Vice-Chair with a discussion paper titled Shoulder Injury and Disability written by Dr. Harris K. Uhtoff, orthopaedic surgeon, dated March This was marked as Exhibit #3 at the hearing. [26] Having heard evidence from the worker, and having had the benefit of submissions from the representatives for the two parties, it is the Vice-Chair s view that it is necessary, considering the conflicting medical opinion, that additional orthopaedic expert opinion is necessary. [27] The Vice-Chair therefore, instructs the Tribunal Counsel Office to refer this interview decision to a different orthopaedic specialist and to seek an opinion upon the following questions: 1. What is the most likely diagnosis of the worker s present medical condition of the left shoulder? Please explain how you reached your conclusion.

5 Page: 4 Decision No. 1121/99I 2. Please explain the term frozen shoulder in relationship to your answer to question 1. Is the worker suffering from the condition known as frozen shoulder? 3. What is the relationship of the most likely diagnosis of the worker s left shoulder to her thumb injury of January 19, 1996? Did the left thumb injury cause or contribute to the worker s left shoulder condition? Please explain your conclusion. 4. Is it medically plausible that the worker would experience related pain in her left shoulder three months after her left thumb accident of January 19, What is the relationship, if any, between diabetes mellitus and shoulder problems (tendinitis, adhesive capsulities, frozen shoulder)? Does this relationship, if any, have application in this case? Please explain your conclusion. 6. Is the assessor able to provide the Vice-Chair with additional literature or other evidence regarding the relationship of shoulder problems (tendinitis, adhesive capsulities, frozen shoulder) and diabetes mellitus. 7. Provide any additional information which you feel would be helpful in understanding the worker s condition and its aetiology. [28] The Vice-Chair will receive the opinion of the assessor based upon these findings of fact contained in this interim decision, and the assessor s review of the case materials. If the assessor recommends a physical examination of the worker, the Vice-Chair will consider the request in conjunction with discussions with the worker s representative. [29] Upon receipt of the assessor s opinion, the representatives of the worker and employer will have an opportunity to review the assessment and make further written submissions. THE DECISION [30] The decision is deferred pending receipt of additional medical evidence. DATED: This 4 th day of August, SIGNED: Thomas Carroll