Transcript Trauma and Overuse Syndromes of the Shoulder

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
I.
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
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 asymtomatic RC tears
• Partial thickness tears are more frequent than
Full thickness tears (50% higher incidence)
Radiologist MRI Terminology
Full Thickness
Tear
Partial Thickness
Tear
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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
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
Return to Work
(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?
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)
Thank You
Samuel I. Brown MD