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

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 1

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 occupational injury? 2

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 3

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 4

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 5

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 6

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% 7

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 8

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 9

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. 10

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 11