Who let Grandpa drive the truck? D. Kelly Agnew, M.D. Orthopedic - - PDF document

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Aging & occupational injuries

Who let Grandpa drive the truck?

• D. Kelly Agnew, M.D.

Orthopedic Surgeon Tri Rivers Consulting Services

Aging workers

• Aging population
• Economics
• Future uncertainty

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Cultural issues

• Wrinkles
• Gray hair
• Sun spots
• Sagging structures
• Arthritis?
• The Man

Wear and tear

• Time
• Body habitus
• Nicotine
• Co-morbidities

– Diabetes – Hypertension – Sleep Apnea – Psychological Disorders

The question is …

Is aging an

• ccupational

injury?

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Is aging an occupational injury?

• What is normal?
• What is injury?
• What is overuse?
• What is YOURS?

Is aging an occupational injury?

• In general:

– Mechanism – Onset – Structural change – Documented progression – Asymmetry

Mechanism of injury

• Atypical activity
• Expected to alter musculoskeletal anatomy
• Severity
• Other activities

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Onset

• Sudden?
• Related to activity?
• Pre-existing?
• Previously symptomatic
• Previous treatment

History & records

• PCP
• Chiropractor
• Pharmacy
• Orthopedic
• Physical medicine & rehabilitation

Structural change

• Alter the degenerative structure
• Aggravate
• Accelerate
• Alter natural history

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Documented progression

• Change in objective parameter
• Faster than expected
• Different than contralateral

Asymmetry

• Why do major joints come in pairs?
• Appearance
• Swelling – palpable, measurable
• Range of motion
• Stability
• Radiographic appearance

Specific examples Time vs. Occupation

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Carpal Tunnel Syndrome

• Gender
• Hypothyroidism
• Diabetes
• Age
• Hand dominance

Nathan studies

• EMG/NCV – not subjective
• Hundreds of hands
• Heavy/highly repetitive to light/non-repetitive
• Recapture/restudy

Results

• No occupational correlation
• Age
• Hand dominance

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Cheaper to treat?

• Infection
• Nerve injury
• RSD

Impingement/Bursitis/RCT

• Age
• Hand dominance
• Smoking
• Rarely occupational
• Anatomy

Asymptomatic cuff tears

• Ultrasound study – 411 volunteers

– 50-59 years old: 13% – 60-69 years old: 20% – 70-79 years old: 31%

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Traumatic tears

• Violent flexion/abduction
• Vertical load
• Not lifting
• Not MVA

Low back degeneration

• The cost of walking upright
• Independent of occupation
• Body habitus
• Smoking

Boden studies

• Asymptomatic individuals
• Variable ages
• No injury history

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Desiccation/bulging

• 15% ages 20-39
• Nearly 100% got over
• Not an injury

“Aggravation”

• Herniation/extrusion of degenerated disc
• Stenosis: Disc or bone fragment

making small canal smaller

Strain in degenerative spine

• Independent diagnoses
• Normal resolution – weeks to months

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Injections

• ESI is not for back pain
• Facet blocks are for DJD
• No one needs 100 TPIs

Hip/knee DJD

• Structural change?
• Pain is not aggravation
• Asymmetry of exam
• Films of both sides

Remember:

It is easier to find the proverbial needle in a haystack … than to make an injured worker happy with a joint replacement.

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TJAs worth fighting

• Stiffness
• Infection
• DVT
• Persistent pain
• Repeated surgery
• RSD

Help us help you!

• Never accept a degenerative diagnosis
• Sprain/strain/contusion
• Gather “old” records
• Examine early if degenerative diagnosis
• Authorize bilateral films

The aging workforce

With age comes experience and … a truckload of musculoskeletal controversy