it's her job duties involve a lot of hand intensive activities including spending at least six hours two thirds of her day typing keyboarding on a computer lifting heavy files particularly on wednesday when she has to pull sixty files for family court judge she does more typing on wednesdays also when she sits with her judge in the court room and transcribed orders for the judge as they go along through the caseload she she  started having difficulties in her hands including not only cramping in her hands and taina her hands but also triggering and her right little finger and that precipitated her need to go to see the doctor she told her supervisor i'm having trouble with my hands i need to go see the doctor so her supervisor testified that she knew that this because she had to have a reason for giving her work excuse you see the doctor she saw a doctor can who was an orthopedist he examined her he determined that she had early tunnel syndrome but she also had a right trigger finger and he injected that finger hoping that that to do the trick now sign at the right palm or side of her hand which he indicates means that the person has some neuropathy in the median nerve he also found positive to nel sign on both wrists which indicates and sacirbey testified compression of the median there both wrists so with that exam a positive x examination he diagnosed by a bilateral carpal tunnel syndrome but he did something further he he did order electro diagnostic tests which were normal and dr bailey said that does happen in fifteen to eighteen i believe percent of cases of patients that he sees that they have normal electro diagnostic tests but then i don't believe she has carpal tunnel but i just think she probably has some kind of auto immune disorder and in order to really diagnose that you have to have testing you have to you have to be seen by a specialist  think the proof is in the putting to your honor dr bailey did go forward with the bilateral carpal tunnel surgeries and in both operative reports he was out able to visualize compression on the median nerve which as you know is had relief the pain in her hands and she got relief of course of the the trigger finger which was a separate surgery done she she had good strength in her hands not perfect but better strengthened in her hands and she did before the surgeries so it might if dr beatty's opinion is off that she didn't have purple tunnel surgery why did she have a positive result after surgery and dr lionell even admit that if there is a positive result after surgery that is an indication of support for a diagnosis of the purple times but her typing wasn't she wasn't doing enough typing in order to constitute repetitive activity that would have led to this from version from why isn't there a record sufficient to support that opinion and then why men and he he was unable to express a difference between the two he looked at the fact that my client was having symptoms when she was doing these activities and he totally threw that out as being relevant he apparently thought she was typing anough during the day but this court has oh over and over supported a causation opinion by a doctor who ties in the symptomology that the claimant has with the job that she's doing and at the time that she's doing that job and that's what that's what my client told dr baden was going on and she she also told told dr ali that by three he threw that out he said in his opinion i believe he said for it to be aggravation there has to be some change in the path alisha where she has to be some narrowing physically and of the now but that's where the aggravation you you look at does does the condition get worse and that's what was going on with my client it started out maybe  month before she went to see dr kind of began with but as she put progressed with her with her job her hand symptoms kept getting worse and worse as she was doing her job lifting the heavy files carrying the files to the judge's cha had swelling in her hands and i think he said that's not indicative of a carpal tunnel situation but you know recall that dr penn did order x rays of my hand which did not show that my client had any arthritic condition which would be an explanation for some he he did have the benefit of dr baden use positive results on the confirm that diagnosis gnosis or to persuade an employer that this is a cosmically related condition that needs to have the surgery occur and he testified in this case of that's why he ordered those tests but he says those she had some kind of possibly auto immune disorder and he said in order to confirm that you're going to have to have this lady examined by a rheumatologist steps in that space there was never any indication that my in her hands that was so constant that she was having to shake them out she she would have triggering in her finger when she was doing this we are all of the symptoms that she was having with pain in her hands and  deposition he based his opinion and then her work her work duties didn't work related to her condition on the condition that he believed she had and that was some auto immune disorder which would be something that  supports that proposition and when i pointed that out in my brief she replied in a reply brief oh no there is some evidence that supports that proposition to the record and what she cited too was arbitrators what arbitrator luskin's language in the initial arbitration decision that think the court has asked appropriate questions that that whether she had the diagnosis of carpal tunnel syndrome is a different question than whether whatever diagnosis she had was causally related to her employment activities dr lyon only felt she did not have carpal tunnel syndrome but he also expressed the opinion that regardless of what her diagnosis was he felt that whatever difficult she was having with her upper extremity same were not related to her employment activities and he base that opinion upon a detailed discussion with her about her job he base that opinion upon her physical examination in fact on her serial physical examinations which were different from the time she saw dr pender the time she saw dr beatty to the time she saw dr lyon l e y and l e plus a chart review including her treatment record with dr pen an additional information from madison county so and i go i know you if you read his deposition all the way through you will see that based on the swelling he would not have been surprised to find some compression in her carpal tunnel  you will also see that he testified that he would expect maybe some relief of her symptoms if in fact there were some compression noted at the time of surgery but he would not have anticipated complete release of her symptoms and in fact she testified there was not complete weakness in her hand she had ongoing complaints of pain and it's so all on following surgery graham so again this is a classic case of a difference of opinion between the two doctors and it does not seem to me there's any set of circumstances under which manifest weight of the evidence allows this court to overturn the decision of the arbitrator as affirmed by the commission as affirmed by the circuit court of madison hobley no thank you well we were atypical examination but if he didn't believe she had carpal tunnel syndrome that the the compression in the hands that the compression in the wrists it would have been borne out by by the surgeries and while she did testify after the surgery she had some pain she did say that the painless and through and she did say she was not totally back to full strength and her hand specialist the strength on her hands was issue that doesn't address all of the issues she was having with her hands prior to the surgery the the not only that the pain in the hands and the triggering but but she