Return-to-Work

Brustein Provides Physician’s Insight on CTD Diagnosis, Treatment and Return-to-Work

Employers should ask physicians for specific diagnoses of their injured workers’ cumulative trauma disorders (CTD), but they should not ignore other employee complaints and symptoms for which there has been no specific diagnosis, said Daniel Brustein, M.D., University CompCare’s medical director.

"Having a specific diagnosis points you in the proper direction for treatment because there are established treatment protocols that can be followed for conditions such as carpal tunnel syndrome and tendinitis," Brustein said. "However, sometimes, all you really have to go on is that the person is experiencing aches and pains and defused weakness in the upper extremities. If you ignore those situations, you’re doing so at your own peril because they often turn out to be the best expensive cases."

Brustein said physicians who see workers’ compensation patients should conduct an extensive physical exam before beginning any targeted pain analysis and treatment. "Even if the pain appears to be centered around the hand and wrist, physical exams should start at the neck and work all the way out to the fingers, " Brustein said. "It is often the case that the hard-to-diagnosis hand problem is really a neck problem."

Brustein said conservative treatment such as stretching exercises, job rotation, rest breaks, over-the-counter medication that includes ibuprofen, and slight job modifications can be very effective in reducing an individual’s pain and disability, even if there is no specific diagnosis.

"Categorize your jobs into low, medium and high risk in terms of exertion, frequency of the activity, posture and how the employee perceives the speed of work. Use transitional work to return people to work faster in lower-risk jobs and try to continuously improve the medium- and high-risk jobs. These efforts can significantly reduce employee complaints, severity rates and injury costs," Brustein said at the Ohio Safety Congress & Expo in March 2002 in Cleveland.