One Hand at a Time
by Lydia Harris, RN, CCM, CLCP, QRP, MSC-C

Employers that hang on to a small group of workers and change their product lines to avoid outsourcing and closure are to be commended. As case managers, we also must help them to survive the high costs of on-the-job injury by seeking the most innovative ideas to keep their workforce onsite and functional for the benefit of the team.

Though hand-intensive work of the assembly and manufacturing plants is being replaced gradually by robotics, there still remains a group of individuals who strain the ligaments and tendons of their hands and fingers daily, just to feed their families and afford them a chosen lifestyle.

I was assigned to a case to help an employer coordinate an FCE (Functional Capacity Evaluation) based upon the description of the claimant’s job, to make the determination about her continuing to work. This seasoned 27-year small part assembly veteran had a cumulative trauma disorder that affected her hands from the wrist down. Surgery should have fixed the problem, but healing was slow and she couldn’t do her regular job. And she let everybody know it.

The employer had to do something. One of the supervisors had heard of the FCE and thought maybe this could help her get back to her old self again. But no one knew how to get one done, or even exactly what it would do for them. So they asked their workers’ compensation insurance carrier if they could have someone to help them with getting her back to work, especially since now more and more injuries were popping up!

So we got the referral to start by taking a look at her job. Of course, this was an employer that only had a job description (from 1956), so a job analysis was necessary to measure her ability to perform it. With the FCE completed by an OT, having the benefit of a video and format that focused on hand-intensive motions, it was easy to measure her effort and solve the first of the burning questions: is she faking?

Well, she wasn’t, so now we had to look at other jobs that she could do without moving her hand a certain way to increase the stress and pain that would make her either take a day off or come to work and complain all day about her circumstance. Neither were good options. So we did something revolutionary and asked the workers to find jobs for her that minimized certain motions. This involved them in the solution of the problem. And it made them feel like they were telling her what to do, but in a positive way. We learned how to take a job apart, and break it into more manageable segments that can be rotated through. It was even easier to describe the jobs when broken down, so we looked at the jobs of another worker, and took out the ones that caused the most symptoms.

When it was over, 12 weeks later, she still had permanent restrictions. “How could this be? We spent all that money and we are no better off than we were in the beginning!” said the employer. But they were wrong.

If nothing else, all doubt is removed about the subjectivity of functional ability and effort exerted by the claimant because of the FCE. The employer learned more about accommodations in the workplace, and that perhaps another step can be taken toward prevention of future injuries. The employees learned that their employer trusted them enough to let them be part of the solution, and cared enough for them to hire a case manager, have them and their jobs evaluated, and work through their physician’s orders with job modifications so that they could return to the work force instead of stay at home collecting wage loss benefits. This employer assisted them in maintaining their lifestyles and their dignity as they tried to heal themselves from occupational injury.

This employer has a loyal workforce as evidenced by their longevity. They both worked for many years doing these hand-intensive jobs and are now older with increased susceptibility to breaking down. The test confirmed that they weren’t exaggerating their problems and indeed do have limitations. If case management, testing or doctor opinions changed that, it would be unfair and would indicate that we have returned to the time when these laws were made to protect Americans in the workplace from killing themselves slowly just to feed their families.