My diagnosis is that she has a compressive and irritative neuropathy in the right median nerve at the wrist and that this is work related.
Her second problem is that of right ROTATOR CUFF TENDONITIS with Impingement and ... this problem is not work-related.
Her third problem is the flare-up of neck pain which occurred in May 1995 and is still present to a mild degree. This is most likely due to degenerative disease in the cervical spine. Her current neck symptoms, however, are minimal. I do not feel that her neck symptoms are work-related as they only began around late April 1995 whilst she was not working.
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Her prognosis is such that she is likely to have ongoing residual pain and paraesthesia from the irritation in the right median nerve at the wrist. This pain is neuropathic in type and although apparently of mild to moderate severity, these symptoms are likely to persist for a further 3-5 years but hopefully will settle in the long term.
The right rotator cuff tendonitis with impingement has not responded to steroid injection and in my opinion she requires arthroscopic decompression of the rotator cuff.
I feel that the overall degree of pain and paraesthesia in the right hand has lessened to a mild degree compared with prior to surgery. However, she still has obvious tenderness in the median nerve with clinical signs of neural irritation which is more than enough to explain the ongoing symptoms in the right hand.
I feel that the problem with the right median nerve at the wrist is definitely work-related. The rotator cuff tendonitis and impingement in the right shoulder, however, only came on when she had been off work for a number of months and really is not work-related. Furthermore, her neck symptoms also began in late April 1995 whilst not working and are not work-related.
The reason why the carpal tunnel syndrome is work-related is the fact that she was ironing 8 hours a day for 5 days a week using a heavy iron. Pressure of the handle of the iron on the carpal tunnel and extending the wrist in this manner would be more than enough to explain her condition.
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The right median nerve compression and irritation has left this lady with a 10% loss of the effective use of her dominant right hand and forearm for the next 5 years. Hopefully by the end of this period her pain level will have eased significantly and she will have better use of the hand.
She also has a 10% permanent disability in the right shoulder as a result of the rotator cuff tendonitis with impingement. This condition, however, is not work-related.
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I have also read the report of my colleague Dr Alan Home, date [sic] 24 June 1996. I agree with Dr Home that the patient has a rotator cuff tendonitis and that this condition is not work-related.
With respect to the carpal tunnel syndrome, I feel that Dr Home has overlooked the fact that the median nerve is quite tender at the wrist and furthermore the patient demonstrates clinical signs of increased neural mechano-sensitivity on stretching the median nerve. These signs are typical of neuropathic pain although I agree that she does not demonstrate features of allodynia etc. She thus does have evidence of median nerve irritation and I feel that this is the prime reason for her ongoing pain. I do not feel that there has been a recurrence of carpal tunnel syndrome as this lady's symptoms never went away following surgery and, in fact, have changed very little despite surgery."