The claimant's birth date of 7/26/49 makes her 60 years of age as of the date of hearing in this matter. The claimant is an employee of General Motors, with whom she has been employed since 1985. Claimant last worked at General Motors on August 10, 2009, and testified that she intended to return to that employment.
Claimant worked both at the Hazelwood and Wentzville facilities, with her latest return to the assembly plant in Wentzville occurring in 2004. Claimant recalls that she was an assembler, and floated at first before being placed on the battery plate install job. To do this job the claimant would start 4 or 5 bolts by hand, and then tighten each with a torque gun. Claimant would also install a water bottle and a horn, each installed by shooting a screw with a torque wrench. By August of 2004 the claimant was suffering from various symptoms in her hands, with tightness and pain in the hands. Claimant relates that the hands would become hot, as if with a fever, with numbness, tingling, and swelling of the hands.
Claimant treated at plant medical with pain medication and ice, and when symptoms continued she had a nerve conduction study that was positive for carpal tunnel syndrome. Claimant postponed consideration of further treatment at her wrists because she was dealing with a separate left shoulder condition, for which she had an operation on 1/7/05. Dr. Rotman, the surgeon with respect to the left shoulder, performed extensive debridement of glenoid and humeral cartilage in the shoulder joint, and also performed a biceps tendon release and reattachment to the bone.
This surgery to the left shoulder was a follow up of surgeries had by Ms. Baxter to her right shoulder in 1999 and to her left shoulder in 2002. The right shoulder surgery was for a full thickness tear of the rotator cuff; the surgery to the left shoulder in 2002 was for what was found to be a nickel size tear of the rotator cuff.
The claimant returned to work following her second left shoulder surgery. Her hand complaints continued unabated, leading to a second nerve conduction study and a second finding of carpal tunnel syndrome bilaterally.
Ms. Baxter was referred to Dr. German, who elicited complaints more severe in the right hand, and a carpal tunnel release was performed by Dr. German on 9/08/2006. In his medical note dated October 6, 2006 (See Claimant's Exhibit A), Dr. German notes that after surgery "symptoms have completely resolved", and makes a request to provide the claimant with a left carpal tunnel release in January of 2007.
In his note dated December 11, 2006, claimant is noted to have "some residual swelling in her right carpal tunnel release" with no symptoms and minimal to no discomfort. A surgery to the left carpal tunnel is noted as having been scheduled.
On 1/19/2007 Dr. German performed a release of the left carpal tunnel. As for the median nerve, Dr. German in his operative note states "The nerve was noted to be hyperemic and flattened but no restriction and with fascicles..."
In his medical note dated 1/26/2007, Dr. German relates that sutures were removed that date and that the claimant had excellent healing. He went so far as to state "A rating may be performed if desired". Temporary total disability benefits were paid for 6 weeks, or into early March of 2007. Ms. Baxter met with Dr. German for a follow up on 2/23/07. The claimant was found to have no numbness or tingling and normal range of motion. Dr. German concluded that the claimant could return to work at any time; was to see the claimant on an as needed basis; and again offered a rating if needed.
Claimant returned to work on the radio install job after her carpal tunnel surgeries. Ms. Baxter testified that she performed the radio install job initially in August of 2005, which means that the radio install job was the job she was performing prior to her right carpal tunnel surgery had just over one year later. On the radio install job the claimant was obliged to shoot eight screws with a torque gun, and would also manually plug in the antenna wire. Claimant would insert a dummy "radio delete" on those jobs that did not require a radio.
The claimant acknowledges that after her carpal tunnel surgeries and upon her return to the radio install job, the use of the torque gun would make her hands go numb, and they would also swell and tingle. Claimant relates that despite these symptoms, the carpal tunnel surgeries helped with her symptoms to the extent that she was able to sleep at night after the surgeries. Claimant continued to self medicate after the surgeries by applying ice packs to her hands after work and during her work breaks, and also sought ice treatment from time to time at the plant dispensary.
Dr. German did not see the claimant from 2/23/07 until approximately one year later, on 1/09/2008, for purposes of a final evaluation. Given the claimant's complaints of numbness and tingling in her hands and her diminished grip strength, Dr. German declined to find the claimant at maximum medical improvement, and proposed the claimant wear a brace for one month at night, with possible repeat nerve conduction study if symptoms did not resolve. Dr. German also posited some other metabolic cause, perhaps some rheumatologic disease as the cause of her complaints.
In his note dated August 8, 2008, Dr. German relates that he had not seen the claimant since January of 2008, despite making numerous attempts to contact the claimant to see if her symptoms had improved.