Orthopedic surgeon offers tips to reduce costs of 'older' injuries

The aging workforce may be less problematic for the workers' comp system than was previously thought. While older workers incur higher overall costs than younger workers, a new report from NCCI suggests the difference is not so dramatic.

One reason is the definition of "older." According to the report, 35 may be the new 50.

"All groups of workers age 35 to 64 appear to have similar costs per worker," NCCI said. "These are reassuring findings in that an aging workforce may have a less negative impact on loss costs per worker than originally thought."

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Frequency differences seem to have largely disappeared. In 1994, the incidence rate for 20 to 24 year olds was 300 per 10,000 full-time equivalent workers while the rate for the 55 to 64 age cohort was 200. In 2009, "those numbers were almost the same at 97 and 93 respectively," according to the report. "The age cohort with the lowest incidence rate in 2009 was actually the 25 to 34 year olds with 87 injuries and illnesses per 10,000 full-time equivalent workers."

What makes costs higher for workers 35 and older is the severity of the injuries. That, the researchers say, is largely attributable to the types of injuries common to younger vs. older workers.

"Older workers are more likely to experience rotator cuff and knee injuries and lower back nerve pain . . . while younger workers are more likely to have sprains and lower back pain," the report says. "The rotator cuff, knee injuries and lower back nerve pain in the top 10 [injuries] for older workers have above average severity while the sprains and lower back pain in the top 10 for younger workers have below average severity for both indemnity and medical."

Detecting traumatic injuries. Employers seeking to reduce their workers' comp costs related to aging workers should understand the difference between chronic and workplace-induced injuries.

"A lot of older workers already have degenerative rotator cuff tears and degenerative meniscal tears prior to any work injury," said Dr. David Cooper, medical director of The Knee Center in Wilkes-Barre, Pa. "The issue is how to tell if the findings on the MRI are trauma-related or acute."

To detect whether a rotator cuff injury is work-related, imagine a cut on someone's arm. A fresh cut would have blood while an old cut would probably have a scar.

"When you look at an MRI, you look for acute blood," Cooper said. "If you have a vascular structure that tears it has some blood . . . if there is no blood or swelling, that's consistent with a chronic process."

Detecting whether a torn meniscus is work-related is a bit trickier. Cooper says asking the right questions helps.

"Many times you can rule it out from the mechanism of injury," he said. "That's key because the MRI can be a little misleading."

As Cooper explained, the meniscus has no blood supply so there would be no bleeding to see. However, the MRI might reveal if the knee has associative arthritis.

"It tears it down, shreds, as opposed to one cut through it, which would be more dramatic," Cooper said. A work-related injury resulting in a torn meniscus "would have to occur with a squat or twist. Otherwise, [an injury] doesn't tear the meniscus."

Read more at the WorkersComp Forum homepage.

January 30, 2012

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