Neck Injuries in Maryland Workers Compensation Claims
Neck injuries in a Maryland Workers Compensation claim create numerous issues that often result in insurance companies refusing to pay for necessary treatment unless ordered to do so by the Maryland Workers Compensation Commission.
Issues include the following:
- Was there a preexisting neck problem? It is not unusual for someone who has had neck problems in the past to aggravate that prior condition by a work- related injury. Maryland Workers Compensation law provides that any exacerbation or accelerations of a pre-existing condition is covered by Workers Compensation. Under Maryland law the employer and Insurance company must take the claimant where they find him. Meaning there is no defense that the person was already susceptible to this kind of injury. If the work-related injury made the condition worse whether as a temporary aggravation or permanently worse than the workers compensation insurance company will have to pay for the medical treatment.
- What if the claimant had a herniated disc before the work- related accident, but now after the work- related accident the doctor wants to do surgery on the same disc that was already herniated before the accident. As long as the need for surgery was made necessary as a result of the work- related accident or the need for surgery was accelerated by the work- related accident, then the surgery will likely be found to be related to the work- related accident. If employee had a herniated disc before the accident and was able to treat it without surgery, but now, since the work- related accident the only way to treat the neck is with surgery, then the Workers Compensation Commission is likely to find the surgery related to the work- related injury.
- When an employee is told that he may need surgery on his neck in the future, but then the employee injures his neck on the job and needs immediate surgery. If the employee can prove that the need for surgery was accelerated by the accident, then the surgery can be found to be work- related.
- Doctors often disagree as to whether neck surgery will help. Neck surgery is often a last resort when all other treatments have failed. Studies suggest, that in the workers compensation arena, few employees injured on the job show significant improvement after having neck surgery and often, the employees are actually worse. Second opinions and careful thought are necessary before an employee should decide to have neck surgery. Even if the Doctor promises you relief and success, this promise does not mean that a patient can- not have an unsatisfactory result.
- Doctors can often disagree as to what body part is causing the injured workers condition. Symptoms involving the neck can include, sore neck, stiffness or pain in shoulders, numbness and tingling in arms and fingers as well as pain in these areas. However, these same symptoms can also be caused by injuries to the shoulder like a rotator cuff injury, injury to the brachial plexus, injuries to the arm like ulnar tendonitis, or injuries to the hand like carpal tunnel syndrome. Doctors after gathering mri, emg, and x-rays may think they know the cause of your symptoms and perform surgery on the neck, only to find out later that the cause of the symptom was another body part and then offer to provide surgery to the other part of the body.
- If a temporary aggravation of your underlying neck condition has returned to pre-injury condition, the workers compensation commission may find that any treatment from that point on is not related to the new work- related accident, but relates back to the medical problems the injured employee was having prior to the accident.
What are the symptoms of a cervical (neck)herniated disc:
- Dull or sharp pain in the neck or between the shoulder blades, which can intensify in certain positions or after certain movements.
- Pain that radiates down the shoulder, arm to the hand or fingers (this is called radiculopathy
- Numbness or tingling in the shoulder or arm.
Millions of people suffer from neck, shoulder, and arm pain. While there are numerous conditions that can result in this type of pain, a common cause is a herniated disk in the neck. Discs, which act as shock absorbers for the spine, are located in between each of the vertebrae in the spine. Each disc contains a tire-like outer band that surrounds a gel-like substance
A herniation occurs when the outer band of the disc breaks or cracks and the gel-like substance from the inside of the disc leaks out, placing pressure on the spinal canal or nerve roots. In addition, the nucleus releases a chemical that can cause irritation to the surrounding nerves causing inflammation and pain.
Most Cervical Disc Herniations occur as a result of sudden stress. This occurs during movements resulting in sudden flexion, extension, or twisting of the neck, such as during a fall or auto accident. Sometimes herniations occur gradually, over weeks or months. However, there are risk factors that can contribute to the chances of a disc herniation, including:
- Aging. As we get older, discs gradually dry out, affecting their strength and resiliency.
- History of major or minor trauma to the cervical spine.
- Lifestyle choices. Lack of regular exercise, not eating a well-balanced diet, and tobacco use substantially contribute to poor disc health.
- Poor posture, incorrect and/or repetitive lifting or twisting can place additional stress on the cervical spine.
A herniated disc in the neck can cause severe pain and symptoms that disrupt a person’s quality of life. However, most symptomatic herniated discs end up resolving on their own. Some studies indicate that cervical radiculopathy from a herniated disc can to start feeling better within 4 to 6 weeks, although some symptoms may last up to 6 months, and more than 80% of cases are symptom-free within 2 to 3 years.
What is the treatment for neck injuries?
The good news is that most cases of cervical disc herniation do not require surgery! There are a number of non-surgical treatments that can help relieve symptoms. A herniated disc cannot be repaired or healed back to a normal state, so the primary goal of treatment is to minimize pain until the inflammatory proteins dry out and symptoms subside. Typically, nonsurgical treatment options will be tried for at least 6 to 12 weeks. If nonsurgical treatments are not providing relief and neurological deficits persist or worsen, such as numbness or weakness in the arm, surgery may be considered as a last option.
Non- operative treatment includes the following:
- Pain medications such as anti-inflammatories to reduce swelling and pain, muscle relaxants to calm spasm, and narcotic painkillers to alleviate acute pain.
- Heat/cold therapy, especially during the first 24-48 hours.
- Physical therapy exercises such as gentle massage, stretching, and neck bracing or traction to decrease pain and increase flexibility.
If non-operative measures do not work, surgery may be recommended. An anterior (from the front) cervical discectomy is the most common surgical procedure to treat damaged cervical discs. The goal of this procedure is to relieve pressure on the nerve roots or on the spinal cord by removing all or part of the damaged disc.
During the surgery, the soft tissues of the neck are separated to expose the offending disc. The disc is removed, to decompress the spinal cord or nerve roots. If necessary, the space left by the removed disc will be filled with a bone graft – a small piece of bone usually taken from the patient’s hip. The bone graft is used to join or fuse the vertebrae together. This is called a fusion. In some cases, some instrumentation (such as plates or screws) may be used to help promote fusion and to add stability to the spine.
During posterior cervical surgery, a portion of the bone covering the nerve may also need to be removed. This procedure is called a laminectomy.
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