Work Comp is a very, very frustrating system to try and deal with. I don’t participate in their panel anymore for exactly that reason. I had patients where the diagnosis was clear the first time they came and saw me, and yet it would take one or two years of battling in the courts. It’s really disgusting, actually, how injured workers, especially if they have a nerve injury, are treated by the Work Comp system. The system is rigged against injured workers. Unfortunately, there are some injured workers who try and game the system. And I think what that’s done, it’s given most of the people who regularly operate within the Work Comp system a jaundice eye towards anybody who looks normal, but complains of pain.
Most peripheral nerve injuries will not show up on any imaging, or blood tests, or what have you. And so, to the untrained eye, somebody with peripheral nerve complaints may look totally normal. And the first thing you’re going to go to as a physician is to think that they’re malingering, or just don’t want to go back to work, whatever.
Eduardo is an interesting patient and interesting case because he was at work and his job involved pushing and pulling heavy laundry carts, weighing hundreds of pounds each. And it was one day at work doing this heavy labor when he felt a sharp pain in the right groin. As is often the case, he was eventually diagnosed with this very tiny hernia, like a two centimeter hernia, and that was deemed to be the source of his pain. He eventually underwent a right inguinal hernia repair, but it did nothing for his pain. And the reason for that was because, most likely, what he had from the beginning was an injury to the groin nerves, the ilioinguinal, iliohypogastric, genital branch, genital femoral. These are the nerves that integrate the groin area.
But his story doesn’t stop there. Unfortunately, as often the case with the Work Comp system, if they can’t see an obvious reason for pain, they just tell the patient that they’re better and go back to work. He was forced to go back to work with this groin pain undiagnosed. And after about six months of trying to continue to work with this right groin pain, he had a secondary injury where he herniated a disc in his lumbar spine area. And so, really, the spine injury was more or less a direct downstream result of the first injury, which was not diagnosed and treated properly.
When Eduardo came to me, we did diagnostic blocks to ascertain the source of the right groin pain, which was nerve damage. And so, he underwent surgery to disconnect those nerves, and that’s been very successful. That’s basically relieved his original right groin pain and testicular pain. He still suffers from sciatica pain. And because with the Work Comp system, these things are all compartmentalized into different cases. He’s going to, at some point after, reopen the other case because he appears to have a separate condition, which could explain the sciatica pain, which is called piriformis syndrome. Work Comp injuries, by their very nature, many of them are high risk for peripheral nerve injury at the same time. Anything that can lacerate you or fracture bones is a high risk mechanism for a peripheral nerve injury at the same time. It’s really sad because these peripheral nerve patients are just chewed up and spit out by the Work Comp system, unfortunately.