- Orthopedic and Neurologic Injuries
- Pulmonary Disease/Lung Disease
Orthopedic injuries can include injuries involving the spine, bones, joints, muscles, nerves and other parts of the skeletal system. Neurologic injuries are injuries involving the nervous system. Together they are the most common types of injuries for which people file New Jersey Workers Compensation claims. Often one injury will cause disability in the orthopedic and neurologic spheres. These injuries can be the result of specific accidents; such as slip and falls, construction accidents and motor vehicle accidents. However, they can also be the result of repetitive motion injuries. By example constant bending and lifting can cause a back injury or constant typing can cause a wrist injury. Some of the more common orthopedic and neurologic injuries are as follows:
- Herniated Disc - This is a rupture of the disc (nucleus pulposis) so that it protrudes out into the spine. It is a very serious injury. This is especially true when the disc extends outward and touches a nerve in the back. This type of nerve involvement will often cause increased pain in the back, with a radiating pain and numbness into the arms, legs, fingers and/or toes. Treatment options range from physical therapy to epidural injections to back surgery. The most common type of surgery to repair a herniated disc is a laminectomy and fusion.
- Bulging Disc - This is a less severe injury than a herniated disc, but it still can be very painful. A bulging disc does not represent a full rupture of the nucleus pulposis. Instead, the disc is pushed out beyond its usual shape. As the name would suggest, it bulges. If the bulge puts pressure on a nerve root it can cause significant pain, along with numbness and tingling. Treatment options include physical therapy and epidural injections, but likely not back surgery.
- Torn Rotator Cuff - This is a shoulder injury. The rotator cuff is part muscle and part tendon. It connects the upper part of the arm (humerus) into the neck. It helps raise and lower the arm. You may sustain either a partial rotator cuff tear or a full rotator cuff tear, with a full tear being more severe. This type of injury causes pain and loss of function. Although physical therapy is usually given a chance to relieve the condition, generally surgery is required. Arthroscopic surgery is most commonly used. However, at times open surgery is necessary, which may also require debridement or placement of screws or other devices. Other common shoulder injuries include shoulder dislocation, shoulder impingement and frozen shoulder.
- Torn Meniscus - This is a knee injury. The knee has three menisci; the anterior meniscus, the medial meniscus and the lateral meniscus. These are fibrous cartilage that provide support and cushioning to the knee. The menisci do have some healing power, so at times physical therapy will be successful. However, if physical therapy fails the knee will require surgery in the form of either a partial meniscectomy or full meniscectomy. Usually, but not always, arthroscopic surgery will be appropriate. A very similar knee injury would be a tear to the anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL).
- Bone Fracture - This is your common broken bone. This may be in the form of a simple fracture (that does not push through the skin) or a compound fracture (in which at least one bone does push through the skin). A fractured bone must be set. Commonly this is done through closed reduction, which simply means setting and casting from outside the skin. However, sometimes an open reduction is necessary. Open reduction is a form of surgery in which the area surrounding the break must be opened and the bone set from within. Many times this type of surgery includes placement of rods and screws to ensure proper healing.
- Carpal Tunnel Syndrome - This is a wrist injury. It occurs when there is a compression and irritation of the median nerve in the wrist. Carpal tunnel syndrome can be due to blunt trauma or repetitive work such as that of secretaries, supermarket checkers, assembly line workers and meat packers. Symptoms include numbness and tingling of the hand, wrist pain, a "pins and needles" feeling at night, weakness in the grip and a loss of coordination. Treatment ranges from rest and use of a brace to surgery. The surgery is called a carpal tunnel release.
- Cubital Tunnel Syndrome -This is very similar to carpal tunnel syndrome, but it is an injury that occurs at the elbow instead of at the wrist. Cubital tunnel syndrome is a compression of the ulnar nerve at the elbow. Symptoms include pain and numbness from the elbow down into the hand and fingers. Treatment ranges from physical therapy to surgery, which is called a cubital tunnel release.
- Hernia - This is an opening or weakness of the muscular structure of the abdomen causing a bulging in the abdomen wall. Hernias can be caused or worsened by physical exertion such as lifting. Symptoms include pain, discomfort and swelling in the abdomen or groin area. Surgery is generally required to repair this condition. The New Jersey Workers Compensation Statute has special requirements regarding hernias so that it is very important to notify the employer immediately.
- Reflex Sympathetic Dystrophy (RSD) - This is otherwise known as Chronic Pain Syndrome. It is a condition that follows an injury such as a fracture or trauma to an arm or leg. Typical symptoms include pain (often "burning" type); tenderness, and swelling of an extremity associates with varying degrees of sweating, warmth and/or coolness; flushing; discoloration; and shiny skin. The symptoms may be significantly out of proportion to the injury and may linger long after the underlying injury has healed. Reflex sympathetic dystrophy is very difficult to diagnosis. However, early diagnosis and treatment is very important to keep the condition from progressing to much more severe, later stages.
Although brain injuries are a type of neurologic injury, they are so specific and conceivably so severe in nature that they deserve their own section. The brain is the part of the central nervous system that is located in the skull. It assumes the extremely important task of being the primary receiver, organizer and distributor of information for the body. Any injury to the brain can have a severe impact on the day to day functioning of the injured worker. Some common brain injuries are as follows:
- Concussion - A Concussion is a traumatic injury to the brain as a result of a violent blow, shaking, or spinning. It is a much more serious injury than people realize. Even a minor concussion can cause permanent brain impairment. The injured worker may feel headache, nausea, dizziness, loss of concentration or vision impairment. Sometimes a person has a second concussion before their brain has recovered from the first. This can lead to what is called second impact syndrome. In the second impact syndrome, massive swelling of the brain causes pressure inside the skull that chokes off the flow of fresh blood and leads to irreparable brain damage or death. It takes considerable time and energy for the brain to repair from a concussion. Changes in the brain start to resolve immediately, but the recovery time seems to vary. The time depends not only on the severity of the blow, but also on how many previous concussions a person has had. Once a person has had a concussion, he or she is as much as four times more likely to sustain a second one. Moreover, after several concussions, it takes less of a blow to cause the injury and requires more time to recover.
- Stroke - A Stroke is the sudden death of some brain cells due to a lack of oxygen. This occurs when the blood flow to the brain is impaired by blockage or rupture of an artery. A Stroke is also called a cerebrovascular accident or, for short, a CVA. The most common symptom is weakness or paralysis of one side of the body with partial or complete loss of voluntary movement or sensation in a leg or arm. There can be speech problems and weak face muscles, causing drooling. Numbness or tingling is very common. A stroke involving the base of the brain can affect balance, vision, swallowing, breathing and even consciousness.
Pulmonary injuries include diseases of airway flow and various forms of cancer. Usually, but not always, these injuries occur as the result of exposure to noxious elements over an extended period time. By example, a construction worker or a factory worker may have been exposed to dust and fumes over the course of many years of employment. Depending upon the length of exposure and the types of substances, the accumulated effects of these exposures can cause a work related pulmonary disability. Some of the more common work related pulmonary/lung diseases are as follows:
- Asbestosis - Asbestosis is a condition featuring scarring of the lungs caused by inhaled asbestosis fibers. It arises from exposure to asbestosis fibers that were once commonly used in construction. Only a relatively short exposure to asbestosis is necessary for a worker to contract asbestosis. There is generally a latency period, meaning that many years can pass from the time of the exposure to the time that the worker is diagnosed with asbestosis. Asbestosis is irreversible. It tends to lead to Chronic Obstructive Pulmonary Disease, a progressive disorder that can be disabling or fatal. When asbestos fibers lodge in the lungs and penetrate through the intestinal tract, they can also lead to lung cancer or to mesothelioma.
- Chronic Obstructive Pulmonary Disease (COPD) -This is defined as any disorder that persistently obstructs bronchial airflow. COPD mainly involves two related diseases - chronic bronchitis and emphysema. Both cause chronic obstruction of air flowing through the airways and in and out of the lungs. In short, it makes it very difficult for the injured worker to breathe. The obstruction is generally permanent and becomes worse over time.
- Mesothelioma - This is a malignant tumor of the mesothelium. Most mesotheliomas begin as one or more nodules that progressively grow to form a solid coating of tumor surrounding the lung, abdominal organs, or heart. Mesothelioma most commonly occurs in the chest cavity and is associated with exposure to asbestos in up to 90% of cases. It has been shown that some asbestos fibers that are inhaled quickly work their way through the lung tissue and into the chest (pleural) cavity. Asbestos fibers that are swallowed have been shown to penetrate the wall of the intestine and appear in the abdominal (peritoneal) cavity. The risk of mesothelioma increases with the intensity and duration of exposure to asbestos. It is debatable whether or not there is any safe exposure level. Mesothelioma typically does not occur for 20 to 50 years following exposure to asbestos. Some forms of asbestos, particularly crocidolite fibers, are more likely to cause mesotheliomas. There is also evidence that mesotheliomas may be caused by other agents including radiation, viruses, and man-made mineral fibers. There is no relationship to smoking. Mesothelioma is currently difficult to treat in most cases and survival beyond two years is unusual.
- Lung Cancer - Cancer of the major organ of respiration - the lung. Lung cancer kills more men and women than any other form of cancer. Since the majority of lung cancer is diagnosed at a relatively late stage, only 10% of all lung cancer patients are ultimately cured. Lung cancers are classified as either small cell or non-small cell cancers. Persistent cough and bloody sputum (spit) can be symptoms of lung cancer. Lung cancer can be diagnosed based on examination of sputum, or tissue examination with biopsy using bronchoscopy, needle through the chest wall, or surgical excision.
- Chronic Bronchitis - Bronchitis is inflammation and swelling of the bronchi. These are the large air tubes leading from the trachea to the lungs that convey air to and from the lungs. Chronic bronchitis usually is defined clinically as a daily cough with production of sputum (spit) for 3 months, two years in a row. In chronic bronchitis, there is inflammation and swelling of the lining of the airways that lead to narrowing and obstruction of the airways. The inflammation stimulates production of mucous (sputum), which can cause further obstruction of the airways. Obstruction of the airways, especially with mucus, increases the likelihood of bacterial lung infections.
- Silicosis - This is a form of lung disease resulting from occupational exposure to silica dust over a period of years. Silicosis causes slowly progressive fibrosis of the lungs, impairment of lung function and a tendency to tuberculosis of the lungs. Silica is a known human carcinogen. There are increased lung cancer rates in workers exposed to respirable-size (breathable) crystalline silica, primarily quartz and crystabolite. These are generated during sandblasting and similar activities in an occupational setting. Silicosis can progress even after a person is no longer exposed to the dust, causing severe shortness of breath years later. The more years of exposure to dust, the greater the risk of the disease. Because there is no effective treatment for silicosis, prevention through exposure control is essential. Managing the dust and preventing the inhalation of particles through the use of filtered air supplies can help reduce the risk of silicosis. It is also known as silicatosis, pneumosilicosis, and stone-mason's disease.
In addition to pulmonary/lung diseases, there are a number of other internal diseases that can occur as a result of work. Most common among these are various forms of cancer and problems with the heart. They are more specifically identified as follows:
- Cancer - This is an abnormal growth of cells which tend to proliferate in an uncontrolled way and, in some cases, to metastasize (spread). Cancer is not one disease. It is a group of more than 100 different and distinctive diseases. It can involve any tissue of the body and have many different forms in each body area. Most cancers are named for the type of cell or organ in which they start. Benign tumors are not cancer; malignant tumors are cancer. Cancer is not contagious. Cancer may also be called malignancy, a malignant tumor, or a neoplasm (literally, a new growth). In addition to lung cancer, common types of cancer include liver cancer, kidney cancer; pancreatic cancer; bone cancer; bladder cancer; brain cancer; cervical cancer and stomach cancer. In the work setting these cancers may be caused by exposure to chemicals or other noxious elements.
- Myocardial Infarction (Heart Attack) - A Myocardial Infarction, otherwise known as a common heart attack, occurs when the heart muscle suddenly becomes deprived of circulating blood. This causes necrosis, or death of the heart tissue. A heart attack can be compensable under New Jersey Workers Compensation Law whether it occurs from a sudden event or as a result of stress and strain over time. As in all New Jersey Workers Compensation injuries, the work exposure does not have to be the sole cause of the heart attack. It need only materially contribute to the heart attack.
New Jersey Workers Compensation Law recognizes that workers may experience psychiatric disability as a result of their work. To have a compensable psychiatric claim, the injured worker must show that the work exposure or incident was objectively stressful; that the incident and/or exposure was something peculiar to the workplace (ie. not common to everyone); and must have medical evidence showing that the work exposure or incident was a material cause of the psychiatric disability. Common types of work related psychiatric conditions are as follows:
- Post-Traumatic Stress Disorder (PTSD) - This is a common anxiety disorder that develops after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Depression, alcohol or other substance abuse, or other anxiety disorders frequently co-occur with PTSD. Symptoms of PTSD include reliving the event through upsetting thoughts, nightmares or flashbacks with a strong mental reaction when reminded of the event; avoiding activities or thoughts that remind you of the event; having a loss of interests in important activities with a feeling of loneliness; and feeling unable to relax and irritable. Physical symptoms such as headaches, gastrointestinal distress, immune system problems, dizziness, chest pain, or discomfort in other parts of the body are common in people with PTSD. Often, these symptoms may be treated without the recognition that they stem from an anxiety disorder.
- Generalized Anxiety Disorder - This is a condition characterized by 6 months or more of chronic, exaggerated worry and tension that is unfounded or much more severe than the normal anxiety most people experience. People with GAD usually expect the worst. They worry excessively about money, health, family, or work, even when there are no signs of trouble. They are unable to relax and often suffer from insomnia. Sometimes the source of the worry is hard to pinpoint. Simply the thought of getting through the day provokes anxiety. Many people with GAD also have physical symptoms, such as fatigue, trembling, muscle tension, headaches, irritability or hot flashes. People with GAD may feel lightheaded or out of breath. They also may feel nauseated or have to go to the bathroom frequently. Nearly 3% of the adult US population age 18 to 54 has GAD during the course of a given year. GAD most often strikes in childhood or adolescence, but can also begin in adulthood. GAD often coexists with depression, substance abuse, and other anxiety disorders.