Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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47. Workers’ Compensation: An Occupational Perspective… 527 Maximal Medical Improvement Physicians who are treating injured workers with groin pain might on occasion be asked to comment on maximal medical improvement (MMI) . MMI is not necessarily related to a prescribed post-hernia repair time, for example, but rather to that point at which little or no further improvement is anticipated (more likely than not) and treatment gains appear to have plateaued. When an injured worker is determined to be at MMI, a physician might also be asked to provide a permanency rating. This rating of permanent impairment will help to determine the amount of benefits for the patient by the workers’ compensation or disability insurance carrier. For example, usual successful hernia repair would be expected to result in a 0 % impairment rating. A patient who reports an absence of pain but for whom there is a recurring groin protrusion with increased abdominal pressure, and for whom there are some appropriate lifting restrictions (and surgery declination), would receive an impairment rating of 10 %. In the case of ongoing pain due to documented residual nerve entrapment, or in the case of recurrent inguinal hernias that are only partially reducible despite repeated surgical repair, it is advised that the American Medical Association’s Guides to the Evaluation of Permanent Impairment be referenced [ 19 ], as these determinations are less straightforward. Conclusion In summary, there is increasing evidence that groin pain and inguinal hernias are not usually related to workplace injuries, that disability duration is often overestimated, and that chronic groin pain and herniorrhaphy recovery are in part related to psychosocial variables, some of which are modifiable. Disability and subjective reports of chronic pain are disproportionally higher among workers’ compensation patients. Workers’ compensation carriers are generally interested in value. If a hernia surgeon is able to document improved outcomes and decreased recurrence rate, there is often an opportunity for a preferred referral relationship (that is not necessarily related to reimbursement). Worker’s compensation can be arcane. Although it is described as a single system, in reality, it is a complex set of often challenging rules and regulations that vary from state to state. If case-specific questions arise, a treating physician can consider engaging the carrier medical director to help clarify.
528 J.S. Pachman and B.P. Jacob Disclosure Dr. Pachman is the Regional Medical Director, Liberty Mutual Group; the views expressed here do not necessarily reflect the views of Liberty Mutual. References 1. Hendry PO, Patterson-Brown S, de Beaux A. Work related aspects of inguinal hernia: a literature review. Surgeon. 2008;6(6):361–5. 2. Jones KR, Burney RE, Peterson M, Christy B. Return to work after inguinal hernia repair. Surgery. 2001;129(2):128–35. 3. Ismail W, Taylor SJ, Beddow E. Advice on driving after groin hernia surgery in the United Kingdom: questionnaire survey. Br Med J. 2000;321(7268):1056. 4. Callesen T, Klarskov V, Bech K, Kehlet H. Short convalescence after inguinal herniorrhaphy with standardized recommendations: duration and reasons for delayed return to work. Eur J Surg. 1999;165(3):236–41. 5. Forbes J, Fry N, Hwang H, Karimuddin AA. Timing of return to work after hernia repair: recommendations based on literature review. BC Med J. 2012;54(7):341–5. 6. Franche RL, Cullen K, Clarke J, Irvin E, Sinclair S, Frank J, Institute for Work & Health (IWH) Workplace-Based RTW Intervention Literature Review Research Team. Workplace- based return-to-work interventions: a systematic review of the quantitative literature. J Occup Rehabil. 2005;15(4):607–31. 7. Bourke JB, Lear PA, Taylor M. Effect of early return to work after elective repair of inguinal hernia: clinical and financial consequences at one year and three years. Lancet. 1981;2(8247):623–5. 8. Salcedo-Wasicek MC, Thirlby RC. Postoperative course after inguinal herniorrhaphy. A case-controlled comparison of patients receiving worker’s compensation vs patients with commercial insurance. Arch Surg. 1995;130(1):29–32. 9. Parés D. Return to work after elective inguinal hernia repair. Cir Esp. 2013;91(8):473–5 (Article in Spanish). 10. Franklin GM, Wickizer TM, Coe NB, Fulton-Kehone D. Workers’ compensation: poor quality health care and the growing disability problem in the United States. Am J Ind Med. 2014;58(3):245–51. doi: 10.1002/ajim.22399 . 11. Dennis R, O’Riordan D. Risk factors for chronic pain after inguinal hernia repair. Ann R Coll Surg Engl. 2007;89(3):218–20. 12. Franklin GM, Mai J, Turner J, Sullivan M, Wickizer T, Fulton- Kehoe D. Bending the prescription opioid dosing and mortality curve: impact of the Washington State opioid guideline. Am J Ind Med. 2012;55(4):225–31. 13. Tripp DA, Nickel JC. Psychosocial aspects of chronic pelvic pain. Pain Clinl Updates. 2013;21(1):1–6. Available from: http://www.iasp-pain.org/PublicationsNews/ NewsletterIssue.aspx?ItemNumber=2063 . Accessed 11 Feb 2015. 14. Shaw WS, Reme SE, Pransky G, Woiszillo MJ, Steenstra IA, Lindon SJ. The pain recovery inventory of concerns and expectations: a psychosocial screening instrument
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Brian P. Jacob · David C. Chen Bru
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The SAGES Manual of Groin Pain Bria
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Foreword Inguinal hernia repair is
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Contents Part I Primary Groin Pain
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Contents ix 22 Management of Inguin
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Contents xi 45 Value-Based Clinical
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xiv Editors and Contributors Jeffre
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xvi Editors and Contributors David
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xviii Editors and Contributors Greg
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xx Editors and Contributors David S
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1. Introduction to Primary and Seco
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10 I.A. Gawlas and W.J. Peacock Ili
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12 I.A. Gawlas and W.J. Peacock Tra
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14 I.A. Gawlas and W.J. Peacock Var
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3. Complex Regional Pain Syndrome T
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4. Chief Complaint of Groin Pain: H
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4. Chief Complaint of Groin Pain…
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42 C. Ma and A. Ramaswamy inguinal
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44 C. Ma and A. Ramaswamy Categoriz
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46 C. Ma and A. Ramaswamy with no s
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48 C. Ma and A. Ramaswamy 26. Aasva
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50 I.M. Daoud and K. Dunn Other per
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52 I.M. Daoud and K. Dunn low herni
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54 I.M. Daoud and K. Dunn In the po
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56 I.M. Daoud and K. Dunn with a he
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58 I.M. Daoud and K. Dunn 13. O’C
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60 G.J. Mancini Occult Hernia Backg
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62 G.J. Mancini Magnetic resonance
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64 G.J. Mancini rocking motion can
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66 G.J. Mancini Unique to the adduc
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68 G.J. Mancini two nerve injuries
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70 G.J. Mancini abdominis has a rep
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72 G.J. Mancini 5. Light D, Ratnasi
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74 J.C. Campbell and G.D. Paiement
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9. Groin Pain Etiology: Spine and B
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10. Groin Pain Etiology: Spermatic
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Table 10.2. European Association of
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138 M. Hibner and C. Coyne Piriform
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140 M. Hibner and C. Coyne Fig. 11.
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142 M. Hibner and C. Coyne Table 11
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144 M. Hibner and C. Coyne present
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146 M. Hibner and C. Coyne Table 11
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148 M. Hibner and C. Coyne Once the
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150 M. Hibner and C. Coyne 3. Hibne
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12. Chronic Pelvic Pain in Women M.
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12. Chronic Pelvic Pain in Women 15
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174 J.M. Miller et al. Knowing the
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176 J.M. Miller et al. Fig. 13.2. A
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182 J.M. Miller et al. Fig. 13.9. C
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184 J.M. Miller et al. Fig. 13.14.
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192 J.M. Miller et al. Cardiac Cath
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194 B.J. Dunkin Noxious peripheral
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196 B.J. Dunkin Table 14.1. Summary
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198 B.J. Dunkin Rectus abdominis Ex
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200 B.J. Dunkin COX-1 COX-2 Celecpx
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202 B.J. Dunkin Table 14.2. Common
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204 B.J. Dunkin Possible Preoperati
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206 B.J. Dunkin Postoperative Pain
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208 B.J. Dunkin Summary Understandi
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15. Chronic Groin Pain Following An
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222 E.L. Felix not seem to alter th
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224 E.L. Felix nerves from the surg
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226 E.L. Felix Fig. 16.2. Lateral f
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228 E.L. Felix It has been establis
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230 E.L. Felix 18. Pollak R, Nyhus
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17. The Orthopedic Perspective on G
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246 J.F.M. Lange Jr. examination an
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248 J.F.M. Lange Jr. and remedial s
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250 J.F.M. Lange Jr. Best available
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252 J.F.M. Lange Jr. Neuropathic pa
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254 J.F.M. Lange Jr. This algorithm
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19. Radiologic Evaluation for Posto
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19 Radiologic Evaluation for Postop
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268 A. Malhotra extended variant of
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270 A. Malhotra steroid injections,
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272 A. Malhotra located just below
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274 A. Malhotra Nociceptive Acute N
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276 A. Malhotra 20. Rozen D, Parvez
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278 R. Álvarez intentionally or in
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Fig. 21.1. Material: A ballpoint pe
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Fig. 21.5. Dermatome mapping compat
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Fig. 21.9. Dermatome mapping compat
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286 R. Álvarez Subsequently, we mu
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288 R. Álvarez G : Granuloma H : H
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290 R. Álvarez Fig. 21.14. Same pa
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292 R. Álvarez 6. Lermite E, Arnau
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294 K.A. Seymour and J.S. Yoo Table
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296 K.A. Seymour and J.S. Yoo repro
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298 K.A. Seymour and J.S. Yoo Recur
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23. Mesh Removal for Chronic Pain:
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23. Mesh Removal for Chronic Pain
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320 I.T. MacQueen et al. inguinodyn
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322 I.T. MacQueen et al. Fig. 24.2.
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324 I.T. MacQueen et al. Timing and
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326 I.T. MacQueen et al. Fig. 24.4.
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328 I.T. MacQueen et al. Posthernio
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330 I.T. MacQueen et al. never be e
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25. Laparoscopic Triple Neurectomy
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26. Chronic Orchialgia: Workup and
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27. The Role of Bioactive Prostheti
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376 G. Campanelli et al. affecting
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378 G. Campanelli et al. into the w
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380 G. Campanelli et al. chronic gr
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382 G. Campanelli et al. A prospect
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384 G. Campanelli et al. open mesh
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386 G. Campanelli et al. 38. Alfier
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29. Prevention of Pain: Optimizing
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30. Prophylactic Neurectomy Versus
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Table 31.1. Selective neurectomy wi
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408 W.M.J. Reinpold and A.D. Schroe
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32. Chronic Groin Pain: Mesh or No
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Part IV Case Reports and Patients
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430 S. Towfigh were irregular and s
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432 S. Towfigh in addressing her sy
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434 S. Towfigh Conclusion We have y
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436 K.W. Kercher Physical Examinati
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438 K.W. Kercher Fig. 34.4. Left ad
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440 K.W. Kercher Fig. 34.5. After d
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442 K.W. Kercher the posterior wall
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444 K.W. Kercher Table 34.2. Surgic
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35. Chronic Post-inguinal Herniorrh
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35 Chronic Post-inguinal Herniorrha
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35 Chronic Post-inguinal Herniorrha
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36. Sports Hernia with Adductor Ten
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464 C.G. DuCoin and G.R. Jacobsen P
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466 C.G. DuCoin and G.R. Jacobsen O
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468 J.A. Blatnik and A.S. Prabhu a
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470 J.A. Blatnik and A.S. Prabhu Fi
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472 J.A. Blatnik and A.S. Prabhu ma
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474 S. Towfigh Physical Exam The pa
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Page 488 and 489: 42. Patient with Chronic Pelvic Pai
Page 490 and 491: 43. Thoracolumbar Syndrome James A.
Page 492 and 493: 43. Thoracolumbar Syndrome 497 The
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Page 518 and 519: 47. Workers’ Compensation: An Occ
Page 526 and 527: 532 Index Athletic pubalgia (cont.)
Page 528 and 529: 534 Index Chronic post-herniorrhaph
Page 530 and 531: 536 Index Groin pain (cont.) magnet
Page 532 and 533: 538 Index Ilioinguinal nerve (IIN)
Page 534 and 535: 540 Index Local anesthetics (cont.)
Page 536 and 537: 542 Index Peripheral nerve entrapme
Page 538 and 539: 544 Index S Sacroiliac (SI) joint d
Page 540: 546 Index Transperineal pudendal ne
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Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

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