One of the most difficult problems in occupational medicine can be determining if an employee’s complaints are from an injury or from degenerative changes that are seen with normal aging. While the mechanism of claimed injury and the past medical history are the strongest determinants, clinicians must evaluate all aspects of the injury in order to get a clear picture.
“It is possible for a degenerative process like arthritis of the back to be very ‘quiet’ while it is progressing,” says Dennis J. Straubinger, DO, MPH, MRO, occupational medicine physician at Saint Francis Medical Center. “Employees may have no more than an occasional backache until a traumatic event like a fall or a lifting episode causes the problem to come to a head. Then they may have nothing but daily pain going forward.”
“The clinical examination may help differentiate,” Straubinger continues. “Some factors are obviously acute: dislocation, active bleeding and sharp fracture lines at the painful site. Some finding suggests a more chronic or degenerative cause: the presence of crystal deposition or arthritic changes on routine X-ray. Some findings may be innocent bystanders: a herniated disc at a level of the spine not associated with the region of pain and numbness in the body.”
In some cases, tests can help confirm causality but are costly and often not enough to solve the puzzle. For example, magnetic resonance imaging (MRI) may show that the problem is widespread — making it difficult to pinpoint that one part that was injured at work.
The 2005 Missouri workers’ compensation law modified the definition of “injury” by limiting the definition to allow compensation only if the accident was the prevailing factor in causing the condition. It also stresses the importance of objective medical findings versus subjective medical complaints. These changes highlight the need for careful medical consideration and thorough documentation.
The bottom line? There is no easy formula to determine whether an injury is degenerative or acute. Each incident must be interpreted by an experienced examiner in the context of a patient’s medical history, test results and clinical condition.
To learn more about dealing with workers’ compensation cases or pre-employment practices, call Saint Francis’ Services to Business at 573-331-5825.