Trauma and Overuse Syndromes of the Shoulder You don’t have to be a Professional Athlete to be Treated Like One

Can You Shoulder the Load?

Shoulder Upper Extremity Neck Injuries Are one of the most common areas of occupational injury

Causes Industrial setting, Manufacturing Products, Repetitive Usage, Over Usage Accidental Motion, Stretch or Rotation of Upper Extremity Falls

Repetitious Activity – May: Lead to Chronic Shoulder Pathology: Impingement Most Commonly Claims may arise from this – NO Acute Event

Abrupt Stretch or Rotational Injury Will Easily be claimed as an Acute Event

FALLS Number 1 cause of shoulder, upper extremity complaint and physiologic injury

Most Common Shoulder Injuries: Muscle Strain/Ligamentous Sprain Rotator Cuff Tears Neck/Cervical problems with referred pain to shoulder/arm/hand Others – should dislocation, labral tears, AC joint separation, fractures

Muscle Strain Ligament Sprain

These Can Occur From: OVER USE

UNDERUSE “Supervisor Injury” Supervisors who try to “help out”

FALLS

II. Rotator Cuff Tears

Caused by: OVER USE

Caused by: UNDER USE

Caused by: FALLS

“Partial Thickness” Tears TRUE FULL THICKNESS Rotator Cuff Tears Should be distinguished from “Partial Thickness” Tears

R Cuff Tears are Common The incidence and prevalence of RC tears increases with age 23% of people age 50-59 have asymptomatic rotator cuff tears At least 51% of pts older than 80 have asym-tomatic RC tears Partial thickness tears are more frequent than Full thickness tears (50% higher incidence)

Radiologist MRI Terminology Full Thickness Tear Partial Thickness Tear

Full Thickness Tear May Be Acute or Chronic – Radiologist should address on MRI

May NOT be a result of recent “complaint” If Chronic: May NOT be a result of recent “complaint”

Partial Thickness Tears: Associated with ongoing impingement: OFTEN not related to current “complaint” Which may only be muscle or ligamentous sprain – No Causation Rarely require surgery

Falls are most common cause III. Neck Issues Falls are most common cause

Cervical Spondylosis/Degenerative Disc Disease May Be Aggravated: Leading to Pain or Radiating Burning, Numbness, Tingling – Shoulder, Arm, Hand

Conservative Treatment Best: Anti inflammatory Meds, Physical Therapy, Short Term Use of Pain Relievers Avoid Surgery – Poor Prognosis for Return to Work…. except

IV. Other Diagnoses Shoulder Dislocation AC Separation Labral Tears Fractures

Diagnosis Specific Treatment: Adhere to conservative principles Surgery only when clear indication May be associated with impairment

Return to Work

Barriers to Recovery from Occupational Injury Anxiety about return $$$ without work FACT: Better Outcome = Lower Impairment Rating

Anxiety about Return….

$$$ Without Work

Better Outcomes Lower Impairment Rating

What Gets Patients Back to Work?

“I Love My Job” Correlates Best With Return to Work And Especially Early (Job Satisfaction)

Early Return to Work = Best Outcome for ALL Patients *Not necessarily elimination of pain, just return to work

Can You Shoulder the Load? Early and accurate assessment of problem Early conservative/supportive treatment Avoidance of surgery when possible Positive environment for work and job satisfaction (hopefully)

Thank You Samuel I. Brown MD