Synopsis
The Medical Disability Advisor, Fourth Edition, was written precisely for this purpose: getting disabled employees back to work in good health and on time. This reference work quickly emerged as the industry standard. Today, thousands of human resource professionals, insurance companies, doctors and nurses use its helpful guidelines and duration timetables.
Ten years ago, Reed Group, Ltd. combined the finest medical research with an easy-to-understand communications style to create a revolutionary resource, The Medical Disability Advisor, First Edition—also known as "the Guidelines." Updating this hardback about every three years, Reed Group recently completed the most significant upgrade in the publication's history: The Medical Disability Advisor, Fourth Edition.
This book offers a plenitude of information for getting disabled employees back to work at the appropriate time. Nicely organized, it describes over 1,000 medical conditions and procedures that may affect the working population. The book illustrates its information with colored drawings, tables, and graphs. The text provides clearly formatted subtopics in a predictable order, to aid the user in locating information quickly.
The Medical Disability Advisor provides "durations" (numbers of days a given disability will generally last for a given job classification) and "explanations" that make those disability durations applicable to the individual employee. Both the durations and the explanations result from medical and statistical research. Under the expertise of the Medical Advisory Board, they are continually refined with each edition, and they are keyed to ICD-9 CM codes.
The Medical Disability Advisor "durations" result from evidence-based medicine practiced at its best intentions. Individual clinical expertise is weighed against clinical data in order to provide the most accurate treatment or recommendation regarding each particular case. The medical expertise allows an intelligent use of data that takes into account the impurities and selection biases inherent in any purely quantitative study. The data, similarly, alerts the individual expert of phenomena that his or her personal experience has not encountered. The result is a balanced, rational, and humane tool for managing a multitude of disability cases as consistently and personally as possible.
The latest edition takes advantage of new information about conditions such as fibromyalgia, carpal tunnel syndrome, complex regional pain syndrome, depression and other complex medical issues. It now includes guidance regarding alternative and complementary therapies as well as a host of other factors that affect disability duration. The duration tables, themselves reviewed and modified, have already been reported by several companies to further reduce company expenditures related to employee absence.
The Medical Disability Advisor's most vital role is to provide a framework for non-adversarial communication among interested parties:
• employees
• employers
• case managers
• benefits administrators
• labor organizations
• workers' compensation
• health care providers
• insurance companies
Primarily intended for those involved in managing medical disabilities, The Medical Disability Advisor is useful as a desk reference work that explains many medical conditions in ordinary English (with technical terms in parentheses).
"synopsis" may belong to another edition of this title.
About the Author
Dr. Presley Reed is Chairman of Reed Group, an international firm that provides FMLA, absence, and disability management services to employers. Dr. Reed is also Editor-in-Chief of The Medical Disability Advisor: Workplace Guidelines for Disability Duration (MDA). The MDA guidelines are in active use by more than 10,000 multi-national employers, insurance carriers, and health care professionals across the US and in 22 other countries.You may also contact Dr. Reed at (800) 347-7443.
Excerpt. © Reprinted by permission. All rights reserved.
Carpal Tunnel Syndrome [excerpted]
Other names / synonyms: CTS, Median Nerve Compression
354, 354.0
Definition
Considerable controversy continues to surround the cause (etiology), definition, diagnosis and treatment of persons with this disorder.
Carpal tunnel syndrome (CTS) refers to a condition where pain, prickling or tingling (paresthesias), or numbness radiates from the wrist into the palm of the hand and then down into the thumb, index, middle, and the thumb-side of the ring fingers. It is caused by an unusual pressure on the median nerve.
The main (median) nerve and its branches enter the hand through an internal opening (carpal tunnel) formed by the wrist bones (carpal bones) and the tough membrane that holds the bones together (transverse carpal ligaments). The median nerve supplies sensation to the palm of the hand, thumb, and first three fingers. Because this passageway is rigid, inflammation, swelling, or increased fluid retention may compress the nerve (nerve entrapment), causing pain and changes in sensation along the pathways where the nerve runs. Pain may eventually extend to the arm, shoulder, or neck.
....
Diagnosis
History: Individuals may describe pain, tingling, numbness, or feeling of weakness in the wrist, hand, or fingers. In mild cases, pain is intermittent and often worsens at night or when individual first arises in the morning. The individual may complain of dropping items more frequently than usual. The fingers may at times feel locked and there may be problems pinching or grasping objects. On occasion, pain may radiate into the forearm, shoulder, neck, or chest. Hands or lower arms feel weak in the morning. Individuals with CTS may have problems performing detailed tasks such as writing or tying shoes, or tasks that require strength. Symptoms may be relieved by shaking the hand.
Physical exam: Changes in sensation are noted along the median nerve in the palm of the hand, thumb, and the first three fingers....
....
Treatment
Conservative treatment may include eliminating or greatly reducing movements or tasks that seem to cause or exacerbate the condition such as repetitive motion of the wrist and fingers or wrist-bending extremes (flexion and extension). Other treatment may include taking anti-inflammatory medication, wearing protective splints while at work and/or sleeping, stretching exercises, diuretics if appropriate, and possible corticosteroid injections into the carpal tunnel. An electrical current may be used to move medication through the skin into the area requiring treatment (iontophoresis).
In chronic or severe cases not related to pregnancy, surgery may be required. The procedure (open carpal tunnel release) involves cutting the ligament (roof of the carpal tunnel) and removing inflamed tissue around the tendons to relieve the pressure on the nerve....
Prognosis
Symptoms may resolve with conservative management including reducing or abstaining from the aggravating activities. If pain and tingling increase or if weakness persists, surgery may be necessary. More than 80% of individuals experience permanent relief of symptoms after carpal tunnel release surgery. Endoscopic surgical methods are believed to have an even higher success rate because they require smaller incisions and shorter recovery time. Activity-related hand pain if due to CTS usually resolves in 1 to 2 months. Tingling and numbness may last a few weeks or months. Grip strength returns to normal, gradually over 1 to 2 years.
Differential Diagnosis
Other possible diagnoses include tendinitis of the wrist, rheumatoid arthritis, a tumor, diabetes, or hypothyroidism. A pinched nerve in the neck or elbow, cervical disc disorder, or thoracic outlet syndrome may mimic the symptoms of CTS.
Specialists
Anesthesiologist
Hand Therapist
Neurologist Neurosurgeon
Orthopedic Surgeon
Physiatrist
Rehabilitation
Individuals with carpal tunnel syndrome may require outpatient therapy. Individuals should receive therapy from an occupational therapist or a physical therapist who is a certified hand therapist.
The first objective of therapy is pain control. Individuals may use heat prior to therapy to increase muscle flexibility and decrease pain. Individuals may use ice packs after therapy to decrease pain and swelling. In addition, splints may be provided that place the wrist and hand in a less stressful position.
The second objective of therapy is ....
Work Restrictions / Accommodations
The individual may need to avoid tasks requiring repetitive wrist motion and extremes of wrist bending (flexion, extension) until the condition is resolved. Additionally, protective wrist splints may be used during work and sleep to maintain neutral wrist positions. Accommodation may be required at workstations such as ergonomically designed computer keyboards to provide support for the individual's hand and wrist. If the individual has had surgery, time off from work may be needed for several weeks for recovery. The individual may be required to avoid heavy lifting and repetitive motion for up to 2 months after surgery.
Comorbid Conditions
Diabetes mellitus or obesity may lengthen disability.
Complications
In half the cases where CTS occurs in one wrist, the other wrist becomes involved. As the use of the hand/wrist increases with repetitive tasks, the symptoms of CTS worsen. Pain, numbness, and weakness may become constant in advanced cases.
Factors Influencing Duration
The ability (or lack thereof) to stop activities that aggravate the condition, response to conservative treatment, and ability to perform tasks while wearing adaptive splints may influence disability time. The endoscopic form of carpal tunnel release surgery involving smaller incisions has a shorter recovery period.
Length of Disability
In a small percentage of cases, individuals may experience chronic problems because of nerve damage that may result from carpal tunnel syndrome. Recovery time for surgical treatment is variable and may take longer with open procedure by up to 50%.
Medical treatment (including injection).
[omitted: Complementary / Alternative Therapies, Duration Tables, Normative Data Graphs, Failure to Recover, and References]
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