Sprain? Strain? Subluxation? Medical Insights That Can Help Attorneys.

Episode Notes

Transcript

Announcer:

Workers Comp Matters, the podcast dedicated to the laws, the landmark cases, and the people that make up the diverse world of workers compensation. Here are your hosts, Jud and Alan Pierce.

Dr. Peter Yeh:

Hello and welcome to another edition of Workers Comp Matters. My name is Judd Pierce. Today we are lucky to have Dr. Peter Yeh on with us. Dr. Peter Yeh is an orthopedic surgeon in Stoneham, Massachusetts. He has over 15 years of experience in the medical field experience in shoulder and upper arm surgery as well as knee and lower limb surgery, and he graduated from Georgetown University Medical Center, perhaps one of my most favorite places to be Washington, DC and Georgetown University and Georgetown in particular. So love to hear some stories about Georgetown from your doctor. Welcome to the program.

Thank you very much, Jud. Thank you. I’m really happy to be here. And yeah, there’s a long line of orthopedists that come out of Georgetown Medicine actually, and a lot of great positive stories, but I actually went to medical school right on September 11th, so that was actually one of my first experiences during that time when I was a first year medical student and the planes hit and DC just became this bore zone and these jet fighters flying overhead with noise that you’d never heard of and hope to never hear again.

Judson Pierce:

Yeah, absolutely. That must’ve been a very, very difficult time to start your medical journey. I wanted that to be really, our first question was how you came about becoming a doctor and a little bit about your background.

Dr. Peter Yeh:

Yeah, no, no, thanks for asking that. It is a journey that I don’t know that I ever thought I’d be in the first place though coming from and immigrating from Taiwan, my parents were very much of the mindset that I should be a physician or a lawyer. I think that’s all they knew and that I had to go to some of the top schools in the country here that they only knew the couple names of. And so that actually wasn’t what I wanted to do. I sort of had the opportunity when they brought us over here, my brother and I and my sister. I really got to explore some of the things out there. And I actually really liked engineering. I actually started off in electrical engineering and I actually, actually that’s what I did both in college, undergraduate and then in the middle of college.

I actually had an experience when I was at Yale where I had an injury to my finger of all things, and I’m almost embarrassed to tell you how I did it and I broke it, but I developed a complication where I had to end up going in for several surgeries as the fracture in my finger got infected. And I went through almost essentially a year’s worth of outpatient office appointments with orthopedists and surgical procedures. And I really got to see what medicine was like as a 19-year-old. At the time, I really had no idea of what medicine was all about other than you seem like if you’re sick, you get this sort of cookie cutter diagnosis and there’s this treatment plan. It wasn’t as exciting as engineering and all the exciting stuff that was then back then and even now. But I really got a chance to see how medicine could be, and that’s ultimately how I switched over because I really got a chance to see how there was a human side, interpersonal side of medicine that I didn’t think was there before. And that’s ultimately why I chose the path of medicine.

Judson Pierce:

Interesting. So my guess would be ultimate Frisbee or something, breaking the finger, maybe a football toss, but maybe we’ll leave that to the next episode we have you on now. What brought you to the place that you’re presently working at now? Agility, orthopedics. And tell us a little bit about the facility and the office you have, how many doctors work there and the areas of specialty.

Dr. Peter Yeh:

Yeah, yeah, no, thanks for asking that question too. I didn’t train or have really any ties to the Boston area, so I came here for the job way back. Oh, now it’s 2011, so it was a while ago and it was for a relationship at the time that didn’t work out. And so I was able to really make Boston home once that happened and have the work with the orthopedics be the thing that really kind of kept me here. And I really enjoyed it and developed relationships. And so at Agility we just happened to find a home where a practice that really was not necessarily in downtown Boston, but in the community where you could treat patients and really become part of that community. And I think that was really what drew me to a place like Agility, orthopedics. We have seven doctors there right now and it really spans multiple disciplines within orthopedics. And we have four physician assistants and we have an occupational and a physical therapy department and staff that range and total staff is in the seventies right now.

So it really takes a lot of manpower, so to speak, to get this private practice working in a way that serves the community well. And we really want to try to bring the ability to practice and really be able to deliver that care sort of in a timely fashion. And obviously with good quality because the area here in the northeast and especially in the Boston area, we’re all really well known for really the quality of medicine that we can bring both surgery and medicine. And so we’re really proud of that, but we want to try to be able to do it in a very, very timely really.

Judson Pierce:

Absolutely. Do you happen to see injured workers as part of your practice and do the others as well?

Dr. Peter Yeh:

Yes, yes. In orthopedics, I think it’s almost inevitable that you’re going to see injured workers in that setting. So we do see a lot of that. It is something that has become a lot of our practice patterns where you have to see them and really get the history because I think that really does change how you might be able to treat or diagnose a condition. And so it’s certainly something that we see a good amount of in our area.

Judson Pierce:

Yeah. How are the cases similar or different from say, someone who hurts their shoulder skiing and I’m speaking from personal experience?

Dr. Peter Yeh:

Yeah, no, they’re definitely similar areas and there’s certainly definitely a good amount of differences. I think for myself, I trained in the sports medicine and shoulder background, and I think when I look at the athletes that I trained or worked under when I was training with some of my mentors, I kind of see workers’ comp patients, people who are injured workers almost as athletes. And I think you almost have to think of it that way because they have a goal in mind, which is to get back to work, get back to that sort of end goal, to be able to do what they need to do, whether it’s work or whether it’s athletics and they need to be at the top of their game in a way. And so in those ways, you have to be able to talk to the patients and in that fashion so that they know that there’s a treatment plan and a regimen that goes in that fashion.

And they’re usually very well conditioned in their own ways. And so that’s certainly something that you have to appreciate. But that’s also certainly the differences too, because their conditioning may be a little bit different than what you might see someone on the NFL football field. And usually you’ll see a wear and tear component. And there’s also certainly non-orthopedic factors that can tie into an injured worker, such as other medical issues that they might have or a lot of psycho social factors that can affect the way you treat them, but also the way they receive treatment, the way they can hear their diagnosis and hear the way that they need to be treated. That can also be very different as well. And so it can be very rewarding at the same time, but also certainly challenging if you’re not aware of those differences.

Judson Pierce:

We had a wonderful episode sometime ago with Dr. Claire Musselman who’s a professor over at Drake University, and she was speaking about these psychosocial factors in the workers’ compensation context, meaning the holistic approach of the injured worker, what he or she is dealing with once they are hurt on the job, for example, they’re dealing with this injury which is for overshadowing everything. It’s causing them to miss work, it’s causing them to be grumpy at home, and they’re also having to navigate this new landscape that is workers’ compensation and sometimes they try to do it without an attorney for better or for worse. Sometimes they do it without getting the right treatment quickly for better or for worse. So I’d be interested maybe right after this break your take on the psychosocial complexities of treating the injured worker and how we can best focus holistically in the legal, medical, and insurance realm to make it a more successful process. Why don’t we take this break and we’ll be right back with our special guest, Dr. Peter Yeh. And we’re back doctor. We were talking about the psychosocial component of the workers’ compensation context. Specifically how long injuries take to resolve, are they prolonged because of things outside the injured workers’ control from time to time? Can you talk to us a little bit about your experience in that and how we can make it a better journey for the injured worker altogether?

Dr. Peter Yeh:

Yeah, I mean there’s so many things to unpack there with that question because it’s not as simple as taking one approach and making it and solving it altogether.

It is quite complex and I don’t know that anyone in a medical field truly understands all the psychosocial factors because I think there’s just so much that goes into it. And as human beings, we all have so many different layers of what makes us who we are. And work is such a big thing in our society of what makes you who you are. You spend, if you think about all the years that you spend learning in school and then ultimately a craft that then puts you on a road where you’re working and the work gives you that self identity and it also gives you worth in terms of your self-worth, but also your financial worth in terms of providing for not only yourself but your family. And so there’s so many layers that tie into that so that when you get hurt, all of that can unravel and we have no idea how someone based off of their upbringing, based off of their training, how they handle that and how you handle that can really dictate how you respond to treatment.

And so I think rather than trying to figure that out in a conversation right now, I think the best thing we can do, as with any difficult problem is I think communication is very important with the injured worker. And I really spent a lot of time discussing some of those factors with some of the patients who walk into my office and especially ones who seem like they’re just dazed or just completely, you could just tell that their demeanor has changed thinking about so many other things other than just the medical injury. And I really talked to ’em about the whole process and what it really requires after the communication part is also communication with your team. The staff that I have that work with me and my partners at Agility, we have spent a lot of time trying to make sure that we have even just certain staff members who are just dedicated to the workers’ comp side of things because it is such a different animal, so to speak than commercial insurers that you need that type of resource to be able to help that injured worker. So yeah, it is just so much out there and ultimately in this case, if there’s litigation involved, if there’s attorney involved, you can imagine that’s another layer of stress and anxiety and things that can certainly contribute to how someone might heal or respond to a medical condition.

Judson Pierce:

Yeah, I think you hit the nail on the head when you said communication. Communication in my line of work, communication in your line of work is essential to getting what our clients, our patients need. Because there is no cookie cutter approach to a workers’ compensation claim. There’s no specific guy who has a bad knee injury on the job, and that will go over to the next person who has that bad knee injury because it’s apples to oranges, right? Every person heals differently. Every person brings different variables to the table, and I’m sure that the one constant that you hear is, please fix me as fast as you can. So how do you speak to that if someone has a traumatic injury on the job? There are certain things that have to take place before the person does get back to a hundred percent. Sometimes you try conservative measures before you go in for surgery, so other times you have to go to surgery right away. Speak a little bit about the differences in terms of conservative measures versus ultimately having a surgery, for instance.

Dr. Peter Yeh:

To answer that, I think it depends on sort of what the injuries, because I think some of the things that we paint, oh, someone’s got a traumatic injury, they have a fall and they never had any issues before and they tear their rotator cuff. I think that kind of is pretty straightforward in terms of, okay, we just got to take yes to surgery, fix you. In some ways that person might be lucky in some ways because it’s a pretty straightforward, but I think the tricky part where we think about conservative care is it’s not so straightforward in terms of how they got hurt and there might be some issues before that that brought them to that point of ultimate injury. And I think that’s where the communication part comes back into play where I’ve got to really peel the layers for that patient to understand why they got to where they were and to try some of the non opera treatments to not only focus on helping with the pain portion so that they go back to work, but also to really help with prevention down the road so that they don’t keep coming back into the office with issues if they do get that initial relief.

Judson Pierce:

What do you think about the technology advances that we’ve had and have they produced better tools for the trade, so to speak, better diagnostics so that you can see what’s going on inside before operation?

Dr. Peter Yeh:

Yeah, surgical advances, I think it’s one of the reasons why I like this whole field of orthopedics. I think our field, I guess with any other fields too, but just the fact that the surgical components, the implants, the technology, the ability to do things that we couldn’t even do two or three years ago that is changing every day. It’s rapidly changing, especially with the technology that’s coming to the fore with the AI and some of the things that we’re just seeing now, it does make it a lot capable for us to fix, for example, rotator cuff tears that I would’ve classified even just two or three years ago as irreparable. Now I have an opportunity to fix it for that person and that patient. So it does really open up the repertoire for that. The technology, obviously some things that move fast like this, you have to also really counsel the patient that some of this stuff is rather new. We don’t have good long-term data on it, so I don’t know what that will be like in five years for that patient’s shoulder if we do it this way. And so I think there’s certain things that you have to communicate. Going back to communication, it’s really important for ’em to understand that what we can do sometimes with technology is great, but it may not necessarily have good long-term data with it yet because we just don’t have have that data yet.

Judson Pierce:

Yeah. Bringing it back to workers’ compensation, again, doctor, as lawyers, we are burdened with the burden of proof always we have to show not beyond a reasonable doubt because those are the criminal lawyers, but for the civil attorneys, workers’ compensation attorneys have to show sort of a direct cause between the work injury and that person’s ailment and disability. Is it something that doctors in your field struggle with sometimes or are they always observant of perhaps speaking to that in their notes? Sometimes we have to actually ask the questions a few times to get a doctor to respond to that because it’s not something that they’re necessarily thinking about. Can you speak a little bit about causation element?

Dr. Peter Yeh:

Yeah, I certainly get the sense, I think in our field, the word lawyers or legal, I think we tend to clam up and I think that’s no offense, and I think that’s no offense taken. Yeah,

Judson Pierce:

I tend to clam up around lawyers too,

Dr. Peter Yeh:

And I think that’s what makes it a little bit more challenging for us as a field. I don’t think we get any training in that when we’re going through residency and medical school training. And so we often don’t necessarily put that in or don’t weigh in on it unless you’re really sort of asked to do so. When it comes to causation, I think there’s two things that I think about when we are talking about the medical field and how they respond to these type of questions. One is when a patient gets injured before anything is done, I think you have to really get a good history to really understand

How something got hurt or someone got hurt, the mechanism with which someone might have taken a fall or had a lifting injury and felt a pop. Those are things that you can, I think pretty clearly relate to why that patient now has shoulder pain or now has a rotator cuff tear. And going back to your technology question earlier, there are now ways that we can look on an MRI where we might get clues where there’s telling us that this is more of an acute injury rather than a wear and tear phenomenon. So those are things that we often look at and see. And I think in the busy practice sometimes we don’t necessarily write that down, even though I think all of us will process that in our mind as we go through the images or as we talk to a patient. And I think in the world of workers’ comp, I think going back to the theme of communication and part of that communication is making sure you put that kind of language down if you’re being asked to, because it does make a big difference for the injured worker when it comes to a legal claim.

And then the second thing I was going to mention up was I think there is afterwards if we treat a patient and we’re asked to talk about disabilities or anything like that, I think it’s hard for some of the doctors that we treat as treatment physicians to weigh in on that sometimes because we all have egos and I think if we feel that someone is disabled after we did their surgery, then we feel like we didn’t do a good enough surgery. And so I think that can get somewhat murky in how some of us are not as comfortable writing some of the language out because of that conflict.

Judson Pierce:

Interesting that you say that because we in the legal community always say that our doctors are like Picassos, they think their paintings are special, they think they should be in the Louvre. Not all paintings are going to be in the Louvre, unfortunately. But I hear what you’re saying. I mean, lawyers definitely have egos as well, I’m sure. We definitely don’t want to be screwing up a case when we can help the person, so I understand that fully. Why don’t we take this quick break and we will be right back for our last segment of the program with Dr. Peter. Yeh. And we’re back. This is perhaps the most fun I’ve had in a long time because lawyers and doctors don’t chat. We don’t really get together. We don’t talk about our professions. So this is a really nice opportunity. Doctor, again, thank you for being on with us, and I hope that the folks who are listening are also getting a little glimpse behind the curtain, so to speak, seeing that doctors and lawyers can talk together and have a good

Dr. Peter Yeh:

Time. That’s right.

Judson Pierce:

Well, one of the things lawyers don’t know how to do is talk about the language of medicine. Even pronouncing the words sometimes are problems for us. So if you could very briefly, I know because this could be a long program, but keep it a short program by saying, okay, here are some terms of art terminology that you lawyers really should think about. Even take a dictionary and do a Google voice to learn how to pronounce better. Give us some examples. Is it tendonitis? Is it synovitis? Is it all those itises?

Dr. Peter Yeh:

Yeah, no, definitely. Tendonitis is a very common one. I mean, it literally just means inflammation of the tendon. And so that can be a very broad stroke of describing it, an inflamed tendon, but it doesn’t tell you what caused it, and you have to really dive deep into the history of something, but it also does not imply a tear, although you could have underlying tearing under a tendon that is inflamed. So that can be quite confusing. So it’s always important to get some clarification there. Adhesive capitalize just going into the shoulder, for example, like that part, we all have a thin membrane in our shoulder that allows us some joint protection, but also this is where the joint itself can be more elastic to move since our shoulder is one of our more mobile joints in our body, but that capsule can get inflamed. So capsulitis means inflamed capsule.

And when it gets inflamed in some patients cases, especially some people who are more genetically predisposed, they may actually have a thickening and scarring of that capsule where it becomes essentially a brick and move. They can’t get that motion any longer. And so essentially we call it a frozen shoulder outside the medical terminology, and that can become quite painful in and of itself. And so that is an important distinction. I think another thing as we talk about shoulders is dislocation and subluxation. I think there’s a difference between those two. Dislocation is something that we typically think of when you pop a joint out and you can’t get that joint back in on your own and you need someone to pop it in for you. That’s something that we classify as more as a dislocation, whereas a subluxation is more of an in and out out and in kind of feel where you can feel it pop out and pop back in or popped out, and then you briefly popped it back in with just a maneuver.

And that’s kind of more of a subluxation. So those are some important differences. I think one of the more common ones that I know that even some of the doctors can sometimes get confused is a difference between a sprain and a strain. A sprain is an injury to the ligaments, and ligaments are what connects one bone to another bone. And so for example, your MCR or medial collateral ligament of your knee connects the bone of your femur to your tibia or your shin bone. And so when you injure that, when you twist your knee and you injure that ligament, we call it a sprain. And that could be a small tear, it could be just an inflammation thing where you just kind of have a little bit of a twisting thing and nothing tore, or it could be a full tear. I mean, anything that’s inflammation or injury, we call it a sprain. Whereas a strain is an injury to a muscle or a tendon, and so not a ligament. So there’s a difference there. So if you injure your rotator cuff, which is a muscle tendon unit, that’s more of a rotator cuff strain. You can’t really call it a rotator cuff sprain because that doesn’t make sense. So those are some things to make sure to keep in mind when you’re reading papers or reports from doctors.

Judson Pierce:

Sprain strain always kind of reminds me of libel or slander. I always thought they were the same thing, but there’s a subtle difference between slander being the spoken defamation of someone, libel being the Written one. That’s just little twists and the language. I wish I had taken Latin when I was a kid. Explain for us briefly if you would, the difference between a cumulative or repetitive type of injury versus more of an acute one. That’s something comes up a lot.

Dr. Peter Yeh:

Yeah, I think that’s certainly a challenge even for me sometimes, because you often, in our fast paced world, it’s easy to just kind of almost make the two sound or be one of the same. But when I really am thinking about it, I feel that cumulative is almost like the overarching umbrella of it’s a gradual and progressive injury that accumulates over time due to some exposure or some stressor basically. And that stressor could be a repetitive movement, and I thinks something that, so I think of repetitive as something that’s a subset of what could accumulate over time. Another cumulative thing is be like, let’s say you’re inhaling a toxin over time because you work in a factory of sorts, or you get x-rays all the time because you work as a radiology tech, and that’s a cumulative type of injury, but it’s not necessarily repetitive. But repetitive could be where you’re someone who’s typing a lot or doing a lot of manual labor where then your wrist is always either flexed or extended. So then you end up getting a carpal tunnel syndrome because of putting your body in that repetitive motion over and over, that accumulates a type of cumulative injury.

Judson Pierce:

What about the impacts that those would have on an injured worker vis-a-vis pain versus just a chronic sort of thing that they can deal with with just getting used to? What effects does the person speaking about his or her pain level do for you in diagnosis and treatment? Is it a recognizable thing?

Dr. Peter Yeh:

Yeah, no, it’s a good question because I often think about, for example, the shoulder joint where I think there’s a lot of us out there. Even people who aren’t having any symptoms at the moment probably aren’t holding their shoulders correctly in a way that would preclude or prevent injury down the road. And whether it’s posture, whether it’s certain types of imbalances in your muscles that can put you at some risk for developing a shoulder issue that here and there, you might develop an ache here or there. But I think the thing that distinguishes it for me is when they ultimately need to come in to see someone like myself, I think that’s the deciding factor because if you can’t manage it, if you can’t figure out how to cope with it and still be very functional, whether it’s a sport or work, that’s a problem. And I think the main thing that really it gets people into the office to see someone like myself is that they lose sleep. And if they’re losing sleep because of this, then there’s a problem because they can’t heal when they’re sleeping, when they’re not sleeping. And so their quality of life just goes down the drain when that happens. And that usually is a big deciding factor for someone. Then they finally, ultimately come in to see someone.

Judson Pierce:

Are there any other topics that we didn’t get to that you really want to help our audience with? Or maybe I should just close out by thanking you and asking you where people can find you if they do lose sleep and they need a doctor of your expertise, how can they find you, doctor?

Dr. Peter Yeh:

Yeah, no, I’m at Agility Orthopedics. We have offices in Stoneham and Malden, and we actually have an office opening up in Northborough in the next couple of weeks. So it’ll be something that will be able to get people to come and see any of us. And our number is 7 8 1 2 7 9 7 0 4 0, and you can easily Google us and we’re here to help.

Judson Pierce:

They’ve got a great staff folks, and especially if you’re in the New England area, look ’em up if you ever have a trouble with a shoulder or a knee or any of the joints that we all need every day. So I’d like to thank again our guests for today, Dr. Peter Yeh, Georgetown grad. Great guy. I’m so happy to have gotten to meet you over the years and know you a little bit more in this episode. So thanks again. And to all those out there, make it a day that matters. We’ll see you soon.

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