Appeal From The Circuit Court of Du Page County No. 99 MR 689 Honorable Robert E. Byrne, Judge Presiding
The opinion of the court was delivered by: Justice Hoffman
The claimant, Debbie Oblak, filed an application for adjustment of claim under the Workers' Compensation Act (Act) (820 ILCS 305/1 et seq. (West 1992)), seeking benefits for injuries she sustained on August 11, 1992, while working as a nurse in the employ of Elmhurst Memorial Hospital (Elmhurst). The Industrial Commission (Commission) ordered Elmhurst to pay the claimant $228 per week for 156.66 weeks for 66 2/3% permanent partial disability (PPD) to her right arm, $253.33 per week for 90 4/7 weeks for temporary total disability (TTD), and $40,419.36 in medical expenses. The circuit court of DuPage County confirmed the Commission's decision. On appeal, Elmhurst contends only that the portion of the Commission's decision ordering it to pay $40,419.36 in medical expenses is against the manifest weight of the evidence.
On August 11, 1992, the claimant sustained an injury to her right hand and arm while working as a nurse for Elmhurst. According to the claimant, she immediately began to experience pain in her right hand and wrist. The claimant sought medical attention at Elmhurst's emergency room on August 13, 1992. At that time, she was diagnosed as suffering from a sprained right wrist. The emergency room physician prescribed a splint and instructed her to seek follow-up treatment from her own physician.
In the five months that followed, the claimant came under the care of seven physicians, four of whom were recommended by Elmhurst, and was treated with therapy and anti-inflammatory medications. Dr. Frank Lagattuta diagnosed the claimant with tenosynovitis of the carpal bone and was of the impression that she sustained an ulnar lesion. Dr. Denes Martonffy arrived at a differential diagnosis of muscular/tendon avulsion of the distal aspect of the upper right extremity and possible soft tissue trauma to the right ulnar nerve at wrist level. During that same period of time, the claimant had an arthrogram, an MRI, and an EMG, none of which revealed any abnormalities. She continued, though, to complain of a burning-type sensation in her right wrist and forearm.
On January 15, 1993, the claimant came under the care of Dr. Kenneth Schiffman. He recorded that the claimant complained of a burning-type pain which seemed to start at the volar ulnar aspect of the forearm with radiation of the pain up the forearm and to the volar aspect of the wrist. He also noted that she complained of occasional numbness and tingling in her fingers. On examination of the claimant's right upper extremity, Dr. Schiffman noted a swelling or prominence at the distal volar ulnar forearm, slightly tender to palpation. His impression at that time was that the claimant injured the flexor superficialis to the small finger and may have disrupted the muscle at the myotendinous junction. Dr. Schiffman recommended occupational therapy with a hand therapist.
The claimant next saw Dr. Schiffman on February 11, 1993. His note of that visit reflects that the claimant still complained of a burning-type pain along the volar ulnar aspect of the wrist and also some pain along the dorsal aspect of the wrist in the region of the distal radial ulnar joint. Dr. Schiffman still was of the impression that the claimant had a possible flexor myotendinous tear. Because the claimant received no relief from therapy and all attempts at conservative treatment had failed, Dr. Schiffman recommended surgery.
On February 24, 1993, Dr. Schiffman performed exploratory surgery on the claimant's right forearm flexor compartment. The myotendinous junction was found to be intact and minimal flexor adhesion was noted.
The claimant continued to treat with Dr. Schiffman postoperatively. His notes state that the claimant continued to complain of pain to the distal aspect of the right distal radial joint as well as at the distal end of the right ulna. Dr. Schiffman recommended a CT scan.
On April 6, 1993, the claimant again saw Dr. Schiffman. Her CT scan showed no signs of subluxation of the distal radioulnar joint. However, the claimant continued to complain of pain to the ulnar aspect of the wrist. Because of the claimant's ongoing pain, Dr. Schiffman recommended that she undergo an arthroscopic examination with a possible triangular fibrocartilage complex debridement and a possible ulnar shortening osteotomy.
At the request of Elmhurst, Dr. Charles Carroll examined the claimant on May 5, 1993. He recorded the claimant's complaints of pain and burning over the ulnar aspect of her right wrist, tenderness over the distal ulna and triangular fibrocartilage complex region, and numbness and pain radiating from her elbow. Dr. Carroll was of the impression that the claimant exhibited evidence of ulnocarpal impingement of her right wrist and a mild ulnar neuritis at the elbow. According to his notes, the ulnar neuritis was responsible for the pain in her forearm, and the ulnocarpal impingement and a possible triangular fibrocartilage complex tear were responsible for her distal ulnar pain. Dr. Carroll wrote that the claimant's options were either to do nothing or to undergo arthroscopy of the wrist and a probable shortening with extra-articular compression plating. He specifically related the claimant's condition to her work-related injury.
On June 3, 1993, Dr. Carroll performed an arthroscopy of the claimant's right wrist with debridement of a triangular fibrocartilage complex tear and an ulnar shortening with the application of a plate. His postoperative diagnosis was a triangular fibrocartilage complex tear with ulnocarpal impingement.
Following surgery, the claimant remained under the care of Dr. Carroll. On July 14, 1993, he noted that the claimant was undergoing therapy and making "slow but steady gains." On November 23, 1993, Dr. Carroll reported that, although the surgery alleviated the claimant's pain traceable to the triangular fibrocartilage complex and distal ulna, she continued to experience a burning sensation to the medial elbow with numbness in the small finger. According to Dr. Carroll, the remaining problem was separate from the ulnocarpal impingement. He noted that the claimant wished to undergo further treatment including an ulnar nerve transportation to alleviate her remaining pain. However, Dr. Carroll recommended that she first see a pain management consultant and suggested Dr. Ron Pawl. Dr. Carroll released the claimant to return to work on that date, but restricted her activities, stating that she was not to use her injured hand.
On January 24, 1994, the claimant was examined by Dr. David J. Capobianco at the Mayo Clinic. Dr. Capobianco's notes of that visit state that he held the impression that the claimant had right hand and arm pain and dysethesias and that he wished to rule out ulnar neuropathy and test her for sympathetically maintained pain syndrome. He referred the claimant to Dr. Stephen D. ...