As a physician specializing in occupational medicine, I’ve seen firsthand how work-related injuries can impact lives and livelihoods. But what if many “injuries” aren’t from trauma at all, but rather age-related changes misinterpreted as damage? Our latest study, published in The Journal of Hand Surgery, dives into this question for unilateral wrist symptoms in workers over 40. Co-authored with Emily H. Jaarsma MD, David Ring MD, PhD, and Niels Brinkman BS, it challenges common assumptions in work injury claims and highlights the power of bilateral imaging.
The Problem: Misinterpreting Symptoms as Trauma
In workers’ compensation, new wrist pain at work is often labeled as an “injury” caused by external forces. However, symptoms from idiopathic (unknown cause) or senescent (age-related) conditions are frequently mistaken for trauma. This leads to overdiagnosis, unnecessary treatments, excessive restrictions, and mislabeled compensation claims.
Drawing from similar evidence in shoulders and knees, we hypothesized that many wrist issues are bilateral and incidental, not tied to a specific incident.
Our Approach: A Deep Dive into Real Claims
We reviewed 64 scrutinized work injury claims from March 2021 to December 2024, all involving persistent unilateral wrist pain attributed to work, with no prior surgery. Every case included bilateral wrist MRI scans as standard protocol under medical oversight.
What We Found: Symmetry Over Trauma
The results were eye-opening:
- MRI abnormalities appeared in 97% of symptomatic wristsand 91% of asymptomatic ones, averaging three findings per wrist.
- Common issues? Articular disc signal changes in 64% of wrists (bilateral in 85%) and extensor carpi ulnaris tendon abnormalities in 45% (bilateral in 72%).
- Incidental Findings: A whopping 95% of abnormalities didn’t match the symptoms’ location.
- Causation Breakdown: 55% attributed to idiopathic/senescent causes, 41% nonspecific (no clear pathophysiology), and only 5% truly traumatic (e.g., fractures or contusions).
- Key Association: Only a trip-and-fall mechanism linked to abnormalities solely in the symptomatic wrist (odds ratio 8.7; 95% CI 1.02–74.00).
In short, workers with one-sided wrist complaints often have matching findings on the other side—pointing to non-traumatic origins rather than work-induced damage.
Why This Matters for Occupational Health
This isn’t just academic; it’s practical. In systems where workers’ compensation covers trauma but not age-related issues, bilateral MRIs provide crucial context. They help avoid labeling normal “wear and tear” as tears or injuries, reducing overtreatment and speeding recovery. For employers, insurers, and clinicians:
- Better use of Diagnostics: Skip unnecessary MRIs or obtain bilateral to clarify extent.
- Ethical Claims Management: Ensure coverage aligns with true pathophysiology, preventing misuse of resources.
- Patient Outcomes: Address root causes like ergonomics or mindset, not just symptoms.
At Opus Medical, where I serve as Chief Medical Officer, we’re applying these insights through physician-led case management to optimize work injury care.
Final Thoughts
If you’re in occupational health, HR, or insurance, let’s rethink how we evaluate wrist claims. Bilateral imaging could be a game-changer in distinguishing trauma from the inevitable effects of time. I’d love to hear your experiences—have you seen similar patterns?
Read the full study (free access for a limited time): https://authors.elsevier.com/c/1mWuT1IffwzG3k