Knee workplace injuries are very common in the workers’ compensation claim ecosystem. The Department of Labor and Industries (L&I) studied the frequency of knee claims from 1999 through 2007. In conclusion, they found that 7% of all claims involve knee conditions. Practically speaking, that translates into roughly 25,000 knee work injury incidents in under 10 years. According to L&I, knee injuries happen mostly to workers in carpentry, truck driving, nursing aid, and housekeeping. The purpose of this article is to provide more insight into L&I claim for knee injury.

Knee workplace injury

The knee is a complex joint. It’s where the lower leg and upper leg join. In other words, the knee joint is the meeting point for the shin and thigh. This important joint must bear weight and connect two large leg bones. That means it must be strong, flexible, and stable. Consequently, there are many important parts of the knee joint that make it function.

The patella (also known as kneecap) is at the center of the knee. There is a medial (or inner) meniscus and a lateral (or outer) meniscus. The meniscus is a tough half-moon looking piece of cartilage that cushions and absorbs shock in the joint. There are also four ligaments in the knee connecting the bones. These ligaments are the medial collateral ligament, posterior cruciate ligament, anterior cruciate ligament, and fibular collateral ligament. According to L&I, of the four types, the medial collateral and anterior cruciate ligaments are the most susceptible to workplace injury.

Then, there’s bursae, which are fluid sacs that surround the knee joint. They help with communication and lubrication in the joint. The bursae act like a cushion and reduce friction inside the joint. The knee also has tendons and muscles. They connect muscles and bones and provide strength and stability to the joint. Unfortunately, all these parts of the knee are susceptible to work injury as well as wear and tear.

L&I data about knee injury at work

In work setting, there are many ways knee injuries occur. There are also many work activities that place extra stress on the joint and increase wear and tear over time. Clearly, knee injuries and common wear and tear can also occur outside work.

In my experience, knee conditions in an L&I claim vary from fairly minor to extremely severe. Doctors often initially diagnose knee conditions as sprains or strains, which we discussed previously. However, according to the data collected by L&I, work-related knee conditions also include meniscus damage and ligament damage. They also include a condition called chondromalacia patellae, tendonitis, bursitis, and enthesopathy. Of course, a serious traumatic work injury can also cause bruising, fractures and breaks in the joint.

L&I guides and publications for knee work injury and conditions

L&I studied workplace injury knee conditions extensively. Therefore, there’s plenty of guidelines for treating knee conditions. In 2017, L&I published a 50-page document outlining conservative care options for work-related knee conditions. The document describes and breaks down treatment options. Also, it offers treatment timelines and contains specific diagnosis, resources, and recommendations.

Generally, L&I’s treatment protocols prefer to try all conservative options. If they fail, then doctors recommend more invasive treatment. Interestingly, L&I published surgical guidelines for work-related knee injury in 2016. This 28-page document outlines the criteria that L&I uses to authorize treatment. Moreover, it covers a variety of surgical procedures appropriate for specific situations.

Notes and summary

In summary, the knee is a complex joint. Knee damage as a result of work activity is fairly common. Furthermore, there are many parts of the knee that can suffer an injury. Knee injuries can be minor, or they can be severe. In fact, there are instances where minor knee damage becomes more severe over time.

L&I studied knee conditions and has many resources for work injury claimants. The same resources are also used by your workers’ compensation attorney, as well as the attending physician on your L&I claim. Specifically, medical providers can use these valuable resources to help ensure knee claims progress appropriately.

Shoulder work injury, and workplace disease involving shoulders, are fairly common. In fact, there are many ways shoulder work injuries can occur. There are also many industrial disease processes that affect shoulders. For instance, when work requires repetitive and heavy use of the arms and shoulders. Like many conditions in L&I claim settings, the cause (or causes) of the shoulder problems frequently becomes an issue.

Shoulder work injury: sprain and strain

Doctors sometime diagnose a workplace injury as sprain or strain. In essence, these usually refer to soft tissue injuries. Here, soft tissues are things like muscles, tendons, and ligaments. These kinds of injuries are extremely common in the workman’s compensation claim ecosystem. Many work activities like reaching over head, lifting, pushing, and pulling cause shoulder sprains and strains. In my experience, medical providers don’t always define sprains and strains the same way.

Some providers use the two terms interchangeably. In general, sprains mean that there’s a damage to tissues connecting bones. In contrast, strains reflect damage to muscles or tissues attaching a muscle to a bone. Sprains and strains can be stretching, tearing, or fraying of the soft tissue. Symptoms include pain, bruising, and swelling. Sprains and strains usually resolve within weeks or a few months. Also, treatment is conservative. For example, over the counter pain relievers, ice, heat, and physical or massage therapy. A cortisone or steroid injection may also be an option for reducing pain and swelling.

Shoulder impingement as a condition in an L&I claim

Shoulder impingement happens following pinching of soft tissues in the shoulder. Usually, the pinching happens during arm movement. The result is pain, swelling, and sometimes weakness. In a workers’ compensation claim, overhead work activities may cause shoulder impingement. Like sprains and strains, doctors often treat shoulder impingement conservatively. Many times, treatment can include physical therapy, home exercise, or injections.

Shoulder tear due to work activity

There are different kinds of shoulder tears that can occur. The most common kinds of tears I see in the workers comp setting are rotator cuff tears and SLAP tears. Rotator cuff tears happen when a rotator cuff tendon rips, either partially or in full. Partial tears are more common. They can sometimes occur without experiencing any symptoms. However, when symptoms are present, they might include pain, stiffness, weakness, and difficulty moving the arm. Personally, in my experience, rotator cuff tears are very common in construction work injury and among healthcare workers. Frequently, repetitive overhead work activities are the culprit. For care, doctors might recommend a variety of treatment options depending on the severity of the tear. Treatment may be conservative like physical therapy or injections. Other times, surgery may be considered if the tear is severe.

SLAP is the abbreviation for “Superior Labrum Anterior Posterior”. SLAP tears involve the labrum. The labrum surrounds the shoulder socket. A SLAP tear is when the tear is in the upper part of the labrum. Here, the tear extends to the back and to the front. Symptoms may include deep pain, popping, clicking, and difficulty sleeping. SLAP tears can happen because of a sudden injury or they can develop over time. Work injury occurrences that may cause a SLAP tear include heavy lifting, a blow to the shoulder, or falling on an outstretched arm. On top, repetitive overhead work activities can cause a SLAP tear over a period of time. Medical providers usually treat SLAP tears conservatively – initially with things like physical therapy and pain management. If conservative treatment fails, then surgery may be necessary.

Frozen shoulder in the workplace

Some refer to the condition frozen shoulder as “adhesive capsulitis”. People that suffer from this condition characterize it as stiffness or inability to move the shoulder joint. This happens form thickening of the shoulder capsule. In some cases, it comes from developing tissue adhesion or scar tissue. Frozen shoulder usually starts with mild symptoms that progress in stages. Initially, symptoms include general aching and sharp pain with movement. Over time, the range of motion decreases.

With the decrease, patients usually report pain and difficulty doing basic daily-living activities. However, if you receive appropriate treatment, the symptoms dissipate, and shoulder activity returns to normal. This can happen in a matter of months. Unfortunately, the symptoms of frozen shoulder can also linger for years. Normally, I see frozen shoulder in workers compensation claim instances following an acute workplace injury.

Shoulder arthritis and joint instability in workers’ comp claims

Unlike soft tissue injuries, arthritis involves significant wear-down of supportive tissue and cartilage in the shoulder. When there’s significant loss of cartilage, the bones in the shoulder joint may become unstable. Specifically, instability refers to looseness in the shoulder joint, which is a ball and socket joint. Simply put, the ball begins to slip in the socket. Sadly, sometimes it can dislocate entirely.

It’s important to know that a sudden work injury damaging the shoulder tissues and ligaments can cause traumatic instability. Yet, it’s also common for instability to develop due to wear and tear over time. If the slippage becomes too severe, treatment may include partial or total joint replacement surgery.

Shoulder work injury and causation

Causation tends to be an issue when more significant shoulder conditions develop. After all, shoulders are an important joint in the human body. They tend to wear down over the years due to various daily activities. Therefore, when a shoulder injury or condition isn’t purely traumatic in nature, it can be challenging to determine whether work activity is a contributing factor.

Generally, if your work requires repetitive shoulder joint activity, especially overhead, there is higher likelihood of a causal connection between work activity and the shoulder condition. Similarly, if a work injury claimant has no shoulder symptoms prior to a work injury but becomes symptomatic after the workplace accident, under the law, there’s likely a causal connection.

Summary and final comments

In summary, the topic of shoulder injury is complex. We use our shoulders very frequently. There are many parts of the shoulder that can suffer a damage due to work injury or workplace activities. Moreover, there are a variety of shoulder medical conditions. Furthermore, one condition may cause or progress into another, and treatment usually begins conservatively.

For me, it’s important to monitor if conservative treatment fails. It’s also critical to track if more severe conditions develop. When that happens, you should ask your doctor or workers’ compensation attorney for assistance. Why? Because you want to ensure that causation does not become a barrier to coverage under your L&I claim in Washington State.

There are many ways for workers to suffer nerve damage in a work injury or work-related disease. For example, when nerve trauma or nerve compression occurs in a workplace injury, it can lead to nerve pain and damage. Another example is a work injury that pinches spinal nerves at the root. Such an injury can cause radiculopathy, which is a type of neuropathy. Furthermore, a workplace injury that crushes the nerve endings may cause peripheral nerve damage. Peripheral nerve damage can also come from diseases such as carpal tunnel syndrome (CTS) and autoimmune disorders. In this article, we cover specific issues relating to L&I claim involving radiculopathy and nerve damage.

Radiculopathy in L&I Claim

Radiculopathy is a common type of nerve damage in work injury and industrial disease workers’ compensation claims. The symptoms occur when a nerve root in the spine is pinched. Many times, radiculopathy can occur in the upper part (or neck part) of the spine, called the cervical region. It can also happen in the middle back, which we refer to as the thoracic region. On top, it can occur in the low back, also known as the lumbar and sacral regions.

Symptoms of radiculopathy include weakness, numbness or tingling. However, different individuals might feel the symptoms in different parts of their body. It all depends on the spinal region and location of the pinch. One well know form of radiculopathy is Sciatica. People often describe sciatica as shooting pains, numbness or tingling down one leg or both legs. Workers experience this type of radiculopathy when the nerves are pinched in the low back.

Peripheral neuropathy in workers’ compensation claim settings

Peripheral neuropathy is a different kind of nerve pain and damage. It doesn’t originate from the spinal nerve root. Peripheral nerves transmit information between the brain and other parts of the body. Moreover, our senses depend on peripheral nerves. For example, they help us feel when something is cold, hot, or sharp. Peripheral nerves are made of fibers. Interestingly, they are insulated by body tissue. They are fragile and they can experience damage easily.

When damage occurs, it impacts the communication between the brain and other body parts. For instance, if the damage is to motor nerves, it can cause difficulty controlling movements or uncontrollable muscle spasm. On top, if the damage is to sensory nerves, it can make it difficult to sense pain or to walk. In addition, it can be difficult to maintain balance or perceive temperature changes. Finally, when the damage is to autonomic nerves, it might impact subconscious functions like blood pressure, breathing, body temperature regulation, and digestion.

In particular, Carpal Tunnel Syndrome is a common work disease that involves peripheral nerve damage. Here, when the peripheral nerves in the wrist and forearm suffer inflammation, then people feel numbness, tingling or burning in their hands and fingers.

Work injury as cause for nerve damage and pain

You’d expect that it’ll be easy to figure out if a workplace injury or industrial disease causes nerve damage or pain. However, there are many non-occupational factors and conditions that can cause nerve problems. For one, diabetes and alcohol abuse are common causes of peripheral neuropathy. Many non-occupational autoimmune disorders also cause neuropathy. Consequently, it can be very difficult to determine the cause of nerve pain or damage. To complicate matters, people might have a preexisting disease like diabetes before their work injury or workplace illness.

Neuropathy in IME exams

Recently, I noticed a new trend. Independent Medical Examiners (IMEs) say that neuropathy is from non-work or non-occupational causes. Also, they say the other causes are genetic factors like gender, or diabetes and alcohol use. I don’t dispute these other factors cause neuropathy. Yet, I think they are taking the easy way out. More explicitly, they are using other conditions too often as convenient excuse for L&I or self-insured employers to avoid covering neuropathy in L&I claims.

When this happens, you must get a clear picture of the work injury claimant’s preexisting health. For that, you must order records from primary care providers or specialists that treated preexisting conditions. In fact, little time and effort collecting this data can go a long way. It can help medical providers formulate a more accurate opinion regarding causation. Sometimes, prior health records show neuropathy before the work injury or workplace disease. However, in many cases there are no previous records or symptoms.

The opinion of a workers’ compensation attorney

Very often, there are no documents or medical history that show prior symptoms. In such cases, it helps us show that symptoms stem, on a more-probably-than-not basis, from the work injury. Furthermore, when there’s objective medical evidence showing that symptoms  relate to the work injury or disease, then it’s even more likely that a causal connection exists.

Neuropathy is a serious condition. It requires knowledgeable treatment to help eliminate long term issues. When the Department of Labor and Industries (L&I) or self-insured employers deny coverage, it can be a major setback for work injury claimants. It can seriously hinder their recovery. Therefore, it’s important to make sure that the causal connection to the work injury or work-related illness is well-documented, to try and prevent treatment delays.