Claimant is a 55 year old right handed woman with a high school education who worked for Employer as a cake decorator from 1989 until 2007. The job of cake decorator involves repetitive use of the upper extremities.
Beginning in 1992, Claimant began having difficulties with her upper extremities. In 1992 she was diagnosed with bilateral carpal tunnel syndrome, and underwent bilateral carpal tunnel releases. Dr. Ollinger performed the surgeries, and released her to full duty in 1993. Claimant returned to work as a cake decorator for Employer. The surgeries helped to temporarily subdue her pain. Claimant settled her claim with Employer for 17\% PPD of the right hand, 15 % of the left hand, and a 15 % load.
In 1995, Claimant began to experience problems with trigger fingers in her right hand. She was found to have triggering of the right index, long, and ring fingers. She came under the care of Dr. Crandall in 1995. He diagnosed the problem as work related, and in February 1996, performed trigger finger releases on her right index, long, and ring fingers. Following surgery, Claimant underwent physical therapy, and returned to work full duty. Although the trigger finger releases helped relieve her pain, she continued to have clicking and difficulty bending her fingers. She settled her claim with Employer for 15 % of the right hand
In 1996, Claimant developed trigger finger in her left hand. In January 1999, Dr. Crandall performed surgery on her left hand for trigger finger releases of the left index, ring, and small fingers. Dr. Crandall released Claimant to full duty in February 1999. The surgeries helped relieve some of the pain in her left hand. Claimant settled her claim with Employer for 15 % PPD of the left hand.
In 1997, Claimant injured her right shoulder when she was thrown from a trailer. Dr. Bradbury performed a glenohumeral arthroscopy and debridement of synovitis subscapularis tendon, and subacromial arthroscopy with initial attempted subacromial decompression, and subsequent open subacromial decompression. The post operative diagnosis was right shoulder impingement syndrome. Following her right shoulder surgery she continued to treat with Dr. Bradbury through 1999. She had extensive physical therapy both before and after her surgery, and cortisone injections. She also treated at the Barnes Hospital pain clinic. She also received treatment from her primary care doctor. Ultimately she received additional orthopedic care from Dr. VanRyn who performed a right shoulder arthroscopy distal clavicle excision in July 2001. The post-operative diagnosis was right shoulder AC joint arthralgia.
Leading up to 2005, Claimant experienced multiple symptoms in her hands as a result of her carpal tunnel syndrome and trigger fingers. Her hands were weak, she had difficulty gripping, and she dropped things. She experienced numbness and tingling at night, and her hands swelled. She had difficulty with her fine motor skills.
Claimant also had difficulty with her right shoulder leading up to 2005. She had reduced range of motion and difficulty lifting above her head. She had difficulty washing her hair, or lifting anything off a shelf. She had pain sleeping at night, and turning over on her side. Leading up to 2005 she had difficulty driving a car, and holding a telephone. She had restrictions in doing her job, and tasks around the house. She had difficulty sweeping, mopping, dusting, gripping, cooking, doing dishes, doing laundry, and baking. She had difficulty with her personal care such as bathing, and washing her hair.
In 2005, Claimant developed additional problems with her hands and her elbows. She saw Dr. Ollinger in January 2005 who found a work related ganglion cyst of the left long finger, as well as work related flexor synovitis of the right long and ring fingers. Claimant saw Dr. Sciortino who diagnosed right trigger thumb and treated it with a cortisone injection.
In February 2006, Dr. Glogovac performed surgery on Claimant's right hand for release of right index and small trigger fingers and right trigger thumb release. In June 2006, Dr. Glogovac operated on her left hand for left trigger thumb release, and released Claimant to return to work in June 2006.
In February 2006, Claimant was examined by Dr. Ollinger, and he diagnosed work related bilateral epicondylitis and cubital tunnel syndrome. Following a course of conservative treatment, in December 2006, Dr. Ollinger operated on the right elbow for ulnar nerve transposition and debridement of the right lateral epicondyle. In February 2007, Dr. Ollinger operated on the left elbow for ulnar nerve transposition and debridement of the left lateral epicondyle. In April 2007, he also operated to remove her ganglion cyst of the left long finger. On August 27, 2007, Dr. Ollinger released Claimant to full duty work, but by that time she was no longer employed.
Claimant settled her claim with Employer for 30\% of each elbow with a 10\% load.
Claimant testified the surgeries she underwent for her 2005 injuries reduced the clicking and sticking in her fingers, but she has problems with gripping, and an increase in her arthritis. The radiation and tingling from her elbows was reduced but she has substantial loss of strength and continued problems. She takes over the counter medications such as Tylenol, Ibuprofen, and Alleve, and has problems sleeping. She gets three to four hours of sleep a night. She has modified her activities. Sweeping, dusting, cooking, opening doors, and picking anything heavy up aggravate her symptoms. Her husband does the majority of the housework, including laundry. She gave up volleyball, and bowling after her first hand and shoulder surgeries, and gave up dancing after her elbow surgeries. Any movement including walking hurts her elbows. She has numbness and tingling in her fingers and thumbs at night, and off and on during the day. She returned to work for a month or two after was released to work by Dr. Ollinger. She was still working light duty, but she was unable to keep up with the pace of the job. Her arms hurt, even though she was working light duty.
The combination of her 2005 injuries and her preexisting injuries has reduced her overall strength. She is only able to drive about 25 to 30 miles without getting fatigued, and then her fingers start to hurt and stick. She has to stop and get out and move her fingers around. She can lift three to five pounds with her r