The most prevalent type of workers compensation injuries are the injuries to the musculoskeletal system. The musculoskeletal system is the muscles, bones, tendons, ligaments, and joints that control the movement of the human body. The doctors most involved in these types of injuries are the orthopedics. The treatment for the musculoskeletal injuries can be as varied as the type of injuries that can occur to musculoskeletal system.
Almost all musculoskeletal injuries involve some degree of pain. The pain can vary from mild to severe depending on the extent of the injury and the employee’s threshold for pain tolerance. Pain is usually local to the site of the injury, but in some injuries it can be diffused (covering an area larger than the injury). The body areas with the most injury claims with resulting pain include:
- the neck
- the shoulders (right side or left side)
- the back (upper, middle and lower)
- the wrist (left or right)
- the knee (left or right)
- the ankle (left or right)
Both diagnostic testing and pain medication may be provided at the start of the treatment for musculoskeletal injury. The pain will be alleviated by correcting the cause of pain, but in the meantime, the doctor will provide the employee with medication to control the pain. This will involve analgesics like acetaminophen for mild pain, nonsteroidal anti-inflammatory drugs for stronger pain, and opioids for severe pain.
The type of diagnostic testing needed for the musculoskeletal injury will vary. If the employee incurred a fall or an object fell on the employee, the doctor may expect a fracture of a bone and will utilize x-rays to confirm a fracture in a bone. X-rays only show images of the bones x-rayed, they do not show any other part of the musculoskeletal system.
If the x-rays confirms a bone fracture, but the x-rays do not provide enough detail for the doctor, the doctor will request a computed tomography (CT) scan to get a better picture of the fracture and the damage to the bone.
If X-rays and/or a CT scan do not identify the problem; the next step normally taken by the doctor is to request a magnetic resonance imaging (MRI) of the injured area. Unlike x-rays and CT scans that show damage to bones, the MRI will produce highly defined images of the joints, identifying abnormalities (injuries) to the muscles, ligaments and tendons. The MRI is commonly used for injuries to the knees, shoulders, wrist, neck and back.
The doctor will review the results of the x-rays and/or the CT scan and/or the MRI to determine the precise nature of the musculoskeletal injury. With the results of these tests, the doctor will decide on the best course of action to treat the injury.
The injury will often interfere with the proper movement of the injured body part. With fractures, immobilization of the bone(s) is the normal course of action to allow the fracture to heal. If the fracture is severe and the bones are displaced from their normal position, the orthopedist will surgically correct the alignment and may use surgical screws, pins or plates to hold the bones in place until they can grow back together.
With damage to ligaments, tendons and cartilage, the doctor will consider several different treatment options. If the damage is minor, the doctor discusses with the employee the option of leaving the injured part alone and letting it heal with time. If the injury needs repairing and is in a joint – the shoulder, elbow, wrist, knee or ankle – the doctor will first consider whether or not the employee is a candidate for arthroscopic surgery. In arthroscopic surgery, the doctor uses a small scope which is inserted in the incision to see the extent of damage and guide the necessary surgical repairs with specially created instruments designed for this type of surgery. The employee benefits from having a minimally invasive procedure to repair the damage and has lesser post surgery associated pain. The work comp insurer benefits by having the employee able to return to work in a shorter period of time.
If the damage is severe to musculoskeletal system, the doctor will perform reconstructive surgery on the damage body part in an effort to restore its function. Reconstructive surgery results in a larger incision, a longer healing period and a greater level of pain in the area of the surgery, then other, less invasive treatments.
The most difficult musculoskeletal injuries to treat are those involving the spine. Spinal fractures, especially those involving degenerative disk diseases, can create significant pain for the employee. Surgical procedures to correct the spine fracture vary. The least invasive technique is vertebroplasy where surgical bone cement is injected into the vertebrae to stabilize the fracture while it heals.
The most common surgical procedure on the spine is the laminectomy where a part of the vertebrae is removed. There are various levels of laminectomy from small incisions with minor scraping of the bone to large incisions with the entire posterior backbone is removed along with overlying ligaments and muscles.
The severity of the musculoskeletal injury determines the course of the medical treatment. If the injury does not require surgical intervention, the course of treatment will often entail physical therapy, or occupational therapy. If the injury does require surgically intervention, once the employee has recovered enough, the doctor will also start a program of physical therapy or occupational therapy.
The therapy is designed to provide the employee with exercises to stretch and strengthen the injured body part. The therapist may also use hot packs and cold packs, whirlpool treatments, electrical stimulation and ultrasound to treat the injured body part. The therapist will also teach the employee conditioning exercises to prevent future injury.
Musculoskeletal injuries will continue to be the most type common workers compensation claims. Many of them can be eliminated through a strong safety program. When they do occur, the employer needs to understand the nature of the injury and the type of treatment that is provided to the employee.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact:RShafer@ReduceYourWorkersComp.com
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