CP# 2010-32557 Sanchez v. The Gap
|STATE OF NEW JERSEY|
|DEPARTMENT OF LABOR AND WORKFORCE DEVELOPMENT|
|DIVISION OF WORKERS' COMPENSATION|
|The Gap,||C.P.# 2010-32557|
This is the matter of Myriam Sanchez v. the Gap, C.P. No. 2010-32557. This case comes before me as a Motion for Medical Treatment and Temporary Disability Benefits. The issue is whether the Petitioner is entitled to treatment to her neck and right shoulder.
On January 26, 2011, the Petitioner filed a Notice of Motion for Medical Treatment and Temporary Disability Benefits seeking treatment to her neck and right shoulder.
The Respondent filed an Answering Statement opposing said Motion on February 16, 2011.
The Petitioner testified that she has pain in her neck area. She takes pain medication every 6 hours. She indicated that she cannot lift or grasp objects. She noted that a can of milk is the most that she can lift. She said that she cannot sweep or mop. She cannot sleep on her right side.
The Petitioner stated that her neck always hurts. She noted that walking causes her pain in her shoulder. In addition, the she testified that if she walks around the block, she develops pain in her neck and right shoulder areas. She also complained that she had to have her hair cut a certain way because she cannot wash her hair with her right hand. She testified that due to the fact that she has problems doing chores around her home that her sister does the housekeeping.
Dr. Kulkarni testified on behalf of the Petitioner. He testified that the Petitioner had tenderness and muscle spasms in her neck and there was some loss of curvature of her neck. He indicated that when he tried to move her neck into different positions, this movement caused her pain. In reference to the examination of the Petitioner’s right shoulder, he indicated “that there was atrophy of the trapezoid and deltoid muscle as well as the head of the humerus on the right which was more prominent than the left because of the atrophy.” He also stated that there was crepitus when he tried to move her right shoulder into different directions.
Dr. Kulkarni reviewed the MRI films regarding Petitioner’s neck and right shoulder. Based on his interpretation of the MRI films, his opinion was that administering treatment to her neck would take priority over treatment to her right shoulder because he did not see a “rotator cuff tear to repair at that time.” His recommendation is that she should be referred to a pain management specialist to administer epidural injections to her neck. He testfied that based on his review of the MRI findings, she had a disc herniation which is pressing on the thecal sac in her neck.
After the neck treatment is addressed, the focus should be shifted to the right shoulder. His opinion is that she needs a subacromial decompression followed by physical therapy.
The Respondent produced Dr. Canario as their medical expert. He noted that upon physical examination of her right arm, he could only raise it to 100 degrees passively. She would not allow her right arm to go beyond that point because she complained of severe pain. However, when her arm was placed at 90 degrees, she maintained her right arm at 90 degrees against gravity on some resistance. Dr. Canario said that there was “no medical reason for her not to be able to move her arm beyond 90 degrees and certainly no reason to hold her arm flexed at 90 degrees. This is just another manifestation of her exaggeration of her symptoms.”
Dr. Canario’s impression was that she clearly embellished her symptoms because she had multiple positive Waddell signs and many inconsistencies in her examination. “A positive Wadell sign is indicative of a non-organic disease.” For example, when he rotated her pelvis, she reported having pain in in the lumbar spine and in her cervical area which is a positive Waddell sign. He said that if he rotates a person’s pelvis, the spine is not involved. He said that because the Petitioner stated she had pain in her cervical and lumbar spines when he rotated her pelvis that she exhibited symptom magnification. He also said that the she started to limp on her right side when she was asked to walk for Dr. Canario’s benefit. He explained that she had “global tenderness” which is a “non-anatomic finding.” He stated that a legitimate injury does not produce tenderness everywhere. He said that a person would have specific tenderness in the area that was injured. He noted that global complaints are a manifestation of symptom magnification.
Dr. Canario also testified that the Petitioner exhibited pain in her cervical spine, thoracic spine and lumbar spine to light touch. He testified that light touch “should not produce the pain in face of an organic disease.” He also said that when he asked the Petitioner to do a straight leg raising test, this test caused her knees to hurt rather than producing back pain or radicular symptoms. Dr. Canario stated that the Petitioner had normal reflexes.
Dr. Canario had an opportunity to review the MRI films regarding the Petitioner’s right shoulder and her neck. Although Dr. Canario also reviewed the MRI report of her right shoulder, which showed tendinitis and a partial undersurface tear of the right rotator cuff, his opinion is that these findings can be ascertained in “any 50-year old.” In reference to the MRI of her cervical spine, he felt that these findings were unremarkable. Although he stated that there was a central protrusion in one of the Petitioner’s cervical discs, his opinion is that this protrusion was not extruded and it did not compress upon the Petitioner’s nerves.
When questioned about whether he would recommend anymore medical treatment regarding the Petitioner’s right shoulder and neck, Dr. Canario stated that “there is no amount of medical treatment that would take away non-organic complaints.”
On cross examination, Dr. Canario explained that restrictions are a completely subjective finding. Dr. Canario noted that if he were to ask someone to move his or her shoulder, a person can refuse to move it at all and be unable to move it fully. He indicated that a passive motion test is a more accurate test than an active motion test. For instance, Dr. Canario explained that if he were to move someone’s arm, he could feel if there was a physical block to motion such as an adhesive capsulitis or frozen shoulder syndrome.
I am denying the Petitioner’s Motion for Medical Treatment and Temporary Disability Benefits for the following reasons: Dr. Canario emphasized that the Petitioner engaged in symptom magnification based on his physical examination of her. Specifically, Dr. Canario noted that if a patient has a legitimate injury, he or she would not have tenderness everywhere but he or she would have specific tenderness to the area that was injured. However, due to the fact that the Petitioner gave global complaints, Dr. Canario stated that she engaged in symptom magnification. Although I must rely upon competent evidence in the record when I make my decision, the Petitioner’s FCE,which was marked for Identification and commented on by Dr. Kulkarni, supports Dr. Canario’s opinion that the Petitioner engaged in symptom magnification.
I agree with Dr. Canario’s and Dr. Kulkarni’s opinions that the Petitioner does not have a rotator cuff tear in her right shoulder. Dr. Canario said that if she had a complete and severe rotator cuff tear, her right arm would drop but her right arm did not drop during his examination of the Petitioner. I also agree with Dr. Canario’s opinion that although there is a protrusion in the her neck, this disc is not extruded and that she has degenerative changes in her neck.
I am giving more weight to Dr. Canario’s findings. Dr. Kulkarni is not Board Certified in Orthopedic Surgery whereas Dr. Canario has been Board Certified in Orthopedic Surgery since 1981. Dr. Canario currently enjoys admitting privileges at Beth Israel Hospital, St. Michael’s Hospital, and the Hospital for Joint Diseases and he treats patients. However, Dr. Kulkarni does not enjoy any admission privileges and the last time he treated patients at his private practice was during the end of 2001. He has no specific training in the field of orthopedic medicine.
I will allow a stenographic fee to William C. O’Brien Associates in the amount of $450, $450 payable by the Respondent.
Theresa L. Yang
Judge of Compensation
Dated: November 23, 2011