1. Expected Rehabilitation Times for Common Upper Extremity Injuries Gordon Iiams, MD

2. What constitutes a common upper extremity injury?

3. A Review of One Hand Surgeons Workers Compensation Case Load: Time Frame 19 Months From September 2008 ToMarch 2010

4. Surgical Case Log Review of Workers Comp Cases Total # of WC Patients 49 Total # of WC Surgeries 66 (9.6%) All Surgeries688

6. Body PartsTotal Finger Tips6 Hand/Finger21 Wrist16 Forearm2 Elbow8 = 53

7. Are there any really simple injuries? Laceration Fracture Crush Soft tissue Bone Everything

8. Even a simple cut is usually complex M.T.: 32 yo WM RHDBox cutter laceration L Hand/ Index Finger Multiple Structures:Flexor Tendons RDA, RDN, FDS, FDP

9. R.T.:42 yo WM RDH L Wrist Laceration-Jigsaw (jagged/ugly)No functional structures injured

10. Recovery Times MMI M.T.1 yrND 8 day RD 11 wks SSLT 2 pt 80% 6 mm R.T.5 ½ weeksRD 1 Week Jagged skin scar

11. Is it fractured or just broken? Its just a fractured finger.

14. What constitutes a Boo Boo?

15. 6 Finger Tip Crush Injuries (12%) Open Tuft Fx Nail Bed Laceration Nerves & Small Vessels of Finger Tip Pulp

18. Summary of Finger Tip Crush Injuries Full Duty – 3 to 9 weeks MMI 2.5-6.5 months AgeMMI No Duty (days) Restricte d Duty (wks) Full Duty (wks) JJ58 M2.5204.57.5 HLF35 F3.5623 GR69 M6.5489 EC21 M4678 CG37 M3162.55 GM48 M

19. Distal Radius Fractures (18%) Extra Articular Intra Articular Comminuted Displaced

23. Summary of Distal Radius Fracture Patients Full Duty 7 wks-6.5 mo MMI 8 mo- 18mo AgeMMIFull DutyJob DL38 F186.5 moStore Mgr SP59 M14Const. Acute-on Chronic CR63 M613 wksMail Carrier JL26 M-Fisherman RSD EH66 F85 moCook RSD RH24 M- MJ45 M-M. Seaman Non- union JV57F7 wks OR RN- Colles JS52 MDOS 04.02.10Electrician

29. 13 other Hand/Finger Crush Injuries = 26%

30. Hand Crush Patients Ages: 22-71 Male/Female: 10/3 Return to Full Duty: 3 to 20 weeks Permanent Impairments: 3 MMI: 4.5 to 18 months

31. Office Evaluation Tools A. B. C. D. A.Goniometer B.Grip Dynamometer C.Pinch Discriminator D.2 Point Discriminator E.ROM F.Grip Strength G.Pinch Strength H.Sensation

41. Sample Impairment Rating G.M 51 FRHDFx-Dx Lt. 5 th CMCJ 1 yr = MMI L SF ROMMP+10-50+20-9025% PIP20-800-10019% DIP0-70 0-70zero

42. Sample Impairment Rating Grip StationRightLeft% SLI I702564 II755033 III856029 IV655023 V654531

43. Sample Impairment Rating G.M. Grip

44. Other Cases Not Discussed Nerve Repair/Decompression Elbow Fractures +/or Dislocations Global Extremity Injuries Ex: Brachial Plexus RSD

45. Reflex Sympathetic Dystrophy Causalgia: Chronic Regional Pain Syndrome Fracture Disease

46. Conclusion Simple or uncomplicated injuries Are not so common

47. Conclusion Recovery times for upper extremity injuries Take 6 months to 1 year Sometimes longer

48. Mitigating Circumstances Crush component RSD Nerve Involvement Elbows Intra-articular Extension Smoking Medical Conditions (ex Diabetes)

49. Thank You!