Claimant is a 43 year old woman who began working for Employer in September 2007 assembling light fixtures. Employer is in the business of manufacturing industrial lights and receptacles that are used in oil refineries and wet areas. Before Claimant began working for Employer she had no problems or symptoms in her hands, arms, or neck. Claimant worked ten hour days, five days a week. The fixtures came in kits, and Claimant assembled and wired them by using hand tools such as screw drivers, wire clippers, pliers, hammers, and ratchets. She also used vibratory hand tools including power screwdrivers and air guns. Claimant was required to lift different weights from 5 to 80 pounds or more, sometimes by herself. Claimant is 5'2", and weighs 120 pounds.
Employer imposed strict quotas. Claimant worked at a waist high table. She pushed, pulled, lifted, reached, carried, gripped, and squeezed with her arms extended away from her body at about chest height. She typically placed 10 wires per light, and each wire cable had 2 to 4 individual wires inside of it, so she placed wire nuts on anywhere from 20 to 40 wires per light. Depending on whether she worked alone or with someone, or if she worked 8 or 10 hours a day, she wired form 64 to 160 lights a day. Consequently, she wired anywhere from 640 to 6,400 wire nuts per day. Each nut required several twists of her wrists then one final hard twist. Claimant's hands and arms were always extended in front of her or above her head so she could pull down the guns she used. Her head was always looking down when she was assembling the light fixtures.
After working for Employer for about three years Claimant started to notice aching and swelling in her hands and fingers, and her hands started waking her up at night. Claimant repeatedly asked her supervisor Ed Colley, as well as other company representatives, for medical treatment, but none was offered. In 2009, Claimant was at a party, and a man fell on her and broke some of her ribs. While Claimant was treating for this injury with Dr. Padda, she mentioned she was having problems with her arms, hands, and neck. On October 20, 2010 Dr. Padda noted her hand symptoms, diagnosed carpal tunnel syndrome and administered injections.
At approximately the same time Claimant's hand symptoms began, she started to experience pain in her neck that radiated along her shoulder girdle into her left medial elbow. Dr. Padda ordered an MRI of her cervical spine which was obtained on November 2, 2010, and revealed a right C5-6 protrusion in the lateral recess where the C6 root exited, and caused some cord compression and stenosis, a bulge at C6-7 with bilateral facet osteoarthritis worse on the right, mild facet osteoarthritis on the right at C3-4 and C4-5, and bilateral facet osteoarthritis at C7-T1. Dr. Padda also ordered an EMG/NCS of the upper extremities which was performed on November 9, 2010, and interpreted as consistent with moderate bilateral median nerve entrapment, and a proximal lesion of the C5-6 root. Dr. Padda diagnosed carpal tunnel syndrome, and on November 22, 2010 scheduled cervical epidural steroid injections. The first injection was performed on the right at C5-6 and C6-7 on December 7, 2010, and bilateral facet joint injections from C5-T2 were administered on January 8, 2011. Dr. Padda administered a left elbow medial epicondyle injection on January 24, 2011. Due to persistent symptoms, Dr. Padda recommended surgery.
On April 7, 2011, Dr. Rotman evaluated Claimant, and noted complaints of bilateral hand swelling, tingling, aching, reduced strength in her right hand, burning pain in her elbows, and awakening at night. Dr. Rotman noted she worked as a job assembler and wired lights since $2008^{1}$, noted she was taking Dilaudid and Neurontin for pain control, reviewed the EMG/NCS, and noted the injections provided minimal relief. Dr. Rotman noted a history of a motor vehicle accident which caused some neck pain into her right shoulder. ${ }^{2}$ Dr. Rotman diagnosed bilateral carpal tunnel syndrome and recommended surgery, and also recommended traction and physical therapy for her neck. He opined there may be a work related component to her carpal tunnel condition based upon her history of repetitive hand intensive activities. He did not see any other risk factors.
[^0]
[^0]: ${ }^{1} Claimant started working for Employer in 2007.
{ }^{2}$ Claimant testified she was never in a motor vehicle accident.
On April 20, 2011, Employer sent Claimant to Concentra, and she was examined by Dr. Cantanzaro, who noted pain in her bilateral posterior elbow, and pain and weakness in her ulnar volar wrists, hands, and forearms. Dr. Cantanzaro diagnosed possible cubital tunnel syndrome and possible carpal tunnel syndrome, requested an updated EMG/NCS, but allowed her to work at regular duty. Dr. Cantanzaro opined work was the prevailing factor in Claimant's injury.
Dr. Evan Crandall reviewed a videotape of Claimant's work activities on July 13, 2011, and opined the activities were hand intensive and a potential cause of tendonitis and carpal tunnel syndrome. Dr. Crandall examined Claimant on November 9, 2011, noted symptoms in her hands since November 2010, diagnosed bilateral carpal tunnel syndrome and left deQuervain's syndrome, and recommended surgery.
Dr. Phillips performed an updated EMG/NCS of Claimant's upper extremities on December 19, 2011 and noted severe right with moderate left carpal tunnel syndrome, borderline left cubital tunnel syndrome, cervical radiculopathy with mild myelopathy, and tendonitis at her left medial and lateral epicondyles. Dr. Crandall reviewed that study on December 1, 2011, and recommended surgery.
On January 26, 2012, Dr. Crandall performed a left open carpal tunnel release and a deQuervain's release. Postoperatively Dr. Crandall recommended a splint, physical therapy, and light duty. Dr. Padda injected her right carpal tunnel again on February 15, 2012.
On February 16, 2012 Dr. Crandall performed a right open carpal tunnel release. Claimant developed a post-operative infection that required hospitalization. She was eventually discharged with an IV. After recovering from her infection, she underwent physical therapy, and was released to work full duty on April 23, 2012. Dr. Crandall found Claiman