There is no diagnosis in the area of workers’ compensation injuries that causes more confusion and outright disbelief than the diagnosis of “osteoarthritis”. How is it possible that I have never had a days knee pain in my life, I went to work, had an injury, now my knee is sore and you are telling me that it is osteoarthritis?
The natural assumption is that an arthritic joint will become painful gradually, with pain increasing steadily over time. For many people, that is indeed what happens. However, for an equal number of people, the wear can progress gradually over a long period of time but not cause any symptoms at all.
That wear has to become painful one day, and often it is a relatively minor injury that is “the straw that broke the camels back”. An injury can trigger the arthritis to become painful and it is possible that following that injury, the joint may never return back to normal. That is to say, there has to be one day in your life when your arthritis becomes painful, and that day may well be the day you had an injury at work.
The other common misconception about osteoarthritis is that it causes a constant level of background low grade pain. In actual fact, osteoarthritis often causes periods of “flare up” which can be separated by periods of quite low grade symptoms which are well tolerated. These flare ups may be triggered again by minor injury, increased activity or be completely random, following on from cold weather, a bad nights sleep, etc.
This history of flare ups and periods of remission has implications for how we treat osteoarthritis. We need a strategy for managing the flare ups, which include things like Panadol, anti-inflammatories, cortisone or lubricant injections, and rest or reduced activity. We also need a long term management strategy which we undertake during the good periods which includes weight loss and low impact strengthening exercises to reduce the frequency and severity of the flare ups. Many people neglect this part of the treatment. When the symptoms are not bad is the time to get on and do the preventive work.
The severity of arthritic symptoms can progress over time but it is impossible to know the rate of the progression. It may be over decades rather than months or years.
Another important point is that you can have quite bad looking x-rays and scans showing severe wear but still have minimal pain (and vice versa).
What does this mean for my workers’ compensation claim?
Firstly, many patients feel that a diagnosis of osteoarthritis is an attempt to diminish or deny their claim. This is not the case. From a purely legal perspective, you had a pain free joint, you had an injury at work, and the joint is now painful. The insurer has a legal responsibility to accept that claim and manage the treatment of this “flare up”. It is true that they may not accept a lifetime of responsibility for your arthritic joint.
Secondly, when your claim is finalised, there is a mechanism to acknowledge and compensate you for arthritic changes. This compensation is payable if there were no arthritic symptoms prior to the work injury. The amount of compensation payable is assessed according to x-ray changes and does not take into account pain levels.
There is no doubt that the diagnosis of osteoarthritis is difficult to understand in the context of an injury, and even more challenging when that injury occurs at work.
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Dr David Colvin consults at:
Western Orthopaedic Clinic
- These rooms are part of St John of God Subiaco Hospital.
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Dr David Colvin operates at:
St John of God Subiaco Hospital
12 Salvado Rd,
Subiaco WA 6008