Advice to Orthopedic Surgeons About Worker Compensation Patients


Fact: Results after upper extremity (shoulder or arm) surgery for worker compensation patients are worse than for non-worker compensation patients.
Fact: Worker compensation patients take longer to recover after shoulder/arm surgery compared with non-worker compensation patients treated for the
same thing.
Fact: Worker compensation patients are much slower to return to their jobs at a preinjury level compared with non-worker compensation patients.
Fact: More worker compensation patients change jobs because of continued pain after surgery compared with non-worker compensation patients.
Fact: Fewer worker compensation patients return to employment at all compared with non-worker compensation patients.

The question is: what are the truths behind these facts? Should orthopedic surgeons approach the treatment of worker compensation patients differently than non-worker compensation patients? And if so, what is advised? The topics of worker compensation and outcomes of upper extremity surgery are taken on by surgeons from two well-respected schools of medicine in the Northeastern United States (Albert Einstein College of Medicine and University of Medicine and Dentistry in New Jersey).

Despite many safety measures in place, the number of workers who suffer shoulder and arm injuries on-the-job each year in the United States is significant. In fact, more days or work are lost each year now from shoulder injuries than for low back pain (which was always the number one cause of absenteeism). Recovery from work-related injuries can be complicated by the fact that workers are financially compensated for bodily injury in the work place. It is tempting to assume that financial gain is the reason for unfavorable outcomes and worse prognoses for these workers.

But from a review of studies done in this area, several factors have come to light that might help explain the differences in results. First, worker compensation patients tend to be younger and expected to be more physically active on-the-job compared with non-worker compensation patients with the same injuries. Returning to preinjury levels of activity may differ between these two groups. Workers must get back to their preinjury level of work activities (e.g., pushing, pulling, or lifting heavy objects, operating heavy equipment). Non-worker compensation patients may be having trouble performing less difficult tasks (e.g., brushing teeth, caring for a child, dressing).

The type of surgery performed may vary from study to study. Results from arthroscopic shoulder surgery are not always the same compared with other surgical techniques (e.g., open surgery or mini-open approaches). The use of alcohol and/or tobacco (known to delay wound healing and recovery) are additional factors to be considered. It is possible that ongoing pain, shoulder stiffness, and lower function after surgery may be worse in some patients as a direct result of these lifestyle factors.

Sometimes pinpointing results after surgery can be difficult. For example, some worker compensation patients do return-to-work but are unable to meet the higher work demands or end up at a lower functional level than before their injury. And sometimes the type of injury and surgery required affect outcomes (e.g., results after elbow surgery are usually worse than after rotator cuff (shoulder) surgery). Worker compensation patients are also more likely to need a second surgery but whether or not this is to regain a higher level of physical function was not reported.

Based on these observations, what advice do the authors give orthopedic surgeons? First, do not assume that financial gain is the cause of delays in recovery or worse outcomes for worker compensation patients. But second, be aware of these statistics even while (third) considering the greater physical demands and stresses each worker compensation patient will face in the workplace. Each state has its own unique worker compensation rules and regulations. Knowing local laws related to return-to-work will help the surgeon when advising each patient. The surgeon should be honest with workers about expected outcomes. And finally, anyone who lingers past the allotted amount of time should be referred to vocational rehabilitation for retraining when progress reaches a plateau.