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.