Carpal Tunnel Surgery – What if it Doesn’t Work?

For some, surgery is an effective treatment option for carpal tunnel syndrome (CTS) after conservative treatment fails to deliver any lasting results. However, for others, carpal tunnel surgery also fails to provide relief. This can be especially disappointing for physicians and dentists who had hoped that surgery would allow them to return to practicing.

Over the years, we’ve represented several clients who did not experience relief from their symptoms following carpal tunnel surgery. In some instances, the surgery was simply not performed correctly or soon enough to prevent permanent nerve damage, but in many instances the symptoms did not resolve because the hand pain, numbness and weakness were being caused or contributed to by other co-morbid conditions (particularly with dentists, due to the demands of the dental profession).

Since we know from experience how frustrating it can be for a professional searching for answers, we’ve attempted to put together a list of some of the conditions our clients have had that manifest similar symptoms to carpal tunnel syndrome below (in no particular order):

    • Cervical Radiculopathy: Occurs when there is damage or disturbance of the nerve function if one or more of the nerve roots near the cervical vertebrae is compressed. Based on location of the damaged root(s), symptoms include pain, loss of sensation to the arm and hand, pain that spreads to the neck, arm, chest, upper back and/or shoulders, muscles weakness and/or numbness, or tingling in the fingers and hand. In some cases, lack of coordination is experienced.
    • Cubital Tunnel Syndrome/Ulnar Entrapment: A condition where the ulnar nerve becomes injured, inflamed, and swollen where it passes through the cubital tunnel on the inside of the elbow. Symptoms include numbness and tingling in the hand and/or ring and little finger, hand pain, weak grip, loss of dexterity, and aching pain on the inside of the elbow.
    • Arthritis of the Metacarpophalangeal Joint of the Thumb: The metacarpophalangeal joint is where the finger bones meet the hand bones (knuckle). This type of arthritis most commonly develops in the thumb and index finger and over time the fingers can shift towards the little finger, called ulnar drift.  Symptoms include pain, loss of motion, swelling, and weakness, which may be made worse when gripping or grasping objects.  Patients may also develop a tendency to drop objects due to severe pain.
    • Multiple Points of Impingement (“Double Crush” Syndrome): Multiple sites of asymptomatic nerve compression along a nerve, that then create a symptomatic compressive neuropathy because of the cumulative compression.
    • Thoracic Outlet Syndrome (TOS): A group of disorders where blood vessels or nerves in the area between the collarbone and first rib are compressed. Symptoms include shoulder and neck pain, along with numbness in the fingers.
    • Chronic Regional Pain Syndrome: Pain that usually affects one limb/extremity, typically after an injury. Symptoms include prolonged pain that is felt as burning and/or a “pins and needles” sensation, as well as increased sensitivity, swelling or stiffness in joints, and/or problems coordinating muscle movements.

While most insurers will pay benefits immediately following CTS surgery, insurers also rely upon durational guidelines to determine how long it will take you to recover. Many insurers also have their in-house doctors contact your surgeon following the surgery and push for a return-to-work date. Consequently, in claims involving CTS surgery, the real fight to maintain benefits most often comes several months after the surgery.

If the dentist or physician has not thought ahead, this can be a particularly stressful time, because the persistent symptoms may necessitate the sale of a practice that is only being kept afloat by temporary associates filling in during the recovery period. Similarly, if you are not prepared with documentation and medical records to demonstrate that the carpal tunnel surgery failed or that you have other co-morbid conditions that continue to prevent you from being able to practice, your benefits may be denied or terminated. Because of this, it is important to have a plan in place for this contingency before having the surgery.

These posts are for informative purposes only and should not be used as a substitute for consultation with and diagnosis by a medical professional. If you are experiencing any of the symptoms described above and have yet to consult with a doctor, do not use this resource to self-diagnose. Please contact your doctor immediately and schedule an appointment to be evaluated for your symptoms.

Search Our Site

 

References:

Webmd.com
Mayo.com
Healthline.com
Carpal-Tunnel.net
AAOS.org
Robert Tiel, MD, Carpal Tunnel Syndrome at LSU, Department of Neurosurgery, LSU Medical Center, http://www.medschool.lsuhsc.edu/neurosurgery/nervecenter/carpal.html.
Michael J. Lee, DPT and Paul C. LaStayo, PT, PhD, CHT, Pronator Syndrome and Other Nerve Compressions That Mimic Carpal Tunnel Syndrome, 34, J Orthop Sports Phys Ther, 601, Oct. 2004

What to Expect When Filing a Disability Claim

When it comes time to file a disability claim, many professionals believe that they’ll just submit their claim forms, have their doctor sign a statement verifying their disabling condition, and start receiving their monthly benefit checks. But filing a disability claim is much more involved than that.

The process begins when you give notice to your insurer of your claim, and request the initial packet of claim forms. Many insurers now require you to call-in to request the forms, as this gives them the opportunity to conduct an impromptu interview, catch you off guard and collect as much information from you as they can before you have a chance to see the claim forms, review your policy or talk with an attorney about the proper scope of a disability claim investigation. And this interview is only the beginning.

Once you have the forms, there are trick questions on the forms that can prejudice your ability to collect if not answered precisely and correctly. After these first forms are submitted, the investigation continues based upon your responses on the claim forms, and the insurance company will likely have several follow-up questions as they look for ways that they can deny your claim, or limit their liability (by, for example, paying you partial/residual disability benefits, instead of total disability benefits).

It’s also important to remember that this is not a one-time process. You will have to continue to provide satisfactory proof of loss to your insurer on an ongoing basis for as long as your claim is active, and your insurer has a right under your policy to continue to investigate your claim at any point until your maximum benefit period is reached and your policy expires.

While each claim is different, insurance companies will typically:

Speak with your treatment providers, family, friends and co-workers about your condition. The insurance company will have you sign authorizations that grant the insurance company sweeping authority to speak directly with a host of individuals (e.g. any physician you have ever been treated by, pharmacies, benefit plan administrators, insurance agents, financial institutions, the Social Security Administration, family, friends, co-workers and employees, among others).

Request a wide range of personal information. Most authorizations also allow the disability insurer to request virtually any information not otherwise barred by law–not just medical records. The information can include medical records, tests, or consultations, prescription history, mental health records, HIV/AIDS treatment information, records for any substance abuse treatment, court records, occupational data, employment history, driving history, financial statements, and your earning history.

Schedule face-to-face interviews with you. Many insurers seek to interview you in your home, so that they can view your surroundings to see if they can find discrepancies in the claim, or learn more about you so that it is easier for them to conduct surveillance. These interviews can be stressful if you’ve never experienced them before, and they can be particularly difficult if you are expected to discuss your medical conditions and the facts surrounding them with a complete stranger who you have never met.

Order an In-Person Exam. The insurance company may claim that the exam is used to verify a disability; however, insurers also use these exams as a means to criticize your provider’s course of treatment, or dispute your own provider’s conclusions and diagnoses. Most disability policies also provide that refusal to participate in an exam allows the insurance company to deny a claim or terminate benefits.

Use a private investigator to conduct surveillance. The insurance company may employ a private investigator to conduct photo, video and/or online surveillance, in an attempt to find discrepancies in your claim, or evidence of “malingering.” This can pose a particular challenge for dentist and physician claims, as oftentimes a dentist or physician’s symptoms may be significantly alleviated once he or she steps away from the demands of practicing.

This process can be very invasive and, if you have never experienced the claim process before, it can be hard to tell whether your insurer is taking things too far. If you feel your insurance company is being too aggressive, an experienced disability insurance attorney can assess the scope of the investigation and advise whether the insurer’s conduct is proper.

10 More Legal Mistakes Professionals Make When
Filing a Claim for Disability (Mistake #10)

In an effort to provide professionals with more information about how the disability claims process works and identify some of the most common pitfalls for professionals filing disability claims, Comitz | Beethe attorneys Ed Comitz and Derek Funk have compiled an updated list of the 10 most common mistakes we are seeing physicians, dentists, and other professionals make when they file claims under the new post-2000 generation of disability policies (which are much more complex and stringent than the policies sold to professionals in the 1980s and 1990s).

In this post, we’ll be looking at the common mistake of cancelling an existing policy and getting a newer policy, without fully understanding or considering how this decision can impact your chances to collect benefits if you ever need to file a claim.

Mistake #10: Replacing Your Old Policy with a New One

Many professionals decide to replace older, smaller value policies with a new policy with a higher monthly benefit, once they reach the point that they can qualify for a higher benefit amount. While this can be more convenient (because you don’t have to keep track of multiple premiums, or file with multiple companies if you end up needing to file a disability claim), generally speaking, older disability policies have more favorable policy definitions and better coverage for professionals. So, if you do have an older policy, it may be better to supplement that coverage, rather than replace it.

Another important consideration to keep in mind when assessing whether to replace existing coverage is that canceling an existing policy and choosing a new one resets pre-existing limitation periods that may have already been satisfied under the older policy. Additionally, if you purchase a new policy, you will likely have to go through the medical underwriting process again and, as a result, conditions that would have been covered under the older policy may be excluded from coverage altogether under the new policy.

Action Step:  Carefully review the pros and cons of replacing an existing policy before cancelling it or letting your policy lapse due to nonpayment of premiums.

To read the rest of the 10 most common mistakes, click here.

To learn more about some of the tactics insurers use to deny claims and other mistakes to avoid, click here.

Search Our Site

Can You Remain Anonymous in a Lawsuit Against Your Insurer?

If your disability claim has been denied or your disability benefits have been terminated, you may be considering filing a lawsuit against your disability insurer, and may be wondering if you have to publicly disclose your name and medical condition in order to so. You may be concerned that filing a lawsuit disclosing your condition could prompt future potential employers to decide not to hire you, in the event that you recover and seek to return to work in your profession. And if your disabling condition is a mental condition, you may (understandably) simply be concerned about the details of your condition being shared with strangers in a public forum.

While, ultimately, whether or not you can remain anonymous in a lawsuit will depend on the particular law of your jurisdiction, a recent case involving Unum suggests that if an insurance company can force you to disclose your name in court filings, it will, even if there is no real basis for doing so (other than, of course, to cause you embarrassment, in the hopes that you will drop your case.

In A.G. v. Unum Life Ins. Co.[1], the claimant worked at a well-known, national law firm prior to her disability. She suffered from a mental health condition and was concerned that publicly disclosing this in court filings could deter law firms from hiring her in the future, should she recover from her condition and attempt to return to work. Because of this, she simply used her initials when she filed her case, and didn’t disclose her full name. In response, Unum filed a motion asking the court to compel her to disclose her full name in the publicly filed court documents.

Because the case was filed in Oregon, the Court applied the Ninth Circuit’s multi-factor test for determining whether a claimant can proceed anonymously. Prior cases applying this test had essentially determined that, in order to proceed anonymously, the claimant had to show a reasonable fear of physical harm. In light of these cases, the Court felt it had no choice but to require A.G. to disclose her name, because (among other things) the harm that she feared was economic and emotional, not physical.

What is perhaps more significant about this case is the fact that the Court also found that Unum failed to show that it would have suffered any prejudice to its case if A.G. had been allowed to stay anonymous. The Court pointed out that Unum obviously already knew A.G.’s full name from the claim forms and medical records that already existed in Unum’s file, and concluded that Unum had made “no showing that [A.G.] proceeding by initials impairs its ability to defend against the allegations.”

Unfortunately, for A.G., this ultimately didn’t matter much, because under the Ninth Circuit’s test, the party wishing to remain anonymous had the burden of proving that the risk of harm was substantial (in addition to showing that the prejudice to the other party was outweighed by this risk). So, in the end, A.G. had to face the unenviable choice of either disclosing her condition publicly or dropping her claim against Unum.

Situations like this are, unfortunately, not uncommon. Insurance companies view claims (and related litigation) as a war of attrition. They know that they have more time, money and industry knowledge than most insureds (particularly insureds who are not represented by counsel) and they also know that there is a social stigma that surrounds mental health diagnoses that can be used to their advantage. For this reason, many insurers aggressively target mental health claims or claimants who are well-known in the community (such as physicians, dentists, and lawyers) because they know that some claimants will choose to drop their claim (or settle for substantially less then they are entitled to) when faced with the prospect of having their mental or physical health publicly disclosed in court proceedings or at trial.

[1] A.G. v. Unum Life Ins. Co., No. 3:17-CV-01414-HZ, 2018 WL 903463 (D. Or. Feb. 14, 2018).

Search Our Site

 

Do You Have the “Own Occupation” Coverage
You Think You Have?

Most physicians and dentists know that they should purchase an “own occupation” policy that provides disability benefits if they are no longer able to practice in their profession. True own occupation policies pay benefits if the insured cannot perform at least one of the material and substantial duties of his or her occupation. Some policies are also specialty-specific and further define “occupation” as the dentist or physician’s specialty.

While true own occupation and specialty-specific policies were commonplace in older disability insurance policies, newer policies are substantially different across the board. Over time, insurance companies have come up with several variations of the “own occupation” provision and these new provisions typically contain additional requirements and limitations that restrict coverage and/or make it much more difficult for professionals to prove they are totally disabled and collect benefits.

This is something that not always apparent from the marketing and application materials provided when you are purchasing the policy. For example, a physician quickly reviewing a policy application may check the box for the “medical occupation definition of total disability” rider because it sounds like what he or she would want if he or she could no longer practice. It’s likely that the physician would just assume that this option is the equivalent of the true own occupation policy described above, and move on to the next part of the form without a second thought. However, if the physician never reviews the subsequently issued policy, he or she may be in for a surprise if the need to file a claim arises.

Here’s an example of what you could get if you ask for a “medical occupation definition of total disability option” (taken from an actual policy):

(Click here for a larger view.)

In addition to this being a particularly confusing, complex total disability definition, this rider would also cost you higher premiums, without providing the disability coverage that you likely wanted.

It is therefore very important to review your policy when it is issued, to ensure you have a complete and accurate understanding of the coverage that you are paying thousands (upon thousands) of dollars in premiums for, so that you have the disability coverage you need, if/when you need it.

Search Our Site

 

How Far Will Insurers Go To Offset Your Benefits?

We have previously discussed benefit offsets, which are provisions in policies that permit the insurer to reduce the amount of your monthly benefits if you are receiving income from certain sources (listed in the policy). While you may be aware that these provisions exist, you may be shocked by how far some insurers are willing to go to reduce benefits.

In the case of Rustad-Link v. Unum[1], Dawn Rustad-Link suffered a below-the-knee amputation after receiving negligent medical care. In addition, she had been diagnosed with multiple sclerosis (MS) several years earlier. Accordingly, she filed for disability benefits under her Unum policy.

At the outset of Rustad-Link’s claim, Unum determined that her MS was the primary disabling condition, and asserted that she had to wait 12 months to receive benefits, because the MS was a pre-existing condition.

Later on in the claim, Rustad-Link received a medical malpractice settlement (in connection with the below-the-knee amputation). When Unum learned about the settlement, it changed it’s prior assessment, determined that the amputation (not the MS) was the primary disabling condition, and asserted that, because of this, they were entitled to offset any income she received as a result of the amputation (i.e. the medical malpractice settlement). Significantly, when asked to assess the situation, Unum’s own in-house attorneys concluded that the settlement proceeds did not qualify as an offset; however, Unum’s “Financial Recovery Unit” ignored this, and continued its efforts to apply and enforce the offset. Unum then claimed that it had overpaid roughly $47,000 in benefits, and informed Rustad-Link that, moving forward, it would be reducing her benefits each month by roughly $2,000 until this amount was repaid to Unum (resulting in a remaining monthly benefit of only $115). Rustad-Link then filed suit to contest Unum’s determination.

Fortunately, the Court saw through Unum’s efforts to improperly apply the offset and concluded that Unum’s interpretation of the policy was “impermissibly self-serving.” In reviewing the record, the Court noted that Unum did not change its assessment until after it learned of the medical malpractice settlement, and concluded that the only purpose behind this change was “to take advantage of the settlement by treating the entirety of her misfortune as income.”

Although, in the end, Rustad-Link was able to avoid an offset, this case highlights the fact that insurance companies are financially motivated to deny and/or reduce your disability benefits, and illustrates how far insurance companies are willing to go to apply an offset. This case also shows that, while many juries have awarded damages and regulators have imposed fines in an effort to deter to bad faith conduct, Unum (and other insurance companies) continue to take aggressive and unreasonable positions in order to benefit their bottom-lines.

[1] Rustad-Link v. Providence Health & Serv., No. CV 16-136-M-DWM, 2018 WL 651833 (D. Mont. Jan. 31, 2018).

Search Our Site

 

Do You Have A Specialty-Specific Policy?

Your ability to collect disability benefits under your insurance policy depends first and foremost on how “total disability” is defined under your policy. As we have previously discussed, if you are a professional choosing a policy, you will want to look for a policy that defines “total disability” in terms of your inability to perform your “own occupation,” and you will want to be sure to look for a true “own-occupation” policy.

While most professionals are aware of the importance of seeking out an “own-occupation” policy, you may not be aware that insurance companies also offer specialty-specific own occupation policies that are tailored to physicians and dentists who are specialists. These policies have a more precise definition of “total disability” that requires the insurance company to not only consider your occupation, but also your specialty when assessing eligibility for disability benefits.

Here’s a few examples of what these specialty-specific policies look like:

Oftentimes, the premiums charged for these types of policies are higher than other policies, but if you end up needing to file a claim down the road, and you are a physician or dentist with a board recognized specialty, this type of “total disability” provision can help ensure that your specialty (and corresponding job duties) are given proper weight. If you have a specialty-specific definition, and your insurance company is not taking into consideration the unique demands and duties of your specialty, you should contact an experienced disability insurance attorney and he or she can ensure that this important provision is enforced.

Search Our Site

 

What is an EMG?

Most people are familiar with CAT scans or MRIs.  EMG tests are another diagnostic tool that are, perhaps, not as well known.

What Is An EMG/NCS?

EMGs and Nerve Conduction Studies (NCSs) are diagnostic procedures that are often done at the same time and are used to assess the health of the muscles and the nerve cells (motor neurons) that control them. Because motor neurons transmit electrical signals that cause muscles to contract, an EMG can record these and turn the signals into sounds, graphs, or numerical values to be interpreted.

During an EMG, a needled electrode is inserted into a muscle to record the electrical activity.  The activity is recorded muscle during rest, slight contraction, and forceful contraction.  This data used to help detect any neuromuscular abnormalities.

In a NCS, electrodes are taped to the skin and the speed and strength of signals between two points is measured. When a signal travels at a slower rate that it should, the nerve may be damaged.

Why Might Your Doctor Order An EMG/ NCS?

Typically, these tests are used to diagnose a nerve or muscle disorder, so a doctor may order them if he/she is looking for an explanation for the following:

What Are EMGs Used For?

They are used, in connection with other tests, to diagnose or rule out muscle disorders, nerve disorders, or disorders affecting the connection between the two, including:

While who is authorized to perform EMGs varies by state, EMGs/NCSs are typically performed by a specialist or a specially trained physician, usually a neurologist, qualified to interpret the data.

These posts are for informative purposes only and should not be used as a substitute for consultation with and diagnosis by a medical professional. If you are experiencing any of the symptoms described above and have yet to consult with a doctor, do not use this resource to self-diagnose. Please contact your doctor immediately and schedule an appointment to be evaluated for your symptoms.

References:

Mayoclinic.com
Webmd.com
Healthline.com
Providence.org

Search Our Site

 

Edward O. Comitz and Michael F. Beethe Named Southwest Super Lawyers for 2018

Ed Comitz and Mike Beethe, the founding members of the firm, have both been named Southwest Super Lawyers for 2018.  This is the seventh consecutive year that Mr. Comitz and Mr. Beethe have been recognized by Super Lawyers for excellence in their fields, insurance coverage and real estate, respectively.

Super Lawyers is a rating service of outstanding lawyers from more than 70 practice areas who have attained a high-degree of peer recognition and professional achievement.  Only 5% of attorneys in the Southwest receive this distinction. The selection process is comprised of independent research, peer nominations and peer evaluations.

Search Our Site

 

Am I Under Surveillance?

In previous posts we’ve looked at when disability insurance companies are most likely to conduct surveillance of claimants and new technologies that they’re deploying to do so.  Surveillance is a common tool used by disability insurance companies in the claims process.  Disability insurers claim that surveillance is merely used as a fraud prevention tool to ensure that claimants’ disabilities are legitimate.

Unfortunately, more often it is used to distort the true nature of the claimant’s disability and deny legitimate disability claims through photos, videos, and observations by investigators that are intentionally taken out of context.  Even if your limited activity is consistent with your disability, a photo or five-second video clip can paint a misleading picture.  Insurers can use this information to terminate disability benefits, shifting the burden to you to prove that the surveillance is not representative of your disability.  This process can drag on for long periods of time – during which you are not receiving your monthly disability benefits.

An insurance company’s investigators may employ a number of different tactics during surveillance of claimants.  In this post we’re going to take a look at several of these tactics and discuss some of the signs that may indicate you are under surveillance.

Social Media

Social media monitoring has become one of the most prominent methods of surveillance used by disability insurers during the claims process.  Disability insurance companies hire tech-savvy millenials to comb the Internet and social media websites for photos, videos, and posts they can use against you.  They will also look for patterns in your photos, check-ins, and posts to better predict where you are at any given time for in-person surveillance.

As a general rule of thumb for social media, you should adjust your privacy settings on Facebook, Instagram, Twitter, and other sites to allow only approved people to view your profile, your posts, and your photos/videos.  Some social media sites have separate privacy settings for your profile and your photos/videos – be sure to take a careful look at how the privacy settings on each site are organized so you’re covering all your bases.

If you receive a friend request from somebody you don’t recognize, it is better to err on the side of caution and reject the request.

 “Interview” by Investigator

One of the most obvious and most common signs that you are under surveillance is an investigator sent to your house by the disability insurance company to “interview” you.  During this interview, they may ask you what you do every hour of the day under the pretense that the insurer needs a better idea of how your disability affects your daily activities.  They may also ask to take a picture of you or take a photocopy of your driver’s license for “the file.”

These requests may seem harmless, but they have an ulterior motive.  The purpose asking what you do every hour of the day isn’t to get a better understanding of your disability, it’s to help the investigator get an idea of where you are at any given time so they can conduct more effective surveillance.  The purpose of taking your photo or asking for a copy of your driver’s license isn’t simply for the file – it’s to help investigators more readily identify you when you are out in public.

Unusual Telephone Calls

If you or your family members begin receiving telephone calls from unusual phone numbers, you might be under surveillance.  Investigators will sometimes call a number associated with you, your residence, or your family members, ask for you, and hang up after they get a response.  This tactic is used to determine whether or not you are home, and if not, to get an idea of where you are so they can conduct surveillance.  If you are able to, keep track of any phone numbers from which you receive multiple suspicious calls, and create a list of Do-Not-Answer phone numbers.

Unusual Vehicles Outside Your House

Investigators are known for sitting outside claimants’ houses for hours at a time to get photos and videos of claimants doing activities around the house and in the front yard.  If you see an unfamiliar car parked on the street near your house for long periods of time, it may be an investigator hired by your disability insurance company.  Occasionally they will put up “blackout” shades in their windows when they park so you cannot identify them, and in some cases will actually go as far as removing their license plates while parked.  If you see a vehicle like this parked near your house, we suggest closing your blinds and avoiding any activity in the front yard.

Unusual Driving Behavior

Another common surveillance tactic used by investigators is “tailing” claimants.  An investigator may follow a claimant for hours at a time as he or she drives around going about their daily activities.  Like home surveillance, tailing creates many opportunities for an investigator to snap a quick video or photo that the disability insurer can use to misrepresent your disability.  If you see a suspicious vehicle following you too closely, changing lanes when you change lanes, or exhibiting other unsafe driving behavior, it may be an investigator from your disability insurance company.

The safest way to determine whether or not you are being followed is to make three consecutive right turns.  If the suspicious vehicle follows you through all three turns, you are likely being followed.  If you are being followed, do not engage in unsafe driving behavior or attempt to confront the other driver.  It is better to simply return to your home.  If their driving behavior is unsafe or makes you uncomfortable, don’t hesitate to call the police.

Strangers at Your Door

Investigators are known to come to claimants’ doors posing as door to door salesmen or community members gathering signatures for petitions.  Like many of the other tactics, this is intended to give the investigator a closer look at your body movements, your posture, and your behavior.  If you see somebody unfamiliar at your door, ask a few questions through the door about the purpose of his or her visit before you open the door.  If the answers do not satisfy you, simply ask them to leave.

Rule Number One

With any of these surveillance tactics, the most important thing to remember is that if you feel uncomfortable or unsafe, you have every right to call the police.  Your disability insurance company has the right to conduct surveillance as long as they obey the law.  However, they do not have the right to trespass, endanger your safety or your family’s safety, or harass you.  If you think you may be under surveillance or have any questions about the tactics being used by your insurer, contact an experienced disability insurance attorney.

Search Our Site

 

Cubital Tunnel Syndrome

In previous posts, we’ve discussed several chronic conditions that can affect dentists in particular, as their jobs require them to hold unnatural, static positions for extended periods of time while continuously gripping instruments. This puts tremendous stress on their musculoskeletal systems, especially their hands, and this is, in part, why dentists experience nearly four times the prevalence of hand, wrist and arm pain found in the general public.

While most dentists and surgeons are likely familiar with carpal tunnel syndrome, there are other conditions affecting the hands that can be just as debilitating. In this post we will examine the causes, diagnosis, symptoms, and treatment of cubital tunnel syndrome, a similar condition that arises from nerve impingement at the elbow.

Overview

Cubital tunnel syndrome is a condition that involves pressure or stretching of the ulnar nerve (also known as the “funny bone” nerve) that runs in a groove on the inner side of the elbow. This can cause numbness or tingling in the ring and small fingers, pain in the forearm, and/or weakness in the hand. Those suffering from cubital tunnel syndrome can find it difficult or impossible to function with the same level of dexterity that they used to have.

Causes

Cubital tunnel syndrome occurs when the ulnar nerve becomes compressed or irritated at the elbow, but the exact cause of this is often unknown. There are several factors that can lead to nerve irritation such as:

  • Keeping your elbow bent for long periods of time
  • Repeatedly bending your elbow
  • Leaning on your elbow for long periods of time
  • Repetitive activities that require the elbow to be flexed
  • Prior fractures or dislocations of the elbow

Diagnosis

In order to diagnose cubital tunnel syndrome, a physician will perform a medical history review and physical examination. The examination will include an evaluation of the sensation of the hand and fingers as well as a test of your elbow reflex. Additional screening may be required, including:

  • X-rays: to check for bone spurs, arthritis, or other places that the bone may be compressing the nerve
  • Nerve conduction studies: to determine how well the nerve is working and to help identify where it is being compressed
  • Electromyogram: a test that measures the electrical discharges produced in the muscles

Symptoms

Generalized symptoms of cubital tunnel syndrome include:

  • Numbness and tingling in the ring finger and pinky finger, usually occurring when the elbow is bent (such as when driving or holding a phone)
  • Feeling of pins and needles or the feeling of the hand “falling asleep” in the ring and pinky finger
  • Weakening of the grip and difficulty with finger coordination, especially when manipulating objects

Severe symptoms can include:

  • Weakness in the ring and little fingers
  • Decreased hand grip
  • Muscle wasting in the hand
  • Curling up of the pinky and ring finger along with pain, or a claw-like deformity of the hand

Treatment

Mild symptoms of cubital tunnel syndrome can be managed with home remedies such as:

  • Avoiding activities that require you to keep your arm bent for long periods of time
  • Avoiding leaning on your elbow or putting pressure on the inside of your arm
  • Keeping your elbow straight at night when sleeping by wrapping a towel around your elbow or wearing an elbow pad backwards
  • Performing nerve gliding exercise

More severe cases of cubital tunnel syndrome may require medical interventions such as:

  • Use of non-steroidal anti-inflammatory drugs (NSAIDs) to reduce swelling around the nerve
  • Use of corticosteroids
  • Bracing or splinting
  • Surgery to increase the size of the cubital tunnel or to transpose the nerve in order to relieve the pressure

These posts are for informative purposes only and should not be used as a substitute for consultation with and diagnosis by a medical professional. If you are experiencing any of the symptoms described above and have yet to consult with a doctor, do not use this resource to self-diagnose. Please contact your doctor immediately and schedule an appointment to be evaluated for your symptoms.

References:

American Society for Surgery of the Hand, http://www.assh.org
American Academy of Orthopaedic Surgeons, https://orthoinfo.aaos.org/
Mayo Clinic, www.mayoclinic.org
WebMD, www.webmd.com
Healthline, www.healthline.com
Dental Products Report, dentalproductsreport.com

Search Our Site

 

Multiple Sclerosis

Multiple sclerosis (MS) is a disease of the central nervous system, which is made up of the brain, spinal cord, and optic nerves. It’s estimated that 2.3 million people worldwide have MS.  In this post we’ll examine the symptoms, causes, diagnosis, and treatment of this disease.

Overview

With MS, the immune system begins to attack the protective sheath, called myelin, that covers the nerve fibers.  The result is faulty communication between the brain and the rest of the body.  The disease may eventually cause the nerves deteriorate and they may even become irreversibly damaged.

The symptoms experienced and the rate of progression and severity of the disease will vary greatly from person to person.  Some individuals may have a very minor form of MS, while others will go on to become paralyzed, or, in rare instances, have a potentially fatal form that progresses rapidly from onset.

MS has several difference courses, in terms of how the disease progresses:

Relapse-Remitting MS: Most people with MS experience times of new symptoms, or relapses, that develop in a relatively short period of time followed by periods remission where there are few or no symptoms.

Secondary-Progressive MS: About 60 to 70% of people with relapse-remitting MS type will go on to experience a steady progression of symptoms.

Primary-Progressive MS: Some individuals have a gradual onset and progression of symptoms without relapses.

Benign MS: MS is considered benign if the individual has no relapses and a mild, stable disability after about 15 years from the time of diagnosis.

Symptoms 

Because MS attacks the central nervous systems, a wide range of symptoms in nearly any function can occur.  Symptoms will also vary in type and severity from one person to another.  Symptoms can resolve, come and go, or be permanent. Common symptoms include:

  • Blurred vision
  • Partial or complete loss of vision
  • Loss of balance
  • Poor coordination
  • Dizziness or vertigo
  • Slurred speech
  • Tremors
  • Tingling
  • Electric shock sensations
  • Numbness or weakness
  • Extreme fatigue
  • Depression
  • Temperature sensitivity
  • Memory and concentration problems
  • Paralysis

Causes and Risks Factors 

While the cause of MS is unknown, many believe it is a mix of genetics and environmental factors.  Scientists have identified several risk factors that may be associated with MS:

  • Genetics and family history
  • Gender (women are 2 to 3 times more likely to develop MS)
  • Age (most people are diagnosed between the ages of 20-50)
  • Certain infections, including the Epstein-Barr virus
  • Certain autoimmune diseases, including type 1 diabetes or thyroid disease
  • Smoking

Diagnosis 

MS is often a hard disease to diagnose, especially because symptoms vary from person to person, can come and go, and are similar to other disorders of the nervous system.  While there is no single diagnostic test, there are several methods physicians use to evaluate individuals for MS, including:

  • Blood tests to screen for other diseases with similar symptoms (e.g. Lyme disease)
  • Balance, coordination, vision, and other tests to see how the nerves are functioning
  • MRIs to detect changes in the brain (lesions) and/or spinal cord
  • Evoked potentials tests, which evaluate electrical activity in the brain
  • Analysis of the cerebrospinal fluid (CSF) in the brain and spinal cord for specific proteins
  • Spinal tap to look for abnormalities in antibodies, and look for infections or other conditions with similar symptoms

Treatment

At present, there is no cure for MS.  However, there are several treatments doctors utilize in an effort to manage symptoms, shorten the length of attacks, and modify the progression of symptoms.  Some of them are listed below.

Treatment to Modify Progression

  • Medications to curb the body’s immune system to attempt to stem the body’s attack on the myelin

Treatment for MS Attacks

  • Corticosteroids to reduce nerve inflammation
  • Muscle relaxants
  • Plasma exchange

Treatments for Symptoms

  • Medications (fatigue, depression, and other symptoms)
  • Muscle relaxants
  • Physical therapy
  • Staying cool, sometimes with devises such as a cooling vest (symptoms often worsen when body temperature rises)
  • Alternative medicine (acupuncture, massage, relaxation techniques)
  • Exercise and reducing stress

Treatment will often involve an interdisciplinary approach and may require treatment from a care team including neurologists, physiatrists, urologists, psychiatrists, physical and occupational therapists, and others as needed.

These posts are for informative purposes only and should not be used as a substitute for consultation with and diagnosis by a medical professional.  If you are experiencing any of the symptoms described below and have yet to consult with a doctor, do not use this resource to self-diagnose.  Please contact your doctor immediately and schedule an appointment to be evaluated for your symptoms.

References

National Multiple Sclerosis Society, https://www.nationalmssociety.org
Mayo Clinic, https://www.mayoclinic.org
John Hopkins Medicine, https://www.hopkinsmedicine.org
WebMD, https://www.mayoclinic.org

Search Our Site

 

Ranking Arizona Names Comitz | Beethe #1 Law Firm for Best Workplace Culture

Comitz Beethe is proud and honored to announce we have been named Arizona’s #1 Law Firm for Best Workplace Culture and the #2 firm in both Healthcare Law and Firm with Under 22 Lawyers by Ranking Arizona: The Best of Arizona Business. Ranking Arizona publishes the results of the largest annual poll of the Arizona business community. Residents are asked to share their opinions of the best products, services, and individuals in the state.

We’ve earned this distinction through the development and execution of studied, meticulously considered strategies aimed at obtaining optimal results for our clients. We have also remained a small firm in order to encourage the sharing of ideas and information in an environment fostered by mutual trust. We pride ourselves on recruiting only the top attorneys in education, skills, and temperament.

We offer dentists, physicians, and other professionals compassion, thoughtful and meticulous legal representation, and are dedicated to making the claims process as painless as possible for each client.  Comitz Beethe offers unparalleled strategy, advocacy, and adaptability.  Our clients have immediate attorney access, including their direct telephone lines and emails.  Each case has a minimum of two attorneys and a paralegal working on it, with senior partners directly involved in developing each case.

Comitz Beethe’s keen legal, medical, and disability industry insight allows us to know what really matters in a case, and we are able to leverage this experience to deliver success.  We are pleased that our dedication has earned us this recognition for both our legal expertise and our firm’s collaborative ethos, which allows us to work together tirelessly in order to exceed our clients’ most optimistic expectations.

Search Our Site

 

Why You Can’t Blindly Rely on Your Agent to Choose the Right Policy for You

In earlier posts we’ve discussed how agents don’t have the authority to change, delete, or add provisions to a disability insurance policy.  We’ve also discussed how most disability insurance policy applications now contain language stating that you cannot rely upon representations made by agents regarding the scope of coverage, or eligibility for coverage.  Thus, while agents can provide helpful advice and help to point you in the direction of a disability insurance policy that may fit your needs, it is ultimately up to you, the purchaser, to review your policy, become familiar with the provisions of the policy, and confirm that you are in fact purchasing the coverage that you expected to receive.

If you don’t take the time to do this, and blindly pay premiums without reviewing your disability insurance policy first, you could end up paying for coverage that provides less protection than you thought you were getting when you applied for the policy.  For example, most physicians and dentists know that their disability insurance policies should be “own occupation”, meaning a policyholder is considered totally disabled (and eligible to collect benefits) when he or she can no longer work in his or her profession, versus being unable to work at all, in any profession.  In some policies, own occupation is further defined as being unable to practice in a particular medical or dental specialty (i.e. anesthesiologist, periodontist, etc.).

Quite often physicians and dentists decide to buy another policy, either because they let a previous one lapse, or because they want to purchase additional coverage as their income increases and they can afford higher premiums, and they ask their agent for a new policy with the “same coverage”.  This can be incredibly difficult or impossible to achieve, because over time disability insurance policies have evolved to become more restrictive, and each company has variations on what they deem an “own occupation” policy.  Consequently, while your agent may present you with a policy that contains the phrase “own occupation”, it may not be a true own occupation policy at all.

For example, some policies are actually conversion policies, which mean they start out as “own occupation” policies, but after a certain time frame (e.g 2 years, or 5 years), they change to an “any occupation” policy, which means that, in order to continue receiving disability benefits, you would have to show that you can’t work at all.  This can be very difficult to prove, particularly if you worked in another capacity for all or some of the prior “own occupation” period.

Even if your agent does locate an own occupation plan with similar premiums and benefit amounts to an older policy, there may also be provisions that cancel each other out in the new and old policies.  One scenario we’ve seen is a disability insurance policy containing the provision that a claimant must not be working (a “no work” provision) in their own occupation or another profession in order to collect benefits, while the second policy states that a claimant must not be working in their own occupation but must be working in another field in order to collect benefits (a “work provision”).  Under this scenario, in essence, one of the policies you’ve been paying years of premiums for is worthless, as both requirements cannot be met at once.

These examples highlight why it is important that you do more than just check an “own-occupation” box on your application and/or blindly rely on your agent’s assurance that a new policy is compatible and/or the same as an existing one.  If you end up with a policy you essentially cannot use, your recourse is limited, as insurance companies have gone to significant lengths to shield themselves from any liability based on an agent’s representations of a policy.  It is therefore far better to take the time to review your policy at the outset, before you pay years of premiums, to ensure that it provides the disability coverage that you applied for and need.

Search Our Site

 

Diabetes: An Overview

We’ve talked before about how diabetes can occur in conjunction with other diseases, such as anxiety, or contribute to certain medical conditions, such as radiculopathy. In this post we will be taking a broader look at diabetes and its complications.

Overview:

Diabetes (diabetes mellitus) refers to a group of diseases, including prediabetes, type 1, type 2, and gestational diabetes. While prediabetes and gestational diabetes can be reversible, types 1 and 2 are chronic and there is currently no cure.

Diabetes can occur either when the pancreas produces very little or no insulin, or when the body does not respond to the insulin that the pancreas does produce. In this post we will examine only types 1 and 2.

Type 1 diabetes typically appears during childhood or adolescence (it is also called juvenile diabetes), and the symptoms come on quickly and are more severe. Type 2 diabetes is more common, and more often occurs in people over 40 (it is often referred to as adult onset diabetes). Those with type 2 diabetes may not exhibit symptoms at first.

Symptoms:

  • Increased thirst
  • Extreme hunger
  • Frequent urination
  • Unexplained weight loss
  • Ketones in the urine
  • Fatigue
  • Irritability
  • Blurred vision
  • Difficulty breathing

Additional symptoms experienced in Type 2 diabetes include:

  • Cuts or sores that are slow to heal
  • Infections
  • Itchy skin (often in the groin area)
  • Recent weight gain
  • Numbness or tingling of the hands and feet
  • Impotence or ED

Causes:

Type 1 diabetes occurs when the body’s immune system destroys the insulin producing cells of the pancreas. Scientists believe that Type 1 is caused by genetic and environmental factors, such as exposure to certain viruses.

Type 2 diabetes is caused primarily by lifestyle factors and genes. Some risk factors include:

  • Being overweight
  • Lack of physical activity
  • High blood pressure
  • Abnormal cholesterol and/or triglyceride levels
  • Family history (having a parent or sibling with diabetes increases risk)
  • Age
  • History of gestational diabetes while pregnant
  • Polycystic ovary syndrome

Diagnosis:

Diabetes can be diagnosed based on blood tests that show a patient’s blood sugar levels, using a glycated hemoglobin (A1C) test, random blood sugar test, fasting blood sugar test, and/or an oral glucose tolerance test.

With respect to type 1 diabetes, a patient’s urine will be analyzed for ketones, a byproduct produced when muscles and fat are used for energy when the body doesn’t have enough insulin to use available glucose.

Treatment:

While there is no cure for diabetes, ongoing monitoring and management of symptoms is required to prevent serious complications from occurring. Possible treatments include:

Lifestyle changes 

  • Diet/healthy eating
  • Exercise
  • Weight loss

Medication

  • Those with Type 1 diabetes must take insulin because it is no longer made by the body
  • Those with Type 2 may need to take insulin, but may also take different medications (such as metformin, which lowers the amount of glucose the liver makes)

Surgery

  • Bariatric surgery
  • Artificial pancreas
  • Pancreatic islet transplantation

Serious Complications:

Undiagnosted, untreated, or resistant to treatment, diabetes can have serious health consequences, including:

  • Cardiovascular disease;
  • Nerve damage (neuropathy), especially in the limbs (which left untreated can result in loss of feeling); nerve damage is also connected to problems with internal organs, weakness, weight-loss, and depression;
  • Kidney damage (nephropathy), which may result in the eventual need for dialysis or kidney transplant;
  • Eye damage (retinopathy), which may result in cataracts, glaucoma, or blindness;
  • Skin conditions, including bacterial and fungal infections;
  • Foot damage, which can often lead to the need for amputation;
  • Depression; and
  • Alzheimer’s disease (type 2 diabetes)—currently there is no agreed upon theory about why there is a correlation between the two diseases.

These posts are for informative purposes only and should not be used as a substitute for consultation with and diagnosis by a medical professional. If you are experiencing any of the symptoms described below and have yet to consult with a doctor, do not use this resource to self-diagnose. Please contact your doctor immediately and schedule an appointment to be evaluated for your symptoms.

References:

Center for Disease Control (CDC), www.cdc.gov
WebMD, webmd.com
Mayo Clinic, mayoclinic.com
National Institute of Diabetes and Digestive and Kidney Disease, www.niddk.nih.gov
American Diabetes Association, www.diabetes.org

Search Our Site