I Didn't Suffer A Specific or Sudden Injury, It Happened Gradually. Is This A Work Injury?

YES, your work was likely a substantial contributing cause and accelerated your injury.

When people think of work injuries, they often think of sudden, unexpected accidents, such as falling off a ladder, being involved in a car accident, slipping and falling, or injuries due to lifting heavy objects. These types of work injuries are known as “specific injuries” under Minnesota workers’ compensation law. These types of injuries are caused by an specific event at a specific time. But what about injuries that occur over a long period of time, that weren’t necessarily caused by a specific event, and didn’t occur at one specific time?

Under Minnesota work comp law, these types of injuries are known as Gillette-type injuries. They are also commonly referred to as cumulative trauma injuries or repetitive motion injuries. Repetitive motion injuries or cumulative trauma injuries are referred to as Gillette-type based on the name of the case where the Minnesota Supreme Court recognized the compensability of these types of injuries.

People in occupations where their job duties require repetitive motions tend to be at greater risk for Gillette-type work injuries; however, almost any type of work activity can cause a cumulative trauma or repetitive motion injury.

Repetitive motion injuries are frequently seen in the following types of occupations:

* Assemblers
* Machine operators
* Textile sewing machine operators
* Secretaries * Cashiers
* Packaging operators
* Electronic assemblers
* Data entry workers
* Truck drivers
* Welders
* Butchers and meat cutters
* Bookkeepers
* Auditors
* Accountants
* Freight, stock and material handlers
* Carpenters
* Hairstylists
* Mechanics
* Dental hygienists
* Construction laborers

There are many factors that affect the development of repetitive motion, cumulative trauma, or Gillette-type injuries:

* Repetitive motion: when a task is repeated frequently it can cause strains and fatigue in muscles, joints and tendons.
* Forceful exertion: tasks that require force place a higher load or stress on muscles, tendons and joints.
* Awkward posture/position: poor posture while performing a task, especially a repetitive task, puts strain on joints and muscles.
* Duration: tasks that require the use of the same muscles for long periods of time can cause fatigue in those muscles and make them susceptible to injury.
* Compression: pressing body parts on hard or sharp surfaces causes a decrease in blood flow to the muscles, tendons and nerves in that area. This can cause symptoms of tingling, numbness and change in sensation, and lead to tissue damage in that area.
* Vibration: activities involving vibration put stress on individual parts or the whole body. * Poor physical health: conditions such as diabetes, cardiovascular disease, Raynaud's, arthritis, smoking, alcoholism, gout, hypertension, poor nutrition, lack of exercise, stress and job dissatisfaction can increase the chance of developing a repetitive motion injury.

Common types of Gillette-type, repetitive motion, cumulative trauma injuries include:

* Tendinitis * Bursitis
* Carpal tunnel syndrome
* Rotator cuff tears
* Lumbar or cervical disc degeneration
* Lumbar or cervical disc herniations or bulges
* Epicondylitis
* Trigger finger
* Tenosynovitis
* Ganglion cyst
* Hand-arm vibration syndrome
* Radial tunnel syndrome
* Cubital tunnel syndrome
* Thoracic outlet syndrome
* Plica syndrome
* Patellofemoral pain syndrome
* Medial collateral tears
* Meniscus tears Gillette-type injuries are very frequently contested by employers and their workers’ compensation insurance company.

If you have sustained a repetitive motion, cumulative trauma, or Gillette-type injury at work, call Atkinson Law Office or click here to send us an email to schedule a free consultation. You may also contact Tom Atkinson directly at 651-324-9514 or visit www.mndisability.com

Work Related de Quervain's Tendonitis

The condition known as de Quervain's tendonitis, or tenosynovitis, results from the tendons at the base of the thumb becoming irritated or inflamed. When the tendon gets inflamed, the tunnel that surrounds it swells, and it becomes painful to move the thumb or wrist. Those who suffer from de Quervain's tendonitis feel pain when they hold things or try to form a fist.

Causes of De Quervain's Tendonitis

Formally known as first dorsal tendonitis, de Quervain's tendonitis is caused when the tendons at the thumb's base become irritated, usually as a result of a new repetitive activity. It is a frequent complaint from new mothers, who need to care for their babies with awkward hand positions they are not familiar with. Furthermore, changes in hormone levels from pregnancy and nursing add to the possibility of the condition showing up in new mothers.

A change to the way the wrist normally works and moves because of a fracture, severe strain or overuse in the work place can also trigger de Quervain's tendonitis because of the new and unusual stress the tendons may incur.

Signs & Symptoms

The main symptom of de Quervain's tendonitis is pain in the side of the wrist near the thumb. The pain might show up either suddenly or over time, but is felt in the wrist's first dorsal compartment. The pain can run up the forearm or down into the thumb. Moving the hand or thumb makes it worse, especially if they are twisted or used to hold onto something firmly.


The base of the thumb may become swollen and a cyst filled with fluid may even appear. The thumb, when moved, may sometimes catch or pop, and it may be hard to pinch. The nerve that lies on top of the tendon's sheath or tunnel may also become irritated and cause the index finger and back of the thumb to become numb.

Diagnosis of Tendonitis

Your hand surgeon will carefully examine your hand and wrist for signs of de Quervain's tendonitis and check if the tendons at the base of the thumb are tender. To test for it, you may be asked to make a fist with your thumb inside your fingers and your hand surgeon may then try to gently bend your fist toward your little finger. If you have de Quervain's tendonitis, this movement will cause pain.

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Non-Surgical & Surgical Treatments

Your hand surgeon will treat the condition so that your pain is removed or lessened by reducing the irritation and swelling in the affected tendons. Your hand doctor may suggest that you wear a splint to rest your thumb and wrist and may recommend some anti-inflammatory medications. Sometimes the inflammation can be relieved by a shot of cortisone or other steroid, and any of these treatments can reduce the swelling and pain. Changing or eliminating the motions that cause the pain can also get rid of them.

If the symptoms are very severe or the treatments tried so far don't work, surgery can often help. During the surgery, your hand surgeon will open up the compartment to give the inflamed tendons more room to move. This procedure eliminates the inflamed tendons swelling even further, which in turn increases the inflammation, and so on. Following the surgery, a splint may be suggested, but once comfort and strength have returned, normal hand, wrist, and thumb function will come back.

Work Related Carpal Tunnel Syndrome

Everyday Minnesota workers deal with a painful condition of the hands and wrists know as Carpal tunnel syndrome (CTS) or median neuritis. Bilateral Carpal Tunnel Syndrome is caused by pressure on the median nerve, which runs from the shoulder down the arm to the hand. In advanced cases, carpal tunnel syndrome can make the simplest chore or activity impossible, such as gripping objects at work to folding laundry at home.  

Carpal tunnel syndrome can occur in one wrist, or both (bilateral carpal tunnel). It affects workers in many industries such as meatpacking, grocery checkout, and assembly work. In nearly two decades of handling Minnesota Workers Compensation matters, attorney Tom Atkinson has found bilateral carpal tunnel syndrome to be especially prevalent among those whose work involves computers, repetitive gripping and grasping of work related parts/tools, fine manipulation, and work with vibratory tools.

Symptoms: In addition to pain, the symptoms of carpal tunnel syndrome include numbness and tingling in the hands. These symptoms are usually felt in the first three fingers and the base of the thumb. Often the pain and other symptoms are worse at night or during sleep.

The figure below shows the parts of the hand and wrist that are involved. Tendons of the fingers, blood vessels, and the median nerve all pass through what is called the carpal tunnel. The carpal tunnel is formed by the carpal ligament in the wrist. Swelling and steady irritation of the tendons that pass through the carpal tunnel create pressure on the median nerve.

Risk factors: The major causes of carpal tunnel syndrome are:

• working with bent wrists;
• a high rate of repetition using the hands;
• vibratory tools;
• a lack of rest for the hands and wrists; and
• forceful hand motions.

All of these risk factors are not necessary to get carpal tunnel syndrome. For example, VDT operators get carpal tunnel syndrome even though modem computers only require a very light force to press the keys. The awkward posture, intense keying, and lack of rest periods are more than enough to cause problems.

Prevention: Carpal tunnel syndrome can be prevented by controlling the risk factors that cause the injury. This is done through the application of ergonomics.Ergonomics means changing the work to fit the worker, rather than making the worker try to fit the work. A comprehensive ergonomics program includes the following elements:

• Engineering controls: This means providing equipment to reduce exposure to risk factors. For example, computer operators need to be able to adjust the height of their chair and/or keyboard in order to avoid having to bend their wrists while keying. Other examples include ergonomically designed hand tools that have angled handles that allow workers to keep their wrists straight while using the tools. 
• Administrative controls: This refers to the pace of work, breaks, other tasks that do not require repetitious hand and wrist movements, and other factors about work organization. 
• Medical management: The management of CTS requires that a correct diagnosis is made and proper medical treatment and follow-up is provided. Working conditions that expose workers to risk factors need to be eliminated or reduced as much as possible. Without such changes, injured workers will still be exposed to the very conditions that caused the problems in the first place, and will likely cause the workers to be injured again. Having injured workers wear wrist braces and then continue to work under the same conditions that caused their injuries is not acceptable or appropriate medical management.

Early and proper treatment is important for this condition. Treatment should start out conservatively with rest and physical therapy. Surgery should not be the first choice. The person's job may have to be redesigned to remove or reduce risk factors at work. Otherwise, the symptoms are likely to get worse and require surgery to relieve the pain.

• Training: Workers and their managers need training about engineering controls, administrative measures, and medical management. Workers should know: how to recognize the signs and symptoms of CTS; who to report them to; how to adjust equipment; when to give their hands and wrists a rest from repetitious and/or forceful motions; and take other steps to prevent getting carpal tunnel syndrome. 
• Program Evaluation: The ergonomics program needs to be evaluated to find out if the number and severity of cases of carpal tunnel syndrome have been reduced. Accurate and complete records need to be kept in order to measure the effectiveness of the program.

If your have experienced bilateral carpel tunnel surgery in the past and were recently laid off OR you have any the symptoms decribed above I urge you to seek medical treatment immediately.  If you do NOT have health insurance please contact me and we can discuss whether your employers workers compensation insurance should provide for your treatment.  I may be reached directly by contacting me at 651-324-9514 (attorney Tom Atkinson) or through my web site www.mndisability.com  The attorneys at Minnesota Disability are available to meet with you throughout Minnesota, seven days a week!