Department of Labor and Industry

Medical Regulations Unit

Scenarios September 16, 2009


1. Low back pain

28 YO female nursing asst
Hurt low back while assisting a patient Continued LBP for over 1 year
MRI – minor disc degeneration at L4-5 X-ray – normal
Neurosurgeon wants to do discogram and fusion

2. Shoulder pain

45 YO male laborer
Doing OH work – sudden onset of shoulder pain MRI – shows 50% tear in supraspinatus tendon tear

3. Knee pain

55 YO male – on feet all day Non-specific injury – knee pain X-ray reveals degenerative arthritis MRI – torn medial meniscus

4. Low back pain with radiculopathy

50 YO male truck driver
Chronic LBP, long-term PT
Non-specific diagnosis with some radiculopathy Normal MRI
Requesting injection therapy

5. Concussion

45 y/o female who tripped and hit her head on a bookshelf.
Initial diagnosis concussion with aggravation of pre-existing migraine headaches. 18 mos. later has had long term PT, psych, cognitive therapy, medication with no appreciable improvement in symptoms.
Further PT, cognitive therapy are requested.

6. Carpal Tunnel Syndrome

32 year old female clerical worker (keyboard use 6 hr per day), with 3 month history of numbness and tingling in both hands. The clinical diagnosis is Carpal Tunnel Syndrome. Neurodiagnostic studies show a mild sensory conduction delay. Treatment has included splinting, anti-inflammatory medication and ergonomic modifications. The provider has requested carpal tunnel release.

7. Whiplash

45 year old male delivery driver, struck from behind while at a stoplight. After 2 mos. he continues to have neck pain and occipital headache. Treatment has included one month of chiropractic treatment with 20% improvement in symptoms. Facet blocks and PT are now requested.