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