Good Housekeeping - White Paper

Queensland Workers’ Compensation data indicates strains and sprains form 29% of claims in domestic workers. The shoulder, upper limbs and back are the body regions most represented in claims.

The workforce is predominantly female, middle-aged and includes a high proportion of people from non-English speaking backgrounds. Employer groups include the accommodation sector, as well as in-home care workers who provide domestic services in people’s homes – with a variety of work environments and equipment.

Determining a workplace illness or injury?

Correct diagnosis of work-related injury is not necessarily as clear as it may look. Misdiagnosis of a range of musculoskeletal symptoms is more common than might be expected. For example, a person may be given the diagnosis of carpal tunnel but is presenting with symptoms in the ulnar nerve (rather than median nerve) distribution.

In cases which seem to be unclear, what steps can supervisors or injury managers take?

From a medical perspective, issues for consideration include:

1. Are further investigations required? Which investigation?

2. Is specialist review required? Who & when?

3. Could it be short term exacerbation of an underlying condition rather than a new condition

What is the role of ageing, gender and other non-work factors?

The process of ageing impacts the musculoskeletal system. When a person presents with symptoms, determining the role of work versus normal ageing can be confusing. For example, in the instance of a shoulder ‘strain’, assessing the other shoulder, which may be asymptomatic is helpful.

Back pain is another common presenting symptom - both in domestic workers and in the general population. How this is managed is most important to the outcome. In back pain cases we want people to keep moving. If people stop moving – and stop using those muscles – then this results in poor stabilisation and increases likelihood of pain.

X-rays and expectation management

Setting up positive expectations of recovery are important when sharing imaging results - especially where back pain is a symptom. A 2014 study looked at the results of spine imaging in a group people who were no symptoms of back pain (refer Table 1.0).

As the participants’ age increased, so too did the percentage of degeneration on imaging. Yet this group had no pain. An asymptomatic 50 year-old has an 80% chance of having evidence of disc degeneration on a scan.

When arranging scanning it is important for medical practitioners to set up a patient’s expectations. We need to emphasise that findings such as disc bulge and other types of degeneration all increase as part of ‘normal’ ageing. And not directly as evidence of injury.

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References

[i] Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2014;36(4):811–816. doi:10.3174/ajnr.A4173 [ii] Hill CL, Gill TK, Shanahan EM, et al. Prevalence and correlates of shoulder pain and stiffness in a population-based study: the North West Adelaide Health Study. Int J Rheum Dis 2010;13:215–22. 10.1111/j.1756-185X.2010.01475.x

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For further information regarding this presentation, please contact LIME Medicolegal.