Claimant indicated she worked ten hours per day, at least four days per week with overtime required. She had a thirtyminute lunch and two ten-minute breaks each day. She estimated it took approximately twenty minutes to complete twelve shirts. She noted that if the material was fleece the job was more difficult and may take more time to complete because it was more difficult to use the scissors. She also had to thread the needle on the sewing machine. She estimated she completed 300-500 shirts per day.
Claimant agreed that the Task Analysis Report, marked as Joint Exhibit II, was consistent with her job duties at Employer. She testified she constantly used her hands at work unless she was on break. The Work Center Ergonomic Job Study, marked as Joint Exhibit I, concluded that a cycle of twelve shirts per cycle consisted of approximately 300 hand movements per cycle per trimmer. This equated to approximately 7500-9000 upper extremity movements per trimmer per shift. Tool hand movements listed a medium, steady motion with approximately 144 hand movements per cycle for both the right and left upper extremities.
Claimant testified that she began noticing tingling, numbness and tenderness in both wrists within a couple of months of working for Employer. She continued to perform her job duties with problems. Her hands progressively became worse until she was seen by her own physician, Dr. Patel. Dr. Patel recommended Naproxyn for four weeks, which did not help, and he then recommended a nerve conduction study. The study was performed at Jefferson Memorial Hospital on March 25, 2003 and demonstrated bilateral median entrapment. Dr. Patel diagnosed carpal tunnel syndrome and indicated to Claimant that it was related to her job. Claimant then notified her Employer of the condition.
Employer sent Claimant to Dr. Ollinger for an evaluation on June 5, 2003. Dr. Ollinger examined Claimant and opined that Claimant had carpal tunnel syndrome and that it's cause was idiopathic. He noted that Claimant had risk factors of female and over 40 years of age. Claimant testified he did not review any records with her, did not ask for the results of any testing performed and did not ask for a job description. Claimant then received a letter stating that her carpal tunnel syndrome was not work-related.
Claimant then sought treatment on her own and Dr. Patel referred her to Dr. Schlafly. She provided information to Dr. Schlafly and was examined by Dr. Schlafly on June 26, 2003. Dr. Schlafly confirmed the diagnosis of carpal tunnel syndrome. He performed a right carpal tunnel release and excision of a ganglion on January 22, 2004. He performed a left carpal tunnel release on February 12, 2004. Claimant testified the surgeries relieved the numbness in her hands and Dr. Schlafly released her on March 15, 2004. When she was released she noticed her hands tired easily, she continued to have weakness and some tenderness. She returned to Employer after her release and continued there as a trimmer until May of 2005. She left Employer when they moved their facility to St. Louis from Desoto. She sought and found a position that did not require her to use her hands repetitively. Her complaints at the time of hearing included continued tenderness, weakness, significant loss of grip strength and difficulty opening jars. She testified that she did not have hobbies such as crochet, guitar or computer work. She takes over the counter medications at times if her hands are tender.
Claimant testified that prior to working for Employer she did not have any complaints in her hands and worked for Head Start. At Head Start she was an assistant cook and did not repetitively use her hands. On cross-examination Claimant testified that she returned to her full-time job as trimmer without restrictions after Dr. Schlafly's release.
Dr. Ollinger testified by deposition on Employer's behalf. He testified that at the time of his examination on June 5, 2003 he had none of Claimant's medical records to review and had no job analysis documentation to review. He relied on the history Claimant provided. He noted Claimant was in good health and listed two diagnoses or impressions after his examination of Claimant: the first that she was a 43 year old female and second, that she presented with bilateral carpal tunnel syndrome. He noted there were no other medical conditions such as thyroid disease, pregnancy or other medical conditions that were risk factors in this case. He testified it was his opinion that Claimant had idiopathic carpal tunnel syndrome consequent to the risk factors of her age and gender. He testified that her work was not a proximate cause or substantial factor for the development of carpal tunnel syndrome. He testified that this conclusion was based upon the time line of the symptom onset. He testified Claimant was employed for about a month when she developed bilateral symptoms simultaneously. He testified Claimant's job was fast and repetitive by her description and involved the right hand as a potential exposure. He testified that by her report, her left hand did not do much at work. He concluded that work was not a factor in the cause of her bilateral carpal tunnel syndrome because the left hand had no exposure "...to work experience at that place in one month." (ER's Exh. 1, p. 12). Dr. Ollinger testified he could not identify with any degree of medical certainty what caused Claimant's carpal tunnel syndrome, but he could state with medical certainty that work was not a significant factor in the development of Claimant's carpal tunnel syndrome.
Dr. Ollinger testified he later received, after discussion with Employer's insurance representative, an ergonomics analysis from The Work Center dated July 7, 2003 and a second Task Analysis Report completed by BJC dated July 24, 2003. Dr. Ollinger testified that the receipt of this information did not alter his initial opinion regarding causation.
Dr. Bruce Schlafly testified by deposition on Claimant's behalf. Dr. Schlafly examined Claimant initially on September 26, 2003. Dr. Schlafly diagnosed bilateral carpal tunnel syndrome and recommended surgery. He performed a right carpal tunnel release and excision of a ganglion on January 22, 2004 and a left carpal tunnel release on February 12, 2004. Dr. Schlafly kept Claimant off work from January 22, 2004 until March 14, 2004. Dr. Schlafly took a history from Claimant and reviewed Claimant's medical records and tests results, the July 24, 2003 Task Analysis Report, Dr. Ollinger's reports and testified that in his opinion within a reasonable degree of certainty the cause of Claimant's bilateral carpal tunnel syndrome was the repetitive work at Employer. Dr. Schlafly opined that Claimant's work for Employer was a substantial factor in the development of Claimant's bilateral carpal tunnel syndrome.
Dr. Schlafly noted that the charges related to the treatment for Claimant's bilateral carpal tunnel syndrome was reasonable and customary. He also testified that the surgeries were needed to cure and relieve the effects of Claimant's condition. Dr. Schlafly testified that he noted Claimant had surgical scars from her releases. Claimant had grip strength of 28 pounds in her right hand and 24 pounds in her left. Claimant had a mildly positive Tinel's Sign on both wrists and a mildly positive Phalen's Sign on both wrists. He testified that these signs were indicative of some residual median nerve irritation. Dr. Schlafly assigned 22.5 % permanent partial disability of each hand and noted there was a synergistic effect of these conditions with the right and left hands.