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

2. Can You Shoulder the Load?

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

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

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

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

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

8. 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

9. Muscle Strain Ligament Sprain

10. These Can
Occur From:
OVER USE

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

12. FALLS

13. II. Rotator Cuff Tears

14. Caused by: OVER USE

15. Caused by:
UNDER USE

16. Caused by:
FALLS

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

18. R Cuff Tears are Common
The incidence and prevalence of RC tears increases with age
23% of people age 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)

19. Radiologist MRI Terminology
Full Thickness Tear
Partial Thickness
Tear

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

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

22. 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

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

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

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

26. IV. Other Diagnoses Shoulder Dislocation AC Separation Labral Tears
Fractures

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

28. Return to Work

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

30. Anxiety about Return….

31. $$$
Without
Work

32. Better Outcomes
Lower
Impairment
Rating

33. What Gets Patients Back to Work?

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

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

36. 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)

37. Thank You
Samuel I. Brown MD