Workers compensation Scheduled Loss of Use for

Central Nervous System Conditions, Peripheral Nerve Injuries

and Entrapment / Compression Neuropathies

You may be wondering what “Scheduled Loss of Use” (SLU) means if you were injured at work. Here’s what you need to know! We follow the Workers’ Compensation Board’s guidelines and you may be eligible for a compensation payment.

When you submit a Scheduled Loss of Use, we evaluate it and determine whether or not your condition is work-related. We’ll issue a conclusion stating that because of your job-related accident, you’ve lost function in the damaged portion of your body that may last a lifetime.

The Workers’ Compensation Guidelines for Assessing Disability are followed in our report. This article is based on New York state workers’ compensation regulations.

Central Nervous System – Cranial Nerves

  1. Initial Nerve
    Anosmia may develop as a result of frontal trauma (coup or contra coup) if the cribriform plate is broken or if the cranial nerves’ perforating filaments are damaged. An upper respiratory infection is the most frequent cause of anosmia. Clinically speaking, an ethmoid fracture may be connected to anosmia.

     

  2. Third, Fourth & Sixth Nerve

    Traumatic anisocoria with Third Nerve involvement, drooping lids (ptosis), and involvement of the ciliary ganglion branches (sphincter of the iris) with dilatation and reflex iridoplegia are all possible. If complete, the pupil is dilated and the eye is turned outward or downward.

    Diplopia with a downward gaze is a symptom of fourth nerve palsy (palsy of the superior oblique). Abduction is weak or paralyzed with a convergent squint in sixth nerve palsy. The corneal clouding, aphakia, or other eye damage sequelae may leave a lifelong facial disfigurement.

     

  3. Fifth NerveOphthalmic, maxillary, or mandibular branches can all develop basal skull fractures as a result of trauma. It is unclear what causes trigeminal neuralgia (douloureux). Despite being incapacitating, it is typically not compensable. The Fifth Nerve’s motor portion, the masseter muscle, is responsible for biting.

     

  4. Seventh NerveThe facial nerve may be damaged by traumatic traumas to the upper neck or face. On the affected side, there is a lack of emotional and volitional movement. The capacity to raise the eyebrow, pout, avert one’s gaze, flash one’s teeth, whistle, or purse the lips is absent. Bell’s phenomenon causes the globe to roll upward when one tries to close their eyes; when they drink, liquid leaks from the affected side.

    Hyperacusis may occur in cases of stapedius muscle dysfunction. Bell’s Palsy’s etiology is uncertain. The stylomastoid foramen swelling may be the cause. It can occasionally be viral and cause outbreaks of Herpes Zoster in the external auditory canal (Ramsey Hunt Syndrome).

    The cause is clear and not reparable. Unless there is a neck or facial damage, it usually isn’t a compensable injury. Up to two-thirds of the ipsilateral tongue may experience taste loss.

     

  5. Eighth NerveComponents of the eighth nerve: cochlear (auditory) and vestibular (equilibrium). A single loss is only moderately incapacitating. Due to communication difficulties, bilateral loss is extremely incapacitating. This can be a very serious occupational impairment.

     

  6. Ninth, Tenth and Eleventh NerveNormally unrelated to injuries that is compensable.

     

  7. Twelfth NerveUnilateral loss typically results from a brainstem infarction rather than trauma and is not particularly disabling.

Peripheral Nervous System

  1. PlexopathiesThe most frequent causes of brachial plexus injury include gunshot wounds and activities that cause excessive stretching and compression, such as lifting large objects or remaining still for an extended period of time while under aesthesia.

    Similar results can result after cervical nerve root avulsion. Vehicle trauma can occasionally cause a complete brachial plexopathy, leaving the arm paralyzed and with no remaining reflexes.

    Due to a severe loss of function and pain, a severe brachial plexopathy may temporarily render a person completely disabled. Wait at least two years to determine if deficiencies develop that might result in a permanent disability or a schedule loss before assuming that a weaker participation will result in a partial disability.

    The biceps, deltoid, supinator longus, brachialis, supraspinatus, infraspinatus, and rhomboid muscles are all impacted by upper brachial plexopathy, which leads to a sequela in which the arm is internally rotated and hung to the side. No changes are made to hand motion.

    Despite occasionally partial function recovery, the prognosis for recovery is favourable. When function returns after two years, revaluate; you might be able to schedule the loss of arm use at that point.

    Injuries to the abducted arm from falls or surgery might cause lower brachial plexopathy. The small hand muscles are weakening and wasting, which could lead to loss of hand function in some cases.

    Even after a rib resection, brachial plexopathies typically allow for a final correction two years later. Consideration of a partial disability that could result in a classification might be necessary in the case of persistently severe weakness and intractable pain.

     

  2. Thoracic Outlet Syndrome
    An aberrant cervical rib, anterior scalene hyperplasia, and hyperabduction may be linked to thoracic outlet syndrome. The anterior and medial scalene muscles can be disturbed, and the brachial plexus can be compressed, by an abnormal cervical rib that arises from the seventh cervical vertebra. Compression of the subclavian artery is another possibility.

    Cervical ribs are present in five tenths of the population, with ten percent of them being symptomatic. Women’s sagging shoulders may be significant, and both men and women’s occupations may be involved. Most frequently, paraesthesia and pain are present. The diagnosis can be made with the aid of the Adson’s sign.

    The test for scalenus anticus muscle occlusion of the subclavian artery is performed using the following technique:

    Patient is seated, elbows at sides, and neck outstretched. The radial pulse is felt during deep breath, and there may be complete obliteration, as the chin is lowered in the direction of the affected side. The diagnosis may not be made with much aid from nerve conduction testing and angiography.

    Carpal tunnel syndrome, ulnar nerve compression in the elbow, and cervical discs can all be mistaken for it. It is possible to schedule loss of arm use if the condition is addressed (e.g., through surgery or other forms of treatment) and only mild symptoms and neurological abnormalities persist; nevertheless, if the condition is severe and persistent, classification should be taken into account.

Entrapment / Compression Neuropathies

Pathophysiology: a nerve that is confined and continually subjected to pressure or movement while travelling through a narrow canal. Ischemic injury causes the epi and perineurium to significantly swell, suffocating the nerve.

  1. Median Nerve – Carpal Tunnel SyndromeThe peripheral nerve entrapment syndrome that affects the upper limb the most frequently is known as Median Nerve – Carpal Tunnel Syndrome.
    The median nerve is typically compressed due to thickening of the synovium surrounding the flexor tendons at the wrist, which can be caused by haemorrhage, callus formation, malunited fractures, etc.

    The thenar eminence may atrophy, the first three and a half fingers may become tingly or numb, the thumb may become weak in opposition, and both the Tinel’s test and the Phalen’s test may be positive.

    Carpal Tunnel Syndrome, with or without decompression, is generally treated with a schedule loss of the hand, which typically results in an average 10–20% loss of function. Consider classification if symptoms continue and the condition becomes incapacitating.

     

  2. Ulnar Nerve – Cubital Tunnel SyndromeElbow

    Due to its superficial position at the elbow, where it is only protected by fascia and skin, the ulnar nerve is vulnerable to direct trauma. It could involve a single major trauma or several minor ones (i.e., constant pressure on the elbow). Although the nerve may be harmed by pressure during aesthesia, this is most often the result of being dragged too tightly up against the ulnar groove.

    As the nerve passes through the two heads of the carpi ulnaris, it is restrained. The following signs and symptoms are present: (a) ring and small finger burning pains and hypesthesia; (b) inability to separate fingers due to interosseous weakness – a significant portion of the hand’s intrinsic muscles are affected; (c) hyperextension of the ring and small fingers caused by weakness of the flexor digitorum profundus at the MCP joint; and (d) flattening of the hypothenar eminence from loss of bulk.

    The preferred medical procedure is ulnar nerve transposition. If there are deficits at the elbow along with ulnar nerve entrapment, the arm is often given a schedule loss of use. Schedule loss of hand use is provided if neurological abnormalities and mobility deficits are restricted to the hands and fingers.

    Wrist

    The palmar trunk and superficial branches of the ulnar nerve are directly injured by force applied to the base of the hypothenar eminence as the bone sits on the thinly cushioned bone in a wrist injury.

    It’s possible that the force is repetitive due to the usage of a certain tool or instrument in the workplace, such pliers or a screwdriver. Using a cane, crutches, or pressure from a splint can cause recurrent damage. The thumb’s pinch strength is the most prominent symptom at this level, while the ring and small fingers experience sensory loss.

     

  3. Anterior Interosseous (Pronator Teres Syndrome)
    The median nerve may become compressed as it travels through the pronator teres muscle heads, resulting in this condition.The most common etiology is direct trauma caused by a severe blow to the upper forearm.

    Compressing the median nerve up against the margin of the sublimis might result in reactive swelling of the nearby muscles. A pronator muscle hypertrophy caused by occult trauma, such as forceful repeated pronation in conjunction with forceful finger flexion, tautens the sublimis edge and compresses the median nerve.

    The thumb, index, middle, and radial part of the ring finger all have sensory loss on their palmar and radial sides.

    The wrist’s inability to pronate and the thumb’s IP joint’s loss of flexion are cases of motor findings. Thenar atrophy is less severe in pronator teres syndrome than it is in carpal tunnel disease. Such clients are often assigned a schedule loss of hand use based on motor and sensory deficits.

     

  4. Posterior InterosseousA neuropathy of the deep muscle branch of the radial nerve is known as Posterior interosseous nerve syndrome. A motor syndrome and, less frequently, a pain syndrome are the two main manifestations of this. The painful syndrome is also known as resistive tennis elbow and radial tunnel syndrome, and it clinically mimics a painful tennis elbow.

    Etiology:
    The posterior interosseous nerve can be constricted by a tumor, ganglia, elbow synovitis, or trauma. A severe injury could result in an elbow dislocation, an ulna fracture with radial head dislocation, or a fractured radial head.

    Compression plates utilized in the open treatment of fractures of the proximal radius have the potential to harm the posterior interosseous nerve. Typically, the supinator muscle’s point of entry under the arcade of Frohse is where the nerve is compressed.

    The muscles supplied by the nerve, including the extensor carpi radialis, the extensor digitorum communis, the extensor indicis propius, the abductor policis longus and brevis, and the extensor policis longus, may exhibit total or partial weakness.

    The wrist is typically displaced radially and has weakness in extension. There will be a weakening in the thumb’s radial abduction as well as the extension of the MCP joints in the fingers and thumb.

    The hands are typically given the schedule loss of use criteria, which is any remaining neurological and functional deficit. The schedule loss of use is assigned to the arms if the examination discovers a deficit of the elbow joint that is directly related.

     

  5. Lateral FemoralThe area of the anterior superior spine where the lateral femoral cutaneous nerve goes through the inguinal ligament is where it is susceptible to an entrapment neuropathy. The nerve’s binding point is here.

    The nerve is tight against the entrapment point if the extremity is abducted. The consequent neuropathy results in hypaesthesia and a burning-type pain over the anterolateral thigh.

    Etiology: It may occur after a direct injury to the region or an anterior ilium fracture. It may be brought on by a pelvic tilt and a shortened limb (post-hip replacement). As a result, the opposing hip is forced into adduction, pushing the deep fascia and nerve up against the entrapment point. Secretaries who spend a lot of time sitting with their legs crossed might not have the same symptoms.

    The condition is known as lateral femoral cutaneous nerve entrapment, it is also known as meralgia paresthetica, it causes burning pain, tingling, and numbness in the outer thigh.

    Compression of the nerve that supplies sensation to the skin of your thigh is what causes it. Its symptoms includes tingling and numbness, burning pain, decreased sensation, increased sensitivity and pain to even a light touch.

    It is rare for patients’ compensation to cover meralgia paresthetica. If there is a residual sensory deficit, it is usually acceptable for a schedule loss of hand use.

     

  6. Tarsal Tunnel Syndrome (Posterior Tibial Entrapment)It happens behind and directly beneath the medial malleolus. The posterior tibialis tendon, flexor hallucis longus, and flexor digitorum longus muscles surround the nerve in this region.

    The structure is covered by the lancinate ligament, which also turns the passageway into an Osseo fibrous tunnel. This tarsal tunnel swelling from tenosynovitis might function as a space-occupying lesion and compressing the nerve.

    Burning pain in the toes and sole of the foot is one of the warning signs and symptoms. When calcaneal branches are affected, the heel is the primary site of discomfort. The buttock may experience pain that is referred along the sciatic axis. The past may contain meaningful trauma. All of the toes’ MTP joints may be affected in terms of flexion.

    Pain along the posterior tibial nerve’s distribution could result from pressure on the nerve. Different ways of holding the heel may help with symptoms. The flexor retinaculum is severed as a form of therapy.

    In workers’ compensation, tarsal tunnel syndrome is rather typical. Scheduled loss of foot function is possible with or without surgery depending on residual deficit and neurological impairments.

     

  7. Plantar (Morton’s Metatarsalgia)At the foot’s metatarsophalangeal joints, hyperextension causes entrapment. The pain is typically felt between the third and fourth toes (Morton’s neuroma).
    The interdigital nerve, which crosses the deep transverse ligament, is tender and anesthetized at the tips of the toes.

    These nerves rise from the foot’s sole and terminate more dorsally on the toes. When the toes are hyperextended at the MTP joints, these neurons are activated against the transverse ligament. Only while walking at first, there is pain that radiates into the third and fourth toes; afterwards, the pain returns on its own at night.

    Loss of foot function is typically scheduled for Morton’s metatarsalgia. A typical name for foot discomfort at the ball of the foot is metatarsalgia. You can be referred to an orthopaedic clinic to contemplate surgery if recommended treatments are unsuccessful and your forefoot pain persists.

    Depending on the underlying source of the issue, surgery might help patients’s symptoms. Only after all other treatments have been tried and failed for at least three months may surgery be considered. After surgery, there may be a recuperation period of many months, during which the foot should not bear weight for the first six weeks.

     

  8. Complications of Plexus and Peripheral Nerve InjuryPain from sensory radiculopathies might refer to the sclerotome (muscle, fascia, periosteum, and bone), which causes the secondary alterations in a joint to become immobile. For instance, a frozen shoulder can exacerbate cervical spondylosis.

    A brachial plexus block or vascular puncture may result in brachial plexus damage. Injection-related neurotoxicity, hematoma formation, and direct needle trauma cause it. Minor, passing discomfort to severe sensory disturbance or motor loss with slow recovery are all possible neurological presentations.

    Both conservative therapy and surgical investigation are used in the management. It should be removed right away, especially if a hematoma occurs. To prevent nerve damage, thorough anatomical knowledge and expert abilities are essential.

Please refer to the Workers Compensation Board website of your state or speak with your Workers Compensation attorney for more information.

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4.9
Based on 92 reviews
Dr Vaksha, is a great doctor very professional knows what he talking about. Treat patient with upmost respect. Thank You
Troy Spencer
16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
blanca ventura
21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
Ita Opico
19:01 25 Oct 22
Love this place From the minute I called I was treated kindly. When I arrived The Dr saw me right away he was compassionate and ordered the appropriate tests for me. I came back in for my follow up and had the same great experience.
Christine Rostock
21:28 23 May 22
Dr Vaksha and Dr karkare are 2 of the best orthopedic doctors around my wife Susan had a very serious broken ankle in March of 2019 she didn't think she was going to walk again Dr vaksha did an excellent surgery on her ankle he said it was his toughest he ever did he put a lot of hardware in her ankle and told her she would be alright she made remarkable recovery thanks to his surgery as of now she regained 100 percent use of her ankle she would highly recommend him to anyone. My own experience with Dr karkare has been wonderful he takes his time with you listens to what you have to say and prescribes various treatments and is very caring I would highly recommend him to anyone I would give both doctors a 10 plus rating we are very happy with them the best.
Harry Jones
23:31 19 May 22
Complete orthopedics is a wonderful place to go when you hurt or injured a great staff and wonderful doctors very knowledgeable and helpful I would recommend this place to all of my family and friends that is in me of orthopedic care I give them 10 thumbs up
Wayne Pemberton
17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
Phoenix Rising
19:54 16 May 22
Dr.Karkare is the best. He listens to everything and explains everything I recommend him to everyone. I am so happy he is my doctor.
Myrna James
00:48 13 May 22
Dr.Kuo is amazing very attentive,caring,and passionate and staff is awsome too.Thank you for everything Dr.kuo.
Erick Murillo
23:17 12 May 22
I was in a car accident November 1 I was referred to Dr. Vaksha For shoulder surgery . I he was amazing he made me feel very comfortable and explained everything that was going to happen from surgery all the way through my physical therapy highly recommend Dr. Vaksha
Yolanda Ojeda
19:37 09 May 22
My appointment with Dr. Vaksha was amazing. Dr. Vaksha was very thorough and kind. I would refer this office to anyone who needs a great orthopedic doctor.
John Senechal
19:54 05 May 22
Scheduling my appointment was quick and easy. The staff was super friendly and down to earth. I was seen on time. The appropriate test, “x-rays” were taken before the conversation with doctor, something I really liked, test for analysis and conversation was done upfront. Dr. V had a great personality and was no BS, straight forward diagnosis and a play on next steps. I am happy I found them and would refer them to friends and family.
Sam
00:46 03 May 22
I have seen Dr. Kuo two times already and he's awesome along with his staff. Very friendly office and I'm glad to be a patient here.
Camaris A
20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
breidy valerio
19:01 22 Apr 22
The staff is truly exceptional, they make you feel comfortable and welcomed. The doctors are amazing,always professional, compassionate and great listeners.
Elizabeth Collado
03:25 09 Apr 22
What a great place! The place is clean and organized.The staff is wonderful. Setting up physical therapy is right there as well.I'm so glad I found this place.
Donna Anne
22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
Emily B
02:49 24 Mar 22
Dr.VAksha is the best, I love the way he treats me as his patient, he is caring,understanding and very attentive to my needs
Mirna Caballero
14:53 03 Mar 22
Great staff. Dr. Vaksha is awesome and takes the time to listen to his patients. He is very compassionate. I would highly recommend this office.
Bebe Doyle
01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
Elizabeth Birchwell
21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
Shaun Berry
18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
Ryan Brigandi
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18
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