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?
ShoulderUpper 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
Will Easily be claimed as an Acute Event
Abrupt Stretch or Rotational Injury
Number 1 cause of shoulder, upper extremity complaint and
physiologic injury
FALLS
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
I.Muscle Strain Ligament Sprain
These CanOccur 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
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
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Partial Thickness Tear
Full Thickness Tear
May Be Acute or Chronic –
Radiologist should address on MRI
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 mostcommon cause
III. Neck Issues
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
Lower Impairment
Rating
Better Outcomes
What Gets Patients Back
to Work?
Correlates Best With Return to Work
And Especially Early Return to Work
(Job Satisfaction)
“I Love My Job”
Early Return to Work =
• Best Outcome for ALL Patients
*Not necessarily elimination of pain, just return to work
1) Early and accurate assessment of problem
2) Early conservative/supportive treatment
3) Avoidance of surgery when possible
4) Positive environment for work and job satisfaction (hopefully)
Can You Shoulder the Load?
Thank You
Samuel I. Brown MD